Patients as teachers: Communication skills training for health professionals. Improving the healthcare experience for consumers with communication disability through the development and delivery of an e-learning and face to face training package for health professionals that uses people with communication disability as content experts and educators

Ms Ruth Townsend1, Ms Kathryn  McKinley2, Ms Joanne Sweeney1

1Austin Health, Melbourne, Australia, 2St Vincent’s Hospital Melbourne, Melbourne, Australia

Background: People with communication disability experience barriers to participation in healthcare decision making (O’Halloran, Hickson & Worrall, 2008) and are at increased risk of medical error and poorer health outcomes (O’Halloran at el, 2008; Patak et al, 2009). All healthcare consumers, including those with communication disability, have a right to participate in conversations about their own healthcare.

For the past five years St Vincent’s Hospital and Austin Health have been training health professionals and students to communicate with people with communication disability using an international program from Toronto, Canada (SCAtm). There are currently no known Australian communication skills training programs that have been developed with and are delivered by people with communication disability.

Aims: To improve the healthcare experience for consumers with communication disability through the development and delivery of an e-learning and face to face training package for health professionals that uses people with communication disability as content experts and educators. To improve the skill and confidence of healthcare professionals when communicating with people with communication disability.

Method: Consumers with communication disability were involved in all aspects of the project including steering committee, curriculum development and delivery of training. The project leads coordinated curriculum development and production of videos of healthcare conversations. The package was trialled at each organisation and evaluations completed.

Results: The project remains underway with an expected completion date mid-2019.

Conclusions: An Australian training package, available 24/7, has been developed targeting the communication skills of healthcare professionals. Consumers were partners in designing, building and delivering this training package that empowers busy clinicians working in hospitals to support people with communication disability.

Key words: communication disability; collaboration; healthcare; communication skills training; consumers as teachers, partner conversation training, e-learning

Financial disclosure: This project was supported by a Practice Partner’s Program grant offered by the Health Issues Centre, Victoria.


Biography:

Kathryn Mckinley

Kathryn is a speech pathologist, clinical lecturer and researcher. She is the Speech Pathology Manager at St Vincent’s Hospital Melbourne and a clinical lecturer at the University of Melbourne. Kathryn teaches communication skills to speech pathology students at the UoM and to health professionals. She has undertaken facilitator training locally and in Dublin and Toronto. Kathryn is passionate about communication, health literacy and communication skills training, particularly for patients and residents who may be more vulnerable as a result of their communication difficulties.

Ruth Townsend

Ruth is a speech pathologist and clinical lead across Continuing Care Services at Austin Health, Melbourne. Ruth has extensive experience working in adult rehabilitation including ABI, Stroke, TBI and dual diagnosis (mental health and ABI). Ruth provides communication skills training to speech pathology students at Latrobe University and to health professionals working at Austin Health and the RMTV program (Rehabilitation Medicine Training Victoria). Ruth has completed communication skills facilitator training in Toronto, Canada and is committed to empowering health professionals to learn how to better support people with communication disability.

An exploration of Social Work best practice in the emergency department of a leading trauma hospitals

Sharon Wells1, Joanne Maret1

1Royal Melbourne Hospital, Melbourne, Australia, 2Royal Melbourne Institute of Technology, Melbourne, Australia

Best practice Social Work includes timely, client-centred and strength-based interventions and processes. With little published research on Social Work services in response to major traumas in ED settings, this study explored current Social Work practice in this context.

Aim: Best practice Social Work includes timely, client-centred and strength-based interventions and processes. With little published research on Social Work services in response to major traumas in ED settings, this study aims to explore current Social Work practice in this context. This research considered Social Work best practice through an examination of the role, hours of service, interventions, and processes in Emergency Department Trauma Team Activations (TTA).

 

Method: A literature review informed the research, with benchmarking  including a mixed-method, cross-sectional survey and interviews of senior Social Workers from nine major trauma hospitals in Australia.

Results

  • Social Work service standards were associated with: 24-hour Social Work service provision; mean EFT of 4; formalised referral and assessment processes; continuity of care.
  • The hours of Social Work service, and number of rostered professionals however, did not always correspond to peak times, or the numbers of ED presentations.
  • Data analysis highlighted the high rates of major trauma and bereavement in ED, and specialist Social Work involvement in crisis-intervention, psychological first aid and bereavement support.

Significance: Published studies indicate the significant immediate and long-term psychosocial impacts of major trauma on the lives of patients and families. Social Workers are equipped with a specialised skill set to mitigate these effects.

