South Burnett Region

Lady Bjelke-Peterson Community Hospital

Current Program	Aged Care and Chronic Disease.
Communities Serviced	Kingaroy within a 30km radius of the CBD
Services Offered	Palliative Care After Hours - support, advice and outreach to the residents of Kingaroy and surrounds. This service will provide support to patients who require palliative care who wish to remain in their own home. Palliative care nurses will provide support, symptom management, After Hours care planning, outreach to home services and advice in the After Hours period while working closely with the patient's GP to provide support to patients and their carers. The palliative care service will be provided at no cost to the patient.
Eligibility Criteria	Provided for individuals who are not able to access any alternative means to receive palliative treatment through their own resources, DVA, MBS or private health insurance. View criterialess
Referral Contact	For referrals, please call Michelle Garrett on 07 4162 1444 or email admissions@lbpch.com.au
Referral Pathway	Referral from GP

Western Downs Region

Darling Downs Hospital and Health Service

Current Program	Darling Downs Hospital and Health Service (DDHHS) Acute Geriatric Evaluation Service (AGES)
Communities Serviced	All Residential Aged Care Facilities (RACF) within the Darling Downs region.
Services Offered	The DDHHS Acute Geriatric Evaluation Service (AGES) will enable improvements in access, efficiency, effectiveness of after-hours care in RACFs by: Working with GPs and practice managers to identify opportunities for collaborative improvements to improve the health outcomes of RACF residents. Developing decision making tools with AGES medical officers, Nurse Navigators, GPs, RACFs, QAS, and Emergency Departments and to support the introduction of Clinical Pathways into RACFs. Offering education for RACF staff around the care pathways and ISBAR to enable effective clinical handover of residents by face to face delivery of education by Nurse Navigators connected to the AGES team. Providing targeted collaborative education in early recognition, escalation and assessment of a deteriorating resident and an awareness of the options for facility based acute care, by the AGES team, with the consent of the GP as the primary health provider. Providing access to after-hours Nurse Navigator assistance. Weekdays till 22:00, and weekends – directly from 10:00 to 18:00, and by a designated after- hours phone contact service, and medical officer after hours. Facilitating the use of Statement of Choices, and My Health Record as means of sharing of information and improving care coordination. Facilitating collaboration to reduce polypharmacy, with geriatrician review and consultation with GP care provider.
Eligibility Criteria	This service is available to Residential Aged Care Facilities in the Darling Downs region View criterialess
Referral Contact	Project Contact: Donna Fitch, Nurse Navigator Aged Care - Acute Geriatric Evaluation Service, DDHHS \| Email donna.fitch@health.qld.gov.au

Somerset Region

There are no service providers currently listed in this region. Please check back again later.

Toowoomba Region

Darling Downs Hospital and Health Service

Current Program	Darling Downs Hospital and Health Service (DDHHS) Acute Geriatric Evaluation Service (AGES)
Communities Serviced	All Residential Aged Care Facilities (RACF) within the Darling Downs region.
Services Offered	The DDHHS Acute Geriatric Evaluation Service (AGES) will enable improvements in access, efficiency, effectiveness of after-hours care in RACFs by: Working with GPs and practice managers to identify opportunities for collaborative improvements to improve the health outcomes of RACF residents. Developing decision making tools with AGES medical officers, Nurse Navigators, GPs, RACFs, QAS, and Emergency Departments and to support the introduction of Clinical Pathways into RACFs. Offering education for RACF staff around the care pathways and ISBAR to enable effective clinical handover of residents by face to face delivery of education by Nurse Navigators connected to the AGES team. Providing targeted collaborative education in early recognition, escalation and assessment of a deteriorating resident and an awareness of the options for facility based acute care, by the AGES team, with the consent of the GP as the primary health provider. Providing access to after-hours Nurse Navigator assistance. Weekdays till 22:00, and weekends – directly from 10:00 to 18:00, and by a designated after- hours phone contact service, and medical officer after hours. Facilitating the use of Statement of Choices, and My Health Record as means of sharing of information and improving care coordination. Facilitating collaboration to reduce polypharmacy, with geriatrician review and consultation with GP care provider.
Eligibility Criteria	This service is available to Residential Aged Care Facilities in the Darling Downs region View criterialess
Referral Contact	Project Contact: Donna Fitch, Nurse Navigator Aged Care - Acute Geriatric Evaluation Service, DDHHS \| Email donna.fitch@health.qld.gov.au

