Supporting older patients in the RMH Emergency Department

Geriatricians Allistar Tinson, Rebecca Tai and Joe Ciantar champion a home first approach in the care of older patients: 

“We use our skills and knowledge in chronic disease management to ask the question – will they really benefit from hospital admission or can we actually manage them in community?”, says ED Geriatrician Bec. 

The EDGE service began in mid-2023 with Joseph “doing a couple days a week in the ED, trying to get to know everybody”.

Since then, they have made huge impacts in reducing the length of stay of older patients at the RMH. Patients with EDGE involvement have an average length of stay of 3.8 days versus 4.8 days without EDGE involvement.  

Through EDGE involvement, 40% of patients are able to avoid an unnecessary inpatient admission and are in instead supported in their home or aged care through our hospital in the home services.  

For the EDGE team, it is important to identify the right place, and right time for older patients to be treated in hospital, as it makes a huge impact for the patient’s outcome.  

“We're all increasingly aware that hospital is not necessarily like the safest place for older people, because they are at risk of getting confused or falling over. 

So getting them at home is sometimes it's a safer thing to do, even though it feels a little bit risky or hard at the time,” says Joseph. 

Instead, older patients can be supported in their homes or in aged care through various programs such as Hospital in the Home (RMH@Home Acute), Geriatric Evaluation Management (GEM), or RMH@Home Subacute.

Alistair reflects that the most impactful journeys he supports through the EDGE service is supporting older patients with their wishes to pass away with dignity in their home environment, as opposed to the hospital:

“These families carry the grief of these moments for the rest of their lives, and onto their next hospital journey as well. So, if we can do that well for them, it doesn’t just impact the patient, it impacts the generation to come.”