Gen Cooper, Dept Health Victoria - Hurrying Home to Hospital, HITH as early as possible


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Gen Cooper, Dept Health Victoria delivered the presentation at the 2014 Discharge Planning Conference.

The 2014 Discharge Planning Conference - Assisting health services to adopt an integrated and consumer directed approach to discharge planning.

For more information about the event, please visit:

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Gen Cooper, Dept Health Victoria - Hurrying Home to Hospital, HITH as early as possible

  1. 1. “Hurrying Home to Hospital” Utilising Hospital in the Home (HITH) as early as possible. Gen Cooper : HITH Senior Project Officer 03 9096 61332
  2. 2. Hospital in the Home (HITH) The Opportunity HITH & Discharge Planning The Evidence Potential Barriers Making a Difference
  3. 3. The Opportunity
  4. 4. The Opportunity Hospital in the Home • 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) 2012-13 Victorian HITH • 27,647 separations • 196,868 HITH bed days • 2.1% all Victorian separations involve HITH • 6.0% of Victorian multi day separations 2013-14 Q1-3 Victorian HITH (indicative data) • 6.4% of Victorian multi day separations
  5. 5. The Opportunity Most common diagnostic related groups (DRGs) • J64B (cellulitis), • F63B (DVT) and • E61B (pulmonary embolus) The most common HITH therapy • intravenous antibiotic therapy for cellulitis, genitourinary, respiratory or postoperative/post-traumatic infections, and • anticoagulant therapy for deep vein thrombosis or pulmonary embolism • chemotherapy at home HITH provides equivalent care that is direct substitution and can be safely delivered at home. This allows scope for a range of care types.
  6. 6. HITH provides a safe and viable alternative to hospital treatment in an environment familiar to the patient and with far less disruption. HITH supports the health system by providing an efficient and flexible resource for hospitals Aim is for patient to receive the most appropriate treatment in the most appropriate setting. HITH & Discharge Planning
  7. 7. HITH & Discharge Planning Consider direct admission to HITH for appropriate clients Consider HITH at the earliest appropriate time
  8. 8. NEAT A whole of system approach Primary care Emergency department Acute admission Sub-acute admission Community services Home Additional capacity OPTIMISE PATIENT FLOW •Redesign •Clinical pathways •Criteria-based discharge •Weekend rounds •Rigorous bed management ALTERNATIVES TO ED ADMISSION •Chronic disease management/ HARP •Resi-care inreach •Direct admissions •Call referral •Expanding primary care SYSTEM COORDINATION •HITH/ PAC/ Transition Care •Health Independence Programs EARLIEST DEFINITIVE CARE •Fast track/streaming •Short Stay Units •Senior consultants ‘up front’ •Access to diagnostic testing •Direct admitting rights •Acute medical units •Acute surgery units •Direct Access (inc Aged Care) 1 SYSTEM COORDINATION •Ambulance arrivals boards •Ambulance distribution •NHS 111 •ED role delineation 2 3 5 6 ADDITIONAL CAPACITY •Fast-track / streaming •Short-stay units •Senior consultants •Diagnostic testing •HARP/resi-care inreach REDUCE VARIATION IN CARE •Clinical guidelines •Clinical pathways 4
  9. 9. HITH Evidence Report on evaluation of Hospital in the Home Programs DLA Phillips Fox 2009 Commissioned by Department of Health Victoria 2009 1. Clearly safe and effective for a range of conditions 2. Cost efficient 3. Patient preference. Highly valued by consumers & carers
  10. 10. Report on evaluation of HITH Programs “It is clear that there is considerable opportunity to increase the utilisation of HITH for a broad range of conditions. Failure to do so represents a lost opportunity in light of the very positive evaluations HITH receives from patients and carers and the literature confirming its utility and efficiency.”
