Aims:
Present MetroSouth GEMRHITH service development journey from 2020 to 2024 to demonstrate the application of audit, qualitative and implementation science to effect practice changes at patient, system, and service levels.
Methods:
The model started as a $1.17 million project funding from Care in the Right Setting in 2019 to address patient flow and the hazards of hospitalization of older adults by delivering high-valued multidisciplinary evaluation, management and rehabilitation hospital in the home model. Funding of $3.6 million over 4 years has been provided from Commonwealth to upscale the program.
Audit results from Performance Explorer and major incidents were presented.
Results:
A total of 1230 patient episodes were analysed. The most common diagnoses were dementia and delirium. Most patients were 80-90 years of age. The most common incidents were falls.
|
Year |
2021 |
2022 |
2023 |
2024 |
|
Completed episodes |
266 |
319 |
366 |
279 |
|
Separations/month |
4-29 |
19-34 |
21-39 |
19-30 |
|
Australian born (%) |
60.2 |
58.62 |
60.0 |
55.76 |
|
Subacute and non-acute SNAP (%) |
81.95 |
70.53 |
64.31 |
60.43 |
|
Average LOS |
8.06 |
6.38 |
7.20 |
8.66 |
|
Discharge home (%) |
89.10 |
90.28 |
88.83 |
85.16 |
|
28-day readmission (%) |
26.8 |
26.0 |
26.3 |
23.8 |
Conclusion:
A cultural shift towards utilization of GEMRHITH as a default for hospital-level subacute care is achievable.
The strategic elements for successful implementation include transdisciplinary collaboration for service development and learning, involvement of patient and support persons, benchmarking, flexibility to change and continuous growth.
Future directions include expansion of referral base, integration with community services, team empowerment and incorporation of telehealth.