Rehabilitation Clinical Services Plan 20172-2€¦ · Rehabilitation services help individuals...

Metro North Hospital and Health Service | Rehabilitation Clinical Services Plan 2017-22 2

Table of contents

1. Introduction .....................................................................................................................3

2. Current services ..............................................................................................................5

3. What do we know ............................................................................................................8

4. Current commitments .................................................................................................... 11

5. Future service directions ............................................................................................... 12

6. Service directions .......................................................................................................... 13

7. Implementation, monitoring and review ......................................................................... 22

8. Background ................................................................................................................... 23

9. Appendices ................................................................................................................... 26


1. Introduction

Rehabilitation services help individuals minimise the loss of physical and cognitive function resulting from illness or injury and therefore are essential for maximising patient outcomes and quality of life. Rehabilitation services also contribute to health system efficiency by enabling increased medical and surgical service activity through reducing unnecessary acute care length of stay and minimising exposure to risks associated with acute care environments such as falls and infection.

Supporting the rehabilitation needs of the community is a priority for Metro North Hospital and Health Service (MNHHS) as outlined in the MNHHS Health Service Strategy 2015-20. To ensure continued effort and results in this area a health service plan has been developed.

The MNHHS Rehabilitation Clinical Services Plan (the Plan) is a five year plan focussing on adult rehabilitation in MNHHS. The Plan will guide service development, service improvement and clinical redesign for rehabilitation services in MNHHS. It builds on the achievements made through the MNHHS Subacute Services Plan 2012-16, and incorporates recommendations from the Statewide adult brain injury rehabilitation health service plan 2016-2026 and the Statewide adult spinal cord injury health service plan 2016-2026.

Overarching documents such as My health, Queensland’s future: Advancing health 2026, the MNHHS Strategic Plan 2016-20, MNHHS Health Service Strategy 2015-20 and Putting People First Strategy 2015 provided the overarching strategic directions that informed the development of the Plan.

In addition to providing excellent patient care, MNHHS has a strong culture of undertaking research and being engaged in education activities. These activities are developing the evidence and workforce required to provide high quality rehabilitation care, in MNHHS and elsewhere, now and into the future.

What’s been achieved? There have been a number of significant achievements in relation to rehabilitation services through implementation of the MNHHS Subacute Services Plan 2012-2016, including:

• commitment to building a dedicated CSCF Level 6 rehabilitation facility within MNHHS

• commitment to building more CSCF Level 4 rehabilitation beds in MNHHS

• enhancing the geriatric and rehabilitation liaison service (GRLS) capacity to pull patients from acute wards to ensure timely access to the right care in the right place

• developing additional rehabilitation capacity at Brighton Health Campus plus additional transition care residential places and addressing patients with special needs


1.1 What is rehabilitation? The definition of rehabilitation used for this Plan is:

Rehabilitation care is care in which the primary clinical purpose or treatment goal is improvement in the functioning of a patient with an impairment, activity limitation or participation restriction due to a health condition. The patient will be capable of actively participating.

Rehabilitation care is always:

− delivered under the management of or informed by a clinician with specialised expertise in rehabilitation, and

− evidenced by an individualised multidisciplinary management plan, which is documented in the patient’s medical record, that includes negotiated goals within specified time frames and formal assessment of functional ability.1

Rehabilitation is provided in a range of settings and involves a multidisciplinary health care team.

Inpatient rehabilitation services In an acute care setting, clinicians can provide restorative therapy and prevent function decline for inpatients of acute care wards during illness or post-surgery. Subacute inpatient rehabilitation service capabilities are described in the Queensland Clinical Services Capability Framework (CSCF)2 rehabilitation service module. Level 6 rehabilitation services provide specialty and subspecialty inpatient and ambulatory settings, including complex multidisciplinary day-only treatment, subspecialist outpatient clinics and specialist community outreach programs. Level 4 inpatient rehabilitation services provide services to clients with moderately complex care needs in acute or post-acute phases in designated units.

Ambulatory rehabilitation services Ambulatory rehabilitation services do not involve an overnight stay at a hospital. Patients may travel to facilities to access services on the days they are required or rehabilitation services can be provided at the patient’s home. Day therapy at hospital sites has the advantage of providing access to collocated outpatient services such as specialist clinics and imaging and diagnostic services.

Locating ambulatory services in community centres can improve efficiency by enabling clinicians to treat more patients per day, and reducing travel time for patients. Home-based rehabilitation involves multi-disciplinary teams that are able to observe patients interacting with their normal environment and for specific functional deficits to be identified and addressed either in person or via telemedicine facilities.

Other rehabilitation services Rehabilitation may be a component of care provided to patients in the Transition Care Program (TCP) which is a time-limited service for patients who have been admitted to a hospital and may benefit from low-intensity therapy, nursing support or personal care before returning to their home. It may also be a component of care in a Geriatric Evaluation and Management (GEM) program, in which the primary clinical purpose or treatment goal is improvement in the functioning of a patient with multi-dimensional needs associated with age-related medical conditions.

1 Australian Institute of Health and Welfare 2013. Development of nationally consistent subacute and non-acute admitted patient care data definitions and guidelines. Cat. no. HSE 135. Canberra: AIHW. 2 Queensland Health. Clinical Services Capability Framework for public and licensed private health facilities (CSCF) v3.2 https://www.health.qld.gov.au/publications/clinical-practice/guidelines-procedures/service-delivery/cscf/cscf-fundamentals-of-the-framework.pdf


2. Current services

This section describes the range of rehabilitation services currently provided in MNHHS.

Inpatient rehabilitation services Acute wards therapy services Allied health staff at all MNHHS inpatient facilities provide restorative therapy and prevent functional decline for inpatients of acute care wards.

Acute stroke units enable multidisciplinary teams with expertise in stroke management to commence therapy from the time of patient admission to acute care. Acute stroke units are located in Royal Brisbane and Womens Hospital (RBWH), The Prince Charles Hospital (TPCH), Redcliffe and Caboolture Hospitals.

