Central Adelaide Local

Health Network

Rehabilitation Services

The Patient Flow Experience in

the SA Brain Injury Rehabilitation

Unit Acute and Sub-Acute Bed

Pressures

Alexandra Totani

Clinical Service Coordinator

SABIRSSouth Australian

Brain Injury Rehabilitation Service

SA Health

Introduction

> This presentation is about the SA BIRU

experience in ensuring our client

population, adults requiring brain injury

rehabilitation, are discharged to the most

appropriate destination.

> How do clients enter/access our service?

> How do clients exit? Where to, after

completion of active rehabilitation?

SA Health

SA Health Landscape

> SA Health - SA has one of the oldest

populations in Australia, 40% of our

hospital patients are 65-85 yrs. of age

> SA Health “Transforming Health” – we

need to provide coordinated care that is

responsive and closer to home

> SA Health aim – Best Care, First Time,

Every Time

SA Health

SA Health Landscape

> SA Health major projects

• New Royal Adelaide Hospital 2016

• EPAS implementation

• State-wide Rehabilitation Service Plan

2009 - 2017

SA Health

South Australia

SA Health

SA Health – Local Health Networks

SA Health

SA Health – CALHN Landscape

> SA Health Rehab Strategic Plan 2009 –

2017 & Rehabilitation Clinical Network

> Relocation of general rehabilitation

service from Central to Northern LHN

> Growth of Tele-Health Rehab Service –

changing how services are delivered &

attained

SA Health

SA Health – CALHN Landscape

> Change management focus & org psych

support during current climate – Staff &

Clients

> Historical affiliation - RAH

> Rehab & Complex Medicine Stream

> Sub acute “expected” to assist Acute sites

ED & bed pressures

SA Health

SA Brain Injury Rehabilitation Unit

> State-wide Service of SA Health in

CALHN

> 28 in-patient beds – acute & community

access

> Referral Source – RAH 57%; FMC 16%;

Community 18%

> “Sister” Wards in acute sector –

Neurology / Stroke / Trauma & Ortho

Services

> “Sister” Community Facility – Highgate

Park (previously Julia Farr Centre)

SA Health

SA Brain Injury Rehabilitation Unit

> 2013-2014 Client Profile

> 163 admissions

> 72% Traumatic ABI; 27% Non-Traumatic

> 429 males, 177 females - Referrals

> Average age 45.8 yrs. old

> 72% from metro SA

> 24% from country SA

> 3% interstate; 2% international

> Ethnicity 92% Caucasian; 3% ATSI; 3%

Asian; 2% Other

SA Health

SA Brain Injury Rehabilitation Unit

> No. of days from approval to admission:

• 466 days waiting in acute sector

• 249 days waiting in community sector

SA Health

SA Brain Injury Rehabilitation Unit

> Length of Stay (LOS) – in acute & rehab,

the entire patient journey

> Moral urgency – everyday spent in

hospital robs people of their identity &

their lives in their own environment within

their own community

SA Health

SA Brain Injury Rehabilitation Unit

> Ready for Rehab? Acute vs Sub Acute

opinion – “ready” to leave acute sector

but not ready for rehab

> Eligibility criteria – open and transparent?

Expert Triage Team - specialised

assessment skills

> Hope & Wait – the consumer/carer

experience

> Building a service to provide lifetime

support for our clients – opportunity to

improve access from WCLHN network

SA Health

SA Brain Injury Rehabilitation Unit

> Welcome to BIRU – Your Rehabilitation

Journey Begins…

> The Tears, The Fears, The Expectations..

> Your Length of Stay – who decides?

> Your Destination – who decides?

> Client Centred Care – efficient approach

to service delivery, multi – disciplinary

team with consumer/carer involvement

> 5 day a week AH Therapy, 24/7 Nursing

SA Health

SA BIRU Discharge Planning

> Our clients have more complex social

issues:

• “Triple Diagnosis”

• ABI

• Substance abuse

• Mental illness

• High Risk Behaviours

• Homelessness

> Planning occurs immediately

> Destination “known”

> Destination “unknown”

> Discharge ready but no destination

SA Health

SA BIRU Discharge Options

> Own home with family +/- carer support –

family deliberations/Guardianship orders

> Home Modifications or House Relocation

(SA Housing Trust)

> Disability Services (DSA) (under 65yrs)

> DSA Supported Accommodation +/- Carer

Support

> Exceptional Needs Unit (ENU) to access

Supported Residential Facilities

> Nursing Home (65yrs and over)

SA Health

SA BIRU Discharge Barriers

> Expected & unexpected…expect the

unexpected!

> Disability SA struggles to meet needs of

our clients, their clients

> Thorough behavioural screening /

personality matching for clients that

require shared accommodation

> Younger persons with Catastrophic ABI

> Country Clients requiring ongoing therapy

> Brain Injury Rehab Community & Home

(BIRCH) limited access

SA Health

SA BIRU Discharge Planning

> LSA – Lifetime Support Assistance,

introduced to SA 1st July 2014

> Cost – financial & emotional (Health &

Finance views)

> Client Centred Care improves efficiency

> Professional Boundaries and Long Stay

Clients

SA Health

Opportunities for Improving Discharge

Planning

> Raise awareness and appreciation of Rehab

patient journey - ABI “invisible” attributes

> Early identification of discharge barriers – cost

effective strategies & programs required

> Transition Facility – CALHN actively looking at

setting this up for clients:

• Completed “Active” Rehabilitation program

• Maintenance Care

• NWB + ABI + multi trauma

• Awaiting placement/accommodation/home

mods

SA Health

References

SA Health Website

www.sahealth.sa.gov.au

SA Health State-wide Rehabilitation Service Plan 2009

– 2017

www.sahealth.sa.gov.au/.../sa+health.../statewide+re

habilitation+service

SA Health Transforming SA Health

www.transforminghealth.sa.gov.au/

“A prospective multicentre study of barriers to

discharge from inpatient rehabilitation”

New,P.W;Jolley,D.J;Cameron,P.A;Olver,J.H;Stoelwinde

r,J.U. MJA 2013; 198:104-108

SA Health

Presenter Contact Details:

Alexandra Totani

Clinical Service Coordinator

SA Brain Injury Rehabilitation Unit

Hampstead Rehabilitation Unit

207-255 Hampstead Rd

Northfield SA 5085

PH: 08 8222 1929

Email alex.totani@health.sa.gov.au