Presenter: Josie Kitch Hospital: Centauri

1. The Health Roundtable New Zealand Physiotherapy Assistants “Fit To Go”: Functional Maintenance Program - Impacts on LOS and Readmission Rates Presenter: Josie KitchHospital: Centauri Josie Kitch, josie.kitch@fmc.sa.gov.au (08) 8204 4048

2. KEY PROBLEMS • Common complication of older patient admitted into acute setting is functional decline during admission • A high proportion (83%) of medical admissions screened were at high or intermediate risk of functional decline. • Aim via new funding as part of winter bed strategy to reduce functional decline and reduced discharge delays in older patients. • Reduced ability for Physiotherapists to perform “maintenance” type work due to high demands

3. INNOVATIONS IMPLEMENTED • Previous studies have shown mixed results Dorevitch, 2003 found reduced LOS of 1.0 day whilst Siebens (2000) showed no beneficial effect using a generic exercise program • FMP has been designed differently than previous studies: • developed to target specific patient groups, • deliver the most effective intervention at lowest cost • is modified and progresses according to patient need • is commenced within 48 hours of admission.

4. RESULTS On average fractional LOS for FMP patients was 1.93 days shorter for 163 patients who received FMP compared to 24 patients who received usual care. Change Graph 1: Difference in average fractional length of stay of FMP compared to usual care patients

5. RESULTS • Discharge Destination • Seventy-three percent of FMP patients (n=119) were discharged to their usual accommodation, compared to 33% (n=8) of the usual care group. • Eight percent of FMP patients (n=13) required a higher level of care on discharge, in comparison with 17% (n=4) of usual care patients. • Graph 2: Change in Accommodation &file

6. RESULTS • ACAT approvals • ACAT approved supported accommodation for 18% fewer of the FMP group (i.e. 33% (n=8) of the usual care patients, and 15% (n=25) of the FMP group). • 28 day readmission rate • Patients who received FMP showed 8% fewer readmissions to FMC within 28 days of discharge (FMP group 9%, n=14; compared to usual care group 17%, n=4).

7. RESULTS a)

8. RESULTS b)

9. Appendix 1: Bed and cost implications Cost-Benefit Analysis • Total beds days saved due to reduced LOS = 314.59 • Estimated readmission days saved = 155.22 • Benefit at $350 per diem cost = $164,433.50 • Costs - $51,858 program delivery; $11,023 Program set up and evaluation. • Total cost $62,881 • Net Benefit $101,552.50 plus increased bed capacity of 3.4 beds.

10. HOW WE DID IT • Two previous trials had been completed (2005, 2006) that indicated solid benefits. Funding of ongoing program discussed as Winter Bed Strategy for 2006. • New Project commenced June 2006 and initial project completed November 2006. • Changes included using the Hospital Admission Risk Profile screening tool (HARP) to identify patients • Resources Used: 0.7 FTE Physiotherapy, 1.5 OPS2, 0.2 ASO

11. Key Success Factors • Previous trials had allowed targeting to be achieved more easily and in alignment with hospital needs – ie patient flow in medicine areas during winter. • Cost-benefit analysis strong. • Committed staff particularly the Physiotherapist leading the Assistants group.

12. LESSONS LEARNT • Functional maintenance, if used in a targeted way and is patient specific is a useful program to address LOS, improved discharge destinations and reduction of readmissions for vulnerable groups. • Having consistent Assistants proved challenging – we need to have consistent permanent assistant staff to get most benefit from the programme – achieved in 2007. • We would have liked to have this as a RCT but funding didn’t extend to this weakening the findings. Need to source funding to undertake RCT.