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Case Report: Discharging the complex, long-stay patient Dr David Skalicky Dr John Estell

29/10/2010 HIMAA, Sydney. Case Report: Discharging the complex, long-stay patient Dr David Skalicky Dr John Estell Department of Rehabilitation Medicine, St George Hospital, SESIAHS. Rehabilitation Medicine. “brings about recovery following loss of function and ability”

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Case Report: Discharging the complex, long-stay patient Dr David Skalicky Dr John Estell

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  1. 29/10/2010 HIMAA, Sydney Case Report: Discharging the complex, long-stay patient Dr David Skalicky Dr John Estell Department of Rehabilitation Medicine, St George Hospital, SESIAHS.

  2. Rehabilitation Medicine • “brings about recovery following loss of function and ability” • “management of disability” • “prevention and reduction of functional loss, activity limitation, and participation restriction”

  3. Table 1: Length of stay for inpatient rehabilitation patients at St George Hospital, Kogarah, Sydney.

  4. Case Study • MB 65 yo female • Admitted to Sutherland hospital on 20/9/2008 • Discharged from St George hospital on 1/6/2010 • Total Length of Stay: 615 days

  5. Case Study • MB 65 yo female • Multidisciplinary intensive inpatient rehabilitation • Goals • To walk short distances independently • To discharge to sister's home on Central Coast

  6. Discharge Diagnoses • 615 days in hospitals • >1000 pages of clinical notes • Accumulated results on eMR • Moving out of area Treatments Specialists Hospitals Other health issues

  7. Objectives • Discharge Summary communicates with • Health Professionals • New GP on the Central Coast • Clinical coding department • Patient • Aims to summarise • Clinical and functional information • Many hours of work from many people • Significant financial expense

  8. Discharge • Medication summary • Short interview • one month before discharge • Patient driven • Discharge interview • Longer interview • three weeks before discharge • Overall perspective on dates and location • Personal perspective on her 'journey'

  9. Discharge • Review of clinical records • Discharge summaries from each hospital admission, and from each episode of care • “Systems Review” template • Preferred to chronological reporting • Draft reviewed by rehabilitation team • Verbal handover to GP

  10. Discharge • Clinical coding and classification • 7 episodes of care at St George Hospital, • 1 episode at Sutherland • 1 episode at St Vincent’s • 125 ICD-10-AM diagnoses • 48 ACHI interventions

  11. Guidelines • Allow time • Plan with the patient • Have a good knowledge of the patient's admission • Seek feedback from the team • Make periodic summaries (every 3-6 months) • Liase with medical record department

  12. Acknowledgements • Rehabilitation Team, Ward 6W, St George.

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