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Health Independence programs (HIP) incorporate a range of services at Melbourne Health which are designed to support and improve the client journey during the transition from acute services to sub acute services and at home.
The programs include:
 Sub-Acute Ambulatory Care Services (SACS)
Hospital Admissions Risk Program (HARP)
Post Acute Care (PAC)
Hospital in the Home (HITH)
Residential Care In-Reach Service
Direct Access Unit (DAU)
The DAU is the single point of access for many of the HIP programs. Client referrals are screened and triaged to the appropriate service by a team of multidiscplinary health professionals (Care coordinators) and administrative support staff.
GP Referrals - for all SACS and HARP programs
GPs can refer using the Victorian Statewide Referral Form (VSRF) VSRF download
Sub-Acute Ambulatory Care Services (SACS)
SACS services at Melbourne Health include:
- Chronic Wound service
- Community Therapy service (including home based and centre based)
- Cognitive, Dementia and Memory Service (CDAMS)
- Falls and Balance Clinic
- Continence service
- Pain management service
- Neuro rehabilitation clinic
- Geriatric evaluation clinic
Click here for more information on Direct Access Unit and SACS services at Melbourne Health.
Hospital Admissions Risk Program (HARP)
The Hospital Admission Risk Program (HARP) - Partnerships in Health (PIH) Program is a service for people with chronic and complex medical conditions who frequently present or are at risk of presenting to hospital and require intensive service coordination.
Target population
The target population for HARP are people who are most likely to benefit from integrated care and have the potential to reduce avoidable hospital use.
These are people who frequently use hospitals or are at risk of hospitalisation and include:
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People with chronic heart disease;
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People with chronic respiratory disease;
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Older people with complex needs; and
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People with complex psychosocial needs;
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People with complications as a result of diabetes.
Services
A range of services are available for referred clients dependent on needs. Services include:
- Cardiac Coach (telephone coaching program)
- Heartwise - includes home nursing, specialist outreach clinic, exercise program
- Diabetes co-management service - Diabetes nurse educators working in General Practice
- Diabetes foot services - includes access to specialised services at RMH, Merri Community Health, Doutta Galla Community Health and home visiting
- Respiratory services - includes community based pulmonary rehabilitation and outreach nursing
- Other non-disease specific services - falls prevention, intensive service coordination - complex needs and/or psychosocial and medication management.
Click here for more information on HARP at Melbourne Health.
Post Acute Care (PAC)
The post acute care program provides support for patients who have been discharged from hospital in order to prevent readmission and assist with recuperation. This program is available to patients who have been discharged from the Royal Melbourne Hospital.
Services include:
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Home nursing
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Personal care
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Physiotherapy
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In-home respite
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Home help
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Ocupational therapy
If you have an enquiry about a patient who is currently on the PAC program or has been discharged and requires further support - please refer to the Direct Access Unit.
Hospital in the Home
The RMH Hospital in The Home Unit (HITH) provides hospital level care for patients in their home environment. It is a safe and efficient substitution for acute in-hospital care for a wide range of conditions.
Treatments
GPs can refer direct to HITH without the patient needing to attend RMH
GP Referrals and enquiries:
| Phone (Business hours) |
(03) 9342 7484 |
| Fax |
(03) 9342 8268 |
| Mobile (out of hours) |
0419 893 685 |
Residentialcare in-reach service
This service was developed as part of the Winter Demand Management Strategy to provide better support for residential care facilities in the Melbourne Health catchment. The service provides an alternative to Emergency Department presentation for clients in Residential care facilities (both low and high care).
Referrals are triaged, and if required clients are visited by RMH specialist nursing and medical outreach staff on the same day in the residential care facility.
Services
- On-site specialist nursing assessment with medical consultation
- Pathology
- Radiology
- In-dwelling catheter management
- Access to specialist services e.g. PEG management, chronic wound management, palliative care
- Streamlined referral to HITH if required
GP referrals and enquiries:
| Phone |
0448 570 420 |
Hours
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Mon-Fri 7am - 9pm
Sat-Sun 8am - 6pm
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