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- Title
Teiripe sa Bhaile Team (TsaB): An Integrated Care, Early Supported Discharge service for Hip Fractures from a Dublin Hospital.
- Authors
Nee, Rory; Cummiskey, Graham; Byrne, Aoife; Spencer, Michelle; Whelan, Mairin; Cunnigham, Conal
- Abstract
Background: Early supported discharge (ESD) programmes have helped to reduce length of stay for hip fracture patients. NICE guidelines recommends considering ESD for patients that are medically stable, are able to transfer short distances and able to participate in rehabilitation but have not yet achieved their full rehabilitation potential. Teiripe sa Bhaile Team (TsaB) provides a multi-disciplinary, patient centred domiciliary rehabilitation for patients with osteoporotic hip fracture admitted to and repaired in St James Hospital. Methods: Patient demographics and data has been collected on all TsaB patients to date with consent from the patients. Primary outcomes were the length of intervention with TsaB, patient directed SMART (specific, measurable, achievable, relevant, time bound) goals set and achieved, changes in functional independence measure (FIM) sores pre and post intervention. Secondary outcomes included morbidity and mortality and Emergency Department and acute hospital usage post discharge from our service. Descriptive data was analysed using Microsoft Exel. Results: From August 2018 until September 2021, 29 patients have been treated by TsaB. Two patients did not complete their rehabilitation with our service and another 3 had limited input due to the COVID-19 pandemic. The average age is 79 years. Eight (27.5%) patients were male. The average length of stay prior to discharge was 17 days, compared to an average length of stay of 54 days for patients having their hip fracture repair and rehabilitation as inpatients. The average length of stay for TsaB was 6 weeks. Fourteen patients had Rockwood clinical frailty score of 6 (moderately frail) on admission to TsaB. The average improvement in FIM score was 41. Twenty-six patients set SMART goals; 5 (19%) patients did not achieve all of their goals. No patients developed pressure ulcers while on our service, or other medical complications. Seven patients were admitted over the 3 years, and on average the time to readmission was 8 months. Three patients (10%) were admitted within 6 months, 2 of which were within 1 month, for non-rehabilitation related issues. Two other patients attended ED within a year of discharge from TsaB, but were not admitted. No patients required initiation of a home care package for discharge, or after our interventions. Conclusion: Through TsaB, we are able to offer a rehabilitation service to patients based around their own needs in the home. Patients were able to set and achieve SMART goals which often included community access. Patients were moderately frail on admission to our service, and the average FIM improvement of 41 (with 20 points being clinically significant) demonstrates the effectiveness of the rehabilitation. Low readmission rates, with 10% in 6 months, demonstrates this is a safe alternative to inpatient care. We saved 1,047 bed days. That no patients required a new or increased home care package is another measure of reablement effectiveness.
- Publication
International Journal of Integrated Care (IJIC), 2022, Vol 22, p1
- ISSN
1568-4156
- Publication type
Academic Journal
- DOI
10.5334/ijic.ICIC22022