Reducing the cost associated with care of elder patients in the ED: Impact of enhanced primary care in an aged care facility

Dr Marc Broadbent1, Dr  Alison Craswell1, Professor Marianne  Wallis1, Dr Elizabeth Marsden2, Ms. Andrea  Taylor2, Ms.  Kaye Coates3, Ms.  Colleen Johnston1

1University of the Sunshine Coast, Sippy Downs, Australia, 2Sunshine Coast Hospital and Health Service, Sunshine Coast, Australia, 3Sundale, Sunshine Coast, Australia

Background: Frail, older people are at increased risk of complications when they require transfer for acute care from their residence, particularly for those in residential aged care facilities (RACF). Interventions that improve health outcomes and reduce potentially avoidable transfer to emergency departments (ED) are integral to managing an ageing population. The care coordination through emergency departments, residential aged care and primary health collaboration (CEDRiC) project coordinates care of the older person between:

  1. A Nurse Practitioner Candidate (NPC) in one RACF providing primary care facility aiming to reduce unnecessary transfer to hospital with onset of acute illness, and
  2. Advanced Practice Clinical Nurses in the local ED providing a Geriatric Emergency Department Intervention (GEDI).

This presentation describes the economic impact on the ED, of the NPC intervention and explores the structures and processes that enhance care in the ED.

Design & Methods: Quasi- experimental, with an embedded qualitative component. Data collected included: i) patient level costing and covariate data from the ED information system and hospital databases, ii) semi structured interviews. Multivariate modelling of quantitative data and themes from the qualitative data pertaining to structures and processes from the intervention, will be presented.

Results: Older people who received NPC care in the RACF incurred less cost to the ED compared to other RACF residents and other people aged 70 years and over. These costs savings related to reductions in ED length of stay. GEDI staff reported enhanced communication and streamlining of care of older people from the RACF when NPC involved.

Conclusion: A NPC providing early intervention for older people in a RACF reduces the demand on EDs, time spent with older patients and saves money, thus freeing resources. GEDI nurses report the goals of transfer are more clear facilitating targeted interventions, expediting care and improving turnaround.


Marc Broadbent commenced working as an academic in 2005 following a career in critical care and emergency nursing. He has experience in coronary care, cardiothoracic, trauma and general intensive care, with his main area of expertise being in trauma and emergency nursing. He has worked as a clinical nurse specialist, nurse educator and nurse manager in emergency departments within Australia and overseas.

Marc has published and presented both nationally and internationally in the area of emergency mental health triage. The management of vulnerable populations in the ED, particularly those with a mental illness, is his research focus. Marc’s work has been cited as the best available evidence for the triage of clients with mental illness in the Australian National Emergency Triage Training Kit. Marc is a member of the Australian College of Mental Health Nurses, a Fellow of the Australian College of Nursing and Associate Editor – Mental Health for the Australasian Emergency Nursing Journal. Marc is currently an expert member of the Mental Health Advisory Group of the Australian Commission on Safety and Quality in Health Care and is contributing to the development of national standards of mental health care.