Dr Lara Kimmel1,2, Ms Dina Watterson1, Mr Jim Sayer1, Ms Lauren Maher1, Ms Jean Bremner1, Ms Anna Kennedy1, Ms Chelsie Ting1, Assoc Prof Lisa Somerville1,3
1The Alfred, Melbourne, Australia, 2Monash University, , Australia, 3La Trobe University, , Australia
Introduction: Early comprehensive multidisciplinary assessment of physical, psychosocial and environmental aspects of health contributes to more efficient and effective patient care. The Targeted Therapy for Acute Recovery Program (TtARP) was piloted at The Alfred in 2017 and formally commenced in 2018 with the aim of determining if patients could be accurately targeted early in their hospital stay in order for safe discharge home to be achieved.
Method: Data was collected over a 5 month period in 2018. Data included basic demographic details, length of stay (LOS) and discharge destination. Functional measures collected included the modified Iowa Level of Assistance Scale (mILOA) – a mobility score ranging from 0 to 36 with a minimal clinically detectable change of 6 points. The Functional Autonomy Measurement System (SMAF) was also collected with a change in 5 points representing clinically significant change. Patients with a mILOA score of 12-25 were specifically targeted for this programme.
Results: 383 patients were seen by TtARP (54% female) with a median age of 75 years (IQR 64, 85). The median acute hospital LOS was 8 days (IQR 6, 13). Overall, 269 patients (70%) were discharged directly home with 76 patients being discharged to sub-acute care. 156 patients were waiting for transfer to sub-acute care when seen by TtARP with 90 (58%) of these achieving safe discharge home from the acute hospital. Both the mILOA and SMAF scores demonstrated clinically significant improvement between admission and discharge [Initial mILOA [median (IQR)]: 13 (9, 17) Discharge mILOA [median (IQR)] :5 (0, 10)] [Initial adjusted SMAF [median (IQR)]: -15 (-23, -7) Discharge adjusted SMAF [median (IQR)]: -2 (-10, 0)].
Conclusion: Large cost saving benefits can be seen with the implementation of an Allied Health run service in the acute hospital providing intensive therapy to targeted patients and preventing unnecessary admissions to sub-acute facilities.
Lara is a physiotherapist at The Alfred Hospital in Melbourne and has worked there for over 20 years. She has extensive experience in the management of orthopaedic and trauma patients and a strong interest in research, having completed a PhD through Monash University in the area of discharge following trauma.