New Models of Care

Medihotels | Observation Medicine | Day Treatment Centres | Fast Track | Co-located GP Clinics

The Victorian Government allocated $19.1m during 2005-06 to improve the overall patient experience in Victoria’s emergency departments. A number of new models of care were rolled out that build on the success of the Hospital Demand Management Strategy and draw on evidence gained from program evaluations and patient feedback.  These form part of a medium-term strategy designed to improve the system’s capacity to manage emergency demand, improve patient services and reduce emergency department waiting times.

Further improvements to Victoria’s emergency departments include the rollout of the HARP Chronic Disease Program (growth funding in 2005-06 of $11m), the Emergency Department Care Coordination Program (to all major metropolitan and regional emergency departments) and the establishment of General Practice Liaison Officers (growth funding of $250,000). Additional funding was also directed to targeted Health Services to implement the following models of care including:

• Observation Medical Units, including Short Stay Units and Medical and Assessment Planning Units
• Day Treatment Centres
• Fast Track models of care in emergency departments
• Co-located General Practice Clinics
• Medihotels - A formal review of Medihotels has commenced and will inform future developments and new funding models. The review will be completed in April 2006.

Medihotels

Victoria’s medihotels provide accommodation and hotel services suited to the needs of self caring consumers accessing acute hospital services. Medihotels provide for people making the transition between the community and acute sectors.

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, 76kb)

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.

Medihotel occupancy data hospital link

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);

Day treatment Centres:

A Day Treatment Centre (DTC) is a designated facility for day-treatment patients who do not require a multiday inpatient bed or emergency department cubicle. Patients who may make use of DTCs include those requiring ascitic taps, IV infusions, and simple biopsies.

Synonyms: Ambulatory Care Centre (ACC), Day Treatment Unit (DTU).

Fast Track:

The fast-track initiative enables timely treatment for people with less serious illnesses or injuries.  Traditionally, patients presenting to EDs are prioritised according to the urgency of their condition.  Urgent patients are treated first, which may lead to extended waiting times for people with less urgent complaints.

The fast-track initiative speeds up the treatment process by identifying low-complexity triage category 4 and 5 patients—patients who require straightforward treatment and are unlikely to need admission to the hospital—and referring them to a designated fast track area. An allocated fast-track doctor and nurse will then assess, treat and discharge the patient. Examples of low-complexity patient problems are: simple wounds and fractures, sprains and strains, and plaster of paris (POP) checks.

Fast-tracking can also identify and quickly treat more urgent patients (i.e. category 3) who require analgesia or a time-critical intervention but who otherwise may have queued with a group of similarly categorised presentations. An example might be a renal colic presentation requiring urgent IV analgesia.

Fast-tracking has been shown to reduce waiting times for people with straightforward, simple complaints, and to reduce waiting room bottlenecks.

Co-located GP Clinics

Following the signing of the Australian Health Care Agreement in August 2003, the Hospital-General Practice (GP) Interface was identified as a key reform area and State Governments were invited to make submissions to address demand in this area.

Co-located GP clinics are currently operating clinics at:

• Frankston Hospital
• Dandenong Hospital
• Wodonga Hospital
• The Northern Hospital

Co-located clinics at Sunshine Hospital and the Royal Children’s Hospital are scheduled to open in 2006.