Rapid Response Rehabilitation Team

(RRRT)

Objectives Brief history of RRRT

Who

What

Where

Patient outcomes

What is RRRT ?

Mobile

Multidisciplinary

In-reach

Rehabilitation team

Clinical Governance Professional

Director of Medical Services

Director of Nursing

Director of Allied Health

Operational

General Manager

Director of Allied Health

Liverpool Director of Rehabilitation

Clinical

Aged Care and Rehabilitation Stream Director

Who are the RRRT?

Staff Specialist- Dr Jim Xu.

Registrar- Dr Chris Stephenson.

Clinical Nurse Consultant- Melissa Bonser.

Physiotherapist- Jarrod Waterlow.

Occupational Therapist- Emily Ilkiw.

Social Worker- Stephanie Kay.

Why do we need a RRRT? Functional decline commonly result in an extended

length of stay.

Liverpool hospital does not have a rehabilitation ward.

“Shortage” of sub acute rehabilitation beds in the area.

Higher acuity of patients.

Chronic and complex care requirements.

Aging population.

Patients not suitable for transfer to a sub acute rehabilitation unit eg HD patients .

Goals of a Rapid Response Rehabilitation Team

Reduce length of stay.

Improve functional patients outcomes.

Minimise hospital acquired functional deterioration.

Co-ordinated discharge planning.

Improve access to rehabilitation.

Provide a quality, coordinated rehabilitation service.

Improve the patient and carer experience.

RRRT Criteria

Target patients who, with additional therapy will be discharged directly home.

The LOS is likely to be 5-10 days.

Provide rehabilitation to patients whom otherwise would not have access.

What do the RRRT do? Debility.

Disability.

Functional limitations by enhancing patients functional independence.

Improving clinical outcomes.

Facilitate earlier discharge.

Link patient with supports and services to facilitate a safe and sustainable discharge.

How ? Provide adjunctive physiotherapy therapy.

OT takes over care of patient.

Program up to 2 weeks (Mon-Fri).

SW takes over care of the patient.

Multidisciplinary model to facilitate the identification of person centred rehabilitation goals, taking into account the patient’s current medical condition, home environment and social supports; to optimise function, return to independence, and to improve quality of life.

Ways to refer to RRRT

Contact Registrar via pager 50554.

Contact CNC via Speed Dial 2672.

Referrals flagged by general Rehabilitation specialists and allied health colleagues.

Discharge Planning Referral to the following if required;

• Compacks services.

• ACAT assessment - RACF, Respite, TACP.

• Case management services.

• Rehab in the Home.

• Day Hospital.

• Outpatient services.

Referrals

Year

Referrals Acceptances

%

2013 (Dec only)

42 33 78

2014

845 546 64

2015

533 340 63

2016

444 236 53

2017

520 265 50

RRRT LOS 2016

Average FIM gain 2016

D/C from hospital at the conclusion of RRRT 2016

Where did they go ? 2016 Home

Other

Total

Jan 17 4 21

Feb 15 3 18

Mar 13 0 13

Apr 14 2 16

May 13 4 17

June 15 2 17

July 15 3 18

Aug 16 3 19

Sept 11 3 14

Oct 12 1 (+ 1 dec) 14

Nov 11 1 12

Dec 14 2 16

RRRT LOS 2017

Ave FIM gain 2017

D/C from hospital at the conclusion of RRRT 2017

Where did they go ? 2017 Home

Other

Total

Jan 11 2 13

Feb 16 4 20

Mar 18 3 21

April 8 2 10

May 11 3 14

May 11 3 14

June 17 2 19

July 18 3 21

Aug 13 4 17

Sept 12 3 15

Oct 13 3 16

Nov 15 3 18

Dec 9 4 (incl 1 x HITH) 13

2016

2017

Month Ave LOS D/C from LH (%)

Ave FIM change

Ave LOS D/C from LH (%)

Ave FIM change

Jan 8.2 75 11.3 10 62 11.8

Feb 8.4 66 15.8 9.4 79 15.8

Mar 9.2 81 14.8 9.6 84 15.3

Apr 8.0 72 13.2 9.4 71 12.6

May 8.3 89 11.8 10 87.5 14.1

June 7.6 74 11.4 12 91 10.2

July 10 85 17.8 6.2 88 6.8

Aug 7.8 76 16.2 14 87 7.8

Sept 7.3 70 11.1 11.6 79 8.3

Oct 14 72 17.3 8.7 84 8.7

Nov 11.2 92 15.7 8.0 82 11.4

Dec 12.2 94 14.1 10.5 75 12.2

How do we assess our effectiveness ?

FIM

Patient surveys

Colleague surveys

Length of stay comparisons?

Summary

RRRT provides early multidisciplinary rehabilitation intervention and therapy

– to improve the overall function of in the acute care hospital, thereby potentially decreasing their length of stay in the acute and subacute sectors.

– to minimise complications of bed rest and psychosocial distress of hospitalisation.

– improved utilisation of community services, outpatient rehabilitation and inpatient rehabilitation.

– to ensure safe and sustainable discharge.