Measuring the Value of the Specialist Management with Acute Rehabilitation Treatment (SMART) Program

Ms Jamie Hunter1, Dr Kristy Coxon2, Ms Caitlyn Robson1

1Westmead Hospital, Westmead, Australia, 2Western Sydney University, Penrith, Australia

Background: The Specialist Management with Acute Rehabilitation Treatment (SMART) program provides multi-disciplinary rehabilitation to acute patients at Westmead Hospital. This program is open to patients across the hospital who have achievable rehabilitation goals. The SMART team work with complex and diverse patients who experience a wide range of rehabilitation outcomes. This study aims to measure changes in patient function from program admission to discharge and identify characteristics of patients most likely to benefit from the program.

Methods: A retrospective file audit was conducted collecting Australasian Rehabilitation Outcomes Centre and Activity Based Funding data for all patients admitted to the SMART program in 2017 and 2018.  Demographic, medical and treatment data were extracted. The Functional Independence Measure (FIM) was used to measure change in function from acute-rehabilitation admission to discharge and compared using Paired t tests. Service outcomes including length of stay, functional change, and discharge destination were modelled using linear and logistic regression to identify patient and service characteristics predicting service outcomes.

Results: Data analysis and extraction is currently underway with approximately 400 patients admitted to SMART in 2017 and 2018.  To date, preliminary data from 2017 (n= 210) indicate patients admitted to the SMART program had an average age of 63 years, experienced an average SMART length of stay of 12 days, functional change of 16 points on the FIM, with a daily FIM efficiency of 2.6 points. Outcomes were linked to both patient and service characteristics including age, diagnosis and length of admission prior to acute-rehabilitation.

Discussion: Measuring patient and service outcomes of acute-rehabilitation helps identify the value and impact of early multi-disciplinary intervention in the acute-rehabilitation phase. Findings may guide referral criteria, and help tailor service provision and rehabilitation timing to maximise service outcomes.


Biography:

Jamie Hunter is an occupational therapist with a Masters of Primary Health Care and a clinical background in rehabilitation and neurology. Jamie is senior Occupational Therapist on the SMART (acute-rehabilitation) team at Westmead Hospital and is a member of the Western Sydney Allied Health Research Steering Committee and the ACI Rehabilitation Network’s Data Measurement and Outcomes Committee.

Dr Kristy Coxon is a registered occupational therapist with a PhD in Public Health from the University of Sydney and a background in clinical practice education and research. Kristy is Academic Course Advisor for the occupational therapy program at Western Sydney University and holds a research fellow position in the Injury Division of The George Institute for Global Health.  Kristy has established a strong research profile in the areas of transport, community mobility, safety and injury prevention. Kristy has presented papers at conferences both nationally and internationally, and has published her research in internationally recognised peer-reviewed journals.

Caitlyn Robson is a 4th year Honours Student at the Western Sydney University

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

Taking an interprofessional approach to improving nutrition for older people in hospital

Dr Adrienne Young1,2, Dr Merrilyn  Banks1, Dr Alison Mudge3, Ms Prue McRae3

1Nutrition and Dietetics, Royal Brisbane And Women’s Hospital, Herston, Australia, 2School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia, 3Internal Medicine, Royal Brisbane and Women’s Hospital, Herston, Australia

Malnutrition and poor dietary intake remains a significant problem for older hospital patients. The complexity of hospital mealtimes and nutrition care necessitates an interdisciplinary approach to improvement. This study monitored nutritional intake of older inpatients (65+ years) over a ten-year period as foodservice and mealtime interventions were progressively implemented into routine practice in a large metropolitan Queensland hospital. Hospital and ward-level interventions were implemented from 2009-2014. These included facilitated implementation of ‘assisted mealtimes’ (by nursing, allied health, and medical, as part of the Eat Walk Engage program), and proactive provision of high protein/energy (HPHE) meals and mid-meals. Allied health assistants supported these interventions. Data were collected on 386 medical inpatients admitted in 2007-08 (n=129, 80±8y, 49% male), 2009 (n=139, 80±8y, 45% male), 2013-14 (n=52, 82±8y, 44% male) and 2017 (n=66, 82±8y, 50% male). Energy and protein intake were calculated from visual plate waste of all meals and mid-meals on Day 4-7 of admission; these were compared to patient requirements. One-way ANOVA and χ2 tests were used to compare cohorts. Nutritional intakes of participants have significantly increased over time (energy: 5073±1850kJ, 5403±2252kJ, 5989±2614kJ, 5954± 2179kJ, p=0.014; protein: 48±19g, 50±21g, 57±26g, 58±24g, p=0.002). The proportion of patients with inadequate energy and protein intakes has also decreased (intake<resting energy expenditure: 59.7%, 53.2%, 44.2%, 34.8%, p<0.001; intake<1g/kg protein: 85.3%, 75.5%, 73.1%, 63.6%, p=0.007). Provision of HPHE diets and mealtime assistance have improved (HPHE: 20.2%, 56.1%, 84.6%, 89.4%, p<0.001; assistance where required: 58.1%, 86.4%, 100%, 85.7%, p<0.001). This ten-year study highlights the importance of continuous quality improvement and interdisciplinary and system-level nutrition care strategies such as mealtime assistance and foodservice improvements to achieve improved intakes of older inpatients. Factors important in creating sustainable change included use of implementation frameworks, multidisciplinary implementation team, assistant workforce, and making small, sequential changes.


