Often linked with rehabilitation services, geriatric assessment and liaison services aim to improve the healthcare journey of elderly patients and aged-care residents. Specialist evaluation, review and assessment of the older person can supplement other aspects of healthcare to minimise the impact of disease and disability on the person and increase their independence and autonomy. Transfers of elderly patients from the acute to sub-acute sectors can be fraught with delays and communication difficulties and some services use specialist roles to help with the movement and placement of these patients. While this model can be applied with different clinical governance arrangements (nurse-led model, multi-disciplinary model), they all improve the care and management of geriatric patients across healthcare.
Geriatric Assessment and Liaison is beneficial when:
- Bed block related to elderly patients in acute beds who are awaiting Rehabilitation or Placement
Expected benefits
For patients:
- Improving the patient journey, achieving a timely transfer/discharge.
For staff:
- ability to provide ongoing patient assessments to assist timely discharges;
- improved consistency of work processes
- improved transfer/discharge processes make increase team satisfaction and morale.
For the hospital:
- Reducing the volume of delayed discharges and therefore improving patient flow
- Increasingly efficient and effective patient care.
Applicability
Applicable to all facilities
Key principles
- Focused team approach to promote early patient assessment and coordinated discharge planning
- Early risk assessment decreases risk of functional decline and improves patient care outcomes
- Specialist staff trained in Geriatric assessment
- Coordinated approach to ongoing care with single-point referral and waiting list management
Objectives
- Decrease discharge delays related to the patient waiting for placement
- Specialist assessment and treatment results in improved quality of care and better patient outcomes
- Improve patient flow across the continuum of care
- Improved service coordination within and across Health Service District/s
- Increased bed access for acute sector with reduction in ALOS
- Reduced risk to aged and rehabilitation patients as most appropriate care is accessed in a timely manner
- Increased efficiencies with referral and transfer process
- Improved data to inform decision making.
Performance indicators
- percentage of patients seen by Geriatric Liaison Team
- Compare data for waiting list (Rehabilitation, Extended Care, etc) times pre/post service
- Monitor Unplanned Readmission Rates
- LOS data
- Quality indicators - Patient and staff satisfaction, adverse events, complaints, staff turnover
- Geriatric Assessment through E-Health (GATE)
- Geriatric Rehabilitation and Liaison Service (GRLS)
- Geriatric and Rehabilitation Liaison Service (G&RLS)