This study found a mismatch between the peak times of major traumas, and Social Work service provision, suggesting a risk for patient and family outcomes, as well as placing an additional burden on medical teams.

The research highlights the need for a dedicated and specialist Social Work service in ED to respond to traumas and bereavements, that reflects critical times of traumas, and ensures the competing critical duty of care needs in ED (child protection and family violence) are not compromised.


Biography:

Sharon Wells is a graduate of Master of Social Work (RMIT). With a background in Strategic Management and Communications, Sharon has initiated social and cultural change projects including the protection and enhancement of significant Aboriginal cultural heritage sites. Joanne Maret has recently completed a Bachelor of Social Work (Honours) and Psychology. With previous experience in the homelessness sector, Joanne has worked on relevant projects including Rooming House Closure Projects and her Honours research.  Sharon and Joanne jointly undertook a research placement at the Royal Melbourne Hospital examining the role of Social Work in response to major traumas in Emergency Departments.

Health service needs (swallowing, nutrition and psychosocial) and personal perceptions of patients attending the Ipswich Hospital Head and Neck Multidisciplinary Clinic. A sub-study of “Does an electronic screening, nutrition and distress screening tool capture those patients and carers who need face-to-face intervention during treatment for head and neck cancer”

Ms Erin  Lawlor1, Ms Kathleen  Dwyer1, Dr Bena Cartmill2,3,4, Prof Elizabeth Ward2,3, Ms Laurelie Wall2,3

1Ipswich Hospital, West Moreton Hospital And Health Service, Ipswich, Australia, 2School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia, 3Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland Health, Brisbane, Australia, 4Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, Australia

National and international cancer agencies have recommended regular involvement of allied health professionals to provide supportive care before, during, and following treatment for head and neck cancer. Currently at Ipswich Hospital (IPH) Head and Neck Cancer (HNC) Multidisciplinary (MDT) Clinic, there is limited opportunity for swallow, nutrition and psychosocial screening and as such, minimal early referral for allied health support. As a result, many patients are unable to access best-practice care. In order to improve this, alternative models of service delivery are required to ensure high risk head and neck cancer patients have optimal access to supportive assessment and intervention for swallowing and nutritional deficits within current staffing and service constraints.

The purpose of this project is to:

  • Perform an analysis of patient health service needs (particularly swallowing, nutrition and psychosocial) at presentation to the HNC MDT Clinic.
  • Explore patient experience when attending the HNC MDT. This will more broadly investigate patient perceptions of the clinic.

The study is being conducted in collaboration with Metro South Hospital and Health Service (MSHHS). A cross-sectional sample of patients diagnosed with HNC and attending the MDT will be eligible to participate. Patients will be excluded if they have severe cognitive deficits, non-English reading/writing, significant vision, or hearing or physical dexterity impairments which would limit their ability to participate.

Participants will be invited to complete a health needs assessment screening tool upon arrival to the HNC MDT. Following the HNC MDT, participants will be asked about their experience and perception of attending. This will include completing the Australian Hospital Patient Experience Question Set (AHPEQS) and a series of ad hoc interview questions.

The results of this study will inform IPH HNC MDT on the health service needs and perceptions of its patient population, and help to direct future service delivery accordingly.


Biography:

Erin Lawlor is an advanced clinical speech pathologist in the acute and outpatient setting at Ipswich Hospital. She has worked across regional, tertiary and quaternary hospital settings in Australia and the United Kingdom. Currently Erin is the Principle Investigator for the project. She has a keen interest in research that is applicable to the clinical setting and patient experience.

Kathleen Dwyer is a Senior Dietitian in cancer care at Ipswich Hospital. Kathleen has a special interest in best practise medical nutrition therapy in head and neck cancer, and has previously worked in radiation and medical oncology, head and neck surgery and multidisciplinary meetings at the Royal Brisbane and Women’s Hospital, Southampton Hospital (United Kingdom) and Nambour General Hospital.

Sensory Training for Arousal Recovery by a Transdisciplinary Team (STARTT) for people with severe brain injury

Chantelle Bowles

1Brighton Brain Injury Service,

With advances in medicine, more young adults with severe brain injury with profound disturbances of consciousness are surviving and requiring rehabilitation. Currently, there are no published rehabilitation guidelines for clinicians to draw upon in their practice with this population.

To address this gap, the Brighton Brain Injury multidisciplinary team completed a comprehensive literature review into intervention to increase arousal in patients with severe brain injury. Consequently, the STARTT program was developed to integrate best practice into a coherent program.