  11. 11. HITH Evidence Deloitte Report: Economic analysis of HITH Commissioned by the HITH Society 2011 Examined 6 HITH care types: cellulitis, venous thrombosis, pulmonary embolus, respiratory infection, chronic obstructive pulmonary disease. HITH was 32% cheaper relative to hospital care across all six AR-DRGs by separation on average. “Health services should be investigating opportunities for HITH growth as a flexible way to manage demand for appropriate patients and care types.”
  12. 12. HITH Evidence- Clinical • HITH provides a safe and viable alternative to hospital treatment in an environment familiar to the patient and with far less disruption. • Comparable mortality, and adverse event rates to inpatient care. (Montalto et al, 2010, Australian Health Review; Tran & Taylor 2009 Australian Health Review, 33 ,3; MacIntyre, 2002, International Journal for Quality in Health Car,14,4; Caplan et al, 1999, Medical Journal of Australia, 170) • As effective as inpatient care (Deloitte Access Economics, 2011, Economic Analysis of Hospital in the Home; Richards et al, 2005, Medical Journal of Australia, 183,5; Caplan ,2006, Medical Journal of Australia, 184,12) • Reduction in complications frequently related to hospital inpatient care such as falls and infections (Richards et al, 2005, Medical Journal of Australia, 183, 5) • For older patients – decrease in delirium, and deterioration in continence and mobility. (Frick et al, 2009, American Journal of managed Care, 15,1; Mendoza et al, 2009, European Journal of Heart Failure; Inouye et al,1999, New England Journal of Medicine,340,9)
  13. 13. HITH Evidence- Health System HITH supports the health system by providing an efficient and flexible resource for hospitals • Cost Effective (Sheppard et al, 2008 ,Cochrane Library of Systematic Reviews; Wilson et al, 2005, Australian Health Review, 29,3; Richards et al, 2005, Medical Journal of Australia, 183,5) • Impact on Health System (including capacity) (Sheppard 2009, Cochrane Library of Systematic Reviews; Cameron et al, 2009, Medical Journal of Australia, 190, 7; O’Neill,2008, Home Healthcare –an Economic Choice for the Health Service; Cameron et al, 2009, Medical Journal of Australia,190,7; Scott, 2010, Australian Health Review, 34,3; Ram et al, 2004,British Medical Journal,329,7461) • Readmission rates- positive preliminary data (DH Victoria)
  14. 14. HITH Evidence- Patient Preference For appropriate patients, HTH offers the best care in the right place. Leff et al, 2005, Annals of Internal Medicine, 143 (11) Wilson et al, 2002, British Journal of General practice, 52
  15. 15. Potential Barriers- ED & Wards • Lack of understanding of HITH and eligibility • Difficulty making referrals after hours and weekends • Difficulty arranging visit more than once a day • Response and responsiveness to referrals “Long Memories” • Completion of referral documentation • Patients that do not meet the HITH admission criteria • Lack of medical lead • Process and timing of PICC line insertions • Review process- time, place, person • Lack of organisational protocols, clinical pathways for HITH
  16. 16. Potential Barriers- HITH • Capped services ‘HITH beds’ • HITH service area, geography, subcontracting • Limited hours, typically evening, overnight, weekend services limited • Time of referral (late decision) • Lack of nursing EFT to support demand, case finding in hospital, recruitment issues • Lack of cars, phones, computers, clinical equipment • Lack of dedicated medical EFT • Lack of space – office, review clinic, treatment room
  17. 17. Making a difference • Executive Support • Medical governance and leadership • Direct substitution- at start or end of episode • Safeguards are in place to ensure equivalent care and quality outcomes • Flexing resources to meet demand- flexible workforce, cars, no capped beds • Staff education/ marketing • Physical space • Patient choice Can I make a HITH referral please?
  18. 18. Making a difference • Emergency & HITH interface • Medical oversight & HITH bed card • Case finding – not waiting for referrals • Residential Aged Care In-reach • HARP • Clinical pathways for HITH suitable conditions • Streamline processes and paperwork