Objective: To establish a Parkinson’s (PD) rapid therapy service offering in-reach to wards and outreach into the community. The aim is to improve overall care, reduce length of stay (LoS), unplanned admissions and readmissions and offer education and support for non-specialist allied health professionals (AHPs).

Background: PD falls into the Health Foundation “high-cost, high-need” category with mean expenditure 20 times greater per patient annually (1), higher risk of unplanned admission, readmission, and longer LoS (2,3). In 2020/21 there were 1270 unplanned PD admissions in our Trust (4 hospitals), 230 due to falls (4). Over a 6-month period at the largest hospital there were an average of 31 unplanned admissions per month with LoS averaging 14 days and falls the biggest cause of these admissions.

Method: In 2023 Parkinson’s UK launched a scheme to “pump prime” novel AHP posts. The charity funds the posts for the first 2 years and the hospital funds thereafter. A successful application led to a physiotherapist and occupational therapist being appointed to develop the Parkinson’s Rapid Advisory & Intervention Service (PRAIS). In the first 3 months they have set up the service, provided in-reach to wards, supported early discharge, and provided education and joint therapy sessions to ward staff. Post-discharge phone calls ensure patients are managing at home. They have conducted home visits and referred/signposted to community or outpatient therapy teams for ongoing intervention. They have supported patients experiencing a Parkinson’s-related crisis at home (attempting to avoid admission) and liaised with community teams offering education, advice and joint home visit sessions for complex patient support.

Results: PRAIS is still in early development but intervention has been welcomed by patients, ward and community teams. Comments include: “They have supported with a complex patient on the ward, given us advice and support we can implement with the patient and nursing staff. It has benefitted the patient and PRAIS input has adapted the way I as an OT approach certain cognitive tasks”, and “knowledgeable, supportive & friendly team -willing to support staff & keep in regular contact with ward therapy team”.

Conclusion: Support and training are welcomed by patients, ward and community teams and we expect PRAIS data will demonstrate better outcomes for PD patients, shorter LoS and reduced admissions and readmissions.

References: 1. Dreyer K, Parry W et al. The Health Foundation: A descriptive analysis of health care use by high-cost, high-need patients in England
2. Shahgholi L, De Jesus S, Wu SS, Pei Q, Hassan A, Armstrong MJ, Martinez-Ramirez D, Schmidt P, Okun MS. Hospitalization and rehospitalization in Parkinson disease patients: Data from the National Parkinson Foundation Centers of Excellence. PLoS One. 2017 Jul 6;12(7):e0180425. doi: 10.1371/journal.pone.0180425. PMID: 28683150; PMCID: PMC5500337.
3. Low V, Ben-Shlomo et al. Measuring the burden and mortality of hospitalisation in Parkinson’s disease: A cross-sectional analysis of the English Hospital Episodes Statistics database 2009–2013. February 16, 2015
4. https://parkinsonsuk.hsj.co.uk/spend-hospital-admissions-people-parkinsons

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