Wodonga HITH service

rises to the challenge!!

Cross Border Hospitals Amalgamate

2

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

3

The good ole days!4

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

• 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 %)

6

A TRULY UNIQUE HEALTH SERVICE (cont)

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

7

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

8

• 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

• 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

10

Workforce Development

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

What Makes a Community

Nurse

12

Driving & Map Reading Skills

To Howlong

To Melb

Primary

School

Stanhope street

Palmers Street

Burrows Road

Tara Drv11 Unite Head Court

13

Environmental Preparation

14

Communication Skills

15

Competencies

• Syringe driver

• Visitrak

• PICC lines

• Doppler

• Digital photography

• Compression bandaging

• Venipuncture

• Cannulation

• VAC

• Baxter infusion

• IV – Alaris pumps

• Portacath

• Anaphylaxis 16

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

17

New Clinical OperationsOrganisational Chart

18

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

Decisions Decisions!!

20

Allied Health Organisation

Chart

21

The Mighty Murray

The Great Divide22

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

23

• 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)

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

To provide acute care to a patient who is

identified as appropriate to receive care at

home

26

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

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

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

29

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

30

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

31

HealthCare@Home

32

Or as pathology often calls HITH

Hospital in the House!!!

33

Cross Border Hospitals

Amalgamate

Wodonga HITH service

rises to the challenge!!

JF1

Slide 34

JF1 Jeanie Farrington, 22/05/2014