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5-6 December 2005 - Melbourne

Short Stay Unit for Medical Patients Presenter: Colleen White/Ibolya Nyulasi Hospital: Cougar Colleen White ( C.White@alfred.org.au 03 9276 6051) Ibolya Nyulasi ( I.Nyulasi@alfred.org.au 03 92763063) Lisa Somerville ( L.Somerville@alfred.org.au 03 92763526). 5-6 December 2005 - Melbourne.

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5-6 December 2005 - Melbourne

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  1. Short Stay Unit for Medical PatientsPresenter: Colleen White/Ibolya NyulasiHospital: CougarColleen White (C.White@alfred.org.au 03 9276 6051)Ibolya Nyulasi (I.Nyulasi@alfred.org.au 03 92763063) Lisa Somerville (L.Somerville@alfred.org.au 03 92763526) 5-6 December 2005 - Melbourne

  2. KEY PROBLEM • Significant under-achievement of DHS target ‘Percentage of patients admitted within 12 hours from ED’ (average 60%), with a target of 80-85%. • In March 04 Cougar patients were averaging a 17 hour wait in ED for admission to ward. • Only A1 hospital without ‘Short Observational Unit’. • New target of 80% admitted within 8hours implemented June 05.

  3. SOLUTION • Short Stay Unit in ED (ESSU) 6 beds and on inpatient medical unit (MSSU) 8 beds commencing October 04. • Allied Health staffing: PT – 4 hours/day OT – 4 hours/day SW – 4 hours/day Nutrition – 1.5 hrs/day SP – 1 hour/day • Funding provided by DHS with internal business case process for AH resources. • Focus to improve access and patient flow within ED and improve patient outcomes by providing rapid model of assessment/management for general medical patients.

  4. INNOVATIONS IMPLEMENTED - AH • Timely and comprehensive AH assessment • Dedicated, experienced ‘Aged Care’ AH team • Blanket referral – all patients seen by AH • Multi-disciplinary and interdisciplinary screening within 24 hours (using screening tool) • 7 day service, specific AH KPIs • 8 beds co-located with dedicated MD team

  5. OUTCOMES SO FAR LOS for admitted general medical patients dec by 3.7 days (from 8.0 to 5.7) 69% of ED patients admitted to ward < 8 hours More streamlined transfer to sub-acute MSSU • ALOS 27- 46 hours (with aim <48 hours) • Occupancy 76% • Average patients/month 80 • Discharge destination: Home 40%, Sub acute 25%, other IP units 28%

  6. LESSONS LEARNT • Strong organisational buy-in/commitment to project was crucial. Also strong AH management support to clinicians. • Interdisciplinary model not relevant to all AH disciplines. • AH team that are experienced and have established good working r’ships is vital; difficult to maintain model of care with ‘external’ w/end staff. • Under-estimated ‘CSM’ time/requirements. • Ensuring consistent approach (eg data capture) more difficult across 5 AH disciplines. • Future development – expand model of care to general medical units/patients.

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