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Heather Banham, The Queen Elizabeth Hospital - Stepping Stones in Care Pathways

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Heather Banham, The Queen Elizabeth Hospital delivered the presentation at the 2013 Hospital in the Home Conference. …

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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  • 1. Stepping Stones in Care Pathways Creating & sustaining best practice through service expansion
  • 2. SA Health The Queen Elizabeth Hospital
  • 3. SA Health In the Beginning > TQEH H@H commenced in 1995 > Grew from pending closure of wards > Daily visits by solo nurse
  • 4. 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
  • 5. 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
  • 6. 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
  • 7. SA Health Section break slide heading here SA Health Drivers for Change: Creating a responsive service.
  • 8. 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
  • 9. 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
  • 10. 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
  • 11. SA Health H@H: expanding the Patient Cohort > Gynaecology Patients > Orthopaedic “oozy wounds” > Iron Infusions > Cytotoxic Infusions
  • 12. SA HealthSA Health Future Steps: Developing a multi-site single service model for Central Adelaide Local Health Network.
  • 13. SA Health Central Adelaide Local Health Network The Royal Adelaide Hospital & The Queen Elizabeth Hospital One region: 2 hospitals
  • 14. 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
  • 15. 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?
  • 16. 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