Community Hospital Interface Program
Service Description
The Community Hospital Interface Program (CHIP) team is a discharge assessment and coordination team supporting patients who have been admitted to hospital and who require ongoing support on discharge. Ongoing care for short term or long term services is facilitated. The Community Hospital Interface Program provides the single point of contact between the hospital, residential facilities or community service providers for patients of the Sunshine Coast Hospital Health Service.
Services Provided
Community Hospital Interface Nurses (CHIP Nurses): Assessment, planning and support on discharge – referring for nursing and non nursing services; review current home care packages, resource for information and a liaison person for service providers
Aged Care Residential Nurses (ACRU Nurses): Liaison between hospital and residential care facilities (nursing homes & hostels) to facilitate timely and appropriate discharges; ensuring clinical handover for discharge and follow up needs are provided to the facilities
Community Hospital Interface Occupational Therapist (CHIP OT): Rapid response in-home safety assessments for access and equipment. Pre-admission plus pre and post discharge home visits only.
Eligibility
- No specific condition
- Frail aged or younger with disability
- Patients requiring nursing services (any age)
- Aged Care Facility residents - existing residents and new placements
- Patients already receiving community services
- All patients with identified potential risks and complex needs on discharge especially falls risk (i.e. home oxygen, palliative care, Hospital in the Home candidates, chronic diseases, home safety)
- Hospital in the Home eligible patients
Referral
- Inpatient: Patient or Hospital multidisciplinary team (doctors, nurses and/or allied health)
Area Serviced
Sunshine Coast University Hospital, Nambour, Caloundra and Maleny Hospitals
Age Range
Across the life span
Cost
- Nil
- Costs associated with Commonwealth Home Support Program (over 65 funding); Queensland Community Care Services (under 65 funding); L1-4 packages (Information on packages is available at My Aged Care)
How to Submit a Referral
Internal verbal referrals are made to the Community Hospital Interface Program nurses or occupational therapist by the multidisciplinary team in the wards/units or by patient/family request
