Jeanie Farrington - Albury Wodonga Health - Cross Border Hospitals Amalgamate - HITH Service Rises...
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Transcript of Jeanie Farrington - Albury Wodonga Health - Cross Border Hospitals Amalgamate - HITH Service Rises...
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Wodonga HITH service
rises to the challenge!!
Cross Border Hospitals Amalgamate
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BACKGROUND Wodonga HITH Service
• Wodonga Hospital HITH Service
� commenced in 1995 as a pilot project,
providing services to patients living in
Victoria
• During the first three years
� one RN worked Monday to Friday
0800 – 1630
• Now a seven days a week service
� AM & PM shifts covering NSW & Victoria
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The good ole days!4
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A TRULY UNIQUE HEALTH SERVICE
• Albury Wodonga Health model
� first cross border health service to exist in
Australia
• Integration began in July 2009
�operating under the Victorian Department
of Health
• Intergovernmental agreement &
service plan from 2012 - 2025
�between NSW & Victorian governments
for delivery of health services5
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• Provides acute, subacute, mental
health, emergency & community
based services
� to approximately 180,000 people living on
the Border & in the East Hume region
• Population projections from 2011 to
2026
�An increase of 25,000 people (10.2 %)
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A TRULY UNIQUE HEALTH SERVICE (cont)
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BENEFITS ALREADY DELIVERED
• Reduced duplication
� Increased number of services using the
same resources
• More streamlined services across
two campuses
• Increased career development
opportunities for staff
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BENEFITS ALREADY DELIVERED (cont)
• Regional mental health & dental
services now under one umbrella
• Strong foundation for service growth
• Better able to respond to population
growth & demographic changes in the
region
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• In early 2011
� New community nursing service nurse
manager appointed
� New Wodonga Campus based
community nursing department created
• Incorporates three community based
services
� Hospital in the Home (HITH)
� District Nursing (DNS)
� Regional Palliative Care Consultancy9
HEALTHCARE@HOME
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• April 2011
� Integration of HITH & DNS
services began
• Aims
� To combine HITH/DNS client lists
� To increase skill sets of staff to
enable working across both areas
• Clinical coordinator
� Position established to support
both services
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Workforce Development
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Skill sets required to provide HITH & DNS services vastly differ:
• Professional development of staff
needed to enable them to work
across both services
• Required competencies identified &
needs of individual nurses
documented
• Clinical nurse educator appointed
at 0.4 FTE, now ongoing11
Challenges
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What Makes a Community
Nurse
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Driving & Map Reading Skills
To Howlong
To Melb
Primary
School
Stanhope street
Palmers Street
Burrows Road
Tara Drv11 Unite Head Court
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Environmental Preparation
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Communication Skills
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Competencies
• Syringe driver
• Visitrak
• PICC lines
• Doppler
• Digital photography
• Compression bandaging
• Venipuncture
• Cannulation
• VAC
• Baxter infusion
• IV – Alaris pumps
• Portacath
• Anaphylaxis 16
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CLINICAL OPERATIONS RESTRUCTURE
• Began in mid April 2013 as integration
of services continued
• Very inclusive working group
established
�staff invited to participate in several cross
campus meetings
• Implemented from 1 January 2014
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New Clinical OperationsOrganisational Chart
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Where Does HITH Fit?
• Several options discussed
� Based in acute stream but remain under
nurse manager of HealthCare@ Home
� Stay as is
• Team decided best option was to stay as is
with opportunity to review in future
� Best opportunity to grow the services
� Broader team rather than service based
� Improved patient centred care – move
clients across two services; often same
staff provide care
� Increased flexibility of service delivery 19
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Decisions Decisions!!
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Allied Health Organisation
Chart
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The Mighty Murray
The Great Divide22
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CROSS BORDER SYSTEMS & LEGISLATION ISSUES
• Many Albury medical staff do not
have admitting rights to Wodonga
� particularly ED doctors (use a number of
locums)
• Patient admission systems differ
(VITAL vs iPM)
� Data incompatible & not accessible to
health information staff
� Data from Albury Campus initially sent
to NSW & then on to DoH Victoria
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• HR/Recruitment
� Different awards
o People must apply to each campus
for permanent positions
o Very recently initiated a cross
campus casual nurse bank
� Nursing Registration
• OH&S
• Drug protocols differ for many
medications 24
SYSTEMS & LEGISLATION ISSUES (cont)
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REFERRAL PROCESS FOR NSW PATIENTS
• Discharged & readmitted onto HITH
as Wodonga Campus patients
• Education of Albury Campus staff is
ongoing
�Albury has not had a HITH service for
many years & then only briefly
• Admitting Albury Campus patients
very time consuming due to distance
(THE MIGHTY MURRAY DIVIDE)!25
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To provide acute care to a patient who is
identified as appropriate to receive care at
home
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CLIENT REVIEWS
HITH Clinic
�Historically clients were reviewed
in ED
o admitted to ED prior to review
with often long waits
�Clinic established mid 2013
�Multi-use now by DNS & DPU
�Orthopaedic patients are reviewed
in outpatient orthopaedic clinic at
Albury Campus 27
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SHORT STAY UNIT
• Established in Albury Campus ED
in March 2014
• Clear admission criteria, goals &
time limits
• Aim is to reduce the number of
patients who might otherwise have
been hospitalised & get people
home
• Dedicated, non-rotational staffing28
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SHORT STAY UNIT (cont)
• Expedites episode of care
�uses clinical pathways for diagnostic
groups eg asthma, chest pain,
cellulitis, DVTs
• Short-term
� less than 24 hours
• Referral to HITH (and allied health)
� written into clinical pathways
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THE FUTURE FOR THE ORGANISATION
• Continue to strengthen Albury
campus to provide most of the acute
services
�consolidating acute & emergency
services
• Consolidation of sub-acute services
over time at the Wodonga campus
� strong demand for these services
continues
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THE FUTURE FOR HITH
Continue to:
• Grow the service for Albury
Campus patients
�Including resources
• Educate Albury staff about HITH
referral process
• Embed HITH/DNS services into the
new Clinical Operations Structure
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HealthCare@Home
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Or as pathology often calls HITH
Hospital in the House!!!
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Cross Border Hospitals
Amalgamate
Wodonga HITH service
rises to the challenge!!
JF1
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Slide 34
JF1 Jeanie Farrington, 22/05/2014