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					       Hospital Demand Management (HDM) Strategy 2003-04

   Health         Project
                                     Project Name                                                                                                 Description                                                                                            Executive Sponsor               Patient Flow Areas
   Service         Code
                                                                 The Day Treatment Centre aims to enhance the management of illness by providing an alternative to overnight inpatient care and by increasing access to Austin Health
                                                                 services. The Day Treatment Centre provides services for patients undergoing day procedures, treatments and investigations. The focus of the unit includes:
                                                                 - Direct substitution for inpatient bed
                               Ambulatory Care Centre/Day                                                                                                                                                                                                         Mark Petty
Austin Health    D 01-079                                        - Wellness and prevention in chronic disease management                                                                                                                                                                Medical Inpatients
                               Treatment Centre                                                                                                                                                                                                  
                                                                 - Early discharge from inpatient beds
                                                                 - Next day reviews for emergency and inpatients
                                                                 - Procedures and investigations

                                                                 The Care Coordination Team is a multidisciplinary team which works generically to provide care coordination to the acute and subacute clinical areas. This supports effective
                                                                 and timely assessment, referral and appropriate discharge of patients returning home. The team is a resource for clinical areas and can provide innovative problem solving to                    Mark Petty            Discharge Hospital - Community
Austin Health    D 01-080      Care Coordinators
                                                                 reduce barriers to discharge planning and also facilitates transfers to the aged care sub-acute units and provides assessment for the Trial at Home, NEDID and Home Choice           Home

                                                                 The aim of the Residential Care Team is to identify patients early in the admission process who potentially require assessment and placement in a residential facility, thus
                                                                 providing a streamlined and coordinated discharge process into long-term care. The Residential Care Team comprises a team of social workers and a clinical nurse
                                                                                                                                                                                                                                                                  Mark Petty            Discharge Hospital - Community
Austin Health    D 01-087      Residential Care Placement Team   consultant, who provide information and support to patients, families and carers when a patient is assessed as requiring low or high residential care. The team also consults
                                                                 directly with aged care facilities if their residents are admitted to hospital, which assists in the patient‟s return to their nursing home or hostel when they are well. The service
                                                                 provides education to families and carers and also to staff about aspects of residential care.

                                                                 The HDM funded GEM beds enhance the ability of the Aged Care Services at Austin Health to provide timely access and specialised multi-disciplinary assessment,
                                                                                                                                                                                                                                                                  Mark Petty
Austin Health    D 01-089      5 GEM beds on-site at ARMC        management and discharge planning for an increased number of patients. Within a 12-month period an additional 60 patients are now able to access Aged Care Inpatient                                                   Medical Access
                                                                 Service at Austin Health.
                                                                 Multidisciplinary Triage (MDT) is a unique method of emergency department staffing, which places an emergency physician at the triage desk, allowing simultaneous nursing
                                                                 and medical assessment. Medical treatment begins immediately as the patient arrives. This service enables time in the waiting room to be utilised by performing                                 Craig White
Austin Health    D 02-095      Multi-disciplinary Triage                                                                                                                                                                                                                                Emergency Care
                                                                 investigations and making early referrals to the appropriate service (Inpatient Unit, Hospital in the Home, general practitioner etc). Many patients can be discharged directly
                                                                 from the waiting room, and those that need a cubicle have much of their medical care completed when they arrive at the cubicle.

                               Emergency Department - Fast       The Fast Track service is a model that provides additional medical and nursing staff and access to a dedicated procedural room with the aim of fast tracking the management                     Craig White
Austin Health    D 03-063                                                                                                                                                                                                                                                               Emergency Care
                               Track                             and eventual discharge of these patient types, particularly Category 4 patients.                                                                                               

                                                                 This program is an extension of the bed management resource unit service and provides an evening bed management service to 2000hrs and morning cover on Saturday and
                                                                 Sunday during the winter months. This service aims to:
                                                                                                                                                                                                                                                                 Craig White
Austin Health    D 02-098      Out of Hours Bed Management       - Optimise emergency and elective patient access                                                                                                                                                                       Bed Management
                                                                 - Provide support to the after hours site manager, inpatient units and emergency department
                                                                 - Support referrals to other demand management services such as the day treatment service and care coordination team.

                                                                 Four flex beds were established as transition beds in which patients should stay no longer than 24hours. Patients in the flex beds are given the highest priority for transfer to
                                                                 their parent unit or ward.
                                                                 - Use of Flex beds is authorised when:
                                                                          o All beds in the hospital are occupied                                                                                                                                                Chris O‟Gorman
Austin Health    D 02-099      4 Flex Beds                                                                                                                                                                                                                                              Bed Management
                                                                          o ED cubicles are full and patients identified for admission are ready for transfer                                                                                            chris.O'
                                                                          o Demand in ED is untenable and bypass is likely
                                                                 - Flex beds are opened at the discretion of the bed resource manager and the after hours site manager in consultation with the ADON allocations and the Nurse in Charge of

                                                                 The Victorian Spinal Cord Service (VSCS) is subject to high demand for acute inpatient services from new traumatic spinal cord injured patients and emergency admissions as
                                                                 a result of serious complications of existing spinal cord injury, most commonly catastrophic pressure sores. Treatment of catastrophic pressure sores consumes considerable
                                                                                                                                                                                                                                                                 Craig White            Discharge hospital - Community
Austin Health    D 02-100      SpORRT- Spinal Outreach Project   resources and admissions utilise a significant number of specialist acute bed days. The SpORRT project works to identify and intervene earlier with those clients with spinal
                                                                 cord injury assessed as “at risk” of developing complications and a subsequent hospitalisation, reduce emergency demand on Austin Health and enhance the capacity of local
                                                                 primary health providers in preventing and managing common complications of spinal cord injured clients living in their community.

                                                                 The continence management service is staffed by a clinical nurse consultant who provides specialist consultation and comprehensive education to staff, family and patients.
                                                                 The aim of the service is to:
                               Continence Management for the                                                                                                                                                                                                      Mark Petty            Discharge hospital - Community
Austin Health    D 02-101                                        - Identify patients with remedial conditions and develop strategies for ongoing management
                               Elderly                                                                                                                                                                                                                Home
                                                                 - Improve the discharge process to the community
                                                                 - Improve level of staff knowledge in acute health in regards to continence management.

                                                                 TRAMS operates as a consultative multidisciplinary team of tracheostomy experts who coordinate the care of all patients with tracheostomy outside of the ICU with the
                                                                 exception of ENT patients. The core team consists of respiratory consultants, clinical nurse consultant, physiotherapists and speech pathologists. TRAMS conducts twice
                                                                 weekly tracheostomy ward rounds, provides multidisciplinary education and develops centre wide tracheostomy policy. As a consultative service TRAMS manages patients in
                                                                 conjunction with the treating unit. Patients with permanent tracheostomy are followed into the community via TRAMS Community Link.

                               Tracheostomy Review and           Discharge planning, education, consumables and follow up care are provided for a limited number of patients with tracheostomy who are unable to go home. The objectives                         Craig White
Austin Health    D 03-061                                                                                                                                                                                                                                                               Medical Access
                               Management Service (TRAMS)        of the service are:                                                                                                                                                            
                                                                 - To support unit staff in managing patients with tracheostomy and to limit the number of adverse events surrounding tracheostomy
                                                                 - To facilitate safe and timely removal of tracheostomy tubes
                                                                 - To establish centre wide tracheostomy policy
                                                                 - To offer multidisciplinary tracheostomy education
                                                                 - To provide discharge planning, case management and equipment for tracheostomies in the community.

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       Hospital Demand Management (HDM) Strategy 2003-04

                                                                    This project was designed to evaluate the role of a Functional Maintenance Program (FMP) in an acute general medical ward. The project commenced with an initial baseline
                                                                    data collection period of two months in July and August 2001. The data collected characterised the patients‟ functional capacity, physical ability and living situation. This was
                                                                                                                                                                                                                                                                  Mark Petty
Austin Health    D 01-003      Functional Maintenance Program       followed by an implementation phase, which ran until the end of August 2002.The implementation phase of the program included a daily exercise program for at risk (>65                                             Medical Access
                                                                    y.o) patients and also promoted functional independence in these patients (a shift away from the traditional model of delivering bed based care). During the final two months
                                                                    (July-August 2002) data was again collected allowing the comparison of patient data pre and post FMP implementation.
                                                                    The clinical leader program works to ensure that patient flow is maintained by:
                                                                    - Assisting in identifying patients appropriate for discharge
                                                                    - Providing support to the ED during pre-bypass
                                                                    - Working on a daily basis with the bed resource manager to identify potential bed blocks
                                                                    - Establishing and chairing weekly meetings with registrars to identify discharge issues and actions                                                                                          Craig White
Austin Health    D 01-004      Clinical Leadership Program          - Weekend ward rounds during winter to assist in efficient discharge of patients                                                                                                                                   Bed Management

                                                                    The surgical clinical leader has focussed on improving the rate of day surgery for specific conditions which has:
                                                                    - Increased day surgery rates
                                                                    - Increased DOSA rates
                                                                    - Assisted in the establishment of protocols

                                                                    Individual patient care is designed through the use of management plans, to ensure maximum independence in the community. Through care co-ordination and case
                                                                    management these plans are implemented to assist patients to manage/reduce symptoms and maintain functional status.
                               Intermittent Home Care-COPD at                                                                                                                                                                                                    Anna Fletcher         Discharge hospital - Community
Barwon Health    D 02-103
                               Home                                 Strong links have been developed with Home Based and Pulmonary Rehabilitation to ensure no duplication of effort occurs and that selected clients receive appropriate           Home
                                                                    referrals. Clients are also referred to GP‟s, community health and other primary care services. Referrals are received from hospital and community based services and from
                                                                    GP‟s, where appropriate clients are directly admitted to Hospital in the Home via GP to effectively manage an infective excerebration of COPD in the community.

