Objective:

We describe the evolution of the Geriatric Flying Squad (GFS), a rapid response outreach team for residential aged care facilities (RACFs) in the local community of a metropolitan tertiary teaching hospital of South East Sydney (SES), Australia. The GFS is a Nurse Practitioner (NP) led service focusing on hospital avoidance mechanisms and bridging the interface between acute care and the community.

Background: Elderly patients have a significant burden of chronic illness, often with complex care needs.

These are individuals who derive clear benefit from rapid access to specialist geriatric care which can be difficult to navigate due to systemic barriers.

Residents of RACFs are the most vulnerable of this patient population who face challenges in timely access to acute care, which can result in inappropriate use of Emergency Departments.

Many of these illnesses can be managed in the community reducing the burden on public hospital resources while improving patient outcomes.

Method: The GFS commenced in 2012 led by a single NP providing outreach to 35 RACFs with approximately 3000 residents.

The initial goals were to implement strategies for hospital avoidance which expanded into a multi-faceted service encompassing education/research, telehealth and a dementia behavioural advisory service.

There is a strong focus on integrating the silos of acute inpatient and community care.

The COVID-19 pandemic added an extra dimension, adding liaison with Public Health Authorities and RACF staff in supporting COVID-19 outbreak management.

Results: Referrals increased from an initial 293 patients in 2012 to 775 patients reviewed for various acute/subacute illnesses in 2023.

90% of these patients were managed out of hospital. 53% of patients were seen within 2 hours of referral.

The GFS team in 2024 consists of 3.0FTE NPs, 1.0 FTE geriatrician and 1.0FTE clinical nurse consultant (CNC) providing outreach 7 days a week.

The CNC role targets education/clinical support along with a piloting a behavioural advisory service.

A research project evaluating confidence in clinical handover was published in 2022.

Conclusion: The GFS provides a viable alternative to hospitalisation for acutely unwell RACF residents by providing specialist medical care in the community setting.

It has also evolved into a valuable education/ research unit, a specialist behavioural management advisory service and provision of a telehealth service.

References: Abstract was presented at the Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting 2024, Christchurch New Zealand.

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