Patients can be discharged to subacute inpatient rehabilitation services or directly home with outpatient treatment in a day hospital, allied health clinic, community health centre or home based care if further therapy is required.

Subacute inpatient rehabilitation services Subacute inpatient rehabilitation services are provided at four facilities in MNHHS. All services are CSCF Level 4. Redcliffe Hospital has 14 beds, RBWH has 30 beds at the Rosemount Campus, TPCH has 23 beds, and there are 50 beds at the Brighton Health Campus designated for rehabilitation.

Ambulatory rehabilitation services Centre-based ambulatory rehabilitation services Day hospital services are provided at two locations in MNHHS. The RBWH operates an ambulatory rehabilitation service from the Geriatric and Rehabilitation Unit (GARU) at the Rosemount Campus, and specialist clinics for rehabilitation assessment, falls and hypertonicity. The Prince Charles Hospital Rehabilitation Day Therapy Unit is located at Chermside.


The specialist needs of patients, who have had limb amputation, including rehabilitation, are addressed by the RBWH amputee service in conjunction with community-based rehabilitation teams (CBRT). The RBWH amputee service supplies and manages interim prostheses and facilitates the provision of long-term prostheses. Multidisciplinary outpatient review clinics are provided at the RBWH and Redcliffe Hospital. Outreach services are also provided at Nambour and Toowoomba Hospitals. Amputee rehabilitation services are provided by CBRT at Redcliffe Community Health Centre.

CBRTs also operate centre-based rehabilitation services at Caboolture, Redcliffe, and North Lakes, for people who are not admitted to a hospital or attending hospital outpatient clinics. Patients are assessed and allocated to programs of up to 12 weeks duration depending on their individual rehabilitation needs. Currently, if ongoing rehabilitation is required patients must be referred on to centre-based (day hospital) ambulatory services.

Home-based ambulatory rehabilitation services CBRTs also provide home-based rehabilitation services for up to 12 weeks. Post-acute care services (PACS) provide home-based therapy services for up to two weeks following hospital presentation.

Associated services The following associated services are not in scope for this plan however they have a role in providing a comprehensive and integrated range of rehabilitation services in MNHHS.

Geriatric and rehabilitation liaison service The geriatric and rehabilitation liaison service (GRLS) is interdisciplinary and provides comprehensive medical, nursing, functional and psychosocial assessment, with a particular focus on older persons. GRLS helps identify patients that may be ready for transfer to subacute services, which may include rehabilitation or community care, to optimise timely and appropriate transfers.

GRLS teams operate within selected acute care wards at RBWH and TPCH, and all wards at Redcliffe Hospital.

Jacana Acquired Brain Injury Centre Jacana Acquired Brain Injury Centre provides inpatient rehabilitation and care for clients with an acquired brain injury (ABI) at Bracken Ridge. Jacana Brighton provides a secure environment for care of clients with a dual diagnosis of acquired brain injury (ABI) and mental illness.

Transition Care Program MNHHS has 70 residential TCP beds at the Brighton Health Campus and 70 places for community based care.

Geriatric Evaluation and Management Rehabilitation forms part of the suite of services provided for patients of geriatric evaluation and management (GEM) units. Older patients are able to access appropriate rehabilitation services in GEM units or dedicated rehabilitation units. GEM beds are available at all MNHHS hospitals.

Rehabilitation engineering Rehabilitation engineering is a statewide service operating from the Herston Campus. The service has two main streams: postural seating modifications mostly for people with wheelchairs where a solution was not available in the commercial or non-government sectors and customised assisted technology for children. The second stream is assisting the management of skin integrity/pressure wounds for people in wheelchairs.


Non-government rehabilitation providers A number of private hospitals, geriatricians, and allied health professionals in the MNHHS region provide a range of inpatient and ambulatory rehabilitation services for orthopaedic, neurological, and cardiopulmonary conditions. Non-government organisations have been funded to provide long-term rehabilitation services for some specific patient groups.

Table 1 provides a summary of the current rehabilitation services in MNHHS.

Table 1: Summary of current MNHHS services rehabilitation services

Inpatient Ambulatory Acute Subacute Centre-based Home-based

Caboolture and Kilcoy Limited acute ward

based therapy service

Not available

Caboolture Hospital Allied Health Department (CBRT)

North Lakes Health Precinct (CBRT)

Community Based Rehabilitation Teams

Redcliffe

Acute ward based therapy service

CSCF Level 4

14 beds

Redcliffe Community Health Centre (CBRT)

North Lakes Health Precinct (CBRT)

TPCH CSCF Level 4

23 beds

TPCH Rehabilitation Day Therapy Unit

Chermside Community Health Centre (CBRT)

RBWH CSCF Level 4

30 beds

Chermside Community Health Centre (CBRT)

GARU Day Hospital

Brighton

Not applicable CSCF Level 4 50 beds Not available

Total 117 beds


3. What do we know 3.1 From the data Unmet demand for rehabilitation services

• Demand for rehabilitation services exceeds supply across MNHHS in all service settings.

• The utilisation rates for admitted rehabilitation services by adult in the Caboolture Hospital catchment are below the MNHHS and state average.

Rehabilitation service historical activity and trends

• Separations for MNHHS residents have increased by 9.7 per cent over the last three years, with same day admissions increasing 15.4 per cent, and overnight admissions decreasing by 1.7 per cent.

• The majority of rehabilitation activity for MNHHS residents (93.7 per cent) occurred at MNHHS hospitals, however the majority of residents from the Caboolture Hospital and a large number of those from Redcliffe Hospital catchment accessed services at TPCH or RBWH.

• Rehabilitation separations at MNHHS facilities increased by 3.4 per cent from 2012-13 to 2014-15. Overnight separations decreased by 10.5 per cent however occupied bed days increased by 2.6 per cent. Same day patients increased by 12.0 per cent.

• MNHHS hospitals predominantly provide rehabilitation services for residents of MNHHS hospital catchments, apart from RBWH where approximately 18 per cent of separations are for residents of other HHSs.

