latrobe.edu.au CRICOS Provider 00115M

Hospital to HomeThe most important transitionA/Prof Natasha LanninAlfred Health & La Trobe University

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Introduction

• Severe ABI affects only a small number of people, however, it has a significant impact on the person and their family and the lifetime care costs are considerable

• Transition from hospital to home is a critical time

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Person with ABIFamily

Rehab Team

Goals Evidence Based Rehabilitation

Lower levels of attendant care

Fewer NH placements

Independence

Higher levels of community integration

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Discharge Planning will commence on admission

Families play a critical role in rehabilitation and lifelong care

Rehab team train families prior to discharge

Person with ABI (& their family) are provided with all the information they

need and want

All rehab is goal-focused

Where there is evidence, evidence is applied

There is a written, goal-directed plan for rehab which allows the person with ABI to

direct their own future

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Changes, Challenges, Choices

Changes

• Changes in rehabilitation over recent years

Challenges faced by clinicians

• Accessing and staying abreast of evidence

• Changing how we have “always done things”

Challenges faced by consumers & families

• Accessing accurate evidence

• Engaging with the rehabilitation team / healthcare workers

Choices

• Translating Evidence into Practice

• Choosing your future

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ChangesRehabilitation Length of stay- 1980’s

• Time from ABI onset to admission to rehabilitation was 22.0 days (SD 17.2)

• Rehabilitation average LOS was then 84.9 days (SD 66.0)

Rehabilitation Length of stay- 1990’s

• Time from ABI onset to admission to rehabilitation was 17.6.0 days (SD 22.0)

• Rehabilitation average LOS was then 54.9 days (SD 84.9)

Rehabilitation Length of stay- 2000’s

• Time from ABI onset to admission to rehabilitation was 14.2 days (SD 17.6)

• Rehabilitation average LOS was then 34.9 days (SD 84.9)

Rehabilitation Audit, Mount Royal Hospital (1989), Rehabilitation Audit, North West Hospital (1995)

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Rehabilitation Setting

• Acute rehabilitation

• Early Support Discharge teams

• Transitional Living Units

• Community Rehabilitation Centres

• Private practitioners

• Telehealth / Telerehab

Rehabilitation should take place in an environment that drives goal attainment and in most instances,

this is surely the person’s own home

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Timing of Rehabilitation

Early rehabilitation is well tolerated in medically stable patients

outstanding questions over timing and efficacy

Rehabilitation intervention research is traditionally undertaken with people who had their brain injury > 2 years prior

Priority areas for further research

• Efficacy of early ADL-based rehabilitative strategies versus Vocation-based rehabilitative strategies

• Efficacy of rehabilitation delivery in the "chronic“ phase or using a slow-stream approach

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Person with ABIFamily

Rehab Team

Goals Evidence Based Rehabilitation

Lower levels of attendant care

Fewer NH placements

Independence

Higher levels of community integration

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Caregiver Support

• What caregiving tasks are most usually completed by paid versus family carers?

• How can hospitals best support informal caregivers?

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Comparison of paid and unpaid care hours per week

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Caregiver Support

• What caregiving tasks are most usually completed by paid versus family carers?

• How can hospitals best support informal caregivers?

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http://www.abiebr.com/

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Tips…• Talk openly and honestly with the healthcare worker to

help build a trusting relationship

• Tell healthcare workers what your goals are (if you know them), but also tell them about what things in your life are your priorities, what things concern you (worry you)

• Ask questions about the injury and what options are, as well questions about therapy treatments and about your progress.

• If you’ve heard about research, talk with your healthcare workers about this

• Repeat questions if the answer is forgotten or not understood

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Qualitative Finding: The difference between HOPE and FALSE PROMISES

Thank you

latrobe.edu.au CRICOS Provider 00115M

Associate Professor Natasha Lannin may be contacted at N.Lannin@latrobe.edu.au

Follow our research on Twitter: @NatashaLannin