Keeping kids closer to home : Experiences of an expanded scope and Allied Health assistant delegation model for paediatric burn rehabilitation

Ms Debra Phillips1, Ms Lauren Matheson1, Dr Tilley Pain1,2, Dr  Gail Kingston1,2

1The Townsville Hospital, Townsville, Australia, 2James Cook University, Townsville, Australia

Background: Post burn injury, rural and remote children are geographically disadvantaged compared to metropolitan children in Australia. Specialist services for burn management are in tertiary hospitals located regional or metropolitan centres; and rural and remote children are more likely to have complications following a burn injury. Children with deeper burns require complicated rehabilitation, including allied health intervention, to achieve optimal outcomes. The Townsville Hospital established the Occupational Therapy Led Paediatric Burns Telehealth Clinic (OTPBTC) to reduce rural disadvantage. In this expanded scope model, the occupational therapist is responsible for monitoring children undergoing active burn rehabilitation rather than a Paediatric Surgeon. Clinical indicators are used to guide re-engagement of the surgeon when review is indicated and Allied Health Assistants are delegated clinical and non-clinical tasks to increase efficiencies.

Aim: The aim of this research is to explore the experiences had by families and clinicians utilizing the OTPBTC.

Method: This qualitative study used an interpretive phenomenological approach to explore family”s and clinician’s experiences with OTPBTC. Families and clinicians who have participated in telehealth reviews were purposefully selected and invited for interview. (HREC/17/QTHS/221)

Results: Themes from the interviews show families value accessing health care services close to home. Staying close to home reduces time off work and school with minimal disruption to daily life. Families and clinicians highlighted their confidence in the occupational therapist’s ability to manage the child’s rehabilitation via telehealth and act as the point of contact for their ongoing care. Rural clinicians benefitted from specialist advice and gained knowledge for their skill development.

Conclusions: This research demonstrates the value families place on receiving care close to home and the role telehealth and expanded scope positions plays in supporting this. Success of this local study demonstrates this model of care can be implemented in other health services across Australia.


Biography: 

Dr Gail Kingston Gail is the Assistant Director of Occupational Therapy at The Townsville Hospital. Since graduating from the University of Sydney in 1992, Gail has worked primarily within acute tertiary hospital settings in NSW and QLD.   She completed a PhD in 2014 titled Occupational therapy and/or physiotherapy services following a traumatic hand injury for people who live in rural and remote locations.  Gail’s ongoing research interests include occupational therapy models of care in acute hospitals and service delivery models for the management of hand and burn injuries in rural and remote residents.

 

Debra Phillips Deb Phillips is a Senior Paediatric Occupational Therapist at The Townsville Hospital.  She has worked with children with burn injuries for over fifteen years and is currently undertaking a post graduate diploma in burns rehabilitation. Debra developed the Occupational Therapy Led Paediatric Burns Telehealth Clinic in 2017 in conjunction with the Paediatric Surgery Department at The Townsville Hospital. This ground-breaking initiative received the Queensland Health Service Delivery Award in 2018.

Who wins when multidisciplinary health students have immersive service learning placements in regional communities with high needs and limited services?

Ms Robyn Fitzroy1

1University Centre For Rural Health, Lismore, Australia

The University Centre for Rural Health (UCRH) in Northern NSW was required to double its multidisciplinary health placements to 4,300 using innovative models. The goal was to develop placements beyond the acute care setting, into communities whilst still meeting curriculum outcomes and skill-development needs of over 23 universities. Placements involved high levels of disadvantage including isolation, limited health literacy and limited health services for community. Finding ways to give multidisciplinary health students a broad, inter-professional and community-immersive placement experience required innovative methods and challenged the existing paradigms used by traditional health settings, community agencies and universities.

A model of placement that met curriculum standards, enabled students to provide a community service and met UCRH and community needs was developed based on four key principles; continuous service, site engagement/enhancement, non-traditional supervision and inter-professionalism. Students placed into schools, pre-schools, aged-care facilities and community clinics are exposed to challenging yet positive rural training.

This models provides continuous service at the placement site with student placement blocks, one after the other. Community engagement is a priority so students learn clinically relevant challenges while simultaneously teaching communities about the benefits of these disciplines. Supervision is not one-to-one or necessarily discipline specific and requires students to expand their inter-professional skills and resilience.

Student services in 2018 included:

  • occupational therapy (254 weeks), speech pathology (223 weeks) -7 schools, 2 aged care
  • dietetics (30 weeks) – Aboriginal Medical Services, Red Cross
  • exercise physiology (40 weeks) community clinic
  • social work (36 weeks) – school, headspace, employment agency.

The community benefits are far-reaching as new services are delivered, health literacy enhanced and an understanding of the roles and value of health care therapies alongside general practice is improved.  The multi-pronged impacts of this model, presents opportunities for expansion and replication and benefits both students and communities.

