Excellence in Patient Care Ambulance Victoria’s Residential Aged Care Enhanced Response (RACER)

Ambulance Victoria

Team: Natasha Krajcar, Ariana Carrodus, Natalie Bemrose, Nicola Reinders, Lindsay Mackay, Diana Zimmermann, Gareth Becker, Larissa Walsh, Ange Iliopoulos, Amanda Thornton, Lina Hawi, Aidan Hill, Melanie Burns, Brent Driscoll, Rob Lasslett

In 2022, Ambulance Victoria’s (AV) Patient Care Academy (PCA) initiated a program of work known as AV Care Connect to introduce alternative care pathways to better connect patients to clear-cut care specific to their needs, and to avoid unnecessary ambulance transportation.

To address patient care efficiencies, the first pathway AV introduced was the Residential Aged Care Enhanced Response (RACER) pathway. This aimed to better connect and coordinate Triple Zero (000) calls made from residential aged care facilities (RACFs).

This priority was informed by extensive data analysis of dispatches. In early 2022, daily data demonstrated that approximately 85 emergency ambulances attended to patients in RACFs, equating to roughly 5% of all emergency ambulance dispatches made by AV. Up to 40% of those patients transported to an ED did not need to be and returned home without admission.

Additionally, a comprehensive review found that following transfer to hospital, a significant proportion of aged care residents experienced increased rates of pressure ulcers (19%), delirium (38%) and a three-fold rise in hospital acquired infection. The team recognised that avoiding unnecessary transfer to hospital EDs was deemed vital in reducing the increased risk of morbidity, hospital re-admission and preventable death in elderly patients.

RACER was therefore developed to apply the existing Victorian Virtual Emergency Department (VVED) infrastructure to connect eligible patients to a specialist emergency telehealth service.

Eligible patients, as of December 2022, include patients residing in RACFs triaged as not needing an emergency ambulance. The pathway relies on AV's Triage Practitioners (TPs) to refer these eligible low acuity patients directly to the VVED when the RACFs Residential In-Reach (RIR) or the patient's own General Practitioner (GP) are unavailable.

In the first three months of its operation, AV’s TPs referred 641 patients to RACER. Of those 641 patients, 448 (70%) were able to safely remain in their home environment or be referred to an Alternative Service Provider (ASP). Daily referrals to ASPs have more than doubled since RACER’s introduction, from an average of three to eight cases per day. Based on this trend, RACER is projected to reduce unnecessary ED presentations by over 2,000 cases annually, and more as the RACER pathway expands to include additional patient cohorts.

As of January 2023, AV has commenced recruitment of an aged care specialist to work alongside TPs, providing capability building and advice to better connect patients to the right care.