Complete guide to Australian hospital patient flow management — access block reduction, length of stay (LOS) optimisation, discharge planning, NEAT alignment, Hospital in the Home (HITH), and patient flow software.
Access block affects 30-40% of admitted ED patients. Australian average LOS is 3.5-4.5 days. HITH and virtual wards reduce LOS and free beds. This guide covers Australian patient flow.
Patient Flow Optimisation Strategies
| Strategy | Impact | Implementation |
|---|---|---|
| NEAT compliance | -30% access block | 4-hour ED target |
| Discharge by noon | -0.5 day LOS | Morning discharge rounds |
| HITH | -2-3 days LOS | Home IV therapy, monitoring |
| Virtual wards | -2-3 days LOS | Remote monitoring at home |
| ERAS pathways | -2-3 days LOS (surgical) | Standardised protocols |
| Weekend discharges | -1-2 days LOS | Weekend discharge support |
| Bed management team | -10% access block | Dedicated bed managers |
| Predictive analytics | -15% access block | Predict demand, plan capacity |
Discharge Planning Process
- Admission: Start discharge planning at admission — estimated discharge date
- Daily review: Review discharge plan daily during ward rounds
- Pre-discharge: Confirm clinical fitness, arrange tests, medications, transport
- Aged care: Arrange aged care placement or community support if needed
- Patient education: Educate patient and family about post-discharge care
- Discharge summary: Complete discharge summary and send to GP
- Medication reconciliation: Reconcile discharge medications
- Follow-up: Arrange outpatient follow-up
- Post-discharge follow-up: Phone follow-up within 48 hours
Hospital in the Home (HITH)
| Condition | Treatment | Duration |
|---|---|---|
| Cellulitis | IV antibiotics at home | 5-7 days |
| DVT | Anticoagulation at home | 3-6 months |
| Post-surgical recovery | Wound care, monitoring | 2-5 days |
| COPD exacerbation | Medication, oxygen, monitoring | 3-5 days |
| Pneumonia (stable) | IV antibiotics at home | 5-7 days |
| Heart failure | Diuresis, monitoring | 3-5 days |
Frequently Asked Questions
- What is access block and how does Australia address it?
- Access block is when ED patients wait > 8 hours for an inpatient bed. Access block affects 30-40% of admitted ED patients in Australia. Solutions: 1) NEAT compliance (4-hour ED target), 2. Discharge by noon, 3. HITH (Hospital in the Home), 4. Virtual wards, 5. Aged care placement teams, 6. Weekend discharges, 7. Bed management teams, 8. Predictive analytics for bed demand.
- What is Hospital in the Home (HITH) in Australia?
- HITH (Hospital in the Home) is an Australian model where hospital-level care is provided at home. Suitable for: cellulitis (IV antibiotics), DVT, post-surgical recovery, COPD exacerbation. HITH reduces LOS, frees beds, and has high patient satisfaction. MBS and state funding support HITH. ~5% of Australian hospital admissions could use HITH.
- What is the Australian average length of stay?
- Australian average LOS: 3.5-4.5 days (all admissions), 1-2 days (day surgery), 5-7 days (complex surgery). LOS varies by DRG. Reducing LOS by 0.5 days saves AUD $500-1,000 per patient. Key strategies: early discharge planning, ERAS, HITH, virtual wards, discharge by noon.