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Background A potential barrier to patient discharge from hospital is communication problems between the treating team and the patient or family regarding discharge planning. Aim To determine if a bedside 'Leaving Hospital Information Sheet' increases patient and family's knowledge of discharge date and destination and the name of the key clinician primarily responsible for team-patient communication. Methods This article is a 'before-after' study of patients, their families and the interdisciplinary ward-based clinical team. Outcomes assessed pre-implementation and post-implementation of a bedside 'Leaving Hospital Information Sheet' containing discharge information for patients and families. Patients and families were asked if they knew the key clinician for team-patient communication and the proposed discharge date and discharge destination. Responses were compared with those set by the team. Staff were surveyed regarding their perceptions of patient awareness of discharge plans and the benefit of the 'Leaving Hospital Information Sheet'. Results Significant improvement occurred regarding patients' knowledge of their key clinician for team-patient communication (31% vs 75%; P = 0.0001), correctly identifying who they were (47% vs 79%; P = 0.02), and correctly reporting their anticipated discharge date (54% vs 86%; P = 0.004). There was significant improvement in the family's knowledge of the anticipated discharge date (78% vs 96%; P = 0.04). Staff reported the 'Leaving Hospital Information Sheet' assisted with communication regarding anticipated discharge date and destination (very helpful n = 11, 39%; a little bit helpful n = 11, 39%). Conclusions A bedside 'Leaving Hospital Information Sheet' can potentially improve communication between patients, families and their treating team. [ABSTRACT FROM AUTHOR]

Study design:Prospective open cohort case series of consecutive patients admitted with spinal cord damage to a spinal rehabilitation unit (SRU) between 1 January 2008 and 31 July 2013.Objectives:Measure the prevalence of barriers to discharge, their reasons and resulting additional unnecessary days in hospital.Setting:SRU, Victoria, Australia.Methods:Consecutive SRU admissions had prospective documentation of key clinical and demographic characteristics, the occurrence of any discharge barrier, the cause(s) and duration of unnecessary hospitalisation.Results:There were 235 patients in the study; 138 (58.7%) were male and the median age was 63 years. Eighty-six (36.6%) patients had a discharge barrier. The most common reasons for a discharge barrier were: waiting for approval for long-term and supported care or services, residential care, home modifications, family deliberations regarding discharge planning and the provision of equipment necessary for discharge. The reasons accounting for the greatest number of additional hospital days were: home modifications, residential care, equipment necessary for discharge, waiting for approval for long-term and supported care or services and accommodation for people unable to return to their previous residence without readily available alternatives. Over the study period 17.5% (3176/18 184) of all bed-days were occupied by patients deemed to be clinically ready for discharge from the SRU but who had a discharge barrier.Conclusions:Barriers to discharge from rehabilitation for patients with spinal cord damage are common, substantial, and represent an important opportunity for health systems improvement. [ABSTRACT FROM AUTHOR]

Study design:Prospective open cohort case series.Objectives:To identify opportunities for improvement by recording duration of key processes from acute hospital admission until spinal rehabilitation unit (SRU) admission.Setting:SRU, Victoria, Australia.Methods:Consecutive referrals of patients with recent spinal cord damage had prospective documentation of the key clinical and demographic characteristics and duration (days) of the following sequential discrete processes: acute hospital admission until referral to SRU, referral until SRU assessment, SRU assessment until ready for transfer to SRU and ready for transfer until SRU admission.Results:A total of 347 patients were referred with median age (interquartile range (IQR)) of 65 (52-76) years. Most patients were male (n=203, 58.5%), had paraplegia (n=267, 77%) and an aetiology due to spinal cord myelopathy (n=280, 80.7%). There was a median of 12 days (IQR 6-20) from acute hospital admission until referral, a median of 1 day (IQR 0-2) from referral till assessment, a median of 0 (IQR 0-3.5) days from assessment till deemed ready and a median of 7 (IQR 2-20) days from deemed ready until transfer to SRU. Overall, patients spent 34.2% (4951/14 478 days) of their acute hospital length of stay waiting for a SRU bed.Conclusions:There are opportunities to improve the efficiency of the acute hospital journey for patients referred to a SRU. The biggest opportunities exist for reducing the time from acute hospital admission till referral to SRU and the time from deemed ready for transfer to SRU till admission. [ABSTRACT FROM AUTHOR]

Study design:Forecasting using population modelling.Objectives:To determine the prevalence of non-traumatic spinal cord injury (NTSCI) on 30 June 2010.Setting:Victoria, Australia.Methods:Modelling used the following data: incidence of NTSCI based on state-wide, population-based, health-administration database of hospital admissions; state and national population profiles and life tables; levels of NTSCI based on national rehabilitation outcomes data; and life expectancy for persons with SCI.Results:The total population prevalence rate was 367.2 per million, whereas the prevalence in adults aged 16 years and older was estimated to be 2027, equivalent to a population prevalence rate of 455 per million persons. There were more males (1097) with NTSCI (prevalence rate males 197.8 per million population; females 169.1 per million population) and the prevalence was much higher among those with paraplegia (prevalence rate 269.3 per million compared to 97.8 per million with tetraplegia) and incomplete NTSCI. Ventilator dependency (prevalence rate 1.6 per million population) and paediatric NTSCI (prevalence rate 6 per million population 15 years old) were extremely rare.Conclusion:We have reported a method for calculating an estimate of the prevalence of NTSCI that provides information that will be vital to optimise health care planning for this group of highly disabled members of society. It is suggested that refinements to the modelling methods are required to enhance its reliability. Future projects should be directed at refining the mortality ratios and performing cohort survival studies. [ABSTRACT FROM AUTHOR]

