Wodonga HITH service
rises to the challenge!!
Cross Border Hospitals Amalgamate
2
BACKGROUND Wodonga HITH Service
• Wodonga Hospital HITH Service
� commenced in 1995 as a pilot project,
providing services to patients living in
Victoria
• During the first three years
� one RN worked Monday to Friday
0800 – 1630
• Now a seven days a week service
� AM & PM shifts covering NSW & Victoria
3
The good ole days!4
A TRULY UNIQUE HEALTH SERVICE
• Albury Wodonga Health model
� first cross border health service to exist in
Australia
• Integration began in July 2009
�operating under the Victorian Department
of Health
• Intergovernmental agreement &
service plan from 2012 - 2025
�between NSW & Victorian governments
for delivery of health services5
• Provides acute, subacute, mental
health, emergency & community
based services
� to approximately 180,000 people living on
the Border & in the East Hume region
• Population projections from 2011 to
2026
�An increase of 25,000 people (10.2 %)
6
A TRULY UNIQUE HEALTH SERVICE (cont)
BENEFITS ALREADY DELIVERED
• Reduced duplication
� Increased number of services using the
same resources
• More streamlined services across
two campuses
• Increased career development
opportunities for staff
7
BENEFITS ALREADY DELIVERED (cont)
• Regional mental health & dental
services now under one umbrella
• Strong foundation for service growth
• Better able to respond to population
growth & demographic changes in the
region
8
• In early 2011
� New community nursing service nurse
manager appointed
� New Wodonga Campus based
community nursing department created
• Incorporates three community based
services
� Hospital in the Home (HITH)
� District Nursing (DNS)
� Regional Palliative Care Consultancy9
HEALTHCARE@HOME
• April 2011
� Integration of HITH & DNS
services began
• Aims
� To combine HITH/DNS client lists
� To increase skill sets of staff to
enable working across both areas
• Clinical coordinator
� Position established to support
both services
10
Workforce Development
Skill sets required to provide HITH & DNS services vastly differ:
• Professional development of staff
needed to enable them to work
across both services
• Required competencies identified &
needs of individual nurses
documented
• Clinical nurse educator appointed
at 0.4 FTE, now ongoing11
Challenges
What Makes a Community
Nurse
12
Driving & Map Reading Skills
To Howlong
To Melb
Primary
School
Stanhope street
Palmers Street
Burrows Road
Tara Drv11 Unite Head Court
13
Environmental Preparation
14
Communication Skills
15
Competencies
• Syringe driver
• Visitrak
• PICC lines
• Doppler
• Digital photography
• Compression bandaging
• Venipuncture
• Cannulation
• VAC
• Baxter infusion
• IV – Alaris pumps
• Portacath
• Anaphylaxis 16
CLINICAL OPERATIONS RESTRUCTURE
• Began in mid April 2013 as integration
of services continued
• Very inclusive working group
established
�staff invited to participate in several cross
campus meetings
• Implemented from 1 January 2014
17
New Clinical OperationsOrganisational Chart
18
Where Does HITH Fit?
• Several options discussed
� Based in acute stream but remain under
nurse manager of HealthCare@ Home
� Stay as is
• Team decided best option was to stay as is
with opportunity to review in future
� Best opportunity to grow the services
� Broader team rather than service based
� Improved patient centred care – move
clients across two services; often same
staff provide care
� Increased flexibility of service delivery 19
Decisions Decisions!!
20
Allied Health Organisation
Chart
21
The Mighty Murray
The Great Divide22
CROSS BORDER SYSTEMS & LEGISLATION ISSUES
• Many Albury medical staff do not
have admitting rights to Wodonga
� particularly ED doctors (use a number of
locums)
• Patient admission systems differ
(VITAL vs iPM)
� Data incompatible & not accessible to
health information staff
� Data from Albury Campus initially sent
to NSW & then on to DoH Victoria
23
• HR/Recruitment
� Different awards
o People must apply to each campus
for permanent positions
o Very recently initiated a cross
campus casual nurse bank
� Nursing Registration
• OH&S
• Drug protocols differ for many
medications 24
SYSTEMS & LEGISLATION ISSUES (cont)
REFERRAL PROCESS FOR NSW PATIENTS
• Discharged & readmitted onto HITH
as Wodonga Campus patients
• Education of Albury Campus staff is
ongoing
�Albury has not had a HITH service for
many years & then only briefly
• Admitting Albury Campus patients
very time consuming due to distance
(THE MIGHTY MURRAY DIVIDE)!25
To provide acute care to a patient who is
identified as appropriate to receive care at
home
26
CLIENT REVIEWS
HITH Clinic
�Historically clients were reviewed
in ED
o admitted to ED prior to review
with often long waits
�Clinic established mid 2013
�Multi-use now by DNS & DPU
�Orthopaedic patients are reviewed
in outpatient orthopaedic clinic at
Albury Campus 27
SHORT STAY UNIT
• Established in Albury Campus ED
in March 2014
• Clear admission criteria, goals &
time limits
• Aim is to reduce the number of
patients who might otherwise have
been hospitalised & get people
home
• Dedicated, non-rotational staffing28
SHORT STAY UNIT (cont)
• Expedites episode of care
�uses clinical pathways for diagnostic
groups eg asthma, chest pain,
cellulitis, DVTs
• Short-term
� less than 24 hours
• Referral to HITH (and allied health)
� written into clinical pathways
29
THE FUTURE FOR THE ORGANISATION
• Continue to strengthen Albury
campus to provide most of the acute
services
�consolidating acute & emergency
services
• Consolidation of sub-acute services
over time at the Wodonga campus
� strong demand for these services
continues
30
THE FUTURE FOR HITH
Continue to:
• Grow the service for Albury
Campus patients
�Including resources
• Educate Albury staff about HITH
referral process
• Embed HITH/DNS services into the
new Clinical Operations Structure
31
HealthCare@Home
32
Or as pathology often calls HITH
Hospital in the House!!!
33
Cross Border Hospitals
Amalgamate
Wodonga HITH service
rises to the challenge!!
JF1
Slide 34
JF1 Jeanie Farrington, 22/05/2014
