MLHD Outreach Rehabilitation Service

Shannon Pike Occupational Therapist /

Rehabilitation Coordinator

Sally McMahonReg Nurse / Rehabilitation

Coordinator

Outreach Rehab Team

Accepting GP of patient

Existing nursing staff at District

Hospital

Rehabilitation Coordinator’s

Rehabilitation Physician

Physiotherapist 1.0 FTE

Occupational Therapist 1.0 FTE

Allied Health Assistants 3.0 FTE (one

each at Narrandera, Temora and

Tumut)

Outreach Service Hub and Spoke Model of Care.

Inpatient Rehabilitation

– Inpatients are admitted to district hospitals under a shared

care agreement between GP and Rehab consultants

– Patients are identified and transferred from Wagga Wagga

Base Hospital or local referral from GPs or transferred from

metropolitan rehab units

Community Rehabilitation

– Referrals come from variety of sources - metropolitan,

Wagga, local, and often continuation of rehabilitation following

inpatient service

Inpatient Process

Wagga patients are assessed by Wagga AH clinicians to develop

AHA programs before transfer – or via telehealth

Coordinator provides information package and gains patient consent

including Telehealth consent.

Programs are delivered by the AHA in each town

The out-reach clinicians visit each site weekly and telehealth

inpatients weekly to upgrade programs as needed

Weekly case conference with site NUM, AHA, rehab consultants and

Wagga AH team

Need for Change

MLHD: 260, 000 people located over 125, 000 sq km

Increasing aging population: >65 yrs in 2011 (16%) and in 2031

(26%)

Increasing WWRRH rehab episodes 200 to 250 over 5 years

Increasing WWRRH acute bed access > increasing utilising

beds in smaller sites

Taking the

road less

travelled….

Applications of Telehealth

Case conferences

Team meetings

Patient review

Education and supervision

Emerging use

Case Conference

Wagga

Coordinators /Medical / Allied Health/Medical/

AHA’s

Temora

NUM/AHA

TumutNUM/AHA

NarranderaNUM/AHA

Telehealth allows

• Flexibility

• Increased engagement

through “virtual

attendance”

Team Meetings

Allows AHA’s at each site to

AHA’s to attend without time cost to travel

Valued team member contributing to service delivery in

‘real time’

See documents being discussed/follow presentation

through screen sharing

Patient Reviews

Initial assessments

– Allied health team

– Rehabilitation consultants

– Joint reviews

Updating programs outside of

scheduled site visits

Pre discharge reviews

Education and Supervision

AHA monthly peer support sessions

Monthly team education

Individual supervision sessions

– Discussion

– Support for specific patient reviews

(AHA and clinicians)

– Patient reviews for learning

opportunity

Emerging use

Participating in family conferences held in outreach sites

Increasing use for supervision sessions

Senior support in ‘real time’

Carer training

Commitment to enhancing use

– QI project

Luke Murray – Outreach Physiotherapist

QI Project underway…..

Develop service specific guidelines to

determine when telehealth assessments

are appropriate to be utilised

Project Aim

Identify inappropriate situations

Determine when high priority telehealth assessments are necessary

Develop clear criteria to assist rotating staff to adopt technology

Determine and address assessment and treatment

skills/adaptations needed to implement (clinicians and AHA’s)

Reinforce uptake of telehealth as alternative

Facilitate all hub based disciplines to implement the technology

Challenges

Behaviours

– Smaller within group discussions not able to be heard by team

members on telehealth

Sound

– Room acoustics

– Internet connection

– Equipment (speakers/computers some more ideal than others)

– Privacy (implementing known privacy and confidentiality procedures)

ensuring no one else enters room

Linking with external organisations

– Unsuccessful to date for example with Universities for research

collaboration

Clinical practice change

– Confidence in the ‘unknown’

Patient Story

Norm is a 68 year old man who

lives in Burcher NSW. Burcher is

118 km from Temora and 206 km

from Wagga Wagga.

Norm had a fall sustaining

incomplete spinal injury in April

2016. After spending 6 months in

Sydney Prince of Wales spinal

unit he was discharged home

using a wheel chair and slide

board for transfer.

Norm’s long term goals were to

walk again, be able to transfer in

and out of their car and get out of

his chair independently. Norm

travelled to Temora weekly to see

the out-reach team in Temora. He

also travelled to Wagga Wagga to

see senior physiotherapist and

Rehabilitation consultant who were

monitoring and supporting the

team with his progress. The senior

physiotherapist often used pexip to

support and advise the out-reach

clinicians on the weekly visits.

Norm progressed until he was

able to mobilise with a high arm

support frame and after 9

months he was admitted to the

Wagga Wagga Rehabilitation in-

patient unit for a boost of rehab

to progress his mobility.

Norm walked out of the Wagga

Wagga Rehabilitation Unit on a 4

wheelie walker, is able to get out

of his chair and is able to transfer

in and out of their car.

Any questions?

Acknowledgment to the Out-Reach Team’ presentation 2017 –

this presentation has been adapted form

Sarah McLaughlinOccupational Therapist

Andrew AtkinsPhysiotherapist

Sophie GaynorAllied Health Assistant (Temora)