Limiting respiratory hospital admissions for children with neuromuscular disease (NMD): Home physiotherapy led model of care

Abstract

Introduction/Aim: Children with severe NMD often have frequent and lengthy hospital admissions for respiratory infections/compromise and require intensive physiotherapy intervention. The aim was to develop a post-acute care/hospital avoidance strategy to facilitate early discharge and keep children with NMD in their home environment safely. Method: Brisbane based NMD infants and children were referred to CHQatHome prior to discharge or via clinician review from January 2017. A Respiratory Physiotherapy Home Action plan was established in collaboration with the family, indicating the parameters for escalating care and contact information, with a physiotherapy visit within 24hrs. A 7-day service was provided with 1-2 sessions per day as needed. Therapists were able to Facetime colleagues from the patient's home to ensure timely access to review and facilitate continuity of care. Results: 8 children were referred, and data reviewed 12 months preand post- CHQatHome program engagement. Pre: Mean LOS 13 days, average admissions 1.75 per year & average ED presentations 2.9 per year Post: Mean LOS 8.67 days, average admissions 0.75 per year & average ED presentations 0.6 per year, CHQatHome Physiotherapy sessions average 7.75 per child per year Since implementation, 6 of the 8 children have had no unplanned admissions. One child with a complex social situation has accounted for four of the admissions. Feedback from families has been overwhelmingly positive. Conclusion: The risk of hospital acquired infections is significant in this patient group, as are as the costs associated with admissions. Using a proactive & individualised hospital avoidance strategy; LOS, DEM presentations and admissions for children with NMD reduced. Despite expected progression of disease, this cohort of children could be effectively managed at home. Due to the success of this model it has now been expanded to other patients with chronic complex respiratory conditions, with Action Plans utilised across Queensland to support and advise local services.L6269395992019-04-02 <br />