The initiator of this work, Dr Lindy Swain is acknowledged.


Biography: 

Robyn Fitzroy is the Program Director at the University Centre for Rural Health

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)

Navigating the challenges of introducing a sub-acute pathway to North West Queensland: Learning together

Ella Dunsford1, Katheryn  Farry2

1Mount Isa Centre For Rural And Remote Health, Mount Isa, Australia, 2North West Hospital and Health Service, Mount Isa, Australia, 3Gidgee Healing, Mount Isa, Australia, 4NWRH, Mount Isa, 4825

Background: Allied health service providers in North West Queensland (NWQ) have historically functioned independently of each other, with collaboration largely clinician dependent. This siloed approach to health care was contributing to fragmented care planning for residents transitioning from Townsville Hospital back to NWQ. The development of the Transition 2 Sub Acute Program across Central and North Queensland triggered the overhaul of our sub acute rehabilitation referral processes.

Aim: The North West Sub Acute Collaborative aimed to improve referral pathways, and in turn the patient journey between Government and Non-Government organisations across Queensland, in line with AHPOQ’s Transition 2 Sub Acute project.

Methods: The Transition to Sub Acute Collaborative identified key stakeholders delivering allied health sub-acute service across NWQ including Gidgee Healing, NWRH, North West Community Rehab and the North West Hospital and Health Service. The collaborative engaged key stakeholders in bi-monthly videoconferences with other sites in Queensland and facilitated two face to face workshops across a 24 month period. Key stakeholders from NWQ formed a region based collaborative to act on operational requirements for commitment to the Transition 2 Sub Acute project and on clinical requirements to translate research and recommendations into practice.

Results: NWQ’s region based collaborative has implemented weekly interagency case conferences between key stakeholders in NWQ, a clinical representative from The Townsville Hospital’s rehabilitation team and a research representative from the Sub Acute Collaborative. The inter-agency case conferences have facilitated more timely and appropriate referrals from The Townsville Hospital, early discharge planning, communication across Government and Non-Government organisations and increased collaboration between Allied Health professionals in NWQ. Clients are involved in care planning during their sub acute inpatient admission and, using the Transition Planning Tool, are able to meet their regional team and coordinate their regional based rehabilitation program before returning home leading to a streamlined transition from inpatient to community based services.

Conclusions/ Recommendations: A regional collaborative approach to sub-acute care planning has provided benefits across client, clinician and service levels within Allied Health organisations in NWQ – working together to face the challenges of introducing a standardised framework into a unique, complex environment.


Biography: 

Ella is the Project Manager and Clinical Lead of Occupational Therapy for North West Community Rehabilitation, based at Mount Isa’s Centre for Rural and Remote Health, James Cook University. Ella is a committed member of the Central and North-West Sub-acute Collaborative that is implementing the ‘Transition 2 Sub-Acute’ project; a project that aims to improve the sub-acute patients journey and expediting care closer to home. She is also a member of the project research team. Raised in regional South Australia, Ella has first-hand experience of the impact of centralisation of services and is committed to reducing inequity of access to health services and improving health outcomes for people living in rural and remote Australia.

Improving rural health through implementation of a pharmacist-led post discharge and high-risk medication service in a rural community

Ms Michelle Rothwell1, Ms Sarah Tinney2, Dr Neil Cottrell3

1Queensland Health, Cairns , Australia, 2Cairns and Hinterland Hospital and Health Service, Atherton , Australia, 3University of Queensland , Brisbane, Australia

Introduction: The 2019 report ‘Medicine Safety: Take Care’ states that 250,000 hospital admissions each year are a result of medication-related problems (MRP’s) costing $1.4 billion with 90% of patients having at least one medication-related problem post discharge from hospital. This study determines the impact of a pharmacist-led post discharge and high-risk medication service on medication misadventure.

Methods: Conducted as part of the Queensland Allied Health Rural Generalist Pathway initiative this is a descriptive study utilising quantitative methodology to collect data prospectively as well as pre- and post-intervention. The intervention is a comprehensive pharmacist medication review for patients identified at risk of medication misadventure Primary outcomes are the subjective and objective measured change in medication adherence and the SF-12 health survey quality of life (QOL) score compared to baseline at three and six months post intervention. Secondary outcomes include the number of identified medication-related problems (MRPs), the number of resolved MRPs and the grading of clinical significance of the MRPs.

Results: 81 patients consented with a complete data set presented so far for 50 patients. Preliminary results show an increase in subjective medication adherence for post discharge patients at three months continued through to six months, with the mental component summary of QOL data considerably lower for patients at discharge compared to the high-risk patients and to baseline. 430 MRPs were identified which is an average of 5.31 MRPs per patient.

