Alfred Health News

Alfred Health's new Acquired Brain Injury (ABI) Unit has had an "extraordinary" first six months, discharging patients who previously had no hope of reintegrating into the community in the short-term.

The ABI Rehabilitation Centre, based at Caulfield Hospital, opened in September 2014 and is a statewide service for moderate to severe brain injury.

Opening in stages, there are currently 33 patients in the unit. Demand for the service is strong and its 42 beds are expected to be filled by the middle of the year.

Associate Professor Peter Hunter, Director Rehabilitation, Aged & Community Care - Alfred Health, says the service has achieved a series of ‘firsts'.

"We have a new group of patients, a new approach on how to care for people with ABI early on and we're providing higher level clinical care - some still have a tracheostomy tube to help them breathe," A/Prof Hunter said.

Clinical lead, ABI Rehabilitation Service Dr Mithu Palit says 40 patients have been discharged so far, with the intensive rehabilitation making a remarkable difference to patients' ability to do daily tasks.

"We've developed a ward up from scratch and we're doing what's never been done before," Dr Palit said.

"There have been a range of patients go through the unit, a mix of male and female, aged between 16 and 78.

"Our patients typically have difficult behaviours due to their conditions, which sets challenging scenarios both clinically and behaviourally.

"One patient who we just discharged home after five months had spent two years in the hospital system, unable to be discharged. He would have required care from two people around the clock. Our task was to reduce his erratic behaviour to a manageable level so he could live in the community.  We achieved that. Now I call that a success."

Commonly, people have acquired a brain injury through car accidents, drug overdoses and some have a dual diagnosis of psychiatric illness along with brain injury.

Nurse manager ABI inpatient unit Katrina Neave leads a large team.

"We now have 50 plus EFT for nursing and 50 plus for Allied Health plus five medical staff. To deliver fantastic outcomes so early is brilliant," she said.

"We have a psychiatric team and all our staff are involved in behavioural management plans. Plus there is a concentration on achieving functional and cognitive goals. Sometimes therapeutic care involves reading to the patient. This can calm patients before we move on to traditional therapy or personal care.

"It is patient and family directed - they lead the care."

A/Prof Hunter adds: "Our service is all about active rehabilitation.

"We toured the world to learn about the best aspects of ABI care and we've implemented that here. It's a unique service for Australia, not just the state.

"Added to that we're collecting data as we go along, in line with a multitude of research projects. That data will be a valuable resource for the whole of Victoria." 

Special design features a success

The centre does has a homely atmosphere. A great deal of time was spent ensuring the design was just right.  Each room has a window seat, ensuites and are designed to not look clinical, so the oxygen and medical paraphernalia is tucked away. The centre has courtyard areas that include a barbecue, basketball hoop, ping pong table and garden therapy area where patients are tending tomatoes, cucumber, parsley and chillies.

"Our goal is for patients to do tasks that are real life specific - we want them to spend an extended time standing and that's what you naturally do when you're by the bbq. That way you reach the therapy goals but it's contextualised in an enriched environment," Dr Palit added.

A low stimulation area with low lighting, darker films on the windows and more sound-proofing has proved effective for highly agitated patients.

"They often come to us from an acute setting in four bed wards and highly stimulated area. They come into this area with a vast reduction of stimulus and they settle within hours," Ms Neave said.

The other focus has been on family, ensuring family is a large part of the rehabilitation process. An emphasis is put on families ensuring they also look after themselves, with a family lounge that is a patient and staff free zone. Here families can prepare a snack, watch TV, let the kids play with toys or take time out while visiting.

Special features are a highlight of the Centre. The basketball hoop can be wound down to suit those in wheelchairs, the kitchen cupboards in the therapy kitchen can be lowered to match the height of home cupboards. Group participation is encouraged, with communal dining all part of the plan to work towards normal, daily life.

When patients are almost ready to be discharged, they move into a corner of the building that has its own kitchen and laundry. Family cares come with them and do a ‘trial of care work'.

"They help the patient out as required - it's like a practice run before they go, in a supported way. We had some families who perhaps didn't fully understand the level of dependency and care their relative required. After a weekend trial, they were able to take the patient home successfully. Nowhere else has this kind of facility; it's amazing," Ms Neave added.