We had the opportunity to pick the brain of Bill Faulkner, Team Leader/Care Coordinator, HARP Community Care Coordination, Rosebud Community Health, Peninsula Health who’ll be speaking at the 3rd Annual Reducing Hospital Readmissions & Discharge Planning Conference 2012 on 30-31 July 2012 in Melbourne.
What has been the most challenging aspect of your work in the last 12 months?
– To have all relevant departments and specialists to communicate in regards to individual frequent presenter’s diagnosis and care/treatment into the future.
In your experience, what are the major contributors to unplanned readmissions?
– Underlying undiagnosed mental health issues such as Borderline Personality Disorder, Anxiety and Depression, which impacts on self-motivation/insight to the need to manage their own health/mental health needs.
– Lack of bulk billing GP’s and Specialists especially in regional areas.
– Many Frequent presenter’s health care is of a low priority, therefore often presents in a crisis rather than forward planning and self-management.
How could these be prevented?
– From the ED to Community: It would be highly beneficial to identify underlying mental health issues (eg; BLP, Anxiety, Depression), and to focus on effective discharge planning and re-linking into community services (ie GP, community health services). This may take extra time/energy at the discharge stage from ED but worth it. Ideally provided by “ED Care Coordinators” to ensure appointments are made and information/investigations/diagnosis/treatment from ED intervention has been clearly communicated with GP (for example, fax or electronically sent information to GP instead of a letter via the patient/client).
– More broadly, consider life skills throughout the life continuum to assist with skills around the importance of health self-management. This could involve programs in schools, but in particular program within the ED and acute setting to assist with self-management skills. (captive audience when stuck in bed as a patient).
What are your top 5 tips for managing frequent presenters?
– Meaningful engagement with a non-judgemental approach.
– Establishing clarity around diagnosis. For example, what is a real condition and what is a symptom…ie; is back pain a symptom or a diagnosis? Is there a clear diagnosis, and provision of best practice treatment /management? Is narcotics the appropriate treatment for symptoms that are not conclusively diagnosed?
– Have all the treating team (acute to community) to communicate and integrate their support and treatment for individual frequent presenters.
– Multi-disciplined team which supports open discussion around clients, with provision of regular client reviews in an environment which encourages constructive non-threatening advice.
– Be tenacious in thoroughly investigating clients diagnosis, bringing together the key health team for the client, and if a very frequent presenter, then a development of a Management Plan for the Emergency Department and if needed, the inpatient setting. All this while remaining engaged with the patient, being transparent and “client focused” on what’s best for the client, even if the client is not always agreeing with this.