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Put simply, hospital-in-the-home programs allow for the early discharge of a patient from hospital. The patient continues to receive nursing care in the familiarity of their home environment when there is no perceived clinical risk to their health. The program also allows the hospital to admit as early as possible another patient for treatment. The Canadian hospital-in-the-home scheme was established in 1981 and is a very early and very good example. The scheme is a government-funded multidisciplinary project that services clients at many hospitals. The project has demonstrated long-term benefits which have resulted in the reduction of the number of hospital beds needed to service patients while, importantly, still providing safe discharge.

As I noted earlier, in Australia several innovative programs have been established. Here in the ACT a variety of programs have been established to reduce the length of hospital stay and provide support following discharge. These have included midwifery programs such as midcall and the neonatal support outreach program from the neonatal intensive care nursery. In 1993 the Community Nursing Service received short-term funding of $61,000 from the Commonwealth to establish an early discharge program in cooperation with Calvary Hospital. The program is known as homecall. In August 1994 the program was extended to Woden Valley Hospital and resulted in nursing support being given to orthopaedic early discharge patients.

The homecall program provides support for a two-week period following discharge. There is a strong focus on rehabilitation and client independence in the program. The 12-month evaluation report found that 104 patients were admitted to the program - 63 from Calvary Hospital and 41 from Woden Valley Hospital. Analysis of the savings was based upon the number of bed days saved, benchmarked against national average length of stay figures. Overall there was a saving, on average, of 2.02 bed days for the 104 clients referred to the program. There was also more than $88,000 in total hospital cost savings for these patients.

The program not only achieved considerable savings but was effective in achieving successful outcomes. About 77 per cent of patients were discharged to self-care and only 15 per cent referred to ongoing community nursing care. Just one per cent of patients were readmitted to Calvary Hospital and about 7 per cent from the orthopaedic early discharge program due to surgical complications. I am also advised that the number of referrals has increased since January this year. It is worth noting, however, that the homecall program is limited by its size and, therefore, there is a need for clinicians to develop strategies to manage the early discharge of patients more effectively. The program can and will be improved, with more patient referrals and more effective use of discharge planning mechanisms. There is also a need to ensure that other community support services are available through existing funding mechanisms such as the HACC program.

The Community Nursing Service can provide an increased level of service in acute and post-acute care. The service has standardised care plans to ensure the continuity of care for its patients. The service also places considerable emphasis on enhancing the skills of its staff to meet changing needs and technologies. For example, the Community Nursing Service now manages many different procedures, including IV therapy. It can provide an alternative to hospitalisation for patients having IV antibiotic therapy.

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