The Journey for Amputee Rehabilitation

Josephine Wong

Day Rehabilitation Centre

Ambulatory & Primary Health Care Directorate

Central Northern Adelaide Health Services

OVERVIEW

• Day Rehabilitation Centre Services

• Background - How it began

• Amputee Pathway – Implementation

• Outcomes

• Challengers Ahead - The way forward

Day Rehabilitation Centre - History

> Transferred from Domiciliary Care SA (DCSA) to Central Northern Adelaide Health Services (CNAHS) March 2007

> Previously accessible only to DCSA clients

> Significant change in population and service directives

> Ongoing change management practices

WELL POPULATION AT RISK ESTABLISHED DISEASE CONTROLLED CHRONIC DISEASE

HEALTHY AGING AT RISK AGING WITH CHRONIC DISEASE AGING WITH CHRONIC AND COMPLEX

POSTACUTE

HEALTHY AGING ASSESSMENT AND MANAGEMENT

CHRONIC DISEASE

MANAGEMENT

Service Delivery Model

Day Rehabilitation Centre - Eligibility

> Adult (17 yrs +)> Physical and cognitive ability to

participate in rehabilitation program> Recent admission/event resulting in

reduced mobility, function and/or communication issues

> Reduces length of stay in hospital> Requires a multidisciplinary team

approach

We have a no wait list policy

Day Rehabilitation Centre -Programs> Intensity and variety of treatment based on

individual need

> Centre bases treatment with some scope for home based

> Goals and progress reviewed regularly at MDT meetings

> Discharged when goals achieved

> Varied LOS

> Developed some specific pathways from acute to community eg stroke, orthopaedic, amputees

Background – Reason for the Amputee Pathway> No access to community based rehabilitation

services for amputees in the northern region of Adelaide

> Resulted in Bed blocking, increased length of stay in hospital, multiple readmissions for same issue

> Patients were often discharged home for wound healing but required readmission to inpatient facilities for prosthetic training and rehab

> Community based rehabilitation for lower limb amputees was identified as a service that could potentially make significant reductions in bed days.

Background – The beginnings of the Amputee Pathway

> Acute and Primary Health Care within CNAHS met

> mapped the current amputee journey from pre-admission to discharge.

> Gaps in current service identified

> Best practice guidelines were used to map the desired state

Amputee Pathway - Gaps> No access to specialized community

rehabilitation

> No rehabilitation options during wound healing

> No rehabilitation following acute discharge

> No onsite prosthetic department

> Rigid removable dressings for trans-tibial amputees not implemented

Amputee Pathway -Implementation> Up-skilling / training staff

> Participating inpatient case conferences and ward rounds

> Sharing resources / equipment, in-services and education

> Building relationships with prosthetics department

> Physiotherapy rotational position from acute hospital to DRC - Creating a shared understanding

Amputee Pathway -Outcomes for clients> Operational Amputee Pathway - Commenced 23rd

July 07

> Positive feedback from clients

> Reduced risk of complications

> More choice for clients

> Location - same campus as HRC

> Improved continuity of care / transition from inpatient to community rehabilitation

> No delay

Amputee Pathway -Outcomes for staff> Improved working relations with acute and

ambulatory & primary health care

> Created opportunities for staff to share knowledge / expertise, learn from one another

> Enabled staff to work across traditional boundaries and explore / use best practice guidelines

> Provided opportunities to expand our services

> Unproblematic and less time consuming more efficient discharge planning

Amputee Pathway -Outcomes for Organisation

> More efficient patient flow through the health care system

> Reduced financial burden

> Eliminated re-admissions

> Decreased ALOS between 1/5/07 – 30/4/08 – 8 days

AROC Report – Episode Length of Stay for Amputees (LOS)

Episode Length of stay for Amputees

Pre DRC (July 06-June 07)• HRC mean LOS 37.6 days

Post DRC (July 07-June 08)• HRC mean LOS 29.1 days

> AROC benchmark LOS = 32.3

Average Length of Stay in Hampstead

29.1

32.3

37.6

31.1

20

22

24

26

28

30

32

34

36

38

40

2006/ 2007 2007/ 2008

HRC Average LOS AROC Benchmark

Amputee Pathway -Challenges ahead / the way forward

> Location of prosthetic department and other outpatient appointments

> A fluid workforce across acute and primary health care

> Rotational positions in other disciplines - continue to work across traditional boundaries

Acknowledgement

> Staff and management at HRC

> Meredith Jolly – Manager of DRC

> Sally Sobels – Program Manager Intermediate Care

> Theron Philp and Jenny Brown – Senior Physiotherapists HRC on Ward 2A

Further Information

Meredith Jolly l Manager DRC

Josephine Wong l Physiotherapist DRC

T: (08) 8222 1848 / (08) 8222 1858

E: meredith.jolly@health.sa.gov.au

E: josephine.wong@health.sa.gov.au