AHA delegation: A quality improvement activity for AHA lead group exercise programs in the low risk outpatient rural setting

Ry Darcy1, Monica Madrid1

1Queensland Health, Mareeba Hospital, Australia

Background: Rates of orthopaedic surgery are increasing nationally, impacting Physiotherapy referrals across sites and increasing wait times for Physiotherapy in rural areas. Larger centres have adopted group programs for postoperative orthopaedic outpatients in response to this demand. Supported by Queensland Department of Health as part of the Allied Health Rural Generalist Pathway strategy, Mareeba Hospital Physiotherapy Department aimed to investigate a more efficient rural service model. Does an Allied Health Assistant (AHA) lead lower limb orthopaedic group exercise program reduce wait list times in a rural hospital outpatient setting?

Method: During 2018 an AHA training package was developed to up-skill a rural AHA and ensure safe delegation of non-complex outpatients following a total hip replacement or total knee replacement. With supervision from a physiotherapist, an AHA lead a once-weekly outpatient orthopaedic group exercise program for a five-month trial.  There were nine participants during the trial period. The program was evaluated with pre/post comparison of qualitative and quantitative data.

Results: The project expanded on existing local AHA training by 33% (additional 8 competencies). Importantly, this has allowed the AHA to lead the group program with minimum input from the Physiotherapist, with 100% patient satisfaction reported. A comparison of the average number of referrals per month with the wait list times pre and post implementation, showed that the group program resulted in a net reduction in physiotherapy staffing input.

Discussion: The model for an AHA lead outpatient lower limb orthopedic group exercise program has been successful. A group setting increases access to therapy, and utilising an AHA to lead the program allows physiotherapist time to be released for other cases, supporting physiotherapy work capacity. Considering this, there may be capacity within the local service for increasing the range of AHA lead groups, which could include patients with other non-complicated lower limb surgery.


Ry D’Arcy is an early career physiotherapist with a passion for rural service provision, who graduated from James Cook University in 2016. Ry is one of the first physiotherapists to complete the level one Rural Generalist Training program, an important milestone for rural physiotherapy training in Queensland. Ry has played a key role within the service development project outlined within the abstract. Ry says that he has enjoyed taking on the service development project and looks forward to future opportunities. Ry continues to practice rurally in Mareeba District Hospital within the Cairns Hinterland Hospital and Health Service, Far North Queensland.

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