Service Coordination projects 2012- 2013 Rochester & Elmore District Health Service.
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Service Coordination projects 2012- 2013 Rochester & Elmore District Health Service
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Transcript of Service Coordination projects 2012- 2013 Rochester & Elmore District Health Service.
Service Coordination projects2012- 2013
Rochester & ElmoreDistrict Health Service
REDHS received funding for service coordination project in both 2012 & 2013
Both projects undertaken by Leanne Rankin Diabetes Educator and community health
nurse at REDHS Previous experience as ICDM worker for
Campaspe PCP.
Issues addressed Central intake
All primary care referrals to central intake Including using Connecting care for all internal and
external referrals. Referral acknowledgement processes
GP Communication Processes when clinicians should communicate to GP
Following initial assessment Any time during episode of care as required On discharge
Templates for all letters
2012 project
Central intake Referral acknowledgement practices both CCC and Fax Use of CCC for all internal referrals within REDHS Use of CCC by REDHS for referrals out
Local agreements with GP Development of local agreements around referrals,
communication and acceptance of Team Care Arrangements
Outcomes 2012 project
Connecting care usage
Outcomes 2012 project
april june march0
10
20
30
40
50
60
70
80
90
receivedsent
Staff change over within Primary Care
Ongoing education for all staff re Connecting care usage
Policies development & implementation
Barriers
Issues addressed Review of last years project areas Care planning
As extension of HACC ASM work to all primary care services
Assessments Review by clinicians and format for client records
Central client record Primary care client record amalgamated into hospital
client record and stored in medical records department.
2013 project.
Medical records standardised UR All records common file and stored in medical records
Service coordination online education package part of PC staff orientation.
Care planning service specific REDHS shared support plan
Assessments.
Outcomes
Issues with HSD and connecting care change over
Ongoing staff changes Ongoing staff education
Barriers
Fortnightly staff meetings Small team New younger clinicians
Enablers
Thanks to PCP for the funding for the project.
Advantages to having a worker at a local level to initiate activities specific to the needs of our own organisation
Networks within service coordination steering committee.
