Case Report: Discharging thecomplex, long-stay patient

Dr David SkalickyDr John Estell

Department of Rehabilitation Medicine,St George Hospital, SESIAHS.

29/10/2010HIMAA, Sydney

Rehabilitation Medicine

“brings about recovery following loss of function and ability”

“management of disability”

“prevention and reduction of functional loss, activity limitation, and participation restriction”

Table 1: Length of stay for inpatient rehabilitation patients at St George Hospital, Kogarah, Sydney.

Mean Rehabilitation Mean Tot HospitalMax

Hospital

YearLength of Stay

(days)Length of Stay

(days)Length of

Stay

2005 21.7 41.6 239

2006 23.8 46.5 278

2007 22.6 43.8 179

2008 25.1 47.5 405

2009 25.6 42.3 193

2010 26.4 45.2 123

Case Study

MB 65 yo female Admitted to Sutherland hospital on 20/9/2008

Discharged from St George hospital on 1/6/2010

Total Length of Stay: 615 days

Hospital LoS Ward

Sutherland 10 months HDU

St George 4 months Respiratory

St Vincent's 3 days Tracheal Stent

St George 6 months Rehabilitation

Case Study

MB 65 yo female

Multidisciplinary intensive inpatient rehabilitation

Goals To walk short distances independently To discharge to sister's home on Central Coast

Perineal Fascitis TracheomalaciaDebridements Critical Care MyopathyMulti Resist Orgs Muscle Deconditioning

Discharge

615 days in hospitals

>1000 pages of clinical notes

Accumulated results on eMR

Moving out of area

Diagnoses

Specialists

Hospitals

Other health issues

Treatments

Objectives

Discharge Summary communicates with Health Professionals New GP on the Central Coast Clinical coding department Patient

Aims to summarise Clinical and functional information Many hours of work from many people Significant financial expense

Discharge

Medication summary Short interview

one month before discharge Patient driven

Discharge interview Longer interview

three weeks before discharge Overall perspective on dates and location Personal perspective on her 'journey'

Discharge

Review of clinical records Discharge summaries from each hospital

admission, and from each episode of care

“Systems Review” template Preferred to chronological reporting

Draft reviewed by rehabilitation team

Verbal handover to GP

Discharge

Clinical coding and classification 7 episodes of care at St George Hospital, 1 episode at Sutherland 1 episode at St Vincent’s

125 ICD-10-AM diagnoses 48 ACHI interventions

Table 2: DRGs from St George hospitalTracheostomy or Ventilation >95h A06ZRespiratory system diagnosis w Non invasive ventilation E41ZOther respiratory system or procedure w catastophic cc E02ARehabilitation w catastrophic or severe cc Z60A

Guidelines Allow time

Plan with the patient

Have a good knowledge of the patient's admission

Seek feedback from the team

Make periodic summaries (every 3-6 months)

Liase with medical record department

Acknowledgements

Rehabilitation Team, Ward 6W, St George.

Physiotherapy Nursing MedicalLina Goh Julie Morrison John Estell

Roman Wu Mei Lau Kenneth ChanMary Dunford Andrew Cole

Occupational Therapy Wafa ZarrougRebecca Patterson Social Work Latika Naidu

Judy HammermanHelen Huynh Medical Records