To the Editor: Sydney’s St Vincent’s Hospital, like many other hospitals, experiences a high occupancy rate which sometimes exceeds 100%, because of continual presentations to the emergency department (ED). NSW Health has recently encouraged new models of community acute/post-acute care (CAPAC) which allow patients to be managed in their homes, thus easing ED overcrowding and avoiding unnecessary presentations.1 However, those presenting most frequently to the ED at St Vincent’s Hospital are homeless. In response, this hospital has sent an outreach team consisting of a medical registrar and a community nurse to the streets of Sydney to deliver a “Backpack” CAPAC service (Figure).

The outreach team provides diagnostic support to homeless people in shelters and crisis centres in the inner City of Sydney area. The team has successfully directed appropriate subacute cases to other health services, without the necessity for attendance at the ED.

Extended episodes of treatment have also been given, including courses of intravenous antibiotics for a range of infections — even subacute bacterial endocarditis has been treated using portable infusion devices.

Inclement weather causes some homeless people to seek refuge in stormwater drains around Sydney. One such patient, with a community-acquired methicillin-resistant Staphylococcus aureus cellulitis, was visited daily in a stormwater drain — his place of residence.

Linkages have also been created with mental health services and non-government organisations.

The Backpack CAPAC service continues St Vincent’s Hospital’s 150-year tradition of providing acute health care to the vulnerable and needy in our community. As this service was initiated with community donations, it has also reduced the drain on health resources.

St Vincent’s Hospital’s outreach team on the streets of Sydney delivering the “Backpack” community acute/post-acute care service to the homeless.