Vitality Passport: Halt frailty, spark vitality

Jeremy Carr1, Melanie  Reeves2

1Back On Track Physiotherapy, Corowa, Australia, 2Murrumbidgee Primary Health Network, Wagga Wagga, Australia

The Vitality Passport is tasked with halting or reversing fraility within community dwelling individuals.  The program uses a multi-component approach via a range of allied health therapies including dietetics, occupational therapy, and physiotherapy.  This presentation details the findings of an independent evaluation of the program.

Frail individuals are at greater risk of avoidable falls, hospital admissions, and the need for institutionalised care. In the Murrumbidgee region, falls related hospitalisations are a significant component of hospital admissions; at a rate of 3,533 per 100,000 women and 2,587 per 100,000 men.  In 2016, 19% of people in Murrumbidgee PHN were over 65 years old and by 2036, this age group is projected to grow to 44% of the population regionally.

Recent randomised controlled trials provide strong evidence that the progression of frailty can be halted or reversed through multicomponent intervention programs.

Participants of the program have access to individual exercise coaching, nutrition advice, cognitive training.  In addition eight group sessions are available to promote socialisation, exercise and health promotion content presented in a workbook resource. Eligible participants are referred to the program through general practice. The program components are delivered as face to face, telehealth and group sessions.

The University of Notre Dame Australia evaluated the program.  Quantitative and qualitative measures included: Edmonton Frailty Scores at 0, 3, 6, and 12 months, participant focus groups, collection of falls calendars, patient satisfaction survey and interviews with general practice staff, allied health staff implementing the program and GPs.

Quantitative and qualitative data suggest the program has been successful in reducing or arresting frailty. There was a significant reduction in frailty as measured using EFS score. Practice staff reported that the program is useful and worthwhile and has the potential to make a considerable difference over time. Data from the falls diaries suggest a positive trend in falls reduction. Participants who responded to the patient satisfaction survey thus far agreed that they had improved quality of life (86.6%) and overall health (85.4%), better physical function (81.4%) and were less fearful of falling as a result of the program (76.9%).

Acknowledgements: Associate Professor Catherine Harding, Dr Alexa Seal of the University of Notre Dame, Narelle Mills & Melanie Reeves of Murrumbidgee Primary Health Network.


Biography: 

Melanie Reeves is Portfolio Manager, General Practice Initiatives, Murrumbidgee Primary Health Network.

Jeremy Carr is the Director of Back On Track Physiotherapy

Transdisciplinary Model of Care between Allied Health and Nursing in a rural sub-acute setting

Kathryn Costello1

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.


Biography:

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.

Beyond a short trial: Exploring the sustainability of allied health expanded scope models of care

Dr Belinda Gavaghan1, Ms Jennifer Finch1, Ms Liza-Jane McBride1

1Allied Health Professions’ Office Of Queensland, Clinical Excellence Queensland, Brisbane, Australia

Background: Queensland’s public health system has invested in a program of allied health expanded scope activities to assist health services to provide effective, equitable and client-centered care. From 2014 to 2016, seed funding was provided to Hospital and Health Services to support the rapid implementation of innovative expanded scope models using a formal hub and spoke approach. Despite successful outcomes in the short term, little is known about the sustainability and spread of expanded scope models over time. The aim of this study is to explore the sustainability of these models two years after the end of the formal project period.

Method: Seventy short interviews were undertaken with project leads and representatives from all models and sites. Discussion focused on the implementation of new models during and in the two years following the end of the formal project period, as well as the enablers and challenges to establishing new models of care as part of routine practice.

Results: Participants reported that 48 models had been successfully implemented, sustained and were embedded as part of routine practice. A further six models had been discontinued following the end of the project period and 32 did not ever commence the implementation phase. Sites that did not progress to implementation were typically spoke sites that did not receive project funding and who may have been interested but not ready for implementation at a local level. Allied health workforce culture and leadership to support change, difficulties recruiting and retaining skilled staff and access to funding for new services were identified as common challenges to the sustainability of expanded scope models of care.

Discussion: To optimise allied health scope of practice and deliver consistent improvements in patient care, there is a need to build on our achievements and successfully adapt, spread and sustain effective models of care. Findings from this study will be used to develop targeted strategies to build allied health capacity and capability to progress and establish expanded scope models as part of routine practice.


