Reviewing Allied Health – no longer the back seat driver

Sue Fitzpatrick1

1Illawarra Shoalhaven Local Health District, Port kembla, Australia

The value of allied health is strongly recognised in health literature, however, this recognition is not readily translated to the prioritisation and utilisation of allied health at local health system levels.

Illawarra Shoalhaven Local Health District underwent an external review of the two largest hospitals in the district.  The rationale for the review was to examine staffing and utilisation, allied health’s role in facilitating patient flow and allied health governance systems. 54 recommendations were made across a range of jurisdictions which were accepted allied health and executive members.

Allied health efficiency should be in the hands of allied health clinicians and leaders. This paper details the process of planning and performing a formal review of allied health and the process of implementing recommended changes. Ownership of the review process and embracing recommended changes was the most important part of evidencing efficiency and in driving new changes in clinical work and clinical governance.

Changes to date include an all of allied health triaging system, sarcopenia program, stroke interdisciplinary assessments and a malnutrition pathway. Enabling allied health across all professions and levels was a significant facilitator of acceptance and innovation following the release of the review report.

This paper will detail the process of the review from choice of reviewers, to provision of information to the reviewers, the review process, report and implementation of the recommendations. Reflection on the process is key to the lessons learnt and the need to have allied health in the driver’s seat when examining systems and processes.

The outcomes of the review process will include what worked well and pitfalls of the process and includes the good, the bad and the contentious. The lessons from the review process take allied health from back seat to front and driving the road to demonstrating efficiency and innovation in the healthcare environment.

Philip, K (2015). Allied health: untapped potential in the Australian health system. Australian Health Review 244-247.


Biography:

Sue has a background as a speech pathologist. Sue completed a doctor of health science in 2016 in clinical supervision in allied health and currenlty works as the executive director of allied health the illawarra shoalhaven region on the south cost of New South Wales. Sue is interested in collaborative leadership and building leadership capacity in allied health professionals.

The feedback tree: A novel way of engaging staff and consumers to provide feedback on hospital foodservices

Margot Leeson-smith1, Christine Eadeh1, Claire  Dux1, Adrienne  Young1

1Royal Brisbane And Women’s Hospital, Herston, Australia

Australian healthcare standards require that consumers are engaged in evaluating and improving service delivery. In dietetics and foodservices, this is traditionally done using validated satisfaction questionnaires. Informal qualitative feedback often provides rich data that may not be captured in standard questionnaires. This project aimed to trial a novel way of collecting consumer and staff feedback in a large metropolitan hospital. Inpatients and staff from 5 acute wards were invited to provide written feedback or suggestions on pictures of apples. These were placed on The Feedback Tree, which was on each ward for at least one month (January-May 2018). The question “How can we improve our foodservice?” was used to prompt feedback.  Responses were collated separately for patients and staff, and categorised into domains (quality, variety, availability, service). Sixty-one “apples” were placed on the tree (38 patients, 23 staff). Patients mostly provided feedback on food quality (n=16, 67% positive), followed by variety (n=13, all suggestions to improve variety) and service (n=13, 50% positive, negative comments mostly related to menu ordering issues). Staff feedback was primarily related to lack of availability of late/missed meal options (n=7) and variety (n=5), and highlighted the problem of poor communication back to staff about foodservices improvements. The Feedback Tree was a visible and engaging way of obtaining feedback. While it did not unearth new information, it confirmed the importance of current and planned improvement initiatives (vending machine for outside hours meals, expanded snack options) and highlighted the need to improve how we close the feedback loop and communicate changes to consumers and staff (new “you said, we did” foodservices communication strategy for staff).


Biography: 

Margot Leeson-Smith is a Dietitian at the Royal Brisbane and Women’s Hospital / Central West Hospital and Health Service

Occupational therapist led environmental assessment and modification to prevent falls: Review of current practice in an Australian rural health service district

Associate Professor Alison Pighills1,2, Dr Anna Tynan3, Ms Linda Furness3

1Mackay Hospital And Health Service, Mackay, Australia, 2James Cook University, Townsville, Australia, 3Darling Downs Health, Toowoomba, Australia

Background: Environmental assessment and modification (EAM) is an effective approach to reducing falls in high risk older people, if provided by occupational therapists (OTs). It has been incorporated into national and international falls prevention guidelines, however, evidence suggests that it is not being implemented in practice. This study aimed to identify factors that support the local adoption of best practice EAM within a rural health service.

