Lack of supports for complex rehab patients causes thousands of lost bed days

Delayed transfers of care led to 3,132 lost bed days at the National Rehabilitation Hospital (NRH) in Dún Laoghaire last year at a cost of €4.4 million, which was equivalent to 38 full programmes of rehabilitation. 

Bed days lost due to delayed transfers of care have averaged between 2,500 and 3,500 annually, according to a NRH spokesperson. 

The issues related primarily to availability of carers and home care supports for highly complex patients. “The NRH is actively working with the HSE to develop high complexity care pathways for patients with complex discharge planning needs,” the NRH’s spokesperson informed the Medical Independent. 

The average waiting period for inpatient admission to the NRH is 89 days. It is 66 days for outpatient consultant clinic appointments and 39 days for outpatient therapy appointments. 

As of early March 2022, 178 adults were waiting for admission to inpatient programmes; 21 children awaited admission to the paediatric inpatient programme; 3,417 adults were waiting for admission to outpatient consultant clinics; 332 adults were waiting for outpatient therapy appointments; and 209 children awaited admission to paediatric outpatient clinics. 

“Steps taken to reduce waiting times include face-to-face review by NRH consultants in the major acute hospitals (particularly Beaumont Hospital as the national neurosurgical centre and the Mater Hospital as the national spinal injuries centre) where the local medical team then avail of expert advice on managing patients awaiting admission to a specialist programme of rehabilitation,” outlined the NRH’s spokesperson. 

“The NRH clinical programmes also have dedicated liaison and outreach rehabilitation specialists who visit other hospitals around the country providing clinical guidance, education, and information to local medical teams, families, and community-based therapists on managing patients awaiting admission to the NRH. Patients awaiting admission are also reviewed by consultant-led multidisciplinary teams in outpatient clinics depending on the patients’ clinical needs.” 

The NRH also works in collaboration with rehabilitation facilities, such as the Royal Hospital Donnybrook and Peamount Healthcare, as part of managed clinical rehabilitation networks providing specialist input as the level one tertiary specialist rehabilitation centre. 

“The NRH is actively working with the HSE to further develop in-reach services into hospitals and outreach services provided by dedicated outreach teams, for people whose access to rehabilitation services was affected due to the pandemic,” added the spokesperson.