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Table 2 Overview of interview themes and sub-themes with illustrative quotes from health professionals

From: Factors impacting hospital avoidance program utilisation in the care of acutely unwell residential aged care facility residents

Theme Sub-theme Illustrative quotes  
1. Resident care need factors 1.1 Residents with cognitive impairment “The type of patient [who would benefit most from ARRT] would be someone who’s frail, who has dementia. That would be an example of condition where it’s better for them not to be in hospital if you can avoid it.” (G1) Geriatrician [ARRT is able to give a resident with delirium] treatment that they would get in hospital, in a much more conducive environment to their actual health and well-being. They’re definitely reducing the adverse effects that they would be exposed in hospital.” (CNC1) ARRT Clinical Nurse Consultant
  1.2 Residents at the end of life “If they’re palliative, if they are dying, they can be cared for - in the majority of facilities - they can be cared for at the facility.” (CNC2) ARRT Clinical Nurse Consultant “We liaised with a palliative care team that hadn’t spoken to her for a few months. And we liaised with ARRT and we did a video conference. And we ended up providing care for her at home that then she was able to pass away after we’d implemented care. Which was amazing and it’s exactly what she wanted.” (ECP) Extended Care Paramedic
2. Family factors 2.1 Family needs and expectations “Families, I think, still see hospital is this gold standard of care, and it is. But I think it’s very hard sometimes to explain to families that [for] their loved ones … the outcome of the treatment of going into hospital may not necessarily change the position or change the condition for their family - for their loved ones. So it’s managing those expectations.” (CNC1) ARRT Clinical Nurse Consultant “There are benefits [of RACF-based management of residents] to the family. The patients kept where they are [and] the family can still visit, can be involved in their care.” (G1) Geriatrician
3. Enabling factors 3.1 Rapid geriatric outreach service “[ARRT has the] ability to provide medical care outside of the hospital, and that includes comprehensive geriatric assessments. That includes provision of certain treatments. So things like antibiotics, fluids, ability to do blood testing, ability to do things like diagnostics. Things like ECGS, bladder scanners, mobile X-ray.” (G1) Geriatrician We’re doing lots of acute assessments of patients … assessing if they’ve been unwell, assessing if they’ve got any sort of major things that we can reverse, but ultimately trying to keep them in the … aged care facility as well … Trying to treat them or apply sort of acute management outside of hospital.” (CNC1) ARRT Clinical Nurse Consultant
  3.2 Coordination of care “I like the fact that AART can refer on to the other teams. So you’ve got the aged care, you’ve got APAC [Acute Post-Acute Care], you’ve got palliative care. And they could even arrange sort of direct admissions and bypass ED as well, so you don’t want necessarily these people to be sitting in emergency.” (ECP) Extended Care Paramedic When I get the phone call from ARRT … I can just basically lookout for the patient as soon as they get on the screen. We can then kind of grab the medical team and say “Hey, let’s quickly get someone on it”, you know, get them seen quickly, get them their scans happening, and then try and get them out quickly. So if someone didn’t jump on board, they may sit in the ambo bay for - I don’t know how many hours … I do think that we can fast track them through [ED] to a degree.” (CNS) ED-based Clinical Nurse Specialist
  3.3 Telehealth “We’re doing so many video conferences - that our capacities, it’s allowed our capacity to build up because you don’t need to go and do the reviews on site. Two reviews this morning already.” (CNC2) ARRT Clinical Nurse Consultant You know, within 5 to 10 min we can start up a video conference with someone in an age care facility.” (G1) Geriatrician 1
  3.4 Relevant skills within the ARRT team “We just work collaboratively. I think that is key to how the team actually works.” (CNC2) ARRT Clinical Nurse Consultant “[ARRT] staff need to be relatively independent and relatively senior and experienced and able to deal flexibly with problems. I think those would be the core components, senior medical, senior nursing and a flexible approach to management.” (G1) Geriatrician
  3.5 Relationships with other services “Develop good relationships with your aged care facilities and your GP’s that are working within them … it just opens up the pathway of referral. Developing pathways from NSW Ambulance into teams like the ARRT service, really developing good relationships with them as well, really opens up the ability to … intercept ambulances.” (CNC1) ARRT Clinical Nurse Consultant “I personally think they’re amazing. It’s a really good service. It ticks the boxes for getting the right patient, the right care, in the right place. And they’re so easy to liaise with, and yeah just fantastic.” (ECP) Extended Care Paramedic
  3.6 Capability building of RACF staff “While [reducing unnecessary hospital admissions is] our primary goal, our secondary goal, which is also very important, is educating, upskilling and providing support for aged care facility staff … with a similar goal in mind.” (G1) Geriatrician 1 “Building up the capacity within the nursing staff. So that they can recognise deterioration early, that they feel more competent and confident they can manage more acutely unwell people.” (CNC2) ARRT Clinical Nurse Consultant
4. Barriers 4.1 Team size “Lately we’re overwhelmed with activity … We’re also working on coronavirus planning for nursing homes, which is entirely separate to our usual business. So time, inadequate numbers of staff. Although we’re trying to address that too. We were actually recruiting a lot of people recently.” (G1) Geriatrician “We’re a small team. It would be great to have a bigger team. Something that we - and I guess that’s another barrier, is if we had more geriatricians, more staff, more expertise in the field, Allied Health that worked directly with us, we might be able to achieve a lot of different things.” (CNC1) ARRT Clinical Nurse Consultant
  4.2 Hours of operation “Extended hours and weekends covered would be great... A lot of the time health issues arise, it’s not on a Monday-Friday 9–5.” (ECP) Extended Care Paramedic “A lot of residential aged care patients do come in [to the ED] after hours, because they haven’t got services like aged care rapid response after hours... [They] do tend to come quite regularly after hours, and we don’t have that support then.” (CNS) ED-based Clinical Nurse Specialist
5. Adaptability and responsiveness 5.1 The COVID-19 pandemic “Coronavirus has probably improved [communication between the hospital and RACFs] too. Because we’re increasing talking to the nursing home. We’re actually having face to face sessions with them. Trying to upskill them, and I guess all that raises awareness of what we’re doing.” (G1) Geriatrician “[The hospital is] much more engaged and [RACFs} are much more engaged than they were six months ago, before the COVID. And particularly the last four months when the realisation of the devastating impact that that disease might have. There’s much more communication, and we’re out there training them on PPE, and infection control measures, right now. So that, in that very focused way we’re much more engaged together. Prior to that, it was spotty. Some places did well, and others, we hardly made much penetration in to at all.” (G2) Geriatrician
  1. RACF Residential aged care facility