Geriatricians and Emergency Physicians – Collaboration for Creativity

Geriatricians and Emergency Physicians – Collaboration for Creativity

By Dr Terry Nash

It’s a pleasure to learn that when two specialties collaborate that both are elevated. I have found it to be an opportunity to learn about the other’s biases and strengths. As Clinical Lead for Comprehensive Aged Residents Emergency Partners in Assessment Care and Treatment (CAREPACT)1 . I have the pleasure of leading a team of Emergency Physicians and Geriatricians dedicated to quality care and increased choice of care for the elderly. Our service has been in South Brisbane since 2014 and we have grown from an Emergency Physician and Clinical Nurse Consultant into a team of Emergency Physicians, Geriatricians, and around 20 nurses. We work across four hospitals, provide a seven day a week telephone triage service, mobile emergency team, nurse navigation, and inpatient gerontic nursing care planning. We provide this service to 94 RACF’s, with approximately 9300 aged care beds. Our mission is to provide an alternative to a visit to an Emergency Department for selected residents in Aged Care – linking the resident to hospital specialist care. We then provide a holistic “end to end” nursing plan from RACF to hospital.

Personally, I have seen that my geriatrician colleagues are the great lateral thinkers. They are always looking to find more detail about a particular problem in search of the solution that few would take the time to appreciate. I have witnessed clinical assessments that look at the objective clinical parameters, followed by the subjective patient experience. Then synthesizing those two approaches into a comprehensive plan. In my specialty of Emergency Medicine, I am considered successful if I can make a rapid risk assessment, take a safe approach when limited information is available or when circumstances are just not ideal.

In an Emergency Department there is chaos, and rarely the time to appreciate the subtle details. In my role with CAREPACT I can approach the care of the elderly in a patient’s own environment. I can see the challenges of nursing in Aged Care and the ensuing workforce challenges that creates. I can provide acute clinical care in an RACF without exposing a patient to the challenging and intrusive Emergency Department environment. I can then learn about the nuance of cognitive impairment, rapidly advancing frailty, and thinking laterally. I have witnessed my Geriatrician colleagues embrace the uncertainty of complex emergency presentations from an RACF and coming on board with managing acute decline, injuries, fractures and suturing.

CAREPACT is a novel model of care, that has been commended in the Royal Commission into Aged Care Quality and Safety 2. We provide clinical support to GP’s, Paramedics, and RACF clinicians at the bedside of residents in Aged Care. There are pathways of care for the RACF workforce, and someone to speak to 7 days a week that can problem solve issues. Our mobile emergency team employs Nurse Practitioners with experience in Emergency and Aged Care. Every clinical interaction has a 7-day follow-up call to close the loop on quality. We review every RACF patient that visits our 4 Emergency Departments – no matter what time of day they have arrived. Across Australia there are multiple models of care that embody some or even all of these approaches. Ultimately, it’s the collaboration between Staff Specialists from different training perspectives that value adds to patient care in a new and creative way.

* CAREPACT – Comprehensive Aged Residents Emergency Partners in Assessment Care and Treatment

  1. Burkett E, Scott I. CARE-PACT: a new paradigm of care for acutely unwell residents 
in aged care facilities. Australian Family Physician. 2015;44:204-9.
  2. Recommendations of the Royal Commission into Aged Care Quality and Safety [Available from: https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-recommendations.pdf.