Queensland’s first Rapid Access Service for Known Patients (RAS-KP) of General Medicine at Princess Alexandra Hospital is proving its value with more than 15 patients each week diverted from a hospital bed and instead provided with a tailored care plan that will get them back to the comforts of home on the same day.
Two years after the establishment of the service, the team have harnessed the efficiencies to prevent wait times of 12 hours or more in emergency for known patients, instead pulling those cases into the RAS-KP within 1-2 hours, diverting presentations through telehealth, and preventing inpatient admission in most cases.
PAH’s first Nurse Practitioner for General Medicine, Jyotsna Chaudhari, has been essential to the success of the service, managing the complex web of referrals, reviews and the ever-present arrivals at the Emergency Department (ED) in her quest to divert patients from unnecessary admission.
“I see eligible patients mostly within the first hour of presentation to ED,” said Jyotsna. “That allows me to begin assessment, investigations, medication reviews, and formalise a care plan in collaboration with the General Medicine team. This close working relationship with the Gen-Med registrars is key to the effectiveness of the service.”
RAS-KP was created to provide timely, efficient care to “known patients” of General Medicine who have at least five years of documented General Medicine history at PA Hospital. These patients often live with chronic illnesses such as COPD or heart failure and present more frequently to ED due to exacerbations or complications.
The goal is to prevent long waits in ED and unnecessary admissions, so success for RAS-KP relies on the team’s ability to identify, intervene and intercept for patients requiring General Medicine care.
Jyotsna actively pulls known patients into the RAS-KP stream based on the criteria from all available avenues (eg, FirstNet, GP, OPD or other referrals) to ensure these patients receive the right care at the right time.
She reaches out to eligible patients at their location on the ramp or waiting room in ED, or they may be pulled into the Interim Admissions Centre (IAC) where Jyotsna weaves the magic of the Rapid Access Service.
“Aside from the care plan for their presenting health issue, I coordinate alternatives such as Hospital in the Home, community nursing, GP review, allied health support, or follow-up in my clinic for interventions such as management of medication titration and repeat investigations,” said Jyotsna.
She says the results highlight that patients pulled into the RAS-KP stream are being assessed within two to three hours rather than 12 hours or more.
“Time is the major KPI, especially reducing door-to-doctor time. But it is much more than that.
“We spend a lot of time talking with patients and families as we work through the investigations, blood tests and x-rays,” said Jyotsna. “Expediting them through these processes gives them a confidence that they can go home safely and that I will follow up.
“For me, it is about quality care.”
One of RAS-KP’s most impactful contributions is preventing repeat ED visits. With ongoing phone reviews, proactive problem-solving, and close collaboration with GPs and community services, patients are less likely to bounce back within 24 to 48 hours which is a key performance indicator for the service.
Jyotsna’s background in urgent care clinics provided a significant foundation for problem solving where managing high demand without inpatient options made her resourceful. Since becoming PA Hospital’s first General Medicine Nurse Practitioner in 2021, she has led with clinical precision and heartfelt empathy.
“The smile on their face when they realise they don’t have to stay in hospital, and that they will get the follow-up they need without coming back through the Emergency Department is very fulfilling,” she said.
Nursing Director of Division of Medicine, Fiona Fullerton praised the collaborative approach of the teams in General Medicine, ED, IAC and patient flow making RAS-KP an exemplar innovation in PA Hospital’s most recent international Magnet® redesignation submission for nursing excellence.
“The commitment across teams to ensure the success of RAS-KP highlights the value it adds to patient flow at PAH with an average of 500 inpatient bed days saved annually for this five-day service,” she said. “Well done to the General Medicine team and to Jyotsna for two years of success.”