The standalone subacute public hospital : an instrumental case study

Subacute care, once referred to as the ‘missing link’ in the healthcare system, is now recognised as an integral part of the Australian health service. The ageing of the Australian population and the growing prevalence of complex chronic disease has placed increasing pressure on acute hospitals. Concurrently, demand for subacute services has grown at almost the same rate as acute care since 2016. Subacute care can be provided in many settings, one being the standalone subacute public hospital. In Australia, these hospitals are currently located predominantly in metropolitan and regional New South Wales and Victoria, but new subacute inpatient services are now being created within acute hospitals or as an annexe to these hospitals. This prompted the question: What is the value of the standalone subacute public hospital? To my knowledge, this will be the first study to investigate stakeholders’ opinions of the value of this type of setting.
To answer the question, a qualitative instrumental case study was conducted in a standalone subacute public hospital in metropolitan Sydney. Four groups of key stakeholders—experts, clinicians, patients, and business partners—shared their knowledge and experiences in 36 semi-structured interviews, exploring the value that the standalone subacute hospital provides to the healthcare system and the challenges this type of hospital can face.
Four themes emerged from thematic analysis of the interview data: ‘The hospital’s environment creates a therapeutic ambience for subacute care’; ‘Time for care in a subacute environment’; ‘A multidisciplinary focus on subacute patient care’; and ‘Challenges to the hospital’s viability create uncertainty’. The first three themes revealed that a separate hospital setting enabled the prioritisation of care in a calm and friendly environment, allowed staff adequate time to provide care and patients to receive care, and supported a multidisciplinary approach to treatment and care that targeted goals and intensified therapy to enhance subacute care. The fourth theme focused on challenges which could compromise the continuing viability of the hospital, namely the absence of acute onsite services, low status and visibility, and underutilisation of beds by local acute hospitals. However, the findings suggest that these challenges may be minimised or eliminated if the subacute and acute hospitals were co-located.
A co-located health campus model of care for metropolitan areas was developed, informed by the study findings. The model proposes the partnership of an acute and subacute hospital on the same campus. The themes generated from the study are integrated into the model to highlight the potential benefits for the acute hospital of facilitating timely and appropriate patient flow to the subacute hospital, simultaneously freeing up beds for acute care purposes. Similarly, the model emphasises how the subacute hospital could benefit from the consistent supply of subacute and non-acute patients, improving the continuum of patient care, minimising the challenges of being a standalone hospital, and maximising the advantages of a subacute environment. The co-located model could be used to guide both further research and future metropolitan health service developments to enhance recognition of the value of the subacute care hospital.