None listed
Conditions
Brief summary
Hospitals are not always the best location to provide care for older people. Supported Discharge Teams have been established in the community to help the transition from hospital to home, whilst reducing hospital length of stay. Despite the obvious attractions of such, the evidence remains mixed, ranging from strong support for disease specific interventions such as stroke to less favourable results for generic services, plus there is a complete absence of evidence surrounding the applicability of the model outside of main urban centres. Waikato DHB recently commenced a pilot Supported Discharge Team, with a view to establish the service across the Waikato should it prove effective. In a randomised controlled trial, we will test the impact of the new service on hospital length of stay, subsequent hospitalisations, institutionalisation and cost. This nationally pertinent research will allow Waikato DHB to make an informed decision around the roll out of the service
Interventions
The START team consists of Health Care Assistants (HCA) trained to Level III on the NZQA framework, Registered Nurses working at an advanced level of practice and Allied health (Physiotherapy and Occupational Therapy). In addition, Consultant Geriatricians provide weekly input through case conferencing.
Within the START intervention, the initial visit to the client following discharge will involve the RN and HCA completing the following with the patient:
1. Assessment of need and determinatio
The START team consists of Health Care Assistants (HCA) trained to Level III on the NZQA framework, Registered Nurses working at an advanced level of practice and Allied health (Physiotherapy and Occupational Therapy). In addition, Consultant Geriatricians provide weekly input through case conferencing. Within the START intervention, the initial visit to the client following discharge will involve the RN and HCA completing the following with the patient: 1. Assessment of need and determination of goals for the patient 2. Development of service plan to support goal attainment 3. Determination of the number of visits required to deliver the service plan Health Care Assistants will provide up to four visits a day, seven days a week and will utilise functional rehabilitation principles to maximise recovery through incorporating exercises within ADL tasks. For instance, progressively increasing walking distance, sit to stands, lying in bed to standing, carrying groceries home from shops and putting away in cupboards. The model focuses on maximising independence rather than fostering dependence and aligns with developing research in New Zealand and significantly, such exercise programmes can be successfully implemented by non-health professionals rather than Physiotherapists. Such a staffing compliment within START will maximise patient recovery and responsiveness and reduce fragmentation. There will be a minimum of weekly reviews / reassessment of the patient by RN and OT/ PT with changes made as required to the service plan. Once patients have returned home, direct clinical care responsibility returns to the General Practitioner (GP). The team will work in close collaboration with GPs and Practice Nurses as well as the specialist community teams and hospital services. The team will work with Patients until their return to independence or until stable but requiring continuing input from community nursing or home care support. Patients will be likely limited to six weeks maximum attendance, though the team on an exception basis may choose to extend this to maximise potential recovery. Patients will be supported to develop meaningful distal goals, which will be interpreted into a therapy ladder to support development of a care plan utilising functional rehabilitation principles.
Sponsors
Waikato District Health Board.
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
65 Years to 100 No limit
Healthy volunteers
No
Inclusion criteria
1. The client is over 65 years (or close in age and interest) and lives within the catchment area Waikato DHB; 2. The client does not require acute hospital based treatment; 3. The client consents to being treated at home by the team, is aware of and is in agreement with the objectives set by the referring inter-disciplinary team; 4. Following assessment, the client is considered to have potential for partial or complete recovery with suitable home rehabilitation within six weeks; 5. The client is able to stand and transfer with one person (with or without the help of a resident carer); 6. The client's home is judged to be safe for the client in addition to the visiting staff and; 7. The client has had a recent acute illness or injury or is at a borderline level of function with an associated reduction in personal (PADL) and / or extended (EADL) activities of daily living and who without input from the team is: I. likely to fail to recuperate full potential of functional recovery; II. or is likely to fail to manage satisfactorily at home despite conventional community support and therefore would be at risk of hospital re-admission or institutionalisation.
Exclusion criteria
1. Clients who have been discharged from acute hospital care for more than 48 hours 2. Clients without clinical need, only social need, e.g. clients needing support during usual caregivers admission to hospital 3. Where the home environment is not conducive to achieving the rehabilitation outcomes for the client 4. Where the clients primary rehabilitation intervention is provided in an outpatient setting 5. Clients with progressive or deteriorating conditions where partial or full recovery cannot be reasonably expected within six weeks (e.g. Palliative care): 6. The client is eligible for assessment, treatment and rehabilitation funded under the injury Prevention, Rehabilitation and Compensation Act (2001) 7. The clients service needs are covered under another service specification or funding stream
Outcome results
None listed