Implementation and evaluation of speech pathology-led referring process for videofluoroscopic swallow studies

Shana Taubert1, Dr  Clare Burns1, Professor Elizabeth Ward2,3, Lynell Bassett1, Dr  Linda Porter4, Penni Burfein1

1Speech Pathology & Audiology, Royal Brisbane & Women’s Hospital, Brisbane, Australia, 2School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia, 3Centre for Functioning & Health Research, Metro South HHS, Brisbane, Australia, 4Medical Imaging, Royal Brisbane & Women’s Hospital, Brisbane , Australia

BACKGROUND: While speech pathologists (SPs) routinely conduct videofluoroscopic swallow studies (VFSS) to inform dysphagia treatment, only doctors are authorised to complete Medical Imaging Request forms. This process increases doctors’ low level procedural duties and can delay patient access to VFSS. An Expanded Scope Practice (ESP) model of care, where SPs complete VFSS Medical Imaging Request Forms, exists in some hospitals. However, evaluation of this model has not been reported.

AIMS: To implement a SP-led VFSS referring process for inpatients at a quaternary hospital and evaluate 1) safety and efficiency of this model; 2) perceptions of treating SPs, ward doctors and radiologists; and 3) perceptions of the ESP SPs.

METHODS: Phase 1: The ESP model was endorsed by Medical Imaging and key hospital stakeholders. Three months of baseline data was collected to examine existing referring processes and adherence by doctors to statutory radiation safety requirements for completing VFSS Medical Imaging Request Forms.

Phase 2: Four SPs with VFSS experience completed two hours training, developed in consultation with Medical Imaging and international practice, to undertake the ESP role of completing VFSS Medical Imaging Request Forms.

Phase 3: Referral processes were examined prospectively for 6 months post implementation of the ESP model. Post implementation, stakeholders completed semi-structured interviews and the service model implementation analysed using the Consolidated Framework for Implementation Research (CFIR) constructs.

RESULTS: Phase 1 data revealed multiple issues with the current medical referring model. Data collection from Phase 3 is nearing completion for 100 patients in the ESP model. Results will be reported regarding efficiency and safety of the ESP model and SP/medical staff perceptions.

DISCUSSION: Evaluation of the implementation of a SP-led VFSS referring model has helped to resolve current issues with VFSS referrals. Data describing the prospective use of this model will help inform future widespread service implementation.


Biography:

Shana is a senior speech Pathologist at Royal Brisbane & Women’s Hospital. She is currently undertaking her PhD on the topic of “Enhancing speech pathology practice in videofluoroscopic swallow studies”.

Development and implementation of a multi-disciplinary training package to improve the confidence and competence of clinicians in the use of Telepractice for outpatient services

Mr Michael Harris1, Ms Naomi Scolari2, Mr Denis Morton2, Ms Sarah Fulton1, Ms Rachel Domalewski1, Dr Laurelie Wishart3, Ms Kelly Hale1, Professor Elizabeth Ward4

1Metro South Health – Bayside Health Network, Cleveland, Brisbane, Australia, 2Metro South Health – Chronic Disease Service, Brisbane, Australia, 3Metro South Health – Allied Health, Brisbane, Australia, 4Centre for Functioning & Health Research, Brisbane, Australia

The integration of telepractice into aspects of routine clinical care remains limited despite technological advances and policy changes, substantial investment, and a growing literature base. Appropriate education and training has shown to be integral to the success and uptake of telepractice, especially for patient related interventions. Staff confidence and perceptions are also integral to the successful implementation of telepractice, as clinicians are responsible for promoting the use of telehealth by selecting and referring suitable patients.

The ultimate objective of this work is to support and promote the uptake of telepractice service delivery models to provide services to outpatients, and to develop a sustainable and skilled health workforce with a positive culture towards telepractice models of care in the future.

The aim of the current project is to develop, implement and evaluate a telepractice training package for clinicians at Redland Hospital.

