Attachment Program for Allied Health Professions in Rehabilitation Services
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1 Attachment Program for Allied Health Professions in Rehabilitation Services Florence Kwok,TMH ClinPsy; Joshua MAK,TMH SST Peg CHEUNG,TMH OTI; Manfield CHAN,TMH PTI 4 May, 2016
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3 Pathway of a Stroke Patient ED RRS Bankstown Lidcombe Stroke Unit Transition Aged Residential Aged + Connecting Program Aged Home Rehab
4 Pathway of a Stroke Patient ED RRS Bankstown Lidcombe Stroke Unit Transition Aged Residential Aged + Connecting Program Aged Home Rehab
5 Pathway of a Stroke Patient - ED Admitted via ED on Sunday Rapid Response Service (RRS) PT and OT & ST (on-call basis): Offer prompt consultation 7-day service, limited cover on public holidays Achieve early discharge from ED
6 Pathway of a Stroke Patient ED RRS Bankstown Lidcombe Stroke Unit Transitio n Aged Residential Aged + Connectin g Program Aged Home Reha b
7 Bankstown-Lidcome Stroke Unit Bankstown-Lidcome Stroke Unit Stroke patient admitted directly to the unit from A&E Provides acute medical management & rehabilitation Intensive rehabilitation often starting on Day 1 or once the medical condition stable
8 Bankstown-Lidcome Stroke Unit Physiotherapy Occupational Therapy Speech Therapy 3 FTE 2.5 FTE 3 FTE 1:1 training session Group session 2x/day Closely work with caregivers Upper limb & ADL training (individual.gp) Pre-discharge planning, e.g. home visit Education aims to improve quality of life Service for swallowing and communication Dining program
9 Bankstown-Lidcome Stroke Unit Rehab with Orthoptics Member of acute stroke team All stroke patients receive a visual assessment Services : Screen any visual problem for TIA & CVA cases Provide special glasses for neurological impairment Assess patients visual acuity for driving fitness Visual training
10 Rehab with Clinical Psychologist 1 clinical psychologist &1 neuro-psychologist Provide service on referral basis Need input from CP: Dementia Advisory Service (DAS) Specialist Mental Services for Older Persons (SMHSOP)
11 Interdisciplinary Bedside Rounds SIBR: bedside round Team members : MOs Nursing staff Allied Health staff +/- pt s family *Early pt/caregiver involvement on D/C Plan
12 Interdisciplinary Conference Rehab meetings held weekly to plan rehab goals, discuss patient progress, coordinate D/C planning Average L.O.S (Acute + in-pt rehab.) : 21 days Also serves as pre-meeting among staff before family conference
13 Special Features of Bankstown- Lidcombe Hospital Stroke Unit Same ward (acute + rehab care) and same team of stroke staff Shifted early from acute to rehabilitation Advantages Patient: no need for adjustment to environment and staff Early initiation of rehabilitation in the unit Intensive therapy starting in acute care Reduced LOS from 28 to days Better gain in the functional outcome
14 Pathway of a Stroke Patient ED RRS Bankstown Lidcombe Stroke Unit Transition Aged Residential Aged + Connecting Program Aged Home Reha b
15 Transitional Aged Program (TACP) Up to 12 weeks of care Buy rehab beds. Government-funded Personnel: MO,case manger, ST, OT, PT, social worker Family involved in case conference
16 Pathway of a Stroke Patient ED RRS Bankstown Lidcombe Stroke Unit Transition Aged Residential Aged + Connecting Program Aged Home Rehab
17 Residential aged care Low level care (hostels) and high level care (nursing homes) Elderly over the age of 65 Provides accommodation, personal and nursing care Most established by non-government and non-profit organizations AH services: PT, OT, ST, Cl Psy, Dietitian, Diversional Therapist care
18 Residential aged care: Geriatric Connecting on May, June, July in 2015 New initiative program Geriatrician out-reach consultation at nursing homes for acute condition On-call basis AED shows support
19 Pathway of a Stroke Patient ED RRS Bankstown Lidcombe Stroke Unit Transition Aged Residential Aged + Connecting Program Aged Home Rehab
20 Aged Home Rehabilitation Target: elderly over 65 & young disabled aboriginal Commonwealth Home Support (Entry Level): house work, personal care, meal preparation, allied health and social support etc. Home Support Package (more complex): personal care, support service and allied health, nursing clinical services
21 Aged Home Rehabilitation Podiatry Medical Officer GP Neurologist Speech Pathologist Multidisciplinary Team RN PT Aged care liaison officer Social worker OT
22 Pathway of a Stroke Patient ED RRS Bankstown Lidcombe Stroke Unit Transition Aged Residential Aged + Connecting Program Aged Home Rehab
23 Stroke Support Group For educational, resources, emotional support OTs act as facilitators
24 Take Home Thoughts Comprehensive coverage of AH Services ED, Transitional stage, Residential stage & Community Start stroke rehab very soon in acute phase Provide the weekend/holiday AH service & establish flexible employment terms to facilitate 7-days manpower coverage
25 Sharing Clinicians (Implication to Hong Kong) PT: Outreaching should be increased Orthoptic: Should be enhanced OT: Beyond home modification in out-reach service CP: Add out-reach service ST: Add community ST
26 THANK YOU
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