Hospital to Home

The most important transition

A/Prof Natasha Lannin
Alfred Health & La Trobe University
latrobe.edu.au

CRICOS Provider 00115M

Introduction
Severe ABI affects only a small
number of people, however, it
has a significant impact on the
person and their family and the
lifetime care costs are
considerable
Transition from hospital to
home is a critical time

Person
with
ABI
Family
Goals

Rehab
Team

Independence
Fewer NH
placements

Evidence Based
Rehabilitation

Lower levels of
attendant care
Higher levels of
community
integration

Discharge Planning will

commence on admission

There is a written, goaldirected plan for rehab which

allows the person with ABI to
direct their own future

All rehab is goal-focused

Rehab team train families

prior to discharge

Where there is evidence,

evidence is applied

Person with ABI (& their

family) are provided with
all the information they
need and want

Families play a critical role in

rehabilitation and lifelong care

Changes, Challenges, Choices

Changes

Changes in rehabilitation over recent years

Challenges faced by clinicians

Accessing and staying abreast of evidence

Changing how we have always done things

Challenges faced by consumers & families

Accessing accurate evidence

Engaging with the rehabilitation team / healthcare workers

Choices

Translating Evidence into Practice

Choosing your future

5

Changes
Rehabilitation Length of stay- 1980s

Time from ABI onset to admission to rehabilitation was 22.0 days (SD 17.2)

Rehabilitation average LOS was then 84.9 days (SD 66.0)

Rehabilitation Length of stay- 1990s

Time from ABI onset to admission to rehabilitation was 17.6.0 days (SD 22.0)

Rehabilitation average LOS was then 54.9 days (SD 84.9)

Rehabilitation Length of stay- 2000s

Time from ABI onset to admission to rehabilitation was 14.2 days (SD 17.6)

Rehabilitation average LOS was then 34.9 days (SD 84.9)

Rehabilitation Audit, Mount Royal Hospital (1989), Rehabilitation Audit, North West Hospital (1995)
6

Rehabilitation Setting

Acute rehabilitation

Early Support Discharge teams

Transitional Living Units

Community Rehabilitation Centres

Private practitioners

Telehealth / Telerehab

Rehabilitation should take place in an environment

that drives goal attainment and in most instances,
this is surely the persons own home
7

Timing of Rehabilitation
Early rehabilitation is well tolerated in medically stable patients
outstanding questions over timing and efficacy
Rehabilitation intervention research is traditionally undertaken
with people who had their brain injury > 2 years prior
Priority areas for further research

Efficacy of early ADL-based rehabilitative strategies versus

Vocation-based rehabilitative strategies

Efficacy of rehabilitation delivery in the "chronic phase or

using a slow-stream approach
8

Person
with
ABI
Family
Goals

Rehab
Team

Independence
Fewer NH
placements

Evidence Based
Rehabilitation

Lower levels of
attendant care
Higher levels of
community
integration

10

Caregiver Support
What caregiving tasks are
most usually completed by
paid versus family carers?
How can hospitals best
support informal caregivers?

11

Comparison of paid and unpaid care hours per week

12

Caregiver Support
What caregiving tasks are
most usually completed by
paid versus family carers?
How can hospitals best
support informal caregivers?

13

14

http://www.abiebr.com/

15

Tips

Talk openly and honestly with the healthcare worker to

help build a trusting relationship

Tell healthcare workers what your goals are (if you know
them), but also tell them about what things in your life are
your priorities, what things concern you (worry you)

Ask questions about the injury and what options are, as

well questions about therapy treatments and about your
progress.

If youve heard about research, talk with your healthcare

workers about this

Repeat questions if the answer is forgotten or not

understood
16

Qualitative Finding: The difference between

HOPE and FALSE PROMISES

17

Thank you

Associate Professor Natasha Lannin may be

contacted at N.Lannin@latrobe.edu.au
Follow our research on Twitter: @NatashaLannin
latrobe.edu.au

CRICOS Provider 00115M