Greater Newcastle Hospital in the Home: Care in the bed you prefer

Public hospitals are facing increasing demand and bed pressures. ¹ Hospital in the Home (HITH) is an established strategy to improve patient flow and facilitate supported discharge. ² In the Greater Newcastle area, HITH services are underutilised. Referral rates to the Greater Newcastle HITH service are not reflective of the increased demand seen in public hospitals.

Greater Newcastle covers a large geographical area with a diverse population of approximately 450,000 people. The population has been shown to have a likelihood of two or more chronic health conditions, higher than state averages, putting the community at higher risk of hospital presentation. ³ The Greater Newcastle HITH provides safe, high-quality care in the community, as an alternative to inpatient hospital care. Whilst the service is well established within Newcastle, it is not always recognised as a viable alternative to inpatient hospital care. The project team has set out to determine and address the underlying cause of this discrepancy.

The aim of this project is to increase utilisation of the HITH service, improve efficiency and maximise the capacity of the service to support both patients and the health system. The project team have engaged with patients, staff and referrers to determine current strengths and opportunities for improvement and innovation. Increasing referrals to the Greater Newcastle HITH service, will support a decreased length of stay in the acute sector for patients, providing the health system a more cost-effective alternative, whilst also reducing the risk of hospital-based complications. An added outcome is the engagement and support of staff to promote a positive experience of care for our patients and their carers leading to health outcomes that are meaningful for them. ¹

The following objectives have been developed to address the needs of our community including patients, referrers, staff and NSW public hospitals:

• Increase the number of referrals to the Greater Newcastle HITH virtual ward by 25% by February 2025.
• Increase Greater Newcastle HITH virtual ward admission capacity by 10% by February 2025 within current HITH nursing full time equivalent.
• Increase the use of technology in the referral, assessment and care of patients by 50% by February 2025.

The team has also identified a number of solutions that are soon to be implemented:

• The implementation of telehealth model to increase the capacity of the service. We recognise the need to become more efficient in the delivery of care, utilising alternate modalities, in order, to meet the increased demand within existing resources. Virtual consultations have the added benefit of reduced carbon footprint, directly addressing Hunter New England Local Health Districts goal of environmental sustainability. ⁴
• During the diagnostic phase, it was identified that Greater Newcastle HITH staff experienced multiple bottlenecks in workflow due to current documentation processes and culture. Streamlining the format of clinical documentation will increase staff efficiency, eliminate duplication, improve patient safety and clinical outcomes.
• During the diagnostic phase, referrers reported that the current referral process via a phone, contributes to frustrations and bottlenecks within the referrer’s workflow processes. The Electronic Patient Journey Board is an established system utilised by hospital staff to refer to Allied Health staff and other Specialty Services. The proposed eReferral process will allow clinicians to refer easily and conveniently, with real time access to referral progress, improving patient discharge planning.
• To support clinicians referring to HITH, a review and update of electronic resources is required and will form an integral part of this project.

View this project's poster from the Centre for Healthcare Redesign graduation December 2023.

References