For the last few weeks, our new High Acuity Discharge Clinic (HADC) has been providing some of our non-COVID patients with rapid clinic access that enables to them wait for tests and/or resolution of illness at home or provide clinic access to treat/review. By reviewing these patients in our HADC, we have been able to safely speed up their discharge or avoid their admission to hospital altogether.
As part of our continuous improvement approach and the excellent feedback we have received, we have made several improvements to how we will run the HADC. These include:
- Face to face/telehealth availability every day, 8am – 5pm in Clinic M, MMC
- Patients requiring imaging will have their imaging appointment and report completed and available inside of 3 business days from accepting referral (except for exceptional circumstances, e.g. the patient requires special preparation that prevents the imaging).
- Expanded patient criteria(see below)
- A clinician-led review model that includes Allied Health, Clinical Nurse Consultants, Nurse Practitioners, and Medical employees.
Our first patient
Our first patient was able to be discharged with a HADC follow-up after an admission under General Medicine for delirium, dehydration, and renal impairment.
A blood test was performed a couple of days after being discharged and the patient was subsequently reviewed in the HADC via Telehealth. The doctor confirmed the improvement in renal function and an increase in oral intake since returning home. The patient was then referred to their general practitioner for ongoing care.
Below we have outlined some additional examples of patients (and their conditions) that can utilise the HADC.
All medical referrals require approval of the medical registrar or consultant, and HADC appointments can be booked if the following criteria is met:
- The patient has independent mobility
A HADC appointment will:
- Facilitate earlier discharge; or
- Avoid admission because the HADC appointment will provide urgent clinic review where the clinician has no other clinic access.
- Flag HADC at the time of referral by including clinic appointment date/time and proposed date for imaging.
- Inpatients being discharged to HADC with outstanding imaging requirements or upcoming booked inpatient appointments will require an EMR referral flagging HADC at the time of discharge. Alternatively, call the modality to inform them of the plan to discharge the patient and attend the HADC. This will ensure these tests are completed as an outpatient with a 3 day turn around ready for their HADC appointment.
- Outpatients who are attending the HADC to prevent admission or patients reviewed in clinic with ongoing imaging requirements will remain on a paper referral ensuring HADC is flagged.
Booking a HADC appointment
Clinicians can call 0436 618 550 to request a HADC appointment time that suits their patients (and is convenient for their team to attend the review).
If calling out of hours, please leave a message on voicemail with patient details, date required, preferred time, and your contact details.
An internal referral via SMR to the High Acuity Discharge Clinic is also required. Please provide the following information:
- Name, designation, contact details of referring clinician
- Review requirements and outstanding tests
- F2F/telehealth appointment
- Approving consultant name
- Flag interpreter requirements
Because of their acuity, some of these patients may require readmission to hospital. This will be arranged via direct admission from the clinic (the clinic nurse will call the bed manager and the clinician will provide the details).
What kind of patients can utilise the HADC?
Here are some examples of patients that can utilise the HADC clinic.
- If there is an incidental finding during an admission under the home unit, but related to a different speciality.
- Home unit inpatient care completed.
- A consultation and further tests required to progress the care for the incidental finding could be done in outpatient setting within the following few days.
- Time could be booked to coincide with a subsequent consultant ward round if required.
- An unwell dialysis patient in a satellite unit that requires medical review after Admission.
- A neurology patient with unexplained symptoms needing tests to clarify a diagnosis.
- A rheumatology patient requiring urgent injection/treatment with no other clinic access that would otherwise need to present to ED for treatment.
- A gastroenterology patient with slowly resolving hepatitis that requires a clinic review to ensure improvement/resolution.
- A subacute patient who has been cleared by allied health but requires improvement in renal function.
For more information, visit (and bookmark) our High Acuity Discharge Clinic (HADC) page.
Approved by Martin Keogh, Chief Operating Officer