Reducing Rehab Waiting Times

A/Prof Stephen WilsonRoyal North Shore Hospital

Key Problem• Problem: Long Rehab wait due to “Iatrogenic disability” causing

increased length of stay in hospital• Factors:Structure of a combined Aged Care and Rehab DeptFocus on medical vs functional issuesPoorly organised Rehab consulting serviceGovernance, leadership, responsibility, accountability, dataStaffing• Drivers: Quality and Activity Based funding

Aim of the Innovation

• The aim of this project was to develop and explore interventions to reduce waiting times for sub-acute rehabilitation patients in acute care and free hospital beds (for more appropriate acute care) by:

• Reducing wait times for transfer to Bed Based sub acute Rehab –improve flow

• Increasing referral and uptake of non bed based options eg Home Based Rehab, Transitional Aged Care, Community Care (COMPACKS)

Baseline Indicators

• Acute hospital Indicators:ALOS 2010/11 was 7.99 days for Rehab Type

change episodeALOS 2010/11 waiting for transfer was 4.91

Days retrieved from Patient Access Transport Unit

Key Changes Implemented

Innovations• Establish Rehabilitation

Department 2011• Patient flow Model developed• Developed acute in-reach

(SMART) and Renal Rehabilitation for stay > 7 days

• Rehab part of Multi Disciplinary Team meetings

• Website portal for rehab options and referral process

• Ensure appropriate and timely rehab type change

• Single point of referral for rehab

Model

OUTCOMES SO FAR

Changes in patient flow• Reduction of patients waiting

for transfer from 1690 (10/11) to 968 (11/12) n=722 patients

• Reduction of bed days waiting from 8263 to 4384 (save 3879 bed days)

• Transitional Aged care27 (10/11) to 47 (11/12)• Community Package 465

(10/11) to 513 (11/12)

Bed days for patients waiting for transfer

LESSONS LEARNT

• Governance• Communication• Multidisciplinary Team vs Single Discipline

assessment• It is possible to Map > Model > Direct Traffic

from bed based to non bed based services