• From 2013 to 2015, annual CBRT referrals increased from 876 to 1011 per annum.

• Patients referred to CBRT tended to be living in the northern region of MNHHS, with the most referrals for residents of Caboolture, Deception Bay, Burpengary, Morayfield, and Kallangur.

Demographics

• Over the next five years the MNHHS adult population is projected to grow from 765,580 to 864,048 persons, an increase of 8.7 per cent. TPCH and RBWH catchments will have the largest adult populations with 356,906 and 335,952 persons respectively. Caboolture and Redcliffe Hospital catchment adult populations will be 186,601 and 183,466 persons respectively.

• Older persons are significant users of rehabilitation services. In 2021, 37.3 per cent of adults living in MNHHS hospital catchments will be aged over 65 years, compared with 17.0 per cent in 2016. The greatest increase in the number of older persons will occur in the Caboolture Hospital (65.7 per cent) and Redcliffe Hospital (52.6 per cent) catchments.

• Rates of poor health and socioeconomic disadvantage are higher amongst residents of the Caboolture and Redcliffe Hospital catchments. Poor health and socioeconomic disadvantage are associated with higher need for health services. This is because the greater prevalence and earlier onset of conditions that lead to functional decline and frailty, and therefore increase the demand for rehabilitation services.

Projected rehabilitation service activity

• Same day rehabilitation activity is projected to increase from 6327 to 7967 between 2016-17 and 2021-22, a 25.9 per cent increase.

• Overnight rehabilitation bed days for MNHHS are expected to increase by 28.7 per cent from 2016-17 to 2021-22 (53,103 to 68,357).


• Projected requirements for MNHHS in 2021-22 are for a total of 208 Level 4 rehabilitation beds based on historical service activity and future population growth. This includes capacity for patients in acute care beds who were unable to access Level 4 rehabilitation services.

3.2 From the literature • There is pressure on acute care resources from increasing demand through an ageing

population, with a flow-on effect to rehabilitation services.

• Early access to rehabilitation optimises length of stay for rehabilitation and acute care, and leads to improved outcomes for patients, with more therapy generally leading to more timely improvement in function.

• Individuals who have higher levels of function at admission become less deconditioned and therefore require less rehabilitation.

• There is the potential to reduce demand for rehabilitation services by increasing levels of physical capacity in at-risk population groups, or via targeted ‘prehabilitation’ interventions before planned surgery.

• Community-based rehabilitation provides the opportunity to reintegrate patients within their local community, and maximise their independence and sense of value, rather than just being an alternative to acute care.

• Early supported discharge models for certain patient profiles leads to better outcomes than inpatient rehabilitation.

• Patient-centred care should address patient concerns with the transition between rehabilitation programs and the community, the emotional challenges of living with a long-term condition, and improving access to community services once discharged from rehabilitation.

• Health professionals who are in contact with patients at increased risk of requiring rehabilitation services can act as partners in identifying the need for intervention and/or participating in risk reduction interventions.


3.3 From our clinicians • Competing service pressures influence clinical decisions and lead to difficulties in placing

patients in the right service.

• The current location of services leads to inequity in access to inpatient rehabilitation services.

• There are delays in identification of patients within acute wards who are ready for rehabilitation.

• Across MNHHS there is inconsistent referral mechanisms, admission/discharge criteria, and limited shared care models, which all hamper service integration and ‘seamless’ service transitions for patients and their families.

• There is suboptimal communication across service settings in MNHHS.

• There is a lack of capacity in ambulatory and/or community-based specialist rehabilitation services.

• Current policies inhibit direct community admissions to rehabilitation services which increase presentations to emergency departments and admissions to acute beds.

• There is poor or no access to diagnostics, specialist medical staff (such as cardiologists and neurologists), and overnight medical cover at stand-alone rehabilitation facilities. This leads to delays in accepting patients for rehabilitation and frequent patient transfers.

• There is limited access to rehabilitation services for residents in the northern region of MNHHS.

• MNHHS does not provide a publicly-funded driving assessment service and there are no supporting policies to inform decisions about the need for driving assessments.

• Hypertonicity services in MNHHS are limited but developing, which presents an opportunity for improving consistency in protocols and processes across services developing at different facilities.

• There is limited provision of appropriate environments for specific patient groups including young people requiring long-term ‘slow-stream’ rehabilitation, bariatric patients, and those requiring isolation for infection control.

• There is variation in the resourcing, assessment tools, and activities, of GRLS across MNHHS facilities.

• The information covered in GRLS assessments overlaps with that used by Aged Care Assessment Teams (ACAT), the Central Referral Unit, and with functional independence measure (FIM) and sub and non-acute patient (SNAP) assessments.

• The RBWH-based rehabilitation engineering service is experiencing increased demand through population growth, which is likely to further increase when co-located with specialist rehabilitation services.

• Recruitment and retention of a skilled workforce across all disciplines is challenging.

• Funding mechanisms aimed at incentivising admitted and centre based care restricts development of home based services.

3.4 From our consumers The majority of rehabilitation services are provided during business hours Monday to Friday which restricts flexibility in service delivery. Coordination between services could be improved.


4. Current commitments

Recognising demand for MNHHS rehabilitation services exceeds current capacity, the Queensland Government has committed to the development of a Specialist Rehabilitation and Ambulatory Care Centre (SRACC) as part of the Herston Quarter redevelopment.

The SRACC will provide 100 designated specialist rehabilitation beds including 40 beds to support patients with complex specialist rehabilitation needs. Ambulatory day therapy, outpatient facilities, rehabilitation engineering, and research and education facilities will also be a feature of SRACC.

It is anticipated construction of the SRACC will begin in 2017 and be operational in 2020.

Specialist Rehabilitation and Ambulatory Care Centre (SRACC) - Artist impression


5. Future service directions

Over the next five years MNHHS commits to growing the capacity and capability of rehabilitation services across the care continuum. Building on the achievements of the MNHHS rehabilitation services, our current services will continue to be enhanced. New models of care will be developed particularly in the home and community settings based on the needs of patients, carers and their families.

