Enhancing Speech Pathology scope with scoping

Ms Nicola Veness1, Ms Mary-Ellen  Tarrant1

1Royal North Shore & Ryde Hospitals, St Leonards, Australia

Fibre-optic Endoscopic Evaluation of Swallow (FEES) is an advanced scope of practice for speech pathology (SP). The Royal North Shore (RNSH) & Ryde Hospital SP department have adapted the QLD FEES competency to develop appropriate skills to provide speech pathology led FEES service across this department. This department covers two sites across three different service models: acute, rehab & community. This process has been refined since its introduction in 2015, enabling more clinicians to become competent over short periods of time. In conjunction with this, both sites have recently have recently secured funding and donations for Karl Storz C-MAC (RNSH n=2 , Ryde Hospital n=1) which is a more portal FEES equipment and dedicated for speech pathology usage

Results: Skill enhancement: In 2015, one clinician (of 15 FTE) was independently scoping on the wards; whereas is 2019, 8 clinicians (of 18 FTE) are independently scoping after achieving competency. A further 7 clinicians are working towards this competency at various stages.

Clinical Care: Overall the FEES service at Ryde Hospital demonstrated service enhancement and cost savings over the period of  The number of patients who received an instrumental assessment increased from 12 to 29 and the average wait time reduced from 6.6 to 1.2 days. The total annual cost for instrumental swallow assessments for patients based at Ryde Hospital reduced from $15, 595 to $6,347, and the average cost of an individual objective assessment reduced from $770 to $163.   This service enhancement was replicated at RNSH. The results of RNSH no longer using borrowed cumbersome equipment from the ENT specialists was an increase in the number of instrumental assessment being performed on the wards, optimising outcomes for patients with dysphagia.

Conclusion:  This new and dedicated speech pathology equipment has enabled our competency training process to be refined and increased efficiency in the development of this competency and dysphagia management for our patients while providing an enhanced service for our patients at a lower overall cost.


Biography:

Nicola is the Senior Allied Health Project Officer in the Workforce Planning and Talent Development branch of the NSW Ministry of Health. Prior to this role, she was a senior speech pathologist and A/deputy manager at Royal North Shore and Ryde Hospitals in the Northern Sydney Local Health District. She has worked clinically as a speech pathologist in tertiary, metro and affiliate hospitals across Sydney, with a particular interest in acute, rehabilitation and palliative care for stroke and other neurological condition. Nicola holds a Bachelor of Commerce and a  Masters of Speech and Language Pathology. She is currently enrolled in a Masters of Public Health (UNSW).

Mary-Ellen is a Speech Pathologist with 20 years’ experience in the profession; 10 of those as the Head of Department of the Speech Pathology Department across Royal North Shore and Ryde Hospitals in Sydney’s lower North Shore. Prior to moving into management, Mary-Ellen had over 10 years’ experience working with adult caseloads in two major tertiary teaching hospitals in Sydney and similar settings in the UK. Her main clinical area of interest was in Neuroscience across the spectrum of neurology with a particularly focus in stroke and neurodegenerative disorders. Mary-Ellen holds a Diploma in Education, a Bachelor of Applied Science in Speech pathology & and MBA in Health Management.

The STAT model improves access to sub-acute ambulatory and community services: A stepped wedge cluster randomised controlled trial

Dr Katherine Harding1,2, Ms Annie  Lewis1,2, Professor Nick Taylor1,2, Professor Sandy Leggat2, Assoc Professor Jenny Watts3

1Eastern Health, Melbourne, Australia, 2La Trobe University, Bundoora, Australia, 3Deakin University, Melbourne, Australia

Background: Poor access to sub-acute ambulatory care and community services has health and economic costs, and increases pressure on patient flow. The STAT model (Specific Timely Appointments for Triage), involves creation of protected appointments for initial assessment based on analysis of demand coupled with initial targeted strategies for patients currently on the waitlist. STAT reduced waiting time in two pilot trials but it was not known if it could be applied broadly across other ambulatory and community services. This NHMRC-funded trial aimed to determine whether the STAT model could reduce waiting time not just in a single, well controlled site, but be broadly applied to a range of ambulatory and community services.

Methods: We conducted a stepped wedge cluster randomised controlled trial (ACTRN12615001016527) involving 8 sites within a large metropolitan health network (n=3,116 patients) comparing STAT with a previously used waitlist and triage approach. The primary outcome was time from referral to first appointment; secondary outcomes measured other aspects of service delivery in the 12 weeks after initial appointment.