                                                                    Approximately 1000 volunteers are providing a range of assistance to patients, clients and or residents across all program areas including: acute health, aged residential care,
                                                                    community and mental health. Over 100 trained volunteers are available on a rostered and 24/7 on-call basis to provide transport assistance to vulnerable people:
                                                                    - Discharge from acute wards
                                                                    - Discharge from emergency department
                                                                    - Discharge from day surgery                                                                                                                                                                                       Discharge hospital - Community
                                                                    - To attend cancer treatment                                                                                                                                                                                       Home
                                                                    - To attend renal dialysis
                                                                                                                                                                                                                                                                 John Mulder
Barwon Health    D 01-007      Welcome Home Service                 - To attend medical appointments                                                                                                                                                                                   Referral Form
                                                                    - To attend day respite centres                                                                                                                                                                                    Brochure
                                                                    - To attend recreational day outings                                                                                                                                                                               Volunteer Role Description
                                                                    - To visit loved ones in the hospital and aged care residential facilities.                                                                                                                                        Client Satisfaction Survey

                                                                    Transport, companionship and support upon discharge has resulted in reduced anxiety for vulnerable patients, safeguards to ensure safe return home particularly to remote
                                                                    locations after hours, reduction in overnight stays for day surgery patients, reduction in overnight stays for emergency department patients, ensuring people who frequently
                                                                    present at emergency department attend support groups and health promotional activities as part of the strategy to decrease their presentations.

                                                                                                                                                                                                                                                                                       Aged Care/ Interim care

                                                                                                                                                                                                                                                                                       Evaluation report
                                                                    Functional Conditioning Programs (FCPs) were introduced at both the Alfred and CGMC. Additional Physiotherapists, Occupational Therapists and Allied Health Assistants                                             FCP process
                                                                    were employed to provide the programs. Patients at risk of deconditioning were targeted and engaged in a program of exercise, mobility and activities. The FCPs were based                                         Alfred PT data collection sheet
                                                                    on successful trials that had been run at the Alfred and CGMC and a baseline data study undertaken at CGMC. Extensive literature is also available to support the benefits of                                      Alfred OT data collection sheet
                                                                    FCPs.                                                                                                                                                                                                              Alfred FCP SWOT analysis
                               Aged Care Access Strategy -                                                                                                                                                                                                            Kim Hill         Functional Conditioning Program
Bayside Health   D 03-068b
                               Functional Conditioning Program      A range of outcome measures were used to provide objective results, including Barthel, Elderly Mobility Score EMS, Timed Up and Go TUG, Burden of Care, Length of Stay,            group schedule
                                                                    Mini Mental Score and Discharge destination. Patient and staff satisfaction surveys were also completed with positive results.
                                                                                                                                                                                                                                                                                       CGMC evaluation report
                                                                    An Interim FCP was also implemented at CGMC, for four months, with extra funds from the Community Interim Project (see Project D 03-068) and again showed very positive                                            CGMC data collection sheets and
                                                                    results with a marked improvement in functional ability and improved discharge destination.                                                                                                                        instructions for use
                                                                                                                                                                                                                                                                                       Joint OT and PT Assessment Form
                                                                                                                                                                                                                                                                                       Classification Scales

                                                                    This proposal was directed at decreased length of stay through increased access to diagnostic radiology. Previous service demands resulted in a backlog of in-patient
                                                                    requests that were not completed, which in turn led to overtime, and/or the procedures being delayed until the next day. This issue exacerbated by access to orderlies to
                                                                    transport patients in a timely manner when radiology was ready.
                               Emergency Admission Access -
                                                                Prior to this project radiology staff arranged patient transportation through the hospital orderly pool. The impact of this arrangement included:
                 D 03-067      Radiology Support Redesign and                                                                                                                                                                                                         Kim Hill
Bayside Health                                                  · Delays in patient transfers to Radiology since Radiology patients may not necessarily be the first priority; this results in reduced patient throughput due to delays between                                        Emergency Access
                 D 02-104      Emergency Department Initiatives                                                                                                                                                                                     
                                                                scans, as staff awaited the arrival of patients at the Radiology Department, (translating to longer length of stay delays and later discharge of patients from the ED and wards).
                                                                · Frequent radiographer interruptions as radiologists are required to perform patient transfers and lifting, or to wait until staff are available to lift. This contributes to delays in
                                                                examinations and prolonged examination times
                                                                · X-ray requests being delayed until the next day or until time was available.
                                                                · Excessive radiographer and radiologist overtime associated with delays in examinations.

                                                                    Implemented in November 2003 funding for this project provided increase of 0.6 EFT for a medical physician at consultant level to provide increased expertise within the
                                                                    PGMU to support the Emergency Department. A condition of the implementation of this increase in medical cover was that all medical consultants within the PGMU rounded                            Kim Hill
Bayside Health   D 03-067a     Emergency Access - PGMU                                                                                                                                                                                                                                 Emergency Access
                                                                    daily and assessed patients and oversaw rapid assessment patients within the Professorial General Medical Unit and the Emergency Department. Additional senior medical          
                                                                    staff are providing seven days consultant cover to improve assessment management and discharge planning.

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       Hospital Demand Management (HDM) Strategy 2003-04

                                                                 Care Coordinators were originally introduced to the emergency department as Disposition Nurses in 1998. They were employed to assist in effective patient through put
                                                                 whilst achieving optimal patient outcomes. The Alfred introduced two inpatient Care Coordinators into the Professorial General Medical Unit (PGMU). The unit was targeted
                                                                 due to large volumes of complex medical patients, broad mix of patients with acute and chronic health problems of all ages, especially the frail and elderly and a significant     Dr Kim Hill, Executive Director, Medical
Bayside Health   D 01-099      Expansion of Care Coordinators                                                                                                                                                                                                                                  Emergency Access
                                                                 number of patients with frequent presentations with above average length of stay. The average length of stay for the PGMU unit for period of April-June 2000 was 9 days            Services
                                                                 which was well above the Health Roundtable average. Based on the success of the trial period of the PGMU care coordinators, further care coordinators have been appointed
                                                                 to other in-patient units Respiratory 2000, Trauma 2000, Cardiology 2001, Orthopaedics 2001. Burns/Plastics 2001, Neurosciences 2002.

                                                                 The Residential Discharge Service is a small team based within the social work department. The team focuses on complex cases and people at risk of long lengths of stay in                                                    Aged Care
                                                                 Interim. Patients with no family/carers able to assist with the placement process and patients with complex needs or difficult behaviours are assisted by this team. The                                                      Interim Care
                               Aged Care Access Strategy -                                                                                                                                                                                                      Sara Watson
Bayside Health   D 03-068a                                       introduction of the Bayside Residential Discharge Policy has supported the work of this group, as well as all Bayside Health Social Workers. This policy provides clear
                               Residential Discharge Service                                                                                                                                                                                    
                                                                 guidelines and timeframes for workers and carers/patients to work to in the process of residential placement and allows performance to be monitored against KPIs. A                                                           Patients Awaiting High Level
                                                                 Residential Data Base has been trialled as a tool to track the process and currently a new database is being developed.                                                                                                       Residential Care Policy

                                                                 A private SRS was contracted to run a six bed community interim program which commenced Sept 1, 2003. The SRS provided all nursing services including 24 hr Div 1 cover
                                                                 and accommodation needs. CGMC contracted a local GP to provide the medical cover. CGMC provided Project Co-ordination, Geriatrician supervision, Pharmacy, Pathology
                                                                                                                                                                                                                                                                 Sara Watson                   Aged Care
                                                                 and Allied Health Services. The program operated as a pilot for 3 months. The clinical outcomes and KPI‟s set for the program were positive. A formal tender process was
                                                                                                                                                                                                                                                              Interim Care
                               Aged Care Access Strategy -       followed to select an appropriate community service provider to partner with in the development of an ongoing program. A meeting between DHS (Janet Laverick) and CGMC
Bayside Health   D 03-068
                               Interim Care                      (Sara Watson) in January 2004 confirmed DHS agreement to utilise the HDM funds from this project in a flexible manner, during the intervening period, to enhance interim
                                                                                                                                                                                                                                                                Karen O'Keefe                  Community Interim Care Pilot
                                                                 throughput and to increase the Functional Conditioning Program (Project D 03-068b) at CGMC to include interim patients as well as the sub-acute GEM patients. The
                                                                 Program Co-ordinator has also been involved in a systems review and change management within CGMC aimed at meeting the HDM KPI‟s of reduced length of stay, increased
                                                                 throughput and saved bed days. Services have been purchased in the community to assist residential discharge and support interim at home programs.

