Mobile Rehabilitation Team St Vincent s Style. Dr Shari Parker Rehabilitation Physician

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1 Mobile Rehabilitation Team St Vincent s Style Dr Shari Parker Rehabilitation Physician

2 Drivers for Change 1. Pressure on beds, bed blocks 2. Evidence for Early Rehabilitation 3. The problem of Deconditioning 4. COAG funding

3 Model of care patients 2 week program 7 day / week therapy (Evidence suggests LOS and cost savings 1)) Inter-disciplinary rehabilitation care We come to you Parallel shared care - hone and rehab teams 90 mins therapy per day In addition to usual ward therapy Case conferences, family meetings

4 Inclusion Criteria LOS > 3 days LOS likely to be with MRT input Impairment with identifiable / realistic goals Stable tolerate up to 90 mins therapy per day Follow commands if needs interpreter must be available during therapy hours Willing to participate Pre-morbid status active participant in community / at home Require at least 2 therapies

5 Exclusion criteria Acute CCU, ICU, MAU, Stroke unit, geriatric ward Febrile > 38.5 o C in last 24 hours. GCS < 13 LOS < 3 days No suitable d/c destination identified

6 Staffing Rehabilitation Physician 0.3 Rehabilitation Registrar 1.0 Clinical Nurse Consultant 0.6 Physiotherapist 1.4 Occupational Therapist 1.4 Social Worker 0.4 Clinical Psychologist 0.2

7 Mobile Rehab Team Process Identify suitable patients Review by CNC / Reg / Consultant Case Conference Inter- Disciplinary Mx Liaison with acute team AROC, M & M Accepted into MRT Team assessments Discharge options

8 Identify suitable patients 1. Risk of de-conditioning / prolonged LOS Complicated patients, prolonged ICU, elderly Psychosocial flags 2. Need rehabilitation, medically or surgically unsuitable for transfer 3. Awaiting rehabilitation 4. Trial of Rehabilitation Direct referrals, case finding Triage system aim to get patients directly home, BUT MRT cannot prolong admission

9 Team Assessments and Mx Medical Full admission MMSE Daily review PT / OT Combined initial assessment FIM GAS TUAG Daily Rx SW / Psychol Psychosocial Assessment Discharge planning DASS 21 Psychology input

10 Discharge options Outpatients Discharge options Home Inpatient rehabilitation Rehab in the home +/- Services

11

12 Results Patients 1 Oct June 2012 = 412 Average LOS = 9.8 days Discharge Destination 55% directly home Usual Accommodation 48% Interim accommodation 6% New Accommodation 1% Return to acute care 8% Other acute hospital 2% Rehab unit 21% Sacred Heart Rehab 12% Deceased 2% Increase annual capacity of Sacred Heart rehab 24%

13 SNAP Classifications Re-conditioning / Restorative 46% Cardiac 18% Pulmonary 13% Brain and Neurological 9% Orthopaedic 6% SCI 2% Amputee 2% Other 4%

14 Age % < > 90 Age (years) MRT filling the gap with the cognitively intact elderly

15 Referral source Haematology Cardiology Thoracic medicine Lung Transplant Neurosurgery Orthopaedics Neurology Vascular surgery Nephrology Gastro-Intestinal Cardiology Heart Failure Cardiothoracic surgery Cardiac Transplant MRT active across entire acute hospital Majority haematology, cardiac and thoracic Involvement welcomed by the acute hospital

16 Number of Patients Functional outcomes FIM Results FIM Efficiency: 1.59 points per day Average Admission FIM = 77 Average discharge FIM = < to to 9 10 to to to to to 59 FIM Score Change Sample Size - 184

17 FIM Score FIM Results FIM Efficiency:1.59 points per day Average Admission FIM = 77 Average discharge FIM = 95 Average FIM change = 18 Admission Discharge FIM Motor Cognitive

18 GAS Goal Attainment Scale Goals are client specific and functional Score Outcome of Goal +2 Much more than expected outcome Mobilise to the bathroom with no aid +1 More than expected outcome Mobilise to the bathroom with a walking stick 0 Expected outcome Mobilise to the bathroom with a rollator Raw score 0 = T-score 50-1 Less than expected outcome Mobilise to the bathroom with FASF -2 Much less than expected outcome Unable to mobilise to the bathroom with a FASF

19 GAS Results Sample Size 171 patients

20 No. of Patients No. of Patients Admission Score Distribution Admission Score T-Score Distribution Buckets Discharge Score Distribution Discharge Score T-Score Distribution Buckets

21 Show me the Money! 240 patients per annum Annual cost of MRT = $527,000 Break even $2196 per patient Avoided admissions (MRT) = sum of annual bed days saved by avoided admissions x bed day cost = 2,622 x $822 = 2,622 bed day saving (8.0 beds at 90% occupancy) or $2,155,068

22 Show me the Money! Rehabilitation enhancements at SVH have produced an annual efficiency of $4,854,247 for an investment of $1,121,92416 Enhancements have generated an efficiency equivalent to an increased capacity by 17.9 beds (at 90% occupancy).

23 Enablers for success of MRT Hospital wide buy in before commencement Close communication with acute medical / surgical teams Nursing, Medical, Allied Health Recurrent hospital wide MRT education Co-location of RITH / MRT office Rehabilitation Fellow = consults coordinator and MRT

24 Additional benefits Raise profile of rehabilitation in acute hospital Raising awareness of the need for early mobilisation / discharge planning paradigm shirt Introducing rehabilitation philosophy early for patients arrive in rehab physically and psychologically prepared for rehab

25 Barriers and pitfalls Patient related Reluctance to participate Too many cooks Close liaison, Brochure Medical factors interruptions to care Unstable patients, investigations Need for short inpatient rehab admission but hard to achieve -? How to not lose momentum Lack of clarity regarding ongoing funding resignations, reduced morale

26 The Future Survival of MRT Options for continuity of care for MRT patients in subacute ARI Acute Rehab initiaive Research RCT of MRT in MVA patients SERC MRT inreach into ICU (Dr Wu)

27 Thankyou Dr Shari Parker

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