Results: Mean time from referral to first appointment reduced from 60 days pre-intervention to 36 days in the post-intervention period across all sites (Incidence Rate Ratio 0.66, 95% CI 0.52 to 0.85) for up to 8 months post intervention without changes in other aspects of service delivery. Variation in waiting time was also reduced, suggesting a reduction in the ‘tail’ of patients previously classified as low priority waiting excessively long periods for assessment.

Discussion: Improvements in access for community outpatient services can be achieved by a relatively simple approach that creates protected assessment appointments for all patients based on analysis of service demand, rather than placing patients on a waitlist and triaging according to perceived urgency.


Biography: 

Project Officer, Eastern Health and La Trobe University

An evaluation of physiotherapist independent prescribing in Queensland

Mr Mark Cruickshank1, Prof Lisa Nissen2, Ms Sonia Sam1

1Royal Brisbane & Women’s Hospital, Brisbane, Australia, 2Queensland University of Technology, Brisbane, Australia

Background: There are many challenges facing the Australian health care sector such as an aging population, increasing burden of chronic disease, and growing community demands for responsiveness. These challenges are associated with an increasing requirement for timely access to medicines which can be restricted, particularly in rural and remote areas, primarily due to maldistribution and shortages in the traditional prescriber workforce. Non-medical prescribing is a method of increasing the number of prescribers to meet community demand for timely access to medicines.

Methods: Following the five steps of the Health Professionals Prescribing Pathway for safe and competent prescribing, Emergency Physiotherapy Practitioners (EPPs), working in primary contact musculoskeletal roles within five emergency departments in Queensland, have undertaken the required training to gain approval to autonomously prescribe under the current State legislative framework and Department of Health credentialing process.  Data is currently being collected for an 18-24 month period with the intention of recruiting all patients who may require prescribing to the extent necessary to enable EPP assessment and management. Data collected will describe the safety of physiotherapist prescribing and evaluate the patient experience and satisfaction of prescribing by physiotherapists.

Results: Preliminary data will be presented. To date over 1300 participants have been recruited to the trial with 1450 medication orders written by EPPs Statewide.  To date, no adverse events have been recorded due to physiotherapy prescriber errors and auditing of medication orders demonstrates above average compliance with national charting guidelines.  Patient experience data shows very high levels of consumer confidence and satisfaction with physiotherapy prescribing.

Discussion: The trial results to date suggest that physiotherapy prescribing can be implemented safely and with high levels of consumer confidence and satisfaction, thus improving community access to timely and appropriate medicines.


Biography:

Mark Cruickshank is the Director of Physiotherapy at the Royal Brisbane and Women’s Hospital.  He is also the Chief Investigator on the Physiotherapy defined scope of practice prescribing trial, which is a multicentre study currently being undertaken at 5 public hospital sites across Queensland.   In addition to this, Mark has a keen interest in the development of expanded and extended scope physiotherapy roles that improve the patient experience and demonstrate value to the health care sector.

Safely moving the critically-ill patient: Yes you can!

Mrs Felicity Prebble1, Mrs Jennifer  Murphy1, Anne Leditschke1

1Mater Health, South Brisbane, Australia

Purpose: The early mobilisation of critically ill patients has recently taken the forefront of intensive care based research. Emerging literature has shown that early mobilisation within the Intensive Care Unit (ICU) can be conducted safely and within a timely manner, if an appropriate assessment and observation takes place by trained staff. Our project aimed to review and analyse the current mobility practices in our Mater Health Services (MHS) ICU through an observational audit, to highlight any frequent barriers to early mobilisation, and ensure compliance with evidence-based clinical guidelines.

Methods: An 8- week observational audit of 140 patients admitted to a mixed medical/respiratory/surgical tertiary ICU (mean age 57.3 ± 41years, mean APACHE III Score 44.12 ± 74.88) was conducted. Outcome measures included length of ICU stay at first active mobility, any adverse events that occurred, and frequent barriers to mobility.

Results: Patients were actively mobilised or transferred out of bed on 188 out of 270 physiotherapy-led interventions (69%).  Of these, 140 consisted of active mobility interventions, 22 of which were ventilated patients (16%). 94 episodes (34.8%) were limited by a barrier to further patient participation, with 30.8% due to low GCS/over-sedation, 27.6% due to a cognitive impairment and 25% haemodynamic instability. Adverse events occurred in 3 out of 270 interventions (1.1%). This low rate of adverse events occurring during physiotherapy-guided interventions, was a confirming factor that early mobilisation can be performed safely with a thorough assessment prior and during the treatment.