Telepractice training has been delivered to staff across 3 teams: Chronic Disease, Physiotherapy and Speech Pathology. The training has consisted of:

  • An introductory PowerPoint presentation
  • Self-paced online training
  • Access to a training manual and printed resources
  • Practical demonstrations
  • Clinical simulations

Pre- and post-training surveys were used to measure change in clinicians’ perceived skill, confidence and perceptions using telepractice for outpatient related activities. The pre- and post-comparisons collected from the clinician surveys were analysed using non-parametric Wilcoxon signed-rank tests.

Statistically significant (p<0.001) increases in perceived knowledge were seen post-training as well as significant increases in confidence for both clinical and non-clinical use of videoconferencing post-training.

Results to date suggest that a telepractice training package is an effective method of developing and sustaining staff skill, knowledge and confidence in the use of telepractice. This research will further evaluate whether this translates into increased uptake of videoconferencing-based telepractice service delivery.

The preliminary results suggest that a comprehensive and varied training package is effective in increasing perceived skills and knowledge and increasing confidence for both clinical and non-clinical uses of videoconferencing. We are yet to determine whether this translates to increased use of videoconferencing 6 months post-training, which will be measured in the final phase of this project.


Biography: 

Michael is the Director of Physiotherapy & Podiatry, Bayside Health Services. The Bayside Health Service is part of the Metro South Hospital and Health Service and includes Redland Hospital, Wynnum-Manly Community Health Centre, Gundu-Pa and the Marie Rose Centre on North Stradbroke Island.

Michael has an interest in the utilisation of telehealth to improve access to services for clients of the Bayside Health Service with a particular focus on those that live on the Moreton Bay Islands.

Michael is presenting today on behalf of a multidisciplinary research team led by Principal Investigator, Denis Morton (Chronic Disease Team Leader, Redland Hospital). Other co-investigators include Ms Sarah Fulton (Speech Pathologist), Ms Kelly Hale (Speech Pathologist), Ms Rachel Domalewski (Physiotherapist), Ms Naomi Scolari (Dietitian), Dr Laurelie Wall (Research Workforce Development Officer) and Professor Elizabeth Ward (Professor, Centre for Functioning & Health Research).

Electronic reporting of allied health cancer care interventions in regional Queensland

Mrs Martine  Waters1, Mr Neil Brebner1, Ms Alicia Chaplain2

1Queensland Health, Brisbane, Australia, 2Allied Health Professions Office Queensland, Brisbane, Australia

There is little evidence documenting skill set requirements for allied health cancer care clinicians in regional areas.  Routine data collection counts occasions of service, but lacks information about interventions carried out. The aim of this project was to electronically capture the interventions undertaken by regional allied health cancer care clinicians, to quantify task frequency and identify potential skill sharing capabilities between clinicians.

Partnering with two regional Queensland public cancer care centres and the Allied Health Professions Office Queensland, a subset of 42 SNOWMED_CT_AU medical terminology intervention codes were selected and incorporated into the allied health cancer care services routine activity capture information system MOSAIQ®.

Customised reports were developed to describe the type and frequency of clinical interventions by facility and discipline. Focus groups were held with clinicians to gain feedback on strategies to improve the accuracy and process of data collection.

Sixteen allied health clinicians from 6 disciplines across 3 facilities electronically recorded descriptive intervention tasks as part of routine activity data collection.  Interim analysis of a one month data snapshot showed that nutrition therapy, screening, counselling and lymphoedema management were the most frequent tasks undertaken.   There was evidence of skill sharing between disciplines with 21 of the interventions (50%) recorded as being delivered by more than one discipline group.

This detailed data informs team leaders of the recruitment attributes required in their facility and guides skill succession planning to increase capacity of existing human resources. The findings highlight a potential for clinicians to gain experience in required skills in a non-cancer setting. Future steps for this project will include: collecting a 6 month data set; validating the task list within a broader context of cancer Statewide; understanding cancer specific skillsets and knowledge acquisition pathways; and understanding barriers and enablers to clinician confidence in the application of core skills in a cancer setting.