Biography:

Dr Belinda Gavaghan is currently A/Director at the Allied Health Professions’ Office of Queensland. Her research focuses on allied health workforce reform and redesign, and particularly the development, implementation and evaluation of new and innovative models of care that optimise scope of practice for allied health professionals. Belinda has degrees in speech pathology (Hons) and public health. She has over 15 years experience as a speech pathologist in public and private healthcare settings and is a graduate of the NSW Public Health Training Program.

A transit pharmacist improves patient flow

Mrs Estelle Jensen1, Mrs Nancy Wang1

1Queensland Health, Brisbane, Australia

Background: The Transit Care Hub (TCH) is an interim ward for patients awaiting transport home from hospital.  It intermittently opens overnight as a 12-bed ward when the hospital reaches full capacity.  When patients discharge from hospital, most wait on the inpatient wards for pharmacists to supply their discharge medication.  Delays in discharge medications can lead to hospital bed block and increase Emergency Department Length of Stay (ELOS). A six-month Transit pharmacist trial began in July 2018 with an aim to improve patient flow by discharging patients earlier from inpatient wards.

Method: During the trial, a new procedure was implemented where patients were discharged from inpatient wards to TCH to await their medications. The Transit pharmacist liaised with ward pharmacists and treating teams to safely dispense medications, create medication lists and counsel patients.

Results: 791 patients were discharged by the Transit pharmacist over the 20-week trial period.  These patients discharged to TCH an average of 70 minutes earlier than other patients (who awaited discharge medications on an inpatient ward).  There was also a 16% increase in the total number of patients discharging through TCH during the trial, reaching the hospitals key performance indicator (KPI).

Over the 20 weeks, this role saved an estimated $100,862. This was calculated through reducing inpatient bed days (70 minutes x 791 patients x $2,312 per bed day), preventing pharmacist overtime when open as an overnight ward (36 nights x $136.50), and preventing three overnight patient stays by reviewing inappropriate bookings for heparin infusion admissions.  It is projected this role could save $265,198 annually.

Discussion: The Transit pharmacist has enhanced patient flow by promoting earlier discharges from the inpatient wards.  The role has successfully been allocated permanent funding as there were clear demonstrated quality and economic benefits.  Other large hospitals could benefit from implementing this service.


Biography:

Senior Pharmacist, Queensland Health

Realising our value through Workforce Development: Developing an Indigenous health workforce

Dr. Alison Nelson1,2

1The Institute for Urban Indigenous Health, Windsor, Australia, 2The University of Queensland, St Lucia, Australia

Background: Developing an effective health workforce in Indigenous health requires an inter-disciplinary, integrated approach across schools, universities and workplaces. It also requires a multi-pronged approach of developing pathways for Indigenous students into health careers. Often the education, training and university sectors fragment the system which makes the development of a workforce in Indigenous health even more complex. To address this, the Institute for Urban indigenous Health (IUIH) has been developing its health workforce over the past 8 years, through a dedicated and integrated ecosystems approach.

Method:  The IUIH has developed a systematic and integrated workforce development pipeline to ensure a focussed and intentional approach to developing health professionals from health service users to school-based trainees to university graduates.  This includes in-reach strategies into schools and universities as well as outreach opportunities for training and placements within IUIH’s network.

Results: IUIH’s workforce initiatives have resulted in growth from 1 allied health professional employed in 2010 to over 70 in 2019 and 30 students/year placed in 2010 to 370 students/year placed in 2018. Fourteen graduates who has undertaken placements with IUIH were employed in 2018/19. IUIH’s school-based training program in allied health and fitness assisting targets young people with significant barriers to academic success with the aim of changing life trajectories. 85% of trainee graduates have continued to employment, with  71% continuing through to university studies.  Several key learnings from this work will be presented including the importance of cultural mentors, pastoral care and graduate support, as well as key leadership from Indigenous allied health professionals and management. In particular real case examples of success stories will be presented.

Conclusion: The development of a culturally responsive workforce in Indigenous health and a growth in allied health positions within Indigenous health services can be achieved and maintained with strong partnerships across schools, universities and Indigenous workplaces when integration and Indigenous leadership are key drivers. IUIH has developed a workforce pipeline model to reflect this.


Biography:

Dr Alison Nelson (B. Occ Thy, M.Occ Thy (research), PhD) is an occupational therapist with extensive research, teaching and practice experience working alongside urban Aboriginal and Torres Strait Islander people. Alison has completed both a research Master’s degree and PhD in the areas of service delivery and perceptions of health for urban Aboriginal and Torres Strait Islander children and young people, and she has published widely in these fields. Alison is currently the Director for Organisational  Development at the Institute for Urban Indigenous Health where she brings together her experience working in both clinical and academic settings.   Alison has a particular interest in developing practical strategies which enable non-Indigenous students, researchers and practitioners to understand effective ways of working alongside Aboriginal and Torres Strait Islander Australians.

