Dr Katherine Kelly1, Cara Antonelli1, Natasha Kosic2, Kristine Greene1
1South Western Sydney Local Health District, Australia, 2South Eastern Sydney Local Health District, Australia
Biography:
Dr Katherine Kelly is the Disability and NDIS Coordinator at South Western Sydney Local Health District. She leads the district’s Disability Resource Team and Carers Program, who are dedicated offering consultation on disability, NDIS, system navigation and carer recognition and support. Katherine is a Speech Pathologist and has completed her PhD on the role Speech Pathologists play in palliative and end-of-life care. Katherine’s current interests related to improving access to health services for people with disability, especially in creating communication accessible services.
Abstract:
Cara Antonelli is the team leader of the Disability Resource Team at South Western Sydney LHD, where she leads a team focused on providing high-quality healthcare through consultation on disability, NDIS, system navigation, and more. She facilitates stakeholder meetings, develops resources, advocates for patients, and leads strategic projects to improve support for individuals with disabilities. With 14 years of experience as an occupational therapist, Cara has worked across public hospitals, NGOs, and government organisations, working in paediatrics, disability, early intervention, acute settings, and stroke rehabilitation. She is passionate about improving healthcare accessibility for people with complex disability needs.
In 2023 the tertiary hospital in SWSLHD discharged 132 patients from acute wards needing NDIS supports for discharge. Their average length of stay was 71 days (range 4-257 days). Staff reported difficulties identifying existing NDIS participants, confusion about their existing levels of NDIS support and the actions needed for these supports to change. There is a risk of people being discharged with suboptimal support and/or experiencing extended stays in hospital.
This project piloted a new discharge planning approach on 5 wards over 4 months, including:
– Three distinct discharge pathways
– Proactive screening for NDIS participant status at admission
– NDIS participant status displayed on electronic medical records and ward electronic patient boards
– Referral to NDIS Health Liaison Officer (HLO) at admission for involvement in collaborative discharge planning (not for just escalation of delays)
– Tracking discharge planning through weekly NDIS participant meeting
– Regular stakeholder and discharge planning meetings
Outcomes:
– NDIS participants identified an average of 25 days (2 days after admission)
– Discharge planning started an average of 19 days earlier
– Average length of stay reduced by 28 days
– 74% of patients (31/42) able to leave hospital without waiting for a full review of funding and supports
Conclusions:
Proactive surveillance for NDIS participant status at admission identifies patients' needs earlier. Earlier identification of NDIS participants allows discharge planning to start earlier. Better coordination between hospital team, NDIS Health Liaison Officer and providers makes discharge planning more efficient. This reduces the length of hospital stay.