Person-centred care will continue to be a central tenet of rehabilitation service delivery in MNHHS. The effectiveness of rehabilitation therapies which ultimately contributes to the quality of life patients can realise when they return to their home and community depends on the degree to which patients participate. It is therefore critical that rehabilitation services continue to engage with patients to establish their therapy goals which can include physical, emotional and social domains.

Over the next five years MNHHS commits to enhancing services through the application of the following principles:

Enga

ged

• Put patients, carers and families at the centre of their care

• Strive to provide the best possible patient experience

• Engage with communities and seek input into service design so that future services continue to meet expectations

• Form meaningful partnerships to support innovation

• Ensure engagement gives everyone an opportunity for an equal voice including those who feel powerless and vulnerable when seeking care

• Assist those accessing services to understand and act on information they are given to help them improve their health

End-

to-e

nd • Be one MNHHS, with multiple hospitals working towards the one goal of high

quality, integrated and compassionate care for our patients

• Provide care that is coordinated, integrated and maximises continuity

• Connect with the wider service provider system so that people can access the right care provider, at the right time and in the right place

Equi

tabl

e

• Enable equity of access and outcome irrespective of location, particularly for hard to reach populations and those with special health needs

• Provide services locally where appropriate and possible

Evid

ence

-bas

ed

• Standardise the patient journey/approach (pathways, processes) for common patient groups and tailor to meet the individual needs

• Be evidenced-based and when there is limited evidence invest in innovation that is evaluated and measured with clear objectives for delivering defined patient benefits and outcomes


6. Service directions

Three service directions have been identified to achieve the desired future state for MNHHS rehabilitation services. A series of measurable objectives and practical evidence-based actions have been listed under each service direction, however, they may also contribute to more than one service direction and/or objective.

Together, the service principles, service directions, and objectives, provide a robust and person-centred framework for MNHHS rehabilitation services, which will be built upon the foundation provided by existing services and previous subacute plans, and be reinforced through the implementation of a comprehensive suite of evidence-based actions.

The service directions are:

1: MNHHS will have clearly defined and integrated rehabilitation pathways across the service system

2: All patients receiving rehabilitation services in MNHHS will have timely and equitable access to the most appropriate service

3: All aspects of MNHHS rehabilitation services will be evidence-based and delivered efficiently


Se

rvic

e di

rect

ion 1 MNHHS will have clearly defined and integrated

rehabilitation pathways across the service system

It is common for rehabilitation patients to make a number of transitions between facilities and providers. The frequency of these transitions makes it critical that systems and processes are in place to promote the integration and coordination of rehabilitation services to optimise patient experiences and outcomes.

A consistent and streamlined mechanism for identification, assessment, allocation, and referral of patients for all rehabilitation services across MNHHS, including community-based and private sector services is our priority. Defining patient pathways within the MNHHS rehabilitation service network will improve patient access to the right care, in the right place, at the right time. Preliminary condition specific patient pathways that represent the desired rehabilitation service model for MNHHS, with consideration of initiatives from overarching statewide rehabilitation plans, are outlined in Appendix A. Pathways will always be adaptable for individual patients according to their specific needs.

Strengthening integration between community-based rehabilitation services with acute and subacute inpatient rehabilitation services will be essential. Consultation liaison services and community based rehabilitation teams will work together to facilitate a patient’s health care journey, delivering coordinated and patient-centred care, creating partnerships across different health providers and sectors, improving patient outcomes and enabling improvements across the system.

Service objectives Implement standardised rehabilitation patient journeys (pathways and processes) for common patient groups and tailor to meet the individual needs.

Enhance rehabilitation service networks across MNHHS to act as one health service, with multiple services working towards the one goal of high quality, integrated and compassionate care for patients.

Enhance the rehabilitation model of care across service settings to focus on functional improvement together with the patient’s social, emotional and mental well-being. This will maximise their quality of life with the goal to remain in the community for as long as possible.

Improve rehabilitation service connections with the wider health and social services system so that people can access the right care provider, at the right time and in the right place.

Service actions

Priority actions Responsibility

1. Patient Access Coordination Hub includes all MNHHS rehabilitation places (beds and ambulatory places) in the patient flow monitoring system and make accessible to all rehabilitation clinicians and GRLS

PACH team and GRLS teams

2. Review the service model and staffing profile for GRLS to promote consistency in the capability and availability of the service across MNHHS

Medicine Clinical Stream

3. Establish a GRLS at Caboolture Hospital Executive Director, Caboolture Hospital



4. Review and refine rehabilitation patient pathways in line with evidence-based practice and peer group benchmarks to optimise patient outcomes and make best use of available rehabilitation resources across the MNHHS

Medicine Clinical Stream (MNHHS Rehabilitation Working Group)

5. Develop a consistent mechanism for identification, assessment, allocation, and referral of patients for rehabilitation services across MNHHS

Medicine Clinical Stream and CISS

6. Adopt, or develop, patient assessment tools and protocols for use by all rehabilitation services and referrers across MNHHS

Executive Directors, MNHHS facilities (rehabilitation services) and Medicine Clinical Stream

7. Develop and disseminate admission and discharge criteria, with associated referral/transfer protocols, for MNHHS rehabilitation services

Medicine Clinical Stream and Executive Director, CISS

8. MNNHS rehabilitation services utilise patient pathways for specific impairments as part of standard practice, with tailoring of pathways where indicated to meet the individual patient needs

Executive Directors, MNHHS facilities (rehabilitation services)

9. Review CBRT service model to promote an integrated, timely and seamless transition from hospital to community

Executive Director, CISS

10. GRLS to develop and maintain an online register of local rehabilitation services, accessible to all MNHHS rehabilitation services, to facilitate communication and appropriate and efficient referrals


Proposed within the next five years Responsibility

11. Develop new pathways for other identified priorities including people with mental health issues and liaise with non-government organisations to develop a pathway for patient who are slowly losing function and require long term rehabilitation.

