Early warning system for elderly admissions to hospital

A Queensland research group has received over $750,000 in federal funding for a three-year project to develop an electronic, standardised screening and risk assessment tool for elderly people in acute hospital care.

The team from the University of Queensland's Centre for Research in Geriatric Medicine, led by Len Gray, Ruth Hubbard and Nancye Peel, will work with researchers from Christchurch Hospital in New Zealand to draw on existing resources developed by the international InterRAI collaboration to develop a streamlined, easy-to-use assessment instrument that can be quickly administered by nurses.

It would screen for risk of falls, delirium or pressure ulcers as well as psychosocial factors that often lead to placement in long-term residential aged care, but would also have a preventive care function.

Associate Professor Hubbard said that while there were a number of different tools and assessments used, few were standardised and many were paper-based and unable to be migrated to a digital environment.

“Our analysis of current nurse-administered assessments indicates a patchwork of tools,” Dr Hubbard said. “Some of these are derived from single symptom screeners and others are home-grown, with unknown validity and reliability. This patchwork results in duplication and poor compliance as some of these instruments aren't completed or are completed sub-optimally.

“They can't integrate with other systems and that limits the ability to communicate the information within and outside the hospital.”

Dr Hubbard said the assessment tools were often quite lengthy and difficult to administer, and many just predict specific adverse events.

“For example, there will be one assessment for falls and another one for pressure ulcers and another one for delirium, so we are trying to integrate all of those assessments into one system. We are going to create a more holistic system.”

The new instrument will be based on the work done by the InterRAI collaborative, which has already developed an assessment instrument for acute are that collects information from multiple domains, she said.

“But that assessment takes between one and four hours to complete, so even if it's the gold standard assessment, we aren't saying that is suitable as a screening tool.

“We are taking the principles from that instrument and abbreviating them so we can develop an instrument that can be completed within 20 minutes and it is suitable for every person coming into hospital.”

She said there were three aims for developing the screening tool. One is to determine the immediate nursing care plan if it flags an issue such as incontinence, for example.

“Secondly, it would indicate the risk of future adverse events or outcomes, where the nursing process has an important preventive function, for example if the person is at high risk of pressure injuries,” she said.

“And thirdly, suggest the need to engage other specialist providers in the care delivery process, for example if the person is at risk of requiring long-term care at discharge.”

While the tool will be electronic, project manager Yvonne Hornby-Turner said it will also be able to generate a hard copy report that can be used as a communication aid for other people looking after the vulnerable older person.

The team has lined up four hospitals – two in Queensland's Darling Downs region and the Princess Alexandra in Brisbane, along with Melbourne's Northern Hospital – and international collaborators include Christchurch Hospital in New Zealand, where InterRAI is well established, and Canada’s Mt Sinai Hospital.

Posted in Aged Care

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