Conclusion:  ICU patients, whilst critically unwell and weak, can be safely mobilised throughout their stay in our unit. Unavoidable adverse events occured in 1% of interventions in ventilated patients. The prioritisation and planning of each patient’s sedation management and mobilisation activity will improve this outcome.


Biography:

Felicity has worked in the Mater Adults Public Intensive Care Unit since 2010. She is currently undertaking a Simulation fellowship with Mater Education in 2019, and is to complete her Graduate Certificate in Health Professional Education. She is also a sessional academic at the Australian Catholic University in their Cardio-Respiratory subjects, along with clinical education at the Mater.

The key to planning, developing, and managing a full-scope assistant workforce – unveiling perceptions around confidence of delegated models of care

Miss Alita Rushton1, Dr Adrienne Young1, Professor Heather Keller2, Associate Professor Judy Bauer3, Dr Jack Bell1,3

1Metro North HHS, Brisbane, Australia, 2University of Waterloo and Schlegel Research Institute, Waterloo, Canada, 3The University of Queensland, Brisbane, Australia

Background: Delegated models of care are integral to delivering values-based healthcare. Opportunities for exploring these models exist within the assistant workforce for both systematised and individualised patient care. Delegation opportunities have been highlighted as a key component in a current state-wide Systematised Interdisciplinary Malnutrition Program for impLementation and Evaluation (SIMPLE). This project aimed to explore the confidence of dietitians and dietetic assistants with respect to delegation of malnutrition care activities.

Method: A quantitative survey with face validity from experts in field was administered across 11 hospitals in Queensland. Likert scales were collapsed into low confidence, neutral, or high confidence. Data is being collected from December 2018 to March 2019.

Results: Preliminary data at time of abstract writing (dietitians n=50; dietetic assistants n=21) reveals very high confidence in dietitian delegation of one or more malnutrition activities to assistants (100%). However, confidence levels for specific activities varied within and across professionals, assistants and sites. Both dietitians and assistants had high levels of confidence in some activities: malnutrition monitoring and evaluation (76% dietitians, 81% assistants); malnutrition education (76% dietitians, 71% assistants). Levels of confidence decreased for other activities including discharge planning and clinical handover (high confidence 62% dietitians, 43% assistants); providing malnutrition professional development (50% dietitians, 43% assistants). The u-shaped curve observed for many activities displayed polarisation of the workforce to either high level of confidence or low level of confidence. None of the nine activities had predominately neutral responses. Assistant perceptions regarding working to full scope demonstrated 47.6% agreement, 4.8% ambivalent, and 47.6% disagreement. Most dietitians perceived assistants were not working to full scope (70%).

Discussion: Highlighting areas of difference and synergy for confidence in delegation, both between and within local professional and assistant workforces, is a ‘must do’ key step to locally tailor, implement and sustain delegated models of care.

Acknowledgements: Queensland Hospitals and staff participating in SIMPLE Phase II and the SIMPLE II Knowledge Translation Team. SIMPLE Phase II has received funding from the Allied Health Professions Office of Queensland, and the MRFF Next Generation Clinical Researchers Program.


Biography:

Alita Rushton is a Nutrition Assistant at The Prince Charles Hospital. Alita completed a bachelor’s degree in Health Science, Nutrition major from Queensland University of Technology and is currently undertaking a Master of Philosophy at The University of Queensland. Alita is focussed towards improving patient malnutrition care through evolving opportunities for Dietitian’s assistant roles and delegated models of care.

Bullseye! Increasing Allied Health resources for targeted patients in the acute hospital to achieve discharge directly home

Dr Lara Kimmel1,2, Ms Dina Watterson1, Mr Jim Sayer1, Ms Lauren Maher1, Ms Jean Bremner1, Ms Anna Kennedy1, Ms Chelsie Ting1, Assoc Prof Lisa  Somerville1,3

1The Alfred, Melbourne, Australia, 2Monash University, , Australia, 3La Trobe University, , Australia

Introduction: Early comprehensive multidisciplinary assessment of physical, psychosocial and environmental aspects of health contributes to more efficient and effective patient care. The Targeted Therapy for Acute Recovery Program (TtARP) was piloted at The Alfred in 2017 and formally commenced in 2018 with the aim of determining if patients could be accurately targeted early in their hospital stay in order for safe discharge home to be achieved.