Civic Assist

Current Program	After Hours - Youth Outreach Program
Communities Serviced	Toowoomba
Services Offered	MetroCare's Street Crew operates every Thursday night between 6 & 11pm in the Toowoomba CBD, primarily on Dent St out the front of Grand Central to support young people aged 12 to 24 years to improve health outcomes. They deliver health promotion to improve awareness including relevant health services, a consumer-lead "accidental counselling" and a referral service to other health and community services in the Toowoomba area.
Eligibility Criteria	Young people under 25 years of age can access the service. View criterialess
Referral Contact	To make a referral, please call 07 4631 5822
Website	Click to visit site
Referral Pathway	Self-referral

Toowoomba Hospice

Current Program	After Hours
Communities Serviced	Toowoomba
Services Offered	Palliative Care
Eligibility Criteria	Hospice care is provided to anyone with a life-limiting health condition, who their doctor believes to be in the end-stage of their illness, needing a level of care that cannot be safely provided at home, or if the client does not wish to die at home. Clients may be referred to the Hospice by themselves, their families and friends, their GP, Community Service Providers and other hospitals. For more information about referring a client please contact our Director of Nursing. View criterialess
Referral Contact	07 4659 8500
Website	Click to visit site

Lockyer Valley Region

There are no service providers currently listed in this region. Please check back again later.

Ipswich Region

West Moreton Hospital and Health Service

Current Program	West Moreton Hospital and Health Service (WMHHS) Residential Aged Care Facilities (RACF) After Hours’ Care Initiative
Communities Serviced	Selected Residential Aged Care Facilities (RACF) within the West Moreton region.
Services Offered	The WMHHS research project will demonstrate improvements in access, efficiency, effectiveness of after-hours care in RACFs by: Developing and implementing strategies to support after-hours’ care in selected RACFs. Empower RACF staff to provide safe, evidenced based care by aiding decision making prior to transfers of residents to emergency departments in the after-hours’ period . Provide resources to enhance clinical assessment, assist with care planning, and promote early intervention to prevent clinical escalation. Collaborate with Ipswich Hospital Emergency Department, Geriatricians, Queensland Ambulance, and general practices to ensure evidence based information is integrated into project resources. Integrate existing resources such as MyHealthRecord and West Moreton Digital Hospital into the project.
Eligibility Criteria	This service is available to Residential Aged Care Facilities in the West Moreton Region View criterialess
Referral Contact	Project Contact: Carol Hope \| Email: wm_serviceimprovement@health.qld.gov.au

Ipswich Hospice Care

Current Program	After Hours - Palliative Care
Communities Serviced	Ipswich
Services Offered	Hospice Based Palliative Care
Eligibility Criteria	Hospice care is provided to anyone with a life-limiting health condition, who their doctor believes to be in the end-stage of their illness, needing a level of care that cannot be safely provided at home, or if the client does not wish to die at home. Clients may be referred to the Hospice by themselves, their families and friends, their GP, Community Service Providers and other hospitals. For more information about referring a client please contact our Director of Nursing. View criterialess
Referral Contact	To make a referral, please call 07 3812 0063
Website	Click to visit site
Referral Pathway	GP or Hospital and Health Service

Scenic Rim Region

There are no service providers currently listed in this region. Please check back again later.

Southern Downs Region

Blue Care

Current Program	Aged Care and Chronic Disease
Communities Serviced	Stanthorpe within a 40km radius of the CBD
Services Offered	Wound Care – In Hours and After Hours. This service will be provided in the most appropriate setting. Blue are staff will work in conjunction with the patient's GP through a referral process for wound care management. Blue Care nurses will provide wound care treatment as medically required at no cost to the patient. To find out more about this service, click here.
Eligibility Criteria	The patient needs to be referred to the wound care program by a medical practitioner due to the acuity and level of complexity of care with the patient requiring additional resources over and above what is usual for community care services. The patient is unable to access any alternative means to receive treatment through their own resources, DVA, MBS or private health insurance. View criterialess
Referral Contact	For referrals, please call Anne Ryan on 07 4636 7982 or Janelle Macdonald on 07 4636 7981 or 0427 585 454
Referral Pathway	Referral from GP

