The Geriatric Rehabilitation And Care Enhancement Pilot (GRACE)

Introduction

The GRACE initiative was a pilot designed to enhance inpatient experience of older adults.  Proportionate moving and handling techniques were introduced as well as increasing the number of therapy staff on a ward reducing reliance on multiple staff for routine ward care. We aimed to improve patients’ functional independence and prevent deconditioning.

Methods

A ward of 26 patients was chosen with a control comparison and nursing staff were upskilled in proportionate manual handling. For 4 weeks, therapy staffing was increased from 2 therapists to 4 and patients given additional therapy input. Standard therapy and nursing care was provided for the control. All patients were included to receive additional input excluding those medically unstable or end of life. Data was collected from both wards including length of stay (LOS), grip strength, gait speed, 4AT, AMTS and TOM’s as well as predicted vs actual discharge pathways.

Results

Throughout the 4-weeks, 150 patients were reviewed across both wards (74 enhanced, 76 control). Enhanced-ward patients improved their cognitive outcome scores (28%) compared to control (22%). 72% of enhanced ward maintained or improved grip strength compared to 55% of control. Average LOS from medically optimised for discharge to actual discharge was reduced by 0.5 days for enhanced-ward patients and 83% maintained or improved on predicted discharge pathways compared to 78% on the control. Staff and patient feedback was positive with no adverse safety incidents.

Conclusion

This pilot demonstrates an optimised model of care that enhances experience of older adult inpatients. By implementing proportionate care techniques and increasing the volume of therapists, patients demonstrated maintained or improved cognitive and physical scores, required the same level of care or less on discharge and LOS reduced. Next steps involve expanding internally with sustained investment, and further research into models of care that reinforce inpatient rehabilitative care.