16 Reducing readmissions from an amputee rehabilitation unit (ARU) to accident and emergency: an MDT approach to service improvement

<h3>Background</h3> The ARU is a 12-bed therapy led unit based in London, specialising in post-amputation rehabilitation following hospital discharge. This project focuses on minimising acute readmissions to hospital in the multi-morbid vascular population, aiming to better control diabetes and reduce smoking, risk factors for wound infections and readmissions. <h3>Aims</h3> To quantify the rate of readmission from ARU to hospital, compared to national data; to identify a primary cause of readmission and subsequently to enact targeted interventions to be re-audited in six months. <h3>Methods</h3> Data was retrospectively collected from all ARU admissions between 01/06/2023 and 31/12/2023; a total of 57 patients identified using internally recorded admission records and data sourced manually from inpatient notes on the electronic systems. The MDT approach to interventions included: working with the local vascular hub to promote wound care post-operatively, adapt admission criteria to ensure clinical optimisation prior to transfer, embedding health promotion education into therapy and implementing a wound focused admission checklist that includes photography and swabbing of wounds at regular intervals <h3>Results</h3> Of the 57 ARU patients admitted, many amputations sequalae of uncontrolled diabetes, there were 12 re-admissions between 9 patients. The primary cause of readmissions was wound infections, with 8/12 (66.7%) originating from a stump wound. Of the 8 wound infections, re-admissions were more common in the first 14 days (5/8), those transferred sooner post-operatively (mean 22.6 days vs 39.0 days) and in those with transtibial amputations (83%). Every patient readmitted had a key co-morbidity associated with poor wound healing, 83% were diabetic and 33% smokers. 8.8% of the 12 re-admissions required surgical re-intervention. <h3>Conclusion</h3> Despite significantly lower readmission, wound infection, and revision surgery rates than expected, the project highlights areas for service improvement, as outlined in methods implemented. This data will be re-audited in 6 months.