JEREMEY HORNE

DAY REHABILITATION UNIT (DRU)

CALVARY HEALTH CARE SYDNEY

DAY REHABILITATION UNIT OVERVIEW

What is a DRU Minimum requirements Calvary Day Rehabilitation Admission Criteria Type of Patients seen in DRU Admitting and Discharge Procedures Hints

WHAT IS DAY REHABILITATION?

The provision of rehabilitation services involving a multidisciplinary team for patients who have a treatment goal following surgery, illness or who have a disability.

It consists of a half day program offering a variety of treatment modalities in one session to enable a more efficient cost effective use of hospital services.

MINIMUM REQUIREMENTS FOR HOSPITAL-BASED DAY

REHABILITATION SERVICES

CALVARY HEALTH CARE SYDNEY

The Minimum Requirements have been developed in consultation with the Royal Australasian College of Physicians’ Australasian Faculty of Rehabilitation Medicine (AFRM).

They have also been endorsed by the Consultative Committee on Private Rehabilitation (CCPR), which has independent industry representation.

REHABILITATION CARE PROVIDED BY A SPECALIST REHABILITATION TEAM ON AN ADMITTED OR NONADMITTED

PATIENT BASIS IN A SPECIALIST REHABILITATION UNIT (A SEPARATE

PHYSICAL SPACE)

Criterion 1

CRITERION 2

REHABILITATION CARE PROVIDED BY A MULTI-DISCIPLINARY TEAM WHICH

IS UNDER THE CLINICAL MANAGEMENT OF A CONSULTANT IN

REHABILITATION MEDICINE OR EQUIVALENT

Criterion 3

REHABILITATION CARE PROVIDED FOR A

PERSON WITH IMPAREMENT OR DISABILITY AND FOR WHOM THERE IS

REASONABLE EXPECTATION OF FUNCTIONAL GAIN.

CRITERION 4

REHABILITATION CARE FOR WHOM THE

PRIMARY TREATMENT GOAL IS IMPROVEMENT IN

FUNCTIONAL STATUS.

CRITERION 5

Rehabilitation care which is evidenced in the medical record by:

an individualised and documented initial and discharge assessment of functional ability by use of a recognised functional assessment measure;

an individualised multidisciplinary rehabilitation plan which includes negotiated rehabilitation goals and indicative time frames; and

hospital-specific documented programs and pathways.

CALVARY DRU

Began in 2005 to help reduce inpatient length of stays when continuous medical and nursing supervision was no longer required.

This allowed patients to be discharged 1 - 2 days early, thus freeing up inpatient beds for new referrals.

The DRU also allowed an increased continuity of care as patient attended 2 – 3 sessions per week for up to 6 weeks.

CALVARY DAY REHABILITATION UNIT

Provides rehabilitation services involving: Physiotherapists

Hydrotherapy

Social Workers

Dieticians

Nurses

Occupational Therapists

Rehabilitation Specialist’s

Exercise Physiologist

MULTIDISCIPLINARY TEAM APPROACH

The Day Rehab team works to identify problem areas and set specific functional interventions.

This approach provides a framework for patient treatment and a systematic plan for recovery.

The team holds case conferences to collaborate on a goal and identify a time line for completion.

The DRU functions essentially just like an inpatient ward, except – patients stay for up to 3 hours. – do a Physiotherapy & EP based exercise program. – attend a Hydrotherapy class. – may access anyone from the multidisciplinary team to address any

problems or concerns they may have.

TREATMENT

The plan of treatment is tailored to specific needs of the patient.

2-5 days per week.

On the 1st session most patients do: 3 minute walk test Timed up and go Berg balance test BMI

Depending on their presenting condition, patients will also be assessed with:

Muscle testing Neurological tests Joint AROM and PROM Gait assessment Palpation tests

Patients > 65 years old have a MMSE or RUDAS test. During the first week patients will all see a rehabilitation specialist.

GOALS OF THE PROGRAM

Provide a continuum of care for patients after surgery or for those experiencing a complication from illness or disability.

Decrease inpatient length of stay.

Assist patients to regain optimal physical communicative and functional abilities.

Reduce complications associated with immobility.

Lessen severity and frequency of exacerbation and to decrease emergency room visits and hospital admissions.

