Challenges of Co-ordinating the Provision

of HiTH Services as a Clinical Manager

Presented by: Simone Dagg

Hunter New England Local Health District

Greater Newcastle Cluster

Community Acute Post Acute Care

HiTH Program Manager

May 2014

Todays Presentation

• Overview of GNC CAPAC HiTH Service:

– Where we live

– What we look like

– What we do

• Identify the challenges faced as a Clinical

Manager

• Present the support tools and strategies for

managing a clinical service in a virtual world

• Future directions

HNE Local Health District – 6 Clusters

CAPAC Catchment Area

The pink line represents

the geographic boundary

for the CAPAC service.

Within 1 hr driving time

from Newcastle CBD.

1500 km2 catchment area (land

area only).

Covers Local Government Areas

of Newcastle, Lake Macquarie and

Port Stephens

Where we work

The CAPAC Umbrella – What we look like

HAH Pre-Hospital

Health / COPs

partnership

6 week

program

TACP Post - Acute

Enablement /

ACF

avoidance

12 week

program

HITH Warfarin Stabilisation

Acute infections

Heart failure

COPD

Rapid response

CAPAC model

• One team / multidisciplinary

• Avoids delays in access to other providers

• Improved responsiveness

• Access to a variety of skills

• Acute and aged care

• Catchment / geographical allocation

• Pooled resources

• Greater flexibility with leave

In Italian ...........

CAPAC Organisational Structure

TACP case

co-ordinators

TACP program manager

Service

Manager

CAPAC

Medical

Director

CAPAC

Service

Development

Co-ordinator

Medical Registrar

CAPAC

Nurses

RN’s

ENs

AINs

OT

Physiotherapy

Dietician

Social worker

Administrati

on

Assistants

HAH program

manager

CAPAC

Allied

Health

Assistants

CAN Role

Allied Health

Team Leader

HITH program

manager

HAH case

co-ordinators

GNC HiTH Service - What We Do

• Anticoagulation: diagnosis include DVT, PE, AF,

TIA / stroke

– Warfarin loading in conjunction with “Clexane”

– Re-stabilisation of INR and Warfarin dosing

• Intravenous antibiotics: (daily service)

– Cellulitis

– Pyelonephritis

• COPD: – Education on signs and symptoms of COPD, to

promote self management strategies for clients

– Comprehensive nursing assessment 3 times per

week

GNC HiTH Service - What We Do

• Heart failure: – Education regarding signs and symptoms of heart

failure, to promote self management strategies for

clients, electrolyte monitoring

– Comprehensive nursing assessment 2nd-3rd daily

– Virtual medical review twice weekly

• Rapid Response:

– Indwelling catheter management

– Supported discharge for frail elderly clients

– Comprehensive home assessment

– On referral to appropriate services

Clinical Leadership Defined

• “...leadership by clinicians of clinicians.”

• “...all those who retained some clinical role, but at the same time took on a

significant part in matters of strategic direction, operational resource

management and collaborative working with colleagues in their own and

other clinical professions, with healthcare managers and with other

managers and professionals in other agencies.”

• “Clinical leadership extends the concept of leadership to add the

responsibilities for the care and safety of clients and the monitoring of both

service and individual outcomes.”

• “Clinical leadership in Community Health is the process of developing a

culture and leading a set of tasks to continually improve the quality and

safety of service delivery to consumers. Effective clinical leadership involves

individuals with the appropriate skills and attributes, at all levels of an

organisation, focussing on multidisciplinary/interdisciplinary service

delivery.”

Clinical Management - Challenges

• Virtual ward

• Medical coverage

• Handover:

– Referrer to service

– Daily from clinicians

– Weekday to weekend

• Scheduling visits:

– Common link as nurses do not own their clients on this service

– Matching skill mix to visits

– HiTH registered nurses only

– Variety of backgrounds and clinical skills

– Geography

– 7 day service work only 5 days

Clinical Management - Challenges

• Managing the “grey” referrals

• Providing clinical guidance to staff, clients and

their carers

• Maintaining a level of clinical knowledge across

several areas of service provision

• Balancing the clinical and management

requirements

• On-call roster

Support Tools

• Multidisciplinary team:

– Management team

– Medical officers

– Allied health

– Administration officers

• Specialised Nurses within team: – Clinical assessment (CAN)

– Wound

– COPD

– Community Cardiac Case Manager (CNS 2)

Support Tools

• Computer applications: – GNC utilises the Clinical Health Information

Enterprise (CHIME) for documentation

– Clinical Applications Portal (CAP)

– Anticoagulation spread sheet

– Heart Failure spread sheet

– E-scheduler

– Auslab

Support Tools

• Mobile technology : – Phones

– Computers

– Video conferencing

– Portable ECG machines

– Spirometers

– POC INR testing

• Clinical leadership education programs

Support Tools

• Access to GNC services: – Diabetes

– Podiatry

– Rapid access clinics

– ComPacks

Mobile Devices

E-scheduler

Anticoagulation – E-scheduler

Anticoagulation Spread Sheet

Heart Failure Spread Sheet - demographics

Heart Failure Spread Sheet - observations

Heart Failure Spread Sheet – medications

Clinical Applications

Even with these tools...........

You can still feel like an island ...........

Future Directions

• Clinicians who are planning on moving into positions

which combine the need to provide clinical leadership

and also manage, need access and the support to

participate in clinical leadership programs which are

provided at a state and local health district level LHD

• Integration of Telehealth applications to enable the “in

time” review of clients while clinicians are still in the

home

Questions ?