Medicine Clinical Stream (MNHHS Rehabilitation Working Group)

12. In conjunction with Children’s Health Queensland paediatric rehabilitation services:

12.1 establish formal links between MNHHS rehabilitation services and Children’s Health Queensland

12.2 develop guidelines for the transition of patients between paediatric and adult rehabilitation services

Executive Directors, MNHHS facilities (rehabilitation services), Women’s and Children’s Clinical Stream, and Medicine Clinical Stream

13. Develop protocols and tools for the assessment and/or referral of patients by non-government providers to MNHHS rehabilitation services

Medicine Clinical Stream and Executive Director, CISS

14. Develop a medium for a patient-held record that provides rapid access to key social and clinical information to promote continuity of care with service transitions


15. Define key clinical and social information to be included within patient-held records



Serv

ice

dire

ctio

n 2 All patients receiving rehabilitation services in MNHHS will have timely and equitable access to the most appropriate service

Access to the right rehabilitation service, in the right care setting at the right time will be enhanced over the next five years as the MNHHS rehabilitation service system grows in capacity and capability. Rehabilitation services in MNHHS will evolve to include timely access to rehabilitation in the following settings:

• home based rehabilitation services for patients who are able to return home safely but have limited mobility

• ambulatory day hospital and specialist outpatient services to provide intensive multi-disciplinary therapy

• the acute inpatient ward through a multidisciplinary team approach to in reach/consultation liaison services including allied health

• comprehensive multidisciplinary inpatient sub-acute rehabilitation services, including inpatient and ambulatory specialist (Level 6) rehabilitation services.

The proposed future for MNHHS rehabilitation services in 2021 includes a total of 205 Level 4 inpatient beds, plus 40 specialist Level 6 inpatient beds (see section 9.2 Appendix B) and increased capacity for ambulatory rehabilitation services.

Figure 1 below presents a summary of the future MNHHS rehabilitation services system following implementation of the plan.

Acute • Specialist consultation

liaison rehabilitation service

• Acute ward based multi-disciplinary teams

Subacute • Specialist Level 6

inpatient rehabilitation service* (SRACC)

• Level 4 inpatient rehabilitation services

• GEM units

• Transition Care – Residential

• CISS ABI service

• Private services

Centre-based • Specialist outpatient

rehabilitation clinics

• Day hospital/therapy units

• Specialist Level 6 transition rehabilitation service*

• Community-based rehabilitation teams


Home-based • Community based

rehabilitation teams

• Transition care – Community

• Post Acute Care Service

• Specialist Level 6 transition rehabilitation service

• Community-based rehabilitation teams


Figure 1: The MNHHS rehabilitation service system following implementation of the plan

Inpatient Ambulatory

Patient Flow Identify – Assess – Triage – Allocate - Refer

* CSCF Level 6 rehabilitation services must provide specialist services for inpatient and ambulatory services that include complex multidisciplinary day-only treatment, subspecialist outpatient clinics and specialist community outreach programs.


Service objectives • Increase ambulatory rehabilitation service capacity across MNHHS.

• Rehabilitation services utilisation rates for residents of all MNHHS hospital catchments are at least the equal to those for Queensland.

• Level 4 inpatient rehabilitation services are provided from facilities in all MNHHS catchments.

Service actions


1. Further analyse MNHHS rehabilitation service activity data by functional impairment group, and align with service activity projections, to guide organisation and resourcing of services to maximise effectiveness and efficiency

HSSP, Medicine Clinical Stream

Ambulatory rehabilitation services

2. On completion of action 1 above, increase the capacity of ambulatory rehabilitation services (CBRT and day therapy centres) to meet the projected demand


3. Increase capacity of ambulatory rehabilitation services to provide cardiac and pulmonary rehabilitation


4. Investigate opportunities to increase accessibility for centre-based ambulatory rehabilitation services by locating within a broader range of facilities such as commercial fitness centres


5. Increase capacity of TPCH Day Therapy Unit through maximising other space within the facility for expansion of gymnasium and clinical room utilisation

Executive Director, TPCH

6. Investigate tele-rehabilitation models to support home-based therapy Executive Director, CISS and COSI

7. Establish specialist ambulatory (centre-based or community-based) transitional rehabilitation service capacity for ABI and Spinal Cord Injury (SCI) patients not eligible for Metro South Hospital and Health Service (MSHHS) ambulatory services, prior to the development of SRACC inpatient services

Executive Director, SRACC and Executive Director, CISS

Inpatient rehabilitation services

8. Increase allied health staffing at Caboolture Hospital to enable additional rehabilitation therapy to be provided to patients on acute wards while awaiting transfer to other facilities for inpatient rehabilitation

Executive Director, Caboolture Hospital

9. Deliver a 28-bed inpatient Level 4 rehabilitation service in the Caboolture Hospital infrastructure redevelopment

Executive Director, Caboolture Hospital



10. Investigate opportunities to:

10.1 partner with NGOs to provide 30 residential transition care places to enable an increase in the CSCF Level 4 inpatient rehabilitation service to 80 beds at Brighton Health Campus

10.2 establish a centre-based ambulatory rehabilitation service at Brighton Health Campus

10.3 enhance/introduce clinical support services such as medical imaging, pathology and pharmacy at Brighton Health Campus


11. Establish a 40-bed Level 6 specialist rehabilitation service (SRACC) to provide comprehensive specialist rehabilitation for complex trauma, stroke, burns, and brain injuries, and spinal injuries patients

Executive Director, SRACC

12. Transfer the 30-bed Level 4 inpatient rehabilitation service (GARU) and Day Hospital to SRACC, and increase bed capacity to a total of 60 CSCF Level 4 inpatient beds

Executive Director, RBWH and Executive Director, SRACC

13. Complete refurbishments at Redcliffe Hospital to enable opening of further Level 4 inpatient rehabilitation beds

Executive Director, Redcliffe Hospital

14. Implement actions from relevant statewide plans such as the Statewide adult brain injury rehabilitation health service plan 2016-2026 recommendation to establish a step-down rehabilitation service. This will include a review of the Jacana ABI Unit service model.


