Published on March 10, 2014
Victoria- supporting HITH & HITH nurses Gen Cooper : HITH Senior Project Officer firstname.lastname@example.org 03 9096 61332
What is HITH in Victoria? • Provision of acute admitted care in the home or suitable environment • Direct substitution - criteria as per Victorian Hospital Admission Policy • Casemix funded • Reported through VAED (Victorian Admitted Episode Dataset) • HITH provides equivalent care that is direct substitution and can be safely delivered at home.
What is not HITH in Victoria Hospital in the Home HITH $110m Hospital Admission Risk Program HARP $80m Post Acute Care PAC $34.5m Subacute Ambulatory Care SACS $163m •Transition Care •Residential In-Reach •HACC •Outpatients
HITH growth in Victoria 2011-12 Victorian HITH • • • • • 25,304 separations & 177,725 HITH bed days Average 487 on program, 487 ‘bed’ equivalent 1.7% all Victorian separations involve HITH 5.6% of Victorian multi day separations 41 health services at 48 sites 2012-13 Q1-3 • • • • • 20,478 separations & 144,979 HITH bed days (extrapolates to 27,304 separations & 193,305) Average approx 530 on program, 530 ‘bed’ equivalent 2.1% all Victorian separations involve HITH 6.0% of Victorian multi day separations
Victorian HITH since 1994 • Each health service responded to their own needs resulting in variation • Differing ‘champions’ • Differing support and resources Aim for • A better service, best practice • More equitable, less variation • More appropriate HITH clients
Department of Health Victoria Supporting HITH • Quality & Efficiency projects • Mobile radiology pilot • Data Provision • HITH WIES Supporting HITH Nurses • HITH Guidelines • HITH Survey • HITH Forums (web based discussion forum & meetings) • Mobile computing decision support
Supporting HITH HITH Quality & Efficiency Projects 2012-13 • Randomised controlled trial of cellulitis treatment • Impact of medical lead model HITH • Telemedicine including point of care testing to support remote & rural areas • Analysis of cellulitis variation • Randomised controlled trial relating to negative pressure wound therapy • Mobile telemedicine to improve paediatric HITH • Establishment of ‘Chemotherapy at Home’ • Examining barriers to HITH
Supporting HITH HITH Quality & Efficiency Projects 2013-14 • HITH in Victoria: A retrospective analysis of HITH pts admitted via emergency • Cost effectiveness of HITH versus inpatient care for DVT/PE • Scoping study of oncology related HITH • SEED Trial- low risk acute coronary syndromes • Education Needs Analysis of HITH Nurses in Victoria
Supporting HITH Mobile Radiology Pilot National Access Target The four-hour National Access Target to reduce emergency department waiting times National Health Reform Agreement Activity Based Funding ( ABF) Mobile Radiology Pilot Falls caused 23.5 % of all trauma deaths, 2nd only to transport related deaths. (Victoria State Trauma Registry, 2009-10 data)
Supporting HITH Data Provision 7.1 % Separations by Top 10 Preferred Language (English excluded) 2.1 YTD HITH multiday separations as % total health service separations compared with peer and state 10.0% 2.50% 2.00% 8.1% 8.1% 8.1% 1.50% 8.0% Health service 4.0% Peer 2.0% 1.00% HS 0.50% Peer 0.00% 6.0% State State 0.0% Q1 Q2 Q3 Q4 7.4 YTD % separations by age compared to peer and state 25% 8.1 YTD Admission source: health service versus peer & state 20% 100% 15% 80% Statistical Health service 60% Peer Newborn 40% Maternity 20% Emergency 10% 5% 0% State 0% Health service Peer State Elective
Supporting HITH HITH WIES • $5 million HITH WIES 2012-13 • $5 million HITH WIES 2013-14
Supporting HITH Nurses
Supporting HITH Nurses HITH Guidelines http://www.health.vic.gov.au/hith/ Aims • Reduce variation • Increase quality • Standards: leadership, staffing, workforce, professional development, clinical governance
Supporting HITH Nurses 2012 HITH Survey • Flexing resources to meet demand- flexible workforce, cars, no capped beds • Clinical pathways for HITH suitable conditions • Dedicated medical governance • Safeguards are in place to ensure equivalent care and quality outcomes • Safety of patients and staff thoroughly assessed • Staff education and competencies
Supporting HITH Nurses Information Sharing - Quickr
HITH Quickr Discussion Forum
Supporting HITH Nurses Mobile Computing Decision Support • Department of Health, & Australian Centre for Health Innovation (CHI). • Aimed at HITH but may have some applicability to other home visiting services. • Aimed at HITH to provide the information to make an informed decision on mobile computing and device selection. • IT technology can assist mobile healthcare, but the real gains come from effective change management, reviewing and reshaping work practices and supporting staff with new processes. • Aims to enhance work practice, efficiency and patient care. May have some applicability to other home visiting services.
Future challenges for HITH • Consider HITH earlier, shorter lengths of stay • Collaborate & share resources- policies, ideas • Look at links within the hospital, particularly Emergency. • Time to look outwards- links with Inreach services that prevent unnecessary presentation from nursing homes • ABF • National Safety and Quality Health Service Standards (NSQHS Standards)
Future Challenges- HITH Nurses • Safety – patients and nurses • Patient advocate- assessment, community resources, identifying and actioning or referring issues beyond reason for HITH • Data collection • Supporting the health system
Take home messages
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