Despite previous research showing that intensive therapy in the acute hospital is safe and leads to improved hospital-based outcomes and that the discharge destination of the trauma patient is often based on administrative rather than patient and injury details, acute rehab models and focused discharge planning remains difficult for some trauma services to achieve within existing resources. Alfred Health and TAC partnered in a 12-month project that invested in early and intensive Allied Health therapy to patients on the Trauma ward.
The new model has led to improved patient and hospital outcomes, better patient flow management, and reduced health service utilisation. It has led to less overall costs for the management of these patients across their entire recovery journey to the Victorian Department of Health (DHS) and Transport Accident Commission (TAC). This is achieved by the increase in early intervention leading to a reduction in costs, especially those associated with post-acute care such as rehabilitation. One of Alfred Health’s key strategic priorities is promoting the “Home First” philosophy and this has been forefront in the design of this new model of care.
The new model of care expanded allied health interventions to a 7-day service and increased the number of hours of therapy, which allowed for an increase in therapy in the trauma ward from 11 hours/week to 24.5 hours/week per patient. The earlier and greater intensity of specialist therapy delivered has realised the following outcomes for this increasingly complex patient cohort:
• Promoting the Home First philosophy
• Reduced inpatient rehabilitation conversion rate, with increase in number of patients being discharged directly home
• Significant increase in bed capacity by reduction in acute and subacute length of stay (especially for major trauma patients)
• Reduction in number of patients being discharged to private hospitals
• No increase in ICU readmissions despite increase percentage of ICU patients discharged to trauma wardwith a shorter ICU average length of stay
• Reduced hospital readmissions
• More patients discharged pre 10am
• Reduced risk of Hospital Acquired Complications
Despite the presence of an older and higher acuity patient cohort in the intensive therapy group compared to 2019, improvement in the overall percentage of patients discharged directly home was achieved, thus avoiding ongoing inpatient bed days and successfully implementing the Home First model of care, a key goal for Alfred Health. COVID-safe requirements did not appear to negatively affect these outcomes.
We are excited to share that due to the success of the project, we have gained ongoing funding for this Model of Care in the Trauma ward at The Alfred. We look forward to publishing our outcomes in peer-reviewed journals and continuing to translate our research into practice for the benefit of the trauma patient population.
Lara Kimmel and Melissa Webb
Allied Health Team Lead – Ward 5 West Alfred Hospital