Issues that will be familiar to providers – but are guaranteed to grab a few headlines today.
Tess Oxley (pictured above) says nearly 60% of the transfers she carries out from aged care to hospitals are unnecessary, but facilities are adamant that residents must be taken to the emergency department and paramedics cannot refuse to take them because that creates further risk for residents.
Over an hour, Ms Oxley – who has worked as a paramedic in southwest Sydney for nine-and-a-half years and made her statement on behalf of the Health Services Union (HSU) (see her shirt above) – said this often results in residents being readmitted shortly after discharge, a practice so common the ambulance services calls it a “warranty job”.
“Why do you think that there is that approach taken by residential aged care facilities to calling out an ambulance?” Senior Counsel Assisting Richard Knowles asked.
“I think it’s – I would like to say it’s patient welfare but I think it’s to try and cover any kind of – whether it’s litigation or any kind of detriment to the facility itself,” she replied. “They know that if they’ve booked an ambulance and they’ve said that that patient has to go to hospital there’s no risk to the facility if anyone deteriorates, that anything bad will happen to the facility.”
The paramedic pointed to better communication with residents – and education for staff – as key to cutting down on emergency department admissions.
“Educating on the different types of falls and the different presentations and how often, you know, that may result in an injury and the likelihood of that injury,” she said. “If we’re a little bit more aware of that and we know which signs and symptoms to look at or if the facility’s staff are, that can avoid a lot of the unnecessary transportations.”
Ms Oxley also pointed to the need for improved handovers, saying she had more than once attempted to transport the wrong resident.
Medication lists are often handwritten (no electronic system again) and advance care plans are rarely kept with a resident’s other paperwork, she told Mr Knowles.
“Do you have any recommendations as to how you might raise – sorry, improve the consistency of what you’re provided with so that you can expect to receive what you wish to receive as a bare minimum?” Mr Knowles queried.
“Again, I think it’s education,” Ms Oxley answered. “So, it’s – if you are handing over as a paramedic, if I’m handing over to a hospital, there is a standard that’s expected of me. And as much as I hate KPIs, it’s measured through a KPI so that is monitored and it’s also measured through the reaction of the hospital to me. So, if my – if it’s an inadequate handover I would be informed of that. I think we need that within the aged care facility so there is that standard that’s expected across all facilities. It shouldn’t be an individual – up to an individual company what’s given and I think there does need to be that pathway for us to provide feedback if it’s inadequate.”
The paramedic also highlighted that she often sees a lack of advance care plans – or their instructions being ignored, particularly where residents have a directive that says they don’t want to go to hospital.
“The facility will say – either say that it’s their policy and so the patient still has to go or that they’ve discussed it with relatives who may or may not be present and that the relatives would like them to go, and they seem to feel that that supersedes the will of what was signed at the time that the directive was signed,” she detailed.
Ms Oxley advocated for clearer information about advance care planning for residents, families and staff.
She was also supportive of the Counsel Assisting’s proposition that facilities collect data on the rate of ambulance call outs – provided it was used to benefit residents.
“It’s one thing to collect a whole heap of data and to have it sat there; it’s another thing to use it,” she pointed out. “I think it’s also important to note not just that an ambulance was called and it was a 000 but what the follow up for that patient was because did they have an extended stay in hospital or were they returned within two hours is a lot more beneficial to know than just that the ambulance came lights and sirens or not, because quite often we will go slow and the patient will be critically ill or we will go fast and it will be something that’s not as serious as stated.”
The Commissioners clearly valued her views – and Commissioner Lynelle Briggs (pictured above right) took the opportunity to raise an idea that hasn’t come up much in the hearings.
“Over the course of these Royal Commissions, particularly in the community meetings, we’ve heard a lot about the role paramedics have played, and there’s no doubt at times it’s the paramedics who are confronted with instances of substandard care that is occurring in residential aged care and they’re quite disturbing instances,” she remarked. “Is there, within the system, a place for reporting of instances such as this that might prevent further problems occurring?”
“Not a direct or a one-way thing of doing it,” Ms Oxley responded. “We – if you know who may be like the clinical nurse specialist is within the hospital or within the primary health network that deals in liaising with the nursing facilities. If you know who that person is you can report to them. You can let the hospital know. You can speak to ambulance management. There is the elder at-risk hotline but not in the way that we have within the health system of direct reporting. There’s definitely nothing like that which is extremely frustrating at times.”
“Yes,” agreed the Commissioner. “Do you think it would be a good idea to do that for both paramedics and for general practitioners?”
“I think you should be able to do that for all health staff,” said Ms Oxley. “Remembering that you may have casualised staff working in these facilities, if a nurse comes, if a care member of staff comes and they notice things that are distressing or that are inappropriate, they shouldn’t have to go and report it to a GP who then – that’s going to be another obstacle that will stop a reporting process. I think anyone involved in the care of them should be able to have a mechanism of reporting.”
Expect to hear more on that proposal then.
