The Journey for Amputee Rehabilitation

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The Journey for Amputee Rehabilitation

• Josephine Wong
• Day Rehabilitation Centre
• Ambulatory Primary Health Care Directorate
• Central Northern Adelaide Health Services

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OVERVIEW

• Day Rehabilitation Centre Services
• Background - How it began
• Amputee Pathway Implementation
• Outcomes
• Challengers Ahead - The way forward

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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

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Service Delivery Model
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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

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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

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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.

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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

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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

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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

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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

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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

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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

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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

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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

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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

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Further Information

• Meredith Jolly l Manager DRC
• Josephine Wong l Physiotherapist DRC
• T [phone] / [phone]
• E meredith.jolly_at_health.sa.gov.au
• E josephine.wong_at_health.sa.gov.au

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