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Maria Draper & Bonnie PimmPrincess Alexandra Hospital, Brisbane
Poster produced by Multi Media Unit, Princess Alexandra Hospital
The GATE program is an aged care assessment and liaison program that advocates for elderly
patients admitted to Princess Alexandra Hospital. It addresses timely review for patients
referred to geriatric rehabilitation, and for approval to residential care, and/or Transition
care programs.
Poor referral pathways for elderly patients had resulted in delays in referrals and duplication
of assessments. This resulted in increased length of stay and decline of the elderly patient.
GATE has streamlined referrals and uses a comprehensive and integrated geriatric assessment
for patients over sixty five to improve patient outcomes.
The implementation in July 2007 focused on single point of referral, Comprehensive Geriatric
Assessment (CGA) of elderly patients by gerontic nurses, data entry into an electronic patient
record, geriatrician review and a formal report produced for the patient records.
The use of technology and management of GARU waiting list by the GATE team has significantly
improved outcomes for the elderly patients
Attention is paid to geriatric syndrome and rehabilitation potential is explored. Elderly
patients are put in right service first time and when ready. The average wait for patients on
the GARU waiting list is < 2 days.
Waiting time for ACAT assessment is now minimal. At time of this report there were only five
age appropriate patients (65 years and greater) in the 600 bed acute care hospital waiting
for ACAT assessment or nursing home placement.
Prior to the commencement of GATE these patients caused significant bed block. 32 % of
patients referred to GATE for ACAT assessment have returned to their home.
The clear referral pathway and early comprehensive geriatric assessment has resulted in
greater than 95% of patients assessed within 2 working days of referral, an increase in patient
throughput in GARU by 25% and a decrease in median LOS by 4 days while the acuity and
complexity of the patients increases.
Destination of ACAT referrals to GATE
Previous referral pathway Proposed Model
Days Awaiting GARU
LOS Admissions by Year
“Geriatric” referral
Geriatrician support
Single Comprehensive
Geriatricassessment
Needs Based
-Geriatric Rehabilitation-Advice-Residential Care-TransitionCare-Community Care
0.0
2.0
4.0
6.0
8.0
1 2 3 4 5 6 7 8 9 10 11 12
Month
Avera
ge D
ays 2007
2008
2009
2010
Other4%
Deceased10%
Hospice facility / palliative care unit
2%
Home32%
Hospital7%
Residential care45%
Other
Deceased
Hospice facility / palliative care unit
Home
Hospital
Residential care
LOS
0.00
10.00
20.00
30.00
40.00
50.00
60.00
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year
Ave
rage
LO
S
Admissions by Year
0
100
200
300
400
500
600
700
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year
Num
nber
The Princess Alexandra Hospital (PAH) is a tertiary teaching hospital in Brisbane, Australia. The Geriatric Assessment Through E-Health (GATE) team have developed an innovative partnership in care delivery of aged care services using an integrated approach to geriatric evaluation
and management through the use of a simplified referral and geriatric assessment process. The service now provides a single point of contact for all geriatric services, rapid triage and timely, comprehensive assessment. It was identified that the lack of a clear referral pathway for
the older person in PAH had resulted in a number of inefficiencies created through delays in contacting the correct referral point, duplication of assessment and the need for cross referral from one agency to another, which in turn resulted in increased length of stay and further
deconditioning of the elderly patient. The previous referral process was largely historical and reflected the development of health programs over time with the acute care setting and community services working in silos. Now a comprehensive geriatric assessment and formal
geriatrician review occurs in any case referred for rehabilitation, residential care or transitional care and also on others on a needs basis (dependent on case complexity). An initial electronic report is produced within 24 hours of referral. The separations in GARU have increased
by twenty five percent in two years and inappropriate referrals to ACAT are now non existent. The GATE program facilitates a smoother care path for the elderly patient and improved continuity of care.
Geriatric Assessment Through E-Health:Princess Alexandra Hospital GATE Program