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2 Become 1: Combining Multi-Site Rehabilitation Services

The Maitland HospitalKurri Kurri Hospital
Project Added:
8 August 2016
Last updated:
19 August 2016

2 Become 1: Combining Multi-Site Rehabilitation Services

Summary

This project relocated Maitland Hospital rehabilitation services to a new expanded rehabilitation facility at Kurri Kurri Hospital, relieving the pressure on acute services at Maitland Hospital.

Aim

To provide additional space for acute beds at Maitland Hospital, by moving rehabilitation services from Maitland Hospital to Kurri Kurri Hospital and introducing a seven-day rehabilitation model of care by December 2016.

Benefits

Phase 1 – Relocating the Rehabilitation Unit to Kurri Kurri Hospital

  • Improves the health outcomes and experience of rehabilitation patients.
  • Delivers an integrated seven-day rehabilitation model of care.
  • Enhances collaboration with staff across multiple facilities.
  • Delivers contemporary treatment models for rehabilitation.
  • Provides an evidence-based, patient-centred model of care.
  • Improves staff competency, confidence and workplace satisfaction.
  • Reduces length of stay in the Rehabilitation Unit.

Phase 2 – Creating additional acute beds at Maitland Hospital

  • Improves Emergency Treatment Performance (ETP) and increases access to acute care services.
  • Reduces the number of patients waiting more than 24 hours for admission.

Background

In 2015, HNELHD identified a need to increase the capacity for acute services at Maitland Hospital, as an interim measure until the commissioning and construction of New Maitland Hospital is complete. A $5 million capital investment was allocated to expand the existing rehabilitation building at Kurri Kurri Hospital. This allows for the relocation of the Maitland Rehabilitation Unit to Kurri Kurri Hospital, resulting in additional space for acute beds at Maitland Hospital.

The first phase of the project involves the construction of the expanded Kurri Kurri Rehabilitation Unit and planning for the transfer of rehabilitation services from Maitland Hospital. This has highlighted a number of challenges that need to be addressed, including:

  • combining two rehabilitation services with different sub-specialties
  • integrating two rehabilitation teams into the one service
  • ensuring the experience and outcomes of patients are not compromised
  • providing access to after-hours and weekend care.

The second phase of the project will involve increasing the capacity of acute beds at Maitland Hospital, once Maitland Hospital rehabilitation services have been relocated to Kurri Kurri Hospital.

Implementation

  • Prior to the project, Kurri Kurri Hospital focused on orthopaedic rehabilitation services, while Maitland Hospital focused on neurological rehabilitation services. A new model of care was developed, to provide clear admission criteria and care pathways for both specialties.
  • Patient interviews revealed that only self-directed therapy occurs on weekends and that patients would value social and diversional activities. A working group is developing therapy models to implement on weekends.
  • A survey of rehabilitation staff indicated that the majority don’t believe their knowledge and skills reflect best practice for the combined caseload. A working group has developed an education program that will meet the needs of staff at both Maitland and Kurri Kurri Rehabilitation Units. This is currently underway and will help staff build their skills, knowledge and confidence in working across all patient groups once the two services are combined.
  • A combined Telehealth and medical model of care is currently being considered, to address the need for after-hours care, as well as management of patients who need to be transferred back to an acute service.
  • A clinical leadership model with shared responsibility among medical, nursing and allied health leadership is currently being trialled. The aim is to influence the culture of the Rehabilitation Unit and focus on developing a high-performance clinical team who deliver patient-centred care.
  • Phase 2 of the project has been initiated and will involve redesigning the acute services at Maitland Hospital, after the rehabilitation beds are vacated.

Project status

  • Implementation - the initiative is ready for implementation or is currently being implemented, piloted or tested.

Key dates

  • July 2015 – December 2016

Implementation sites

  • Maitland Hospital, HNELHD
  • Kurri Kurri Hospital, HNELHD

Partnerships

  • Research, Innovation and Partnerships, HNELHD
  • Organisational Development and Design, HNELHD
  • Human Resources, HNELHD
  • Capital Works, HNELHD
  • Aged Care and Rehabilitation Service (ACARS) Network, HNELHD
  • Centre for Healthcare Redesign

Evaluation

  • As of July 2016, the relocation of rehabilitation services has not occurred. Full implementation of all solutions is dependent on this relocation, however many solutions are currently underway.
  • Phase 1 evaluation will measure and monitor:
    • average length of stay in the Rehabilitation Unit
    • functional improvement measures
    • patient satisfaction surveys, using the Patient Experience Tracking System
    • patient feedback on the seven-day service
    • patient rounding
    • staff confidence in skillset, measured using a Likert scale
    • staff competency levels prior to and following training
    • leader rounding of staff.
  • Phase 2 evaluation will measure and monitor:
    • ETP at Maitland Hospital
    • ETP of admitted patients
    • number of patients waiting longer than 24 hours for admission.

Lessons learnt

  • It’s important to recognise internal resistance to change and develop strategies to manage this, as well as develop a strong case for change that acknowledges the needs of both staff and patients.
  • Regular communication, stakeholder engagement and strong executive sponsorship are all important elements of a successful project.

Related resources

Further reading

  • Visser P, Dwyer A, Moran J et al. Medical emergency response in a sub-acute hospital: improving the model of care for deteriorating patients. Australian Health Review 2014; 38(2): 169-76.
  • Australasian Rehabilitation Nurses Association. The deteriorating patient in the sub-acute setting. Bendigo Health; 2015.

Contact

Elizabeth Smith
Change Manager
The New Maitland Hospital
Hunter New England Local Health District
Phone: 0427 803 806
elizabeth.smith@hnehealth.nsw.gov.au

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