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.

Strategies for increasing allied health recruitment and retention in rural Australia – a rapid review

Ms Rebecca Heron-dowling1, Mr Hassan Kadous1, Ms Cath Maloney2

1NSW Ministry Of Health, North Sydney, Australia; 2Services for Australian Rural and Remote Allied Health (SARRAH)

In 2018, NSW Health commissioned a consultancy to write a rapid review outlining effective and ineffective strategies for increasing the efficacy of allied health recruitment and retention in Australia. Although there is considerable research identifying factors that influence allied health recruitment and retention in rural areas, there is limited quality evidence to demonstrate the impact of recruitment and retention interventions on workforce outcomes.

The rapid review synthesises a balance of Australian and international research, grey literature and industry knowledge to inform a NSW Health led, multiagency allied health rural and remote workforce summit in 2019.

The strongest evidence for recruitment and retention for Allied Health Professionals to rural and remote practice relate to rural background, curriculum that reflects rural health issues, quality rural placements. One of the strongest lines of emerging evidence is the ‘Rural Pipeline’ – recruitment of students from rural backgrounds, delivery of regional training, exposure during training to rural curriculum and placements, and developing regional postgraduate training opportunities.

Factors that influence retention are broadly categorised as professional and organisational, social (family and personal), and financial which are modifiable to varying extents, and non-modifiable factors such as location and community amenity.

Areas for innovation have been identified throughout the report and will be explored at a NSW Health led, multiagency allied health rural and remote workforce summit.


Biography: 

Cath Maloney is the A/Chief Executive Officer of Services for Australian Rural and Remote Allied Health (SARRAH)

Is “Rehab Vision” and effective tool to improve patient knowledge and understanding of inpatient rehabilitation?

Miss Kylie Draper1,2, Professor David Greenfield2, Doctor Indu Nair1

1Sydney Local Health District, , Australia, 2The University of Tasmania, , Australia

BACKGROUND: Inter-hospital transfers facilitate optimal continuity of care however, no standardised education existed within our acute-care and rehabilitation facilities. Patient feedback identified a gap in service delivery indicating a lack of information provided prior to hospital transfer resulting in a negative association to experience and recovery.

METHODS: A quantitative randomised case-controlled study was conducted at a quaternary acute-care hospital for patients identified for inpatient rehabilitation at a secondary facility. “Rehab Vision” was developed by staff with consumer engagement: a seven-minute educational video portraying the rehabilitation hospital. Participants included adult inpatients (18-100years) referred for inpatient rehabilitation. Those with cognitive impairment or inability to comprehend English were excluded. All participants completed a baseline questionnaire evaluating their understanding of the inpatient rehabilitation process. Participants in the treatment group were shown “Rehab Vision” and completed a post-video questionnaire.

RESULTS: Twenty-one patients (10 male; 11 female) (8 treatment; 12 control; 1 did not consent) were eligible to participate. The majority (40%) were admitted from an orthopaedic ward, corresponding with the finding of orthopaedic conditions as the primary diagnosis for 52% of participants. The mean age for all participants was 71years (range 84-27years). Mean age for the treatment group was 73years (range 64-52years). Improvements in patient knowledge and understanding were observed across all questions following the provision of “Rehab Vision”. Furthermore, following the provision of “Rehab Vision” a statistically significant improvement was identified for participant reaction (p=.001) and knowledge of rehabilitation (p=.003), with all patients reporting an overall positive response. Findings confirmed the positive impact of adequate education to utilise patient engagement along with the benefits of standardised communication to improve handover.

