Critical Appraisal of a Rehabilitation Program - Essay Example

?RGH RGH Critical Appraisal of a rehabilitation Program Introduction The repatriation general hospital (RGH) was built in 1942. It was considered as a military hospital and began operating with 105 beds on a site largely surrounded by orchards and open land (Repatriation General Hospital [RGH], 2012). The hospital primary objective was to care for servicemen and women who returned from World War II. The hospital aimed to offer medical treatment to ex-military people who have returned from the war. In the early 1970s, the hospital began accepting community patients. Due to this, it became a teaching hospital affiliated with Flinders University. In 1995, the hospital was transferred from the Commonwealth Government’s Repatriation Commission to the State Government of South Australia. Currently the hospital is transformed to a modern acute care teaching hospital with over 300 beds. It serves veterans, older people, and the southern community (Repatriation General Hospital [RGH], 2012). The hospital provides many rehabilitation services that include but not limited to day rehabilitation, inpatient rehabilitation and pulmonary rehabilitation. This paper will discuss how the in-patient rehabilitation service is provided, the target population, the staff provided, the assessment tools, opportunities and constraints that might influence the development of the in-patient rehabilitation service within the repatriation general hospital. Service provision Target Population RGH provides services to people who live in the suburbs of Adelaide or people who live in South Australia. The target population of the in-patient rehabilitation at the RGH is primarily focused on neurological adult’s patients such as stroke, multiple sclerosis, Guillain-Barre syndrome patients. In addition, the hospital also provides services to hemiplegic and orthopedic patients. The services that the in-patient rehabilitation provides are physiotherapy, occupational therapy, and speech therapy. The physiotherapy sessions are provided at the gym within the hospital. Physiotherapist provides individual sessions that are patient centered. They mostly focused on helping the patient to achieve their maximum mobility and help them to achieve their treatment goals. Occupational therapist will provide individualized sessions for each patient as well. They will primarily focus on improving the patient’s cognitive abilities, arrange visits to the patient’s house before discharge and help the patients to achieve dependence with their daily live activities. Finally the speech therapist will focus on improving the patients’ communication skills and provide them with exercises that strengthening the muscles of the mouth. Referral sources The referral system is based on the current South Australia health guidelines (SA Health, 2013). The referral system starts from the general practitioner or the medical specialist from the acute care hospital. They will assess the patients’ suitability for the rehabilitation program and then they will be transferred from the acute care setting to the RGH. All referrals should include the patient demographic information and contact details, refereeing practitioner contact details, comprehensive reason of the referral, alerts to infectious status, allergies or communicable diseases that may affect the staff and patients being treated in the same facility, investigations and treatment undertaken, and the relevant psycho-social issues (SA Health, 2013). The patient waiting time will vary according to the patient’s clinical urgency of his condition and level of the demand of the services. Facilities provided Major equipment The in-patient rehabilitation at the RGH is well organized department. The in-patient rehabilitation service includes 40 beds. Each patient will have assigned timetable which include the start time of each session. At the physiotherapy gym, 5 patients will be allowed to start their session at the same time for an hour. The equipment that are provided at the inpatient rehabilitation services are treadmills, cycle ergo meter, parallel bars, balance boards and Armeo therapy robotic device, which allow the early rehabilitation of the patient’s upper limb motor abilities (Hocoma, n.d.). The occupational therapist therapy room includes puzzles, color-coded toys to help the patient with the spatial organization and decision-making skills. A Study conducted by Fiez, Petersen, Cheney, and Raichle (1992), showed that using puzzles with patient who suffers from cognitive impartment because of cerebral vascular accident can improve their diction making abilities and also improves their ability to detect an error (Fiez et al., 1992). Furthermore occupational therapist will use special facilities such as fully equipped kitchen to use it while training the patients for meals preparation and cleaning in an effort to help the patients achieve dependence with their daily live activities. Finally, speech pathologist use assistive applications on I pads designed to help patients with communication difficulties. Staffing At the RGH inpatient rehabilitation the staff involves 6 physiotherapists, 4 occupational therapists, 2 speech therapists and 1 social worker, and 1 program assistance. All therapists are available at the gym and therapy rooms during the operating times which are from 8 am until 5 pm to ensure that all patients are participated and monitored during their appropriate treatment sessions. The in-patient rehabilitation services also provide part time jobs for students at times when they need extra assistances. Opportunities and