Targeted Acute Rehabilitation Program (TARP) increases discharges directly home and improves functional mobility in acute hospitalised inpatients.
James Walker1, Stephen Quick1, Julia Layer1, James Sayer3, Adam Semciw1,2 1Northern Health, Melbourne, Victoria, Australia2La Trobe University, Bundoora, Victoria, Australia3Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia
Abstract
Aim: To assess the impact of a roving multidisciplinary allied health team (physiotherapist, occupational therapist, social worker and allied health assistant) providing targeted and intensive rehabilitation to acute inpatients on discharge destination, functional mobility, bed-day savings and patient and staff satisfaction.
Design: A pragmatic pre-post implementation design was used.
Method: A retrospective propensity-matched audit process was undertaken. A control cohort consisted of past patients that were retrospectively deemed eligible for participation in TARP based on their age, need for multi-disciplinary involvement, estimated discharge destination and functional mobility as measured by the Modified Iowa Level of Assistance Scale (mILOA). The odds of being discharged directly home, and demonstrating a clinically significant improvement in mILOA score, were compared with a logistic regression. Patient and staff satisfaction of TARP were measured through a mixed-methods survey.
Results: Compared to the matched control group, male TARP participants were 9.71 times more likely to discharge directly home from the acute setting (CI 5.05 to 19.34, p<.001). Female TARP participants were 3.64 times more likely to discharge directly home (CI 2.05 to 6.58, p<.001). TARP participants were 3.77 times more likely to experience a clinically significant improvement in mILOA score during their acute stay (CI 2.51 to 5.73, p<.001). Positive outcomes regarding bed-day savings and staff and patient satisfaction were also observed. Conclusion: TARP was effective at improving mobility and increasing discharges directly home from the acute setting, resulting in bed-day savings and positive network cost-benefit.
Biography
James Walker is a senior clinician physiotherapist with Northern Health at the Northern Hospital, Epping, Victoria. He has undertaken post-graduate studies in health leadership and gerontology. He has a keen interest in service redesign as his network responds to increasing demand and demographic changes, acting as project leader for the Targeted Acute Rehabilitation Program throughout 2022.