Conclusions: The high number of identified MRPs per patient emphasises the risk of medication misadventure. Preliminary data suggests the pharmacist intervention improves medication adherence and the effect is sustained. QOL mental component summary data may contribute to evidence that patients in the immediate post discharge period are at most risk of medication misadventure. Further work on this study will complete evaluation data and measure the impact on acute service use.


Biography: 

Sarah Tinney is a hospital pharmacist who has been working in rural hospitals since 2013. She is passionate about improving medication services in rural areas, with particular interests in antimicrobial stewardship, medication safety and deprescribing. Among her achievements, Sarah has implemented a rural multidisciplinary antimicrobial stewardship round at Atherton Hospital, which was highlighted at the 2018 SHPA Medicines Management conference.

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.

Improving equity in access to dietetic services across Western NSW LHD by utilising a Virtual Dietetic Service

Catherine Forbes1, Nicole Litwin-Farrell1

1Western NSW LHD, Forbes, Australia, 2Western NSW LHD, Parkes, Australia

A lack of Dietetic resources in Western NSW Local Health District means that residents at risk of malnutrition in Multi-Purpose Services (MPS) in our LHD who are at risk of malnutrition are not always identified at being at risk of malnutrition and do not always receive appropriate nutritional intervention.

The aim of this pilot project was to determine if we could improve the nutritional status of residents at risk of malnutrition in MPS facilities utilising a Virtual Dietetic Service (VDS).

Method: Telehealth was identified as a method of service delivery which could be utilised to improve access to allied health services for residents in MPS facilities. Discussions occurred with key stake holders and seven MPS sites in WNSWLHD were chosen to pilot a VDS. Residents in these sites who scored an MST greater than 2 on routine screening were referred to the Virtual Dietitian who utilised telehealth technology to assess the client and provide nutrition education and support to both the client and staff in the MPS facility.

Results: All residents with an MST score > 2 are now referred to the VDS, over two hundred Virtual Dietetic interventions have occurred since the pilot commenced. Identified benefits reported by sites utilising the VDS have included: a reduction in falls, upskilling of staff, and an increase in the number of residents undergoing routine malnutrition screening.

Discussion/Recommendation: A virtual Dietetic Service has been shown to be an effective model for increasing equity in access and providing better nutrition care to residents in MPS facilities in Western NSW LHD


Biography:

Catherine Forbes has worked as a Dietitian in Ruural locations in South Australia, Victoria and New South Wales over the past 20 years. She is currently the Nutrition and Dietetics Clinical Advisor for Western NSW Local Health District and has a passion for improving the health of rural people.

Approaches to system-level implementation of the Allied Health Rural Generalist Pathway: experiences from three jurisdictions

Kendra Strong1, Ms  Ilsa Nielsen2, Ms Renae Moore3, Ms  Gemma Tuxworth1, Ms Susannah Lennox1, Ms Michelle Rothwell4

1Department Of Health, Tasmanian Government, Hobart, Australia, 2Department of Health, Queensland Health, Cairns, Australia, 3Top End Health Service, Northern Territory Government, Darwin, Australia, 4Cunningham Centre, Darling Downs Hospital and Health Service, Toowoomba , Australia

Introduction

The Allied Health Rural Generalist (AHRG) Pathway aims to deliver better services for rural and remote communities and improve workforce sustainability.  Implementation sites employ trainees in supportive, early career, designated training roles and implement service development strategies. System-level approaches to AHRG Pathway implementation are underway in public health services in Queensland, Northern Territory and Tasmania.

Methods/strategy

Four system-level strategies have been used to implement the AHRG Pathway:

  1. Supernumerary training positions funded and coordinated at organisation level (Queensland, Tasmania, Northern Territory).
  2. Centrally-administered funds for education fees (Queensland, Tasmania).
  3. Changes to human resources and industrial instruments to integrate rural generalist training and link progression to the development of rural capabilities (Queensland, commencing in Tasmania).
  4. Funding support packages provided through an agreement between health services and state department of health for an agreed number of training positions (Queensland).

Outcomes

Twenty-two supernumerary training positions were implemented and evaluated over trial periods in Queensland (2014-18), four in Northern Territory (2017-18) and eight in Tasmania (2018-20). Queensland Health identified the supernumerary funding model is effective in the jurisdictional ‘proof of concept’ phase, but provides diminishing returns and restricts growth beyond this stage.  Education fee funding programs for existing staff have been underutilised or challenging to develop in all jurisdictions. Human resource and industrial integration of the pathway is regarded as critical, but requires further work to implement.  Queensland’s newly-developed funding support package model enables greater local control over implementation processes and resources, and has doubled the number of training roles.

Conclusion

The various approaches of three state and territory governments to implementation of the AHRG Pathway demonstrates the need for systems to respond to regional challenges and opportunities.  Further evaluation of implementation approaches will be critical to informing national development of the pathway and realising benefits for rural and remote services.


Biography:

Kendra Strong is the Chief Allied Health Advisor at the Department of Health, Tasmania

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