constraints that influenced the development of the service The inpatient rehabilitation programs at RGH are funded by the state. It is an ongoing funded program that is meant to serve patients who live at the southern region of Adelaide, Victor harbor, and South East of Adelaide. Therefore, there is a geographical and transportation constraint for people who live at the rural and remote regions to attend the services. Furthermore, the hospital has close links with flinders university medical center most of the patients are refereed from there. However the facility only provides 40 beds for in- patient rehabilitation, which might lead to an increased patient Wait time. Taking these constraints into consideration, the hospital administration is now considering expanding the services and includes more beds into the services. Rehabilitation process Relevancy of teamwork At the RGH in-patient rehabilitation setting, an interdisciplinary team approach was mainly used during the application of the interventions. This type of teamwork is critically important since it delivers high quality patient care, improve the staff morale and it increases the patient safety (Jones, A., & Jones, D. 2011). The interdisciplinary team approach nowadays is widely adopted by many hospitals, since it helps with improving the hospital based care through the regular team meeting that facilitate shared record keeping and allow for inter-disciplinary goal setting (Jones, A., & Jones, D. 2011). At RGH inpatient rehabilitation program a case conference is held once a week to discuss the patient cases, goals settings, discharge plans and coordinate between the different disciplines. Moreover a daily morning hand over is done between the clinicians disciplines, to ensure that each patient is assessed for progression and whether if each patient received the right medical intervention. The degree of the overlap between the teams proves that it allow for learning opportunities towards the role of other team disciplines (Williams &Laungani, 1999). It is evident that this approach is well tolerated among the in-patient rehabilitation program staff and also it helped patients to achieve fast improvement in regaining their mobility and self-dependence. Involvement of patients and family One of the basic principles of delivering effective rehabilitation process is involving the patient’s family (Taylor, Daid, Phillips, Fields, &Scherger, 2003). It is important to inform caregivers of the nature of the patient’s disease, the rehabilitation process and their involvement in it and the prospect of the patient’s recovery. It is evident that the early involvement of the family in the patient’s rehabilitation plan will minimize any future constraints the family might face after discharge. The interdisciplinary team will work closely with the patient’ family by provide information of the available lists of the support groups and arrange for the emotional counseling session if families needed so. Also the in-patient rehabilitation program at the RGH will provide once a week educational session for patient’s caregiver. This educational session plays an important role on informing the patient’s caregiver or family on how they can help patient to overcome their new state of disability. Another important factor the clinicians at in- patient rehabilitation program focused on is involving the patient’s him or herself in their rehabilitation plan. By doing this clinicians ensured that every patient’s rehabilitation goals are relevant to their specific needs and at the same time they also granted the highest level of patient’s involvement into his or her rehabilitation process. A study was done by Playford et al. (2000), indicated that involving the patient in goal setting helps the patient to determine their own priorities in the rehabilitations process and it lead to an increase their focus and concentration. Assessment of patients It is significant to note that before admitting the patient, three registered nurses, who work at the triage, will meet the patient at the private or public medical centre to evaluate their eligibility for the rehabilitation program. After the triage nurses approves the patient, a specialized physician and two registered nurses will evaluate the patient’s medical condition, such as the level of their disability and/or the nature of their illness. Afterwards the patient will be placed into one of three treatment categories: the red category which is for patients whose estimated stay is up to 3 months, the orange category which is for patients who are estimated stay 4 to 6 weeks, and lastly the green category which is for patients who are estimated to stay for 2 to 4 weeks. The classification of patients will be based on the physician and nurse experience in the rehabilitation field. After the patient is placed in a treatment category, the rehabilitation team members—a physician, nurse, physiotherapist, occupational therapist, speech pathologist, social worker, will perform their own evaluations in their areas of expertise. These evaluations are based on specific outcome measurements that relate to their disciplines. For example, the physiotherapist performance uses a 6-minute walk test, timed up go test, and a functional independence test, while the occupational therapist may use a motor assessment test for upper limbs, functional needs assessment test, and the Fugl-Meyer Motor Assessment Scale (Townsville Mental Health Services, n.d.). The rehabilitation team uses high validity and reliability outcome measurements to improve the efficacy and accuracy of the evaluation process and to improve the efficiency