New Models of Care
On this page: Co-located After Hours General Practice (AHGP) Clinics| ED care coordination | Fast Track | General Practice | Medihotels | Observation Medicine | Observation Models of Care | Primary contact physiotherapy service
The Victorian Government has introduced and mainstreamed new models of care to address the consistent growth in demand for hospital services, particularly emergency care. These models of care ensure patients receive timely care in the most appropriate setting with greater patient choice in treatment and service provision. The new models of care are designed to minimise avoidable ED presentations, provide alternatives to inpatient admission, reduce the length of stay in hospital and prevent unplanned readmissions.
Victoria's models of care include:
Victoria’s co-located after hours general practice (GP) clinics are special-purpose services located within a public hospital, near or adjacent to its emergency department (ED). The role of the co-located AHGP clinics is to provide timely, safe and accessible services for consumers seeking primary medical care outside business hours.
The Framework for the Victorian co-located after-hours general practice clinics has been developed by the Department of Health as a resource for health services, general practices and GP divisions engaged in providing co-located AHGP clinics. It provides an overall structure for establishing and operating AHGP clinics and is intended to promote consistency of practice and support continued service improvement.
Clinical governance of co-located and well-located after-hours general practice services – A framework and toolkit has been developed by DLA Phillips Fox to ensure continuous improvement in the safety and quality of care. The framework covers six domains:
In Victoria, ED care coordination services are provided either by an established multidisciplinary team within the hospital ED or by the hospital’s allied health or ambulatory care services on an episodic basis in response to a referral from the ED. Care coordination practitioners work as part of the ED team providing skills and information that contribute to the patients’ overall treatment and care.
The guidelines are designed to promote consistency of practice and to support continued service improvements by providing:
The role of ED care coordination services is to minimise hospital use by facilitating timely access to an integrated system of community based services. In particular, ED care coordination services have a role in:
The 12 core functions associated with providing a care coordination service in a hospital ED are as follows:
Fast track services centre on the ED care processes in a treatment pathway designated for the timely assessment, treatment and discharge of people seeking primary care type services for less serious illnesses and injuries. The services are provided by a multidisciplinary team in an identified area of the ED.
Fast track services have developed from a redesign of existing ED processes. Redesign activities are part of a broader management strategy directed at improving processes, reducing costs and improving the quality and timely delivery of services. According to redesign principles, care processes that are sufficiently similar can be grouped into value streams. These value streams can be managed separately to increase overall efficiency and reliability of the care processes.
Streaming care: Fast track services in Victorian hospital emergency departments documents various initiatives undertaken by Victorian health services establishing fast track services and the learnings associated with these changes. The discussion paper outlines the:
The discussion paper aligns with the department’s Redesigning Hospital Care Program, a four-year statewide initiative aimed at building health service capability to create, spread and sustain improvements in the delivery of patient care by applying process redesign methodologies.
The discussion paper informed the Streaming care: Fast track services forum held on 12 February 2009 for ED clinicians to consider past and future service developments in fast track services and to support health services to re-engage in the process redesign activities that underpin this model of care.
Victoria’s General Practice Liaison (GPL) Program is comprised of health service based GPL units supported by a statewide program coordination service that is focused on systems change and improvement at the interface between hospitals and general practice.
The framework for the Victorian General Practice Liaison Program is a resource providing an overall structure and strategic direction for the GPL services operating in the State’s public hospital system. It delineates the role of the GPL program and its core functions, outlines the structure, governance and coordination of the program and establishes the strategic directions and associated planning processes for the program.
The framework followed a formal review of the GPL Program conducted by Amos Consulting in 2006.
The role of the GPL Program is to promote an integrated, person-centred health care system providing quality care and better health outcomes for Victorians. In particular, the GPL Program has a role in:
The framework outlines a service and governance structure that ensures the GPL Program has a strategic, cross health service function with a focus on systems change and improvement,
The framework supports the three-year planning process developed for the GPL program services to ensure alignment with government and health service policy directions and to promote accountability, information sharing and outcome measurement. The planning framework:
The framework for the Victorian General Practice Liaison Program establishes a statewide program coordination structure that supports health services to provide a GPL Program in accordance with departmental policies and strategic directions.
Annual reports are available on the activities undertaken by the GPL Program in 2007-08 and 2008-09.
Medihotels represent a relatively new model of care that provides a substitute for multi-day admitted inpatient care. They form part of a whole of health service approach to improving access to hospital services.
The framework for medihotels in Victorian public health services has been developed by the Department of Health to assist health services in the planning, organisation and delivery of medihotel services and to support continued service improvements.
