CALVARY HEALTH CARE SYDNEY DAY REHABILITATION UNIT (DRU) JEREMEY HORNE

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1 CALVARY HEALTH CARE SYDNEY DAY REHABILITATION UNIT (DRU) JEREMEY HORNE

2 DAY REHABILITATION UNIT OVERVIEW What is a DRU Minimum requirements Calvary Day Rehabilitation Admission Criteria Type of Patients seen in DRU Admitting and Discharge Procedures Hints

3 WHAT IS DAY REHABILITATION? The provision of rehabilitation services involving a multidisciplinary team for patients who have a treatment goal following surgery, illness or who have a disability. It consists of a half day program offering a variety of treatment modalities in one session to enable a more efficient cost effective use of hospital services.

4 CALVARY HEALTH CARE SYDNEY MINIMUM REQUIREMENTS FOR HOSPITAL-BASED DAY REHABILITATION SERVICES

5 The Minimum Requirements have been developed in consultation with the Royal Australasian College of Physicians Australasian Faculty of Rehabilitation Medicine (AFRM). They have also been endorsed by the Consultative Committee on Private Rehabilitation (CCPR), which has independent industry representation.

6 Criterion 1 REHABILITATION CARE PROVIDED BY A SPECALIST REHABILITATION TEAM ON AN ADMITTED OR NONADMITTED PATIENT BASIS IN A SPECIALIST REHABILITATION UNIT (A SEPARATE PHYSICAL SPACE)

7 CRITERION 2 REHABILITATION CARE PROVIDED BY A MULTI-DISCIPLINARY TEAM WHICH IS UNDER THE CLINICAL MANAGEMENT OF A CONSULTANT IN REHABILITATION MEDICINE OR EQUIVALENT

8 Criterion 3 REHABILITATION CARE PROVIDED FOR A PERSON WITH IMPAREMENT OR DISABILITY AND FOR WHOM THERE IS REASONABLE EXPECTATION OF FUNCTIONAL GAIN.

9 CRITERION 4 REHABILITATION CARE FOR WHOM THE PRIMARY TREATMENT GOAL IS IMPROVEMENT IN FUNCTIONAL STATUS.

10 CRITERION 5 Rehabilitation care which is evidenced in the medical record by: an individualised and documented initial and discharge assessment of functional ability by use of a recognised functional assessment measure; an individualised multidisciplinary rehabilitation plan which includes negotiated rehabilitation goals and indicative time frames; and hospital-specific documented programs and pathways.

11 CALVARY DRU Began in 2005 to help reduce inpatient length of stays when continuous medical and nursing supervision was no longer required. This allowed patients to be discharged 1-2 days early, thus freeing up inpatient beds for new referrals. The DRU also allowed an increased continuity of care as patient attended 2 3 sessions per week for up to 6 weeks.

12 CALVARY DAY REHABILITATION UNIT Provides rehabilitation services involving: Physiotherapists Hydrotherapy Social Workers Dieticians Nurses Occupational Therapists Rehabilitation Specialist s Exercise Physiologist

13 MULTIDISCIPLINARY TEAM APPROACH The Day Rehab team works to identify problem areas and set specific functional interventions. This approach provides a framework for patient treatment and a systematic plan for recovery. The team holds case conferences to collaborate on a goal and identify a time line for completion. The DRU functions essentially just like an inpatient ward, except patients stay for up to 3 hours. do a Physiotherapy & EP based exercise program. attend a Hydrotherapy class. may access anyone from the multidisciplinary team to address any problems or concerns they may have.

14 TREATMENT The plan of treatment is tailored to specific needs of the patient. 2-5 days per week. On the 1 st session most patients do: 3 minute walk test Timed up and go Berg balance test BMI Depending on their presenting condition, patients will also be assessed with: Muscle testing Neurological tests Joint AROM and PROM Gait assessment Palpation tests Patients > 65 years old have a MMSE or RUDAS test. During the first week patients will all see a rehabilitation specialist.

15 GOALS OF THE PROGRAM Provide a continuum of care for patients after surgery or for those experiencing a complication from illness or disability. Decrease inpatient length of stay. Assist patients to regain optimal physical communicative and functional abilities. Reduce complications associated with immobility. Lessen severity and frequency of exacerbation and to decrease emergency room visits and hospital admissions. Support and educate patients/family/caregiver about the disability, coping and recognising the early signs of complications (especially post surgery). Community reintegration.

