None listed
Conditions
Brief summary
Medical patients often present to hospital with both medical and functional problems, including social dependency, reduced mobility and cognitive impairment. As such, discharge planning forms an important part of a patient’s hospital stay. At present, an allied health team – consisting mainly of physiotherapists, occupational therapists, social workers, dieticians and speech pathologists – make recommendations for a discharge destination based on clinical experience. If the patient is not for discharge home they may require further allied health intervention at subacute. This process is potentially problematic when clinicians disagree on discharge destination. This can delay discharge and increase the patient’s length of stay. It can also detrimentally impact on the patient and family experience. We hypothesis that deficits in mobility (both pre-admission and during admission), impaired cognition and inadequate social supports will be closely related to patients needing subacute on acute hospital discharge. There are a number of commonly used tools to measure such factors in the General Medical population. These include the de Morton Mobility Index (DEMMI) which has been used to assess mobility and predict discharge destination in this population, however, it has not considered the interplay of other factors. Other tools, such as the Alpha Functional Independence Measure (AlphaFIM), Charlson Co-morbidity Index (CCI), and the Blaylock Risk Assessment Screening Score (BRASS) and the Rowland Universal Dementia Screening Scale (RUDAS) have considered function, cognition, co-morbidities and social support but they have generally been used to assess current function, predict mortality and length of stay, rather than holistically determine the need for subacute. It is currently unknown which of these tools, when administered during an acute hospital stay, can best predict need for subacute.
Interventions
General medical patients often present with both clinical and functional problems and discharge planning often needs consideration of social dependency, and both physical and cognitive function.
Patients referred to Physiotherapy and admitted under a General Medical bed card and at the Royal Melbourne Hospital will be prospectively screened for inclusion into this study. The following data will be collected on 480 patients:
- Patient Demographics (age, gender, language spoken, co-morbidities,
General medical patients often present with both clinical and functional problems and discharge planning often needs consideration of social dependency, and both physical and cognitive function. Patients referred to Physiotherapy and admitted under a General Medical bed card and at the Royal Melbourne Hospital will be prospectively screened for inclusion into this study. The following data will be collected on 480 patients: - Patient Demographics (age, gender, language spoken, co-morbidities, social situation and social supports) - Medical information: (principle diagnosis, medications, visual and or hearing deficits) - The Blaylock Risk Assessment Screening Score (BRASS) - an index used to predict patients who are at risk for prolonged hospital stay and need for discharge planning - The de Morton Mobility Index (DEMMI) - a reliable and valid interval level index that accurately measures mobility levels in older acute medical patients - The Alpha Functional Independence Measure (AlphaFIM): A standardised functional measure which covers mobility and cognitive domains - The Rowland Universal Dementia Assessment Scale (RUDAS): A valid and reliable measure of cognition - Number of falls in the past six months - Number of previous hospital admissions in the past three months
Sponsors
Aruska D'Souza
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
- Patients referred to Physiotherapy and admitted under General Medical units, including those “outliers” on wards outside of the General Medical wards at the Royal Melbourne Hospital. - Patients under a General Medical bed card but requiring ICU will be eligible once they are dis-charged to the ward as this is where discharge planning would typically commence.
Exclusion criteria
- Patients who are for palliation - Patients already recruited who are readmitted - Patients under 18 years of age - Patients transferred from other units (including the Acute Medical and Short Stay Units) and who have already had Physiotherapy intervention will not be included. - Similarly, patients who have had their initial Physiotherapy contact on the weekend or public holidays will not be included (including those patients transferred from ICU and seen on the ward on the weekend or public holiday). Patients admitted on the weekend or public holiday who have not had any physiotherapy intervention will remain appropriate to be included.
Outcome results
None listed