Meeting the need: Establishing hospital avoidance services in metropolitan Adelaide

Background: Central Adelaide Local Health Network (CALHN) is a state government run public hospital organisation in South Australia comprised of five hospitals with two emergency departments. The population we serve is diverse in location and in their health and social care requirements. To accommodate an increasing unmet community demand, CALHN introduced a model of care that accommodates consumers with urgent non-emergency care needs.

Approach: Healthcare in Australia is largely funded by the government, with primary care covered by the Federal government's Medicare scheme and public hospitals by the states and territories. The Medicare scheme is poised for reform to ensure it meets the needs of an evolving healthcare landscape. In the meantime, increasing demand for healthcare that is not sustained by current primary care structures and services means that public hospitals - with an always open door and no out-of-pocket expenses - are being overwhelmed by demand. This mismatch in capacity and demand often sees the state-run public hospitals creating solutions that may be seen as foundationally primary care. CALHN first created a hospital avoidance model of care in 2019. It was designed as a multidisciplinary ""rapid see, treat, discharge"" service to accommodate consumers on a trajectory to an emergency department, but whose care needs do not require emergency medicine (typically Australasian Triage Scale categories 3 and 4). The service also focusses on the care needs of those from diverse backgrounds who may have a level of vulnerability, including older people, those with a disability, First Nations people, people experiencing homelessness or from culturally and linguistically diverse communities. The service was established in a community location, approximately 7 kilometers from the nearest emergency department. Following the success of this service, CALHN designed a second service, largely based on the original but with significant consumer engagement to inform the model. The second service was designed to be located onsite at one of its tertiary public teaching hospitals; this nuance provided both opportunities and challenges in the design.

Results: The second service has been operational since 15 July 2024 and to date has provided care for over 2,000 consumers. The original service, in the same time period, has provided care for 2,800 consumers. Collectively, this represents close to 5,000 consumers who have been redirected from CALHN emergency departments. Whilst this model of care does not solve the structural problems of healthcare in Australia, it does provide a person-centred, care-level appropriate alternative for consumers in the CALHN community whilst reducing activity presenting to the busy emergency departments.

Implications: Healthcare demand is creating opportunities for organisations to do things differently. Traditional hospital models need to evolve to meet this demand whilst governments plan an approach to system reform that will sustain growing demand. Our next steps are to review the model in early 2025, to ensure the referral pathways are capturing the right consumers, and that activity base covers the costs of the service.