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Daniel Wilckens delivered the presentation at 2014 Hospital in the Home Conference. The 2014 Hospital in the Home Conference included practical presentations such as Medico Legal Issues, Public Private Partnership Driving HITH Growth, HITH implementation, Clinical Redesign and Impact on Clinical Governance & Performance, Advanced Care Planning and more. For more information about the event, please visit: http://www.informa.com.au/HITHconference14
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Criteria Led Discharge and HITH
Melissa McCusker
Daniel Wilckens
Criteria-led discharge (CLD) – What is it?
• “simple discharge”
• Predetermined criteria for
patient discharge by
Nursing, Allied Health and
junior Medical staff
• Allows for the patient to be
discharged as soon as it is
clinically and socially
appropriate
Why is CLD needed?
• Manage LOS
• Reduce delays to discharge
• Improve utilisation of clinician’s time and skills
• Increased demand and throughput without additional resources
• Key Department of Health Patient Flow Strategy
• Improved patient and staff satisfaction
How does CLD work?
• CLD process is supported by predetermined
criteria set by the HITH Medical Officer (MO)
and a documented procedure with clear
guidelines for use
• An estimated date of discharge (EDD) is
determined on transfer to HITH service
CLD Implementation at the Queen Elizabeth II
(QEII) & Princess Alexandra (PA) Hospitals
• Total of 47 patients in 2013 (9% of all HITH
separations)
– 42 identified as suitable
– 5 did not meet the criteria
• Day of Discharge
– 55% weekday (26)
– 45% weekend discharges (21)
HITH Average Length of Stay
Hospital in the Home Average Length of Stay (ALOS)
2012 vs 2013
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2
3
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Januar
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May
June
July
August
Septe
mber
October
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Decem
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ALO
S (
da
ys)
2012
2013
Target
HITH ALOS by DRG
Cellulitis
Hospital in the Home Cellulitis Length of Stay 2012 vs 2013
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6
Janu
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Febru
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Mar
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Octobe
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Dece
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LO
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Days)
2012
2013
HITH ALOS by DRG
Infection
Hospital in the Home Infection Length of Stay 2012 vs 2013
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Janu
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mbe
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Dece
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Days)
2012
2013
HITH ALOS by DRG
DVT,PE and AF
Hospital in the Home Length of Stay DVT, PE and AF 2012 vs 2013
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Janu
ary
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Mar
chApr
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May
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ust
Sep
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Octobe
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Nove
mbe
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Dece
mbe
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LO
S (
Days)
2012
2013
Results
• Nil readmissions
• Nil reported adverse
events
Lessons Learned
• Clinical risk is minimised
• Medical Governance is essential
• Clear pathway if criteria not met
• Must have highly skilled Nursing staff
Acknowledgements
• Hospital Avoidance and Patient Flow Project,
Metro South Health
• Metro South HITH Nursing and Medical team,
with a special mention to Lisa Hauritz, CN
• Clinical Access and Redesign Unit (CARU)
• QEII United Clinical Services Redesign Project