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 Healt...
TQEH
Hospital@Home
> TQEH is a general
hospital within the
Central Adelaide Local
Health Network
> H@H visits
approximatel...
Patient Cohort
> Acute adult surgical and medical patients
> TQEH Clinical governance and care pathway
> Diverse populatio...
How we work
>
>
>
>
>

Experienced Clinical Nurses; advanced skill set
Twice daily acute nursing care
Direct reporting to ...
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 / Hospita...
Responding to Service Demand
>
>
>
>
>
>

Increasing patient cohort numbers
Diversifying existing patient cohort
Shortenin...
Diversifying the H@H Service
>
>
>
>
>
>

Expanding staff skill set
Education updates, training
Research findings: Best Pr...
H@H: expanding the Patient Cohort

> Gynaecology
Patients
> Orthopaedic
“oozy wounds”
> Iron Infusions
> Cytotoxic
Infusio...
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
...
Central Adelaide H@H: Stepping
into the future
> RAH 6 month service expansion pilot
• Diversify the current RAH Haematolo...
Where are we now?
> Defining the Service
• Key Stakeholders: who are they?
• Relationship building: Clinical
governance
• ...
H@H into the future
> Developing confidence in H@H model and
staff
• Changing culture: “we’ve always done it
this way”
> R...
Heather Banham, The Queen Elizabeth Hospital: Stepping Stones in Care Pathways: Creating & Sustaining Best Practice throug...
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Heather Banham, The Queen Elizabeth Hospital: Stepping Stones in Care Pathways: Creating & Sustaining Best Practice through Service Expansion

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Heather Banham, Project Manager & Respecting Patient Choices Facilitator, The Queen Elizabeth Hospital delivered this presentation at the 2013 Hospital in the Home conference. This 2-day event is a nurse oriented program to improve HITH services and maximise hospital efficiency. For more information about the annual event, please visit the conference website: http://www.communitycareconferences.com.au/hospitalinthehome

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Heather Banham, The Queen Elizabeth Hospital: Stepping Stones in Care Pathways: Creating & Sustaining Best Practice through Service Expansion

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