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ACTIONS FOR POLICY AND IMPLEMENTATION
Action is needed to address the serious difficulties faced by people with chronic illness in navigating the health system, as the current complexity of the health system is leading to unnecessary ED presentations, missed appointments, and even disengagement with the health system.
The positive results of the Nurse Navigator program show the benefit, and neccessity for some individuals, of navigational services to help them traverse appropriate health services. These results indicate the fundamental urgency of development of these programs as a way to improve patient outcomes, experiences, and reduce costs.
Services such as Nurse Navigators need to be able to develop a direct relationship with their clientele base to reengage them with the health system; to improve health outcomes and reduce unnecessary burden on the health system.
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RESEARCH CONTEXT
A major problem for people with chronic illness whether they be elderly or young parents with a very sick child is navigating the health care system. Given this, it is not surprising that many presentations at Emergency Departments in Australian hospitals could be managed through a primary care service. In 2016 the Queensland Labor government instigated the Nurse Navigator program. This program saw 400 senior nurses appointed across the various Hospital and Health Services and allocated a patient load. These patients were flagged as individuals who had high levels of ED admissions, had missed a number of out-patient appointments or had disengaged with the health care system.
The Evaluation of the Nurse Navigator program was completed in 2021, and examined the work of the NN between 2018 to 2021. It was a mixed method longitudinal study that drew on the personal experiences of the nurses, and patients as well as data on reductions in hospital admissions, increases in attendance at outpatient clinics, reduced length of stay, patient satisfaction, health literacy, and sustainability including social return on investment across all 16 Hospital and Health Services. The Evaluation team, led by Professor Clare Harvey from CQUniversity, joined by colleagues from Curtin, Murdoch, Flinders, Queensland University of Technology, and Eastern Institute of Technology, New Zealand, examined these metrics for navigated patients. There were significant reductions in ED, outpatient and inpatient visits for the 7000 patients in the program.
One difficulty for many patients with chronic conditions is navigating the many outpatient clinic appointments they have. This is particularly so for those in rural and regional Queensland who may find themselves having to travel long distances. The work of the Nurse Navigators resulted in a significant reduction in missed appointments. This was a direct result of the navigator relationship, and the way in which they were able to assist patients to reconnect with the health system. A number of the Nurse Navigators were experienced Aboriginal or Torres Strait Islander senior nurses who were able to assist their client base to re-connect with health services, contributing to Closing the Gap. The research team have published several papers on the outcomes.
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Ongoing information on the nurse navigator program is available here.
The full evaluation can be accessed at by contacting Professor Clare Harvey.