Methods: A concurrent mixed methods study using the Integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework was conducted in a health service in Queensland, encompassing rural and regional populations. An audit was conducted on eligible medical charts. An online survey of occupational therapists’ knowledge, confidence, attitudes and experience of EAM was completed. Focus group discussions were also carried out.

Results: Survey results identified that most OTs were aware of, confident, and experienced in EAM for falls prevention. Chart audits, however, revealed that none of the patients received this intervention. Thematic analysis of focus group discussions identified three key themes which influenced uptake of EAM: confidence in, and awareness of evidence; key stakeholders’ support and knowledge of OT; and, time and resources required for implementation. Contextual issues unique to rural and regional service delivery also influenced uptake, including: geographical and sociocultural diversities of communities; differing organisational structures which result in OTs being line managed by other professions; and, limited access to professional development.  Availability of local peer support, and engagement of multiple stakeholders from various professions were highlighted as key facilitators to support change.

Discussion: Occupational therapists reported that they carried out best practice EAM for falls prevention but the medical chart audit provided no evidence of this happening in practice. This study provided an understanding of factors that influence whether OTs implement best practice EAM in a rural health service.


Biography:

Alison completed her PhD in 2008 at the University of York, UK, which involved a RCT (n=238), to evaluate the clinical effectiveness of environmental assessment and modification to prevent falls in older people. She was awarded the University of York K M Stott prize for the best PhD thesis. She is currently a co-investigator on a multi-centre RCT in the UK (n=1333) which replicates her PhD research on a larger scale. Her research interests include: falls prevention, rural and remote models of care, professional skill sharing and delegation; and, research capacity development.

Four disciplines and a national program. Lessons from a collaboration to strengthen a palliative care simulation–based learning experience (SBLE)

Ms Kylie Ash1, Mr David Klug1, Mr Nathan Reeves2, Distinguished Professor Patsy Yates1, Ms Marie-Claire 0’Shea2

1Queensland University of Technology, Kelvin Grove, Australia, 2Griffith University, Southport, Australia

Background of the project or initiative: Griffith University academics hold expertise in interprofessional simulation-based learning and individual discipline curricula. The Palliative Care Curriculum for Undergraduates (PCC4U) project aims to improve the skill and confidence of health professionals to care for palliative patients. These teams collaborated to redesign elements of a SBLE to develop palliative care and interprofessional capabilities.

The method of research or project implementation: A Collaboration Agreement provided a framework for rights and responsibilities of collaborating partners. The PCC4U palliative care graduate capabilities and interprofessional capabilities informed the review of learning objectives for four discipline cohorts and curriculum mapping. The PCC4U team provided advice on integrating PCC4U resources to strengthen the inclusion of palliative care in the online, pre-simulation learning module and 5.5 hour face-to-face high-fidelity human-patient simulation experience. Post activity, ninety-eight students (39 dietitians, 12 exercise physiologists, 41 pharmacists, and 5 social workers) completed a 44-item PCC4U Palliative Care Graduate Capability Questionnaire.

Project results: Key enablers of this collaboration included early engagement allowing time for planning, review and development activities. Academics’ expertise in individual discipline and interprofessional capabilities enhanced mapping of learning objectives to the palliative care capabilities. The curriculum mapping identified opportunities to improve palliative care learning. PCC4U resources were integrated in a range of formats including eLearning modules, interactive tutorials, lecture and simulation. SBLE feedback was captured though peer review, student survey, critical observers and stakeholder reflection.

Discussion of the outcomes and implications: The PCC4U project supports the inclusion of palliative care through the provision of free learning and teaching resources and partnership opportunities. PCC4U resources provided a valuable foundation in the development and delivery of palliative care education for different health disciplines. Griffith University cross-discipline and sector collaboration has strengthened the review, redevelopment and ongoing refinement of SBLE which will inform delivery in 2019. Further research is required to understand the impact of SBLE on students’ preparation to work with palliative patients in an interdisciplinary context.


