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Initiatives to ease pressure of winter ‘peaks’


8 April 2004

Initiatives to ease pressure of winter ‘peaks’ in hospital demand pay off year-round for HBDHB

A number of initiatives introduced over the past 12 months, are starting to make a positive difference by lessening the impact acute medical patients have on the availability of beds for elective surgery patients, according to Alistair Ayto, Hawke’s Bay District Health Board’s group manager of medical and surgical services.

Mr Ayto said the decrease in demand was particularly noticeable in January and February 2004 when an average of 34.5 less beds were needed each day across the whole hospital.

“While we expect to be quieter over summer, this year the demand really dropped off over the summer months.

He said the effect of a range of initiatives were now starting to pay dividends, in terms of ensuring beds were available for those who really needed them; coupled with more patients receiving a higher level of care in community settings.

“We now have a dedicated hospital ‘bed manager’ whose role includes ensuring that when patients are admitted, they are in the most appropriate area of the hospital for their condition. The bed manager is always planning ahead, looking at where people are likely to be discharged from each day, and ensuring maximum utilisation of available beds.

“There has been a much greater emphasis on discharge planning. The discharge lounge, introduced last winter has remained open, and is a good way to free up beds for acute patients; while those who are on their way home can spend time in a comfortable lounge room within the hospital while they receive their final documentation and prescriptions before being collected.

“We now have case coordinators for eight specialties. Case coordinators are experienced nurses who have specialised in one area of nursing. They work with patients who have complex needs, and their role includes liaising with individual patients’ GPs, family/whanau and other health professionals providing care for a patient to ensure everything is coordinated and the patient is receiving the right care, in the right place at the right time.

“Some patients requiring intravenous medications have been receiving their treatment at home, rather than having to be admitted to hospital. This is proving to be less disruptive to patients who can get on with their lives, and back to work sooner.

“An increase in the number of doctors on the acute roster, means patients are being seen sooner, and therefore treatment can commence earlier. Over the past year we have increased the number of physicians from 9 to 12.

Board member and chair of HBDHB’s Hospital Advisory Committee, Dr David Marshall, said he was very impressed with the progress that had been made. “It’s very gratifying to see significant decreases in hospital readmission rates, average length of stay and importantly, a real drop in the number of elective surgery procedures having to be postponed due to no available beds,” he said.

There have been no postponements due to no beds in the past three months (Jan - March 2004) and only 18 in the three months prior. During the winter ‘peak’ last year up to 120 elective procedures were having to be postponed.

Alistair Ayto said the DHB could not take all the credit for the improved performance. “GPs in the region are a partner in this success. A new initiative called ‘Coordinated Primary Options’ has been trialed in the area since November 2003. This has seen over 20 people treated by their GP each month, rather than being admitted to hospital. The GPs receive additional funding to provide alternative acute treatment for patients who fit certain criteria.

“The commissioning of the new Acute Assessment Unit in July this year should further improve the situation. With the new building comes a new model of care, with renewed emphasis on assessing patients to admit, rather than admitting patients to assess them, which is what was sometimes happening in the past,” Alistair Ayto said.

“At this time of year we are also promoting influenza vaccination amongst our own staff, and those in the ‘at risk’ groups. We have a large number of clients with respiratory and cardiac conditions and they are being offered a special immunisation to protect them from pneumococcal infections.

Mr Ayto said the DHB trialed a ‘sub acute’ care option last winter, which saw a small number of patients receiving ongoing care in a rest-home once discharged from the hospital. “These were people who weren’t well enough to be home alone, but needed some additional support to regain their independence,” Mr Ayto said. “We won’t be introducing this as a permanent option at this stage, as we believe the initiatives we are putting in place will ensure that hospital beds are available for those who need them,” Mr Ayto said.

“The medical and surgical services staff have worked incredibly hard to see these initiatives to fruition, and it’s a credit to them that we have increased efficiency while maintaining a high standard of patient care,” Alistair Ayto said.


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