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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 [email protected]
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