Biography:

Kylie Ash is a Registered Nurse with experience in clinical and education roles in oncology and haematology practice settings. Kylie has been involved in a number of large national workforce development projects to improve the intersection of health education and evidence based practice with health policy. Kylie is currently the National Manager for the Palliative Care Curriculum for Undergraduates project (PCC4U). Kylie is actively engaged with professional nursing organisations and is committed to promotion of excellence within the cancer and palliative care workforce.

 

‘Functional Freedom for Fallers with Fractures’ – where do we invest intervention to maximise outcomes for our consumers

Mr Nicholas Davis1

1Central Coast Local Health District,

With approximately 1 in 3 Australians aged 65 and over falling every year, and up to 6% of these suffering a fracture, the resulting functional restriction can often result in devastating outcomes. Our service wanted to determine what aspects of client intervention we should be investing in.

We collated post intervention observational data from 121 consumers of the Transitional Aged Care Program (TACP) Central Coast Local Health District (CCLHD) who had fallen, suffered a fracture, and required surgical intervention, to determine the significance of measured predictors and variables on function via statistical analysis (January 2017 to June 2018). Functional outcome measures analysed included consumer identified mobility and falls specific goals, the DeMorton Mobility Index (DEMMI), the Modified Barthel Index (MBI), and exercise tolerance. We also investigated the impact of mild to moderate cognitive impairment on functional outcomes, and whether certain covariates are statistically significant (including sex, age, duration of intervention, carer and family assistance, service provider assistance and home exercise compliance). A Lightening Oral Presentation with accompanying ePoster will summarise outcomes and key learning for future practice and research.

Early results of statistical analysis, via linear and mixed effects regression modelling, have highlighted that functional improvements (via the DEMMI) for consumers with mild-moderate cognitive impairment are significantly less than consumers without cognitive impairment. Furthermore, whilst a negative association exists with identified mild-moderate cognitive impairment, this did not reach statistical significance in relation to goal attainment and the MBI. Current results show that duration of intervention, family assistance and the interaction of mild-moderate cognitive impairment and time had a significant effect on exercise tolerance, with a statistically significant difference between groups. Further analysis underway will identify significance of other covariates (carer, family, and/or service provider assistance with exercise, and exercise compliance) for presentation.


Biography: 

Nicholas Davis, Senior Physiotherapist, Transitional Aged Care Program, Central Coast Local Health District

Realising the value of a student led service learning placement in challenging mental health stigma: “This placement has changed me for ever”

Mrs Nicole Killey1, Mrs Jane Ferns2

1University Of Newcastle Department Of Rural Health, Coffs Harbour, Australia, 2University Of Newcastle Department Of Rural Health, Taree, Australia

Background: Service-learning (SL) placements aim to address health inequities experienced by underserved populations by linking purposeful service activities by health students with their academic curriculum to enrich their learning experiences. Through a collaboration between the University of Newcastle Department of Rural Health (UONDRH) and Momentum Collective (MC) a pilot SL placement was developed for occupational therapy (OT) students. MC is a regional community based organisation that provides support for people who are vulnerable or disadvantaged, including a residential mental health rehabilitation service.

Method: Two second-year OT students participated in a SL placement over seven weeks. Following completion of a needs assessment with consumers, students planned and implemented group and individual consumer programs. Based on their experiences and feedback from MC staff and consumers, students developed a report providing recommendations for future student led programs. The UONDRH SL placement evaluation was completed by students and MC management.

Results: Feedback from UONDRH SL placement evaluations highlighted unintended positive outcomes beyond the placement learning objectives. Students developed a greater understanding of consumers in the mental health setting challenging their preconceptions. MC highlighted the value of this placement in reducing the stigma towards consumers of mental health services.

