Published on March 10, 2014
Stepping Stones in Care Pathways Creating & sustaining best practice through service expansion
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 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
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 SA Health
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