Problem Statement

Demand for hospital beds within CM Health has been steadily increasing over recent years and often exceeds the existing capacity. Optimising people’s access to acute care within community health services, and supporting acute hospital flow by avoiding admission and providing early support to patients and their whaanau will take the pressure off the system.

The Community Health Teams support patients and their whaanau by enhancing their transition to community care, and ensuring patients can manage safely at home, with adequate supports, after they have presented to hospital. Community clinicians also work alongside primary care to increase supports and interventions, as required, so patients can continue to be safely and adequately cared for within their home and community, and to avoid the need for unnecessary hospital presentations. This model of care provides flexibility for patients and enables more care to be delivered outside of the hospital.

Hospital in the Home is an alternative acute care pathway to inpatient admission, enabling patients to receive hospital-level care at home, and reducing demand for Middlemore Hospital beds.

Hospital in the Home offers patients and their whaanau a choice as to where treatment will be located, and enables a wider variety of acute care to be provided within people’s homes and the community.

Community Central provides a centralised coordination and clinical triage function for all acute and non-acute care within the Community Health Service.

What are we trying to achieve?

Our goal is to fully establish a Hospital in the Home model of care that supports the CM Health system by providing a greater level of acute care within the community. This will be done through:

  • supported discharge – through an enhanced hospital-to-home transition pathway, enabling more clinical treatment and monitoring to happen within the patient’s home. The pathway will provides early transition of care, through rapid access to community-based multi-disciplinary assessment and short-term intensive care packages, enabling individuals to return home as quickly as possible after a hospital admission.
  • admission avoidance – through locally based rapid access to multidisciplinary assessment and treatment within the patient’s home or local clinic facility, and access to short-term care packages that can prevent the need for hospital presentation.

The aim is to develop the capacity for up to 20 patients at a time to be managed within the community under the Hospital in the Home approach. Under the model, all patients will remain under the duty of care of a senior medical physician employed by CM Health.

What have we done?

We have established and implemented a Hospital in the Home pathway focusing on supported discharge for patients with long-term conditions. To date, there have been approximately 100 patients admitted to the pathway since it commenced in June 2018.




 Forty six per cent of the patients admitted to date to Hospital in the Home have had a primary diagnosis of heart failure. We have demonstrated that these patients can safely receive both treatment and clinical observation within their home environment.

We are currently working across the hospital and community to build awareness of and confidence in the level of care that can be safely provided within the community, and thus continue to build capacity within the model. We are working collaboratively with secondary care to understand how to identify appropriate patients for the model of care and the range of care that can be provided within it.

Where to from here?

From September 2019, we will have two senior medical officers based within Middlemore Hospital who will lead and drive capacity for the Hospital in the Home pathway. In addition, the Community Health Service will have two nurse practitioners, who will collaborate closely with the medical physicians and general practice to increase the range of acute care provided within the community, through both supported discharge and admission avoidance pathways.

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