From Medical Excellence to Personal Confidence
2 December 2016 Last updated:
16 December 2016
From Medical Excellence to Personal Confidence
St Vincent’s Hospital Sydney (SVHS) reviewed its Hospital In The Home (HITH) service and implemented a number of improvements, including care pathways, inclusion and exclusion criteria, online referral processes, communication among healthcare teams and shared care planning with patients.
View a poster from the Centre for Healthcare graduation, December 2016.
To improve the patient experience by providing a cost-effective, sustainable and person-centred HITH service based on best practice.
- Improves patient satisfaction and involves the patient in decisions about their care.
- Ensures that patients stay in hospital for the optimal amount of time, reducing the risk of adverse events due to an extended hospital stay.
- Increases awareness of and occupancy in HITH services.
- Improves nursing skills and capacity, with enhanced HITH education on the ward.
- Increases staff satisfaction and morale.
- Improves the quality of care to patients through streamlined and efficient service delivery.
- Increases bed availability and maximises the efficiency of hospital resources.
Over the past 10 years, there has been a rising interest in HITH services, prompted by the outcomes of several national and international reviews on the HITH model of care. The studies identified that:
- patients have better or equal clinical health outcomes in comparison to traditional inpatient admissions
- patients and their carers report increased satisfaction when treated via HITH models
- HITH services are more cost effective than hospital stays.
In Australia, HITH services have been shown to support patient flow, help hospitals meet the Emergency Treatment Performance (ETP) benchmark, increase capacity within the healthcare system and improve the patient experience. The SVHS HITH began in 2013 and has grown to a 10-bed service. The healthcare professionals that run the service include a senior staff specialist, registrar, clinical nurse consultant and registered nurse. This changes depending on the clinical needs of the patients, their treatment duration and geographical location.
Prior to the project, the ETP for SVHS was around 69%, with a target of 81%. There was an opportunity to increase the number of patients in the HITH service, to improve ETP, avoid patient hospitalisations and reduce length of stay. However, a clinical redesign process was required, to ensure growth is sustainable and positively impacts patient safety, healthcare expenditure and service delivery. It was determined that an integrated model of care would allow patients to be treated in the right place at the right time.
- A workflow chart was developed and distributed to all major referral sources, highlighting the criteria for admission to HITH and referral process. The chart is easy to understand and applicable in day-to-day operations. It has also been uploaded for use as an online referral.
- In-service education was delivered to staff, to improve their understanding of HITH and increase their confidence in referring patients to the service. Clinical nurse educators supported this initiative with further education to patients and staff.
- A HITH Liaison Nurse was recruited to expand the competency of HITH nurses, through practical training and oversight of service delivery.
A video was created to promote the HITH service among potential HITH patients.
Implementation - the initiative is ready for implementation or is currently being implemented, piloted or tested.
February 2016 – July 2017
Xavier Inpatient Wards, St Vincent’s Hospital Sydney
- A full evaluation of the project will take place in July 2017, with the aim of reducing hospital length of stay for patients with cellulitis, pyelonephritis, urinary tract infections and chronic obstructive pulmonary disease by 25%.
- Patient experience trackers have been used to measure satisfaction levels, with an improvement in all parameters from 85% in March 2016 to 90% in December 2016.
- Staff satisfaction with the HITH referral process improved from 35% in March 2016 to 75% in December 2016.
- Staff confidence in referring patients to the HITH service and staff understanding of HITH increased from 37% in March 2016 to 80% in December 2016.
- Staff understanding of the inclusion and exclusion criteria for HITH patients increased from 12.5% in March 2016 to 80% in December 2016.
Strong leadership and teamwork is essential to the success of the project, as is consultation with staff and patients. It’s also important to communicate regularly with stakeholder groups to overcome any resistance to change.
- Page A. Talking Healthcare Home Ideas Lab. Penrith: Centre for Health Research, Western Sydney University; 2016.
- Shepperd S, Iliffe S, Doll HA et al. ‘Hospital at home’ services to avoid admission to hospital. The Cochrane Library; 2016. DOI: 10.1002/14651858.CD007491.pub2.
- NSW Health. Hospital in the Home
Nurse Manager Chronic and Complex Services
St Vincent’s Hospital Sydney
Sydney Local Health District
Phone: 02 8382 1518
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