Method: Data was collected over a 5 month period in 2018.  Data included basic demographic details, length of stay (LOS) and discharge destination.  Functional measures collected included the modified Iowa Level of Assistance Scale (mILOA) – a mobility score ranging from 0 to 36 with a minimal clinically detectable change of 6 points. The Functional Autonomy Measurement System (SMAF) was also collected with a change in 5 points representing clinically significant change.  Patients with a mILOA score of 12-25 were specifically targeted for this programme.

Results: 383 patients were seen by TtARP (54% female) with a median age of 75 years (IQR 64, 85). The median acute hospital LOS was 8 days (IQR 6, 13).  Overall, 269 patients (70%) were discharged directly home with 76 patients being discharged to sub-acute care.  156 patients were waiting for transfer to sub-acute care when seen by TtARP with 90 (58%) of these achieving safe discharge home from the acute hospital.  Both the mILOA and SMAF scores demonstrated clinically significant improvement between admission and discharge [Initial mILOA [median (IQR)]: 13 (9, 17) Discharge mILOA [median (IQR)] :5 (0, 10)] [Initial adjusted SMAF [median (IQR)]: -15 (-23, -7) Discharge adjusted SMAF [median (IQR)]: -2 (-10, 0)].

Conclusion: Large cost saving benefits can be seen with the implementation of an Allied Health run service in the acute hospital providing intensive therapy to targeted patients and preventing unnecessary admissions to sub-acute facilities.


Biography:

Lara is a physiotherapist at The Alfred Hospital in Melbourne  and has worked there for over 20 years.  She has extensive experience in the management of orthopaedic and trauma patients and a strong interest in research, having completed a PhD through Monash University in the area of discharge following trauma.

Unleashing the power of Allied Health in Capital and Coast DHB – a transformative new model of care and priorities for change

Dorothy Clendon1, Chantalle  Corbett1

1Capital And Coast District Health Board,

Capital & Coast District Health Board (CCDHB), is located in New Zealand’s capital city Wellington, and purchases and provides health services for over 300,000 people.

In early 2018 CCDHB embarked on a journey to unleash the power of Allied Health – designing a new model of care to describe how Allied Health (Therapies) will work to improve health and wellbeing outcomes for our population, and identifying priorities for change.

Over 90% (over 200 clinicians) of health-funded Allied Health in CCDHB is employed by the Hospital.  Over 70% of Allied Health activity takes place in hospital settings, either as inpatients or outpatients.

The new model of care was developed using feedback from stakeholders, international developments and collaboration with Allied Health across the district, to be finalised following consultation in February 2018.  The new model provides a transformative vision for Allied Health; with an emphasis on equity, a drive for innovation, and a focus on improving health outcomes and well-being.

The first priorities for change include:

  1. Improving discharge and preventing admission – decreasing the number, time and impact of hospital stays and maximising people’s return to function after an illness or event, particularly for older people.
  2. Acting early – supporting people and their whānau to take control of their health and well-being through brief, timely advice and interventions and encouraging self-management, particularly for older people, people with long term conditions, and children and families.
  3. Using Allied Health expertise to improve outcomes and efficiency of the system through triaging and assessing orthopaedic referrals.

Developing and growing Allied Health leadership across the system will continue to be critical to the success of this work.

Substantial investment proposals for 2019/20 are under construction.  We will present how CCDHB is progressing these priorities and share our experience of how to introduce and implement transformative changes to Allied Health service delivery.


Biography:

Dorothy Clendon trained as a physiotherapist at Otago University and worked in a variety of hospital and community settings in New Zealand and England.  Dorothy moved into planning and funding of health services in a DHB in New Zealand, before returning to England to manage a Community Health Development team in a Primary Care Trust, and lead the Trust’s Patient and Public Involvement in Health work.  Back in New Zealand Dorothy worked at the Ministry of Health developing services in tobacco control, cancer screening and older people’s community services.  Since February 2018 Dorothy has been leading CCDHBs’ major project on the future model of care for Allied Health across all settings.