Other initiatives

15. Develop a mechanism to monitor access to rehabilitation services by hospital catchments


16. Develop a mechanism to monitor and address delays in access to rehabilitation services in line with evidence-based timeframes specified by MNHHS rehabilitation service pathways


17. Investigate opportunities to increase broader access to gait laboratory services for rehabilitation patients.

Executive Director, RBWH and Director, Gait Laboratory

18. Liaise with National Disability Insurance Scheme(NDIS) providers to facilitate placement of young people with a disability requiring slow stream rehabilitation or residential placement


19. Identify a suitable service setting for non-weight bearing patients and those awaiting QCAT determinations of capacity prior to discharge to residential care


20. Develop infrastructure guidelines that provide for patient-centred care, number of clinical and administrative spaces and dimensions, and appropriate bed arrangements for management of specific patient cohorts (eg bariatric and infectious patients)

MNHHS Corporate Systems and Infrastructure Unit

21. Develop a MNHHS policy on the provision of a public driver assessment service including potential revenue sources such as NDIS and workplace injury or motor vehicle accident insurance schemes


22. Establish a driver assessment service for MNHHS which includes development of clinical guidelines for the assessment of patient capacity to drive motor vehicles, including referral for specialised driving assessment where indicated

Executive Director, CISS and Medicine Clinical Stream


Serv

ice

dire

ctio

n 3 All aspects of MNHHS rehabilitation services will be evidence-based and delivered efficiently

Outcomes for patients accessing rehabilitation services are influenced by both the quality and quantity of treatment provided for them. The dose-response principle provides the imperative for most patients for greater frequency of therapy to achieve functional gains in a shorter timeframe. Reducing delays to the initiation of rehabilitation, and to discharge once functional goals have been achieved, will further optimise length of stay and enhance rehabilitation service efficiency.

MNHHS rehabilitation services currently play an important role in encouraging clinical research and educating the future clinical workforce. There is an opportunity to collaborate further with educational and research institutions to coordinate the rehabilitation research agenda to target MNHHS service improvement priorities.

Collecting and reporting service outcomes in a consistent manner allows for benchmarking across MNHHS and with national peers. Working collaboratively with MNHHS rehabilitation colleagues to review this information, and other rehabilitation issues, will provide the opportunity to foster innovation by drawing on different perspectives and expertise to the benefit of all services.

Service objectives • To deliver evidenced-based services and contribute to research, innovation, and

education, that is evaluated and measured with clear objectives for delivering defined patient benefits and outcomes.

• To partner with research and education institutions to support a culture of innovation and research opportunities in rehabilitation services including using technology to advance innovative models of care workforce development.


Service actions


1. Develop evidence-based rehabilitation protocols that include guidelines for optimal service type and therapy dose (that are amenable to be tailored to individual needs) for conditions commonly managed by MNHHS rehabilitation services


2. Implement discharge planning at the time of admission to inform patients and carers of the likely length of stay and facilitate patient flows

Executive Directors, MNHHS facilities


3. MNHHS rehabilitation services collaborate to develop consistent clinical and business processes for hypertonicity services


4. All MNHHS rehabilitation services collect and report Australasian Rehabilitation Outcomes Centre (AROC) data for all patients regardless of length of stay, with selected data reported according to AROC guidelines


5. Facilitate research projects consistent with the direction of Rehabilitation Clinical Services Plan.


6. Develop a mechanism to ensure regular review of rehabilitation models of care and opportunities to trial and/or adopt new and emerging practices and technologies such as robotics and telerehabilitation.

Executive Directors MNHHS & Medicine Clinical Stream

7. Implement annual Rehabilitation Audit Team review of acute care wards at all MNHHS facilities to monitor impact of delayed transfer to rehabilitation services


8. Advance workforce development opportunities across disciplines with research and university partners.

Executive Directors MNHHS & Medicine Clinical Stream

9. Establish formal links between MNHHS inpatient rehabilitation services and CBRT to promote communication and service integration


Team Leader, CBRT


Proposed within the next five years Responsibility

10. Define impairment groups and locations for trialling six or seven day-per-week inpatient rehabilitation service to optimise rehabilitation efficiency and length of stay


11. Establish an integrated education, training and research program for rehabilitation services in collaboration with MNHHS workforce unit, professional leads and universities and other research institutions



12. Develop an information technology system that supports high quality rehabilitation care by integrating patient needs/goals, care pathways, clinical protocols, and discharge planning.

Metro North Information Technology

13. Develop consistent tools and protocols for assessing rehabilitation service performance within MNHHS, based on the achievement of patient goals (social and functional)


14. Improve communication across professional boundaries to foster inter-professional practice




7. Implementation, monitoring and review 7.1 Implementation and monitoring Implementation will be led by the MNHHS Medicine Clinical Stream in a staged process over the five year plan timeline, with support from the Clinical Operations and Strategy Implementation (COSI) Unit and in consultation with MNHHS Clinical Directorates.

A MNHHS Clinical Stream, Clinical Directorate, or service, has been assigned responsibility to lead the implementation of each of the service actions. It is intended that these actions will be integrated into Directorate and clinical unit operational plans. A workforce plan should also be developed to support implementation.

7.2 Review and reporting As part of its role in relation to clinical service plans, the MNHHS Health Service Strategy and Planning Unit will support Medicine Clinical Stream to conduct an annual review of the extent to which the plan has been implemented and report findings to the Medicine Clinical Stream Leadership, and MNHHS Operational Leadership Team and Senior Executive Team.

7.3 Resource implications Efforts were made during the planning process to ensure service actions were realistic in scope and would represent value for money. It is envisaged that MNHHS budgetary processes will be utilised to seek funding for service actions requiring additional resources, which may include workforce, infrastructure, ICT, or support services.


8. Background

Planning scope The scope of the Plan encompasses adult (people aged 15 and over) rehabilitation services provided within the MNHHS geographic boundaries.