The people accommodated in a Medihotel include consumers who are mobile, self caring with daily living skills and medication management , need minimal or no supervision and do not require overnight inpatient care, including those who:
In 2001, a number of new observation medicine models were established
across Victoria through the Hospital Demand Management Strategy (HDMS).
These units were classified as either Short Stay Observation Units (SOUs)
or Medical Assessment and Planning Units (MAPUs). The 2004 review of
these units, commissioned by HDMS and carried out by Clinical Epidemiology
and Health Service Evaluation, confirmed their potential to improve emergency
access and reduce inpatient length of stay. It has been decided that
clinical practice should be standardised and that funding for the units
should, in principle, be made available to all Health Services.
Observation medicine delivers intensive short-term assessment, observation or therapy to optimise the early treatment and discharge of selected emergency patients. The model is an alternative to extended stays in hospital EDs and/or the use of multi-day inpatient beds for short-term care. The observation medicine unit is a ward-like setting usually located near an ED or specialty inpatient ward (for example medical, paediatric, psychiatric).
The Department of Human Services has released new Observation Medicine Guidelines 2009. The new guidelines have been developed to assist health services to implement and operate observation medicine units that reflect good practice models of care. The new guidelines outline key principles for observation medicine as well as planning, implementation and operational service parameters for observation medicine units, and describe funding and service monitoring arrangements.
A self assessment tool has been developed to assist public hospitals in Victoria to implement the Observation
Medicine Guidelines 2009. It provides a guide for self-assessment as part of your ongoing quality monitoring processes for observation medicine units (e.g. Short Stay, Medical Assessment and Planning).
The self-assessment tool will assist you to identify priority elements for action and a process to facilitate implementation of a service that is well aligned with the guidelines.
Short Stay Observation Unit (SOU)
Short Stay Observation units are designed for patients who, with proper assessment and treatment, are likely to be discharged within 24 hours. This includes patients who require tests to determine the seriousness of their condition (e.g., minor head injury, chest pain, and drug overdose) or a short course of treatment for conditions that may be rapidly resolved (for example, asthma, allergic reactions and renal colic). ED physicians manage these patients and their expected length of stay is 4-24 hours.
SOUs also provide a location for patients to receive allied health and social support intervention, such as physiotherapy assessment or social welfare services before discharge.
The intensive assessment and treatment available in the SOU has been shown to reduce length of stay. SOUs are attached to emergency departments and provide care in a quiet and comfortable setting. In the past, such patients may have been unnecessarily admitted to a ward or may have remained in the emergency department for long periods.
Synomym: Emergency Observation Unit (EOU)
Medical Assessment and Planning Unit (MAPU)
MAPUs are designed to receive medical inpatients for observation, care and treatment prior to transfer to an appropriate ward or discharge. They are often used to geographically co-locate emergency acute medical admissions.
Patients are managed by medical physicians with collaborative multidisciplinary input for up to 48 hours in order to facilitate intensive treatment, the engagement of appropriate allied health services and the streamlining of care-planning processes. Emergency patients that require specialty services such as CCU and ICU are not managed through MAPUs. These patients will usually be transferred directly to an acute or subacute ward.
MAPUs can significantly reduce inpatient length of stay, improve patient outcomes and benefit hospital KPIs such as bypass, HEWS and 8-hour waits.
Synonyms: Rapid Assessment Medical Unit (RAMU); Acute Medical Care Unit (AMCU);
Primary contact physiotherapy services were first introduced into some Victorian hospital EDs in 2004. Primary contact physiotherapy services allow suitably qualified and experienced physiotherapists a ‘first contact’ role in addressing and managing ‘appropriately identified’, non-urgent patients after triage in the ED. Primary contact physiotherapists have primary management responsibility for their patients within the ED context, with or without collaboration of other ED staff.
The model of care was developed to address rising demand for treatment of ‘primary care type’ patients in EDs across Victoria. The model was also trialled to address shortages in the availability of suitably qualified medical and nursing professionals, explore advanced scope of practice opportunities for senior physiotherapists and improve patient flow through the ED.A formal review of primary contact physiotherapy services in Victorian public hospital EDs was undertaken in March-August 2010. The purpose of the review was to establish the impact of the primary contact physiotherapy services on the timeliness, quality of service delivery and patient flow in Victorian public hospital EDs and to determine the future of this model of care in Victoria.
Last updated: 23 June, 2011
Contact: This web site is managed and authorised by the Statewide Emergency Program Unit of the Metropolitan Health and Aged Care Services Division of the Victorian State Government, Department of Health, Australia