Impact of transdiciplinary advanced allied health practitioners within paediatric neurodevelopmental and behavioural clinics, in a regional public hospital and health service outpatient department

Mrs Julie Creen1,2, Dr Ann Kennedy-Behr2, Dr Michele Verdonck2, Mrs Kellee Gee1

1Sunshine Coast Hospital and Health Service , Birtinya, Australia, 2University of the Sunshine Coast, Maroochydore, Australia

Introduction: Within public paediatric outpatient services, literature has indicated difficulties with long waitlists, engaging families and high failure to attend rates. A small number of studies have reported that advanced allied health practitioners (AAHP) are an effective strategy to reduce long waitlists in outpatient departments.

Objective: This study investigated the impact of a transdisciplinary AAHP in a public paediatric outpatient department for children referred for concerns with development, learning and/or behaviour. It was hypothesised that if a child is initially assessed by an AAHP they will have a shorter wait time from referral to initial consultation, earlier diagnosis, and are less likely to require a medical specialist appointment.

Methods: From 2014 to 2017 a total number of 225 participants were involved comprising of 75 children who saw a medical specialist in 2014, 75 who attended AAHP initially in 2014 and 75 who attended AAHP initially in 2016. De-identifiable clinical, demographic and service provision data were gathered from hospital records to test hypotheses.

Results:  A chi-square test indicated that the percentage of participants who required an appointment with a medical specialist differed significantly among the groups, X2 (2, N = 225) = 59.81, p =<.000. This indicated a significant reduction in the amount of children requiring medical specialist consultations after attending appointments with AAHP.

The Kruskal Wallis test detected a statistically significant difference between groups on time from referral to diagnosis, H(2) = 20.51, p<.000, and wait time from referral to initial consultation, H(2) = 130.44, p<.000. Therefore, the AAHP significantly reduced waitlist time, and time to diagnosis over the two-year period of the study.

Conclusion: This study provides preliminary evidence that utilisation of AAHP’s in paediatric outpatient departments can reduce waitlists, reduce amount of medical specialist appointments required and provide earlier diagnosis for children with neurodevelopmental, behavioural and/or learning difficulties.


Biography:

Julie Creen has been an occupational therapist for 17 years and has specialised in working with children and families in a variety of settings, in Australia, United Kingdom and Ireland. Since 2014 Julie has been working as an paediatric advanced allied health practitioner at the sunshine coast hospital and health service. This role has focused on expanding allied health practice to assist medical colleagues in providing a high level of care and expertise to children with neurodevelopmental, behavioural and learning concerns. Julie is completing a PhD through the University of the Sunshine Coast evaluating advanced allied health practice and parental engagement and motivation in family centred consultative therapy.

Creating a useful and sustainable Allied Health activity dashboard

Ms Tanya Trevena1

1Ballarat Health Services, Ballarat, Australia

Background: The Allied Health Activity Dashboard evolved rapidly due to several concurrent expectations and concerns being placed on the service. These included our service purchasers not knowing if they were getting ‘what they paid for’, our team members not consistently recording their workforce/daily/clinic activity, and the existing reporting files requiring high-level excel knowledge, with several (likely) corrupt calculator files being used throughout the process. In order to advocate for more allied health staff, we needed a more efficient, accurate and useful tool to demonstrate who was working where, and where we meeting targets.

Method of project implementation: Implementation of the project, and resulting dashboard has been multi-factorial as there were several system, human, information technology and cultural aspects to analyse, consider, update and implement. The overall project was given a timelines (almost a year), with activity ‘clustered’ into similar bite-sized activities. Analysis, collaboration with key system-level teams, clinical champions and training were the key factors for success.

Project results: The project has resulted in one standardised, automatically populated dashboard. Key Performance Indicators (KPIs) such as time or occasions of service are all mapped to disciplines, as well as at the team-level. New definitions, processes, manuals and training have been implemented, models of care have, and will continue to be reviewed, errors are reported and corrected, and the clinicians are better at capturing their work.

Outcomes and implications: The Allied Health team, and in particular, its leadership team now have clean data; a consistent set of expectations and rules to follow for data management; a commitment to improving efficiencies and workforce utilization; and we now have a way to identify if we are over or under-serving our service purchasers (through the KPIs). The new level of transparency has its own risks, and is now the focus of the leadership team.


