One Episode of Care .

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Ballarat Health Services
ACHSE Breakfast Forum 19 April 2002
One Episode of Care . National Demonstration
Hospitals Program Sharon Donovan, Executive
Director - Nursing Services Wendy
Hubbard, Director - Allied Health Service Mark
Yates, Director - Aged Care and Rehabilitation
Medicine
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Ballarat Health Services and the Grampians Region
Horsham l
Ararat l
BALLARAT
l
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What is the sub-acute system?

• Sub-acute may be
• - post-acute
• - direct from community
• - inpatient or outpatient
• Distinct from acute care
• - disability / handicap vs illness /
  impairment
• - longer vs. shorter care
• - complexity vs. intensity
• Distinct from residential care but sub-acute
  care can avoid or expedite entry to residential
  care

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How does the Interface Occur?
Function
Community Living
Failing with Community Living
Recovering from Hospital Care
Subacute outpatient programs
Inpatient Sub-acute Care
Acute Care
Time
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Risk Identification and Management

• Specific to older Australians and targeted
• Syndrome specific (falls / continence)
• Timely application of risk assessments which are
  easy to apply
• Incorporating risk specific action plans /
  pathways

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Interdependence of Systems Enabling Acute Care

• Free the acute services to address the acute
  condition
• Accurate diagnosis of comorbidities and
  identification of other issues including
  disability and handicap
• Appropriate movement from acute management

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Interdependence of Systems
Interface Management
Risk Management
Sub-acute
Acute
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One Episode of Care in Practice - Changing the
System

• Identifying leverage points
• Early risk assessment
• Appropriate acute medical management
• A managed interface
• Completing the loop

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Joint Replacement Flow Chart
Risk Screen
Emergency surgery
Elective Surgery
Risk Screen
Interface management
Appropriate acute care with risk management
Timely movement to sub-acute systems
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Benefits of a Single Episode

• Continuous integrated involvement by staff with
  appropriate skills at various care stages
• Interlinking of specialist clinics (Falls /
  Continence / Dementia) with the whole system
• Early discharge notification to families, GPs and
  community services

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Benefits of a Single Episode

• Minimisation of stay and associated risks in
  acute hospital (ALOS decreased by 2.4 days)
• Efficiency of bed use (WIES casemix funding pbd
  increased by 0.11)
• Minimisation of duplication and repetition

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One Episode of Care in Collaborating Hospitals

• Promote the philosophy of one episode of care
• Identify the skills and service linkages required
  to implement the model
• Establish risk assessment and management
  processes
• Facilitate the redesign of systems and resources
  (including financial)
• Evaluate project outcomes

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One Episode of Care in Collaborating Hospitals

• Identify patients and diagnostic groups most
  likely to benefit from application of the model
• Map collaborator resources across the entire
  episode
• Identify and coordinate project champions at
  collaborating hospitals
• Educate and consult to enhance skills
• Implement and evaluate model

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One Episode of Care Enhancement Project

• Broaden current model to encompass complex
  medical patient groups
• Further develop indicators for early
  identification and intervention
• Adapt and scale model to suit a variety of rural
  and regional settings
• Implement model in hub and spoke framework

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Summary

• One episode of care operates in a service system
• One episode of care is a philosophy that has the
  capacity to
• - improve hospital care for older Australians
• - improve efficiency in the delivery of acute
  care
• Transferable to rural and regional settings
  across various levels of system complexity