Hands Rapid Access Service to reduce Length of Stay

Aim

To evaluate the implementation of a rapid access hand therapy service as an alternative, patient centred pathway to optimise flow through Emergency Department, improve patient and staff experiences, healthcare outcomes and cost-effectiveness.

Outcomes

Better care pathways: Patient flow, improved access and community initiatives.

The Hands Rapid Access Service model of care has the potential to be spread to other HHSs with demonstrated total service payback of invested funds within six months through improving patient flow, reduced emergency length of stay and fracture clinic diversion for stable, non-surgical hand injuries.

Providing rapid access to hand therapy for this patient cohort has demonstrated positive outcomes for patients, including statistically significant improvement of quality-of-life measures and improved patient experience. During the implementation of the service at The Prince Charles Hospital, overwhelmingly positive support was received from key stakeholders including the Directors of Emergency, Orthopaedics, Nursing, and Allied Health, and staff working in these clinical areas.

The successful implementation of this innovative service model at TPCH should facilitate the introduction of similar services at other hospitals. Providing rapid access to hand therapy direct from ED for stable, non-surgical hand injuries can improve patient outcomes without clinical incident, reduce length of stay in emergency with corresponding cost savings, and successfully divert eligible patients from fracture clinic, further streamlining the patient journey. There is capacity for scale and spread of this service model, with successful expansion of entry points already achieved including virtual ED, minor injuries unit, and GP referrals. Further reduction in care transition could be achieved by removing legislative barriers to occupational therapists requesting medical imaging.

Background

To evaluate the implementation of a rapid access hand therapy service as an alternative, patient centred pathway to optimise flow through Emergency Department, improve patient and staff experiences, healthcare outcomes and cost-effectiveness.

Discussion

A mixed-methods approach of evaluation, embedded within the Metro North Health Evaluation Framework was utilised to evaluate the implementation of the hands rapid access service. Patient-Reported Experience Measures (PREMs) and Patient-Reported Outcome Measures (PROMs) were collected via a consumer survey (paper or online based on consumer preference) and using the EQ-5D-5L health-related quality of measure completed pre and post treatment. Clinicians who refer to the service were invited to share their perceptions of the service via an online survey. Finally, a cost effectiveness analysis was conducted to quantify the economic impact of the service.

Results;

Preliminary analysis of 11 months of complete data demonstrated improved NEAT targets for this patient cohort, 94.5% of patients admitted to ED during Hand Rapid Access Service hours met NEAT targets (<240minutes). Average ED length of stay was reduced by 53 minutes for hands rapid access patients seen during service hours and by 38 minutes across all service hours when compared to hand related diagnoses prior to service implementation.

Preliminary cost modelling based on the 38-minute average time saving per patient and total time saving of 227.37 hours over 11 months yielded a total saving of $110,087.42 in costed Emergency Department service hours (estimates from National Emergency Care Data). Reduced length of stay cost savings yielded a 97.69% return on investment in 11 months, or a total health service pay-back of invested model costs within less than six months. Patient-reported outcomes based on pre/post treatment health-related quality of life measures (n=120) demonstrated statistically significant improvements (p<0.001) in five of the six domains of the EQ-5D-5L including self-care, usual activities, pain and discomfort, anxiety and depression and general health.

Initial analysis on 130 completed consumer surveys showed overwhelming positive patient experience with 100% reported good or very good experience and would recommend the service. Qualitative responses highlighted the importance of local, timely access to specialist services and compassionately delivered care. Ten ED clinicians completed the stakeholder survey with 100% recommending the continuation of the hands rapid access service, agreeing that patients were rapidly retrieved from emergency; the service positively impacts the patient experience, efficiency, and quality of care; and the service has improved access to specialist advice and treatment of in-scope hand injuries.