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Heather Banham, The Queen Elizabeth Hospital delivered the presentation at the 2013 Hospital in the Home Conference. The Hospital in the Home Conference is a nurse oriented program packed with comprehensive case studies to improve HITH services and maximise hospital efficiency throughout Australia. For more information about the event, please visit: http://www.communitycareconferences.com.au/HITHevent
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Stepping Stones in Care Pathways
Creating & sustaining best practice through
service expansion
SA Health
The Queen Elizabeth
Hospital
SA Health
In the Beginning
> TQEH H@H commenced in 1995
> Grew from pending closure of wards
> Daily visits by solo nurse
SA Health
TQEH
Hospital@Home
> TQEH is a general
hospital within the
Central Adelaide Local
Health Network
> H@H visits
approximately 10,000
people per year
> H@H Monthly visit
average of
850-900 patients
> Annual H@H figures are
trending upward
SA Health
Patient Cohort
> Acute adult surgical and medical patients
> TQEH Clinical governance and care pathway
> Diverse population
• Culture
• Socio-economic status
• Ageing & isolation
> Identified via hospital staff referral and assessed
as suitable by the H@H Case Finder
• Risk assessment
• Patient consent
SA Health
How we work
> Experienced Clinical Nurses; advanced skill set
> Twice daily acute nursing care
> Direct reporting to the TQEH Medical teams
> Average patient load of 8-10 per nurse
> 3 nurses per day visiting within 10km radius
SA Health
Section break slide heading here
SA Health
Drivers for Change:
Creating a responsive service.
SA Health
Health Service Demand
> Deloitte’s Review and Report
findings
> Service demand: increased hospital
presentations / Hospital Avoidance
> Service Access: Bed blockages
> Emergency Department 4 hour
target
> Elective Surgery targets
SA Health
Responding to Service Demand
> Increasing patient cohort numbers
> Diversifying existing patient cohort
> Shortening in-hospital LOS
> Improving service access/bed access
> Responding to daily discharge demands
> Supporting ED 4 hour target
SA Health
Diversifying the H@H Service
> Expanding staff skill set
> Education updates, training
> Research findings: Best Practice in H@H
> Equipment
> Flexible working hours
> Responding to patient need: additional
visits / review
> Creating opportunities for early & safe
discharge
• Staff confidence
• Protocol development
• Increased communication with clinical teams
SA Health
H@H: expanding the Patient Cohort
> Gynaecology
Patients
> Orthopaedic
“oozy wounds”
> Iron Infusions
> Cytotoxic
Infusions
SA Health SA Health
Future Steps:
Developing a multi-site
single service model for
Central Adelaide Local
Health Network.
SA Health
Central Adelaide Local Health Network
The Royal Adelaide Hospital &
The Queen Elizabeth Hospital
One region: 2 hospitals
SA Health
Central Adelaide H@H: Stepping
into the future
> RAH 6 month service expansion pilot
• Diversify the current RAH Haematology /
Oncology H@H service
• Provide twice daily visits
• Staff Recruitment
> Pilot Evaluation
SA Health
Where are we now?
> Defining the Service
• Key Stakeholders: who are they?
• Relationship building: Clinical
governance
• Service coordination
• Creating pathways: where to start?
• Expected outcomes: what will the
service look like?
SA Health
H@H into the future
> Developing confidence in H@H model and
staff
• Changing culture: “we’ve always done it
this way”
> Risk Management: what if we don’t change?
> Barriers to change?
• Clinician perception
• Skill mix
• Patient safety
• Patient perception
• Staff safety
• Service cost v current in-hospital cost
