Access to Care
Author: Ann Allenby, Director Clinical Redesign
AWH is consistent with
national and international experience in experiencing considerable challenges
with accessibility and flows in and around the service system. As a result, access to care was identified as a priority issue for Albury Wodonga
Health in the period 2019-22. In 2020-21 considerable work has
been undertaken to identify the issues, lay the ground work for improvement and
set the agenda for the next three years of work.
The following pieces of work have been
completed in the last year:
- Completion of the Discovery report that
identifies the key access to care issues across the organisation.
- A three year implementation plan to systematically work towards the vision of “Improving the
community’s access to timely quality care.”
The main recommendations include:
- Review of the Daily Operating System (DOS) to
ensure readiness of the organisation on a daily basis
- Create alternate care pathways with home
based and ambulatory programs
- Decrease length of stay in hospital
- Develop a model of care to better support
people with mental health and/or addiction needs
- Work with external providers to either
prevent requirement for hospital based care or provide step down options to get
people close to home as soon as practical
- Implementation of DOS, AWH's Daily Operating System, where the access status of the organisation is visible
24hrs a day supported by a series of huddles that positions active problem-solving, lead by the clinical executives.
This has returned 140hrs/week of nurse leadership time back to the
clinical units each week.
- Implementation of electronic E-White Boards
in both Emergency Departments – which enables bed managers, food services,
administration and other teams to access information remotely and remove the need for ED Clinical Coordinators
to communicate changes.
- Implementation of a Regional Operating
System – which is a system where the status of the regional health services
come together to discuss access issues on a twice weekly basis. The aim is to understand each other’s issues
and work together to ensure safe and appropriate transfer to and from regional
- Work to detail out models of care
particularly in light of future service developments, such as, cardiology
service planning, Hospital@Home, Sub-Acute@Home and Acute Care of the Elderly –
these help provide clarity and facilitate detailed planning for future service
- Other ground work has commenced in this
financial year including, reviewing discharge practices, understanding regional
transfer process in depth, reviewing and understanding the community program
models of care.
Author: Karyn O’Loughlin, Director Allied Health
The Fracture Clinic is one of out busiest services. Patients come from all over a huge catchment area, extending from Deniliquin 212 kms away to the west, to Khancoban 156km away to the east. In 2019 almost 4000 people were seen in the clinic, an average of just under 80 patients per clinic. This demand had been building dramatically over the last few years with the figure above a 40 percent increase on five years earlier. Unfortunately, this workload began to become more than the clinic could manage. Patient wait times could extend to several hours wait, staff began to struggle under the load and other services, such as Physiotherapy and Community Rehabilitation, were being delayed or cancelled. A project was undertaken to manage this increase and the main solution proposed was to start a ‘Virtual Fracture Clinic’.
A Virtual Fracture Clinic is where referrals are assessed and triaged and appropriate patients can be managed remotely. Staff review the history and imaging of each referral to determine what services are required and how this can be delivered. Many patients can be managed safely and appropriately through telehealth, reducing demand on the face to face clinic and improving patient access to care by allowing them to receive care in their own home. The clinic also can provide virtual reviews to patients who have previously attending the face to face clinic who only need simple interventions such as a check of their fracture position on X-ray or advice on when to commence certain exercises. Virtual Fracture Clinics have been established in several locations across Australia, with two such clinics in Melbourne and several spread through Queensland. Evidence from the clinics at Royal Melbourne Health and Western Health shows that such clinics can reduce fracture clinic presentations significantly without increased risk of complications.
Our clinic started in July 2020 and is run by specially trained, advanced practice physiotherapists. Since then over 700 patients have been virtually managed through the clinic with well over 15 000 km of patient travel has been avoided. The changes through the clinic have led to a 26 percent reduction in the number of patients requiring review by the orthopaedic team in both the Wound Review and Fracture Clinics, greatly alleviating the problems of staff demand and patient wait times described above. The clinic also provides a contact point for patients of the fracture clinic throughout the week, allowing for patient and staff queries to be answered promptly. This means a range of problems relating to fractures to be solved immediately without the patient presenting to the emergency department or having to wait for the next fracture clinic. The Virtual Fracture Clinic is a key part of fracture management at AWH and will continue to improve patient care and access for years to come.
The Upper Hume Regional Health Partnership
Author: Siobhan Stewart, Regional Partnership Manager
The Upper Hume area of Victoria comprises the Local Government Areas of Wodonga, Indigo, Towong and Alpine. The Upper Hume Local Area Health Partnership (the partnership) includes all public health services within these areas.
Supporting enhanced clinical governance across all partner services is a priority of the Upper Hume Regional Health Partnership.
Achievements in clinical governance to date include:
- establishment of a regional morbidity and mortality meeting (North East Small Rural Health Service Clinical Review Meeting)
- completion of a report on local processes regarding care of deteriorating patients
- adoption of a procedure for reporting multi-site incidents.
In 2020-21, three sessions of the North East Small Rural Health Service Clinical Review meeting were held. Over the past 12 months, the meeting has evolved to reflect the constraints of the COVID-19 environment and its impact on Victorian health services. Moving the meeting online has been well received by participants and will likely continue beyond the easing of restrictions.
The meeting is coordinated by Beechworth Heath Service with regular participation from Albury Wodonga Health, Tallangatta Health Service, Corryong Health Service and Alpine Health Service.
In 2021, a clinical governance community of practice has been established to further support a regional approach to clinical governance within the Upper Hume. The Community of Practice will provide an opportunity for developing clinical governance and quality professionalism in the region;
- for reviewing and where appropriate, standardising clinical governance systems and processes to ensure they align with the Victorian Clinical Governance Framework
- for sharing knowledge and expertise
- for developing additional common reporting principles and mechanisms such as the North East Small Rural Health Service Clinical Review Meeting.
You may also like to read about an ongoing research project regarding transfers of older patients between AWH and small rural health services in our area. The Transfer of Older Persons (TOP) project is a collaborative study between Albury Wodonga Health, La Trobe University, Beechworth Health, Corryong Health, Tallangatta Health Service, and Culcairn Hospital. It was funded by Albury Wodonga Health and La Trobe University, John Richards Centre for Rural Aging Research, read more about this project here