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8. A model of levels of care
- Service providers should take a 'whole systems' approach to the management of health care services during a pandemic.
- Use of a stepped level of care model can facilitate a whole systems approach to managing access to appropriate levels of care.
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In developing surge capacity in the context of pandemic influenza, there are three interrelated elements to consider:
- the physical aspects of creating extra capacity, i.e. creating space, providing staff, supplying resources and/or managing the process
- prioritising services to release capacity
- prioritising patients and clinical interventions to control demand.
These three elements will be present to a variable extent in the surge response, depending on the magnitude of the challenge and the resources available.
A whole-systems approach to the provision of healthcare services is essential in a pandemic. A stepped level of care model has been developed to help planners and service providers adopt this approach, and to better understand and mitigate any potential adverse effects of proposed altered service provisions.
The stepped level of care approach to the integrated management of healthcare services during a pandemic is based on a series of levels of care ranging from independent self care through to critical care (Figure 10). In this simple model, a step up in level reflects an increasing resource requirement per patient or client and a decreasing service capacity. Some of the features associated with each level of care, and possible locations of such care, are illustrated in Figure 11. Initially in a pandemic, it may be possible to increase capacity in line with increased demand. However, as a pandemic develops, healthcare organisations will need to promote and facilitate the use of less resource-intensive levels of health care, and potentially restrict access to more resource-intensive levels of care. General practice will play a pivotal role in providing and coordinating community-based health services in a pandemic, and in managing the flow of patients to secondary care services, care homes and other residential settings.
Figure 10: Levels of care*
The resource requirement per patient/client increases with each step while the relative service capacity decreases with each step.
Figure 11: Levels of care, features and locations
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