1. Reducing Rehab Waiting Times A/Prof Stephen Wilson Royal North Shore Hospital

2. 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 Dept Focus on medical vs functional issues Poorly organised Rehab consulting service Governance, leadership, responsibility, accountability, data Staffing Drivers: Quality and Activity Based funding

3. 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)

4. Baseline Indicators Acute hospital Indicators: ALOS 2010/11 was 7.99 days for Rehab Type change episode ALOS 2010/11 waiting for transfer was 4.91 Days retrieved from Patient Access Transport Unit

5. 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

6. 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 care 27 (10/11) to 47 (11/12) Community Package 465 (10/11) to 513 (11/12) Bed days for patients waiting for transfer

7. 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