Service re-engineering of Community Geriatrics Assessment Service (2012-13)

Background and purpose: The Community Geriatrics Assessment Service (CGAS) was started in 1993. Finite resources and challenges of an aged frail population have led CGAS to re-engineer its services. For community-based care and appropriate use of hospital services, our approach included (1) team empowerment with clarity of service direction, feedback, and training, (2) enhancement of patient-centred care by efficient workflow and support for staff of residential care homes for the elderly (RCHE), and (3) adoption of a collaborative model with hospital partners for seamless care. Methods: To align service direction and improved communication among CGAS staff, team building workshop and service manuals communicated core values, standards of care and staff competency requirements. Staff training in infection control and end-of-life care was organised. Quarterly operational meetings identified suboptimally performing RCHEs for measures such as team visits during winter surge. Clinical audits, senior walk around, and 11 clinical protocols facilitated clinical decision-making. To support RCHEs, extended CGAS service hours and simplified workflow was facilitated with a CGAT/RCHE communication manual and early symptoms detection checklist. Regular continuous quality improvement programmes were drivers for improving care standards. A collaborative approach with hospital partners and consultant-led ward rounds improved inpatient follow-up. Results: Regular operational meetings identified sub-optimal RCHES for enhanced patient care activities. 75 sessions of senior walk around was conducted in 85 homes (>4500 residents) and 7 team visits with enhanced nursing input to 6 homes with high admission rates. There was a significant reduction of the overall accident and emergency department attendance from 26% to 13% in target homes and 23.2% reduction in restraint use. 'Tele-CGAS' enabled cost-effective patient care by using iPads, with better visual resolution, easier access to bedbound residents, support for remote homes in Cheung Chau and a reduction of expenses by 85%. Collaborative partnerships with palliative care and emergency team facilitated end-of-life care for residents, partnerships with pharmacy and IT teams enabled efficient dispensing and remote CMS use and partnership with infection control teams to contain MDRO spread. Conclusion: In spite of continuous challenges, CGAS has improved quality of care for RCHE residents aided by reengineering of CGAS services