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5-6 December 2005 - Melbourne

Orthopaedic Rehabilitation in the Home Program (ORITH) Presenter: Dina Watterson Hospital: The Royal Melbourne Hospital, Vulcan Key Contact : Debbie Munro, Allied Health Manager Surgery, Debbie.Munro@mh.org.au , 0438599264. 5-6 December 2005 - Melbourne. KEY PROBLEMS.

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5-6 December 2005 - Melbourne

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  1. Orthopaedic Rehabilitation in the Home Program (ORITH)Presenter: Dina WattersonHospital: The Royal Melbourne Hospital, VulcanKey Contact:Debbie Munro, Allied Health Manager Surgery, Debbie.Munro@mh.org.au, 0438599264 5-6 December 2005 - Melbourne

  2. KEY PROBLEMS • Patients having uncomplicated total hip replacement (THR) and total knee replacement (TKR) had an average length of stay of 7.5 and 6.8 days respectively. • The last few days of admission was identified as high AH intensive and less nursing and medical intensive. • A change of the model of care provided the opportunity to maximise patient outcomes and reduce length of stay.

  3. HOW WE DID IT • Project Started: Initial Project commenced late 2003 with a review in April 2004 for operational planning and 2004/2005 budget submission. • Staffing: 0.7 Physio, 0.5 OT, Nursing, Medical cover • Funding: Initial Funding HDM • Duration: Program has continued and expanded since June 2004.

  4. INNOVATIONS IMPLEMENTED • Redesigning of the Model of care from pre-admission to home. • Clear eligibility criteria and discharge criteria. • Operational policies and KPI/Measurement • Patient information booklets. • Early discharge from the acute setting with rehabilitation in the home from Physio, OT and nursing staff.

  5. OUTCOMES SO FAR • For the months November 2003 through to May 2005, 139 patients completed the ORITH program. • On average 5.45 physiotherapy home visits. 3.2 nursing visits per patient. • OT Nov 2003 until March 2005 received 1.29 visits and 2.77 interventions from March 2005 onwards.   • The average acute LOS for patients undergoing TKR and THR, (including revisions) was 5.19 days.

  6. OUTCOMES SO FAR • State average for the same DRG’s of 9.4 days (State acute LOS average figures used are based on Nov 04 to March 05 data). • The average LOS in the ORITH program was 9.5 days • Total acute bed day saving of 381 days for THR and TKR if we compare the RMH acute LOS with the state average for this group of patients. • Barthel demonstrated a 14% improvement score from admission, 86 to discharge 98.

  7. ORITH OutcomesTable compares the average acute hospital LOS for RITH with state average

  8. LESSONS LEARNT • Get steering group to consider all issues within PAC, AH and ward, rehab consultants and exec sponsor • Get consultants on board - ORITH pts remain under joint Rehab/ortho bed card • Prepare pts well for d/c - meet staff who they will see at home in the ward... • Must do pre-admission assessment and generate Community referrals at this time. • Get funding for everything eg car. drugs etc

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