Darling Downs Hospital and Health Service

Current Program	Darling Downs Hospital and Health Service (DDHHS) Acute Geriatric Evaluation Service (AGES)
Communities Serviced	All Residential Aged Care Facilities (RACF) within the Darling Downs region.
Services Offered	The DDHHS Acute Geriatric Evaluation Service (AGES) will enable improvements in access, efficiency, effectiveness of after-hours care in RACFs by: Working with GPs and practice managers to identify opportunities for collaborative improvements to improve the health outcomes of RACF residents. Developing decision making tools with AGES medical officers, Nurse Navigators, GPs, RACFs, QAS, and Emergency Departments and to support the introduction of Clinical Pathways into RACFs. Offering education for RACF staff around the care pathways and ISBAR to enable effective clinical handover of residents by face to face delivery of education by Nurse Navigators connected to the AGES team. Providing targeted collaborative education in early recognition, escalation and assessment of a deteriorating resident and an awareness of the options for facility based acute care, by the AGES team, with the consent of the GP as the primary health provider. Providing access to after-hours Nurse Navigator assistance. Weekdays till 22:00, and weekends – directly from 10:00 to 18:00, and by a designated after- hours phone contact service, and medical officer after hours. Facilitating the use of Statement of Choices, and My Health Record as means of sharing of information and improving care coordination. Facilitating collaboration to reduce polypharmacy, with geriatrician review and consultation with GP care provider.
Eligibility Criteria	This service is available to Residential Aged Care Facilities in the Darling Downs region View criterialess
Referral Contact	Project Contact: Donna Fitch, Nurse Navigator Aged Care - Acute Geriatric Evaluation Service, DDHHS \| Email donna.fitch@health.qld.gov.au

Goondiwindi Region

Darling Downs Hospital and Health Service

Current Program	Darling Downs Hospital and Health Service (DDHHS) Acute Geriatric Evaluation Service (AGES)
Communities Serviced	All Residential Aged Care Facilities (RACF) within the Darling Downs region.
Services Offered	The DDHHS Acute Geriatric Evaluation Service (AGES) will enable improvements in access, efficiency, effectiveness of after-hours care in RACFs by: Working with GPs and practice managers to identify opportunities for collaborative improvements to improve the health outcomes of RACF residents. Developing decision making tools with AGES medical officers, Nurse Navigators, GPs, RACFs, QAS, and Emergency Departments and to support the introduction of Clinical Pathways into RACFs. Offering education for RACF staff around the care pathways and ISBAR to enable effective clinical handover of residents by face to face delivery of education by Nurse Navigators connected to the AGES team. Providing targeted collaborative education in early recognition, escalation and assessment of a deteriorating resident and an awareness of the options for facility based acute care, by the AGES team, with the consent of the GP as the primary health provider. Providing access to after-hours Nurse Navigator assistance. Weekdays till 22:00, and weekends – directly from 10:00 to 18:00, and by a designated after- hours phone contact service, and medical officer after hours. Facilitating the use of Statement of Choices, and My Health Record as means of sharing of information and improving care coordination. Facilitating collaboration to reduce polypharmacy, with geriatrician review and consultation with GP care provider.
Eligibility Criteria	This service is available to Residential Aged Care Facilities in the Darling Downs region View criterialess
Referral Contact	Project Contact: Donna Fitch, Nurse Navigator Aged Care - Acute Geriatric Evaluation Service, DDHHS \| Email donna.fitch@health.qld.gov.au

Cherbourg Region

There are no service providers currently listed in this region. Please check back again later.

Boonah Area

West Moreton Hospital and Health Service

Current Program	West Moreton Hospital and Health Service (WMHHS) Residential Aged Care Facilities (RACF) After Hours’ Care Initiative
Communities Serviced	Selected Residential Aged Care Facilities (RACF) within the West Moreton region.
Services Offered	The WMHHS research project will demonstrate improvements in access, efficiency, effectiveness of after-hours care in RACFs by: Developing and implementing strategies to support after-hours’ care in selected RACFs. Empower RACF staff to provide safe, evidenced based care by aiding decision making prior to transfers of residents to emergency departments in the after-hours’ period . Provide resources to enhance clinical assessment, assist with care planning, and promote early intervention to prevent clinical escalation. Collaborate with Ipswich Hospital Emergency Department, Geriatricians, Queensland Ambulance, and general practices to ensure evidence based information is integrated into project resources. Integrate existing resources such as MyHealthRecord and West Moreton Digital Hospital into the project.
Eligibility Criteria	This service is available to Residential Aged Care Facilities in the West Moreton Region View criterialess
Referral Contact	Project Contact: Carol Hope \| Email: wm_serviceimprovement@health.qld.gov.au