EVALUATION OF A SUB-ACUTE THERAPY MODEL OF CARE FOR HOSPITALISED OLDER PATIENTS IN THE ACUTE HOSPITAL SETTING

A. Brown¹, A. Jacob¹, M. Thuraisingam¹, E. Katsoupa¹, R. Goonan¹, W. Bower^1,2

¹Royal Melbourne Hospital, Allied Health, Parkville, Australia, ²University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Parkville, Australia

Background: Many older persons require a period of inpatient sub-acute rehabilitation after acute hospitalisation due to underlying frailty, co-morbidities and reduced physical functioning. Access to inpatient acute and sub-acute hospital beds has been significantly impacted by the COVID-19 pandemic and has resulted in reduced hospital flow globally. As a consequence, there has been an increase in acute hospital length of stay (LOS) and delayed patient access to specialised geriatric care including geriatricians, nursing and allied health. Older persons awaiting rehabilitation in an acute hospital setting are often deprioritised by acute therapists due to competing demands and therefore have reduced access to allied health intervention. This can lead to further functional decline, increased hospital LOS and change of discharge destination post hospital admission.

Purpose: To address barriers to patient flow and improve access to necessary sub-acute care, a new model of care was designed providing increased physiotherapy and occupational therapy for patients in the acute hospital setting who were waitlisted for geriatric rehabilitation. The purpose of this model of care was to expedite safe discharge home, decrease demand for inpatient sub-acute services and reduce functional decline in elderly hospitalised patients. The aim of this study was to evaluate the effectiveness of the new model of care in the acute hospital setting.

Methods: A prospective audit of a new model of care implemented at a metropolitan tertiary hospital in Melbourne, Australia over a period of January – May 2022. Data collected included discharge destination from acute hospital, length of stay across acute and sub-acute hospital and admission and discharge scores for the Katz Index of Activities of Daily Living (Katz), de Morton Mobility Index (DEMMI) and Functional Ambulation Classification (FAC) outcome scales.

Results: In total 80 patients (49% female, median age 85.0 [IQR 79.0-88.3]) were seen by the program. 22.5% of participants were discharged home directly from the acute hospital with supportive services and avoided sub-acute inpatient hospitalisation. Median LOS in acute was 14.0 [IQR 13.0 – 26.0] days and mean LOS in sub-acute was 20.8 (SD 11.2) days. Katz score did not significantly change (Z= -0.688, p= 0.491) from admission to discharge. Additional treatment elicited a statistically significant change in median DEMMI raw score (Z= -6.170, p< 0.001) and FAC score (Z= -4.368, p< 0.001) from admission to discharge. Admission and discharge performance respectively were 3% and 21% for walking independently, 31% and 50% for standing unsupported and 48% and 74% for being able to rise from a chair.

Conclusions: In a cohort of frail, older patients in acute hospital care, the new model of care involving additional physiotherapy and occupational therapy intervention was feasible to implement, able to facilitate early discharge home from hospital and improve functional independence.

Implications: Additional physiotherapy and occupational therapy can play an important role in facilitating timely discharge from acute hospitals in older persons and improving functional decline thereby reducing demand on sub-acute rehabilitation services. The program has now been extended, with increased staffing to develop the program into a seven day a week service model.

Funding acknowledgements: This project did not receive any specific funding.

Keywords:
Rehabilitation
Older people
Hospital flow

Topics:
Older people
Disability & rehabilitation
Research methodology, knowledge translation & implementation science

Did this work require ethics approval? No

Reason: This project was approved as a quality improvement project as per the institutional Human Ethics process (QA2012138). Please see supporting email confirmation.