alexandra totani - sa health calhn - acute & sub-acute bed pressures - the sa brain injury...
DESCRIPTION
Alexandra Totani delivered this presentation at the 2014 Acquired Brain Injury conference. The conference gave case studies of ABI and NDIS, supporting people with cognitive and behavioural impairments after ABI and FASD developments and implications for Australia going forward. Find out more at http://bit.ly/1zgqdKmTRANSCRIPT
Central Adelaide Local
Health Network
Rehabilitation Services
The Patient Flow Experience in
the SA Brain Injury Rehabilitation
Unit Acute and Sub-Acute Bed
Pressures
Alexandra Totani
Clinical Service Coordinator
SABIRSSouth Australian
Brain Injury Rehabilitation Service
SA Health
Introduction
> This presentation is about the SA BIRU
experience in ensuring our client
population, adults requiring brain injury
rehabilitation, are discharged to the most
appropriate destination.
> How do clients enter/access our service?
> How do clients exit? Where to, after
completion of active rehabilitation?
SA Health
SA Health Landscape
> SA Health - SA has one of the oldest
populations in Australia, 40% of our
hospital patients are 65-85 yrs. of age
> SA Health “Transforming Health” – we
need to provide coordinated care that is
responsive and closer to home
> SA Health aim – Best Care, First Time,
Every Time
SA Health
SA Health Landscape
> SA Health major projects
• New Royal Adelaide Hospital 2016
• EPAS implementation
• State-wide Rehabilitation Service Plan
2009 - 2017
SA Health
South Australia
SA Health
SA Health – Local Health Networks
SA Health
SA Health – CALHN Landscape
> SA Health Rehab Strategic Plan 2009 –
2017 & Rehabilitation Clinical Network
> Relocation of general rehabilitation
service from Central to Northern LHN
> Growth of Tele-Health Rehab Service –
changing how services are delivered &
attained
SA Health
SA Health – CALHN Landscape
> Change management focus & org psych
support during current climate – Staff &
Clients
> Historical affiliation - RAH
> Rehab & Complex Medicine Stream
> Sub acute “expected” to assist Acute sites
ED & bed pressures
SA Health
SA Brain Injury Rehabilitation Unit
> State-wide Service of SA Health in
CALHN
> 28 in-patient beds – acute & community
access
> Referral Source – RAH 57%; FMC 16%;
Community 18%
> “Sister” Wards in acute sector –
Neurology / Stroke / Trauma & Ortho
Services
> “Sister” Community Facility – Highgate
Park (previously Julia Farr Centre)
SA Health
SA Brain Injury Rehabilitation Unit
> 2013-2014 Client Profile
> 163 admissions
> 72% Traumatic ABI; 27% Non-Traumatic
> 429 males, 177 females - Referrals
> Average age 45.8 yrs. old
> 72% from metro SA
> 24% from country SA
> 3% interstate; 2% international
> Ethnicity 92% Caucasian; 3% ATSI; 3%
Asian; 2% Other
SA Health
SA Brain Injury Rehabilitation Unit
> No. of days from approval to admission:
• 466 days waiting in acute sector
• 249 days waiting in community sector
SA Health
SA Brain Injury Rehabilitation Unit
> Length of Stay (LOS) – in acute & rehab,
the entire patient journey
> Moral urgency – everyday spent in
hospital robs people of their identity &
their lives in their own environment within
their own community
SA Health
SA Brain Injury Rehabilitation Unit
> Ready for Rehab? Acute vs Sub Acute
opinion – “ready” to leave acute sector
but not ready for rehab
> Eligibility criteria – open and transparent?
Expert Triage Team - specialised
assessment skills
> Hope & Wait – the consumer/carer
experience
> Building a service to provide lifetime
support for our clients – opportunity to
improve access from WCLHN network
SA Health
SA Brain Injury Rehabilitation Unit
> Welcome to BIRU – Your Rehabilitation
Journey Begins…
> The Tears, The Fears, The Expectations..
> Your Length of Stay – who decides?
> Your Destination – who decides?
> Client Centred Care – efficient approach
to service delivery, multi – disciplinary
team with consumer/carer involvement
> 5 day a week AH Therapy, 24/7 Nursing
SA Health
SA BIRU Discharge Planning
> Our clients have more complex social
issues:
• “Triple Diagnosis”
• ABI
• Substance abuse
• Mental illness
• High Risk Behaviours
• Homelessness
> Planning occurs immediately
> Destination “known”
> Destination “unknown”
> Discharge ready but no destination
SA Health
SA BIRU Discharge Options
> Own home with family +/- carer support –
family deliberations/Guardianship orders
> Home Modifications or House Relocation
(SA Housing Trust)
> Disability Services (DSA) (under 65yrs)
> DSA Supported Accommodation +/- Carer
Support
> Exceptional Needs Unit (ENU) to access
Supported Residential Facilities
> Nursing Home (65yrs and over)
SA Health
SA BIRU Discharge Barriers
> Expected & unexpected…expect the
unexpected!
> Disability SA struggles to meet needs of
our clients, their clients
> Thorough behavioural screening /
personality matching for clients that
require shared accommodation
> Younger persons with Catastrophic ABI
> Country Clients requiring ongoing therapy
> Brain Injury Rehab Community & Home
(BIRCH) limited access
SA Health
SA BIRU Discharge Planning
> LSA – Lifetime Support Assistance,
introduced to SA 1st July 2014
> Cost – financial & emotional (Health &
Finance views)
> Client Centred Care improves efficiency
> Professional Boundaries and Long Stay
Clients
SA Health
Opportunities for Improving Discharge
Planning
> Raise awareness and appreciation of Rehab
patient journey - ABI “invisible” attributes
> Early identification of discharge barriers – cost
effective strategies & programs required
> Transition Facility – CALHN actively looking at
setting this up for clients:
• Completed “Active” Rehabilitation program
• Maintenance Care
• NWB + ABI + multi trauma
• Awaiting placement/accommodation/home
mods
SA Health
References
SA Health Website
www.sahealth.sa.gov.au
SA Health State-wide Rehabilitation Service Plan 2009
– 2017
www.sahealth.sa.gov.au/.../sa+health.../statewide+re
habilitation+service
SA Health Transforming SA Health
www.transforminghealth.sa.gov.au/
“A prospective multicentre study of barriers to
discharge from inpatient rehabilitation”
New,P.W;Jolley,D.J;Cameron,P.A;Olver,J.H;Stoelwinde
r,J.U. MJA 2013; 198:104-108
SA Health
Presenter Contact Details:
Alexandra Totani
Clinical Service Coordinator
SA Brain Injury Rehabilitation Unit
Hampstead Rehabilitation Unit
207-255 Hampstead Rd
Northfield SA 5085
PH: 08 8222 1929
Email [email protected]