STARTT develops individualised programs based around recorded familiar auditory stimulation. A family member retells a shared memory and the team adds referenced music, visual, somatosensory, olfactory and gustatory stimulation appropriate to the client’s needs. The program is prescribed by a multidisciplinary team, including Occupational Therapist, Speech Pathologist, Physiotherapist, Music Therapist, and Psychologist, as each participant will require varying degrees of stimulus within each sensory domain. This creates a personally relevant, enriched sensory experience which is then delivered intensively by team members and, where appropriate, by trained family members. STARTT streamlines intervention processes and increases staff capacity to deliver therapy by integrating goals.

To date, three patients have participated in the pilot program and will be presented as case studies illustrating STARTT and showing initial results. All three participants started the program at a minimally conscious state and have since emerged. Outcome measures include arousal, functional recovery, and goal attainment scale (GAS). Sustainability of the program in the workplace is being currently measured, with measures including staff surveys and family surveys. Funding has been recently sourced to ensure the program is sustainable as part of standard care and for gathering of sufficient clinical data to inform a single case study design research project for publication.


Biography: To be confirmed

Animal assisted therapy in a paediatric urban Indigenous health setting

Mrs Ashley Potgieter1

1The Institute For Urban Indigenous Health, Brisbane, Australia

Background: Animal Assisted Therapy (AAT) has long been recognised as a valuable tool to engage clients and provide physical, social and emotional outcomes. AAT can help clients with supporting their ability to regulate emotions, improve motivation to participate, hand function and can decrease hyperactivity behaviours (Elmaci, & Cevizci, 2015). The Institute for Urban Indigenous Health (IUIH) has established a System of Care, which guides the operation of the organisations services to ensure that we are being culturally responsive in all activities that are undertaken. This presentation will provide an overview of AAT and how it has been used in a culturally responsive manner within this setting.

Method: The IUIH Allied Health team utilise an inter-professional approach where possible when working with Aboriginal and Torres Strait Islander clients. A certified therapy dog has attended Aboriginal and Torres Strait Islander Community Controlled Health Clinics in South East Queensland to provide Animal Assisted Therapy services to children and their families within this inter-professional service delivery model.  Examples of integrating AAT within an IP team will be provided including de-identified case studies to demonstrate the effectiveness of this intervention. Client outcomes are measured using the Australian Therapy Outcome Measure for Indigenous Clients (ATOMIC).

Discussion: The incorporation of a therapy dog has complemented using a yarning approach and has assisted clinicians to build connections with clients, the foundation for intervention. Since using this approach, client attendance has improved, and findings from outcome measures indicate that within sessions, clients are more relaxed and motivated to engage.

Reference

Elmaci, D, & Cevizci, S. (2015). Dog-assisted therapies and activities in rehabilitation of children with cerebral palsy and physical and mental disabilities. International Journal of Environmental Research and Public Health, 12(5), 5046-5060.


Biography:

Ashley Potgieter is an Occupational Therapist currently working at The Institute for Urban Indigenous Health. She graduated from the University of Queensland in 2013 as an Occupational Therapist (B.Occ Thy), and completed further post graduate study MAdv Occ Thy. She completed Animal Assisted Therapy training in 2016 and has since worked in a variety of settings using this approach. Ashley started working with the Institute in 2017 and is committed to helping First Australians to improve health outcomes. She values working in a multidisciplinary team with Aboriginal and Torres Strait Islander children and their families, as well as working with adults.

Creating new pharmacy services at a large tertiary hospital

Mrs Estelle Jensen1, Ms Victoria Forrester1

1Queensland Health, Brisbane, Australia

Background: Pharmacists provide essential patient safety services and provide large financial benefits through medication management. The Princess Alexandra Hospital has created five trial senior (HP4) pharmacist positions over the last two years. These roles have arisen in areas without previous pharmacy services due to medication incidents, requests from nursing or medical staff for a clinical pharmacy service, and successful projects established at other sites. The new roles are: Perioperative, Security and Prisoners (“Security”), Transit Care Hub and Patient Flow (“Transit”), Ophthalmology Outpatient Clinic and Transplant Outpatient Clinic. Innovative pharmacist roles offer opportunities to improve services and expand pharmacy scope, but can be challenging to establish.

Method: When a new service was suggested, key stakeholders were engaged and reportable outcomes for the position were identified. Other sites with similar positions were also consulted. Stakeholder committees containing pharmacists, nurses and doctors were established to provide strategic direction for the role and to get initial business case funding. The successful candidates presented periodic progress reports to the stakeholder committee throughout the trial. Final reports were prepared and presented to the hospital’s Executive Committee midway and at completion of the trials. Business cases for permanent funding were submitted at the conclusion of the trial period.

