Volume 189 - Issue 4
Health services under siege: the case for clinical process redesign
Authors: Stephen F Wilson and Nicholas Collins
Med J Aust 2008; 189 (4): 238-240. || doi: 10.5694/j.1326-5377.2008.tb02006.x
Published online: 18 August 2008
Published online: 18 August 2008
To the Editor: The authors of the recent supplement on clinical process redesign have shown that improvement can occur in the efficiency and quality of hospital care.1 They acknowledged that this process was accompanied by an investment in external consultants and a boost to the system of 1800 beds. These interventions were necessary, and have been successful in the short term. However, these measures alone may not be sustainable for hospitals in the long term with the projected needs for the health care of an ageing population.2
The table in the appendix to the supplement showed most hospitals continuing to perform poorly in their response to increasing demands on emergency departments (EDs), with corresponding increases in admissions to hospital.3 It was interesting to note that, of all the hospitals listed, Campbelltown Hospital, with the largest increase in demand (27%), also had the lowest increase in admissions through its ED (6%). A similar phenomenon was noted at Bankstown Hospital, which had a 27% increase in demand and a 13% increase in admissions. Could these have been the result of the community and ambulatory redesign that occurred in these hospitals from 2000 to 2004?4 The common feature of these two hospitals is the linkages developed between ED community nurses and general practitioners, creating a situation whereby increasing demand does not have to rely entirely on hospital beds as a solution.5
The case of an older woman with diabetes, sepsis and heart failure described in one of the supplement articles6 implicates a failure in community chronic disease management, as well as hospital care. Older people will continue coming to EDs, and will continue to be admitted to hospital in increasing numbers. To avert future crises in health care, the success of hospital redesign needs to be matched by an equally well resourced redesign of primary health and community care.
References
- Health services under siege: the case for clinical process redesign. Med J Aust 2008; 188 (6 Suppl): S1-S40. 0_CBBFCBEH
- Australian Bureau of Statistics. Disability, ageing and carers. Canberra: ABS, 1998. (ABS Cat. No. 4430.0.) 0_pgfId-1777314
- Health services under siege: the case for clinical process redesign. Appendix: Impact of redesign on emergency and elective access in 24 New South Wales hospitals from the financial years 2004–05 to 2006–07. Med J Aust 2008; 188 (6 Suppl): S36-S37. <eMJA full text>
- Wilson SF, Chapman M, Nancarrow L, Collins J. Macarthur model for ambulatory services. Aust Health Rev 2001; 24: 187-192. 0_i1091843
- Wilson SF, Collins N. Emergency medicine. Ambulatory alternatives exist [letter]. BMJ 2002; 325: 389. 0_i1091846
- O’Connell TJ, Ben-Tovim DI, McCaughan BC, et al. Health services under siege: the case for clinical process redesign. Med J Aust 2008; 188 (6 Suppl): S9-S13. 0_i1091848