                                                                 The program provided supported care to individuals with complex care needs, in addition to their HIV status, who are unable to be accommodated in mainstream community
                                                                 services. There are no other accommodation options available for individuals with this range of complex care needs. The site has 9 flats, which are a mix of single and
                                                                                                                                                                                                                                                                                               Accommodation Model for
                                                                 double bedroom flats. Attendant carers provide 24hour care and are supported through close links with The Alfred specialist medical, nursing and allied health staff. The                           Kim Hill
Bayside Health   D 02-105      HIV Community Based Service                                                                                                                                                                                                                                     Demand Management
                                                                 service also included a psychiatric nurse for support to the patients and carers. The program comprised of two streams. The HDM funded component provided substitution            
                                                                 for acute beds through the provision of respite and long term accommodation for long stay Fairfield House patients. The Public Health funded component provided
                                                                 emergency accommodation and support for at risk HIV patients. The combination of the two streams into one service provided a more cost effective and integrated service

                                                                 The project provided expansion of dedicated senior medical cover for the Fast Track (Medical Triage) area within the Emergency Department at The Alfred from four days per
                                                                 week to seven days per week. The model was highly effective in reducing the patient waiting times and absconding rates for less urgent patients (Cat 3, 4 &5) who present
                                                                 to the Emergency Department. The increased medical cover was successful in expediting the assessment and disposition of patients who did not required admission to
                                                                 hospital The initiative extended increased medical cover to 7 days per week by employing Senior Medical Staff and Registrars to cover Friday to Sunday. The initiative was
                                                                 implemented in consultation with the SouthCity Division of GP‟s to maximise the additional benefits of improving the interaction of the Emergency Department and General                            Kim Hill
Bayside Health   D 01-093      Increased Medical Triage in ED                                                                                                                                                                                                                                  Emergency Access

                                                                 The project has provided funding to allow 24 hours medical cover, previously funding has left 0200 – 0700 hours uncovered by Senior Medical Staff.

                                                                 The project has seen an increase in the timeliness of expediting the disposition of patients who do not require admission to the hospital.

                                                                 Medical Ambulatory Day Unit (MADU) is a 27 bed facility that provides clinical care and treatment for patients in a day setting. Patients can be admitted to the MADU on an
                                                                 elective or emergency basis depending on availability of accommodation. The MADU provides day treatment for patients requiring a wide range of medical clinical conditions
                                                                 including patients requiring abdominal paracentesis, lumbar punctures, and transfusions. Patients may require one day or consecutive day treatments and can return to their
                                                                                                                                                                                                                                                                                               Elective Surgery
                               Medical Ambulatory Day Unit and   usual place of residence or can be accommodated in the Medihotel, or the local hotel overnight. Demand within the unit grew significantly within the first 12 months of the                         Kim Hill
Bayside Health   D 01-096                                                                                                                                                                                                                                                                      Clinical Practice Change
                               Medihotel (MADU)                  unit opening and now is at full capacity within the current staffing/funding arrangements. All clinical units within the hospital have utilised the MADU and Medihotel. MADU      
                                                                                                                                                                                                                                                                                               Emergency Access
                                                                 initially opened in September 2001 with funding from the Hospital Demand Management (HDM) from the Department of Human Services. Due to significant demand, the
                                                                 MADU increased to 27 beds in October 2002. The unit is supported by all parent units and Allied Health provision is provided by in-patient Allied Health staff from the relevant
                                                                 parent units responsible for the patient care.

                                                                 The project was developed to address the extended length of stay (LOS), and request for different care options, of non-compensable ABI patients at The Alfred by directly
                                                                 purchasing alternative services to facilitate discharge to appropriate agencies care. This group of patients have had limited options for subacute or community care and there
                                                                 is a recognised gap in service available between the completion of acute care at The Alfred and the commencement of sub acute care provided through the Slow To Recover

                               Non-compensable ABI Pts - STR     Patients with acquired brain injuries who were unable to be discharged to the community or transferred to subacute care, within existing programs, are identified by clinical                       Kim Hill
Bayside Health   D 02-106                                                                                                                                                                                                                                                                      Clinical Practice Change
                               Program for Bayside               units in conjunction with Bed Assignment and the Long Stay Round. Care Coordinators from Neuroscience and Trauma units oversee the discharge planning process for these           
                                                                 patients and negotiate a care plan with alternative care providers.

                                                                 The patient group of non compensable ABI experience difficulty accessing appropriate care as they are predominantly a younger patient group and often placed in Aged Care
                                                                 facilities who are not set up to manage their care. These patients are disadvantaged, as they are unable to access services that are readily available to compensable patients
                                                                 and the project was specifically targeted towards funding options for these patients.

                                                                 The primary aim of this strategy was to address the management of long waiting Category 2 & 3 elective surgery patients. The constant balance between access for
                                                                 emergency patients from and Category 1 elective surgery patients had led to increased waiting times for Category 2 & 3 patients. The project has undertaken:
                                                                 - Extensive audit of waiting list – focus on plastics, orthopaedics and urology long waiting Cat 2 &3
                                                                 - Organised care plans for long waiting patients still requiring treatment, reviews and follow up
                                                                 - Liaison with heads of units, registrars and Pre Admission Clinic to ensure Cat 2 & 3 patients were ready for surgery
                                                                 - Liaison with heads of units to remove patients from the list if they no longer required treatment
                               Category 3 Elective Strategy      - Development and monitoring of long wait spreadsheet                                                                                                                                               Kim Hill
Bayside Health   D 03-065                                                                                                                                                                                                                                                                      Category 3 Elective Surgery
                               (Plastics)                        - Established protocols and strategies to improve access to SDMH including Operating Theatre review of available time and negotiated additional sessions. Additional              
                                                                 equipment organised.
                                                                 - Follow up of 40 outstanding ESAS patients and negotiated appropriate treatment
                                                                 - Identified 40 potential ESAS patients. Removed from list if surgery already undertaken. Negotiated appropriate intervention if still requiring treatment.
                                                                 - Extensive liaison with Pre Admission Clinic to ensure long wait patients booked.
                                                                 - Review and redesign of Cardiothoracic unit booking practises has led to a drop in HIP rate for this unit
                                                                 - Facilitate additional Plastics theatre sessions negotiated at The Alfred and SDMH

                                                                 Data analysis and extracts are provided to emergency department directors, acute service managers and the HDM and HARP coordination office. This role supports the
                                                                                                                                                                                                                                                                 Debbie Leach
Eastern Health   D 01-110      Bed Access Management Data        emergency departments and HDM and HARP projects with evidence-based action learning that facilitates sustainable process improvement. This position also coordinates the                                                      Bed Management
                                                                 collation of data for the monthly DHS HDM Reports.

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       Hospital Demand Management (HDM) Strategy 2003-04

                                                                   This project aims to:

                                                                   -   Improve efficiency of inpatient management of emergency admitted patients in general medicine                                                                                            Lee Hamley
Eastern Health     D 01-111    Clinical Managers                                                                                                                                                                                                                                          Medical Access
                                                                   -   Facilitate patient flow from emergency department to discharge.                                                                                                         
                                                                   -   Improve access to inpatient medical beds for the Emergency Department
                                                                   -   Facilitate a reduction in exit block from the Emergency Department which is a key factor in Bypass and length of stay prior to admission.

                                                                                                                                                                                                                                                                                          Medical Access
                                                                   To provide early assessment, consultation and immediate and ongoing therapy as clinically required to minimise the loss of functional ability for those patients 70 years. This
                               Maroondah Acute Aged Program                                                                                                                                                                                                    Anne Bergin
Eastern Health     D 03-072                                        ensures effective managing of acute and complex clinical issues in a timely and integrated manner that enhances bed access, reduces length of stay and restores functional                                             Functional Enhancement Pilot -
                                                                   ability.                                                                                                                                                                                                               Plan
                                                                                                                                                                                                                                                                                          Analysis and Review

                                                                                                                                                                                                                                                               Debbie Leach
                                                                   To facilitate the flow of patients through the ED by allowing selected patients to have investigations and treatment initiated ahead of cubicle or doctor availability. Increased
                               Expand Medical Triage and Fast      use of Senior Medical Staff at the hospitals “front door” enables rapid screening, assessment and management of patients and thereby improves hospital access and
Eastern Health     D 02-198                                                                                                                                                                                                                                    Lee Hamley                 Emergency Care
                               Track - All Sites                   utilisation and patient satisfaction. Fast Track aims to decrease the length of stay for discharged patients and to improve staff and patient satisfaction. Patients suitable for
                                                                   Fast Track are identified at Triage.
                                                                                                                                                                                                                                                                Zoltan Kokai

                               Eastern HDM & HARP                  To establish and resource a central point of coordination (Program Unit) by aggregating project support and facilitation functions centrally for HDM (& HARP) initiatives at                                           Discharge hospital - Community
Eastern Health     D 03-071                                                                                                                                                                                                                                     Zoltan Kokai
                               Coordination Office                 Eastern Health .                                                                                                                                                                                                       Home

                                                                   To positively impact on ED quality care, early intervention and discharge planning and re-presentation rates through provision of rapid access multidisciplinary allied health
                                                                   services in emergency medicine, comprising:
                                                                   - Rapid response to allied health referrals                                                                                                                                                                            Emergency Care
                               Allied Health in the ED /                                                                                                                                                                                                       Christine Bessell
Eastern Health     D 02-110                                        - Effective service delivery and discharge planning for targeted patients with complex needs
                               Community Interface                                                                                                                                                                                           
                                                                   - Timely therapeutic and social assessment aligned with early commencement of treatment for targeted admitted patients                                                                                                 Interim report
                                                                   - Addressing problems of frequent re-presenters by developing multi-disciplinary community based care-plans
                                                                   - Improved community links at the ED-Community interface to ensure relevant social and therapeutic intervention for discharge.