The following conditions/patient groups are considered in the Plan as they are most likely to access rehabilitation services:

• orthopaedic injuries • multi trauma • strokes

• burns • acquired brain injuries • spinal cord injuries

• amputations • deconditioning

Excluded from the Plan were rehabilitation services for:

• children aged 14 years or younger, who will generally access specialised paediatric rehabilitation services provided by Lady Cilento Children’s Hospital

• alcohol, tobacco and other drugs, mental health, and specific outpatients programs for cardiac and pulmonary conditions, as they will be incorporated within other health service planning processes

• people with intellectual and/or physical disabilities requiring long-term residential care will be met from within existing health and community service frameworks and will be guided by the impending Disability Care National Disability Insurance Scheme.

The Plan includes reference to the impact that objectives and actions may have on enabling and support functions such as workforce, support services, information management, and infrastructure, equipment, and assets, however, implementation planning and detailed costing of actions was outside scope of this plan.

Planning assumptions The following statements have been assumed to hold true for the development and implementation of the project:

• service activity data collections and projections provide a valid indication of historical and future changes in MNHHS rehabilitation service catchment population and demand for inpatient rehabilitation services

• MNHHS will retain responsibility for delivery of rehabilitation services to the current population catchment

• the Australian National Sub and Non-Acute Patient (AN-SNAP) dataset adequately represents admitted rehabilitation service activity in MNHHS.

Policy and planning frameworks The MNHHS Strategy and Planning Unit led the development of the plan under the guidance of the MNHHS Medicine Clinical Stream’s Rehabilitation Working Group, and in collaboration with other MNHHS business and clinical units. The following policy and planning frameworks and guiding documents were considered:

• Metro North Hospital and Health Service Strategic Plan 2015-19

• Metro North Hospital and Health Service Health Strategy 2015-20

• Guide to Health Service Planning Version 3 (2015)


• Clinical Services Capability Framework for Public and Licensed Private Health Facilities version 3.2 (CSCF v3.2) (Rehabilitation Services module) (see summary at Appendix C)

• Queensland Statewide Rehabilitation Medicines Services Plan 2008–2012

• MNHHS Subacute Health Service Plan 2012-2016

• MNHHS Specialist Rehabilitation Options Paper, August 2013

• Model of Care: Interim Specialist Rehabilitation Services, 2015

• Clinical consideration of the interim solutions for RBWH Rehabilitation Service, May 2015

• Statewide adult spinal cord injury health service plan 2016-2026, Queensland Health, April 2016

• Statewide adult brain injury rehabilitation health service plan 2016-2026, Queensland Health, April 2016

• Queensland Statewide Stroke Services Framework (in development)

• Stroke Services Framework 2013.

Background papers Four background papers were written to inform the development of the plan, presenting information covering:

• characteristics of the MNHHS population profile and projected changes

• literature relating to rehabilitation services, including the Australian and international policy context, rehabilitation research themes, and horizon scanning

• current MNHHS rehabilitation services

• recent activity and trends in MNHHS rehabilitation services.

For planning purposes MNHHS is divided into four hospital catchment areas, based on patient flows. The four catchment areas are:

• Royal Brisbane and Women’s Hospital

• The Prince Charles Hospital

• Redcliffe Hospital

• Caboolture Hospital.


Consultation A number of interviews were conducted with senior clinicians and executives with responsibility for rehabilitation services in MNHHS. Additional stakeholders were engaged through the planning project steering group and clinical consultation workshops.

The Rehabilitation Working Group of the MNHHS Medicine Clinical Stream were the project steering group and provided the means for engaging MNHHS clinicians and facilities during the developmental stages of the plan. Meetings were held monthly to provide input to the planning project scope and plan, and to discuss issues related to the planning project.

Consultation workshops were conducted at Redcliffe Hospital, Caboolture Hospital, Brighton Health Campus, TPCH and RBWH to enable rehabilitation clinicians to discuss local issues and priorities. A further workshop was convened with representatives from all MNHHS rehabilitation services to provide focussed input on the draft rehabilitation action plan and patient pathways.

The following key MNHHS stakeholders were invited to provide feedback on the draft plan:

• Metro North Hospital and Health Community Board Advisory Group

• Rehabilitation services clinicians

• Aboriginal and Torres Strait Health Unit

• Clinical Streams

• Clinical Directorates

• MNHHS business units

• MNHHS professional leads.

The following external stakeholders were also given the opportunity to provide input on the plan:

• Brisbane North PHN

• National Stroke Foundation

• Spinal Cord Injury Association

• Synapse

• Council on the Ageing (QLD)

• University of Queensland.


9. Appendices

9.1 Appendix A: MNHHS rehabilitation service patient pathways The pathways reflect current rehabilitation services pathways (not the entire patient journey) and planned or desirable rehabilitation services and set a foundation for further refinement and development of criteria for entry to each element.

Rehabilitation services currently provided by MNHHS are presented in blue boxes and lines, services currently provided by other HHSs are in purple, and planned rehabilitation services are in green.

Amputee rehabilitation pathway


Severe burns rehabilitation pathway

Multi-trauma rehabilitation pathway


ABI rehabilitation pathway

Orthopaedic rehabilitation pathway


Stroke rehabilitation pathway

Spinal cord injury rehabilitation pathway


General deconditioning pathway


9.2 Appendix B: Proposed future MNHHS rehabilitation services to 2021

Facilities

Inpatient Ambulatory

Acute Subacute Centre-based Home-based

Caboolture

Multidisciplinary team treating patients in acute wards

Level 4 service - 28 beds

Caboolture Community Health Centre CBRT

North Lakes Health Precinct CBRT

Enhanced range of rehabilitation services provided in the home

Redcliffe


Redcliffe Community Health Centre CBRT

North Lakes Health Precinct CBRT

TPCH


TPCH Rehabilitation Day Therapy Unit

RBWH Level 6 specialist rehabilitation consultation liaison service* accessed from SRACC

Accessed within SRACC

Accessed within SRACC Day Therapy Unit

Brighton

Not applicable Level 4 service –

80 beds

Redcliffe Community Health Centre CBRT

Brighton Health Campus Day Therapy Unit

SRACC Level 6 specialist rehabilitation consultation liaison service*

Level 6 specialist service* – 40 beds


SRACC Day Therapy Unit

Level 6 specialist transition rehabilitation service

Level 6 specialist transition rehabilitation service

Total 249 beds * CSCF Level 6 rehabilitation services must provide specialist services for inpatient and ambulatory services that include complex multidisciplinary day-only treatment, subspecialist outpatient clinics and specialist community outreach programs.


