Integrated care, hospital to community: Improving patient journey

Ms Glenda Rayment1, Ms Charity Omwoyo, M Susana Sanmiguel, Ms Karina Castro

1Liverpool Hospital, Liverpool, Australia

Introduction

PD is a mode of renal replacement therapy performed in the home that has several advantages compared to hospital-based dialysis such as flexibility and freedom. Peritonitis is the major cause of technique failure for PD, with adherence to antibiotic therapy essential for resolution.  An innovative model of care was developed and implemented in 2016 between a tertiary referral hospital and Community Health services for the management of peritonitis.

Aim

The aim of this project was to effectively manage PD-related peritonitis in the home, utilising the existing health system resources, overall promoting adherence to antibiotic therapy and decreasing hospital length of stay (LOS).

Context

This is a 3 – year review of Community Health Service involvement in managing PD-related peritonitis at home. Over this period, there were 365 PD-related peritonitis presentations with an average of 121 presentations per year, of which over 70% were treated in their homes utilising the Community Health Service. During this 3 -year period, there were a total number of 257 referrals to Community Health Service, with an average of 85 referrals per year.

Conclusion

This model of care effectively utilized existing resources within the health system to improve patient outcomes by integrating patient care from the hospital to the community health sector. This has also increased patient adherence to antibiotic treatment due to the convenience of administering antibiotics in the patient’s homes, and also reduced hospital LOS by approximately 3598 bed days over the 3 year period.


Biography:

Charity Omwoyo is the Nurse Practitioner in the Renal Home Therapies Unit. Charity has worked previously as an NP in CKD. Charity has worked in Renal units across Australia and also has international experience working in the USA and Kenya. In her spare time, Charity is undertaking a degree in Law.

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