Unless they are very, sick older people are better off at home than in hospital, says EngAGE Orbit team leader Sarah Shanahan.
The team provides a rapid-response service to assess whether older people can return home rather than receive inappropriate treatment. By avoiding admissions to hospital and better supporting patients in their own home on discharge, complications associated with hospital stays were reduced.
It won the Southern Community Laboratories Excellence in Service Improvement Award and went on to win the Royston Hospital Supreme Award at the recent Hawke's Bay Health Awards.
Judges praised its work, saying it featured progressive innovation that was patient-centred and evidence-based.
The rapid-response service assesses older people as referred by Hawke's Bay Hospital's Emergency Department (ED) and Acute Assessment unit, St John ambulance service and City Medical Napier.
Ms Shanahan said previously medical staff would err on the side of caution and step up care to a level that wasn't always needed.
She gave the example of a 90-year-old needing a walking frame being treated at City Medical for a broken wrist.
"They might put the wrist in a cast and provide medical treatment, but then the City Medical team may not be confident about how that person would manage at home," she said.
"They can call the Orbit team who can go and visit that person at their own home rather than having to transfer them to ED."
She said frail older people often had complex medical histories so were more likely to be admitted to hospital from ED than any other age group.
An EngAGE Orbit team member visited patients "so we can get people home with the right support and equipment and the right follow-up that is in their best interest".
Working with St John Ambulance Service was a recent development where EngAGE's frailty pathway was proving invaluable, she said.
St John often saw elderly people who had fallen in their home but were not significantly injured.
"Quite often they pick that person up and just have to leave them and we don't really know if they are going to be okay.
"Now they can actually call our team who can follow-up, potentially the same day."
Often St John saw evidence in the home "that things aren't right".
"Maybe the fridge is empty or they are not managing very well to look after themselves, so now they can call us."
She said previously St John's way to help a patient was to bring them to ED and sometimes they had to find their own way home that evening.
The EngAGE team started in 2010 with just three people. The physiotherapist, occupational therapist and social worker quickly became interdisciplinary, she said.
"Historically a patient would see the social worker, and then the physio and occupational therapist. You'd see one after the other and it have to tell your story over and over.
"We have learnt aspects of each other's role so that we can provide a holistic assessment, so only one professional sees the person."
Once assessed and at home, another service could take over to provide support.
The improvement in efficiency and patient experience took another leap in November last year when the rapid-response team moved to a seven-day service with extended hours.
Previously they worked Monday to Friday 8am to 4.30pm, like many other hospital services.
"We could see from the statistics 90 per cent more of many frail older people came to ED at the weekend over any other time of the week.
"Also there is a peak in presentations in the afternoon, so when someone was ready to see us we were finishing up and leaving."
On November 9 last year hours extended to 7am to 7pm, seven-days-a-week, and in that time 1000 more patients seen.
She said she would like the service made available to all medical facilities but it was important to gauge the need first.
"The last thing you want is to say, we're a rapid response team, but then be inundated and unable to respond rapidly."