Introducing a clinically effective allied health rapid discharge team within a complex aged subacute in-patient cohort on a cost recovery basis: the Supported Patient centred Early Discharge (SPeED) initiative
Peter Hough A , Stephanie Gleeson A , Nataliya Shkuratova A , Freya Coker B C and Cylie Williams
B C D
A Peninsula Health, Subacute Allied Health, The Mornington Centre, corner Tyalla Grove and Separation Street, Mornington, Vic. 3931, Australia. Email: sgleeson@phcn.vic.gov.au; nshkuratova@hotmail.com; phough@phcn.vic.gov.au
B Peninsula Health, Allied Health, Frankston Hospital, 2 Hastings Road, Frankston, Vic. 3199, Australia. Email: fcoker@phcn.vic.gov.au
C Monash University, School of Primary and Allied Health Care, McMahons Road, Frankston, Vic. 3199, Australia.
D Corresponding author. Email: cyliewilliams@phcn.vic.gov.au
Australian Health Review 44(6) 931-934 https://doi.org/10.1071/AH19137
Submitted: 2 July 2019 Accepted: 15 December 2019 Published: 18 September 2020
Abstract
This case study reports the outcomes of an early supported discharge program. This model of care was trialled after Victoria introduced subacute weighted inlier equivalent separations funding to subacute in-patients in 2016. An allied health team (Supported Patient centred Early Discharge (SPeED)) managed patients suitable for assessment, intervention and early supported discharge (ESD). The SPeED cohort was compared to a matched historical control. Data included no advantage financially (NAF) days, length of stay (LOS), functional independence measure (FIM) scores and 30-day readmission rates. Staff and patient experiences were collected through surveys and call-back data. Regression analysis compared quantitative data, whereas a broad thematic approach compared qualitative data. There were no differences between the study cohort and historical control in age or sex (P > 0.05). The SPeED cohort had lower median NAF days (F = −21.38; 95% confidence interval (CI) −37.70, −15.00; P < 0.001), shorter LOS (F) = 4.65; 95% CI −0.41, −0.02; P = 0.034), fewer readmissions within 30 days (odds ratio 0.14; 95% CI −0.03, 0.68; P = 0.014) and greater change in FIM scores during admission (F = 4.20; 95% CI 0.16, 10.74; P = 0.044). Staff morale was high in recognition of improved patient care. Patient satisfaction remained positive across the SPeED cohort and historical control group. The introduction of a dedicated allied health ESD team within a geriatric evaluation and management population is effective and enhances patient outcomes.
What is known about the topic? Changing public subacute in-patient funding models places increased demand on providers to attain shorter patient LOS with finite staffing resources. Current published literature confirms the efficacy of rapid discharge programs in complex older adult cohorts only in the areas of stroke and respiratory conditions.
What does this paper add? For clinicians and health service executives, this paper explores the potential to extend rapid discharge programs for complex older adult patients across a broad cohort of conditions through the introduction of a dedicated allied health rapid discharge team. It presents an intervention that seeks to balance patient-centred care with optimal funding and organisational outcomes.
What are the implications for practitioners? The study findings highlight a promising opportunity for dedicated allied health rapid discharge teams within complex older adult in-patient populations to both optimise early patient preferred discharge and improve organisational financial performance.
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