The readiness is all for a cultural shift away from hospital to Home in the Hospital.
Dr Daryl Kroschel headed west in July with his young family to become Silver Chain’s first full-time director of its Home Hospital service. As Deputy Director of one of the country’s most successful Hospital in the Home (HITH) services, Cabrini Health in Victoria, he’s been able to hit the ground running.
However, Silver Chain’s large government remit and the area covered makes the challenge a unique and exciting one.
“The extent of the service here in WA makes Silver Chain’s Home Hospital (HH) unique in as far as it’s system-wide approach. For a large part, this role is liaising with the hospitals to make the interface as smooth and as consistent as possible,” he said.
The call on services such as Home Hospital will only grow in the future and Daryl told Medical Forum that Silver Chain held a contract with the State Government in terms of bed days.
“There are a lot of services being delivered in hospital that should be delivered in the community – estimates put the figure at around 20% of people who don’t need to be there so our mandate is to try and treat those people in the community from the outset. Hospitals will more and more become the preserve for people who are acutely sick, so we are there to facilitate early discharge for those who can be accommodated in the community.”
From a governance perspective, Daryl said HH had worked hard to establish a sound structure with a medical, safety and quality committee that had policy and protocol oversight.
“Medical governance and ensuring patient safety is paramount and we have processes in place, especially around the deteriorating patient and particularly in the clinical handover. We know this is an area of high risk for any health service but particularly when there are multiple services involved,” Daryl said.
There is also a representative body from various specialist disciplines including infectious diseases, respiratory, emergency, geriatrics, haematology giving input.
From an operations perspective, Daryl said the HH was trying to grow its own medical workforce, which saw the recent announcement that Silver Chain would be offering an expanded Community Residency Program in 2016 for 60 junior doctors with 12 RMO positions over five rotations.
It’s a boost for all concerned – it offers junior doctors a foundation of community care which will reverberate throughout their career and the health system and it will give Silver Chain a flexible and expanded workforce across its hospice and Home Hospital services.
Daryl says GPs and nurse practitioners (NPs) remain essential ingredients but there is a move towards salaried staff rather than calling on those in private practice.
“The arrival of the RMOs will give us vertical integration in terms of structure so we will be able to define the key roles around GPs and NPs and have greater opportunity to get out and see more patients in their homes.”
“It’s been really great couple of months. The service has grown immensely this year so the opportunity to be involved in a service that reaches right across the metro area is quite unique and that’s what’s drawn me here. The equivalent doesn’t exist anywhere in Australia.”