                                                                   Drawing on an „Action-Research‟ methodology, project objectives are to:
                                                                   - Identify the frequency and nature of AOD presentations in the ED                                                                                                                                                     Emergency Care
                                                                   - Develop broad strategies to support this client-group (eg referral pathways, training)
                               Alcohol & Other Drug Risk                                                                                                                                                                                                       Barbara Kelly
Eastern Health     D 02-108                                        - Provide clinical support to ED staff (eg clinical work, primary/secondary consultation)                                                                                                                              Alcohol & Drug Reduction
                               Reduction Strategy                                                                                                                                                                                             
                                                                                                                                                                                                                                                                                          Strategy Mental Health Drug &
                                                                   A joint steering committee with the „Psychiatric Liaison Nurse Project‟ was established to ensure collaborative practice and minimise overlap. This team has helped drive the                                          Alcohol Program Action Plan
                                                                   project model, which consists of: research, strategic interventions and direct clinical work.

                                                                   There is a strong emphasis on bridging the clinical pathways of care and treatment at critical points of care and decision making i.e., access to services, assessment phase
                                                                                                                                                                                                                                                                  Liz Burgat
Eastern Health     D 02-111    Psychiatric Liaison Nurse           and linking in with the most appropriate service ensuring responsive and effective care and outcome for clients. Another component of this new initiative is to provide                                                Emergency Care
                                                                   consultation and education to both Emergency Department and In-patient staff on the treatment of mental illness and interventions required.

                               Oncology Palliative Care                                                                                                                                                                                                       Andrea McCance              Discharge hospital - Community
Eastern Health     D 02-116                                        Refining palliative care planning and outcomes for hospital inpatients
                               Discharge Co-ordinator                                                                                                                                                                                              Home
                                                                   The development of a admitting unit for the HITH (HHU) allowing direct referrals. The incorporation of medical services into the current HITH model thereby improving the
                                                                   efficiency and effectiveness of services. The provision of a 24 hour HITH medical consultancy service· Providing support for the Emergency Department· Securing the ability of
                                                                                                                                                                                                                                                              Christine Kilpatrick        Discharge hospital - Community
Melbourne Health   D 02-117    HITH Direct Referrals               HITH to receive transfers 24 hourly· Providing a seamless timely service that ensures a speedy transfer· Providing the options for community services to directly refer to the
                                                                   HITH unit there by preventing an emergency presentation. The provision of a visiting medical service for patients · Enabling an increase in the acuity of patients transferred
                                                                   to HITH· Reducing the need to return patients for medical review· Increasing the HITH units responsiveness to changes in the patients condition

                                                                                                                                                                                                                                                                                          Discharge hospital - Community
Melbourne Health   D 02-118    Continuity of Care for Older People ###########################################################################################################

Melbourne Health   D 02-119    Re-engineer Surgical Patient Flows Review of perioperative services inclusive of operating sessions, day surgery area, patient bookings - flows.                                                                                                           Bed Management

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       Hospital Demand Management (HDM) Strategy 2003-04

                                                                    This pool of funds has been used for a number of purposes throughout the year. Specifically, the resources employed through these funds related to : - the introduction of
                                                                    acute geriatric services within the ED, including the appointment of a Director, Acute Geriatric Medicine. This has overcome deficiencies previously existing within the ED and
                               One Episode of Care for High Risk    Royal Melbourne Hospital to a more coordinated approach for high risk and elderly patients presenting in the ED- The funding for the Melbourne health review of Perioperative
Melbourne Health   D 02-121                                                                                                                                                                                                                                                          Medical Access
                               Surgical Patients                    services particularly relating to improvements to the operating room template as well as assisting in determining the optimum configuration of services on the 3rd floor of the
                                                                    RMH campus with the impending commissioning of the 3 West procedure unit. - Other Demand management initiatives arising from time to time specifically relating to high
                                                                    risk, complex and or elderly patients across both the emergency and ward part of the patients journey.

                                                                    In the 2003-4 financial year-this HDM funding has continued to underpin a range of Hospital Simulation and other modeling activities which have allowed staffing and sundries
                                                                    to facilitate-· analysis and implementation activities· testing and usage of simulations at MH · participation in planning for subsequent development activities· transfer of
Melbourne Health   D 03-078    New Modelling                                                                                                                                                                                                                                         Bed Management
                                                                    lessons to MH from partner sites· exploration of complementary technologies and techniques (eg- Markov models). The funding has also supported data analysis and
                                                                    evaluation activities around other HDM projects in the hospital

                               Active Management of the Waiting
Melbourne Health   D 03-075                                     More efficient and effective management of patient assignment to the elective surgery waiting list                                                                                                                   Elective Surgery

                                                                    Provides administrative capacity for the consideration of process improvement plans supporting - HDM / HARP projects. - Continuation of project support for Patient
                               Coordination and Management
Melbourne Health   D 03-076                                         Management taskforce requests- Improvements to Performance Measurement unit reporting capabilities specifically in relation to demand measurement reporting systems-
                               Unit HDM Strategy
                                                                    Preliminary work and support for Patient Flow collaborative program.

                                                                  The Rapid Assessment Team (RAT) is based on the principle that an Emergency Physician works with a triage nurse to rapidly assess all patients presenting to the Emergency
                                                                  Department as soon as possible after they arrive. An initial assessment is made, appropriate investigations ordered and analgesia provided. The next step is for the RAT
                                                                  Emergency Physician to hand over the patient to the Emergency Physician Floor Coordinator who is responsible for the allocation and coordination of patients amongst the                        Ian Carson
Northern Health    D 01-030    Increased Medical Triage in the ED                                                                                                                                                                                                                    Emergency Care
                                                                  resident and registrar medical staff. They are responsible for ensuring that all patients are managed in a timely manner, and ensure that disposition decisions are made as     
                                                                  soon as feasible. Medical staff in the Emergency Department are not to self select which patients they see, rather it is the responsibility of the Floor Coordinator to manage
                                                                  the work flows and allocate patients

                                                                 Funding of a HMO 3 position enabled the Aged Care Medical Unit to be established in July 1999. Patients are either admitted directly to the unit or are transferred from other
                                                                 units during their inpatient stay. The unit manages the following groups of patients:
                                                                 - Patients admitted directly from nursing homes or hostels
                                                                 - Patients admitted with stroke
                               Continuation of Aged Care Medical                                                                                                                                                                                                Maree Glynn
Northern Health    D 01-133                                      - Patients waiting for admission to a sub-acute facility                                                                                                                                                            Medical Access
                                                                 - Patients identified as having complex discharge planning needs.

                                                                    Patients are also identified at various medical meetings and ward meetings that occur on a daily basis. Patients can be referred to the Unit by medical, nursing and allied
                                                                    health staff. A care coordinator is attached to this unit and identified suitable patients also.

                                                                    This service enables the identification and follow-up of patients who are likely to be discharged on weekends. The Weekend Discharge Service is staffed by the care                         Maree Glynn          Discharge hospital - Community
Northern Health    D 01-134    Weekend Discharge Service
                                                                    coordination team who play a valuable role in planning discharges.                                                                                                                Home

                                                                    The Inpatient Model of Service developed is a combination of acute restoration and rehabilitation towards pre-morbid function, and handicap compensation where restoration
                                                                    is not possible or limited.The target group includes the frail aged (over 65 years), patients with complex needs due to co-morbidity, patients listed as waiting for rehabilitation
                                                                    and those with high care needs assessed as requiring alternative accommodation to home.The provision of additional Occupational Therapy, Physiotherapy and Social Work
                                                                    staff has enabled:
                                                                    1. Earlier identification of and intervention for patients requiring rehabilitation. Intervention has included individual and group work aimed at improving mobility and function.
                               Additional Allied Health staff for                                                                                                                                                                                               Maree Glynn
Northern Health    D 01-135                                         2. Improved multidisciplinary team work for discharge planning through the establishment of daily handover meetings, Aged Care Meeting, joint education sessions and                                             Medical Access
                               complex discharge management                                                                                                                                                                                      
                                                                    Residential Care Team.
                                                                    3. Capacity for service enhancement which has assisted in limiting duplication of processes between acute and subacute sites and creating a positive ageing environment for
                                                                    patients (through establishment of an Aged Care Medical Unit).
                                                                    4. More appropriate levels of therapeutic intervention for enhanced patient care and patient throughput.
                                                                    5. Greater integration of Allied Health staff teams within the hospital via attendance at continuum of care and hospital activity meetings.

