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 Ballarat Health Services ACHSE Breakfast Forum 19 April 2002

Ballarat Health Services BALLARAT Horsham Ararat Ballarat Health Services and the Grampians Region

Ballarat Health Services l Sub-acute may be - post-acute - direct from community - inpatient or outpatient l Distinct from acute care - disability / handicap vs illness / impairment - longer vs. shorter care - complexity vs. intensity l Distinct from residential care …… but sub-acute care can avoid or expedite entry to residential care What is the sub-acute system?

Ballarat Health Services How does the Interface Occur? Community Living Failing with Community Living Inpatient Sub-acute Care Acute Care Time Function Recovering from Hospital Care Subacute outpatient programs

Ballarat Health Services l Specific to older Australians and targeted l Syndrome specific (falls / continence) l Timely application of risk assessments which are easy to apply l Incorporating risk specific action plans / pathways Risk Identification and Management

Ballarat Health Services l Free the acute services to address the acute condition l Accurate diagnosis of comorbidities and identification of other issues including disability and handicap l Appropriate movement from acute management Interdependence of Systems Enabling Acute Care

Ballarat Health Services Acute Risk Management Interface Management Interdependence of Systems Sub-acute

Ballarat Health Services l Identifying leverage points l Early risk assessment l Appropriate acute medical management l A managed interface l Completing the loop One Episode of Care in Practice - Changing the System

Ballarat Health Services Interface management Elective Surgery Emergency surgery Risk Screen Appropriate acute care with risk management Timely movement to sub-acute systems Joint Replacement Flow Chart

Ballarat Health Services l Continuous integrated involvement by staff with appropriate skills at various care stages l Interlinking of specialist clinics (Falls / Continence / Dementia) with the whole system l Early discharge notification to families, GPs and community services Benefits of a Single Episode

Ballarat Health Services l Minimisation of stay and associated risks in acute hospital (ALOS decreased by 2.4 days) l Efficiency of bed use (WIES casemix funding pbd increased by 0.11) l Minimisation of duplication and repetition Benefits of a Single Episode

Ballarat Health Services l Promote the philosophy of one episode of care l Identify the skills and service linkages required to implement the model l Establish risk assessment and management processes l Facilitate the redesign of systems and resources (including financial) l Evaluate project outcomes One Episode of Care in Collaborating Hospitals

Ballarat Health Services l Identify patients and diagnostic groups most likely to benefit from application of the model l Map collaborator resources across the entire episode l Identify and coordinate project champions at collaborating hospitals l Educate and consult to enhance skills l Implement and evaluate model One Episode of Care in Collaborating Hospitals

Ballarat Health Services l Broaden current model to encompass complex medical patient groups l Further develop indicators for early identification and intervention l Adapt and scale model to suit a variety of rural and regional settings l Implement model in hub and spoke framework One Episode of Care Enhancement Project

Ballarat Health Services Summary l One episode of care operates in a service system l 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 l Transferable to rural and regional settings across various levels of system complexity