Discussion: This SL placement emerged as an innovative solution for meeting the need for professional practice placement experiences.  While it was anticipated that students would have the opportunity to experience working in a community mental health service, the unintended outcome of reducing the stigma of mental health was inspiring.  This experience has broadened our understanding of the potential learning opportunities, specifically challenging students to reflect upon their own assumptions related to mental health and the associated stigma experienced by consumers, which will inform future placement design.


Biography:

Since graduating from University of Queensland I have worked primarily in adult rehabilitation and community settings across regional NSW and the UK.  I have an interest in student education and currently hold the position of Associate Lecturer Occupational Therapy with UONDRH, Coffs Harbour.

Translating Research into Practice – How confident are Allied Health Clinicians?

Mrs Sally E Barrimore1, Dr Ashley E Cameron2,3, Dr Adrienne M Young4, Dr Ingrid J Hickman5,6, A/Prof Katrina L  Campbell1,6

1Allied Health Services, Metro North Hospital and Health Service, Brisbane, Australia, 2Clinical Support Services, Metro South Hospital and Health Service, Brisbane, Australia, 3Department of Speech Pathology, Princess Alexandra Hospital, Brisbane, Australia, 4Department of Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Brisbane, Australia, 5Mater Research Institute – University of Queensland, Brisbane, Australia, 6Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia

Translating research into practice (TRIP) is a multi-step process of implementing widespread clinical practice change to align with the best available scientific evidence. This study aims to determine confidence levels to translate research into practice amongst Allied Health (AH) clinicians. A quantitative questionnaire with face validity was disseminated across 12 sites in metropolitan hospital and health service districts in Queensland, Australia. The questionnaire collected demographic information, awareness of TRIP and confidence with various aspects of TRIP using a 100mm visual analogue scale. Association between confidence and respondent demographics including site and years’ experience was also assessed. Questionnaires were completed by 374 AH clinicians (67% at senior/management level, 52% with 10+yrs experience, 18% prior TRIP training). Moderate confidence was reported for identifying an evidence practice gap (median 70, IQR 50-80), finding relevant literature or evidence (median 67, IQR 40-84), and sharing this evidence with colleagues (median 70, IQR 50-85). Clinicians were much less confident in choosing a theoretical approach or TRIP framework (median 20, IQR 3-50), implementing a practice change (median 40, IQR 15-61), assessing barriers and enablers (median 50, IQR 25-70) and supporting less experienced clinicians undertaking TRIP (median 42, IQR 14-68). There was a weak positive correlation between years of experience and confidence of implementing practice change based on TRIP (rho = .127, p = .017). Majority of respondents (89%, n = 333) reported interest in learning more about TRIP. The results of this questionnaire indicated that AH clinicians were interested in TRIP but had low confidence in implementing research into practice. These findings will be used in the expansion of an AH TRIP training and support program, with the purpose of developing an AH workforce that is skilled and confident in TRIP to improve the quality of health service delivery.


Biography:

Dr Ashley Cameron graduated with a Bachelor of Psychology from the Queensland University of Technology in 2007 and a Masters of Speech Pathology Studies from the University of Queensland in 2009. In 2018 she completed her PhD at the University of Queensland where she investigated approaches to enhance the participation of individuals with acquired communication difficulties in the healthcare setting. Ashley has worked at the Princess Alexandra Hospital since 2010 and has a specialised focus in neurosciences and the translation of clinical research.

Service change and Supporting Lifestyle and Activity Modification after Transient Ischaemic Attack (S+SLAM-TIA): Measuring the value of implementing an evidence based secondary stroke prevention program into a health service

Dr Heidi Janssen1,2,3, Mr Chris Catchpole1, Ms Anne Sweetapple1, Ms Gillian Mason3, Ms Diana Colvin2, Ms Anjelica Carlos1, A/Prof Coralie English2, Prof Louise Ada4, Prof Robin Callister2, Ms Maria Sammut2, Mr Tony Edser5, Dr Carlos Garcia Esperon1, Ms Michelle Russell1, Mr Ashley Young1, Dr Dianne Marsden1, Ms Ena Fisher1, Dr Peter MacIsaac3, Dr Gary Crowfoot2, Prof Frini Karayanidis2, A/Prof Frederick Rohan Walker2, Dr Lin K Ong2, Ms Monique Hourne1, Prof Andrew Searles3, Prof John Attia3, Mr Jonathan  Holt1, Prof John Wiggers1, Ms Rhonda Walker1, Ms Derene Anderson1, A/Prof Michael Pollack1, Prof Neil James Spratt1, Prof Michael Nilsson2, Dr Kirsti Haracz2, Prof Christopher Levi6

