Mercy Hospital for Women Mercy @ Home May 2014 IIR conference

Patient / Family centered Model of Care for Domiciliary and

Hospital In the Home (HITH) Program

RM has the credentialed skills to visit mother and baby under Stream A and

Stream B.

Stream A: Domiciliary care that services the mother and baby post delivery

(up to 9 days).

Stream B: The baby is admitted to the nurseries for medical care post

delivery and is then transferred home for further medical management to

HITH. E.g.: Weight < 2500 grams, Prematurity prior to 37 weeks, Jaundice,

congenital abnormalities, chemically dependant clients.

OR

The mother is admitted to HITH because of complications arising from the

birth, e.g.: psychiatric conditions, complicated obstetric history such as PE,

breast abscess, wound care, and some gynaecology complications.

Mercy @ Home Model of care

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M@H is responsible and accountable for our outcomes, and costs. We

processes each patient using a common platform of measurement called

DoNel program (Clinical care, variances, addresses, LOS, time, type of

care and visit. We barcode and collect this data for every visit.

Stream A: is funded by the department of health services and is called a

Variable Maternity Services Grant (VMSG).

(Funding under review by the Department of Health: activity based funding)

Stream B: Funding is through variable case mix payments called Weighted

Inliers' Equivalent Separation (WEIS).

Funding

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1. To be responsive for safe high quality care that is changing, sustainable

and responsive to the patient and their families needs.(eg early

discharge, IV ABS for babies)

2. To provide care that is guided by consumer participation, MH, DoH,

external and internal key stakeholders. (National Safety Quality Health

Standards)

3. Patients will have informed choices to meet their health care needs e.g.:

shared care with GP’s, team nursing, maternity group practice, rotation of

NICU nurses, transition care for the vulnerable, access to multi

disciplinary teams and the vulnerable support network.

MH supports the Victorian Maternity and

Newborn Services health framework

2012-2022 Guidelines of Equity and Access

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Jan – Dec 2011: 6018 births Males 3104 Females 3046

Jan – Dec 2012: 5724 births Males 3077 Females 2940

Jan - Dec 2013: 6153 births Males 2959 Females 2760

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Mercy Hospital for Women

Births 2011-2013

Mercy @ Home Demographic Area

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Service Stats for Mercy @ Home

Use of data to understand our clinical

practise and improve patient care

2011-2014

Bed Days for 2011-2012: 5566

Bed Days for 2012- 2013: 5785

Bed Days for 2013-2014: 5974 ( period 1/7/13- 20/05/14)

Mercy @ Home Bed Days for HITH

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Domiciliary Care/ HITH Care

International Overview:

UK Daily Postnatal Visits for 7 days.

Netherlands Daily Postnatal Visits for 7 Days + homecare assistance

USA Private system no PNC with some obstetric nurses for home

births

Canada: discharged 24 hours no domiciliary care. MCH

nurses(variable)

Case Study (picture)

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Case study NVD

Mother is discharged home with Twin1, 2700 grams and Twin 2, 3200 grams.

Clinical coordinator does her ward round in the morning and Triages the patient

Allocates the patient to the RM

Case Study

RM has a handover of the patient

Rings the patient with a nominated time frame, collects her clinical pathway along with her bar code reader for entry into the DoNel Program

Activates her Go finder tracking system before she leaves and has between 4-5 visits /day

Visits the patient at home (Mother and babies are visited under the domiciliary care package).

Arrives at the visit to find Twin 2 cold unresponsive and not feeding.

Twin 2 is admitted to MHW NICU unit, ventilated .

Day 3 Twin 2 is transferred to HITH.

Clinical coordinator organises the visit with RM to visit both mother and baby under two separate programmes

1. Person Centred: Every patient under the Domiciliary and HITH

programme is offered a visit within 48hours to meet a KPI of 100%.

M@H are partners in care of both these babies and their mother

M@H Quality Quality Framework for Patient/

Family Centred Care

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M@H Quality Framework for

Patient/Family Centered Care

Integrated Care “Common Organisational Unit” who take responsibility for a

patient/family centered unit

Streamline services for Domiciliary and HITH care around the family

The patients clinical journey is organised by the clinical coordinator and is

efficient and effective (daily runs are scheduled with a multidisciplinary

team of clinicians) to meet individually tailored patient/family centered care

using the right midwife and the right resources to meet the patients health

care needs.

With the support of medical governance, autonomous RM’s, MCH support

mother and baby were discharged home.

Safe: “You are Safe” in a single structured unit

Integrated safe home visits for the patient/family are achieved with the

support of Social Workers who coordinate:

Child First Berry Street

DHS Refugee Support Groups Obstetricians

Aboriginal Services Paediatricians

Interpreters Psychiatrists

Vulnerable Children’s support Services Urogynae

Maternal and Child Health Care Child First

Enhanced Care Family Court

Violence Against Women Task force Infection control

Lactation support Diabetic educator

Mother Baby Units Parent Education Programs (DoNel)

M@H Quality Framework for

Patient/Family Centered Care

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All patients who receive a visit have a safe home risk assessment

A GPS service with blue tooth facilities is installed in all our rating 5 cars.

A duress alarm system and tracking system is linked to a program at Mercy

to keep staff safe on the road and when visiting.

If required 2 patients will visit the patient e.g.: social worker, aboriginal liaison

worker.

Safety for M@H Staff

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Effective and appropriate care, right care, right

time, right outcome for an expandable service

that will partner with patients and their family.

Partnering with consumers and using resources to meet the emerging needs

of our patients with the right care.

Using MH’s strategic plan, our values, policy and guidelines for quality care,

we can respond to the needs of every patient and their families by

streamlining our services to meet consumer needs at the right time.

The significant decrease in the LOS from 8-14 days (1950) to 6hrs-2 days for

a NVD and 4 days for a CS today has resulted in “naturalising” the care

and moving away from “medicalisation” with the right outcome.

With significant cost savings benefits and meeting clinical demand we are

achieving the right health outcome for patients and their families at MH.

For the patient and family:

Active involvement by the patient in the delivery of patient/family centered

care

For the Hospital

Using data to achieve best practice care to improve quality patient outcomes.

Aligning the unit to support the strategic and quality plans for the hospital.

For the Staff

Streamlining the services for a safe and effective home care visit, using the

resources to be effective carers, (looking at workforce/demand/daily)

Outcomes for Mercy@ Home

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Futuristic Goals:

“We must move away from a supply-driven health care system organised

around what physicians do and toward a patient –centred system

organised around what patients need”

(Porter M.E, Lee T. H. “The Strategy that will fix health Care”, Harvard

Business Review 2013)

“HITH is a bridge to connected

care”

My Vision: To stimulate innovation and growth and recognise our achievements

Mobile Medical Units for clinical support

Introduce Face time for all mothers babies and clinicians at MH

Tele medicine: Mobile access to all medical resources via a tablet. Having access to our programs such as BOS, DoNel, SPI, CPF, visual aids for assessment (trial in progress)

Remote patient monitoring bringing the hospital to the home

John Hopkins in Maryland, (Psych patients)

Eg:1million Americans receive remote cardiac monitoring decreasing readmission rates, freeing up beds. (2012 American Telemedicine Association)

200,000 children in India receive Primary Health care through a program called “Smile on Wheels”

Thank You