Biography:

Tanya has over fifteen years’ experience in health care, specialising in workforce development, project management, leadership and business acumen. These experiences have been in allied health, cancer and palliative care, clinical support services, telehealth and rural health. Tanya completed an MBA in 2017 and has since developed an interest in data management, finance and sustainable leadership. Key areas of strength include curiosity, a love of learning, a drive to make a difference to the health of communities, and building dynamic teams. In her spare time, Tanya likes to ski, read, watch movies, stay fit and explore the world.

Development of a framework to evaluate implementation of an interprofessional education and practice organisation-wide strategy to foster integrated family centred care

Kristine Kelly1, Claire  Costello1, Tania Hobson1

1Queensland Children’s Hospital, South Brisbane, Australia

BACKGROUND – Healthcare teams are responding to complex challenges to deliver quality, safe and cost-effective healthcare by transforming traditional approaches of healthcare delivery to incorporate Interprofessional practice (IPP), underpinned by Inter-professional education (IPE) ¹²³.   To fully realise the benefits and efficiencies IPP and IPE can effect, it is imperative that healthcare services develop an organisation-wide understanding of principles of IPE and IPP¹²⁵ , thus Children’s Health Queensland Hospital and Health Services (CHQ-HSS) has developed an organisation-wide IPE/IPP strategy including an evaluation framework and workforce awareness survey (WAS) to ensure internal consistency in longitudinal evaluation.

AIM – To establish a consistent approach to evaluation of organisational learning related to an IPE/IPP strategy and to monitor organisational understanding of IPP/IPE by sampling the workforce of CHQ longitudinally through a phased roll out of the strategy.

METHOD – A working group of interprofessional champions from CHQ-HHS was convened.  An international partnership was formalised with the Centre for Interprofessional Education, University of Toronto. Literature reviews were conducted to inform WAS content and develop the Evaluation framework cross-referenced to organisational learning effectiveness as described by Kirkpatrick-Phillips⁴. Consultation incorporated review by CHQ representatives and international partners. A pilot awareness survey was undertaken with a sample population of workforce (clinical and non-clinical) to refine its effectiveness. Communication and distribution plan optimised workforce engagement and survey completion rates.

RESULTS & DISCUSSION – Initial data collection phase is underway for phase1/horizon1 of the strategy.  Results from this stage will be analysed & presented.  Findings from the evaluation framework and awareness survey will serve to inform future planning for targeted IPE/ IPP activity within CHQ-HHS existing and emerging workforce with the aim of improving integration of care and optimising clinical outcomes for those target populations best serviced by interprofessional models of care. Ongoing evaluation of IPE/IPP activities across horizons of implementation will be measured according to the evaluation framework.


Biography:

Kris Kelly is an Allied Health Workforce Development Officer and Co-chair of the Children’s Health Queensland  Inter-professional Working Group.  She has been involved in educating allied health students within the university context and during clinical placement  with of focus on inter-professional education in a paediatric context.  Her work has included paediatric workforce education and training also incorporating inter- professional education with emphasis on  inter professional models of care and simulation based learning  for over a decade.

Groups 4 Health (G4H): Building connectedness to support health in transitioning home from rehabilitation

Ms Julian  Whitmore1, Professor Catherine  Haslam2

1Metro North Hospital and Health Service, Community and Oral Health Directorate, Australia, 2University of Queensland, St Lucia, Australia

Background: Social engagement is key in protecting health, but challenging for those transitioning home after intensive rehabilitation. Targeting this issue is a new social group intervention, Groups 4 Health (G4H), that helps people to reconnect and extend their social group-based relationships in ways that support their health. In this feasibility study, we developed and piloted an adaptation of this program — G4H: Going Home — focusing on older adults transitioning home from rehabilitation.

Method: 30 participants (mean age=74.9; F=19, M=12) were recruited, among whom 12 completed all 5 sessions of the program and all measures. Primary measures at three timepoints (pre-G4H, end-G4H, 1-month follow-up) were depression, loneliness and quality of life (QoL). A smaller sample of participants (n=5) also took part in qualitative interviews aimed at gauging their experience of the program.

