Familiar tasks key to patients’ rehabilitation

Former New Zealand test cricketer Louise Clough (83) makes a cup of tea in the Older Personal Assessment and Liaison Unit’s rehab kitchen at Dunedin Hospital, watched by team members (from left) Rose McAtamney, Helen Murphy, Jake Jamieson, Toni Auchinvole, Pam Prasad and Lynn McLachlan. PHOTO: GREGOR RICHARDSON

Louise Clough used to strike fear into batswomen as one of the fastest bowlers in Otago cricket.

She goes somewhat slower these days, the 83-year-old taking her time to make a cup of tea.

However, she is not in the comfort of her home, she is on the sixth floor of Dunedin Hospital and the humble cuppa is an important part of her rehabilitation following a series of falls.

She has had the good fortune to be admitted to the Older Personal Assessment and Liaison Unit (Opal), a ward dedicated not only to getting people out of the hospital and back home, but also to making sure they can cope when they get back.

All district health boards monitor their readmission rate — how many patients who have been discharged end up coming back again — to ensure people are being sent home when they are truly ready to go.

Older people, frail and often unsteady at the best of times and especially so after a medical procedure, are particularly at risk of readmission, which is where Opal comes in.

"We get people in here as quickly as possible so we can keep them moving," clinical leader Dr Toni Auchinvole said.

"People in hospital sit there in bed because they think that’s what they’re supposed to do. They’re trying to be good patients, but keeping older people moving is the key to getting them home as soon as possible."

A host of medical studies show that the longer an older person spends in hospital, the worse their prognosis.

While Opal wants its patients home quickly, the unit’s work is not about getting people out of the hospital as fast as possible.

The unit is selective about its patients — they need to be able to cope when they get home and have support systems in place to ensure that they can manage — and intensive in its treatment regime.

Patients receive an initial and comprehensive geriatric assessment, before the Opal team decides what support and treatment the patient needs, and the best place for them to receive it.

"They need to be medically stable, so our team can be confident of taking care of them straight from the emergency department or from hospital or general medicine," Dr Auchinvole said.

"Those departments also needed to be confident that we could care for their patients, because they had plenty to be taken care of ... if people are really sick, they need to be in a different service, but if they are stable, this is the right place to be."

Just as a younger person rehabilitating from a sports injury, Opal patients also work out and receive physiotherapy, although of a far less intensive variety.

The unit has its own gym, where even a few repetitions of a simple task such as climbing a stair or walking backwards can make a world of difference.

There is also the aforementioned kitchen, sitting room and dining room, where patients carry out simple household chores, such as making their own breakfast, to reassure both their carers and themselves that they are up to the task.

"Those skills can be very easy to lose in a hospital setting," Dr Auchinvole said.

"Sometimes, if you are frail, it might only take a couple of days of not doing those things to tip them over the edge, so people often manage better in their own homes where they have to do those things."

Opal’s remit extends beyond physical treatment. Its team includes occupational therapists and social workers, who work closely with the SDHB Home Team to ensure all is in readiness for when a patient leaves the unit.

"The patient review is designed to quickly identify anything else they might need," associate charge nurse manager Pam Prasad said.

"We assess their physical and mental wellbeing right at the beginning and we can pick up what their level of functioning is, but we also regularly review them as a team to ensure we are on the right track."

"In other wards, the patients are only looked at by the clinicians, and after they are pronounced well enough they might call in the physio and the occupational therapist," OT Rose McAtamney said.

"Here, everyone is looking at the same person at the same time so we are moving in the same direction together and everyone is working right from the start on what is needed to get the patient home."

Social worker Jake Jamieson works with the patients and their families, anticipating questions and liaising with home care providers to ensure everything is in place for when they are discharged.

"When the time comes to leave there are naturally a few anxieties, and I find it helps a lot if most of those can be addressed beforehand. It can make a big difference."

Opal was opened as a trial by the SDHB and its work has not gone unnoticed, being given permanent footing and receiving high praise for its impact on readmission rates in a recent briefing to the board.

New Zealanders now live longer than ever and the average age of the population is steadily rising, which means Opal will not be running out of work any time soon.

"We started with four beds, we are now between eight and 10 beds, and we know there are a large and growing number of patients who could use this service," Dr Auchinvole said.

"There are probably people in an acute ward somewhere who could do with being in here or in a service that runs like this instead, and that’s still work which is evolution."

mike.houlahan@odt.co.nz