Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
MLHD Outreach Rehabilitation Service
Shannon Pike Occupational Therapist /
Rehabilitation Coordinator
Sally McMahonReg Nurse / Rehabilitation
Coordinator
Outreach Rehab Team
Accepting GP of patient
Existing nursing staff at District
Hospital
Rehabilitation Coordinator’s
Rehabilitation Physician
Physiotherapist 1.0 FTE
Occupational Therapist 1.0 FTE
Allied Health Assistants 3.0 FTE (one
each at Narrandera, Temora and
Tumut)
Outreach Service Hub and Spoke Model of Care.
Inpatient Rehabilitation
– Inpatients are admitted to district hospitals under a shared
care agreement between GP and Rehab consultants
– Patients are identified and transferred from Wagga Wagga
Base Hospital or local referral from GPs or transferred from
metropolitan rehab units
Community Rehabilitation
– Referrals come from variety of sources - metropolitan,
Wagga, local, and often continuation of rehabilitation following
inpatient service
Inpatient Process
Wagga patients are assessed by Wagga AH clinicians to develop
AHA programs before transfer – or via telehealth
Coordinator provides information package and gains patient consent
including Telehealth consent.
Programs are delivered by the AHA in each town
The out-reach clinicians visit each site weekly and telehealth
inpatients weekly to upgrade programs as needed
Weekly case conference with site NUM, AHA, rehab consultants and
Wagga AH team
Need for Change
MLHD: 260, 000 people located over 125, 000 sq km
Increasing aging population: >65 yrs in 2011 (16%) and in 2031
(26%)
Increasing WWRRH rehab episodes 200 to 250 over 5 years
Increasing WWRRH acute bed access > increasing utilising
beds in smaller sites
Taking the
road less
travelled….
Applications of Telehealth
Case conferences
Team meetings
Patient review
Education and supervision
Emerging use
Case Conference
Wagga
Coordinators /Medical / Allied Health/Medical/
AHA’s
Temora
NUM/AHA
TumutNUM/AHA
NarranderaNUM/AHA
Telehealth allows
• Flexibility
• Increased engagement
through “virtual
attendance”
Team Meetings
Allows AHA’s at each site to
AHA’s to attend without time cost to travel
Valued team member contributing to service delivery in
‘real time’
See documents being discussed/follow presentation
through screen sharing
Patient Reviews
Initial assessments
– Allied health team
– Rehabilitation consultants
– Joint reviews
Updating programs outside of
scheduled site visits
Pre discharge reviews
Education and Supervision
AHA monthly peer support sessions
Monthly team education
Individual supervision sessions
– Discussion
– Support for specific patient reviews
(AHA and clinicians)
– Patient reviews for learning
opportunity
Emerging use
Participating in family conferences held in outreach sites
Increasing use for supervision sessions
Senior support in ‘real time’
Carer training
Commitment to enhancing use
– QI project
Luke Murray – Outreach Physiotherapist
QI Project underway…..
Develop service specific guidelines to
determine when telehealth assessments
are appropriate to be utilised
Project Aim
Identify inappropriate situations
Determine when high priority telehealth assessments are necessary
Develop clear criteria to assist rotating staff to adopt technology
Determine and address assessment and treatment
skills/adaptations needed to implement (clinicians and AHA’s)
Reinforce uptake of telehealth as alternative
Facilitate all hub based disciplines to implement the technology
Challenges
Behaviours
– Smaller within group discussions not able to be heard by team
members on telehealth
Sound
– Room acoustics
– Internet connection
– Equipment (speakers/computers some more ideal than others)
– Privacy (implementing known privacy and confidentiality procedures)
ensuring no one else enters room
Linking with external organisations
– Unsuccessful to date for example with Universities for research
collaboration
Clinical practice change
– Confidence in the ‘unknown’
Patient Story
Norm is a 68 year old man who
lives in Burcher NSW. Burcher is
118 km from Temora and 206 km
from Wagga Wagga.
Norm had a fall sustaining
incomplete spinal injury in April
2016. After spending 6 months in
Sydney Prince of Wales spinal
unit he was discharged home
using a wheel chair and slide
board for transfer.
Norm’s long term goals were to
walk again, be able to transfer in
and out of their car and get out of
his chair independently. Norm
travelled to Temora weekly to see
the out-reach team in Temora. He
also travelled to Wagga Wagga to
see senior physiotherapist and
Rehabilitation consultant who were
monitoring and supporting the
team with his progress. The senior
physiotherapist often used pexip to
support and advise the out-reach
clinicians on the weekly visits.
Norm progressed until he was
able to mobilise with a high arm
support frame and after 9
months he was admitted to the
Wagga Wagga Rehabilitation in-
patient unit for a boost of rehab
to progress his mobility.
Norm walked out of the Wagga
Wagga Rehabilitation Unit on a 4
wheelie walker, is able to get out
of his chair and is able to transfer
in and out of their car.
Any questions?
Acknowledgment to the Out-Reach Team’ presentation 2017 –
this presentation has been adapted form
Sarah McLaughlinOccupational Therapist
Andrew AtkinsPhysiotherapist
Sophie GaynorAllied Health Assistant (Temora)