Table 3 Estimated staff input for RITH for reconditioning programs
From: Cost modelling rehabilitation in the home for reconditioning in the Australian context
Occasions Of Service (“OOS”) and other clinical events per RITH reconditioning episode | ||||||
|---|---|---|---|---|---|---|
OOS per Episode by AN-SNAP Class | Assumptions and Information Sources | |||||
4AR1 | 4AR2 | 4AR3 | 4AR4 | Weighted Averagea | ||
Allied health staff | ||||||
Physiotherapist | 6.0 | 7.3 | 7.8 | 9.5 | 7.0 | - Allied Health staff mix and allied health OOS are derived from: the consensus view of the clinical co-investigators; the AFRM Inpatient Standards (2019) [19] and the AFRM Ambulatory Standards (2014) [20] for the Reconditioning impairment type; and allied health staff type by impairment group for reconditioning reported in the AROC Ambulatory Report 2021 [21] - From the above sources, we have derived and assumed percentage of allied health time as: Physiotherapist (30%); Allied Health Assistant (AHA) (20%); Occupational Therapist (20%); Exercise Physiologist (20%); Dietician (10%). Changes in allied health staff mix percentages, except for the proportion of allied health assistant input, will not materially impact the cost of providing RITH (shown in Tables 4 and 5) as allied health staff are costed the same, except for AHA’s who are costed less - From the above sources, two allied health sessions per day, for 6 of 7 days per week (with the weekend day being a Saturday) are assumed, resulting in an average of 1.7 allied health sessions per day over 7 days - We have assumed that each allied health OOS is 60 min with the patient, plus 30 min to allow visit preparation and documentation, plus 40 min of travel time (total staff resource investment of 130 min per OOS) - We have assumed that if a patient required social work or psychology input, these could be substituted for other clinical sessions - We have costed all allied health occasions of service as face-to-face, although it may be possible that some could occur via telerehabilitation - Based on the consensus view of the clinical co-investigators, an average of one weekly rehabilitation physician review (which could be by telehealth), is assumed, of 45 min duration plus 30 min preparation, documentation, and medical correspondence time (total of 75 min per OOS). An initial rehabilitation physician assessment in the acute hospital is not costed as we consider this predates the commencement of RITH - Published sources to assist in the determination of nursing and clinical case management OOS in RITH are limited. Based on the consensus view of the clinical co-investigators, an average of one OOS per week of nursing and two OOS per week of clinical case management is assumed, with each OOS comprising 60 min with the patient plus 30 min preparation and documentation time plus 40 min travel (i.e., 130 min per OOS) - It is recognised that some RITH for reconditioning patients might require greater nursing support, in which case a rehabilitation nurse can be designated the clinical case manager. There will be no material variation in the cost of RITH if the clinical case manager is a rehabilitation nurse or an allied health professional as both staff are costed at the same hourly rate - Based on the consensus view of the clinical co-investigators, allowance is made for one case conference per week for five clinical staff, including the rehabilitation physician; and daily MDT huddles on other weekdays. The duration of a case conference is assumed to be 15 min; the MDT huddles during the week are considered to be cost equivalent to one case conference - Based on the consensus view of the clinical co-investigators, allowance is made for two ‘planning/case coordination events’ per week to account for such things as rostering of staff, liaison with patients regarding appointments, organising case conferences, and other ad hoc administrative and reporting tasks to support RITH, communicating with patients, carers and family members about progress, liaising with and organising in-home community support services and arranging equipment. Each planning event is costed at 120 min of clinical staff time |
Allied Health Assistant (AHA) | 4.0 | 4.8 | 5.2 | 6.3 | 4.6 | |
Occupational Therapist | 4.0 | 4.8 | 5.2 | 6.3 | 4.6 | |
Exercise physiologist | 4.0 | 4.8 | 5.2 | 6.3 | 4.6 | |
Dietician | 2.0 | 2.4 | 2.6 | 3.2 | 2.3 | |
Allied Health OOS per episode | 20.1 | 24.2 | 26.1 | 31.7 | 23.2 | |
Allied Health OOS per day | 1.7 | 1.7 | 1.7 | 1.7 | 1.7 | |
Other clinical staff | ||||||
Rehabilitation Physician | 1.7 | 2.0 | 2.2 | 2.6 | 1.9 | |
Registered Nurse/Rehabilitation nurse | 1.7 | 2.0 | 2.2 | 2.6 | 1.9 | |
Clinical case manager | 3.3 | 4.0 | 4.3 | 5.3 | 3.9 | |
Other Clinical OOS per episode | 6.7 | 8.1 | 8.7 | 10.6 | 7.7 | |
Total clinical staff | ||||||
Total Clinical OOS per episodeb | 26.7 | 32.2 | 34.7 | 42.3 | 31.0 | |
Total Clinical OOS per dayc | 2.3 | 2.3 | 2.3 | 2.3 | 2.3 | |
Other clinical events | ||||||
Case conferences/MDT huddle | 3.3 | 4.0 | 4.3 | 5.3 | 3.9 | |
Clinicians per case conference/MDT huddle | 5.0 | |||||
Planning/case coordination events per episode | 3.3 | 4.0 | 4.3 | 5.3 | 3.9 | |
Average Length of Stay (ALOS) per episoded | 11.7 | 14.1 | 15.2 | 18.5 | 13.6 | |