16 Ageing population in SESIAHS

17 DAY REHABILTATION STAFF The DRU is staffed by 3 Physiotherapists 1 Exercise Physiologist 1 Physiotherapy aid 1 Enrolled nurse 3 Administration Officers 1 Bus Driver 1 Rehabilitation Specialist

18 DRU SERVICE Services run between (mon-fri) 9am-12pm 1pm-4pm (Sat) 8:30am-1:30pm Patients without transport can be transported to and from DRU on the patient bus. Sessions run with patients at a time. Patients are split into 2 groups, one does Hydrotherapy first while the other does Gym. At the end of the first session the groups swap over. After the sessions patients have a light snack and are returned home on the bus. The same program runs again in the afternoon. Sessions for inpatients are also run by DRU staff around these times on a daily basis as well as maintenance group sessions and Dr s clinics.

19 DRU Service Upon discharge, patients are given an individually tailored home program and referred to their local over 60 s strengthening class as appropriate, or to CRAG s services such as mobility group. DRU also offers maintenance sessions for those motivated to continue with their exercise program. This is not covered by Medicare or Private Insurance. Patient s pay a small fee per session and is available only for those who have attended DRU. Patient s come in and use the gym and hydrotherapy facilities with minimal supervision, just as they would when attending a local gym.

20 DRU Occasions Of Service (OOS) Initially the service was set up to service only patients from St. George or Calvary hospitals. In its initial year, episodes of care(eoc) were just over In 2006 the service was expanded and referrals were accepted from GP s, allied health workers and other hospitals outside the St. George area. In 2008 EOC had increased to > In 2009 OOS had further increased to In 2010 OOS were up again to In 2011 OOS were In 2010 the overall service including maintenance group, clinics and inpatients OOS was In 2011 this increased to In 2012 we were closed for 3 month due to renovations so patient numbers were affected So far in 2013 we are averaging 30 EOC per day for DRU and 42 for all services, (DRU, clinics, maintenance) this equtes to >7200 DRU EOC and > 10,000 across all services.

21 ADMISSION CRITERIA - POLICY Suitable patients will be those who meet the following criteria: Cognitively intact, or with minimal cognitive impairment only An ability to participate, and undertake the new learning required for a rehabilitation program. Potential for functional improvement from the rehabilitation program. Medically stable. Ability to self-administer medicines. Safe for staff to access a person s home environment and to transport the patient to the Day Rehabilitation Unit. Socially able to integrate into a rehabilitation setting. Motivated to improve independence, and remain at home (or hostel). Resident of the St George District i.e. the municipalities of Rockdale, Kogarah and Hurstville. Adult, i.e. 16 years and above.

22 REFERRAL FORM

23 TYPE OF PATIENTS SEEN IN DRU Orthopaedics Joint replacements Fractures Spinal Surgery i.e.. decompression, fusions Reduced mobility Deconditioning Falls Cancer Rehab Lower back pain Musculoskeletal conditions Cardiac rehab Parkinson s disease We do not see acute stroke patients.

24 CALVARY DRU STATISTICS Current DRU referral Sources 2011 Source Inpatients 35% G.P. 25% Specialist 30% Other (PT, CNC) 5% Total number of referrals per month = 80+

25 ADMITTING AND DISCHARGE PROCEDURES All patients who attend DRU are admitted as an inpatient for the time they are in session. As a result they are admitted via the IPM system (i.patient manager) at start of session and discharged at end. Also check-in & check-out on EMR. While admitted, patients cannot have a CC, they must be discharged from IPM for this to occur. This occurs at 4 pm daily.

26 Hints for setting up a DRU Start small, build staff as clientel numbers grow Preferably a large space for the service to grow Have a clearly defined clientel and all the necessary services to offer appropriate services Consistent referral base- GP s, hospitals etc Affective advertising, brochures Administrative officers- paperwork+++ Bus service- clear pick up areas for am and pm Patient parking if possible Well equipped gym and pool Separate Dr s clinic room and PT Ax rooms

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