Victoria- supporting HITH & HITH nurses
Gen Cooper : HITH Senior Project Officer
gen.cooper@health.vic.gov.au
03 9096 61332
What is HITH in Victoria?
• Provision of acute admitted care in
the home or suitable environment
• Direct substitution - c...
What is not HITH in Victoria
Hospital in the Home
HITH
$110m
Subacute Ambulatory Care
SACS
$163m
•Transition Care
•Residen...
HITH growth in Victoria
2011-12 Victorian HITH
• 25,304 separations & 177,725 HITH bed days
• Average 487 on program, 487 ...
Victorian HITH since 1994
• Each health service responded to their own needs
resulting in variation
• Differing ‘champions...
Department of Health Victoria
Supporting HITH
• Quality & Efficiency projects
• Mobile radiology pilot
• Data Provision
• ...
Supporting HITH
HITH Quality & Efficiency Projects
2012-13
• Randomised controlled trial of cellulitis treatment
• Impact ...
Supporting HITH
HITH Quality & Efficiency Projects
2013-14
• HITH in Victoria: A retrospective analysis
of HITH pts admitt...
Supporting HITH
Mobile Radiology Pilot
Mobile Radiology Pilot
Falls caused 23.5 % of all
trauma deaths, 2nd only to
transp...
Supporting HITH
Data Provision
8.1% 8.1% 8.1%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
Q1 Q2 Q3 Q4
2.1 YTD HITH multiday separations...
PRISM Report
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
• Sta...
Supporting HITH Nurses
2012 HITH Survey
• Flexing resources to meet demand- flexible workforce, cars,
no capped beds
• Cli...
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...
Future challenges for HITH
• Consider HITH earlier, shorter lengths of stay
• Collaborate & share resources- policies, ide...
Future Challenges- HITH Nurses
• Safety – patients and nurses
• Patient advocate- assessment, community resources, identif...
Take home messages
Gen Cooper, Department of Health Victoria - Victoria - Supporting HITH & HITH nurses
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Gen Cooper, Department of Health Victoria - Victoria - Supporting HITH & HITH nurses

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Gen Cooper, Department of Health Victoria 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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Gen Cooper, Department of Health Victoria - Victoria - Supporting HITH & HITH nurses

  1. 1. Victoria- supporting HITH & HITH nurses Gen Cooper : HITH Senior Project Officer gen.cooper@health.vic.gov.au 03 9096 61332
  2. 2. 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.
  3. 3. What is not HITH in Victoria Hospital in the Home HITH $110m Subacute Ambulatory Care SACS $163m •Transition Care •Residential In-Reach •HACC •Outpatients Post Acute Care PAC $34.5m Hospital Admission Risk Program HARP $80m
  4. 4. 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
  5. 5. 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
  6. 6. 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
  7. 7. 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
  8. 8. 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
  9. 9. Supporting HITH Mobile Radiology Pilot Mobile Radiology Pilot Falls caused 23.5 % of all trauma deaths, 2nd only to transport related deaths. (Victoria State Trauma Registry, 2009-10 data) National Access Target The four-hour National Access Target to reduce emergency department waiting times National Health Reform Agreement Activity Based Funding ( ABF)
  10. 10. Supporting HITH Data Provision 8.1% 8.1% 8.1% 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% Q1 Q2 Q3 Q4 2.1 YTD HITH multiday separations as % total health service separations compared with peer and state Health service Peer State 0% 20% 40% 60% 80% 100% Health service Peer State 8.1 YTD Admission source: health service versus peer & state Statistical Newborn Maternity Emergency Elective 0% 5% 10% 15% 20% 25% 7.4 YTD % separations by age compared to peer and state Health service Peer State 0.00% 0.50% 1.00% 1.50% 2.00% 2.50% 7.1 % Separations by Top 10 Preferred Language (English excluded) HS Peer State
  11. 11. PRISM Report
  12. 12. Supporting HITH HITH WIES • $5 million HITH WIES 2012-13 • $5 million HITH WIES 2013-14
  13. 13. Supporting HITH Nurses
  14. 14. 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
  15. 15. 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
  16. 16. Supporting HITH Nurses Information Sharing - Quickr
  17. 17. HITH Quickr Discussion Forum
  18. 18. 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.
  19. 19. 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)
  20. 20. 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
  21. 21. Take home messages

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