Background: The Stroke-Specific In-Reach Rehabilitation (SSIR) Model of Care is designed to provide a multidisciplinary rehabilitation service to patients admitted with a stroke to an acute hospital. The Functional Independence Measure (FIM) is a uniform system of measurement used in all Australian and New Zealand Rehabilitation Centres that measures level of disability. Admission and discharge FIM data are collected for all SSIR patients admitted at Royal North Shore Hospital (RNSH). The SSIR has two streams; Full (patients for discharge home) and Supplementary (patients for transfer to an inpatient rehabilitation facility).
Aims: To determine the effectiveness and efficiency of a SSIR Model of Care in a Tertiary Metropolitan Hospital.
Method: The AN-SNAP calculator developed by the Australasian Rehabilitation Outcome Centre was utilised to benchmark the SSIR against national averages of rehabilitation admissions. Time from hospital admission to program commencement, length of stay, discharge destination and location, and FIM efficiency was calculated for each stream. Data was collected for all SSIR patients over a 6 month period.
Results: On average patients commenced the SSIR 8.9days into their hospital admission, and were on the program for an average of 7.8days. Specifically, length of stay was 7.2days for ‘Full’ patients and 10.1 days for ‘Supplementary’ patients. The Program discharged 39%(28) of patients home, 49%(35) of patients to an inpatient rehabilitation facility and 12%(9) of patients were discharged back to the acute ward. 86%(62) of patients on the program lived in the Local Health District. The SSIR has a mean FIM efficiency of 1.6. Specifically, for ‘Full’ patients the FIM efficiency was 2.2, and for ‘Supplementary’ patients the FIM efficiency was 1.1. A FIM efficiency of >0.66/day is clinically significant. This demonstrates clinically significant changes across all streams.
Conclusion: The SSIR Model of Care at RNSH provides an effective, efficient rehabilitation service that improves patient outcomes and flow.