The Illawarra Shoalhaven Local Health District (ISLHD) has implemented a range of strategies aimed at improving patient’s hospital experience, including the Confused Hospitalised Older Person Study (CHOPS). The ISLHD covers a 250 kilometre coastal strip south of Sydney. Wollongong Hospital is its major referral and teaching hospital, Shoalhaven District Memorial Hospital and seven other hospitals provide acute care or other speciality services, such as aged care, rehabilitation and palliative care.
Issues and problems faced
The ISLHD has a large elderly population, with almost 20% of the community aged over 65, compared to the NSW average of 14.5%. In 2014, elderly residents in the ISLHD attended 3,802 outpatient clinics. Key priorities for the ISLHD have been to raise awareness in the community of dementia and delirium, and to implement ongoing and successful long-term strategies to support awareness. Additionally, coordinating strategies across health care providers has been vital for the ISLHD, as well as a stronger focus on person-centred care.
Strategies that made a difference
A range of strategies were implemented by ISLHD including:
- Developing a district-wide strategic plan for the management of dementia in the acute hospital settingImplementing CHOPS at Wollongong Hospital, with the Agency for Clinical Innovation (ACI)
- Implementing the geriatrician in practice (GIP) project in the Shoalhaven community
- Collaborating with Alzheimer’s Australia and younger onset dementia clinics on the Living with memory loss program
- Running Understanding dementia workshops and Dementia and specialling duties education in Shoalhaven
- Rolling out a Delirium screening tool across the ISLHD
- Implementing TOP 5, a carer-clinician communication program to personalise care, at Shellharbour and Bulli Hospitals, and Wollongong Hospital aged care ward
- Collaborating with the Dementia Training Study Centre on dementia and the environment at Wollongong, Bulli and Shellharbour hospitals
- Collaborating with the ACI and the University of Wollongong on the Objective Structured Clinical Examinations delirium education initiative.
Outcomes
Collaboration with carers is a occurring and remains a priority across the ISLHD. Staff use the TOP5 or ‘sunflower’ templates. In fact, falls by older persons have been reduced during the piloting of these tools in two units. CHOPS is currently undergoing evaluation, and improvements have already been noticed in the environment, in collaborative care practices and delirium screening.
Comments from staff on new initiatives:
- Shoalhaven workshops – “I would recommend anyone to attend, would be good for the wider community”
- Delirium screening tool – “this is a tool I will use”
- Comment from a patient on the GIP project – “Thank you. I have never been able to convince my husband to see a specialist at the hospital about his memory and very bad moods. Being able to bring him to the GP meant he was agreeable and even more relaxed. I feel so much better that we have been able to finally start this process!”
Tips for others
- Mentoring culture is a requirement, be approachable
- Staff ownership is vital to success
- Support at all levels is needed
- Involving all staff is helpful, not just clinicians
- Listen to carers and older people in hospital
- Collaborate.
Where to from here?
- Continue to build on the work already done
- Dissemination of Australian Commission on Safety and Quality in Health Care resources and promotion of the Caring for Cognitive Impairment campaign
- Implementation of the ISLHD strategic plan.
Learn more about other hospitals that have signed up to the campaign here.
For more information, contact Steve Swan on steve.swan@health.nsw.gov.au.
