Geriatric Flying Squad
The Geriatric Flying Squad GFS.
Rapid Assessment for the Functionally Declining Patient.
The GFS is a multidisciplinary care team expressly for patients with a sub-acute functional decline and multiple and chronic conditions, including dementia, occurring in the 65+ population.
The GFS model responds to community referrals, with an inbuilt triage system to be able to give priority to urgent cases. The multidisciplinary team is based in the outpatients department at WMH and provides both clinic-based and domiciliary assessments and is geared to respond to emergency calls from community care providers and General Practitioners.
The flying squad’s comprehensive geriatric assessment and management process will determine the patient’s needs. The GFS team can, for a short period, manage the patient at home, utilising community services and the out-patient department at WMH. Where required, an admission can be arranged to sub-acute care at WMH, thus avoiding the Emergency Department.
The GFS Team
The multi-disciplinary team consists of
- Clinical Nurse Consultant (CNC)
- Clinical Nurse Specialist (CNS)
- Social Work
- Occupational Therapy
- Clinical Psychologist
The service also has access to all the services at War Memorial Hospital such as
- Speech pathology
- Specialist clinics
- Continence Management
- Hydrotherapy pool
Hospital can provide transport to out-patient appointments at the hospital.
How the process works
When a patient is referred, the referrals will be assessed by the Clinical Nurse Consultant. A telephone call will be made to the referrer and the patient triaged based on the referral and the phone call.
Patients will be visited at home by the CNC or the CNS and an initial assessment will take place. The patient’s case will then be discussed at the multi-disciplinary case meeting. Subsequently, the geriatrician and other members of the team may visit the patient at home to conduct further assessments, or the patient will be brought in to the WMH out-patients department for review.
Once the assessment is completed, a plan of care will be formulated. This will be discussed with patients and care-givers. Assistance will be given short-term to carry out this plan.
Who to Refer
Patients 65 years and older who are failing in the community as a result of:
Co-morbidities and poly-pharmacy
Poor social support
How to REFER
Referrals can be made by anyone via the Northern Network Access and Referral Centre.
A detailed written GP referral is required.