CONCLUSION: “Rehab Vision” is an effective tool to improve patient knowledge and understanding of inpatient rehabilitation. As a result, “Rehab Vision” will be implemented as part of standardised care and widely distributed to staff and consumers.

ACKNOWLEDGEMENTS: Sandeep Gupta, Kiel Harvey, Jane Linton, Michael Morris and John Sheehy.


Biography:

Kylie is a speech pathologist currently working at Balmain Hospital within rehabilitation and sub-acute aged care. Kylie also has a variety of clinical experience in acute and outpatient settings. She has additionally been involved in clinical supervision and training of both undergraduate and post graduate speech pathology students. Kylie has completed a Bachelor of Health Sciences (Hearing and Speech) at The University of Sydney and Bachelor of Health Sciences (Speech Pathology) at Charles Sturt University. She was also successful in receiving a Sydney Local Health District Scholarship to complete a Masters of Health Service Management through The University of Tasmania.

Remotely satisfied: The experiences of health students undertaking Work Integrated Learning placements in the Northern Territory

Dr  Narelle  Campbell1, Annie Farthing2, Jessie  Anderson2, Leigh Moore1, Susan Witt1

1Flinders NT, Darwin, Australia, 2Centre for Remote Health, Alice Springs, Australia

Background: Placing undergraduate health students in underserved areas with a view to them taking up employment after graduation is a strategy of the Commonwealth government funded Rural Health Multidisciplinary Training (RHMT) program.  Students who are satisfied with their placements indicate a strong intention to return to take up remote and rural practice after graduation (see Smith et al 2018 and Smith et al 2017).  This presentation investigates the experiences and perceptions of nursing and allied health students who undertook a placement in the Northern Territory, in areas classified by the Modified Monash Model as MMM5, MMM6 and MMM7.

Method: Flinders NT auspices the RHMT program in the Northern Territory, supporting additional nursing and allied health placements.  After each placement, students are invited to participate in an anonymous survey which gathers a mix of quantitative and qualitative data about their placements.

Results: Over 2017 and 2018 the survey had a 33% response rate. Data from 309 nursing and allied health students will be presented with 92% indicating they were satisfied with their placement experience; 74% rating their experience as better or much better than their metropolitan placement/s; and 82% indicating the placement encouraged them to consider living and working in a rural or remote location after graduation.

Discussion:  Survey data demonstrates that students undertaking placements in the NT are very satisfied with the quality of their placement and their experiences have influenced them to consider returning.  It also shows the students rate their experiences in the NT as being generally “better than” previous experiences in metropolitan areas.

Flinders NT is commencing a Work Location Outcomes study in 2019 that will track the students for 10 years to see if intention has translated into outcomes and what the career trajectory of these placement students looks like.

Smith, T. et al 2018 DOI: 10.2147/JMDH.S150623

Smith, T. et al 2017 doi:10.1111/ajr.12375


Biography:

Annie Farthing has lived in Central Australia since 1992 working as a physiotherapist in urban and remote contexts, in community health, rehabilitation, aged care, disability and chronic disease. Annie is currently an academic at the Centre for Remote Health developing new and innovative placement opportunities for Allied Health students, as well as working as a locum for Tangentyere Council in their Integrated Team Care Program.

A New Era of Opportunity: Informatics for Allied Health

Ms Danielle Hornsby1

1Townsville Hospital And Health Service, Townsville, Australia

As electronic medical records (EMR) become common place in our hospitals nationally, allied health leaders have a window of opportunity to mine the rich data source, to rapidly change the way we measure the value of our services and our care. To harness this, we must think differently about the way our clinicians identify, collect, capture and consume data.

This presentation will challenge allied health leaders to consider the value proposition of old dated methods of data collection, and introduce an alternative prospect for mining structured data from EMRs. The presentation will provide a real case study from a tertiary hospital (Townsville Hospital), to demonstrate the organisational, operational, workforce and service impacts of switching out self-reported data, to a platform providing real-time data for clinicians, by clinicians.

This implementation, over a 12 month period, released the equivalent of eight full-time equivalent allied health professionals back to frontline care, produced a net saving of over $1million per annum, and dramatically changed the way that clinicians interacted with information dashboards to improve their day to day work.  The presentation will outline the methods, toolsets and organisational change strategies used, so that other leaders can effectively advocate for new solutions within their own settings.


