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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
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