                                                                    Locating a senior Emergency Specialist at triage has allowed for numerous patients to be either expeditiously referred to their General Practitioner, directly to specialist
                                                                    outpatient clinics or to receive initial or definitive management within the Triage area prior to discharge or transfer to an Emergency Department cubicle for more detailed
                                                                    assessmentThe process also allows for a rapid initial specialist assessment of patients, as well as for drug ordering and triage initiated requesting of defined pathology and
                                                                                                                                                                                                                                                                  Ian Carson
Northern Health    D 02-123    ED Fast Track Service                radiological investigationsThe use of Emergency Physician triage has allowed process times to be reduced to allow efficiency gains that have impacted on all areas of patient                                    Emergency Care
                                                                    management in the Emergency Department and reduced pressure on limited resources. Improvements in capacity and productivity measures such as ambulance bypass and
                                                                    12 hour length of stays have been seenBy apportioning a discreet area, with trained staff and rapid access to simple investigative and treatment modalities, fast track
                                                                    patients have been seen more quickly and the delays in their care reduced.

                                                                    A Cutting Length of Stay in the Emergency Department (CLOSED) program is used to augment previous HDM initiatives, including the Short Stay Unit, Rapid Assessment
                                                                    Team and Fast Track Service, to further reduce times to treatment for non admitted Emergency Department patients.There was a need to provide a more focused service to
                                                                    complement existing strategies to further reduce patient time in the Emergency Department. Fast track has identified one mechanism to enhance patient throughput, though
                                                                    it is not an appropriate mechanism for many of the patients identified for the CLOSED project.The CLOSED project is conducted weekdays from 8am – 4:30pm, and operates
                                                                    in an area within the Emergency Department termed the Emergency Clinic (EC). Emergency Department patients who meet various criteria are targeted for entry into this
                               Cutting Length of Stay in the ED     program. These include:                                                                                                                                                                    Robert Burnham
Northern Health    D 03-041                                                                                                                                                                                                                                                          Emergency Care
                               (CLOSED) Project                     - Patients recalled for result follow-up                                                                                                                                    
                                                                    - Next day fracture and plaster cast checks
                                                                    - Eye reviews
                                                                    - Scheduled patient reviews after initial treatment in the Emergency Department
                                                                    - Emergency Department, Short Stay Unit, and medically initiated HITH patient reviews
                                                                    - Some Emergency Department triage category 4 and 5 patients who need more complex treatment than the Fast Track service can provide.

       F:\Metro Service Relations\Hospital Demand\Emergency Demand\HDM Project\2003-2004\Project Status Report\Project Summaries.xls                                                                                                                                                                     Page...5
       Hospital Demand Management (HDM) Strategy 2003-04

                                                                   The project has screened a total of 333 patients and recruited 142 patients to the study. Of the 191 patients not recruited, 76 declined to participate and 78 were missed
                                                                   (discharged prior to assessment). The remaining patients were excluded due to difficulties with assessment. Patients form culturally diverse backgrounds were assessed using
                                                                   professional interpreters. Delirium was found in 21% of patients. Risk factors identified were: age, female sex, living in a residential aged care facility prior to admission, prior
                               DELirium Intervention in the                                                                                                                                                                                                           Maree Glynn
Northern Health    D 03-092                                        diagnosis of cognitive impairment and increased illness severity. Mean length of stay was 16.1 days for delirious patients versus 12.3 days for non-delirious patients. Patients                                             Medical Access
                               Elderly (DELITE): reducing the risk                                                                                                                                                                                     
                                                                   with delirium experienced a significant decline in their functional status (mean drop in Barthel score 8.5 versus 27.7). Patients with delirium were more likely to be discharged
                                                                   to a destination providing increased care levels (eg rehabilitation or residential care) than those without delirium (53% vs 31%). There was a trend to increased mortality in
                                                                   the delirious group (13% vs 5%). A patient „at risk‟ identification tool is being developed.

                                                                    The model of service delivery was to build on existing structures and other initiatives that were either mainstream services or funded under other projects and enhance
                                                                    communication mechanisms between the different services involved. The original plan was to:
                                                                    - Increase the capacity of care coordination in the ED and blend this role with the post-acute care team
                                                                                                                                                                                                                                                                       Anne Fox
Northern Health    D 01-034    Care Substitution (weekends)         - Increase in the capacity of the Post Acute Care Service based at TNH to follow-up clients and review their initial care plans in a timely way                                                                             Medical Access
                                                                    - Develop a range of service interventions that would ensure a safe discharge, including establishing "out of hours" purchasing arrangements with a community provider etc.
                                                                    - Develop mechanisms to link the client back to the GP for medical management
                                                                    - Develop protocols for referral to ACAS Rapid Response if an ACAS type assessment is required to develop a long term care plan for the client.

                               Extended Day Procedure Unit          Prior to the extension of the operating hours of Day Procedure Unit they closed at 7.00 pm each evening. This project has meant that the Day Procedure Unit is now open                          Christine Lamotte
Northern Health    D 01-035                                                                                                                                                                                                                                                                     Bed Management
                               Hours                                until 9.00 pm, Monday to Friday and on Saturdays from 7.00 am to 5.00 pm.                                                                                                        

                                                                    An Elective Surgery Coordinator was appointed in September, 2003. Since commencing she has worked closely with the theatre booking clerks, surgeons and other relevant
                                                                    staff to refine our processes for placing patients on the elective waiting list and booking their procedures.· Elective Surgery Coordinator has worked closely with DHS and the                  Christine Lamotte
Northern Health    D 03-093    Elective Surgery Coordinator                                                                                                                                                                                                                                     Bed Management
                                                                    designated centres to coordinate both General Surgical and orthopaedic long wait patients being offered surgery at the designated centres.· Elective Surgery Coordinator has     
                                                                    targeted long wait Category 2 patients to ensure that a management plan is put in place to enable them to have their surgery performed.

                                                                    The recruitment of additional Social Work, Speech Pathology, Dietetic, Occupational Therapy and Physiotherapy staff has provided Allied Health with the capacity to respond
                                                                    to patient referrals in a timely manner and provide critical, early intervention to patients. This has assisted in throughput of patients in the ED/SSU and prevented
                                                                    unnecessary inpatient admissions. Although the staff are based in the ED/SSU they can also work across inpatient units when patients are admitted and in this way intervene                                                 Emergency Care
                                                                    early for patients at risk of deconditioning or developing complications. The additional staff has helped to establish a comprehensive multidisciplinary team in the ED/SSU
                               Early Intervention and Risk          involving allied health, care coordination, medical and nursing staff. Types of interventions which have improved patient care include:                                                       Jenni Gratton-Vaughan         Occupational Therapy Policy and
Northern Health    D 02-195
                               Assessment Service                   - Timely swallowing assessment to prevent patients unnecessarily remaining as nil by mouth                                                                                      Procedures
                                                                    - Early mobility assessment and establishment of exercise programs to prevent falls                                                                                                                                         Social Work in the ED
                                                                    - Enhanced counselling and linking of patients to internal and external service providers                                                                                                                                   Service Proposal/plan
                                                                    - Early diagnosis of Diabetes Mellitus and immediate provision of appropriate dietary education
                                                                    - Timely Home Visits and subsequent provision of aids and equipment

                               Expansion of Community Therapy       CTS provides a client-focused model of rehabilitative therapy. Services are delivered in the home or centre or both. The project has increased capacity to manage more                          Maree Cuddihy               Discharge hospital - Community
Northern Health    D 03-042
                               Service (CTS)                        patients and provide a timely response to client referrals. Inpatients are prioritised to assist with the length of stay in the acute and sub acute sectors.                               Home

                                                                    The key aims of the project are to:
                                                                    - provide a rapid response to frail older people in a time of crisis                                                                                                                                                        Emergency Care
                               ACAS Rapid Response (ARRP)-                                                                                                                                                                                                             Anne Fox
Northern Health    D 02-126                                         - divert an admission to acute or subacute care that can better be handled in the community divert a presentation at ED
                                                                    - prevent a deterioration in a person's condition or home situation                                                                                                                                                         Policy and Procedure Manual
                                                                    - restore or improve the person's level of function and enable them to remain in the community in the longer term after the intervention is completed

                                                                    The Fast Track Service continues to operate 24hours per day, seven days per week. It is an initiative that has integrated well, and remains valuable to operations within the
                                                                    Emergency Department (ED). The key role of the Clinical Support Nurse, as an expert clinical emergency nurse is to support nursing colleagues, medical staff and allied
                                                                    health workers in the ED in the smooth and timely delivery of quality patient care.

