Victoria- supporting HITH & HITH nurses

Gen Cooper : HITH Senior Project Officer

gen.cooper@health.vic.gov.au

03 9096 61332

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.

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

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

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

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

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

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

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)

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

PRISM Report

Supporting HITH

HITH WIES

• $5 million HITH WIES 2012-13

• $5 million HITH WIES 2013-14

Supporting HITH Nurses

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

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

Supporting HITH Nurses

Information Sharing - Quickr

HITH Quickr Discussion Forum

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.

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)

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

Take home messages