1Hunter New England Local Health District, Newcastle, Australia, 2University of Newcastle, Newcastle, Australia, 3Hunter Medical Research Institute, Newcastle, Australia, 4The University of Sydney, Sydney, Australia, 5Planet Fitness Health Clubs, Newcastle, Australia, 6The Sydney Partnership for Health, Education, Research & Enterprise (SPHERE), Sydney, Australia

Background: Patients are at greater risk of having recurrent cardiovascular events within 5 years after transient ischaemic attack (TIA). Despite the evidence that participation in a secondary stroke prevention program significantly reduces recurrent stroke risk, no such programs were available to NSW Health TIA patients. The Hunter New England Local Health District’s (HNELHD) Community Stroke Team sought to address this service gap.

Method: The Supporting Lifestyle and Activity Modification after TIA (SLAM-TIA) pilot program was developed utilising existing HNELHD resources and telehealth services. It was delivered in a community gym and supported patient self-management of stroke risk reduction through group education and exercise. Evaluation of this pilot program informed the non-randomised controlled trial currently underway, Service change +SLAM-TIA (S+SLAM-TIA). S+SLAM-TIA will determine the effect at a patient and service level of implementation of the SLAM-TIA program. The aim is to detect a 0.5SD difference (Cohen’s d=0.5) between groups in the co-primary outcomes of time in moderately-vigorous physical activity (MVPA) (accelerometry) and systolic blood pressure (SBP) (i.e. 15.5 min in MVPA & 9 mmHg in SBP) (80% power, adjusted p-value of 0.025, n= 86 patients/group). Semi-structured interviews will determine (i) patient experience (ii) barriers and enablers to participation in exercise and in service implementation, and (iii) ways to build and maintain referral partnerships. Health utilisation costs will be calculated using NSW Health Activity Based Funding Portal and a tailored Client Services Receipt Inventory.

Results: The pilot program (24 patients) resulted in a significant reduction in SBP (14.6 ± 10.2 mmHg, p<0.001); increased participation in exercise beyond the program; and high patient satisfaction. Data collection for the S+SLAM-TIA trial is ongoing.

Discussion: Piloting and subsequent evaluation of a new program informed a clinical trial which will measure the value at a patient and service level of implementation of an evidence based secondary stroke prevention program.


Biography: To be confirmed

What mapping perinatal education tells us about the needs of expectant and new parents and the multidisciplinary team that provides this education?

Ms Sheridan Guyatt1,3, Dr Shelley Wilkinson1,2, Associate Professor Michael  Beckmann1,2, Dr  Brianna Fjeldsoe3

1Mater Health, South Brisbane, Australia, 2Mater Research, South Brisbane, Australia, 3University of Queensland, St Lucia, Australia

Background: Perinatal education (PNE) is an expected part of antenatal care. Health care providers (HCP) set PNE content which currently does not influence pregnancy outcomes or align with attendees’ expectations. Mapping PNE allows understanding of what is currently provided for women and their partners, how they use these services, the strengths, gaps, weaknesses and opportunities for change.

Aim: To understand the needs of expectant and new parents by systematically mapping PNE at the Mater Mothers Hospitals (MMH), Brisbane.

Method: Survey of MMH HCP delivering PNE (Aug-Oct 2018) on the content, format and reach (attendance rates).

Analysis: Qualitative analysis including comparing published guidelines with MMH PNE.

Key Findings: There were14 unique PNE offerings delivered by eight different health professionals from a mix of allied health and nursing disciplines with no pharmacy or medical staff involvement. Interdisciplinary co-facilitation, ‘peer teaching’, engaging support people and ‘learning through doing’ were underutilised and education outcomes are not consistently measured.

