Leading Better Value Care
Local vignette – Central Coast LHD

Chronic obstructive pulmonary disease

Inpatient liaison service and rapid access – a clinician's perspective

By Darren Pulleybank

27 Apr 2021 Reading time approximately

What is important to know about your service?

Wyong Hospital is a 300 bed, B1 peer group hospital. It provides care to a population of approximately 170,000 people, with a higher than the national average of Aboriginal and Torres Strait Islander population at 4.9%. The hospital runs using a visiting medical officer driven general rotating admitting roster, this often results in those with chronic obstructive pulmonary disease (COPD) being cared for by an unrelated sub-specialty team. This directly influences patient flow, in that, length of stay largely exceeds the average when compared to if they were cared for by a respiratory team. Key care points are often overlooked including spirometry, inhaler device technique, and the use of and weaning of oxygen.

What organisational model do you use?

An inpatient liaison service with a rapid access clinic.

Diagnostic testing
leads to
Exacerbation management
leads to
Ongoing care
leads to
Last year of life

What is special about the way care is delivered that is valuable for others to know?

Wyong Hospital has implemented an inpatient liaison service for patients with COPD. A clinical nurse specialist (grade 2) is able to case find patients admitted with a primary diagnosis of COPD through the Electronic Medical Record or referrals can be made by nursing and medical staff. The patient is usually reviewed on the day of referral.

A rapid access clinic is also available for patients at risk of representing to hospital and to also ensure timely access to a specialist. The rapid access clinic is held once per week in the outpatient setting. It provides patients with access to a respiratory specialist without a referral and at no cost.

Patients can be referred to the clinic from the emergency department, inpatient setting or through the rehabilitation teams in the community.

A companion document describes options for organisational models in COPD. One option is a Respiratory Coordinated Care Program – this vignette describes the model from a local perspective.

How does it make a difference?

It provides the patients with a sense of support, and a consistent familiar face. It also ensures that they receive care in line with the COPD guidelines. The rapid access clinic provides these patients with a one-off appointment seeing a respiratory specialist without need of a referral, at no cost. It helps to reduce readmissions and patients anxiety about their appointments.

What tips do you have for others?

  • An absolute non-negotiable is the support of your direct line manager and the head of the department.
  • Align it with the goals of the district.
  • The setting would require access to spirometry and adequate clinic space with administration support.

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