1. The Journey for Amputee Rehabilitation Josephine Wong Day Rehabilitation Centre Ambulatory & Primary Health Care Directorate Central Northern Adelaide Health Services

2. OVERVIEW Day Rehabilitation Centre Services Background - How it began Amputee Pathway – Implementation Outcomes Challengers Ahead - The way forward

3. 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

4. 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

5. 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

6. 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

7. 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.

8. 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

11. 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

12. 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

13. Amputee Pathway - Outcomes for clients >Operational Amputee Pathway - Commenced 23 rd 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

14. 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

15. 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

16. 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

18. 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

19. 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

20. Further Information Meredith Jolly l Manager DRC Josephine Wong l Physiotherapist DRC T: (08) 8222 1848 / (08) 8222 1858 E: meredith.jolly@health.sa.gov.au E: josephine.wong@health.sa.gov.au