The effect of increasing and developing the allied health role with older inpatients with complex ne

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The effect of increasing and developing the
allied health role with older inpatients with
complex needs

• Tammy Hayward, Physiotherapist
• Sharyn Chaplin, Brenton Kortman Meredith
  Stewart
• Repatriation General Hospital
• Daw Park
• Adelaide

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Background

• Aged and Extended Care Unit
• Typically frail, older patients with complex
  needs
• Staffing
• Ward vs. Casemix Length of Stay

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Aims of Project

• With the provision of more specialist Allied
  Health knowledge and comprehensive assessment the
  aims of the project were
• To decrease length of stay
• To improve timeliness of Allied Health Referrals
• To improve responsiveness of Allied Health to
  referrals
• To consolidate the multi-disciplinary team

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Initiatives

• Staffing changes - increased time and seniority,
  and appointment of a Team Leader
• Patient Screening and Pre-morbid Profiling
• Management of Outliers
• Team development

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Screening Profiling

• Screening for risk factors
• Age greater than 80 years
• Living alone or limited supports
• Receiving community services
• Self-care or mobility issues
• Carer support role for others
• Significant co-morbidity / disability
• Self rated health poor or fair
• At high risk of non-adherence to treatment
• Development of Profiling
• How the Profiling was conducted

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Evaluation

• Length of Stay (LOS) data
• Screening review
• Survey
• Key performance indicators

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Results

• LOS data showed average decrease of 1.4 days for
  261 patients seen over 6 months (this is equal to
  365 bed days!)

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Results

• Screening
• review of a small sample showed 15 did not
  require profiling and had simple discharge needs
• Survey responses
• overwhelmingly positive - some respondent
  comments
• often referred to in order to get information
  relevant to discharge planning as information
  easy to find
• patient and family issues seem to be apparent
  earlier in the discharge planning process
• I find that I get referrals that would normally
  get missed by medical / nursing staff

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Results continued...

• Key Performance Indicators
• were met for January 2005 (the first month they
  were introduced)
• Project was extended
• initially until December 2004, now until June
  2005
• hopeful of positions being advertised as ongoing
• Anecdotal effects
• increased efficiency of discharge planning
• better organised ward environment overall

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Limitations

• Project was limited to Social Work, Occupational
  Therapy Physiotherapy
• Variation in ward staff
• Environmental limitations
• Time limitations
• Difficulty measuring some outcomes such as
  readmissions
• Multiple other variables affecting LOS

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Next Steps / Where to from here

• Further refinement of screening guidelines
• Expansion of the project to multi-disciplinary
  team
• Address the environmental limitations of the ward
• Consider a comprehensive Geriatric Evaluation and
  Management (GEM) unit as a further development of
  the ward

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Summary

• Increase in Allied Health staffing and
  coordination on the Aged Care Ward
• Improved discharge planning
• Decreased length of stay

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References

• Holland DE, Harris MR, Pankratz S et al
  Prospective Evaluation of a Screen for Complex
  Discharge Planning in Hospitalized Adults J Am
  Geriatr Soc 200351678-682
• Moss JE, Flower CL, Houghton LM et al A
  multidisciplinary Care Coordination Team improves
  emergency department discharge planning practice
  Med J Aust 2002177435-439
• Victorian Government Department of Human
  Services, 2003. Improving patient transition
  from hospital to the community A good practice
  guide for hospitals. Continuing Care Unit,
  Metropolitan Health and Aged Care Division
• Victorian Government Department of Human
  Services, 2003. Transitioning care a review of
  the Effective Discharge Strategy Final Report
  Melbourne, Department of Human Services.
• Victorian Government Department of Human
  Services, 1998. Final report of the development
  of a risk screening tool for service needs
  following discharge from acute care project.
  Melbourne, Department of Human Services.