1. Influencing Demand – Altering Preload for Canterbury EDs Dr Greg Hamilton Planning and Funding

2. The Problem Longer stays driven by three factors Need system-wide solutions Pre-load community activities to reduce demand Contractility effective functioning of ED After-load services to accept people from ED – hospital and community

3. Outcomes logic - Pre-load

4. Data Driven Response – Weekly Dashboard

5. Patients arriving at ED

6. ED attendances

7. ED admission rate

8. 111 calls transported to ED

9. Managing Acute Demand Supported Discharge and CREST After Hours and Nurse led telephone triage Acute Demand Management Services

10. Opportunity for People to Stay Home 755 755 clients so far 2,600 Capacity to manage 2,600 pa CREST 17% 17% decline in rest home bed days over 2 years 18,000 18,000 acute admissions managed in the community Ambulance diversion to primary care as required

11. CREST Activity

12. Nurse led telephone triage

13. Acute Demand Management Services (ADMS) Community-based health services to support patients who can be safely managed in the community Applied during an acute medical episode (up to 5 days) When a hospital presentation would otherwise be imminent Commenced in 2000 within urban Christchurch to support extend patient care

14. Where we have been? In 2000, ADMS commenced within urban Christchurch to support Pegasus practices to extend patient care Since October 2007 services expanded to all Canterbury patients from Kaikoura to Ashburton Engagement of general practice

15. ADMS: a collaborative approach Acute community nursing services Community observation services Timely supported discharge liaison service (hospital- based) Service coordination Packages of Care (POC) – general practice Rapid diagnostics: radiology and lab services Consumables 5 hours/1000 patients (post quake)

16. Who refers to ADMS? Any health professional can refer a patient into ADMS who would otherwise need assessment and/or treatment within Secondary Care –GP –Practice nurse –Community nurse –Midwife –Ambulance paramedic –Hospital physician or staff nurse (ED and inpatient)

17. Monthly referrals to ADMS

18. ADMS referral monitoring

19. ADMS Referrals – Variation by General Practice

20. Most Common Referrals to ADMS Oct 2007- Jul 2010

21. The New Challenge ADMS Post 22 February... Increased breadth of ADMS services available to high needs patients Population determinants of health (especially housing) mean increased risk of deterioration and hospital attendance Proactive management of vulnerable population by general practice – 5 hours/1000 patients ADMS re-invigorated with General Practice Teams through Pegasus Education to increase utilisation

22. Change in inpatient discharge rates (2000 – 2009) 22

23. Acute Medical Discharges

24. Next Steps ADMS Service Level Alliance established - clinical and service leadership to drive service development and improvement –ADMS in residential care –Stronger linkages with St John –Community management for COPD –Service improvement – coordination, problem solving, trust, acute nursing Project Chain – coordinated care management