Better Sooner More Convenient Primary Care - New Zealand Doctor

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Appendix Three: Acute care 1. Aspirational statement All West Coasters will know how to appropriately access acute and after hours care and will be satisfied with the service received. 2 Project overview This project has three main aspects: introducing HML nurse phone triage after hours, increasing community knowledge of how to access after hours care appropriately, and upskilling nurses to provide more acute care after hours and within office hours. It builds on the West Coast After Hours Plan which is available for review. If patients who are acutely unwell are unable to be seen during the day by their usual GP/nurse team, then this increases the demand for after hours care and inappropriate use of emergency departments. The project on the redesign of core general practice care addresses this issue. 3 Problem definition Key problems in the provision of both after hours care and acute care within office hours are: the burden of after hours call lack of community understanding of how to access after hours services high rates of triage 5 attendances at Greymouth ED, both during office hours and after hours variation in training and skills of nurses providing after hours and acute care. For greater detail on the current situation see Appendix One. Recruitment and retention and decreasing the waiting time to be seen in general practice are important contributors to after hours issues; they are covered in other project plans. Business case appendices V12 AC 25Feb2010 Page 18
4 Objectives to implement nurse phone triage throughout the West Coast after hours to provide advanced training for nurses doing after hours call to implement the use of standing orders in all practices to increase community understanding of how to use after hours services to decrease inappropriate attendances at ED to increase coordination of care between practices and ED. 5 Benefits and gains Output measures Indicator Baseline Target – Yr 1 HML triage in place By June 10 Community education campaign implemented Number of nurses with PG Cert in Assessment and Pharmacology or equivalent ED and hospital pharmacy able to access patient MedTech notes Year 2 Year 3 By August Rptd in April Rptd in April 2010 11 20 25 30 No In place Outcome measures Indicator Number of triage 5 seen at Greymouth ED 07.00-15.30 Mon - Fri Number of triage 5 seen at Greymouth ED 15.30-22.40 Mon - Fri Number of triage 5 seen 22.40- 08.00 Mon - Sun Numbers of triage 5 seen at weekends 08.00-22.40 Numbers triaged and redirected/wk Baseline YTD to Dec 09 Target – Yr 1 Year 2 Year 3 43/week 40 35 30 11/week 9 8 7 1.75/week 1.7 1.6 1.5 15/week 13 12 11 0 7 14 21 Business case appendices V12 AC 25Feb2010 Page 19
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Business Case Better, Sooner, More
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1 Caveats/status This business case
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Current situation By three years Wa
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staffed on a capacity model - in wh
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support from DHBs, specialist clini
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10.4 Key milestones................
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Annual government health funding pe
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Ambulatory Sensitive Hospitalisatio
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The base populations of the three d
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Māori/Pacific Not Māori/Pacific D
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4.7 West Coast region service deliv
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5 Future model of care 5.1 The desi
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support them. Help with understandi
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LEVERS VISION Better, sooner, more
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providing the majority of care). Th
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The Community Health System Deliver
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To better integrate the support pro
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5.5 Enablers A key aspect of this b
Page 37 and 38: Two rounds of meetings with front l
Page 39 and 40: While doctor-nurse substitution has
Page 41 and 42: Nick Goodwin, Kings Fund 14 , in hi
Page 43 and 44: Quality domains Each new initiative
Page 45 and 46: Preventative Acute LTC management R
Page 47 and 48: Preventative Acute LTC management R
Page 49 and 50: The core services are provided or p
Page 51 and 52: Total required FTEs for the Grey IF
Page 53 and 54: 7 Governance, Ownership & Managemen
Page 55 and 56: Option D: PHO/DHB jointly owned Pri
Page 57 and 58: The IFHS will need the ability to b
Page 59 and 60: Of note, a large proportion of the
Page 61 and 62: The DHB delegates decision making o
Page 63 and 64: Limited integration of community se
Page 65 and 66: 10.4 Key milestones The table below
Page 67 and 68: Expanded pharmacy roles Improving a
Page 69 and 70: Devolved community based services w
Page 71 and 72: Appendices Appendix One: Health Equ
Page 73 and 74: ongoing GP shortage creating an env
Page 75 and 76: 10. What are the unintended consequ
Page 77 and 78: It is common for people with an acu
Page 79 and 80: Outcome measures Indicator Baseline
Page 81 and 82: determine ratio of nurses and GPs t
Page 83 and 84: C. Extended role for pharmacists:
Page 85 and 86: 11 Engagement Working group who dev
Page 87: Appendix B: Acutely unwell adult pa
Page 91 and 92: Review Buller after hours arrangeme
Page 93 and 94: Year three Community education camp
Page 95 and 96: 13 Costs Budget considerations:
Page 97 and 98: established. This group now oversee
Page 99 and 100: Output measures Tobacco control / s
Page 101 and 102: Improving immunisation coverage - h
Page 103 and 104: Year three Continued joint plan
Page 105 and 106: extending health promotion activiti
Page 107 and 108: Immunisation Coverage Funder Provid
Page 109 and 110: The Community Health System Deliver
Page 111 and 112: Clinical care Practice self managem
Page 113 and 114: and increases in the numbers of pat
Page 115 and 116: Ambulatory Sensitive Hospitalisatio
Page 117 and 118: % CVD on lipid lowering drugs, beta
Page 119 and 120: Health navigators/ kaiawhina: chan
Page 121 and 122: Committee‟s objectives 41 of prov
Page 123 and 124: - lack of consistency of care betwe
Page 125 and 126: qualifications and skills. Where ca
Page 127 and 128: 6 Deliverables / activities Impleme
Page 129 and 130: “With an aging population and an
Page 131 and 132: Differences between revenue generat
Page 133 and 134: Appendix Seven: Integration - Healt
Page 135 and 136: It is expected that HealthPathways
Page 137 and 138: Year two implement the process to
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Low uptake by primary and secondary
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Appendix Eight: Improved access to
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to easily access by telephone). Oth
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Year One - July 2010 to June 2011 T
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LECG 50 evaluated whether “the im
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Appendix Nine: Referred services 1.
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them by technical errors or lack of
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Identify patients that would benefi
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• Provision of patient specific m
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12 Organisational accountabilities
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emain under the care and management
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Service user pathways in an optimal
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Model for shared care pathways deve
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Implementation plan: to June 30 Dev
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Year two Review progress, outcome m
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10 Risk analysis Risk Probability I
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Appendix Eleven: Frail older people
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ehab and treatment programmes that
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Year one: Maintain and continue the
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Māori have a higher incidence of m
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11 Organisational accountabilities
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There are often vacancies for allie
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6 Deliverables / activities Program
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Professional development: Provide
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Mainstream arguments are concerned
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Appendix Thirteen: IFHCs - Faciliti
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A key possibility is that land at t
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This option is effectively a Greenf
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7 Westland IFHC Facilities options
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Year two Substantive-IFHC in Greymo
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12 Costs Capital costs Greymouth IF
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utilize MedTech, but via their own
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4 Objectives: To implement c
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Security An individual‟s health i
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8 Effect on inequalities The increa
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Appendix Fifteen: Project advisory
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