                                                                    The CSN is rostered each shift, seven days per week and is filled by an experienced emergency nurse who has completed competencies related to Nurse Initiated Analgesia
                                                                    (NIA), including the administration of inhalation analgesia, and Nurse Initiated X-Rays (NIXR). They also are competent in ECG analysis and the initial emergency
                                                                    management of patients presenting with cardiac related chest pain, including the administration and management of Thrombolytic therapy. Additionally they are competent in
                                                                    intravenous cannulation and the initiation of first line treatments such as administration of nebulised medication for asthma, initial management of distal limb injuries
                               Fast Track in ED (non clinical                                                                                                                                                                                                        Peter Bradford             Emergency Access
Peninsula Health   D 01-139                                         including fractures, and management of eye injuries.
                               support and CNS)                                                                                                                                                                                                              Clinical Practice Change
                                                                    The Clinical Information Co-ordinator (non clinical support) was developed to provide real time administrative assistance and support to the Clinical staff within the ED
                                                                    according to a position description and list of duties specifically written for the role, and under the guidance of the ED NUM and Director. The principal purpose of the role is
                                                                    minimise the non-patient contact time of the Clinical staff per episode of care. This allows improved time and motion dynamics of clinical activities aiming to maximise
                                                                    clinical throughput and reduce waiting times to medical assessment and intervention. Patient turnover is improved by promoting the presence of clinical staff at
                                                                    the bedside and streamlining management tasks. The position is responsible for facilitating the „real time‟ data entry into the electronic Patient Care Information
                                                                    System used by all staff in particular the medical staff.

                                                                    The Clinical Enhancement project was based on providing clinical education to up-skill nursing staff working within the Emergency Department environment, encourage
                                                                    retention of existing staff and aid in recruitment of new staff. In early 2002 the project commenced with the recruitment of four qualified emergency nurses each possessing
                                                                    postgraduate tertiary qualifications in Critical Care as well as tertiary qualifications in education.
                               Clinical Skills Enhancement                                                                                                                                                                                                           Peter Bradford             Emergency Access
Peninsula Health   D 02-127
                               program                                                                                                                                                                                                                       Clinical Practice Change
                                                                    The aims were to clinically support the nursing staff, with ongoing education on emergency nursing practices over 16 hours per day 7 days per week. The importance of
                                                                    these practices was considered not only vital but also essential in energising and cherishing the confidence of nurses that were largely leaving the profession. Established
                                                                    pathways for growth and development have been made demonstrating achievable career directions within the emergency setting.

                                                                    A medical registrar has been appointed to the Emergency Department. This registrar works 0900 hrs to 1900 hrs but this will soon change to 1200 hrs to 2200 hrs as the
                               Process Redesign of Medical          busiest period in ED is from 1700 to 2200 hrs. The funding provides for two medical registrars in ED to access patients during the busiest activity period. The response from                    Peter Bradford
Peninsula Health   D 02-129                                                                                                                                                                                                                                                                     Emergency Access
                               Patients in ED                       ED has been very positive with a huge improvement in the rapidity of patient assessment and handover to inpatient units. A special medical registrar admission form, for ED      
                                                                    patients, has been developed, the form is attached.

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        Hospital Demand Management (HDM) Strategy 2003-04

                                                                    The position was introduced into Peninsula Health‟s acute settings to work with the Aged Care and Rehab Consultants to provide skilled aged care assessments in a timely
Peninsula Health   D 02-132     Aged Care Coordinator               manner and to work with bed management to facilitate the transfer of patients to an appropriate sub-acute setting thus reducing the number of patients in acute waiting for           Siva Sivarajah                        Aged Care/Interim Care
                                                                    transfer to sub-acute. The position also aims to enhance the involvement of families and carers in the assessment process.
                                                                    The streamline model was based on developing a service that met peak demand for the client group, namely the category 4&5 patients presenting with a simple injury or
                                                                    illness that can be treated quickly and easily.

                                                                    The service operates out of the ED utilising resources available including consult room 3, employing the services of a medical officer, to care solely for the streamline patients.
                                                                    This Medical Officer on most occasions is a General Practitioner from the local area. A nursing staff member from the current roster/staffing is allocated to work with the
                                                                    Medical Officer as requisite to assist procedures, medication delivery, and facilitate expeditious episodes of care. The nursing staff allocated to work in Streamline are
                                                                    advanced nurses with advanced practise skills. Further clinical development has been supported by the Emergency Department Nurse Educators upskilling staff in Nurse
                                                                    Initiated Analgesia and Nurse Initiated X-rays.

                                                                    The streamline patients are triaged to the service according to specific inclusion and exclusion criteria to ensure the aims of the project are met. To minimise disruption to the                Peter Bradford            Clinical Practice Change
Peninsula Health   D 02-147     After Hours Primary Care Clinic     care of other patients waiting for treatment in Frankston Emergency Department a separate waiting area has been identified for use and patients are directed to this waiting             Emergency Access
                                                                    area by following a
                                                                    green line on the floor. The aim of this is to remove the streamline patients from the main waiting area, where it may be perceived they are receiving preferential treatment.
                                                                    Streamline patients are identified on the Frankston Emergency Department computer system with a Red Star to place them apart from the other patients waiting in the ED.
                                                                    This also identified the streamline patient to the ED Medical Officer's to prevent them from treating the streamline allocated patients at the expense of other waiting
                                                                    patients.The Emergency Department assessment and treatment form is also stamped with a red star to support staff in identifying Streamline patients.

                                                                    To minimise disruption to the existing co-located and privately operated fee for service Medicentre at Frankston Hospital, patients continue to be offered the option of being
                                                                    to the Medicentre from triage as they had been previously. The streamline service has not been promoted amongst the local community to avoid inappropriate utilisation of
                                                                    The programme is aligned operationally to the Community Rehabilitation Centres at Frankston and Rosebud. The KPI provided was an increase in the „places‟ target set for
                                                                    these 2 CRC‟s. The project is now fully incorporated into the reviewed model of care for the CRCs.
                                                                    · The programme has a dual focus of decreasing the LOS for those inpatient referred and avoiding admissions and re- admissions of clients presenting at E.D, whose condition
                                                                    could be remediated by multi disciplinary community based therapy.
                                                                    · Evidence of its effectiveness is shown in the LOS figures for the 2 inpatient units at Frankston and one at Rosebud which has reduced from 22.5 in 2002-03 to 20.18 in 2003-

                                Improved Access to Community        Initially it was anticipated that 10% of all referrals received by the CRC‟s would fit into this criteria, however the percentage has been far higher, with 63 of the past 105                    Siva Sivarajah            Emergency Access
Peninsula Health   D 02-196                                         clients referred coming from inpatient wards (60%). In addition the number of individual clients has increased from an average of 61 per month prior to implementation of
                                Allied Health                                                                                                                                                                                                               Clinical Practice Change
                                                                    the project to 67 per month immediately after implementation, to 101, 18 months post implementation. The profile of a „typical‟ CRC client has altered over the past 18
                                                                    months, which reflects this streaming effect,
                                                                    and the focus is now clearly on time limited, goal orientated, multi disciplinary interventions.

                                                                    Waiting List management strategies have now been implemented. Clients are now triaged as being „urgent‟ or „routine‟, and appointments allocated appropriately. A review of
                                                                    intake / referral processes through our ACCESS system has greatly enhanced the capacity for rapid response to demand. All clients are triaged through this single point
                                                                    of entry telephone service, client details are then transferred electronically to the treating multi disciplinary team. A new initiative of group programmes to enhance client

                                                                    In the initial phase of the project, there was a statistical examination of patient flow through Medicine. Deficiencies identified included (i) lack of discharges on Sundays,                                              Elective Surgery
                                                                                                                                                                                                                                                                      Peter Bradford
Peninsula Health   D 03-050     Medical Change Management ()        leading to excessive patient numbers in ED Sunday night and Monday morning, causing by pass (ii) poor timing of discharges in relation to demand, namely mostly in the                                                      Clinical Practice Change
                                                                    afternoon and causing a problem with morning surgical electives (iii) blocks to transfers within the healthcare network such as to aged care.                                                                               Emergency Access

                                                                    The admission lounge is situated on level 3, adjacent to the waiting list/admissions offices. The function and resources of the lounge have been extended to accommodate
                                                                    discharge patients, Emergency Department transit patients awaiting an inpatient bed and patients undergoing blood transfusions. The hours of the lounge have been                                 Peter Bradford
Peninsula Health   D 03-051     Admission Lounge                                                                                                                                                                                                                                                Access Block
                                                                    extended to improve patient flow. IT resources have been made available for medical staff to complete the electronic discharge process. The admission process has been            
                                                                    reviewed and patients are now admitted earlier to assist with anaesthetic preparation in the Operating Suite.

                                                                    1.   RVEEH is a designated centre for ENT patients.
Royal Victorian
                                                                    2.   Patients from other hospitals have been transferred for their ENT surgical procedure.                                                                                                        Clare Douglas
Eye and Ear        D 03-082     ESAS Designated centre (RVEEH)                                                                                                                                                                                                                                  Surgical Access
                                                                    3.   Once removed from waiting list, further surgery/management patient is returned to target hospital.                                                                        
                                                                    4.   This was managed by ESAS coordinator.

