Online delivers new service for country geriatric systems

With a continuing increase in the number of Australians needing health care, new methods are now being developed and used online to provide specialist medical expertise and assist older people based in distant locations.

Comprehensive geriatric assessment (CGA) is a core procedure which improves functional recovery and reduces the need for long-term institutional care, and can be delivered by geriatricians and gerontic nurses. CGA itself is time-consuming and cannot be delivered personally by staff in many rural hospitals where those geriatric services are absent.

But as outlined in the December issue of the Australasian Journal on Ageing, an online system has been developed and tested over a four year period by the Academic Unit in Geriatric Medicine at the University of Queensland and the Centre for Online Health at the same university which can enable a geriatrician to review and report an assessment online and can be viewed by clinicians inside and outside the hospital via the Internet.

It has operated successfully at the Toowoomba Base hospital which has 300 beds and services a community of 100,000 people. The hospital has a 25-bed geriatric and rehabilitation ward but no geriatrician. Instead patients are assessed by a nurse within 48 hours of admission and then reported online by a geriatrician in Brisbane. These assessments provide the basis for triage decisions including transfer to the geriatric ward. Contact is maintained between patient, local nurse assessor, and the geriatrician through an online electronic information system and mobile videoconference as required.

Len Gray and Richard Wootton of the University of Queensland said that the system was “still in evolution, with many aspects undergoing refinement”. But they said that early evidence suggested the approach to be “accurate, safe, appealing to clinicians, and efficient. Overall, the system appears to be meeting its two key objectives of improved access and efficiency”.