13 July 2016

UC sub-acute hospital to deliver super service

| Kim Fischer
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About twelve months ago, my daughter developed swelling and redness in one of her eyes. We were lucky enough to get an appointment with our local GP the same day, but were shocked to be told that we needed to go to Canberra Hospital emergency admissions straight away.

Our GP was concerned that our daughter might have orbital cellulitis – a rare but very serious condition that requires immediate attention. Nine hours and an exhaustive number of tests later, we returned home with the all-clear. Every single staff member was professional and sympathetic and although it turned out to be a false alarm, it was definitely a case where being safe rather than sorry was the right approach.

Aside from being grateful for having access to a health system as good as Australia’s (thank you Gough Whitlam), the whole episode made me more appreciative of the complex role of hospitals.

People think mostly of the front line services of emergency, intensive care, and maternity wards when they imagine a “hospital”. But hospitals are also responsible for administering a huge network of specialist tests and care for patients. Many of these patients have complex conditions that may take days, months, or even years to treat – and particularly in the case of elderly patients, there may be no realistic chance of a permanent cure.

My daughter’s experience with the hospital is known as acute care: a serious episode where hospital attention is required immediately. After discharge there was only a minimal likelihood that she would need to return.

On the other hand, sub-acute care is where “the patient’s need for care is driven predominantly by his or her functional status rather than principal diagnosis”. Put simply, the goal is long-term improvements in quality of life even if no simplistic “cure” is possible.

The UC Public Hospital currently under construction and due to open in 2018 is such a sub-acute facility. It is being designed to offer:

  • General rehabilitation
  • Psychiatric rehabilitation
  • Geriatric evaluation and management
  • Mental health day services

Its location at the University of Canberra will provide additional opportunities for integrating teaching, training and research to improve short and long term patient outcomes.

Sub-acute facilities are a comparatively new innovation but are vital for a well-functioning hospital system since they free up capacity in acute facilities. They are not “second class hospitals”, but facilities that are optimised to deliver long-term rehabilitation and care for conditions that are not life-threatening.

The ideal model for sub-acute care is a multidisciplinary assessment by specialists, leading to individual care plans that ultimately lead to the patient being discharged into their home environment to receive supported care. As our population in Canberra ages, the need for high-quality sub-acute care has never been greater. Executed well, sub-acute care delivers “responsive, patient centred, flexible and holistic care” with benefits to both staff and patients.

It’s really important to correct this misconception about the role of the UC public hospital given the misleading criticisms made by the Canberra Liberals back in 2015. For sub-acute care, the goal is quality of life, not admission to a bed. Putting a sub-acute patient in a hospital bed should really only be done where no other option is available.

Have you had to go through rehabilitation or another form of sub-acute care? What was your experience like?

Kim Fischer is an ACT Labor candidate for the seat of Ginninderra in the 2016 ACT Legislative Assembly election.

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dungfungus said :

I worked for many years as the administrative manager of the (then) Rehabilitation and Aged Care Serivce at TCH (1989-1994). I was privileged to work for Professor Sinnett who saw the commonality between rehab and aged care. Both had more to do with quality of life than acute illness.

Prof Sinnett saw rehab as the bridge between and acute episode and independence at home.

For much too long this bridge has been only available at TCH and often has been the Cinderella of health services at that august venue.

It is fantastic to see this bridge pop up at the alternative public hospital site in the ACT.

Kim has it spot on.

I would also add that acute medicine can be reduced to two concepts: sticking something into you or cutting something out of you.

Rehab is about helping the patient/client help themselves to an improved quality of life.

Oh… and my other experience is with the Cardiac Rehabilitation Unit at TCH after my heart attack. They not only helped me to get back to where I was before the episode but probably saved my life.

I speak with some experience and well said Kim.

Can we call you Dr. John from now on?

John Hargreaves10:36 am 04 May 16

I worked for many years as the administrative manager of the (then) Rehabilitation and Aged Care Serivce at TCH (1989-1994). I was privileged to work for Professor Sinnett who saw the commonality between rehab and aged care. Both had more to do with quality of life than acute illness.

Prof Sinnett saw rehab as the bridge between and acute episode and independence at home.

For much too long this bridge has been only available at TCH and often has been the Cinderella of health services at that august venue.

It is fantastic to see this bridge pop up at the alternative public hospital site in the ACT.

Kim has it spot on.

I would also add that acute medicine can be reduced to two concepts: sticking something into you or cutting something out of you.

Rehab is about helping the patient/client help themselves to an improved quality of life.

Oh… and my other experience is with the Cardiac Rehabilitation Unit at TCH after my heart attack. They not only helped me to get back to where I was before the episode but probably saved my life.

I speak with some experience and well said Kim.

David64 said :

Charlotte to answer your question: I have personal and third-party experience of sub-acute care. I went through several months of physical rehab after a serious car accident (physio mainly, but some post-op stuff as well) and I found the care to be of high quality. It was all administered by the public health system, I had no private cover, and I was treated really well and made a complete recovery.

My criticism applies to the third-party sub-acute care I witnessed. It was administered by ACT Mental Health services and it was less successful. Counselling was offered but it fell to very inexperienced young counsellors who were completely out of their depth and, though their intentions were good, did not help the situation. In that respect I have since encouraged others needing mental health care to source it privately.

It wasn’t Charlottes’ question actually.

And by Charlotte, I meant Kim. D’oh. Sorry!

Charlotte to answer your question: I have personal and third-party experience of sub-acute care. I went through several months of physical rehab after a serious car accident (physio mainly, but some post-op stuff as well) and I found the care to be of high quality. It was all administered by the public health system, I had no private cover, and I was treated really well and made a complete recovery.

My criticism applies to the third-party sub-acute care I witnessed. It was administered by ACT Mental Health services and it was less successful. Counselling was offered but it fell to very inexperienced young counsellors who were completely out of their depth and, though their intentions were good, did not help the situation. In that respect I have since encouraged others needing mental health care to source it privately.

I think this is a great article and an important distinction to understand. Keep it up!

“hospital to deliver super service”. ACT Labor spin doctors must be 18 year olds. Sounds like a line from a dry cleaners pamphlet.

rommeldog56 said :

You would have received the same level of service without any input from Gough Whitlam.
I am old enough to remember health services available before Whitlam introduced “free health care” (the same one that costs most of us a $40 co-payment every time we go to a GP).
Things are no better now and in some cases, arguably worse.

Same with tertiary education – when my parents went to Uni, it was entirely free for a majority of students on the proviso they demonstrated the academic wherewithal to deserve a place.
Whitlam didn’t introduce “free” tertiary education, he introduced the idea that anybody was entitled to a university place, regardless of academic ability. And now we all pay.

You would have received the same level of service without any input from Gough Whitlam.
I am old enough to remember health services available before Whitlam introduced “free health care” (the same one that costs most of us a $40 co-payment every time we go to a GP).
Things are no better now and in some cases, arguably worse.

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