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Innovative programmes deliver more community-based care in Canterbury

Case Study

posted by Alastair McLean on 2012-04-18 10:01:32.386

A range of programmes to deliver more community-based health care in Canterbury is reducing demand on the emergency department (ED) and resulting in fewer hospital admissions. 

Canterbury DHB Planning and Funding Team Leader, Dr Greg Hamilton, says the first step was to establish a team of clinical champions representing community-based, ED and hospital-based health services, and identify what they jointly wanted to achieve across the health system.

‘We’ve taken a whole of system approach, based on the principle that most patient’s home in the health system is with their general practice, and health services should be provided as close as possible to their home.’

He says it’s important that solutions are data driven. This includes daily and weekly reports on ED status delivered to decision-makers throughout the Canterbury health system. The reports include the number of ED presentations, GP referrals to ED, 111 calls transported to ED, rates of hospital admission from ED, as well as a number of other indicators from across the system. 

‘ED is a really good gauge of how the whole health system is running. People can look at these reports and know what parts of the system are under stress.’

CREST – the supported discharge and community rehabilitation enablement support team– is an important part of the mix. Six teams of nursing and allied health staff provide intensive support – up to four visits a day – to a patient in their home for up to six weeks.

CREST has had 800 clients over the 11 months it’s been operating. It currently has about 180 clients in the programme and the capacity to accept more. 

‘People like the opportunity to be looked after at home,’ says Dr Hamilton. ‘Until recently CREST’s work has focused largely on supported discharges. But it’s now taking on a more proactive role, driven by general practice, of preventing hospital admissions.’

Another service, the acute demand management programme, uses 12 highly skilled community nurses to support patients for up to five days who would otherwise go to hospital because of an acute medical episode.

The DHB will also pay for patients to be observed either in general practice or in one of five designated observation beds in a 24-hour surgery.

Another aspect of the programme sees GPs being paid to extend care beyond the normal 15-minute consultation in order to manage more complex cases. It is supported by rapid turnaround radiology and laboratory diagnostic services.

The DHB also has the option of ambulance diversion when ED and hospital services are nearing gridlock. St John is asked to deliver patients they would normally bring to the ED to either a GP or a 24-hour surgery if it is safe to do so.

Dr Hamilton says the nurse-led afterhours telephone triage service is also important in preventing unnecessary presentations to the ED, because only a small percentage of those who call their GP afterhours are triaged as requiring ED-level care.

He says after the February 2010 earthquake, the DHB asked GPs to pro-actively manage their most vulnerable patients.

‘We went to GPs and said we’ve got issues with the loss of a number of hospital beds and we need you to do as much as you can to treat people in the community. They really took up that challenge and the DHB paid for an extra five hours of nursing, allied health or administrative time per thousand 1000 patients to help them do that.’

Against the national trend, there’s been a substantial reduction in the number of people presenting to the Christchurch ED since the earthquake, which Dr Hamilton says is out of proportion to the number of people who have left the city. 

‘To date, numbers attending ED are still below expected, but look to be slowly returning. People may be seeking alternative care options in the community.’

The DHB is now looking at the interface of acute demand management with residential care, further strengthening links with St John, and community management of patients with chronic obstructive pulmonary disease.

 

Related items on HIIRC:

The initial health-system response to the earthquake in Christchurch, New Zealand in February, 2011

Canterbury health system achieving health targets but faces ongoing quake-related challenges

Health Target performance still strong despite a shaken year

Dr Greg Hamilton presented on this topic at the Shorter Stays in Emergency Departments Forum, held in Wellington on 26th March 2012. His powerpoint presentation is attached below.

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