Study design:Community cross-sectional self-report survey of adults with spinal cord injury (SCI).Objectives:The aim of this study was to examine the likelihood of depression, anxiety and stress in adults with non-traumatic SCI (NT-SCI) compared with adults with traumatic SCI (T-SCI).Setting:Victoria, Australia. Adults (N=443; NT-SCI n=62) living in the community and attending specialist SCI rehabilitation clinics.Methods:Participants completed a self-report survey by internet, telephone or hard copy. Items included demographic and injury-related characteristics and the short form Depression, Anxiety and Stress Scale (DASS-21).Results:Persons with NT-SCI were significantly more likely to be female (P<0.05), older (P<0.001) and have lower-level incomplete injuries (P<0.001). The probability of depression, anxiety or stress in respondents with NT-SCI did not differ from persons with T-SCI (P>0.05). Overall, the prevalence of adverse mental health problems defined by scoring above DASS-21 cutoffs, were depression 37%, anxiety 30%, and clinically significant stress 25%.Conclusions:This study examined multiple mental health outcomes after NT-SCI in Australia. This study provides some evidence that the results of studies of depression, anxiety or stress in persons with T-SCI can be generalised to those with NT-SCI in the post-acute phase. NT-SCI patients are also at substantial risk of poor mental health outcomes. General demographic and injury-related characteristics do not seem to be important factors associated with the mental health of adults with SCI whether the SCI is traumatic or non-traumatic in origin. [ABSTRACT FROM AUTHOR]

Study design:Prospective, observational study.Objectives:To determine the proportion of patients with non-traumatic spinal cord injury (NTSCI) who regain the ability to walk and to describe walking outcomes with reference to three commonly used clinical measures of walking capacity.Setting:Spinal Rehabilitation Unit specializing in NTSCI, Melbourne, Australia.Methods:Demographic, clinical and mobility data collected from a consecutive cohort of patients admitted to the spinal rehabilitation unit between March 2006 and December 2007. Main outcome measures were the Timed Up And Go (TUG), the 10-m walk test (10 mWT) and the 6-min walk test (6MWT). Logistic regression analysis was conducted to explore predictors of walking ability after NTSCI.Results:Of 62 patients, 30 (48%) regained some capacity to walk during inpatient rehabilitation. Initial ASIA grade was the strongest predictor of walking. Twenty-seven patients regained the ability to perform functional tests (TUG, 10 mWT and 6MWT) of walking at ∼2 months after injury. Their performance at discharge remained low compared with normal scores but were similar to those measured in some studies of subjects with traumatic spinal cord injury (TSCI).Conclusion:Three simple clinical tests of walking suggest that half of all NTSCI patients are able to walk at discharge from inpatient rehabilitation. Their gait speed, however, remained impaired and not compatible with safe and efficient community walking. [ABSTRACT FROM AUTHOR]

Objective: To examine short- and medium-term outcomes of percutaneous coronary interventions (PCIs), with a focus on comparing drug-eluting stents (DESs) with bare-metal stents (BMSs).Design, Setting and Participants: Retrospective analysis of data from the Melbourne Interventional Group (MIG) registry, a large multicentre Australian registry. The study cohort consisted of 6364 consecutive patients undergoing 7167 PCIs between April 2004 and August 2007.Main Outcome Measures: Clinical events including death, myocardial infarction (MI), target lesion revascularisation (TLR), target vessel revascularisation (TVR) and major adverse cardiac events (MACE) (a composite of death, MI and TVR), at 30 days and at 12 months.Results: The cohort was predominantly male (74%), with a mean age of 64.7 years (SD, 12.0 years). DESs were used in 3482 (51.4%) of PCIs. In the overall cohort, rates of clinical events were low at 30 days: mortality (1.9%), MI (2.4%), TLR (2.0%), TVR (2.4%) and MACE (5.7%). At 12 months, event rates were: mortality (5.2%), MI (6.0%), TLR (5.8%), TVR (8.2%) and MACE (16.2%). Patients receiving DESs had similar mortality rates to those receiving BMSs (4.0% v 6.0%; P = 0.62 [propensity score-adjusted]); late thrombosis rates were also similar in the two groups (0.8% v 1.1%; P = 0.38). The proportion of patients receiving DESs fell significantly over time, from 54.9% in the first 24 months to 44.7% in the last 15 months of the study period (P < 0.01). Independent predictors of 12-month mortality included diabetes, renal failure, ST-segment-elevation MI and cardiogenic shock.Conclusion: Our clinical event rates were comparable with international registry outcomes. Rates of mortality and stent thrombosis were no higher in patients with DESs than those with BMSs. Although DESs were used in about half the procedures (preferentially for higher-risk lesions), recent trends suggest their use is in decline. [ABSTRACT FROM AUTHOR]

Strategies for managing increasing health system demand have focused on the acute sector and chronic disease management in the community, with little attention on the role of rehabilitation. There were over 53 000 inpatient rehabilitation episodes in Australia in 2006. We argue that rehabilitation can improve patient flow and outcomes in acute care if engaged early. The effectiveness of rehabilitation can be enhanced by increasing the intensity of therapy and developing models of rehabilitation that provide alternatives to inpatient care. Factors that reduce the efficiency of rehabilitation services include the location of many services in small, stand-alone hospitals without acute support; the lack of options for managing younger people with acquired disability in the community; and deficiencies in government programs for the supply of aids, equipment and home modifications. Improving the organisation of rehabilitation services should improve access to acute and rehabilitation inpatient beds, improve patient outcomes and reduce costs. [ABSTRACT FROM AUTHOR]