Vitality in Aged Care

Miss Melanie Reeves1, Mr Jeremy Carr3

1Murrumbidgee Primary Health Network, Wagga Wagga, Australia , 2Wagga Wagga Campus of the Rural Clinical School, School of Medicine Sydney University of Notre Dame Australia, Wagga Wagga , 2650, 3Back On Track Physiotherapy, Corowa ,  Australia

The Vitality Passport is tasked with halting or reversing frailty within individuals. The program uses a multi-component approach delivered by 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 of New South Wales, 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 Primary Health Network 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%).


Biography: 

Melanie Reeves is Portfolio Manager, General Practice Initiatives, Murrumbidgee Primary Health Network.   Jeremy Carr is the Director of Back On Track Physiotherapy

Time to care: Queensland Podiatry Telehealth service for foot disease

Sarah Jensen1, Jason  Warnock1

1Metro North Hospital and Health Service, Brisbane, Australia

Early assessment and management of foot disease (ulcer, infection, ischaemia and acute Charcot) is associated with improved outcomes, including reducing hospitalisation and preventable amputations. Across Queensland access to interdisciplinary high risk foot services is a key component to improving clinical outcomes for persons with foot disease.

In response, the Queensland Department of Health has provided recurrent funding for a 1.0 full-time equivalent position to both Metro North (MN) Hospital and Health Service (HHS) and Cairns and Hinterland (CH) HHS to deliver a Statewide Podiatry Telehealth Service, one component of a broader $4.7 million investment to ambulatory high risk foot services across the state.

The aim of this new service will be to increase the accessibility of podiatry input to foot disease management where patients are unable to access equivalent services within their local communities. Piloting of the model of care will commence in MNHHS from February 2019. The initial phase of the model of care will be the discharge transference of care from tertiary hospital to local healthcare providers. Given this cohort’s high risk for rehospitalisation, coordination and continuity of care between hospital and community is vital. This service provision is expected to result in improved outcomes for consumers and reduce the need to travel unnecessary for specialist reviews. Evaluation of the pilot will focus on the effectiveness of the Statewide Podiatry Telehealth Service to:

  • improve more equitable access to specialised high risk foot podiatry input
  • provide a clinically effective and efficient means to deliver foot disease management
  • build a broader health workforce’s skills and confidence in caring for persons with foot disease.

The findings from the pilot phase are expected to provide valuable learnings in establishing a safe and effective model of care by July 2019 and encourage other HHSs to incorporate podiatry telehealth as part of their service provision.


Biography: 

Jason Warnock is the MNHHS Director of Podiatry

Experience of leadership and management clinicians in implementing best practice in inpatient management of people with obesity in a metropolitan public health service

Ms Alison Qvist1, Dr Danielle Hitch1

1Western Health, Footscray, Australia

Background: Two thirds of Australians are overweight or obese, with an increased risk of associated comorbidities. The proportion of patients admitted to hospital with comorbid obesity is increasing, incurring mounting challenges for healthcare delivery. Nationally and internationally, obese patients have been reported to experience inadequate quality of care, increased length of stay and adverse events such as pneumonia, infection, falls, and pressure injuries leading to increased cost of care. The challenges associated with providing this cohort with safe, satisfactory care in a way that maintains their dignity have therefore been recognised. The aim of this study was to better understand perceptions and experiences of leadership and management clinicians in providing health care for inpatients with obesity.

Method: A qualitative approach is being undertaken, aiming to sample 6-10 leaders and managers in an inpatient health care service. Interpretative phenomenological analysis will be use to understand their perceptions around best care.

Results: This study has low risk ethics approval, and interviews are currently underway. Preliminary analysis indicates the domains of physical environment, psychosocial wellbeing and technical complexity of care being the main barriers to delivering care to this population. Analysis will be completed and full results of the study will be available for detailed presentation at this conference.

Discussion: The perspectives of leaders and managers are crucial to understanding both the current and future practice context in regards to the care of people with obesity. A broader project using experience-based co-design to develop a model of care for patients with obesity is planned. This project will also explore the perspectives of healthcare professionals and people with obesity using the service, and the findings of the study described here will also contribute to this model.


Biography: 

Alison Qvist is a Health Information Officer – Allied Health at Western Health

1237

NAHC Conferences

2007, Hobart (7th NAHC)

2009, Canberra (8th NAHC)

2012, Canberra (9th NAHC)

2013, Brisbane (10th NAHC)

2015, Melbourne (11th NAHC)

2017, Sydney (12th NAHC)

2019, Brisbane (13th NAHC)

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