Northern Adelaide Local Health Network (NALHN) noted an increase in ‘potentially preventable admissions’, disease centred rather than patient centred care and a high 28 day readmission rate.
In response to the above, NALHN developed a Chronic Disease Management Unit (CDMU) aimed at bringing programs providing chronic disease care together. The following changes occurred:
• Staff co-located together and unified expectations of clinicians (e.g. clinic templates, caseload, etc.) were established
• Upskilling of staff to undertake advanced care / palliative care discussions
• Increasing consumer engagement in initiatives such as hand held records
As a result a decrease in ‘Potentially preventable admissions’ in 2015/16 vs 2014/15 has been reported. Specifically:
• 10% decrease in ‘diabetes complications’
• 10% decrease in ‘cellulitis’
• 23% decrease in ‘COPD’
• Significant decreases in occupied bed days as a result of above - eg. COPD ~ 800 bed days saved in 2015/16
Click here to view a summary slide of the Innovation.