1Boonah Hospital, Australia
Background: Rural hospitals traditionally provide communities with local medical services and sub-acute care for patients transferring back from larger hospitals. These facilities are often located closer to home for patients, however they are also frequently subject to reduced access to allied health services, which play a vital role in the delivery of optimal care. Boonah hospital, a rural site in West Moreton Health, provides rehabilitation and sub-acute services. It was identified through service analysis that skill sharing and delegation of tasks between allied health and nursing staff could increase access to appropriate care in a more timely manner, decreasing length of stay and expediating achievement of patient centred functional goals. The model aimed to provide a 24/7 approach to functional rehabilitation through optimisation of professional scope of practice.
Method: The Calderdale Framework was utilised to facilitate re-design through service and task analysis. Clinical task instructions were identified and developed to provide theoretical and practical training for staff. Chart audits were completed pre- and post-implementation, along with analysis of Pi5, Hibiscus data and staff and patient experience surveys.
Results: Preliminary data indicates that formal skill sharing and delegation practices are valued by staff and allow them to work more effectively. Optimisation of nursing staff scope of practice has enabled functional assessment and meaningful intervention in a more timely and intense manner. Implementation of Clinical Task Instructions has increased staff confidence to perform tasks and documentation reflects more meaningful assessment and comprehensive documentation skills. Further data analysis is required to determine impact on patient satisfaction, LOS and performance indicators.
Discussion: The ongoing challenge to provide effective healthcare within an environment of restricted resources requires sustainable models of care. A transdisciplinary model is proving to be successful in maintaining high standards of care while increasing efficiency within existing resources.
Kathryn Costello is a senior physiotherapist working currently as a rural generalist at Boonah hospital. She has had experience working across the continuum of inpatient, outpatient and community services within QLD health and has a passion for rehabilitation and improving the access and quality of care to rural patients.