Modifying current ward and Rehabilitation in the Home (RITH) processes to facilitate the earlier discharge of patients from a Stroke and Rehabilitation unit. Rodrigo Mejias Rochelle Hoggan WA Stroke Services Study Day 2016, Rodrigo Mejias

smphu.health.wa.gov.au Chasing decreased length of stay: The Holy Grail of Inpatient Healthcare

What we will cover: QI project that achieved a LOS reduction by… 3.8 days Practicalities of how we did it Interesting findings we came across How this may be relevant across healthcare settings in reducing LOS WA Stroke Services Study Day 2016, Rodrigo Mejias

RITH Hospital Substitution/ ESD Embedded within SMHS Allied Health Rx and Ax 7 day service WA Stroke Services Study Day 2016, Rodrigo Mejias

RITH Acute Hospital Substitution ABF Pricing parameters BenchmarkingLOS WA Stroke Services Study Day 2016, Rodrigo Mejias

Question – Can modifying RITH and Ward processes streamline the Inpatient rehabilitation journey to help reduce LOS? WA Stroke Services Study Day 2016, Rodrigo Mejias

Aim: Earlier Discharge with higher dependency Integrated DC planning Education ID of Barriers WA Stroke Services Study Day 2016, Rodrigo Mejias

How we did it Identifying the status quo Setting the parameters Implementing the interventions Collecting the information WA Stroke Services Study Day 2016, Rodrigo Mejias

Process Interventions – What Worked ? Early discharge planning Allocation of RITH therapist to the ward WA Stroke Services Study Day 2016, Rodrigo Mejias

RITH Therapist ID ESD candidates Attend meetings Work with ward staff Education Monitoring Document WA Stroke Services Study Day 2016, Rodrigo Mejias

Results – Sample population 76 patients included in project sample. 30 patients DC home with RITH WA Stroke Services Study Day 2016, Rodrigo Mejias

Results LOS – Reduction = 3.8 days for stroke patients FIM Inpatient DC score = 12 points less for stroke patients! Data demonstrating clients were DC at a more dependent level. Data demonstrating clients were DC at a more dependent level. WA Stroke Services Study Day 2016, Rodrigo Mejias

Results

The realities of DC Barriers Discharge Barriers Medical/tests Equipment Services Family Support Patient Factors WA Stroke Services Study Day 2016, Rodrigo Mejias

Barriers to Discharge Awaiting Equipment 2 Patients Discharge Services 1 Patient Family/Carer training 2 Patients Patient Anxiety 1 Patient Medical Barriers 7 Patients WA Stroke Services Study Day 2016, Rodrigo Mejias

Conclusions Project changed perceptions about discharge and “culture” surrounding DC criteria. “This project helped to instil confidence in the RITH service to effectively support patients going home early.” “This project helped to instil confidence in the RITH service to effectively support patients going home early.” DC processes can be streamlined to reduce LOS – Early is Key Key Strategies Relationships and trust DC planning from admission - Involving RITH early. Education WA Stroke Services Study Day 2016, Rodrigo Mejias

More work is needed! Population numbers small Impact of other variables? Limited project staffing/funding WA Stroke Services Study Day 2016, Rodrigo Mejias

The Future How do we translate what we learned? Can 3.8 days be reproduced or improved? Work underway to roll out project on a larger scale. Thank You Thank You WA Stroke Services Study Day 2016, Rodrigo Mejias

Acknowledgements Fremantle Hospital and Health Service: Sarah Amesz, Jon Harris, Prof. David Bruce Rehabilitation in the Home – Fremantle Emma Crossing