9.3 Appendix C: Clinical Services Capability Framework – rehabilitation services module

Level 4 Level 5 Level 6 Service description

• provides ambulatory and/or inpatient rehabilitation services to clients with moderately complex care needs in acute or postacute phases.

• provided in general rehabilitation clinics and through multidisciplinary day therapy programs.

• inpatient care provided within a designated unit.

• coordinated by health professional with experience, knowledge and skills in rehabilitation reflecting casemix of the service.

• rehabilitation team caring for adult patients includes rehabilitation physicians and/or geriatricians with skills in rehabilitation.

• may have dedicated allied health staff.

• may provide care for clients who no longer require higher level or subspecialty interventions.

• may provide outreach services to lower level services, as well as clinical and professional support and advice through established networks.

• may provide access to leisure and/or diversional therapy

• provides specialty and subspecialty ambulatory and/or inpatient rehabilitation services.

• ambulatory services may include subspecialty rehabilitation outpatient clinics and multidisciplinary day-only therapy programs.

• inpatient care is provided in designated specialty units for clients with complex care needs.

• may have access to hydrotherapy and independent living unit

• provides specialist and subspecialist services for clients with care needs of highest complexity.

• provided in designated unit/s with dedicated multidisciplinary teams.

• ambulatory services include complex multidisciplinary day-only treatment, subspecialist outpatient clinics and specialist community outreach programs.

• may be statewide or superspecialty service.

Service requirements

As per Level 3, plus: • patient care plans developed

collaboratively by multidisciplinary team and include structured ward rounds and multidisciplinary case conferencing arrangements.

• multidisciplinary team with demonstrated experience, and specific knowledge and skills, in delivery of rehabilitation services.

• provides internal consultancy services.

• established partnerships with local community-based rehabilitation teams or similar ambulatory rehabilitation programs to facilitate referral and admission processes.

• affiliations with local, state and/or national professional associations.

• access to Aboriginal and Torres Strait Islander support service, where required.

• documented process to ensure clients have access to acute and critical care 24 hour/s.

• access to acute pain service within 1 week.

• access to orthotic and podiatry services within 2 weeks.

• access to prosthetic services within 1 week and available within 1 month.

• access to clinical measurement services within 1 month.

As per Level 4, plus: • service has wide

geographic catchment, which may include statewide and/or crossborder referrals.

• multidisciplinary team has demonstrated experience, and advanced knowledge and skills, in delivery of rehabilitation services pertaining to specialty /subspecialty area.

• both rehabilitation physicians and geriatricians with skills in rehabilitation within adult rehabilitation services.

• children’s rehabilitation specialists as required by Level 5 children’s rehabilitation services.

• staff engaged with local, state and/or national professional associations.

• access to leisure therapy and/or diversional therapy programs

• access to orthotic services within 1 week.

• access to prosthetic services within 1 week and available within 2 weeks.

• access to clinical

As per Level 5, plus: • extensive range of allied

health professionals onsite.

• range of diagnostic services relating to individual specialty and/or subspecialty on-site.

• may provide specialist and subspecialty statewide consultancy services, and subspecialty outreach services.

• evidence of statewide consultation and leadership role within relevant specialty and/or subspecialty.

• has representation in state, national and/or international professional associations.

• access to pool of specialty equipment pertaining to subspecialty area.


measurement services within 2 weeks.

• access to psychologists with skills appropriate to casemix within 2 weeks.

• access to podiatry services within 2 weeks.

• access to audiology services within 1 month.

• access to persistent pain service within 1 month.

• access to rehabilitation engineering services within 1 month.

Workforce requirements

As per Level 3, plus:

Medical • access during business hour/s to

registered medical practitioner or advanced or basic trainee in rehabilitation or geriatric medicine.

• access 24 hour/s to registered medical practitioner in advanced training or registered medical specialist.

• access - 24 hours - to registered medical specialists with credentials in general surgery and orthopaedic surgery.

• access to registered medical specialist with credentials in rehabilitation and/or geriatric medicine.

Nursing • suitably qualified and experienced

nurse manager (however titled) for the service.

As per Level 4, plus:

Medical • access - 24 hours - to

registered medical specialists, with credentials in rehabilitation and geriatric medicine.

• may have lead clinician with qualifications and credentials relevant to specific specialty area with responsibility for clinical governance of individual specialty and/or subspecialty units.

• access to registered medical specialists with credentials in cardiology, neurology, endocrinology, gastroenterology and rheumatology within 1 week.

• access to registered medical specialists with credentials in neurosurgery, vascular surgery and urology within 1 week.

Nursing • nursing staff may include

advanced rehabilitation specialist nurses as described by Australasian Rehabilitation Nurses Association or nurses working towards specialist recognition.

Allied health • allied health professionals

with demonstrated advanced level of knowledge and skills pertaining to casemix.

• range of allied health professionals reflects casemix of specialty and/or subspecialty.

• access during business hours to physiotherapist, 7 days a week.

• access during business hours to social worker, 7 days a week.

As per Level 5, plus: • multidisciplinary team has

experience, and advanced knowledge and skills, in delivery of rehabilitation services pertaining to specific specialty and/or subspecialty area/s, and may have postgraduate qualifications.

Medical • registered medical

specialist with credentials in practice of rehabilitation medicine pertaining to subspecialty area.

Nursing • dedicated nurse

practitioner desirable.

Allied health • allied health professionals • include staff with

demonstrated specialist-level knowledge and skills pertaining to casemix.

• allied health professionals demonstrate high-level activity in setting statewide standards.

• access to rehabilitation engineer within 1 week.

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