Murrumbidgee Care ConneXion

Wagga Wagga Base Hospital’s (WWBH) Emergency Department (ED) capacity is exceeded beyond 100% each day making it challenging to deliver safe and timely care to patients. A lack of alternative referral pathways available for low-acuity ED presentations and limited health literacy of consumers results in patients defaulting to the ED for their non-emergency concerns. 44% of presentations to WWBH ED are classified as “non-emergent”.

A high percentage of these patients experience an extensive length of stay, unnecessarily exposing them to hospital-acquired infections and potential adverse outcomes. Chief complaints relate to extensive ED wait times with an associated lack of privacy and dignity while sitting in an overcrowded waiting area. 8% of these low acuity presentations leave the ED without waiting for assessment and treatment. During the COVID-19 pandemic, over 7000 people in Murrumbidgee Local Health District (MLHD) were able to have their acute health care needs managed successfully in the community, preventing an unnecessary presentation to the ED.

A Whole of Health (WoH) collaborative approach resulted in a central triage intake service of expert clinicians, who remotely assessed individual care needs and tailor-designed care delivery to manage the patient effectively within a home or community setting. This successful ED avoidance strategy provided the motivation to explore alternative referral pathways to deliver urgent care services for other patient cohorts across the MLHD. This would improve access times for patients of the WWBH ED requiring emergency care.

Easing unnecessary demand on emergency resources

Murrumbidgee Care ConneXion is a proposed Model of Care (MoC) providing a centralised contact point for community-facing clinicians including NSW Ambulance , general practice GP, and residential aged care facilities (RACF). It will enable MLHD consumers to receive coordinated urgent and non-urgent care services in the community ensuring quality patient journeys and supporting the WWBH ED to retain its focus on delivering emergency care.

By connecting consumers with the right care, at the right time and by the right care provider, the care is tailor-made for them, enabling a targeted response and avoiding an extended length of stay in the ED. Where possible, platforms such as virtual care and in-reach services will be utilised, to support urgent care delivered in the home or an alternate care location, in an appropriate time frame. Ultimately, implementing this innovation will provide centralised coordination of community-facing patients, into existing MLHD and Murrumbidgee Primary Health network (MPHN) services.

MoC to be implemented in a phased approach

The Murrumbidgee Care ConneXion has not progressed to the implementation phase. The project team has not yet identified a funding source, which has delayed MLHD executive approval to commence. However, the case for change and measurable objectives of the project have been outlined, a MoC has been developed, details of the implementation plan have been drafted, and engagement and support from stakeholders secured.

The project team created this MoC following data collection during the clinical redesign diagnostics phase. Analysing the Victorian Virtual ED operationally as well as liaising with Clinical Director Dr Loren Sher has provided the basis for our project to be built on.¹ The Murrumbidgee Care ConneXion Community of Practice (CoP) meets fortnightly with senior managers from interagency organisations and internal stake holders. This collaboration enables clinical service silos to be removed and collaboration improved. This improves patient experiences, reduces gaps in service delivery and eliminates duplication.

The project team will implement the MoC as a phased approach due to the scale and complexity of the innovation, starting with GP referrals only, then extending to NSW Ambulance and RACF.  Care ConneXion Coordinators will be employed from 8am-11pm, 7-days a week to receive virtual care calls from clinicians based outside of the MLHD acute services facility. This hybrid approach enables a face-to-face clinical assessment while liaising with MLHD clinicians virtually to establish an individualised plan to comprehensively meet the patient’s urgent care needs in the communities.  A repository of community-facing services within the Murrumbidgee region will be referred to, and the appropriate service activated, to deliver care needs to the patient in the right care location.

Cultivating ongoing inter-agency collaboration

The WoH approach consists of major change management and multiple governance structures which is a significant project with many inter-agency stakeholders. For this reason, we were required to scale down the scope of our project from a district solution to a local one. As the referral hospital for the district, we selected WWBH.

Through the Accelerating Implementation Methodology (AIM), we were able to assess the climate for implementation readiness.² Through this process we have come to understand the need to wait for the right climate for change including funding sources, to enable the project to be feasible and sustainable. In the meantime, we will continue to cultivate ongoing inter-agency collaboration for project readiness, when finance is no longer a barrier.

View this project's poster from the Centre for Healthcare Redesign graduation August 2024.

References