Work of ART: Profiling the First 100 Patients Discharged Home From an Acute Hospital with the Active Recovery Team (ART)

Abstract

Background The Active Recovery Team (ART) is a new therapy lead rehabilitation team that offers supported discharge and admission avoidance from a large acute hospital. This interdisciplinary team consists of a physiotherapist, occupational therapist, medical social worker and two therapy assistants. ART accepts referrals from all services within the hospital including the emergency department. Methods As ART is a new service, a retrospective audit of the first 100 patients who discharged on the pathway was completed. Demographics included age, sex, referring specialty, presenting complaint, frailty (measured by the Clinical Frailty Score) and level of input received. ART use the coding of low, medium and high intensity to describe the intervention provided based on dosage (visits) and complexity. Results Most (67%) of the group were female and mean age was 77 years. Only 8% were pre-frail (CFS 0-3), 86% were living with mild to moderate frailty (CFS 4-6) and 6% considered severely frail (CFS 7-9). The type of intervention patients received was 31% low, 33% medium and 36% high intensity. Referrals came from a range of specialties, but the highest percentage of referrals were from emergency medicine (29%), medicine (20%), orthopaedics (18%) and geriatric medicine (16%). Most (53%) initially presented post a fall at home. Most frequent reason for ART referral (78%) was that the patient was discharging home not at their functional baseline but had potential to an achieve a specific goal(s) with further input (most frequently within domains of mobility indoors/outdoors, transfers, stairs and activities of daily living). Conclusion This is an effective pathway that improves the transition from hospital to home. ART offer patients an opportunity for further rehabilitation at home with continuity of care from the acute hospital. Future work will examine the impact of ART on length of stay, readmission rate and explore patient satisfaction with this service.