CARE-PACT Mobile emergency assessment, care and treatment team: An integral component of an integrated approach to management of acute health-care needs of residents of aged care facilities

Chia Hsin Tony Hsiung1,

1 Nurse Practitioner, Princess Alexandra Hospital, CARE-PACT/Redland Hospital Emergency Department, Brisbane, QLD,

The ageing population presents a demand management challenge for modern health care systems. Emergency departments (EDs) are often utilized as the gateway to medical care and are being increasingly faced with growing numbers of geriatric presentations.  This population causes disproportionate impacts on EDs, due to their requirement for more intensive investigation, longer lengths of stay (both in ED and inpatient beds). Whilst the transfer of RACFs residents to the ED may be necessary, many conditions, including pain and symptom relief, indwelling catheter care, wound management and antibiotic therapy can be managed within the RACF with support, skill and expertise. The risk of adverse events for RACF residents’ especially cognitive impaired groups who present to hospitals is well documented. On the other hand, hospital transfers are often distressing for the residents and often contribute to high incidence of pressure area injuries and delirium.

Current acute care substitution models predominantly focus on traditional patient cohorts and fail to consider the unique, accredited professional environment of RACFs. In the current RACF model of care, there is often a failure to address the complex array of factors that influence RACF staffs ability to care for patients in the facility with acute medical needs resulting in unplanned and avoidable presentations to ED, including the RACF staff skill mix and resources, perceived risk, lack of medical support and patient functional and cognitive impairment. Patients and families consistently express desire to receive acute treatment in their home environments. Further, it is well-documented that transferring elderly patients to ED can be distressing and increases the risk of iatrogenic complications. CARE-PACT (Comprehensive Aged Residents Emergency and Partners in Assessment, Care and Treatment) is a partnership between Residential Aged Care Facilities (RACFs), General Practitioners (GPs), Primary Care providers and the Health and Hospital Service. The service aims to support GPs and RACF staff in the provision of best care for residents of RACFs with acute health care needs, in the most appropriate location.  The aim of the CARE-PACT is to deliver high-quality gerontic nursing and emergency specialist assessment, collaborative care planning, skill sharing across the care continuum and an individualised resident-focused approach. Implementing a service with specific focus and training in gerontology can be beneficial across the care continuum in terms of improving gerontic assessment skills, but also provides the opportunity to improve care for this vulnerable group.

One component of the integrated care program, CARE-PACT, entails a mobile ED assessment, care and treatment team.  This is operationally led by an emergency trained nurse practitioner, with further training and interest in geriatric medicine, with clinical governance held by the programs’ dedicated ED physicians.  This emergency substitutive care service and demand management program provides an ED equivalent assessment within the RACF.  It aims to improve quality of emergency healthcare to this vulnerable geriatric population, whilst reducing exposure to the often frightening and high risk ED environment.  The mobile ED assessment service reviews and manages RACF residents with selected acute healthcare needs in the resident’s own environment.   This article provides an in-depth description of the CARE-PACT mobile ED assessment service, with case examples to demonstrate the potential benefits of this program, both at patient and systems level.


I am a Master of Nursing student from Monash University, Australia. I am particularly interested in disaster preparedness and Emergency Department triage practices. I have also been involved in honours project on “Knowledge, Attitudes and Practices among University Students towards Psychological Counseling”. I administered survey tool and administered quantitative analysis. I have published my research project in Publication at Forum of Sri Lanka Medical Educationists first academic session.