The Health Roundtable Implementation of Agency for Clinical Innovation (ACI) Orthogeriatric Model of Care Tracey Drabsch Orange Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct b_HRT1215-Session1_DRABSCH_ORANGE_NSW

The Health Roundtable KEY PROBLEM In Mid 2010 within OHS there appeared to be issues surrounding: Capacity for inpatient services to consistently provide multidisciplinary orthogeriatric care Inconsistent patient discharge planning and goal setting Handover to the NF was reportedly inconsistent and not multidisciplinary in nature Understanding of resources and staffing available in NF was limited Continuity of care between facilities, follow up and community care lacked clear process 2

The Health Roundtable AIM OF THIS INNOVATION Evaluate the implementation of the ACI Orthogeriatric Model of Care within Orange Health Service before and after the Sub-Acute Care Team (Senior Clinicians - Medical, Nursing, Allied Health) involvement Establish baseline information within a regional hospital via medical record audit. Pre Team June June 2009 (n=50). Post Team Sept Feb 2011 (n=30). 3

The Health Roundtable 4 Joint Question for Orthogeriatrics Collaborative Care with the Orthopaedic/Acute Teams Sub-Acute Care Team Multidisciplinary Team NF Teams Outreach visits Patient follow up Education Outreach Co-ordinator Sub-Acute Care Team members “THE HUB” ORANGE inpatient Neighbouring Facility Multidisciplinary Handover to Neighbouring Facilities & Teams Sub-Acute Care Team Hub and Spoke Model of Care from OHS 4

The Health Roundtable Outcomes & Evaluation Statistically significant increase in:  Occupational Therapy involvement  Social Work involvement  Documentation of weight bearing status, pre-morbid mobility and pre-morbid function  Aperients given  Paracetamol charted  Medical discharge summaries sent to the General Practitioners  Handover information including the patient’s equipment needs, goals and contact details, physiotherapy, dietetics and social work discharge summaries 5 5

The Health Roundtable Outcomes & Evaluation Statistically significant decrease in:  Nutrition assistant  Initiation of discharge planning (3.9 days to 2.6 days)  Complications such as pressure ulcers, electrolyte imbalance and wound infection 6 6 6

The Health Roundtable Lessons Learned  Senior Multidisciplinary Clinical Teams are able to implement change  Guidelines with clinical validity and authority to work from provide a good platform to guide, build and sustain clinical practice changes within a service  Consistent communication of keeping patient care the focus is essential with change management  Consistency of team activity over a prolonged period is effective in maintaining service provision  Teams work well with teams  Networking is key to providing a more seamless patient journey 7 7