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:

• Co-located After Hours General Practice (AHGP) Clinics
• Emergency Department Care Coordination
• Fast track models of care in emergency departments
• General Practice Liaison Program
• Medihotels
• Observation Medical Units, including Short Stay Units and Medical and Assessment Planning Units.

Co-located After Hours General Practice (AHGP) Clinics

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.
Co located After Hours GP Clinics:

• provide acute, episodic primary care services on a walk in basis
• operate outside business hours on evenings, weekends and public holidays
• provide an alternative to treatment in a hospital ED
  
• are designed to support the provision of emergency primary care in the community.

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.

The framework describes the key aspects of service delivery and outlines the governance, management and organisational structure supporting the clinics. Key areas addressed include:

• collaborative partnerships between health services, general practices and GP divisions
• criteria for establishing new co-located AHGP clinics
• scope of services provided
• physical facilities
• access to services through signage, consumer information and screening criteria
• continuity of care through notifications and information exchange between services
• the Medicare program, funding and billing practices
• practice management and administration
• staffing
• performance monitoring
• clinical governance

Framework for Victorian co-located after-hours general practice clinics (PDF File, 562KB)

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:

• governance structures
• purposes, roles and responsibilities
• systems to deliver quality clinical care
• provider competence and performance
• data and information
• clinical risk management

Clinical governance of co-located and well-located after-hours general practice services (PDF File, 1.04MB)

ED care coordination

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 for the Victorian Emergency Department Care Coordination Program have been developed by the Department of Health as a resource for health services delivering emergency care. They delineate the role of the program, its core functions and outline the structure and governance features of the program.

Guidelines for the Victorian Emergency Department Care Coordination Program (PDF File, 266KB)

Emergency Department Care Coordination Self Assessment Tool (Word file, 684KB) - July 2010

The guidelines are designed to promote consistency of practice and to support continued service improvements by providing:

• a shared understanding of ED care coordination services across Victoria
• a basis for continuous service development through comparing existing and best practise guidelines
• a means of ongoing service monitoring and development.

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:

• facilitating safe and timely discharge to the community
• providing person centred-care that encourages and supports consumer and carer participation
• providing a primary access point within the hospital ED for community based services
• promoting continuity of care within and across hospital and community sectors

The 12 core functions associated with providing a care coordination service in a hospital ED are as follows:

• initial contact
• initial needs identification
• assessment
• care planning
• referral
• intervention
• service brokerage
• early discharge planning
• follow up services
• outreach services
• stakeholder engagement
• consumer and carer engagement.

Fast track services

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:

• background an progressive development of fast track services
• process redesign principles
• Victoria’s Redesigning Hospital Care Program
• key features of the state’s fast track services
• evidence of the effectiveness of this model of care
• initiatives undertaken by the hospitals operating fast track services and the associated learning points.

Discussion paper: Streaming care: Fast track services in hospital emergency departments 2008 (pdf, 663kb)

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.

Report on the Streaming care: Fast track service forum (pdf, 194kb)

General Practice Liaison Program

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.

Framework for the Victorian General Practice Liaison Program 2007 (pdf, 223kb)

The framework followed a formal review of the GPL Program conducted by Amos Consulting in 2006.

Review of the General Practive Liason Program (pdf, 2.16mb)

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:

• improving access to services
• promoting continuity of care across health services
• building strong working relationships that promote sustainable collaboration and partnerships between services
• improving the quality of health care
• contributing to a reorientation of the health system so that the mix of hospital and community-based services ensures care is provided in the most appropriate setting and minimises the need for acute care
• optimising resource use and the efficiency of care across multiple providers.

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:

• sets key departmental strategic directions
• outlines statewide strategic goals for the program
• delineates the steps involved in the planning cycle and the processes governing the preparation and review of annual action plans.
  

General Practitioner Liaison Program Planning process 2007–10 (pdf, 127kb)

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.

Annual report 2007-2008 (pdf, 605kb)

Annual report 2008-2009 (pdf, 1.02mb)

 Annual report 2009-2010

Medihotels

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 framework for medihotels in Victorian public health services (pdf, 142kb)

Framework for medihotels in Victorian public health services self-assessment tool 2010 (doc, 506kb)

Medihotels:

• provide high quality, non-ward type accommodation and hotel services that reflect the environment and character of a hotel
• are located within or in close proximity to a hospital
• are accessed on referral from clinical, diagnostic and other hospital units following a screening process
• provide minimal supervision and support for consumers
• ensure access to prearranged episodic care similar to that generally available within the community
• provide facilities for a family member or carer as required.

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:

• must travel long distances to access acute services, particularly those residing in rural areas
• require access to acute hospital services for investigations, treatment or clinical review over a series of days
• require overnight accommodation in anticipation of a next-day acute care admission, day procedure or next day review following a surgical intervention.

Observation medicine

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.

To this end, consultation has been undertaken to allow stakeholders to provide feedback with regard to Health Services level implementation and roles and responsibilities, and further guidelines are currently being produced.

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.

Observation Medicine Guidelines 2009 (pdf, 578kb)

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.

Observation Medicine Self-Assessment Tool (PDF File 110KB) - July 2009

Observation Medicine Self-Assessment Worksheet (MS Word File 453KB) - July 2009

Observation models of care

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 service

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.

  Review of primary contact physiotherapy services final report