Residential Aged Care Facilities (RACF) are home to our most chronic, complex and vulnerable patients who are frequently on more than 10 medications and are recurrently admitted to Emergency Departments for treatment.  In Australia by 2050 there is projected to be a 400% increase in the number of people over 85 years of age and the proportion of the population aged over 65 will account for one third of admissions and half the total bed days in acute care facilities.  These trends are consistent across all developed countries and are driving increased focus on IT solutions to better manage the health information of residents. 

One area of concern is with regards to the transfer of a patient form or record.  This is the form that is carried by the patient with the information required at the Emergency Department (ED).  Residents are routinely sent to ED via the ambulance service with numerous forms that are meant to be interpreted by the ambulance paramedics and then in turn the ED nurses, registrars and doctors. The problem is each RACF has a different form, which captures information in a different order making it difficult to locate the medical information necessary to commence effective treatment for a resident. What is deemed relevant information by one health professional, is deemed not relevant by another.  When the resident arrives at the ED it’s conceivable that the forms are either missing or in part missing which wastes valuable time in commencing treatment especially if the nurse is not immediately available.  Clinicians at both ends of a transfer of a resident from a RACF to a hospital ED for acute assessment are frustrated.

What are the key elements of the problem? 

• The current transfer forms are not providing transparent information to clinicians in the order and format that they need it so that they can assess and treat the patient quickly and effectively
• Medication charts are not always attached 
• Resuscitation orders/Advanced Care Directives (ACD) are often missing
• Contact details for the resident’s General Practitioner, next of kin and additional numbers are needed
• Observations, diagnostic test results and treatment prior to transfer are required
• Reason for transfer is key information and not always easy to find, if at all
• There is not a simple system to gather the information needed from multiple sources and people and then collate, condense and format this information into an easy to read and comprehend format

RACF orgniasations have begun to make investments that provide electronic health information useful to that organisation but in most cases is not shared with the acute sector and information that needs to follow the patient is usually still in a paper format.

The ideal recommended solution is an interactive standardised Transfer of Care Form for all residents of RACFs, developed electronically and sourcing information from the various paper based and accessible electronic systems.

It will contain the essential clinical information up front including the reason for transfer, the observations, diagnostic tests and treatment prior to transfer and the current medication chart. 

This will require integration with Hosptials, Community Pharmacy for medications and information from RACFs. 

This solution must be able to be used by all RACFs, whether they are using Aged Care Software of any kind or are paper based.

Technologies such as Vitro which have a robust integration capability, flexibility in incorporating the various types of information required and are easy for all users to adapt are the solutions that will connect aged care with the rest of the healthcare continuum.  

The best value proposition for residents in RACFs is for their clinical information to be shared point to point between medical professionals involved in their treatment. 

Jeff joined Sláinte as Global Vice President of Sales & Marketing. He has extensive experience in Healthcare, previously working for companies such as Allscripts, Cerner and Fujitsu Technology Solutions. Jeff was awarded a BSBA by the University of Denver and an MBA from the Loyola College in Maryland in the USA, he has responsibility for the sales and marketing strategy throughout Europe, the Middle East, Australia and the UK.

LinkedIn: au.linkedin.com/pub/jeffrey-smoot/17/239/5aa