Problem
The Northern Territory (NT) is the most rapidly aging population in Australia. Current statistics reveal a shortage of residential aged care (RAC) beds and limited access to home care to meet current and future demand. There is a limited specialist workforce with 2.8FTE Geriatricians for the NT.
Design Methods
Front Door Frailty (FDF) services commenced August 2024 in Royal Darwin Hospital Emergency Department (ED). This includes clinical care in line with international best practice with rapid comprehensive assessment, delirium screening, acute, trauma and after care.
Practice Change
FDF commenced in the constraints of existing FTE. 250 unique older patients received emergency care alongside outpatient care and representations.
Following initial advocacy, a department wide effort, executive investment and clear service planning, we received $5.75 million in funding as part of a total package of $14.7 million. This has secured the future of the service and 7.5FTE for ED and community frailty care for the next 4 years.
Audit
The mean and median age of patients seen is 82 years old with a mean and median clinical frailty scale score of 5. There was an overall discharge rate of 75% within 24 hours from ED with a 90% discharge rate of those residing in RAC. The 28-day mortality of patients seen is less than 5% with adjusted mortality of those not receiving palliative care of 1%.
Conclusions
FDF services in settings of limited resource can provide comparable outcomes to larger centres through the provision of geriatrician led care.