Biography:

Martine has been an accredited practicing dietitian since 2000. She has an extensive clinical background in both metro hospitals and regional centres including rural outreach. Martine is currently studying clinical redesign and works as a workforce development Officer for Cancer Care. She has collaborated with Allied health Professions Office Queensland and regional cancer care facilities to implement and pilot electronic data capture of allied health intervention terminology in cancer care to inform local workforce planning. Martine holds a chair on the Statewide Cancer Network Executive Steering Committee and through a statewide allied health clinical cancer care reference group, she focuses on professional collaboration between HHS’s to develop pathways and infrastructure to facilitate consistent clinical standards promoting improved service integration for patients.

Is there a link between clinician reported time spent on research and research success?

Dr Angela T Chang1, Dr Adrienne Young1, Dr Anna Farrell1, Prof Jennifer Strong1, Dr Gai Harrison1, A/Prof Jennifer Paratz1, Mr Peter Buttrum1, Ms Michelle Cottrell1, Dr Peter Window1, Dr Merrilyn Banks1, Dr Susan de Jersey1

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

Background: A lack of time to undertake research is a commonly reported barrier for allied health clinicians. The aim of this study was to investigate current research outputs and self-reported time spent on research and evaluation activity, and the relationship between these measures.

Methods: A prospective survey of self-reported time spent on research and evaluation activities and retrospective audit of research output across nine allied health teams was undertaken. Surveys were repeated monthly over three months (Jan to March 2018) and an average calculated for analysis.  Average hours per team was calculated as percentage of funded full time equivalent (FTE) hours. Peer-reviewed publications, research funding and number of research or evaluation projects from July 2017 to June 2018 were extracted from departmental records and average per FTE calculated. Kendell Correlations compared time and output measures per FTE between teams.

Results: Completed surveys were received from 490 respondents (average response rate 43.2%). On average 37.5% of respondents (range 0 to 67.5% across teams) reported spending time on research or evaluation during work time. The total time reported was 1383.2 hours per month, average 2.69% of FTE (range 0% to 6.96% of FTE). A total of 68 publications were authored, average 0.22/FTE (range 0 to 0.73/FTE). Over $809K in external research funding was received, average $2.6k/FTE (range $0 to $11.5k/FTE) and 221 research or evaluation projects undertaken in the period, average 0.72/FTE (range 0 to 2.32/FTE). Proportion of team members reporting time on research was positively correlated with number of research or evaluation projects (rT=0.7778, p=0.0293), no other significant correlations were found.

Conclusion: There was variation in research time and outputs across allied health teams. Increased proportion of team members spending time on research was associated with higher number of research projects being undertaken, but this was not associated with increased publications or grant success.


Biography:

Angela completed her PhD studies in 2005 and has worked in a range of settings including as an academic at the University of Queensland, Research and Development Consulting and health workforce policy roles in federal and state health departments.  She is currently in a research capacity building role and provides support and mentoring to allied health clinicians based at the Royal Brisbane and Women’s Hospital.

Are we doing what they’re doing? Tube weaning at The Canberra Hospital and internationally

Kathryn  Rodda1

1The Canberra Hospital , Chifley, Australia

AIMS: Tube dependence can be an expensive and detrimental side effect of managing medically complex children.  Evidence from international sites shows that hunger provocation tube weaning is effective at increasing successful return to oral feeding (Hartdorff et al, 2015).  Research shows that 90% of hunger provocation tube weans are successful, with a 75% success rate on the first attempt and the majority of children weaned on the second attempt (Wilken et al, 2013).  However, there are only anecdotal reports on the use and success of hunger provocation tube weaning in hospitals in Australia (Gardiner et al, 2016).

This retrospective review examines success rates of hunger provocation tube weaning at The Canberra Hospital’s (TCH) Children’s Feeding Clinic (CFC), and a thematic review of the factors contributing to unsuccessful tube weans.

