RMH Residential In Reach

Our Residential In Reach (RIR) service provides acute support, early intervention and patient-centred health care to residents in residential aged care facilities.

Key points

We provide care and support to clients in Residents of Aged Care Facilities (RACFs) as an alternative to coming to the emergency department
RIR is a free service staffed 7 days a week by Clinical Nurse Consultants and Geriatricians (specialist doctors skilled in the care of older people with complex health issues)
We accept referrals from RACFs, GPs, Locum doctors, Ambulance Victoria, Victorian Virtual Emergency Department (VVED), emergency departments and hospital wards

Patients need a referral from their GP or healthcare provider. Access referral information

What we do

We comprise a specialised team who help facilitate the best health outcomes for residents living in aged care facilities.

Our Residential In Reach (RIR) service aims to reduce potentially avoidable presentations to the Emergency Department by providing acute support, early intervention and patient-centred healthcare in residential aged care facilities. It is not intended to replace the primary care provided by general practitioners (GPs).

Our team of highly trained Clinical Nurse Consultants (CNCs) have advanced clinical experience in critical care specialties including Emergency and Intensive Care. Our nursing team liaise closely with consulting geriatricians from the Royal Melbourne Hospital (RMH), as well as other appropriate community services.

What we offer

Assessment and management of acutely unwell or deteriorating residents
Initial treatment with intravenous therapies (diuretics, antibiotics) - with referrals for ongoing support as needed
Acute palliative care support
Review of falls and injuries
Emergency and routine care of PEG, SPC and IDC
Trial of void (TOV)
Specialist geriatrician consultation to support GP with complex medical issues/care
Iron infusions (requires GP referral)
Assessment and management of delirium
Support and Advice for Residents with Behavioural and Psychological Symptoms (BPSD) of Dementia
Acute wound management advice

Who can use our service

Our Residential In Reach (RIR) is an acute referral service that aims to provide assistance for resident at RACFs.

Are unable to access the resident’s GP (or if the GP is requesting additional RIR support)
Are considering sending a resident to the emergency department
Need assistance to perform a procedure
Need timely clinical advice

Assessment and follow-up care

The assessment comprises an initial comprehensive consultation and management plan. We liaise with family, facilities staff and the Geriatrician from the RMH.

Following initial assessment and treatment, if ongoing or continuing care is required, referral to an appropriate service (including RMH@Home Acute or community/outreach palliative care support) will be made or recommended.

We may also recommend follow up with other community care providers such as:

BASICS
Aged Psychiatry Assessment & Treatment Teams (APATT)
Dementia Support Australia
Wound nurse consultant
Community Palliative Care Service
Private geriatricians

A copy of In Reach’s detailed assessment and management plan will be provided to the RACF and faxed to the resident's GP.

For patients

For health professionals

Referrals

Phone referrals accepted

We accept phone referrals from GPs, locums, ambulance services, aged care facility staff. We also accept internal referrals from the RMH wards and Emergency.

To refer a patient, call the Triage Clinical Nurse Consultant on 0448 570 420

Referrals are triaged. If required, specialist RMH nursing and medical staff can visit the patient on the same day in the residential care facility.

An In Reach nurse will attend the facility and assess the resident. An In Reach nurse will then call to notify the referrer of the resident’s assessment and discuss whether any treatment needs to be initiated.

Special referral instructions

HealthPathways Melbourne provides guidance on best practice assessment and management of common medical conditions, including when and where to refer patients.

Parkville Connect is a secure web-based portal providing GPs, specialists and other health professionals with information in the Parkville electronic medical record (EMR).

Affiliates

RMH@Home Acute

The RMH@Home Acute service provides inpatient acute and subacute care for patients in their home environment. It is a safe, comfortable and efficient substitution for in-hospital care for a wide range of conditions.

24 hours a day, 7 days a week
0419 893 685

RAPID

RAPID, a Royal Melbourne Hospital and Peter MacCallum Cancer Centre initiative, provides patients with rapid and responsive access to symptom management and expert assessment and intervention, extending hospital palliative care expertise to patients in the community. The team can assist patients and their family with complex decision-making, goal-setting, specialist symptom advice and treatment, as well as urgent linkage with community palliative care services (MCM and Mercy Palliative Care) if needed.

Monday to Friday 8am to 4.30pm
0439 573 526