Stroke stream- transport

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Vascular Network Transport Discussion Paper- November 2009
Transport Phase
Working Well
Challenging Areas
Pre-hospital
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Interhospital transfers
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Good support x ambulance
service re rapid and appropriate
transfer in event of acute
vascular event.
Strong linkage with ambulance
service re changing models of
care and closer contact with
acute care teams when
geographically feasible.
Multiple options include
Wingaway, Ambulance (air &
road), Transport for Health,
Cardiology transport (based at
JHH for GNC/LH cluster) with
access depending on level of
escort and clinical support
needed
Central booking has improved
access
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Discharge home
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Some ambulance transport
available but not necessarily
timely.
Brief includes HNE transport for
health available to take pts
home
Family
HACC available if fit criteria
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Low numbers of patients utilise ambulance
services in the event of an acute vascular
episode.
Some clinicians do not clearly recommend
ambulance for emergency care and transport.
Very occasional use of families to transport.
Isolated or non-acute patients requiring transfer
may require admission to facilitate transfer for
urgent procedural need, i.e. renal patients with
vascular access issues
Is there criteria describing those patients
suitable for hospital transport?
Limited internal transport vehicles reduces
availability.
Access to appropriate & timely transport
Transport issues impacted upon by transfer
processes.
Definition for renal pts receiving dialysis (&
other non-admitted pts) in hospital settings
needs to be reviewed as clinical needs occur
that cannot wait 48hrs turn-around for nonemergency transport. Dialysis patients need
access sorted out at tertiary hospital ASAP
Internal transport won’t transport home. Will
transport to nursing home/other hospitals.
48hr transport delay with ambulance
Residents returning to HNE poorly supported –
(need more information re same to HTU)
Community transport/HACC not always
available when required
Metro hospitals contact local hospitals for
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Anticipated needs for the future
(say next 5 years)
 Need to promote utilisation of
ambulance service in the event
of acute vascular episode.
 Ambulance bypass options may
be expanded
 Varying models of transport
(ambulance vs helicopter)
impacted upon by changing
clinical practice
 HNE internal transport more
flexible – out of hours, w/ends,
long trips
 Increasing transport demand
due to aging population and comorbidity
 Timely and appropriate
transport to facility care at either
RRH or local hospital – 48 hrs
too long
 Consideration of cardiologytype transport service rurally to
promote effective utilisation of
rural cath lab/diagnostic CT etc.
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Increasing demand with aging
population and co-morbidity
Are there transport options
available for all population
groups especially in
communities where public
transport limited/not available?
Transport Phase
Attendance at Clinics/
outpt services or
Community based
health services
Working Well
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More services provided closer
to home
Some HACC/Community
transport, some for limited
period of time
DVA assists
Payment incentives to GPs to
deliver services for pts closer to
home
Utilising local acute health care
services when specialist
services no longer required
Good community transport
Newcastle-Port Stephens-Lake
Macquarie
Home dialysis
Home visiting services
Transport for Health options
Challenging Areas
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Anticipated needs for the future
(say next 5 years)
assistance
Long distances but few regional airports
Variable, often limited public transport
Wheelchair access often limited
Distance to travel for face to face specialist
services
Demand for HACC outstrips capacity
Some clients not eligible for community
transport/sometimes transport not available
Need for Aboriginal facilitated transport
Availability and eligibility esp. renal pts
IPTAAS requirements(100km one way) will
always exclude somebody, e.g. patients who sit
just outside IPTAAS rules but travel
considerable volume of kilometres per week more geared for the occasional appointment
every now and then
Matching prearranged transport with changing
app’t times
Acute admission may occur to improve access
to transport
High cost of co-contribution sometimes limits
clients’ capacity to attend ongoing programs
Long travel times with some transport providers
Urgent vascular access for non-admitted
patients is unpredictable
Definition for renal pts receiving dialysis (&
other non-admitted pts) in hospital settings
needs to be reviewed as clinical needs occur
that cannot wait 48hrs turn-around for nonemergency transport. Dialysis patients need
access sorted out at tertiary hospital ASAP
Transport to specialist appointments/tests for
RACF patients and patients with mobility
issues/cant sit in a chair/bed bound. Many
patients are being transported for specialist
appointments in clinics at the
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Telehealth/outreach services to
reduce need for transport
Consultation with councils and
business to better meet needs
of local communities for
public/private transport.
Advocacy for IPTAASconsideration for clients
attending regular outpatients
appointment exceeding certain
kms over each week, not just
one way
Increasing demand with aging
population
Transport Phase
Accessing
investigations
Working Well
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Challenging Areas
Some specialist outreach clinics
Matching appointments to preexisting visits
Transport for Heath options
IPTAAS
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JHH/RNC/Specialist rooms whom can't sit in a
chair, Patient Transport (Ambulance) must
transfer them off stretcher for the appointment
and there is no facility to put them, access to
the rooms is limited for the stretcher and there
are no lifting devices etc....
Cost of emergency ambulance booking
May experience lengthy delays awaiting
ambulance transport
Limited availability of internal transport where
relevant
Demand for Transport for Health options
Public transport limited
Acute admission may occur to improve access
to transport
Consideration of outpt transport needs for ED
pts unable to drive who require semi-urgent
follow-up/ investigations after non-admitted
episode, e.g. access to Transport for Health
Wingaway an expensive option also incurring
accommodation costs
Air ambulance very costly
Demand for Transport for Health options
IPTAAS, local follow-up
encouraged
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Very limited air services and long distances
Limited public transport
Ambulance/internal transport
available/utilised at some sites
but not universally leading to
inequity
Home based services
Transport for Health options
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Accessing specialist
appointments within
HNE
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Accessing specialist
appointments out of
HNE
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Anticipated needs for the future
(say next 5 years)
Page 3 of 4
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Growth with changing models of
care requiring more timely
access to investigations
Increasing demand due to aging
population
Growth – outreach/telehealth
options
IPTAAS changing with growing
need – not everyone can afford
to wait 8 weeks for
reimbursement for
extensive/expensive trip to
Newcastle/Sydney and stating
there for extended periods of
time
A/A
Themes:
 Existing HNE transport options need expansion to meet timely demand and promote equitable access. Is there a feedback mechanism as demand
changes to assist with service evaluation?
 Ongoing dialogue with Ambulance service to promote an effective response to care needs, e.g. Thrombolysis for Stroke/Cardiac, 10 PCI
 Clear definitions describing which inpts and outpts are eligible for what and are they equitable definitions?
 Matching to ensure multiple appointments are concurrent to reduce need for transport on multiple days
 Outreach clinics/Telehealth/home visiting services
 Community campaign to promote use of ambulance for emergency care
 Improve vascular access to be more equitable across Area
 How much involvement does Health have in discussion with Gov’t re access to public transport?
 Discharge planning to include consideration of transport requirements for semi-urgent investigations in next few days
 Advocacy for IPTAAS rules to be amended to 1. consider level of isolation rather than distance & 2. pts with high demand needs (renal)
 Measuring impact for those who can’t access transport services as part of evaluation of transport service
 Electronic/web-based booking system to reduce impact around 48 hr booking requirement
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