Mrs Melanie Haley1, Ms Jude Boyd1, Ms Lisa Done2, Ms Bianca Summers1, Ms Allison Farley3, Ms Anne Pagram1, Ms Annette Leong1, Ms Candice Fergeus1, Ms Monica Derum1, Mr Christopher Sloan1
1Eastern Health, Melbourne, Australia, 2Peninsula Health, Mornington, Australia, 3Western Health, Melbourne, Australia
Design and Setting: A quasi experimental (non-randomised, controlled) research trial was conducted across three general medical wards within a large public hospital in Melbourne, Australia from September to December 2019.
Study Participants: Patients were eligible if they were admitted to general medical wards and deemed by the Senior Allied Health project team as likely to benefit from targeted therapy to prevent unnecessary sub-acute admission and/or to improve hospital and patient related outcomes.
Interventions: Intervention was additional physiotherapy and occupational therapy input by senior staff in addition to usual care to targeted patients.
Main Outcome Measure(s): The primary outcome measure was discharge destination, specifically discharge home compared to sub-acute care. Secondary measures included acute hospital length of stay, total hospital length of stay, readmission within 30 days of discharge, and sub-acute length of stay less than five days. Patient related outcomes were functional autonomy and level of assistance required for mobility.
Results: Participants in the intervention group received a median of 155 minutes more allied health input in comparison to the usual care group (p=0.01). There were improvements in median hospital LOS (p=0.01), acute length of stay (p=0.05), discharge destination from acute (p=0.01), readmission rates within 30 days (p=0.01), level of functional autonomy on discharge (p=0.02), and level of assistance required for mobility and change from admission to discharge (p=0.01).
Conclusion: Additional senior physiotherapy, occupational therapy and allied health assistant input to selected patients on a general medical ward improved hospital and patient outcomes, in particular avoidance of subacute admissions.
Melanie Haley is a clinical lead physiotherapist in the area of aged and complex care at Eastern Health. Melanie is a member of the Care of Older People governance committee of Safer Care Victoria and an Australian Physiotherapy Council Assessor. Melanie has over 20 years of clinical experience in areas including falls and balance, GEM, vestibular rehabilitation, general medicine, post acute care, GEM at Home, community rehabilitation and acquired brain injury and is the chair of the Falls Working Group of Eastern Health. Melanie completed her Masters of Gerontology in 2013 and has first and second author publications in the areas of delirium, exercise, disability and frailty.