New joint venture by four Dublin hospitals ensures home modifications are undertaken quickly to facilitate speedier patient discharges, writes Fiona Tyrrell
A simple joint venture between four Dublin hospitals is speeding up patient discharge and having a knock-on effect on the availability of acute beds.
By cutting through the red tape, Action Van, a project shared between the Royal Hospital Donnybrook, St Vincent's, St Colmcille's and St Michael's hospitals as well as three local health offices, ensures home modifications are undertaken quickly to facilitate a speedier discharge for patients.
When an older patient is medically cleared for discharge, simple modifications are often required for their home - an extra bannister, a grab rail, a raised toilet seat or the provision of a motorised wheelchair.
Such alternations take at least two-three weeks and, according to a 2001 Eastern Regional Health Authority report, sometimes take up to three years to sort out.
As a result, discharge is often postponed, causing distress for the patient and their families and putting a strain on hospital resources.
Patients cost €2,000 a week at the Royal Hospital Donnybrook and, based on the average patient stay of 70 days, the rehabilitation spend is in the region of €20,000.
Meanwhile, a two-week delay in discharge at an acute hospital means someone else is on a trolley for 14 days, according to Conor Leonard, operations manager at the Royal Hospital Donnybrook, who manages the project.
Now, thanks to the new scheme, Action Van's Eamonn Sharkey liaises with the hospital occupational therapists and carries out the home modifications and other measures necessary to clear the way for the patient's discharge home.
This practical partnership has sped up more than 120 hospital discharges in the past year, according to Leonard.
The scheme has now been selected as one of 16 finalists in the Health Service Executive's 2006 innovation awards.
The stroke rehabilitation service in the Royal Hospital has experienced a 50 per cent throughput since the project started. Although it is hard to attribute this increase specifically to the new service, it is a dramatic increase, Leonard says.
The service is "very comprehensive", according to Seán Murphy, a retired teacher and client of Action Van, who suffered from a stroke last year and spent six months in the Royal Hospital.
Since his discharge last May, the Action Van project has ensured that his house is fitted with grab handles to help him balance, as well as an additional bannister on the stairs.
Sharkey, along with the hospital's occupational therapist, accompanied Murphy home when he was discharged from hospital and watched his everyday routine to find out what modifications were needed, Murphy explains.
When not working on hospital discharges, Sharkey works for community therapists, distributing and recycling equipment such as armchairs, powered wheelchairs and bath aids.
Grab rails, extra banisters and bathroom modifications, particularly aids for getting in and out of showers and baths, are top of the modification list, according to Sharkey.
Previously, the hospital occupational therapist had to liaise with the community occupational therapist to organise any modifications. But now, when Sharkey gets the call, he can be in and out of a client's house within a matter of days. Keeping the most common aids in stock also speeds up the process, he adds.
The service received initial funding from the Royal Hospital's Slán Abhaile programme (an intensive home-care scheme to allow elderly patients to return home after a hospital stay) and from the dormant funds accounts.
Leonard says the service is an excellent example of how local collaboration and co-operation between different parts of the health service can provide better services for older people and ensure better use of costly resources such as hospital beds.
Action Van "came out of the goodwill between hospital and community staff that was built up as part of Slán Abhaile", he says.
Therapy managers in the different areas had established excellent relationships and were willing to take the extra step that made sharing Action Van possible, he explains.
According to Leonard, different models were considered, including contracting out all or some of the service. However, by moving into contracting, costs escalate straight away, simply because the provider has to make a profit, he says.
"You can also lose valuable time if every time a rail is needed someone has to visit, issue a quotation, get it approved, send someone to do the job, issue an invoice and process payment.
"Action Van has the job done in the time a contractor would take to even provide the quotation."
