The Non-Weight Bearing Pathway: A Community Based Alternative to Inpatient Rehabilitation.

Purpose

In England, over 4.5 million bed days are used annually for admissions related to falls and fractures in older adults. Immobility in older adults poses an additional health risk. Those considered frail are at greater risk of suddenly deteriorating both physically and mentally. Many patients develop decreased confidence, social isolation and an increased reliance on social care and family, thus preventing complications is essential. Fractures designated Non-Weight Bearing (NWB) are challenging to manage in an ageing population and therefore, an NWB initiative was developed to provide early facilitated discharge and rehabilitate patients at home.

£319,615
Net savings between August 2018 and May 2019.

Approach

NWB patients were identified using specific inclusion criteria. Consent was obtained and the necessary documentation completed by the Physiotherapist and Occupational Therapist. “SMART” goals were identified, and a tailored management plan developed. A Package of Care (POC) and equipment was organised and follow-up Physiotherapy at home arranged. Patients were reviewed up to four times following the first two weeks of discharge. Sessions were adapted according to need and weaned weekly as functional status improved. Once no longer NWB; patient care was transferred to an appropriate team. Patients were provided with two copies of “EQ-5D-5L” and a generic trust feedback form for completion.

Outcomes

Results: Data were collected on 26 patients over a 9-month period between August 2018 and May 2019. Age range varied between 32 and 95, average age 71. Patients remained on the pathway up to 11 weeks, average 5.9 weeks. Average patient contacts totalled 9.9. 85% of patients saw a decrease in number of therapy sessions required. 3% showed an increase. All patients saw an improvement in functional status. 92% of patients required a Rollator Frame or less supportive aid on transfer of care. 81% required a Musculoskeletal Outpatients’ referral, the remainder required a community therapy referral. No patient required transfer to a step-up facility for inpatient rehabilitation. Response rate of the EQ-5D-5L was low, however did identify a need for psychological support following trauma.

Conclusion(s): With an ageing population, the prevalence of falls is likely to increase. Fractures have major financial implications for the NHS. Medically stable NWB patients requiring in-patient rehabilitation remained in hospital unnecessarily as the number requiring rehabilitation far exceeded the number of rehabilitation beds commissioned. The NWB Pathway was designed as an alternative service to provide early supported discharge and high-quality rehabilitation in a patient’s own home which led to reduced pressure on hospital beds and improvement in quality of life. Pathway implementation demonstrated itself as a cost-effective community-based alternative to in-patient rehabilitation, however, highlighted more emphasis be placed on psychological well-being following trauma.

Cost and savings

Between August 2018 and May 2019: cost of therapy hours = £4920.39, bed days saved (local tariff cost £359) £324,536. Net financial gain = £319,615.61. This pathway has continued from May 2019 to present and has continued to make additional savings.

Implications

The NWB pathway demonstrated itself as a valuable alternative to in-patient rehabilitation and could be cascaded across other acute hospital settings. Trauma can affect emotional well-being and Allied Health Professionals are ideally placed to identify and provide psychological first aid in patient management.

Top three learning points

No further details. 

Funding acknowledgements

Therapy staff initially worked additional bank shifts to support pathway implementation but was later supported from existing departmental resources.