1. One Episode of Care ……. National Demonstration Hospitals Program Sharon Donovan, Executive Director - Nursing Services Wendy Hubbard, Director - Allied Health Service Mark Yates, Director - Aged Care and Rehabilitation Medicine Ballarat Health Services ACHSE Breakfast Forum 19 April 2002

2. Ballarat Health Services BALLARAT Horsham Ararat Ballarat Health Services and the Grampians Region

3. Ballarat Health Services l Sub-acute may be - post-acute - direct from community - inpatient or outpatient l Distinct from acute care - disability / handicap vs illness / impairment - longer vs. shorter care - complexity vs. intensity l Distinct from residential care …… but sub-acute care can avoid or expedite entry to residential care What is the sub-acute system?

4. Ballarat Health Services How does the Interface Occur? Community Living Failing with Community Living Inpatient Sub-acute Care Acute Care Time Function Recovering from Hospital Care Subacute outpatient programs

5. Ballarat Health Services l Specific to older Australians and targeted l Syndrome specific (falls / continence) l Timely application of risk assessments which are easy to apply l Incorporating risk specific action plans / pathways Risk Identification and Management

6. Ballarat Health Services l Free the acute services to address the acute condition l Accurate diagnosis of comorbidities and identification of other issues including disability and handicap l Appropriate movement from acute management Interdependence of Systems Enabling Acute Care

7. Ballarat Health Services Acute Risk Management Interface Management Interdependence of Systems Sub-acute

8. Ballarat Health Services l Identifying leverage points l Early risk assessment l Appropriate acute medical management l A managed interface l Completing the loop One Episode of Care in Practice - Changing the System

9. Ballarat Health Services Interface management Elective Surgery Emergency surgery Risk Screen Appropriate acute care with risk management Timely movement to sub-acute systems Joint Replacement Flow Chart

10. Ballarat Health Services l Continuous integrated involvement by staff with appropriate skills at various care stages l Interlinking of specialist clinics (Falls / Continence / Dementia) with the whole system l Early discharge notification to families, GPs and community services Benefits of a Single Episode

11. Ballarat Health Services l Minimisation of stay and associated risks in acute hospital (ALOS decreased by 2.4 days) l Efficiency of bed use (WIES casemix funding pbd increased by 0.11) l Minimisation of duplication and repetition Benefits of a Single Episode

12. Ballarat Health Services l Promote the philosophy of one episode of care l Identify the skills and service linkages required to implement the model l Establish risk assessment and management processes l Facilitate the redesign of systems and resources (including financial) l Evaluate project outcomes One Episode of Care in Collaborating Hospitals

13. Ballarat Health Services l Identify patients and diagnostic groups most likely to benefit from application of the model l Map collaborator resources across the entire episode l Identify and coordinate project champions at collaborating hospitals l Educate and consult to enhance skills l Implement and evaluate model One Episode of Care in Collaborating Hospitals

14. Ballarat Health Services l Broaden current model to encompass complex medical patient groups l Further develop indicators for early identification and intervention l Adapt and scale model to suit a variety of rural and regional settings l Implement model in hub and spoke framework One Episode of Care Enhancement Project

15. Ballarat Health Services Summary l One episode of care operates in a service system l One episode of care is a philosophy that has the capacity to -improve hospital care for older Australians -improve efficiency in the delivery of acute care l Transferable to rural and regional settings across various levels of system complexity