Southern Health    D 01-147a    Medical Triage in ED                To reduce waiting time and ED length of stay for Category 4 patients who have “see and treat” type conditions                                                                         lakshmi.sumitheran@southernhealth.or Emergency Care
                                                                    The clinic is staffed with a medical officer and a nurse. The hours of operation are from 1200hrs until 2030hrs, 7 days per week. The clinic is designed to provide rapid                         John Stanway
Southern Health    D 01-147b    ED Fast Track                                                                                                                                                                                                                                                   Emergency Care
                                                                    assessment to patients in category four and five. It was also designed to reduce the number of patients that leave the ED without being seen by a doctor.                    
                                                                    Increase security staff presence in the ED to protect staff and reduce the level of violent incidents to staff by patients and visitors. Also to protect patients and visitors from
                                                                                                                                                                                                                                                                    Lakshmi Sumithran
                                                                    others. Provide clerical support to the ED medical staff to enable them to concentrate on clinical care and therefore to reduce waiting times. Provision of debriefing and
Southern Health    D 01-148a    ED Security at Dandenong                                                                                                                                                                                         Emergency Care
                                                                    counselling for staff on stressful issues including training in verbal and physical strategies to assist with the management of aggressive behaviour for individuals and the
                                                                    team. Improving the ED environment and staff facilities to improve morale.
                                                                    Both Clayton and Dandenong emergency departments were identified as having escalating security related incidents. These incidents involved aggressive and threatening
                                                                                                                                                                                                                                                                  Michael Robinson
Southern Health    D 01-148b    ED Security Corporate               behaviour by patients and relatives commonly exacerbated by the triage process. Providing a proactive approach to patient and staff safety by initiating a permanent security                                             Emergency Care
                                                                    presence in the emergency departments at both Dandenong and Clayton. This presence was targeted at peak activity times.

                                                                    Facilitation of more timely assessment, discharge planning and intervention by allied health staff, enabling weekend discharges and reductions in length-of-stay, thereby
                                                                    releasing beds at both Dandenong Hospital and Monash Medical Centre. Target groups are:                                                                                                                                     Discharge
                                                                                                                                                                                                                                                                       Sue Blake
Southern Health    D 01-151a    After hours weekend Allied Health   - Patients likely to be discharged on a Saturday/Sunday or Monday if they receive allied health service
                                                                    - Patients admitted over a weekend requiring allied health assessment to commence active treatment                                                                                                                          Allied Health Service
                                                                    - General medical unit patients with a long length of stay

                                                                    Facilitation of more timely assessment, discharge planning and intervention by allied health staff, enabling weekend discharges and reductions in length-of-stay, thereby
                                                                    releasing beds at both Dandenong Hospital and Monash Medical Centre. Target groups are:                                                                                                                                     Discharge
                                                                                                                                                                                                                                                                       Sue Blake
Southern Health    D 01-151b    After hours weekend Allied Health   - Patients likely to be discharged on a Saturday/Sunday or Monday if they receive allied health service
                                                                    - Patients admitted over a weekend requiring allied health assessment to commence active treatment                                                                                                                          Allied Health Service
                                                                    - General medical unit patients with a long length of stay

        F:\Metro Service Relations\Hospital Demand\Emergency Demand\HDM Project\2003-2004\Project Status Report\Project Summaries.xls                                                                                                                                                                                   Page...7
        Hospital Demand Management (HDM) Strategy 2003-04

                                                                      Additional funding for medical registrar /consultant cover on the weekends was funded. This aimed to improve quality of care, reduce length of stay by continuing active
                                                                      management over the weekends. The project also aimed to increase discharges on weekends and to shift Tuesday discharges to Mondays having had more active
                                                                                                                                                                                                                                                                       Richard Mullaly           Discharge hospital - Community
Southern Health   D 01 – 151 c   Weekend medical Staff                management over the weekend. Previously the only medical registrar on for the weekend was in ED and could not review ward patients unless critically ill. In addition
                                                                      weekend handovers were improved from a systems point of view to optimise quality of care and discharges (handover sheets included). Also internal funding was used to
                                                                      fund a further increase in medical cover on the weekends (Sundays) with similar aims.

                                                                      The additional funding was used for medical consultant ward rounds on weekends, in particular Sunday‟s. By providing the additional ward rounds it would reduce patient LOS
                  D 01-151d      Weekend Medical Staff Ward                                                                                                                                                                                                           John Stanway               Discharge hospital - Community
Southern Health                                                       and at the same time improve quality of care. The project allowed patients to be discharged over the weekend, hence not allowing the Emergency Department to be full of
                  D 01-151e      Rounds                                                                                                                                                                                                              Home
                                                                      patients waiting for admission on Monday morning.

                                                                      The EDLS will identify persons assessed in the ED by the Enhanced Crisis Assessment and Treatment Team (ECATT) as having a mental disorder and who are waiting for
                                                                      availability of a psychiatric inpatient unit bed, or intensive support in the community by the Crisis Assessment and Treatment Team (CATT) where the CATT is not able to
                                                                      respond immediately. The EDLS will be active in the inpatient units in promoting and supporting Early Discharge Management (EDM) as a means of increasing bed
                                                                      availability, and in the provision of brief intensive support to persons discharged as an interim measure until the CATT or other appropriate service can take on full
                                 Early Discharge Liaison Service                                                                                                                                                                                                      Saji Damodaran
Southern Health   D 03-057                                            responsibility. The Service will be active in the ED by identifying with the ECATT those people who can be discharged from the ED with brief support from the EDLS.The                                                    Emergency Care
                                                                      capacity of ED will be increased by:(a) Transferring patients with a psychiatric condition to a more appropriate setting and in a timely manner.(b) Improved responsiveness to
                                                                      psychiatric care events(c) Instilling better mechanisms for direct admissions to the inpatient units thus resulting in reduced mental health presentation to ED (d) Reducing the
                                                                      incidence of aggression, violence and assaults in ED resulting from lengthy periods of waiting.(e) Supporting the ED staff in
                                                                      managing mental health conditions.
                                                                      The Peak Flow Program is for patients with one of the following; COPD, Asthma, Pulmonary Fibrosis or Bronchiectasis, who also meet a set criteria. The Peak Flow initiative
                                                                      will lead to the early identification of deterioration in these patients, provide rapid access to assessment and investigations within the acute setting through a respiratory
                                                                                                                                                                                                                                                                      John Stanway
Southern Health   D 03-084       Peak Flow Program                    assessment unit (RAU) and aim for improved communication to General Practitioners once a patient is discharged. General Practitioners and patients enrolled in the Program                                                 Medical Access
                                                                      will have a central point of contact to the acute setting in the role of a Respiratory Community Care Consultant and a dedicated Respiratory Assessment Unit (RAU) Medical
                                                                      Initially used four main facilities (The Mews, Perpetual In The Pines, Oakmoor and Le Grand) in different municipalities offering families closer proximity. Areas included                     John Stanway
Southern Health   D 03-120       Winter Transitional Care - Clayton                                                                                                                                                                                                                              Bed Management
                                                                      Windsor, Oakleigh, Camberwell and Kew. At certain stages during the winter months Clayton was purchasing up to 12 Private Interim Care beds.                               
                                                                  The Abberfield Project evolved from current work practices and evaluations, recognising the need for case managing interim care patients into private beds. Background
                                 Winter Transitional Care -
Southern Health   D 03-121                                        Southern Health purchased private interim beds on an ad hoc basis in the local area. This practice continues as abberfield is too far for most families of patients at                                                         Bed Management
                                                                  The Diabetes Ambulatory Care Service (DACS) is the first such service established for children and adolescents in Victoria. Approximately 70% of our newly diagnosed
                                                                  patients have circumvented inpatient admission. A purpose built area was developed adjacent to one of the Monash Medical Centre children‟s wards comprising a waiting
                                                                  area, reception, treatment room, education rooms and offices. Additional staff recruitment began in October 2002 and the DACS Unit opened in May 2003. New technologies
                                                                  such as insulin pump therapy and continuous blood glucose monitoring have been developed with funding available for equipment purchases and increased staffing required.
                                                                                                                                                                                                                                                                        Caroline Clark
Southern Health   D 03-122       Diabetes Ambulatory Care Service Due to funding constraints the unit is only able to function 8am to 6pm on week days, and a limited inpatient admission is still required when patients are admitted directly to                                               Medical Access
                                                                  the DACS unit either from their local GP or from the Monash Medical Centre Paediatric Emergency Department Triage Nurse. Established patients with unstable diabetes or
                                                                  intercurrent illness are also assessed and managed in the DACS Unit if possible. Currently, we manage 60-70 newly diagnosed patients annually and have 550 aged less than
                                                                  19 years. Overall the Ambulatory Care Project has been very successful and we recommend
                                                                  continuation and development of this most effective model of diabetes care.

                                                                 The Acute Medical Care Unit was designed to stream patients from the emergency department with a collaborative model approach of intensive nursing, medical and allied
                                 Better Emergency Access Through health with the aim to reduce the LOS for general medical patients and provide monitored beds for these patients. The Acute medical care unit was also developed to
                                                                                                                                                                                                                                                                      John Stanway
Southern Health   D 03-125       Improved Streaming and Patient  facilitate discharges from the Emergency department within 6 hours or less and has established a close working relationship with the Emergency department. The unit is team                                                     Emergency Care
                                 Flow (RASEC)                    based with all members located on the Acute Medical Care Unit and all patients cared by the same multidisciplinary team with twice daily team meetings. All medical staff
                                                                 attend the meetings including the AMCU Medical consultant. All team members were specifically employed to assist the model of care within the Acute medical care unit.

                                                                      The project commenced operation in February 2002. The objective has been to increase the clinical capacity of sub-acute services at Kingston Centre through the earlier
                                                                                                                                                                                                                                                                          Alan Lilly
Southern Health   D01-043        Enhanced Sub-Acute Capacity          admission of patients after their acute episode of care. This then takes the form of direct admissions via the Emergency Department as well as developing the capacity to                                                  Bed Management
                                                                      manage higher levels of illness and the ability to affect discharges on the weekend.

