gen cooper, department of health victoria: supporting hith and hith nurses
DESCRIPTION
Gen Cooper, Senior Project Officer, Department of Health Victoria 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/hospitalinthehomeTRANSCRIPT
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Victoria- supporting HITH & HITH nurses
Gen Cooper : HITH Senior Project Officer
03 9096 61332
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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.
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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
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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
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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
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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
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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
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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
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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)
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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%
Healthservice
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
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PRISM Report
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Supporting HITH
HITH WIES
• $5 million HITH WIES 2012-13
• $5 million HITH WIES 2013-14
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Supporting HITH Nurses
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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
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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
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Supporting HITH Nurses
Information Sharing - Quickr
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HITH Quickr Discussion Forum
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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.
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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)
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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
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Take home messages