Biography:

Danielle, as well as her role as an Executive Director Allied Health, has been an executive sponsor for EMR implementations for the past decade in Queensland, and has first hand experience in the transformation of practice and process in hospitals related to digitisation. She has lead several state and national award winning initiatives, including pioneering the development of real-time tools for allied health clinicians to visualise service data, and the integration of biomedical equipment to transform the way that deteriorating patients are managed. She has a passion for challenging our ways of thinking about measuring allied health value, particularly the types of data that reflect contemporary health issues.

Lets do better together: Training for health professionals on transgender and gender diverse affirmative practice in a hospital context

Andrew Wale-corey1, Simone Sheridan1

1The Royal Melbourne Hospital, Parkville, Australia

Background: A recent Australian study found that Transgender and Gender Diverse (TGD) patients experience high rates of discrimination when accessing mainstream healthcare services.  A lack of knowledge of TGD issues and insensitive questioning were the most common forms of reported discrimination (Department of Health, 2014).  Research suggests that the TGD population experience poorer physical and mental health outcomes due to stigma and social exclusion (Department of Health, 2014). Improving the provision of TGD affirmative health care may contribute to decreased health disparities and assist in creating safe and accessible health care for TGD people.

Objectives:  To develop, implement and evaluate a co-design education and training package with the Zoe Belle Gender Collective on affirmative language and sensitive questions for Nursing, Medical, Allied Health and Administrative staff.

Methods:  Single site cross-sectional survey measuring participants’ knowledge and confidence related to TGD experiences and affirmative practice skills.

Results: Preliminary results for 116 participants (84 nursing staff, 19 Allied Health Clinicians and 13 Medical Staff) show an increase in knowledge regarding the use of TGD safe language, importance of pronouns and asking sensitive questions to TGD patients. Furthermore, many participants identified an increase in knowledge regarding TGD experiences and inclusive/affirmative practice. The study is ongoing with a hospital wide roll out in 2019.

Significance:  Improving health professionals’ TDG knowledge and affirmative practice skills can assist in mitigating the effects of discrimination and harassment, which in turn may improve TDG health and wellbeing. This study describes a co-design, inter professional, time efficient, low-cost method to deliver education and examines its effectiveness.


Biography:

Andrew Wale-Corey is a Social Worker at the Royal Melbourne Hospital.  Andrew has clinical experience in Emergency Surgery, Trauma, Stroke, Neurology and Cardiology and a keen interest in LGBTIQA inclusive and affirmative practice.  Andrew is a member of the RMH LGBTIQA Working Party, a member of the Family Safety Advocacy Initiative, and was recently nominated for an Allied Health Respect Award for their work with LGBTIQA patients, staff, advocacy and education.

Simone Sheridan is a Clinical Nurse Educator at the Royal Melbourne Hospital.  Simone has a dedicated interest in providing safe and accessible care for all patient with a focus on the LGBTIQA community.  Simone is a key member of the RMH LGBTIQA Working Party and runs the ‘Let’s Talk about Sex’ training day. She is currently working with the Family Safety team to provide education to nursing staff with regards to Family Violence.

A picture maybe worth a thousand words but a narrative is priceless

Ms Maryanne Long1, Ms  Sonia  Wood1

1Southern Queensland Rural Health, Toowoomba , Australia

Research evidence suggests that peer to peer communication is a potentially influential tool to leverage interest and engage students in the conversation in relationship to the uptake of rural student placement pathways. A significant learning from the Educating Health Professionals in Interprofessional Care (ehpic™) training is the importance of sharing of stories. Informed by an interprofessional education framework, working collaboratively with students and other stakeholders, Southern Queensland Rural Health (SQRH) developed a project based on action research principles to create an innovative rural placement promotional resource. The narrative project engaged with students who discussed their recent rural placements from both a student learning and lifestyle / community engagement perspective.

The narratives took the form of written story-telling and one video production. The journeys of two University of Queensland (UQ) Social Work (S.W.) students transitioning from rural placement to graduate social work positions in rural towns are highlighted, thereby identifying a key employment pathway and addressing the critical issue of recruitment of graduate social workers.

The project resulted in the collation of a range of powerful narratives. Working with our partners, SQRH are currently trialing methods of the most effective way of sharing narratives with students. The target audience, SW students at UQ are currently being accessed via the promotions UQ SW Field Student Blackboard, guest lecture segments and the SQRH social media platforms and website.

Aligned with the action research cycle, currently the project is working through the observing and reflection phases prior to planning the next stage of this evolving project. Rates of pre and post project UQ SW student rural placement data will be monitored and will inform the next phase.


Biography: To be confirmed

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.

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