                                                                                                                                                                                                                                                                       Sue Blake
                                 Clinical Review of Varicose Veins / A pilot was established in Southern Health focused on Category 2 and Category 3 General Surgery and Vascular Surgery patients who have waited longer than clinically
Southern Health   D 03-132                                                                                                                                                                                                                              Surgical Access
                                 prioritisation                      desirable for varicose vein surgery.

                                                                                                                                                                                                                                                                                                 Medical Access

                                                                                                                                                                                                                                                                                                 Assessment Form
                                                                                                                                                                                                                                                                                                 Consultation Form
                                                                                                                                                                                                                                                                                                 Referral and Assessment Flow
St. Vincent's                                                         The Aged Care Consultation Service (ACCS) is an interdisciplinary team specialising in comprehensive assessment and management of older people in the acute care setting.                       Peter Hunter               Chart
                  D 03-044       Aged Care Consultation Service
Health                                                                The collaborative team provides a mechanism through which evidence-based practice can be delivered.                                                                                      Functional Maintenance Program
                                                                                                                                                                                                                                                                                                 Quality and Management Plan
                                                                                                                                                                                                                                                                                                 Consumer Feedback Survey
                                                                                                                                                                                                                                                                                                 Delirium Guidelines

                                                                      The ESAS Program at St. Vincent‟s Health (SVH) is in its second year and has been set up to triage and treat category 2 and 3 patients requiring orthopaedic and urology
                                                                      procedures. Patients that have waited longer than the desired category times are referred to SVH from a range of Melbourne metropolitan hospitals for timely treatment. All
St. Vincent's                    Elective Surgery Access Service      patients attend a “one stop program” where they have both a surgical consultation and a thorough pre-admission process to optimise their health prior to surgery. At                            Cynthia Dowell
                  D 03-047                                                                                                                                                                                                                                                                       Surgical Access
Health                           (ESAS) – Stage 2                     completion, they are given a date for their specified surgical procedure. ESAS theatres are quarantined, as are four orthopaedic beds. This ensures optimal utilisation and    
                                                                      minimises cancellations, thus throughput is assured. Extensive discharge planning occurs at pre-admission assisted by the use of a “Discharge Predictor Tool”. The majority
                                                                      of patients are discharged directly home with a comprehensive Hospital in the Home Program to avoid additional strain on inpatient rehabilitation resources.

                                                                      During peak periods for multiple attendances at triage, a member of senior medical staff assists nursing staff in triage. In addition, the SMS holds the „GP hotline phone‟ so
St. Vincent's                                                         that he/she is familiar with the patients‟ presenting problem before their arrival and has instituted investigations, tried to find a bed or notified an inpatient doctor. The SMS
                  D 01-061       Increased Medical Triage in ED                                                                                                                                                                                                      Brendan Murphy              Emergency Care
Health                                                                on medically assisted triage is also involved in results review, quality assurance and Hospital in the Home recruitment and follow up of recalled patients. The multi-tasking
                                                                      aspect of the SMS role enables the greatest benefit from available time, as well as being able to provide immediate medical intervention.

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        Hospital Demand Management (HDM) Strategy 2003-04

                                Darebin Community Rehabilitation Darebin CRC, located in Northcote, was established in November 2002 by St Vincent‟s Health (SVH) to provide interdisciplinary community-based rehabilitation for the
St. Vincent's                                                                                                                                                                                                                                                 Neth Hinton           Discharge hospital - Community
                  D02 - 145     Centre – Extending Care to the   residents of the City of Darebin. It provides a responsive person-centred community based service that assists in reducing demands on emergency departments, acute and
Health                                                                                                                                                                                                                                             Home
                                Community                        sub acute inpatient beds and also receives referrals from local general practitioners and community services.

                                                                   Physiotherapy (PT) and Occupational Therapy (OT) services are provided over the weekend to create a seven-day a week service. An allied health assistant provides support
                                                                   on both Saturday and Sunday mornings, with the Occupational Therapist working six-hour days. The physiotherapist works eight-hour days. The service commenced in
                                                                   2002 with only a physiotherapy component. Even though this was seen to be an effective, there was a recognised need for functionally based OT treatment and weekend                                              Discharge
St. Vincent's
                  D 03-045      Weekend Therapy                    home visits to provide a more comprehensive and interdisciplinary service. The inclusion of an OT weekend service also provides scope for an interdisciplinary assessment for              Stephen Vale
                                                                   weekend patient admissions, as well as provision for weekend discharge home visits. Patients are timetabled according to departmental guidelines by the therapists                                               Allied Health Service
                                                                   responsible for the overall patient management during the working week. The timetable is created in conjunction with nursing staff to ensure that it is appropriate in terms of
                                                                   patient readiness, the patient‟s functional level of ability, and to integrate nursing in the delivery of the weekend therapy program.

                                                                   The Occupational Therapy High Level of Care (HLC) Discharge Coordination Program is aimed towards achieving optimal outcomes for patients assessed as requiring nursing
                                Occupational Therapy High Level    home level of care, but who wish to return home directly from acute setting. The program provides early identification and ongoing discharge coordination/management of
St. Vincent's                                                                                                                                                                                                                                                 Peter Hunter
                  D 03-046      of Care Discharge Coordination     HLC patients in the acute environment, to ensure a smooth and safe transition to their own home with family/carers. This is achieved through a dedicated, specialised                                            Allied Health Service
                                Program                            occupational therapist (OT) working collaboratively with the patient, the patient‟s family and general practitioner, carers, external care providers, community agencies and the
                                                                   inpatient multidisciplinary team to best meet their needs.

                                                                                                                                                                                                                                                                                    Discharge hospital - Community
St. Vincent's     D 02-141 /                                       To assist in the development and implementation of a model that provides private accommodation for St. Vincent‟s Health patients who require access to hospital services                   Cynthia Dowell
                                Ambulatory Care Centre/Medihotel                                                                                                                                                                                                                    Patient/Carer External
Health            D 02-142                                         without the need for an acute inpatient or Medihotel bed.                                                                                                                 
                                                                                                                                                                                                                                                                                    Accommodation - Policy
                                                                                                                                                                                                                                                                                    Local Services/Accommodation
                                                                                                                                                                                                                                                                                    Discharge hospital - Community
Western Health    D 01-054      Inpatient clinical coordination    The Clinical Coordinators is an advanced practice nurse who works alongside the RAMU medical, nursing and allied health staff

                                Bed Alignment/ Coordinated         To ensure that patients received right service/ right place at the right time and to match service (beds) to demand rather than provide a full service and wait for the activity          Maree Wilson
Western Health    D 03-055                                                                                                                                                                                                                                                          Bed Management
                                Resource Management                to fill the service provided.                                                                                                                                              

                                                                   In achieving the above aims, the project works to implement the Patients First Model of Care, described below. This is being done through re-organisation of current
                                                                   services in terms of configuration and models of care. In addition the Patients First Model of Care has been used as the basis for all HARP funded projects, including the                   Jon Evans
Western Health    D 03-108      Patients First                                                                                                                                                                                                                                      Medical Access
                                                                   CDMP, Complex Needs, Outpatient Redevelopment Strategy and Residential Care Liaison. Work also concentrates increasing access to HITH through re-organisation of             
                                                                   current resources. Patients First is also being used as the service model for the Melton Super Clinic.

                                                                                                                                                                                                                                                                                    Emergency Care

                                                                                                                                                                                                                                                                                    Neurological Assessment
                                                                                                                                                                                                                                                                                    Managing Patients With Acute
                                                                                                                                                                                                                                                                                    Nursing Assessment for a Patient
                                                                   An advanced practice nurse and ED consultant see and treat a selected range of patients whose treatment time is estimated to be less than 1 hour, do not require care on a                                       who has Fallen
                                                                   patient trolley and who do not have a requirement for narcotic analgesia. The target groups of patients were those who have a triage presenting complaint grouped into minor                                     Nurse Discharge Planning
                                                                   injuries, minor complaints, results, administration and minor infections. By using senior medical staff seeing these patients in a “fast track” area we hypothesized that waiting                                Continence Management
Western Health    D 03-056      Fast Track in ED
                                                                   times and treatment times would be reduced compared with these patients being processed through the usual triage priority model of care. Inherent in this model was the                                          Strategies
                                                                   training of nursing staff to achieve advanced practice skills in areas such as single limb X-ray ordering, provision of analgesia, would management, splinting and plaster                                       Community Care Needs
                                                                   application.                                                                                                                                                                                                     Legal Orders
                                                                                                                                                                                                                                                                                    Admission and Discharge
                                                                                                                                                                                                                                                                                    Planning Assessment
                                                                                                                                                                                                                                                                                    Patient Admission,
                                                                                                                                                                                                                                                                                    Intra/Interhospital Transfer &
                                                                                                                                                                                                                                                                                    Discharge Checklist
                                                                                                                                                                                                                                                                                    Complex Patient Needs Screen
                                                                                                                                                                                                                                                                                    Bed Alignment Strategy

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