Results: Three of the roles have received permanent funding: Perioperative, Transit and Security. Annual cost savings that offset the expense of the position were demonstrated for the first two; $279,785 and $265,198 respectively. The Security role has improved safety for correctional patients, reduced readmissions and provided cost savings to the ward. The other two roles are still in trial periods.

Conclusion: Innovative pharmacist roles optimise patient safety outside of traditional inpatient wards and upskill the pharmacy workforce. Collaboration and strategic direction are imperative to the success of establishing these roles.


Biography: To be confirmed

Neuromotor and functional performance of older men with and without pre-sarcopenia

Dr Sean Horan1,2, Mr Blayne Arnold1, Dr Benjamin Weeks1,2, Dr Justin Kavanagh1,2

1School of Allied Health Sciences, Griffith University, Gold Coast, Australia, 2Menzies Health Institute Queensland, , Australia

Introduction: Skeletal muscle mass increases over the first three decades of life, declines steadily through middle age, and more rapidly in older age. Sarcopenia describes a condition of significant loss of muscle mass in conjunction with reduced strength and function. While the changes in mass, strength and function across the lifespan are well-documented, little is known of the underlying mechanisms. This work sort to examine the neuromotor mechanisms that underpin changes in muscles mass and function in older men.

Methods: Twenty-one older men (74.8 ±4.9yrs; height: 174.4 ±6.5cm; 84.3 ±11.4kg) and 10 younger men (26.4 ±4.2yrs; height: 178.8 ±7.8cm; 75.9 ±11.1kg) were recruited. Muscle and fat mass were determined by DXA (Norland XR-800, USA). Functional performance was examined with isometric knee extension, timed-up-and-go (TUG), 5-times sit-to-stand (5TSTS), and self-selected gait speed. Neuromotor measures included Level of Voluntary Activation (LoVA; 20%, 40%, 60% 80%, MVC) during a plantar flexion task, using tibial nerve stimulation. Plantar and dorsi flexor force were recorded, as well as muscle activity using EMG.

Results: Three older men were classified with pre-sarcopenia based on DXA-derived measures of appendicular lean mass (<6.8kg/m2). No differences in LoVA were observed between young men, older men, and older men with pre-sarcopenia (YM: 20%=17.6, 40%=50.7, 60%=82.9, 80%=93.8, 100%=96.7; OM: 20%=20.5, 40%=56.3, 60%=81.3, 80%=93.1, 100%=95.5; PS: 20%=23.7, 40%=58.0, 60%=81.9, 80%=93.9, 100%=96.1). Although not significant, pre-sarcopenic men achieved the lowest dorsi flexor (YM=40.5N; OM=33.0N; PS=25.1N), plantar flexor (YM=154.5N; OM=106.7.0N; PS=70.8N), and knee extensor forces (YM=841.7N; OM=509.2N; PS=361.0N). No differences in functional performance measures were observed.

Discussion: These preliminary findings suggest that older men with pre-sarcopenia maintain functional abilities and demonstrate similar levels of voluntary muscle activation to healthy men despite apparent deficits in strength. Recruitment is ongoing and further work will examine neuromotor characteristics in response to fatigue and muscle inhibition.

Acknowledgements: This work was supported by a Physiotherapy Research Fellowship from the Health Innovation, Investment, and Research Office, Queensland Health.


Biography:

Sean Horan is a Senior Lecturer at Griffith University on the Gold Coast, Queensland. Sean teaches musculoskeletal physiotherapy into both the undergraduate and postgraduate physiotherapy programs at Griffith. His key research areas of interest include the neuromotor mechanisms underlying the development of sarcopenia; the development of exercise interventions aimed at slowing or reversing the effects of osteoporosis; and the examination of the effects of surgical and physical activity interventions on paediatric muscuolskeletal conditions of the feet and lower limbs.

Realising the benefits and avoiding the pitfalls of automation: A state-wide clinical service delivery initiative

Dr Rachel Brough1, Ms Kristen Morris1

1Medical Aids Subsidy Scheme – Queensland Health, Cannon Hill, Australia

This presentation gives an overview of the allied health team’s role in developing eApply, an online application system now in use at Medical Aids Subsidy Scheme (MASS).

eApply was developed to improve the efficiency of the assistive technology (AT) application process at MASS for:

  1. Prescribing therapists, by eliminating the ability to accidentally omit key information and providing a user-friendly interface that reduces completion time of applications
  2. MASS, by replacing manual checking of form data with automated algorithms and reducing the number of applications requiring clinical review
  3. Clients, by tracking their own application progress and reducing delays.

