Integrated systems, interdisciplinary teams, full scope practice and delegation to deliver better value healthcare? A SIMPLE case for change

Dr Jack Bell1,2, Dr Adrienne Young1, Jan Hill3, Dr Merrilyn Banks1, a/Prof Tracy Comans2, Rhiannon Barnes4, Professor Heather  Keller5

1Metro North HHS, , , 2The University of Queensland, , , 3Metro South HHS, , , 4Queensland Health, , , 5University of Waterloo and Schlegel Reseach Institute, , Canada

Aim: A paradigm shift is required to manage increasing patient throughput and demand on allied health services in acute hospitals. Systematised, Interdisciplinary Malnutrition Program Implementation and Evaluation (SIMPLE) aims to provide better nutritional care to hospital inpatients without increased dietetic resources. This study describes quantitative findings associated with implementing the SIMPLE approach to managing malnutrition in six Queensland hospitals, and provides a case example for successful interdisciplinary and delegated models of care reform.

Methods: A multisite before-and-after design to evaluate the impact of SIMPLE program implementation across 6 Queensland hospitals. A combination of systematised, interdisciplinary and delegated nutrition care interventions were tailored to fit individual sites using a facilitated implementation science approach. Documented and observed practices were audited and used with patient reported outcomes to evaluate success.

Results: Audit data was available for 1036 patients (median 72 years, male 52.9%, malnutrition risk of 44.6%). Preliminary findings for 5 sites compared nutritionally at-risk patients audited at baseline (n=168) with at-risk patients audited 5-6 months after SIMPLE implementation (n=174). Significantly improved inpatient food and nutrient delivery (67.9 versus 83.9%; χ(1) 12.081, p=0.001) and coordination of care (45.8 versus 57.5%; χ(1) 4.636, p=0.031) processes were observed following early implementation of the new model. A non-significant improvement was observed for nutrition education processes (44.0 versus 52.9%; χ(1) 2.666, p=0.103). No additional clinical funding was provided and there was no significant increase in median dietitian occasions of service associated with implementation (p=0.686). Trends towards increased delegation to assistant staff were also observed (p=0.082).

Conclusions: Shifting to a model of care that supports integrated, systems based approaches, healthcare teams working together, full scope of practice, and appropriate delegation improves audited and patient reported outcomes. When this is delivered without an increase in clinical funding, this equals better value healthcare and makes a SIMPLE case for change.

(This study was supported with grants from the Allied Health Professions Office of Queensland, and The Australian Centre For Health Services Innovation (AusHSI))


Dr Bell is an advanced dietitian, a conjoint Principal Research Fellow with University of Queensland and Metro North Hospital Health Service, and a current MRFF TRIP Fellow. As an implementation scientist Jack currently works with teams across Queensland and Canada to implement systematised, interdisciplinary malnutrition care in hospitals. As a member of the Queensland Clinical Senate and Metro North Clinical Council Jack advocates for high value healthcare and better work/life balance.

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