Greater Auckland Integrated Health Network (GAIHN) response to Tim Parke’s ‘Diversion of emergency acute workload to primary care: attractive private sector alternative to public hospital emergency departments?’

Tim Parke1 refers to the need for a "real focus on truly determining "right patient, right place, right time" in the provision of acute services. The successful roll out of the GAIHN Community based management of Ambulance transported patients' project is a step towards achieving of this goal and gives a broader range of options to better deal with acute events in the community.The major goal of the GAIHN programme is to achieve a reduction of avoidable hospitalisations.GAIHN in conjunction with the Auckland Regional Primary Options for Acute Care(POAC) Service has been working closely with the four Auckland Emergency Departments (ED), St John and Accident & Medical (A&M) facilities to establish a new pathway for patients and make community based care more accessible.Although this is not a new process for St John, charges to patients have in the past meant patients, who could otherwise have been safely and efficiently treated in a primary care setting, have chosen to go to a hospital emergency department. The POAC service will fund the cost of treatment in a community setting.In order to ensure that potential pitfalls are minimised and to really focus on "right patient, right place, right time", the Auckland region (including St John, the EDs and the A&M Facilities) has agreed a set of clinical guidelines for the paramedics to work with.In addition, local agreements under a Memorandum of Understanding (MoU) with the participating A&M Facilities ensure that good communication and re-engagement with the patients Medical Home is prioritised in order to facilitate better ongoing management of their health needs. Stage 2 of this project, anticipated to take place in March, includes transporting patients to their medical home, further strengthening the appropriate primary care relationships.The new arrangements are being monitored closely to ensure that only appropriate patients are utilising this option.Clinical leadership, collaboration and engagement across services and professional groups have been key in the success and roll out of this project. However, as noted by Tim Parke, this is only one of a series of initiatives necessary to address the unsustainable rising demand in acute admissions to hospital.Reporting have indicated that the ‘GAIHN Community based management of Ambulance transported patients project' in the first four weeks transported more than 160 patients to A&Ms.Background information on the project and the GAIHN work programme is located in the ‘Work Programme' section of the GAIHN website www.gaihn.health.nz Campbell Brebner GAIHN Clinical Lead Penrose, Auckland