One Episode of Care ……. National Demonstration Hospitals Program Sharon Donovan,

1. Ballarat Health Services ACHSE Breakfast Forum 19 April 2002 One Episode of Care ……. National Demonstration Hospitals Program Sharon Donovan, Executive Director - Nursing Services Wendy Hubbard, Director - Allied Health Service Mark Yates, Director - Aged Care and Rehabilitation Medicine

2. Ballarat Health Services and the Grampians Region Horsham l Ararat l BALLARAT l Ballarat Health Services

3. What is the sub-acute system? • Sub-acute may be - post-acute - direct from community - inpatient or outpatient • Distinct from acute care - disability / handicap vs illness / impairment - longer vs. shorter care - complexity vs. intensity • Distinct from residential care …… but sub-acute care can avoid or expedite entry to residential care Ballarat Health Services

4. How does the Interface Occur? Function Community Living Failing with Community Living Recovering from Hospital Care Subacute outpatient programs Inpatient Sub-acute Care Acute Care Time Ballarat Health Services

5. Risk Identification and Management • Specific to older Australians and targeted • Syndrome specific (falls / continence) • Timely application of risk assessments which are easy to apply • Incorporating risk specific action plans / pathways Ballarat Health Services

6. Interdependence of Systems Enabling Acute Care • Free the acute services to address the acute condition • Accurate diagnosis of comorbidities and identification of other issues including disability and handicap • Appropriate movement from acute management Ballarat Health Services

7. Interdependence of Systems Interface Management Risk Management Sub-acute Acute Ballarat Health Services

8. One Episode of Care in Practice - Changing the System • Identifying leverage points • Early risk assessment • Appropriate acute medical management • A managed interface • Completing the loop Ballarat Health Services

9. Joint Replacement Flow Chart Risk Screen Emergency surgery Elective Surgery Risk Screen Interface management Appropriate acute care with risk management Timely movement to sub-acute systems Ballarat Health Services

10. Benefits of a Single Episode • Continuous integrated involvement by staff with appropriate skills at various care stages • Interlinking of specialist clinics (Falls / Continence / Dementia) with the whole system • Early discharge notification to families, GPs and community services Ballarat Health Services

11. Benefits of a Single Episode • Minimisation of stay and associated risks in acute hospital (ALOS decreased by 2.4 days) • Efficiency of bed use (WIES casemix funding pbd increased by 0.11) • Minimisation of duplication and repetition Ballarat Health Services

12. One Episode of Care in Collaborating Hospitals • Promote the philosophy of one episode of care • Identify the skills and service linkages required to implement the model • Establish risk assessment and management processes • Facilitate the redesign of systems and resources (including financial) • Evaluate project outcomes Ballarat Health Services

13. One Episode of Care in Collaborating Hospitals • Identify patients and diagnostic groups most likely to benefit from application of the model • Map collaborator resources across the entire episode • Identify and coordinate project champions at collaborating hospitals • Educate and consult to enhance skills • Implement and evaluate model Ballarat Health Services

14. One Episode of Care Enhancement Project • Broaden current model to encompass complex medical patient groups • Further develop indicators for early identification and intervention • Adapt and scale model to suit a variety of rural and regional settings • Implement model in hub and spoke framework Ballarat Health Services

15. Summary • One episode of care operates in a service system • One episode of care is a philosophy that has the capacity to - improve hospital care for older Australians - improve efficiency in the delivery of acute care • Transferable to rural and regional settings across various levels of system complexity Ballarat Health Services