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Saving lives, saving money

Mark Cormack writes:

Gideon Caplan’s study of “hospital in the home” services, see Croakey and the Medical Journal of Australia , is a welcome contribution to the debate around the important place of innovation in health reform.

It’s a simple premise: when it is safe and appropriate, an individual needing treatment is far better to remain in the familiar surroundings of where they live than being put through the dislocation of going to hospital. This is not only better for the patient, it also takes pressure off the health system.

Professor Caplan’s study clearly articulates why this is a better outcome for the community. At the highest, most important level, it is
saving lives. Hospitalisation, he explains, increases the risk of delirium due to change of environment and disturbance of sleep, falls, pressure ulcers and cross infections.

For older people especially, these complications can be fatal.

Professor Caplan also says home-based care has also seen a decline in readmission rates.

Another positive for the community, but equally important for relieving pressure on the system through a reduction in the need for beds and cutting the cost of providing treatment. (Care provided in the home is on average 32 per cent cheaper according to a Deloitte Access Economics report quoted in the study.)

Job  change and patient jeopardy

For Health Workforce Australia, these last points are the most relevant to our core objectives and reason for establishment.

An ageing population, increasing burden of chronic and preventable disease and the spiraling price of providing care means Australia’s health system is going to be overwhelmed by costs and demand at some point if we do not act. Central to this are looming health workforce issues captured in detail for the first time in HWA’s Health Workforce 2025  series, published in three volumes in the second half of 2012.

In addressing these problems, changing the way we work and train people is just as important as increasing the number of health
professionals we have.

HWA has a range of programs that are driving this type of change.  We know that these initiatives also have the potential to raise the bar on patient outcomes, but it is not always an easy argument to gain traction with.

In rolling out important HWA change programs – Expanded Scope of Practice for example –one of the strongest arguments we are confronted with is that innovation will jeopardise safety. Professor Caplan’s study turns the tables on this self-interested, fear-based thinking.

In fact, his study clearly shows the opposite – properly executed innovation in a health setting can save lives.

It goes without saying that maintaining safety standards is the highest priority with any workforce reform that is undertaken, but the Hospital in the Home program demonstrates the potential of innovation for wholesale improvement on the status quo – saving lives as well as saving money.

We have similar hopes for HWA’s pilot project to extend the role of paramedics.

The project has been set up to primarily reduce pressure on emergency departments by treating people where they live.

It has potentially very positive benefits for the community as well, particularly in aged care settings.

The aim of this extended scope of practice project is to build extended care paramedics’ skills around patient assessment and delivery
of coordinated quality care.

Extended care benefits patients

Take the following example of a situation that would have a very different outcome under this reform.  A staff member in a regional residential care facility notices one of their residents is showing signs of increased confusion. The facility’s doctor is not able to
attend immediately, so the staff member phones the Ambulance Service to request a transfer to the regional emergency department, which is an hour away, so the resident can be assessed.

Under this new scope of practice project, there is alternative option.  An extended care paramedic is available to attend and, in consultation by phone with the medical officer, undertakes a clinical assessment, diagnoses and initiates treatment. The
paramedic  can collect test samples and send to a pathology lab for the medical officer and/or the resident’s regular GP to follow up.

While this is all happening, the resident has been able to remain in his or her room and has remained calm, rather than being unsettled by a long journey in an ambulance followed by a wait in the emergency department of the local hospital – an experience that could have brought about a deterioration in condition and necessitated admission to a ward.

A long-distance journey to hospital and possible admission for the resident has been avoided.  Faster diagnosis and care has been provided.  Pressure on the facility doctor and emergency department has been relieved. The paramedic has a greater sense of involvement in a multi-disciplinary team of carers.

This project is being implemented across four states and territories at five sites. Funds have been provided by HWA to put work models in place in local communities and look at how they can be adapted to local needs and conditions nationally.

Like Hospital in the Home, the potential for this project to create meaningful change is enormous. The challenge for both initiatives and others like them, however, will be to generate support in the appropriate quarters to accelerate their impact.

Professor Caplan says it may take a crisis for this to happen. With the publication of the workforce projections contained in HW2025, we can tell you with reliable accuracy that without significant reform, that crisis is coming.

MARK CORMACK  is Chief Executive Officer, Health Workforce Australia,  a Commonwealth statutory authority created to drive a strategic, long-term program aimed at building a sustainable health workforce.

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  • 1
    Raymond Bange
    Posted December 27, 2012 at 1:40 am | Permalink

    One of the goals of health reform should be to improve access to primary care within a patient-friendly environment at appropriate times.
    The increasing focus on primary care has highlighted the importance of access to an appropriate primary health care team for medical problems that arise outside normal business hours and on weekends and holidays.
    Studies in the US (2010 Health Tracking Household Survey) have found that one in five people who attempted after-hours contact with their primary care provider reported it was “very difficult” or “somewhat difficult” to reach a clinician. Those who reported less difficulty contacting a clinician after hours had significantly fewer emergency department visits and lower rates of unmet medical need than people who experienced more difficulty. Not surprisingly, these findings indicate that increasing support to offer or coordinate after-hours care may help reduce rates of emergency department use and unmet medical need.
    Equally important is that many issues can be resolved in the home or within the patient environment by using the advanced skills of health and allied health practitioners such as paramedics and the delivery of care by various innovative means – by phone, by internet, in person or through some combination of inter-professional practice, depending on the patient’s needs.

    As Mark has noted, Australia has a wonderful opportunity to explore the options and innovate in health care delivery by utilising the advanced skills of paramedic professionals and other members of the health care team in out-of-hospital care. I look forward to the results of the current studies replicating the beneficial outcomes experienced with several well-documented studies overseas.

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