Support and educate patients/family/caregiver about the disability, coping and recognising the early signs of complications (especially post surgery).

Community reintegration.

Ageing population in SESIAHS

DAY REHABILTATION STAFF

The DRU is staffed by 3 Physiotherapists

1 Exercise Physiologist

1 Physiotherapy aid

1 Enrolled nurse

3 Administration Officers

1 Bus Driver

1 Rehabilitation Specialist

DRU SERVICE

Services run between (mon-Fri) 9am-12pm 1pm-4pm (Sat) 8:30am-1:30pm Patients without transport can be transported to and from DRU on the patient

bus.

Sessions run with 16-20 patients at a time.

Patients are split into 2 groups, one does Hydrotherapy first while the other does Gym. At the end of the first session the groups swap over. After the sessions patients have a light snack and are returned home on the bus.

The same program runs again in the afternoon.

Sessions for inpatients are also run by DRU staff around these times on a daily basis as well as maintenance group sessions and Dr’s clinics.

DRU Service

Upon discharge, patients are given an individually tailored home program and referred to their local over 60’s strengthening class as appropriate, or to CRAG’s services such as mobility group.

DRU also offers maintenance sessions for those motivated to continue with their exercise program.

– This is not covered by Medicare or Private Insurance.

– Patient’s pay a small fee per session and is available only for those who have attended DRU.

– Patient’s come in and use the gym and hydrotherapy facilities with minimal supervision, just as they would when attending a local gym.

DRU Occasions Of Service (OOS)

Initially the service was set up to service only patients from St. George or Calvary hospitals. In its initial year, episodes of care(EOC) were just over 2000.

In 2006 the service was expanded and referrals were accepted from GP’s, allied health workers and other hospitals outside the St. George area.

In 2008 EOC had increased to > 2500.

In 2009 OOS had further increased to 3000.

In 2010 OOS were up again to 5400.

In 2011 OOS were 5500.

In 2010 the overall service including maintenance group, clinics and inpatients OOS was 7562.

In 2011 this increased to 8100.

In 2012 we were closed for 3 month due to renovations so patient numbers were affected

So far in 2013 we are averaging 30 EOC per day for DRU and 42 for all services, (DRU, clinics, maintenance) this equtes to >7200 DRU EOC and > 10,000 across all services.

ADMISSION CRITERIA - POLICY

Suitable patients will be those who meet the following criteria: Cognitively intact, or with minimal cognitive impairment only

An ability to participate, and undertake the new learning required for a rehabilitation program.

Potential for functional improvement from the rehabilitation program. Medically stable.

Ability to self-administer medicines.

Safe for staff to access a person’s home environment and to transport the patient to the Day Rehabilitation Unit.

Socially able to integrate into a rehabilitation setting.

Motivated to improve independence, and remain at home (or hostel).

Resident of the St George District i.e. the municipalities of Rockdale, Kogarah and Hurstville.

Adult, i.e. 16 years and above.

REFERRAL FORM

TYPE OF PATIENTS SEEN IN DRU

Orthopaedics Joint replacements

Fractures

Spinal Surgery i.e.. decompression, fusions

Reduced mobility

Deconditioning

Falls

Cancer Rehab

Lower back pain

Musculoskeletal conditions

Cardiac rehab

Parkinson’s disease

We do not see acute stroke patients.

CALVARY DRU STATISTICS

Current DRU referral Sources 2011

Source

Inpatients 35%

G.P. 25%

Specialist 30%

Other (PT, CNC) 5%

Total number of referrals per month = 80+

ADMITTING AND DISCHARGE PROCEDURES

All patients who attend DRU are admitted as an inpatient for the time they are in session.

As a result they are admitted via the IPM system (i.patient manager) at start of session and discharged at end. Also check-in & check-out on EMR.

While admitted, patients cannot have a CC, they must be discharged from IPM for this to occur. This occurs at 4 pm daily.

Hints for setting up a DRU

Start small, build staff as clientel numbers grow

Preferably a large space for the service to grow

Have a clearly defined clientel and all the necessary services to offer appropriate services

Consistent referral base- GP’s, hospitals etc

Affective advertising, brochures

Administrative officers- paperwork+++

Bus service- clear pick up areas for am and pm

Patient parking if possible

Well equipped gym and pool

Separate Dr’s clinic room and PT Ax rooms