Making home first a priority: increasing discharges to early home-based rehabilitation from a tertiary acute stroke and neurology unit using low-cost interventions identified using the Capacity Opportunity Motivation model of Behaviour change – A pre-post study
Celeste Trussell1, Aruska D’Souza1, Mithra Thuraisingam1, Kiara Tatt1, Eloise Thompson1 1Royal Melbourne Hospital, Parkville , Victoria, Australia
Abstract
Background
With a hospital-wide strategic priority of “home first” and stroke related hospitalisations increasing nationwide, our hospital saw the need to increase utilisation of our early supported discharge service (ESD) by our acute stroke and neurology cohort. Our aim was to increase this cohort’s referrals and discharges to ESD, through low-cost interventions identified using the COM-B (Capacity, Opportunity, Motivation) model of Behaviour change.
Method
Pre-post study in acute stroke and neurology. The primary outcome of interest was discharges to ESD. Small scale interventions were identified based on staff survey using the COM-B. Public consumers reviewed the interventions and gave feedback prior to implementation. Interventions delivered over an 8 month period included: sharing ESD patient stories, referral checklist, and refinement of referral communication channels.
Results
Data were analysed on 1181 patients in the pre-phase (median age 65 [50-77] years, females 47%) and 631 patients in the post phase (median age 66 [52-76] years, females 47%). Pre and post patient groups were similar with respect to admission speciality (stroke or neurology) and admission continence. Discharges with ESD statistically increased from 4% (n=51) in the pre-phase to 7% (n=44) in the post-phase (p=0.02). Nineteen staff were surveyed in the pre-phase, and 29 in the post. Post-survey staff reported increased levels of ESD knowledge (pre-survey 42%, post-survey 79%, p=0.008) and increased confidence in referring (pre-survey 37%, post-survey 69%, p=0.028).
Discussion
The COM-B model in conjunction with consumer consultation can be used to tailor low-cost interventions for behaviour change and increase service utilisation of ESD.
Biography
Dr D’Souza is an early-career researcher and physiotherapist with over 11 years of clinical experience in acute care. She was awarded her PhD in 2023 (Predicting Discharge Destination in Acute General Medicine). Dr D’Souza has published four papers and obtained over $160,000 in competitive grant funding. She currently works as the Allied Health Knowledge and Research Translation lead at the Royal Melbourne Hospital and leads multi-disciplinary projects across allied health that investigate a broad range of important clinical areas including Outcome Measurement in acute, COVID-19, Trauma, LGBTQIA+ Patient Liaison Service, General Medicine and Staff Digital Health capability.