A critical success factor for the project was the involvement of the allied health team in all stages of development, from specifying requirements to the vendor, through to supervision of testing and acceptance of the system. Clinical judgement was essential in determining where automation is effective, and where it is not realistic.

The allied health team conducted a systematic review of clinical work flow processes and developed written specifications for these. The review and specifications document were incorporated into the design of eApply by the program vendor through a process of collaborative development and testing.

The allied health team also played an important role in organisation change management, helping staff at MASS navigate the perceived threat that automation poses to job security.

Implementation of the eApply online application resulted in improvement in both internal and external processing times of applications. The project also resulted in identifying other areas of work practices that could be improved as well as increased opportunities to focus on other areas of work for all staff.

The process of involving the allied health team in the lifecycle of the project to translate clinical decision making can be applied by other organisations interested in converting aspects of clinical practice into a digital system.


Biography: To be confirmed

The R.A.C.E. to prevent falls

Maidei Machina1

1Westmead Hospital, Westmead, 2145

Introduction: 40-50% of community-dwellers aged 75+ fall each year; with 30% of these falls resulting in injuries that reduce mobility and independence. The Rapid Access of Care and Evaluation (R.A.C.E.) program, which is a 5-day post-acute community-based program that provides allied health and medical input for geriatric patients, was developed to assess and address risks which may predispose geriatric patient to falls.

Aims: The aims of this investigation were to: 1) identify the primary types of falls prevention and falls management interventions provided by R.A.C.E. allied health professionals and medical staff, and 2) identify barriers that impede patient/care uptake and adherence to falls prevention and falls management recommendations.

Methods: Data were extracted from the medical records of 15 geriatric patients aged 70+ with repeat fall presentations on R.A.C.E. Data was manually coded and analysed for themes to: 1) determine the primary types of falls prevention and falls management interventions provided to patients, and 2) identify clinician/patient-reported barriers to client/carer to uptake and adherence to falls prevention and falls management recommendations.

Results: Seven themes emerged from the data. These included: 1) decreased functional status, 2) impaired cognitive function, 3) lack of readiness for change, 4) level of education and health literacy, 5) limited social supports, 6) limited financial resources, and 7) limited provision of culturally appropriate and responsive interventions. Inadequate follow-up of allied health professional and medical staff recommendations by patients and/or their carers was frequently noted on the patients second presentation.

Discussion: The inadequate uptake, follow-up and adherence to falls prevention and falls management interventions highlights the complexities involved in providing a ‘just right’ level of fall management for geriatric patients. The development of client-centred and culturally sensitive falls prevention and management strategies must remain a primary focus of improving patient outcomes on post-acute community-based care services like R.A.C.E.


Biography: To be confirmed

Improving equity in access to dietetic services across Western NSW LHD by utilising a Virtual Dietetic Service

Catherine Forbes1, Nicole Litwin-Farrell1

1Western NSW LHD, Forbes, Australia, 2Western NSW LHD, Parkes, Australia

A lack of Dietetic resources in Western NSW Local Health District means that residents at risk of malnutrition in Multi-Purpose Services (MPS) in our LHD who are at risk of malnutrition are not always identified at being at risk of malnutrition and do not always receive appropriate nutritional intervention.

The aim of this pilot project was to determine if we could improve the nutritional status of residents at risk of malnutrition in MPS facilities utilising a Virtual Dietetic Service (VDS).

Method: Telehealth was identified as a method of service delivery which could be utilised to improve access to allied health services for residents in MPS facilities. Discussions occurred with key stake holders and seven MPS sites in WNSWLHD were chosen to pilot a VDS. Residents in these sites who scored an MST greater than 2 on routine screening were referred to the Virtual Dietitian who utilised telehealth technology to assess the client and provide nutrition education and support to both the client and staff in the MPS facility.

Results: All residents with an MST score > 2 are now referred to the VDS, over two hundred Virtual Dietetic interventions have occurred since the pilot commenced. Identified benefits reported by sites utilising the VDS have included: a reduction in falls, upskilling of staff, and an increase in the number of residents undergoing routine malnutrition screening.

Discussion/Recommendation: A virtual Dietetic Service has been shown to be an effective model for increasing equity in access and providing better nutrition care to residents in MPS facilities in Western NSW LHD


Biography:

Catherine Forbes has worked as a Dietitian in Ruural locations in South Australia, Victoria and New South Wales over the past 20 years. She is currently the Nutrition and Dietetics Clinical Advisor for Western NSW Local Health District and has a passion for improving the health of rural people.

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