December 20, 2023
As our population ages we are seeing more patients with chronic disease present to ED and more acute presentations to hospital. This is already increasing pressure on our strained health workforce and facilities.
This research from Finland showed “there was a three-fold increase in ED visits made by patients 80 years or more compared to those under 80, and aging of the population will lead to a rapid increase in the number of ED visits.”
The same study concluded it “unlikely that increasing ED resources is feasible. Instead, the focus should be on chronic care of the aged and prevention of potentially avoidable ED visits.”
In the future our hospitals will not have room to accommodate all the older people who are, statistically speaking, likely to present to ED. Furthermore, our limited workforce will not have the capacity to meet the needs of all those people in the community. Change is needed.
Over the next 15 years, Statistics NZ predicts that the number of people aged 85+ will increase by around 100,000 people. If we accept that hospital and resthome beds will not keep pace, then the only logical strategy is to get better at managing the health of older people at home, potentially many thousands of older people every year.
This isn’t a new phenomenon. We have always needed to safely manage the health of older people at home. We have some excellent services with dedicated people who have been doing exactly this for decades. Recently, this research from NZ recommended that “specialised teams and pathways [be developed] to optimise perioperative care for the geriatric surgical population”. By optimising care for this cohort, we can relieve pressure on hospitals.
Some NZ hospitals have already set up specialised teams to provide post-acute care for older people following injury. These supported discharge teams have proven to be highly effective. Research by Parsons et al, concludes that “Supported Discharge Teams (SDT) can provide an important role in reducing hospital length of stay and readmissions of older people following an injury.”
Parsons’ randomised controlled trial found that participants in the SDT group had a shorter length of stay when compared to usual care (mean 20.9 days vs 26.6 days), and in a 12 month period spent less time in hospital and had approximately 10% lower healthcare costs.
These SDT health services are coming under increasing pressure as aging demographic trends start to make their impact felt, but baby boomers are only just now approaching the age of 80. We are only at the very cusp of this large demographic bubble entering old age.
Remote patient monitoring (of the kind Spritely supplies) can increase capacity for our supported discharge teams. This will help to keep more older people safe at home and out of hospital. SDTs like Hoki ki te Kāinga in Hawkes Bay can create enhanced models of care by adding RPM, which according to team leader Natasha Williams, saves nurses time and increases clinical oversight of patients. Check out the video below.
Using Spritely to improve patient capacity means that more patients can be supported in the community concurrently. This can free up hundreds of extra hospital bed nights every year in Hawkes Bay. If used nationally it could free up thousands and thousands of bed nights in NZ by increasing the capacity of SDTs, which are proven to enable earlier discharge and minimise readmissions for older people.
The cost of not doing this was recently examined in Australia, where the Australian Medical Association published this analysis estimating savings of around $30 – $60 million if out-of-home rehabilitation services had the capacity to accommodate all clinically eligible “total knee replacement” patients.
Spritely has developed a completely new way of remote patient monitoring that makes it very easy for clinicians and patients to use. Even older people, with limited experience of technology, are quickly set up with 1-tap video calling and automated vitals recording. There is no need for them to connect to anything, download anything, set up anything or pair anything. Gone are the days when a nurse can spend 20 minutes just trying to start a zoom call with a patient. Spritely has now been evaluated by Te Whatu Ora Hawkes Bay hospital and we are thrilled with the overwhelmingly positive report from the team there.
Spritely is an equitable solution, ideally suited to helping SDT teams manage the recovery of more people in the community. Especially those that might otherwise struggle to get the benefit of remote patient monitoring.