hod - rehabilitation medicine campbelltown & camden hospitals · traditional pathway ed acute...
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Dr Tuan-Anh Nguyen HOD - Rehabilitation Medicine
Campbelltown & Camden Hospitals
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Unique Challenges
309, 792
2016 >500,000
2036
Fastest population growth rate in NSW
Campbelltown Hospital ED is in top 3 busiest EDs in NSW
(70, 654 presentations in 2017)
$632 million expansion at Campbelltown Hospital for acute services by
2031
(no funding for expansion of subacute inpatient services)
Macarthur Catchment – 3073 sq km
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TRADITIONAL PATHWAY
ED ACUTE
Inreach (mobile)
Rehab Service “RAP”
Inpatient
Rehab
(Camden)
Outpatient
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Rehabilitation In The Home (RITH)
Subacute “Hospital In The Home” service
Provide an alternative option to subacute inpatient
rehabilitation admission
Facilitate earlier transition to home
Maximise function for clients in a community setting
Average admission duration 2 weeks
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Eligibility
>18 years of age
Meet admission criteria for inpatient Rehabilitation care
Realistic & achievable Rehabilitation goals
Medically suitable for transition home
Functional level currently suitable for care in the home
Assessed and accepted by Rehabilitation Medicine Staff
Specialist
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ESTABLISHMENT OF RITH Commenced end April 2017
Initial pilot funding - 1 Physiotherapist and 1 Occupational
therapist
Current RITH team:
1 Physiotherapist
1 Occupational Therapist
1 Allied Health Assistant
1 RITH Registrar
* 0.4 RITH Staff Specialist (& other Rehab Medicine SS)
Clinical Governance – Rehab Medicine Department
Operational Governance – Rehab Medicine/PT/OT
Partnership with Community Nursing & Macarthur
Ambulatory Care Service (MACS)
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RITH Pathways
RITH
Acute
Inpatient RAP
Community
Inpatient
Rehabilitation
Primary Care
(public & private) Outpatients
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RITH Admission Assessed and accepted to RITH by Rehab Medicine
team
RITH registrar co-ordinates admission with RITH team, acute medical team and informs GP
Transfer to “RITH ward” (CTN) Rehab care type change
Initial RITH Allied Health assessment within 24 hours
Initial RITH Medical assessment within 72 hours
Initial Community Nursing assessment – within 72 hours but earlier if clinically indicated
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RITH Processes
Daily Allied Health intervention (except weekends)
Medical reviews – minimum once weekly, or as
required
Community nursing over weekend (mainly phone
contact)
Daily MDT “Patient Journey Board” (PJB) meetings
Weekly case conference
All clinical notes entered into eMR2
Access to RITH via phone 24/7 (Rehab ward afterhours)
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Discharge Planning
Plan
• Planned at PJB and case conference
• Discussed with client and carer
Referrals
• Referred to relevant community/outpatient services
• Verbal and discharge summary to GPs
Discharge
• Discharged from “RITH ward”
• AN-SNAP/RITH data entry
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Case Study
63M admitted to Liverpool Hosp 6/8/17 -diabetic foot infection and PVD SFA
angioplasty and 4th toe amputation
bilateral knee pain limiting mobility – “due
to OA”
Discharge function – mod Ax1 STS. Mob
SBA 70m 4WRF. Mod Ax1 stairs. Assist with
pADLs
Referred to RITH for ongoing rehab at
home
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Issues Initial RITH PT review 21/8/17
mobility affected by knee pain
Wheelchair mobility instead of RF
Initial RITH OT review 22/8/17 cluttered home environment
Bed & lounge height too low
using coffee table as bed cradle
RITH Medical review 23/8/17 Knee pain - minor OA changes on x-rays
onset of knee pain in hospital, Hx gout
Right foot pain at night affecting sleep
Community Nursing review 23/8/17 Right 4th toe amputation site wound dressing
Maceration between 2-3rd toes and new 3rd toe ulcer - dressed
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RITH Interventions Medical
Commenced on NSAID for acute gout
Commenced Pregabalin for night pain Referred to rheumatology clinic
Physiotherapy LL strengthening, STS practice Balance exercises and gait retraining
Occupation Therapy Equipment (bed and chair raisers, bed cradle)
Falls education/ removal fall hazards Self care retraining Support letter to DOH for home mods (remove stairs and
install ramp)
Nursing Wound dressing and monitoring
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RITH Discharge 30/8/17 Pain
Left knee pain resolved with NSAIDS
Night pain improved
Mobility
Independent STS and transfers
Independent mobility 4WRF indoors
Referred for outpatient physiotherapy at Camden
Self care
Independent showering with chair and SV dressing
Equipment hired through ELP
Wound
Maceration resolved on 2-3rd toes
Ongoing wound dressings to amputation site
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Data Type Results
Number of Clients 102
Mean Age 71 years
Mean Length of Stay (LOS) 11 days
Mean FIM Change 10 points
FIM Efficiency/day 0.9
RITH Outcomes May 2017-February 2018
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Stroke
21%
Reconditioning
27%
Other
11%
Orthopaedic
33%
Neurological
8%
Impairment Groups
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0
10
20
30
40
50
60
70
Strongly Disagree Disagree Neutral Agree Strongly Agree
Client Experience Survey
I am satisfied with quality of RITH service
I am satisfied with the amount of therapy I received
I was involved in setting my rehab goals and how they could be achieved
I felt I achieved the rehab goals set
Likes “I liked it was at home. Better for morale”
“Staff weren’t disrupted or interrupted by other staff, it made me feel like I mattered”
Dislikes “ Service should go for longer”
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Key Lessons So Far
Clear clinical and operational
governance
Collaboration
Ongoing promotion and clinician
engagement
Functional criteria, rather than just
Diagnostic or Age
Early referrals
Communication
Interdisciplinary approach
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Challenges Appropriate referrals and selection of clients for RITH
External hospital referrals
Medications
Weekend reviews
“Same day” referrals
Travel distance
Culture change
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Future scope Staffing to maintain/increase capacity
and enhance service
Engaging with private health care providers
Telehealth
Enhance links with academic partners
Links with ED
Inreach to residential facilities
Facilitate RITH establishment in other LHDs
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RITH Team
Jade Martin (OT)
Catherine Carnegie (PT)
Dr Mekala Thayalan (RITH Staff Specialist)
Dr Rohan Choudhuri (Registrar)
Cameron Thompson (Allied Health assistant)
Lukas Szymanek (PT HOD)
Deanna Aplitt (former OT HOD)
Meagan Elder (A/HOD OT)
Department of Rehabilitation Medicine
Physiotherapy and Occupational Therapy Departments
Community Nursing
Campbelltown Hospital Executive
Jo Burdajewicz (MoH)
Loretta Andersen (former Director Allied Health)
A/Prof Friedbert Kohler (AC&R Stream Director – SWSLHD)
Sue Pickett (MACS NUM)
Dr Bilyana Konstantinova (Former MACS Director)
Acknowledgements