Attendance was poor with the most popular being the inpatient breastfeeding class (37.4%). Only 19.1% and 17.5% attended the two most popular outpatient session and the remaining 11 PNE sessions attended by less than 5.5% of women. PNE participation rates were concentrated around the last trimester of pregnancy and the inpatient postnatal period compared to women’s known information seeking behaviours in early pregnancy and post discharge. Collectively there is good coverage of the recommended content of PNE but when considered alongside attendance rates there is little attention given to psychological preparation for parenthood.

Discussion: The MMH provides a diverse range of PNE across the perinatal period. Participation and continuity between different PNE is poor. This data provides insight into the need of expectant and new parents and allows for assessment of gaps in current PNE to inform the interdisciplinary co-creation of an evidence based, outcome focussed perinatal education program.


Biography:

Sheridan is a Physiotherapist with over 25 years’ experience working with pregnant and postnatal women in both public and private settings here in Queensland and also in Tasmania. She is currently the Team Leader for the Mothers, Women’s and Pelvic Health Physiotherapy Team at the Mater Mothers Hospital, South Brisbane where over 10 000 babies are born each year. Sheridan is completing a PhD through the Faculty of Medicine, University of Queensland. She is passionate about interdisciplinary practise, effective patient communication and how together we can achieve great outcomes for expectant and new parents.

Tables and chairs: An interdisciplinary approach to improving the hospital environment for patients

Dr Adrienne Young1, Dr Peter Thomas2, Ms Prue  McRae3, Ms Mikaela Wheeler4

1Nutrition and Dietetics, Royal Brisbane And Women’s Hospital, Herston, Australia, 2Physiotherapy, Royal Brisbane and Women’s Hospital, Herston, Australia, 3Internal Medicine, Royal Brisbane and Women’s Hospital, Herston, Australia, 4School of Human Movement and Nutrition Sciences, St Lucia, Australia

Physical environment and equipment play a key role in promoting recovery and preventing harm in hospital. For example, having the necessary space and appropriate equipment to sit out in a chair can improve function and meal intake, and prevent pressure injuries. In a tertiary metropolitan hospital in Queensland, Australia, consumer and staff feedback indicated a lack of and/or defective patient tables and chairs at the bedside. In line with the new Comprehensive Care Standard, an integrated and interdisciplinary approach was taken by Physiotherapy and Nutrition and Dietetics to audit the current state of patient chairs and tables, and make recommendations to hospital executive. Two physiotherapists conducted a hospital-wide audit of chairs, noting defects posing potential harm to patients and/or staff (e.g. skin tears, pressure injury, injury from manual handling). A random selection of 59 tables was audited by a dietetic student and the patient themselves. A scale of 1-5 (5 = “great difficulty”) was used by each assessor to rate stability, moveability (wheels, adjusting height up and down), and ease of using the lever. Only twelve patients participated in the audit; others declined due to previously observing/experiencing difficulties moving tables. Of 381 chairs audited, 127 (33%) were deemed to be defective; common defects included torn vinyl (chair base, arm rest) and broken frame. The moveability of tables was problematic for patients (median rating for wheels: 4, adjust up: 5, adjust down: 5) and dietetic student (wheels: 3, adjust up: 3, adjust down: 4); patients also found the lever mechanism difficult to use (median: 4). Defects in basic patient equipment was observed to be common, with significant potential impact on patient care and outcomes. Data from this interdisciplinary audit have been used to secure recurrent budget for equipment maintenance and replacement, and research funding to co-design improvements to patient bedside environment.


Biography:

Dr Adrienne Young is an Accredited Practicing Dietitian, and is currently Principal Research Fellow, Allied Health Professions at the Royal Brisbane and Women’s Hospital. Her PhD research on improving nutritional intake of older medical inpatients has been of interest nationally and internationally, with Adrienne awarded the Health Practitioner Researcher of the Year at the Royal Brisbane and Women’s Hospital research symposium in 2018, and New Researcher Award at the International Congress of Dietetics in 2012. Adrienne has continued to research in the area of malnutrition in older people, with recent work also focused on workforce development to prepare allied health professionals to translate research into their practice.

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