Results: Analysis of the full sample revealed clinically significant change in depression scores (of >2 points on the scale) between the pre-G4H and follow-up, and the post-G4H and follow-up periods. For the 12 completers, only the difference between post-G4H and follow-up was clinically significant. There was improvement on the remaining variables in both samples — with a small decline in loneliness and small increase in QoL between pre-G4H and follow up timepoints. Qualitative feedback was largely positive with the experiences of sharing and learning with others and realising the value of social groups emerging as common themes.

Discussion: The program had its greatest impact on mental health alongside raising awareness of the importance of others as a resource to support health in a challenging period of transitioning home. These data support investment in testing G4H further, with appropriate controls, to address alternative explanations for improvement and address generalisability. Alongside these data we discuss the program’s wider feasibility and challenges of delivering G4H within an active rehabilitation program.


Biography: 

Juliann Whitmore is an experienced Social Worker (Bachelor of Social Work, 1st class honours) with over 20 years’ clinical experience.  Juliann has worked in various roles in her field including child protection, with children with severe behavioural issues and their families, as a parenting specialist in child health and indigenous child health, with patients undergoing rehabilitation and in residential transition care working with clients transitioning home or into Residential Aged Care. Further Juliann has been a supervisor, a team leader and manager of Social Workers and other allied health staff.  She has experience in the design, implementation and review of new or revised organisational policies and procedures and models of practice. Juliann has undertaken a project on Domestic and Family Violence and was part of the roll out of the Domestic and Family Violence training in Community and Oral Health, Queensland Health. Juliann is passionate about clinical leadership and the growth of the team members meeting their own goals, those of their clients and the organisation.

 

In 2018 working for Community and Oral Health, Queensland Health, Juliann was the principal co-investigator in a collaborative research project with the University of Queensland and Ballycara Residential Aged Care Home and Wellness program.  This funded research study was to evaluate the effects of Groups 4 Health: Going Home program.     This social group intervention focused on helping people to reconnect and build their social connections within their community on transitioning home after a period in hospital believing that social engagement is key in protecting a person’s overall health.

Embedding advanced practice in gastrostomy tube management: Two years on

Ms Belinda Steer1, Ms Kim Lunardi2, Ms Liz  Broughan3, Ms Tobi Erickson4, Ms Tracey Martin5, Ms Leonie Pearce4, Ms Natalie Simmance2, Dr Judi Porter6

1Peter Maccallum Cancer Centre, Melbourne, Australia, 2St Vincent’s Hospital, Fitzroy, Australia, 3Northeast Health, Wangaratta, Australia , 4Austin Hospital, Heidelberg, Australia, 5Northern Health, Epping, Australia, 6Eastern Health, Box Hill, Australia

Background: Novel Advanced Scope of Practice (ASP) roles in gastrostomy tube (g-tube) management for dietitians were implemented in 5 Victorian health services in mid-2016. Following implementation there was evidence that these roles had resulted in diverting emergency department (ED) and endoscopy presentations, and therefore healthcare savings. This project looked at the results 2 years post-implementation.

Methods: A range of patient and service level outcome data were maintained by individual healthcare services and collated by a project lead.

Results: Across the 5 healthcare services, 8 dietitians have been credentialed in the ASP g-tube role with another 4 staff in training. Since commencement, >440 consults have been provided by the ASP dietitians. This includes >285 g-tube changes or removals, diverting >30 patients from ED, >140 patients from endoscopy and >335 patients from Gastroenterology review, at conservative cost savings of > AU$320,000 to the healthcare system.

This new model of care (including dietitian-led g-tube clinics and on call consultative services) has: 1) improved access to care from 2 months to 0-2 days; 2) reduced episodes of care for g-tube issues from 2-3 to 1; and 3) increased patient service satisfaction. Multi-disciplinary clinician satisfaction remains high, with medical staff actively promoting the ASP g-tube service to colleagues and patients, and the ASP dietitians reporting increased job satisfaction. The ability to provide comprehensive care for these complex patients, acknowledgement of their advanced nutrition support skills, and potential for career development were key reasons for this increase.

Conclusions: Embedding of this ASP role has bridged gaps and removed barriers previously placed on dietitians caring for patients with g-tubes. This has enabled the provision of comprehensive, patient-centred care and supported dietetic work at the full scope of practice. Further opportunities for ASP dietitian roles have been identified.


Biography:

Belinda Steer is Head of the Nutrition and Speech Pathology Department at Peter MacCallum Cancer Centre in Melbourne. She has over 15 years experience as a clinical dietitian, including over 10 years specialising in oncology nutrition. and has a passion for providing high quality, patient-centred care.

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