Hornsby Ku-ring-gai Hospital – GRACE (Geriatric Rapid Acute Care Evaluation)

NSLHD’s geriatric outreach service aims to keep older and frail people with acute health needs safe at home by providing specialist geriatric team support covering peak times of need on weekdays. 

Aims:

1. Align the geriatric outreach service to the strategic direction of NSLHD, proactively managing frail and older patients at risk of presenting to an emergency department(ED)
2. Support NSW Ambulance initiatives, such as the NSW Ambulance Virtual Clinical Care Centre (VCCC)
3. Provide the basis for clarity and consistency in referrals, interventions,and linked services
4. Ensure equitable access to the geriatric outreach service to patients across the district
5. Support the ability to monitor and evaluate service activity and outcomes
6. The objective of the geriatric outreach service is to treat patients experiencing an acute decline which may necessitate a transfer to ED if not medically reviewed within 48 hours.
7. Response times aim to be within 4 hours, with a maximum of 24 hours(currently limited to business hours on weekdays only).

We care for…

• Rapid acute medical assessment
• Falls assessment and management following a fall with high likelihood of a subsequent fall
• Comprehensive Geriatric Assessment for people at risk of hospitalisation
• Heart failure and chronic obstructive pulmonary disease(COPD) management
• Infections
• Fracture management
• Behavioural support
• Intravenous therapy
• Pain management
• Medication
• Management of indwelling tubes
• Wound management / skin infections
• Care coordination
• End of life care
   

• Aged 70 years and over or have an age-related illness
• Aboriginal and Torres Strait Islander people 60yearsof age and above
• Residents of the community within NSLHD boundaries including residents of RACFs
• Experiencing an acute clinical, functional, or cognitive decline and are at risk of imminent hospitalisation(within 48 hours)
• Patients who are not at risk of imminent hospitalisation are referred to other appropriate services if necessary.

The use of decision support tools such as the  DETECT website (www.detect.snhn.net) and printed resources by RACFs is strongly encouraged by the geriatric outreach service. 

DETECT is a deteriorating resident clinical decision tool which includes point of care symptom checkers, clinical decision flowcharts, educational videos, as well as additional resources and contact links. 

Identification of resident needs and appropriate classification according to their risk is key to obtaining the right services at the right time.