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Escalating concern: the GP, after-hours care and 000

Aged care staff Residents & families Facility leadership 6 min read

By Dr Josh Hatch, FRACGP

Noticing a change only helps if it reaches someone who can act on it. The Quality Standards require changes and deterioration to be escalated and communicated, and require processes that let residents, their supporters and health practitioners escalate concerns 1.

Numbers in the text link to the 6 sources listed at the foot of this page.

Structured calls

ISBAR stands for Identify, Situation, Background, Assessment and Recommendation, and is used to make handovers in clinical settings safer 26.

A systematic review of SBAR, the same format without the opening identify step, found 11 studies in hospitals, primary care and nursing homes, most with before-and-after designs. It found moderate evidence that SBAR improves patient safety, especially when used to structure telephone calls, and noted a lack of high-quality research 25.

An ISBAR call about a resident

  1. Identify. Your name and role, the facility, and the resident’s full name and date of birth.

  2. Situation. What has changed, and since when. “She has been more confused and drowsy since this morning and has eaten nothing today.”

  3. Background. Relevant conditions, recent medicine changes, recent falls or hospital stays, and what the goals of care or advance care plan say about treatment and transfer.

  4. Assessment. A full set of observations compared with the resident’s usual values, what has been checked, such as bowels, bladder, pain and intake, and what you think is going on.

  5. Recommendation. What you are asking for: a review today, advice, a medicine order or a transfer, and when you will call back if things change.

Who to call

In hours, the usual first contact is the resident’s own GP. Out of hours, facilities rely on after-hours medical services, hospital outreach lines where they exist, and 000.

In Queensland, several public hospital services run telephone triage lines for registered nurses, clinical managers and GPs working in residential aged care, with hours that differ from line to line 32. In New South Wales, some local health districts run similar outreach, such as the nurse-led Aged Care Emergency service in Hunter New England 30. What exists varies by region, so the local numbers are worth knowing before they are needed.

When to call 000

Healthdirect lists these among the reasons to call triple zero (000) for an ambulance 27.

  • Loss of consciousness, even if brief.

  • Chest pain.

  • Sudden weakness in the face, arm or leg, or trouble speaking.

  • Breathing problems.

  • A sudden collapse or an unexplained fall.

  • A seizure.

  • Bleeding that cannot be controlled.

  • Any other major concern about a person’s health or wellbeing.

Related pages on this site

Sources cited on this page

  1. 1 Australian Government Department of Health, Disability and Ageing. Strengthened Aged Care Quality Standards (November 2025; implemented 1 November 2025). Outcome 3.2, Actions 3.2.4 and 3.2.5; Outcome 3.3, Action 3.3.3; Outcome 5.2, Actions 5.2.1 and 5.2.2; Outcome 5.4, Actions 5.4.2 and 5.4.5. View source
  2. 25 Müller M, Jürgens J, Redaèlli M, Klingberg K, Hautz WE, Stock S. Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review. BMJ Open. 2018;8:e022202. (Eight before-and-after studies and three controlled trials, including nursing homes.) View source
  3. 26 Aged Care Quality and Safety Commission, resource library. ISBAR: Identify, Situation, Background, Assessment and Recommendation. (Undated; listed as a state or territory resource, not a Commission publication.) View source
  4. 27 Healthdirect Australia. Calling triple zero (000). (Last reviewed August 2025.) View source
  5. 30 Sunner C, Giles M, Ball J, et al. Implementation and evaluation of a nurse-led intervention to augment an existing residential aged care facility outreach service with a visual telehealth consultation: stepped-wedge cluster randomised controlled trial. BMC Health Serv Res. 2023;23:1429. (16 facilities in two New South Wales local health districts.) View source
  6. 32 Queensland Health. RaSS telephone triage contacts for registered nurses, clinical managers and GPs. (Last updated 20 April 2022.) View source

See every source cited across the deteriorating resident section →

Written by Dr Josh Hatch, FRACGP. General information only, reflecting his reading of the published evidence as at November 2026. It is not individual medical advice, does not create a doctor–patient relationship, and must not be used to start, stop or change any treatment, and it does not set escalation rules for any facility. Antibiotic choices and doses follow current prescribing guidelines and local advice. Evidence, Australian regulatory requirements and local services change — always confirm current advice with the treating GP and the facility’s own procedures.

This is general education, not a clinical protocol. The doctors who practise with Umbrella Aged Care are independent general practitioners, and each makes their own clinical decisions with the resident and family. Your GP’s advice for an individual may differ from what is written here. If it does, please ask them to talk it through with you.

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