The industry problem/opportunity
Many older individuals in aged care are highly frail, with complex health needs, multiple long-term conditions, and weakened immune systems that make them more prone to acute deterioration. Resident transfers to emergency departments and subsequent hospitalisations are frequent, with 13-40% of transfers considered avoidable through referral to hospital in-reach services. However, reliably detecting deterioration in these populations is difficult, involving a complex interplay of bio-psycho-functional factors that existing physiological-based tools fail to take account of. Additionally, workforce factors limit the sector’s current ability to systematically screen for deterioration.
The solution and outcomes
This collaboration between DHCRC, Telstra Health – the largest Australian-based provider of software solutions for residential aged care – and RMIT University resulted in the development and validation of an innovative electronic screening and risk prediction tool for deterioration in aged care residents. The tool monitors structured and free-text electronic record data for 36 evidence-based bio-psycho-functional indicators of deterioration and categorises residents with a frailty index based on this screening. The system also offers alerts for risk of falls, depression, and mortality, with data displayed on a dashboard for staff to view at individual or cohort levels.
The impact
This pioneering innovation has the potential to enhance the safety and quality of care in residential aged care settings while easing demands on healthcare providers through reducing costly emergency interventions. The tool demonstrated the ability to effectively and accurately provide actionable insights by identifying frailty phenotypes and predict adverse events from automated analysis of routinely captured data. The cutting-edge digital health tool won Cooperative Research Australia’s 2024 Award for Impact, as well as Research Australia’s Health and Medical Research Award 2024 for Digital and Data Health Innovation.
The insight
Telstra Health’s Chief Health Officer, Dr Monica Trujillo, said: “This type of innovation, which has been standard practice for so long in hospital settings, is long overdue in the residential aged care sector and has enormous potential to uplift the safety and quality of care provided to residents.”
Data scientist and RMIT project lead Dr Tabinda Sarwar said: “It was only through this collaboration that we could gain the valuable insights to ensure our solutions were practical, effective, and tailored to real-world needs.”
What’s next
Planning is underway to transition the prototype solution to production through its integration with Telstra Health’s clinical and care management software, supporting its scaled implementation across multiple sites and providers. Telstra Health’s Clinical Manager is already used in over 350 facilities in Australia and supports almost one-third of residents (>60,000 individuals) in Australian aged care facilities.
