Walanga Gul: 48 hour follow up – “Just calling to have a yarn”

First Nations people living with chronic disease are more likely to be re-admitted to hospital within 28 days compared to non-Aboriginal people. Unplanned re-admissions result in increased expense to the health system and impact negatively on the client’s quality of life and their psycho-social wellbeing. ¹ The Nepean Blue Mountains Local Health District (NBMLHD) 48 Hour Follow Up Service was found to not be servicing all First Nations people referred to the service in the Penrith local government area.

Only 47% of clients referred to the service were contacted within 48 hours, with 32% of clients unable to be contacted at all. One in ten of clients re-presented to Nepean Hospital within 28 days of discharge. Our clients reported that they were fearful of who the caller might be and that they were worried they may be asked to return to hospital. They reported prioritising their family commitments over their own health needs. Clients were lacking a cultural connection to our service and voiced the need to have the service “feel like family.” Staff voiced their dissatisfaction in not being able to contact the client within the first 48 hours post-discharge from hospital. They expressed feelings of being deflated, disheartened and overwhelmed, and acknowledged a change to the model of care was needed.

Walanga Gul - Darug language for "follow up"

This project aims to improve follow-up care provided to First Nations people after they return home from hospital. The NBMLHD Primary Care and Community Health team worked with the local community to review and improve the existing 48 Hour Follow Up program, including the co-design of a culturally appropriate patient reported experience measure (PREM) and update of an existing model of care (MOC).  The Walanga Gul project commenced in February 2021; Walanga Gul is Darug language for “follow up”. As the project had impacts for a vulnerable population, the need for ethics approval was identified early in the initiation phase. There were significant delays associated with both the ethics applications and the COVID-19 pandemic. Consequently, diagnostics did not commence until December 2022.

Diagnostics included a literature review, individual patient journey interviews, focus group/art workshop, file reviews, service data analysis, a process mapping workshop and an issues identification and prioritisation workshop. Qualitative data was analysed by theme. Key issues included inability to successfully contact clients by phone after discharge, an outdated model of care and referral criteria, and poor client engagement.

Co-designing a bespoke PREM

The project team commenced implementation of solutions in September, 2023. The co-design of the PREM included a survey designed in collaboration with local community, implementation with the QARS platform in September, 2023 and distribution of the PREM in October, 2023. As of November 2023, a small number of responses have been received.

The following progress has been made in updating the MOC:

• Transition to patient Flow Portal as source of referral. This allows greater flexibility in identification and screening of referrals and brings the team in line with the Planned Care for Better Health MOC processes.
• Remove ineligibility criteria based on time spent in ED. The project has not yet included referrals for clients who have spent any amount of time in ED. This is due to workforce issues that have occurred outside the scope of the project. This part of the solution has been put on hold until the critical workforce stabilises.
• Enhance the use of SMS to support contact with clients.

There has been the implementation of the name “Walanga Gul”, which includes updates to promotional resources. The project continues in the implementation phase.

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

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