METHODS: Retrospective review of outcomes since commencing hunger provocation tube weaning at TCH (2015 – 2018 inclusive). Review of patient, carer and environmental characteristics of successful and unsuccessful tube weans

RESULTS

  • 42 tube weans managed by TCH CFC 2015 – 2018.
  • 30/42 (71%) successful first time, 9 of the remaining successful second attempt (total successful = 39/42 = 93%).
  • 3/42 unsuccessful in first 2 attempts (7%).

Reasons for unsuccessful tube weans can be grouped into three main areas – patient specific, parent/carer expectations and stress, and environmental factors.  Parent factors are most likely to result in a second unsuccessful tube wean attempt.

CONCLUSION: Hunger provocation tube weaning managed by TCH Children’s Feeding Clinic has similar success rates to published international data.

CLINICAL SIGNIFICANCE: Hunger provocation tube weaning is generally effective and should be considered for all medically appropriate children.

REFERENCES: Gardiner, Vuillermin and Fuller (2016).  A descriptive comparison of approaches to paediatric tube weaning across five countries.  International Journal of Speech Language Pathology


Biography:

Kathryn is a speech pathologist working in the area of acute neonatal and paediatric feeding.  Her clinical work includes establishing feeding in sick and premature neonates, feeding and dysphagia support and management for children with complex feeding and medical presentations, and tracheostomy management.

What supports allied health students on placement to begin to think, feel and act as a health professional?

Mrs Linda Furness1,2,3, Dr  Anna Tynan1,2,4, Dr Jenny Ostini2

1Darling Downs Health, Toowoomba, Australia, 2University of Southern Queensland, Toowoomba, Australia, 3Griffith University, Gold Coast, Australia, 4University of Queensland, Rural Clinical School, Toowoomba, Australia

Background: Clinical placements support student health professionals to become effective practitioners by integrating their knowledge and skills and supporting their development of professional identity so they come to ‘think, feel and act’ like a member of their profession. In a study conducted by Ashby, Adler, and Herbert (2016), practice education was identified by 98% of occupational therapy students across five countries as having the greatest influence on professional identity development. There are few studies examining the impact of clinical placement on the development of allied health students’ professional identity. The purpose of this study is to examine the influences on development of professional identity in allied health students undertaking clinical placements in a rural and regional health service.

Methods: Qualitative thematic analysis. Focus groups were audio recorded, transcribed verbatim and analysed thematically.

Results: 17 allied health staff whose roles support clinical education in the health service; 11 new graduates and 12 students representing the professions of Physiotherapy, Speech Pathology, Social Work, Nutrition and Dietetics, Psychology and Occupational Therapy, participated in separate focus group discussions. Refinement of themes was undertaken through the framework of ‘thinking, feeling and acting’ as a member of the profession. Three themes were identified: experiences supporting learning; socialisation and connectedness; and ‘unzip the student suit’.

Conclusion: When clinical educators acknowledge and implement strategies to support students to ‘think, feel and act’ as a member of their profession, it strengthens their professional identity. Other staff in the service and contact with patients also plays a key role in supporting development of students’ professional identity. These results highlight the need to consider orientation activities and opportunities for workplace connections, provision of quality learning experiences and balancing student learning and autonomy with patient care in supporting students to think, feel and act’ as a member of their profession.


Biography:

Linda graduated as an occupational therapist in 1989, and since that time has worked in rural and regional service delivery. She has worked in a number of clinical, case management, management and education roles.

Linda is currently employed as a Clinical Education Support Officer and Clinical Education Leader – Adult Physical within the Occupational Therapy Clinical Education Program (OTCEP). OTCEP supports the clinical education of pre-entry occupational therapy students and new graduates in Queensland Health Hospital and Health service facilities. She is also involved in a number of research projects aimed at enhancing rural and regional occupational therapy service delivery.

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