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Taking the hospital to the home

With a growing effort to keep people out of hospital, community based services are meeting an important need, writes Greta Marsh.

It’s late on a Friday afternoon and 45-year-old Mary is in a great deal of pain from a laceration she sustained from a recent fall. At first she tried to manage her own wound care, but now it is infected so she takes herself to her GP.

She has increased swelling and wound exudate and is unable to use her hand. Her GP commences her on oral antibiotics but he doesn’t have the resources to manage Mary’s wound or monitor her over the weekend.

This is a common situation faced by GPs and patients, and on many occasions the only solution is going to hospital. But instead of having to wait it out in the emergency department, Mary was able to receive the help she needed in her own home.

She is joining a growing number of Western Australia residents receiving this care as a result of Silver Chain’s home hospital service.

Launched in February, the service is the centre piece of the state government’s Friend in Need Emergency (FINE) scheme and provides an integrated and co-ordinated community based service in the home to patients across the Perth metropolitan area.

“Silver Chain home hospital comprises the community based non-inpatient acute and complex component of the FINE scheme,” says Chris McGowan, Silver Chain CEO.

“The FINE scheme aims to deliver care and support to people in need by enhancing the capacity of the community care sector to provide care for patients in their own home. Our service provides hospital level care enabling patients to remain in their own home, rather than present to an emergency department or be admitted into hospital.”

It also offers a new priority response assessment (PRA) service for patients who don’t require an emergency response but require an advanced clinical assessment.

“Our priority response nurse practitioners will provide an assessment and on the spot care within four hours,” says McGowan.

“This allows many patients, especially those in residential care facilities, to be managed in their home rather than being transferred to an emergency department for care.”

Patients can be admitted to the home hospital upon referral by their GP, specialist or Silver Chain home hospital medical officer.

The home hospital enhances continuity of care for patients by including the patient’s usual GP in the provision of required care.

“These links with GPs are complemented by a multidisciplinary approach to care provision. The home hospital team includes specialist GPs, nurse practitioners, registered nurses, allied health practitioners, enrolled nurses and care aides,” says McGowan.

“The recent introduction of nurse practitioners to the team will allow more flexibility and responsiveness and is an element of the innovative priority response assessment service. Nurse practitioners are able to assess patients, order diagnostic investigations and prescribe medications thus expanding the capability of the service to respond to community needs.”

On Mary being referred by her GP to Silver Chain’s community nursing program, on assessment, it is identified that she needs some support around the house while she is receiving wound care to her hand. The nurses attending to Mary’s care liaise with her GP as required and advise him when the wound has healed, and she is discharged from the service and didn’t have to present to the hospital.


Silver Chain Home Hospital caters for patients who have a range of short term clinical care requirements, offering the following services:

Priority response assessment (PRA) is a non-emergency service that provides advanced clinical assessments within four hours. This assessment may lead to the provision of short term acute care interventions to address an immediate need or admission to other services.

Hospital at home provides care in the home for patients who would otherwise require hospitalisation, are clinically stable and require 24 hour medical governance. Treatment for ambulatory care sensitive conditions requiring IV antibiotics; anticoagulation therapy; rehydration therapy.

Post acute care service provides post acute interventions for patients in the immediate post discharge period from hospital or a HITH program.

Community nursing is provided for care interventions not requiring 24 hour medical governance, as an alternative to admitting patients to hospital.

All Silver Chain Home Hospital services include the option of home support services or allied health as required.

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