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A Transdisciplinary Allied Health "Flying Squad" to Overcome Non-Medical Barriers to Discharge From Hospital: A
Aruska N D'Souza1,2, James Fitzpatrick1, Kate Palmer1
1The Royal Melbourne Hospital, Allied Health, The Royal Melbourne Hospital, Parkville, Australia.
Rationale:
Acutely hospitalised patients may be medically ready for discharge but face psychosocial and other non-medical barriers to returning home. This increases their length of stay and may lead to exposure to hospital associated risks such as hospital-acquired infections. To address these non-medical delays, a transdisciplinary allied health service (the Flying Squad, n = 1.9 Full Time Equivalent professionals) was established at The Royal Melbourne Hospital.
Aims And Objectives:
To evaluate the feasibility (demand, implementation, practicality, acceptability and limited efficacy) of this service.
Method:
A single-site observational study was conducted to determine the demand (number of referrals and patient characteristics including indicators of complexity via the Blaylock Risk Assessment Screening Score; BRASS), implementation (timing of referrals and home visits completed), practicality (case examples, adverse events), acceptability (compliments and complaints) and limited efficacy (estimated number of hospital days saved through the Flying Squad intervention [anticipated minus actual length of stay], discharge destination, hospital length of stay and 28-day readmissions).
Results:
Over 12 months, 147 participants were seen by the Flying Squad professionals (median age 64 years [Interquartile Range 51-78 years], 61% male, on day 14 [Interquartile age 7-24] of their hospital admission). Median BRASS scores were 14 (Interquartile Range 9-19] indicating "at risk of requiring extended discharge planning". Fifty-four home visits were completed for 34 (23%) participants, and one adverse event was reported (fall with no injuries during a home visit). The service won two hospital Awards for Excellence. The median length of hospital stay was 26 [13-45] days; 80 (54%) participants were discharged directly home, and 13 (9%) were readmitted after 28 days. It was estimated that the Flying Squad saved 756 hospital days over 12 months.
Conclusion:
The Flying Squad was a feasible service that may assist with addressing non-medical barriers to discharge.
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