Headline- Reducing the burden of care
Intro – The Day Hospital/Assessment & Treatment Centre (A&TC) St Finbarr’s
Hospital, Cork, had a pivotal role in optimising health, function and wellness in older
adults, Ms. Mary J. Foley, Advanced Nurse Practitioner in Rehabilitation at St
Finbarr’s Hospital, told the Conference.
The Assessment & Treatment Centre (A&TC) facilitated timely access to specialist,
diagnostic, rehabilitative and therapeutic interventions reducing the need for hospital
admission and facilitating early discharge from hospital. In addition to Nursing,
Therapy, Medical Review and Comprehensive Geriatric Assessment, specialist clinics
included Memory, Movement Disorder, Falls and Mobility, Anti-coagulation,
Infusion/Transfusion and Continence Advisory.
“Complex case management and community liaison support clinics sustain frail older
adults in their own homes, supporting families and reducing burden of care,” she said.
Ms. Foley said the key functions of the A&TC were@

Comprehensive geriatric assessment, diagnosis and treatment.

Rapid access, admission avoidance clinics and crisis intervention

Specialist nursing assessment, diagnostic procedures and therapeutic
interventions based on evidence based practice.

Therapy Input as part of community based rehabilitation, PD/Falls Classes.

Speciality clinics including falls and syncope, movement disorders such as
Parkinson’s, memory, anti-coagulation, infusion and continence management.

Community Liaison Support Clinics for complex case management and ongoing
monitoring of frail older adults.

Chronic disease management in partnership with primary care teams and
statutory and voluntary agencies.

Stroke Follow-Up, Health Promotion/Education and Healthy Ageing.
In 2013, the Assessment and Treatment Centre (A&TC), Cork received an Irish
Medical Times Award for best Out Patient Initiative. This was in acknowledgement of
the quality improvement process responsible for the successful transition from a generic
day hospital to a specialist ambulatory care centre with expanded person centred
services and with increased activity and efficiency. “
“The A&TC addresses complex health care needs, supports chronic disease
management and aids long term care decisions. Rapid access clinics reduce
inappropriate admissions, facilitate early discharge and supports ongoing care in the
community and long term care decisions. Independent living is prolonged, enabling
optimum function and independence.”
Ms. Foley said Day Hospitals were required to function as the coordination, information
and training hub for services for older patients, supporting integration between hospital
and community based services (RCPI/HSE 2012). The Assessment & Treatment Centre
served three hospitals in Cork City in addition to St Finbarr’s large Rehabilitation Unit
and provided outreach services into the community linking with day centres and
support agencies.
The main source of referral were General Practitioners and the A&TC facilitated
timely access to specialist, diagnostic, rehabilitative and therapeutic interventions,
reducing the need for hospital admission and bed crisis in emergency departments.
Ms Foley provided an example of the cost efficiency of Day Hospitals which included
treatment of a patient with anaemia and hypomagnesaemia requiring 60 day hospital
attendances for 13 red Blood cell units and 49 magnesium infusions which cost a total of
€9,678. It was estimated that the same treatment provided as an in-patient would have
cost a total of €21,231.
She said that the strengths of the A&TC were its strong person centred philosophy of
care, specialist input and multidisciplinary team working. Patients benefitted from this
information exchange and focused intervention. The Centre of Gerontology and
Rehabilitation was on St Finbarr’s site therefore there was a strong quality
improvement focus supported by research and education. In the context of the All
Ireland Gerontological Nurses Conference, Ms Foley highlighted the significant role of
the nurse, in developing nurse led services responsive to the needs of older adults. She
stressed the importance of ongoing education and opportunities for expanded scope of
practice facilitated by academic courses such as nurse prescribing and gerontological
nursing.
She said there was further scope for development with development of nurse specialist
posts, referral pathways and measurement of performance indicators. “The Day
Hospital/Assessment & Treatment Centre is a person centred cost effective means of
addressing the complex health care needs of older adults addressing quality of life issues
and promoting optimum health, function and wellbeing.”
Pull out quote
1. The strengths of the A&TC were its strong person centred philosophy of care,
specialist input and multidisciplinary team working.