Ortho rehab audit at Kauvery Hospital, Trichy

S Chockalingam

Department of Orthopaedics, Kauvery Hospital, Trichy

Background

Do Ortho patients need rehabilitation?

Fragile patients have multiple medical co-morbidities and deteriorating health conditions, which may lead to falls and fractures. It may not be safe to send them home early; rehabilitation processes would help the patient and relatives by facilitating a smoother transition.

Goals of rehabilitation

To improve balance and reduce repeated falls
To improve the function of the patient
To have a satisfactory experience

Existing Ortho Rehabilitation methods

Santé Service Bayonne: a French approach to home care, for the elderly, the physically handicapped, and the terminally ill, 1977
Peterborough Hospital home care program since 1978
Nursing homes, rehabilitation centres, residential care homes, home care by the relatives

Available rehabilitation support to our ortho patients

Nurse visit at home
Physiotherapist visit
Domiciliary help
Physio and the domestic helper
Carer Support to the family, often by relatives, neighbours, and well wishers

HAMSA Rehabilitation Centre

HAMSA came as a rehab facility next door, primarily a neuro rehab, started in November 2022. It offers nursing support and has a medical officer in the daytime and emergency cover from the main hospital. Physiotherapist and occupational therapist support was given, and home visits were also arranged. Our Orthopaedic Department started sending patients to HAMSA as a step-down care from March 2023.

Materials

Patients referred by the orthopaedic team following the acute care. Ortho continuum care by the team members whilst in HAMSA and discharge planning made by a multi-disciplinary approach with input from the Ortho team.

A total of 175 patients have been admitted to HAMSA for rehabilitation, since its opening in 2022

A total of 25 Orthopaedic patients were admitted at HAMSA (14%)
Only the 25 orthopaedic patients were audited, and all other patients excluded
Most of them had treatment for fragility fractures (18/25) 72%
16 patients with proximal femur fractures,
One each with pelvic fracture and acetabulum fracture
Two patients had a second fragility fracture.

Comorbidity

In 25 patients, 11 patients have at least two co morbidities

Comorbidity	No. of patients
Fragility fracture	18
Diabetes	12
Hypertension	9
CAD or heart failure	6
Respiratory illness	3
Previous fragility fracture	2
No comorbidities (96 and 97 year old)	2

Surgery Patients

within 24 hr	within 48 hr	within 72 hr	within 96 hr	not have surgery
2	7	14	17	1

Duration of stay in the main hospital (KCN) after surgery

Duration of stay at HAMSA
Readmissions back to KCN
Subjective measure of Rehabilitation at HAMSA
Objective measure of Rehabilitation at HAMSA

Quantification of rehabilitation

Subjective measure: Feedback
Objective measure: Functional independence score
Objective measure: Berg Balance Scale

Results

Duration of stay at KCN after surgery

One patient stayed for 2 days
Two patients stayed for 3 days
Three patients stayed for 4 days
Four patients stayed for 5 days
Two patients stayed for 6 days
One patient stayed for 7 days
One patient stayed for 11 days

Duration of HAMSA Stay

Four days to 43 days

Readmissions

Two patients were readmitted from HAMSA to KCN
Hyponatremia and pressure sore management
No Orthopaedic related readmissions
One patient discharged from HAMSA, readmitted with DVT
One patient discharged home from KCN, admitted to HAMSA for rehab

Feedback

Functional Independence Measure – FIM

A total of 126 points (18×7)

Pre and Post FIM

Improvement in FIM

Berg Balance Scale

A total of 56 points (14×4)

Pre and Post Berg

Improvement in Berg

Summary

HAMSA has provided good service to elderly orthopaedic patients with fragility score. The functional improvement and improvement in the balance to prevent falls has been demonstrated.

Scope for further study and audit

Hospital at home instead of HAMSA for selected patients: Peterborough model
Reducing the stay at HAMSA
Medical problems encountered whilst at HAMSA
Readmissions to the main hospital (2 patients 8% were readmitted)
Sustainability of the improvement subsequent to discharge from HAMSA.

Acknowledgement

Ortho team members, HAMSA and KCN Nurses and secretary and the database.

Dr Chokalingam

Dr. S. Chockalingam
HOD – Department of Orthopaedics

Ortho rehab audit at Kauvery Hospital, Trichy

Ortho rehab audit at Kauvery Hospital, Trichy

S Chockalingam

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