Rehabilitation Services Development Project

Transcription

1 Rehabilitation Services Development Project Peak Union Forum Friday, 11 March 2016 Project Lead: Prof Maria Crotty Project Manager: Anthea Hamilton

2 Rehabilitation Services Development project To develop models of care for metropolitan rehabilitation services, including spinal and brain injury rehabilitation. To provide recommendations to the Ministerial Clinical Advisory Group (MCAG) to ensure that rehabilitation services in South Australia are able to meet a core set of standards for rehabilitation services These are aligned to evidence and standards: o Transforming Health Standards and values (patient centred, safe, effective, accessible, efficient, and equitable). o National Stroke Foundation Guidelines o Australasian Faculty of Rehabilitation Medicine o Ontario Rehabilitation Care Alliance o Alfred Health o Australasian Rehabilitation Outcome Measures

3 Process to date Project announced by Clinical Ambassador Check on 1 June Rehabilitation Services Development Workshop was held on Friday 26 June 2015 with over 90 participants with multi-disciplinary representation from each LHN as well as non-clinical and consumer. Following expression of interest to participate, three expert workgroups subsequently convened, comprising over 60 members across each workgroup (see hand-out): o General (inpatient) rehabilitation, chaired by Prof Maria Crotty and Dr Andrew Wilkinson o Acute Rehabilitation, chaired by Dr Zoe Adey-Wakeling and Dr Sian Naik o Ambulatory Rehabilitation, chaired by Claire Morris and Dr Maria Paul Sub-workgroup convened to develop amputee specific pathway, chaired by Prof Maria Crotty.

4 Process (continued) Between July and December 2015, expert workgroups (EWG) have met as follows: o General (inpatient) Rehab: 30 July, 13 August, 11 September o Acute Rehab: 6 August, 10 September o Ambulatory Rehab: 17 September, 1 October o Amputee pathway: 29 September, 5 November o Combined EWG meeting: 12 November Members advised on standardised operating principles, practice standards, key performance indicators. The General EWG also advised on minimum standards for a recovery unit.

5 Process (continued) Project progress reported as follows: MCAG - mid project review on 23 September 2015 Operational Advisory Group 24 September 2015 Project Lead and Project Manager have held additional discussions based on EWG advice: Safety & Quality - KPIs, Patient Reported Outcomes tool Finance & LHN/EWG representatives - funding models Nursing and Midwifery Office nurse practitioner and rehab competencies for senior nursing

6 Service improvements / benefits of the project Strong evidence base for rehabilitation in neurological conditions and in older people problem in SA is access. Increase in ambulatory = increase in access. Eg. for every $1 spent on ambulatory rehabilitation $2 is saved on readmission and care costs (Ontario figures) Less one size fits all - provision of a variety of settings for various recovery pathways Increased intensity of treatments = increased episodes per bed. Increased use of technologies = tele-rehabilitation across all units to achieve increased access

7 Key DRAFT recommendations to date: Expansion of ambulatory and outpatient access including telehealth. Same funding models at all Rehab Units across the state. A minimum of 2 hours active motor therapy per patient on a 6 days/week is provided, with a view to moving to 3 hours a day within 3 years. Supervised therapy is available 6-7 days per week, opportunities for practice available in all sites. State KPIs to include patient therapy time (Ontario). 7 day a week admissions, 6 day a week therapy, 6 day review of patient progress by key decision makers including the Rehabilitation Physician Early plans in acute, transparent decision making (using standard and agreed set of criteria) of all referrals to ensure right service, right time, first time. Interprofessional team structures and models across all settings. Integration of management across settings (structures to avoid silos eg home services separate from inpatient services). Clinician access to metrics eg Predictive LOS via EPAS and KPIs Every rehabilitation service to provide a safe and effective environment (outdoor mobility, assessment/training areas) to ensure patients achieve optimal mobility before their return home. Every service to have access to outside gardens (strongly held consumer position)

8 Key DRAFT Performance Indicators Key KPIs aligned to rehabilitation standards Core KPIs include: Carer training documented (Acute Stroke Clinical Care Standard 7a) Proportion of rehab patients who receive a minimum of 2 hours direct task specific therapy by the core therapies on 6 days/week. Measured, monitored. Documented SMART goals for all ambulatory programs (Target 90% of patients hold copy of plan for their ongoing treatment) (evidence Acute Stroke Clinical Care Standard 6b). Every rehab service should be able to demonstrate consumer involvement in structures Evidence of use of Patient Reported Outcome Measures (PROMS) Proportion of rehab patients achieving target LOS (Consensus target for rehab = All SA services will be in the top quartile of national benchmarking AROC) Shift in proportion of patients inpatient versus ambulatory (eg 70% of stroke rehab inpatients with admission FIM (AROC); High proportion of patients with stroke accessing ESD/RITH (target = 40%)

9 Implementation challenges Priority is establishment of expanded ambulatory rehabilitation services prior to service moves, eg HRC to TQEH. To ensure system capacity to meet demand associated with hospital move, orthogeriartrics and stroke plans (eg. 7 day acute LOS target for stroke and hip fracture ; reduction in inpatient rehab bed capacity) Service efficiency is reliant on expanded telehealth capacity for ambulatory rehabilitation services. Significant infrastructure and work on access rules and storage required. Capacity to operate 6 day rehabilitation service across each LHN depends on service redesigns. Issues to be worked though with the interface between Health and Disability Services Real time access to metrics required by clinicians Implementation supports for first 12 months

10 What s next The Service Design Review is in development Draft Model of Care will subsequently be launched for consultation for a four week period anticipated April 2016 o Consultation will include industrial bodies Consultation will be reviewed and project will be completed and presented to: o Ministerial Clinical Advisory Group (MCAG) o Transforming Health Operational Management Committee (THOMC) o Transforming Health Implementation Committee (THIC) for endorsement Anticipated that implementation processes will commence 1 July 2016.

11 Any Questions?