Frail patients praise new care model

An older man stands between two other men beside a hospital bed.
Senior Physiotherapist Adam Horrocks, John Jones and Fiona Stanley Fremantle Hospitals Group Geriatric Medicine Head Dr Bhaskar Mandal
November 1, 2019

“I am going to a place where my medical needs will be met as soon as possible and I will be going home.”

That’s the wonderful reality for many older people coming to Fiona Stanley Hospital’s Emergency Department, thanks to the success of the hospital’s Frailty Unit.

The 12-bed unit is a new approach to caring for elderly and frail patients that is the first of its kind in Australia.

John Jones (84) of Hamilton Hill is a one of the patients who has high praise for the Frailty Unit, saying it’s “a marvellous service.”

This May John arrived at FSH’s ED in an ambulance with severe chest pain and difficulty breathing, and was subsequently diagnosed as having a lung infection.

“I was home the next day,” John said. “I was brought straight in, had all the tests I needed and saw a cardiologist very quickly.”

Despite having to return in the following months, John is grateful for the opportunity the Frailty Unit team has given him for the time at home in between emergencies.

“I have no complaints about this place – in fact you could say it looks like I’m getting to the stage where I like it,” John said.

However, John is happiest at his home of 59 years where he lives with his wife and one of his daughters, with visits from his extended family including two other children, five grandchildren, and four great-grandchildren (with another two on the way).

“I love to be home, and I do like my workshop,” John said. “We look after two of the great-grandchildren each week, so it’s an active life and the crowd at Christmas is getting bigger.”

Geriatric Medicine Head Bhaskar Mandal said the aim of the geriatrician-led, patient-centred care model was to get seniors home where they could maintain their usual activities and keep their independence.

“We take ED patients who meet a fragility score and they are seen by a senior consultant within four to eight hours,” Bhaskar said.

“Half of those patients leave hospital within a day and a half, and 30 per cent go home within 72 hours.”

Not only is patient satisfaction high, but the hospital can free up beds for other patients.

The unit has also found that the re-admission rate for these patients has not increased – it isn’t the case of people being discharged too early and having to come back later for more treatment.

Bhaskar said sometimes people think that hospital is the best place for their elderly relatives, but statistics show the longer older patients stay in hospital, the more quickly they declined.

Evidence shows patients recover quicker at home.

The Frailty Unit strongly promotes CHOICE (Consider Home Over Inpatient Care Every time). This mind-set recognises the benefits of diverting care into the community as soon as possible.

Partnerships with services such as RITH (Rehabilitation In The Home) have helped the Frailty Unit set up early, supported patient discharge plans.

Starting in November, a frailty 'hot clinic’ and a CHOICE team will support FSH and Fremantle Hospital aged-care wards.

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