Action Van puts people back in their places

The stairs in Colette FitzGerald’s home were looking like an insurmountable obstacle between her and her bedroom and bathroom, after she needed surgery on a badly broken ankle at the end of last year.

Yet she was keen to get home for Christmas, although she still needed the support of a walking frame.

Recuperating in the Royal Hospital Donnybrook for several weeks after being operated on in St Vincent's University Hospital, she wondered how she was going to manage the stairs back at her house in Sandycove, Co Dublin.

There was a banister on only one side and that one banister didn’t go all the way up the first flight of the stairs. Luckily for her, the Royal Hospital has pioneered an Action Van service to streamline house adaptations so that patients can go home as soon as they are deemed well enough.

A member of the hospital’s occupational therapy team goes out to patients’ homes to see what’s needed and then a technician is dispatched to do the essential work, be it stair rails, grab rails, the fitting of toilet and/or shower seats, and other minor safety improvements.

Home assessment
It cuts out the lengthy process of referring the patient to a community occupational therapist to do the home assessment, followed by locating and waiting for a handyman to do the work.

The Action Van service can deal with installations within two to four working days, explains its co-ordinator, Jo Cannon, while there used to be a wait of four to six weeks through community services.

This delay would be even greater now due to cutbacks in the community occupational therapy services, she points out.

For FitzGerald, a widow in her 70s, the fitting of a rail on the second side of the stairs was enough to get her home initially, with a grab rail in the bathroom to follow.

The Action Van is a win-win situation. Patients get back to their own homes sooner and hospital beds are vacated quicker.

Since its inception, three other south Dublin hospitals have joined the service – St Vincent’s, St Columcille’s and St Michael’s. From 2010 to 2012 there was a 21 per cent increase in the number of referrals from the four hospitals. And last year, demand jumped another 19 per cent.

It’s a scheme that could be replicated around the State to improve hospital discharge rates, says Cannon, who is occupation therapy manager at the Royal Hospital Donnybrook.

“Every day a person stays in hospital waiting for a piece of equipment or a rail is a waste. It is difficult to put a figure on the bed days saved through the Action Van service. However, in 2013 alone, over 300 hospital discharges were accelerated, saving valuable bed days for all four hospitals,” she points out. A bed night in the Royal Hospital costs about €500, while in St Vincent’s it would be €700-€1,000.

Patient safety
The service not only reduces the length of stay in hospital but also improves the patient's safety at home, lowering the risk of re-admission, Cannon

says. It also eliminates unnecessary duplication of work by hospital-based and community-based occupational therapists.

Now an essential element in the planning of discharges from these four hospitals, there’s a template there for others to follow.

The day The Irish Times visited Colette FitzGerald, the Action Van man, Eamonn Sharkey, was upstairs fitting a grab rail beside the toilet in the bathroom. As well as doing all the installations for this service, he delivers some equipment for community occupational therapists.

Although FitzGerald had to go back into hospital in January due to complications, she is now progressing well and getting around with the help of crutches. And the safety improvements to the house not only mean that every part of her house is accessible but they also give her a feeling of confidence that she won’t fall again.

For more information see rhd.ie