Guardianship in hospitals: a collaborative pilot project
Rob Hoffman
A F , Sally Costar A , Tass Kostopoulos B , Justine Little C , Aaron Livingstone D , Fiona McAlinden C , Paul Newland D , Jacinta Re C , Dina Watterson A and Terry P. Haines E
A Allied Health, Alfred Health (Caulfield Hospital), 260 Kooyong Road, Caulfield, Vic. 3162, Australia. Email: s.costar@alfred.org.au; d.watterson@alfred.org.au
B Allied Health, Eastern Health, 251 Mountain Highway, Wantirna, Vic. 3152, Australia. Email: tassos.kostopoulos@easternhealth.org.au
C Community and Allied Health, Monash Health, 400 Warrigal Road, Cheltenham, Vic. 3192, Australia. Email: justine.little@monashhealth.org; fiona.mcalinden@monashhealth.org; jacinta.re@monashhealth.org
D Office of the Public Advocate (Victoria), 1/204 Lygon Street, Carlton, Vic. 3053, Australia. Email: aaron.livingstone@justice.vic.gov.au; paul.newland@justice.vic.gov.au
E School of Primary and Allied Health Care, Monash University Peninsula Campus, Moorooduc Hwy, Frankston, Vic. 3199, Australia. Email: terrence.haines@monash.edu
F Corresponding author. Email: r.hoffman@alfred.org.au
Australian Health Review 44(2) 322-327 https://doi.org/10.1071/AH19019
Submitted: 22 January 2019 Accepted: 1 May 2019 Published: 7 November 2019
Abstract
Objectives This paper describes the development, implementation and preliminary results of a collaborative pilot project aimed at reducing the time hospital-based patients with cognitive impairments spend waiting for the allocation of legally appointed Advocate Guardian decision makers from the Office of the Public Advocate (OPA). The aim of the study was to investigate the effect of increased availability of public advocate guardians on guardian allocation waits, patient discharge outcomes and healthcare system demand.
Methods A multi-institutional pilot program created a dedicated hospital guardian team within OPA, funded by the health networks, to reduce the time to guardian allocation for patients within each network. A multisite, quasi-experimental historical control group design was used, with initial data collection over 12 months, followed by study of 12-month post-implementation cohorts.
Results Under the pilot program, the time from guardianship order lodgement to guardian allocation decreased significantly from 46.5 to 22.9 days, halving the average time hospital-based patients spend waiting for a guardian (difference –23.55 days, two-sample t(154) = –6.575, P < 0.0001, 95% confidence interval [–30.65, –16.48].). Mean total length of stay decreased from 163.2 to 148.5 days. The estimated value of the reduction in allocation wait time was A$15 473 per patient, or A$5 of resources released per A$1 spent on increased staffing.
Conclusions Direction of a small amount of resources from health services to staff within OPA appears to have created much greater savings for the health services involved. The pilot program has reduced the period of time vulnerable patients spend waiting in hospital for a guardian.
What is known about the topic? Guardianship resources are under increasing stress, with demand outstripping funding and hospital-based applicants deprioritised due to assumptions of lower risk, leading to extensive wait times for guardian allocation.
What does this paper add? The paper quantifies the impact of greater guardianship resourcing on access to both guardianship and healthcare resources, highlighting benefits for vulnerable patient groups, healthcare system sustainability and access to both guardianship and healthcare resources for the broader community.
What are the implications for clinicians? Improving patient flow through healthcare systems may involve allocating resources to services that are managed outside the healthcare system where ‘bottlenecks’, such as wait times for guardian allocation, have been identified.
References
[1] Kortebein P, Symons TB, Ferrando A, Paddon-Jones D, Ronsen O, Protas E. Functional impact of 10 days of bed rest in healthy older adults. J Gerontol A Biol Sci Med Sci 2008; 63 1076–81.| Functional impact of 10 days of bed rest in healthy older adults.Crossref | GoogleScholarGoogle Scholar | 18948558PubMed |
[2] Hoogerduijn JG, Buurman BM, Korevaar JC, Grobbee DE, de Rooij SE, Schuurmans MJ. The prediction of functional decline in older hospitalised patients. Age Ageing 2012; 41 381–7.
| The prediction of functional decline in older hospitalised patients.Crossref | GoogleScholarGoogle Scholar | 22378613PubMed |
[3] Mitchell BG, Shaban RZ, MacBeth D, Wood C-J, Russo PL. The burden of healthcare-associated infection in Australian hospitals: a systematic review of the literature. Infect Dis Health 2017; 22 117–28.
| The burden of healthcare-associated infection in Australian hospitals: a systematic review of the literature.Crossref | GoogleScholarGoogle Scholar |
[4] Hitcho EB, Krauss MJ, Birge S, Dunagan WC, Fischer I, Johnson S, Nast PA, Constantinou E, Fraser VJ. Characteristics and circumstances of falls in a hospital setting: a prospective analysis. J Gen Intern Med 2004; 19 732–9.
| Characteristics and circumstances of falls in a hospital setting: a prospective analysis.Crossref | GoogleScholarGoogle Scholar | 15209586PubMed |
[5] Department of Health & Human Services (Victoria). Guardianship and least restrictive practice in Victoria. 2018. Available at: https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/older-people/resources/guardianship [verified 16 September 2019].
[6] Australian Guardianship and Administration Council. National standards of public guardianship 2016. 2016. Available at: https://www.publicadvocate.vic.gov.au/our-services/publications-forms/guardianship-a-administration/guardianship-1/357-national-standards-of-public-guardianship [verified 16 September 2019].
[7] Office of the Public Advocate. Guardianship in hospital: an analysis of cases at the Office of the Public Advocate, Victoria. 2015. Available at: https://www.publicadvocate.vic.gov.au/our-services/publications-forms/research-reports/guardianship/guardianship-in-hospital/255-guardianship-in-hospital [verified 16 September 2019].
[8] Office of the Public Advocate. Annual report 2017–18. 2018. Available at https://www.publicadvocate.vic.gov.au/our-services/publications-forms/strategic-plans-and-annual-reports/opa-annual-report-2017/539-opa-annual-report-2018 [verified 16 September 2019].
[9] Office of the Public Advocate. Growing Complexity in Guardianship: Trends in the Advocate Guardian Program. Office of the Public Advocate, Victoria – 2016. 2016. Available at: https://www.publicadvocate.vic.gov.au/our-services/publications-forms/research-reports/guardianship/guardianship-in-hospital/316-growing-complexity-in-guardianship-trends-in-the-advocate-guardian-program-office-of-the-public-advocate-victoria-2016 [verified 16 September 2019].
[10] Independent Hospital Pricing Authority. National hospital cost data collection, public hospitals cost report, round 20 (financial year 2015–16), tables 6 and 22. 2018. Available at: https://www.ihpa.gov.au/publications/national-hospital-cost-data-collection-public-hospitals-cost-report-round-20-0 [verified 16 September 2019].