of the rehabilitation program (Jones, A., & Jones, D. 2011). Delivery of rehabilitation intervention: The inpatient rehabilitation program will work closely with patients and families in order to help patient to achieve the best outcomes of their therapeutic goals. Patients will receive varying hours of therapy sessions according to each patient’s needs. The therapy sessions is usually delivered individually, however group sessions will be offered for educational classes. Patients will interact with each other during recreational sessions and at lunch time. The in-patient rehabilitation program at RGH adopted approach that encourages patient’s critical thinking and problem solving process. Clinicians will help the patients on physical training, support, education, improving the patient cognitive abilities and counseling for clients and families. Continuity of care post-exit from the rehabilitation program Patients will be discharged from the rehabilitation service once they achieve their treatment goals. They will also receive pre-arranged appointments for follow-up from their general practitioner and the home care services. The regular visits to the general practitioner will allow the general practitioner to detect any change in the patient functional status and therefore it will help them to make the appropriate referrals for subsequent round of rehabilitation. The clinicians will also provide a list of community rehabilitation programs that provide rehabilitation services. Many patients prefer to attend these programs to prevent deterioration of their conditions and also to help maintain their physical fitness. Community rehabilitation programs showed great benefits to the community, since it reduces the frequency of travel to communities, and as a consequence saves the patient’s time and money (Taylor et al., 2004). Conclusion In conclusion, the repatriation general hospital was constructed in 1962 as a military hospital. The major aim of its construction was to provide care for military service men and women after the end of world war two. In 1995, the hospital was changed from the Commonwealth Government’s Repatriation Commission to the State Government of South Australia in order to serve the southern community. The hospital offers services to people who live in Southern Australia. Its main target population includes adult patients suffering from multiple sclerosis. It is significant to note that it also target hemiplegic and orthopedic patients. The referral system of RGH begins from the general practitioner/ the medical specialist from the acute care hospital. They evaluate the patients’ suitability for the rehabilitation program and recommend their transfer to the RGH Acute care unit. In addition, RGH provide inpatient services that include physiotherapy, occupational therapy, and speech therapy. RGH has sufficient staff and equipments to ensure improved service provision to people in Southern Australia. The clinicians also offer different community rehabilitation programs. Many patients in Southern Australia prefer to attend these programs to prevent deterioration of their conditions and assist maintain their physical and mental health. Since its inception, RGH has greatly people from Southern Australia. It aims to improve its programs to ensure that majority people from Australia and other parts of the world access their services. References Fiez, J. A., Petersen, S. E., Cheney, M. K., &Raichle, M. E. (1992). Impaired non-motor learning and error detection associated with cerebellar damage A single case study. Brain, 115(1), 155-178. Hocoma. (n.d.). The Armeo® Therapy Concept. Retrieved from: http://www.hocoma.com/fileadmin/user/Dokumente/Armeo/BRO_Armeo_Therapy_Concept_130225_en.pdf Jones, A., & Jones, D. (2011). Improving teamwork, trust and safety: An ethnographic study of an Inter-professional initiative. Journal of Interprofessional Care, 25(3), 175-181. Playford, E. D., Dawson, L., Limbert, V., Smith, M., Ward, C. D., & Wells, R. (2000). Goal-setting in rehabilitation: Report of a workshop to explore professionals’ perceptions of goal-setting. Clinical Rehabilitation, 14(5), 491-496. Repatriation General Hospital [RGH]. (2012). History of ‘the Repat’. Retrieved from: http://sahealth.sa.gov.au/wps/wcm/connect/8f7b14004b54e19083acf79a087db869/Repat+History+RGH+20120514.pdf?MOD=AJPERES&CACHEID=8f7b14004b54e19083acf79a087db869 Taylor, R. B., Daid, A. K., Phillips, D. M., Fields, S. A., &Scherger, J. E. (2003). Cerebrovascular disease. In M. H. Bross& D. C. Campbell (Eds.), Family medicine: Principles and practice (pp. 554-555). New York, NY: Springer-Verlag. Retrieved from: http://books.google.com.au/books?id=icdGAAAAQBAJ&pg=PA555&dq=the+involvement+of+the+patient+family+in+the+rehabilitation+process&hl=en&sa=X&ei=SEWPUuKbL4yviQeGmIHICA&ved=0CDUQ6AEwAQ#v=onepage&q=the%20involvement%20of%20the%20patient%20family%20in%20the%20rehabilitation%20process&f=false Taylor, R. S., Brown, A., Ebrahim, S., Jolliffe, J., Noorani, H., Rees, K., ... &Oldridge, N. (2004). Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. The American journal of medicine, 116(10), 682-692. Townsville Mental Health Services. (n.d.). Occupational therapy. Retrieved from: http://qotfc.edu.au/mental-health/documents/links/ot_resources_townsville_mhs.pdf SA Health. (2013). Patient Assistance Transport Scheme. Retrieved from: http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+services/outpatient+services/outpatient+referral+process Williams, G., &Laungani, P. (1999). Analysis of teamwork in an NHS community trust: An empirical study. Journal of Interprofessional Care, 13(1), 19-28. Read More