Improving patient health outcomes and hospital efficiency through innovative workforce redesign in pharmacy

Mrs Desiree Terrill1

1Department Health Human Services, Melbourne, Australia, 2Alfred Health, Melbourne, Australia

Abstract:

Aim:
To undertake a multi-centre health economic evaluation translating a partnered pharmacist medication charting (PPMC) model in patients admitted to public hospital General Medical Units.

Method:
This unblinded, prospective cohort study compared patients admitted to General Medical Units before and after the intervention in seven public hospitals in Victoria from June 2016 to June 2017. The intervention involved medication charting by pharmacists using a partnered pharmacist model compared to traditional medication charting. The primary outcome measure was length of inpatient hospital stay. Secondary outcome measures were medication errors detected within 24 hours of patient admission, identified by an independent pharmacist assessor.

Results:
A total of 8,648 patients were included in the study. Patients who received the PPMC intervention had reduced median length of hospital stay from 4.7 days to 4.2 days (p<0.001). The PPMC was associated with a reduction in proportion of patients with at least one medication error from 66% to 3.6%. The average saving per PPMC intervention admission was $834 ($7,254 for PPMC compared with $8,088 for standard care, with a cost benefit ratio of 1:17. Savings were driven by reduced complications and increased safety rather than productivity. All hospitals sustained PPMC operation since funding ceased in June 2017. Cost modelling of state-wide roll-out of the PPMC model operating during business hours suggests potential savings of $232 million per annum can be achieved.

Significance of the findings:
Expansion of the partnered pharmacist charting model across multiple organisations is effective and feasible, and is recommended for health services.

Biography:

Desiree Terrill is a Senior Policy Advisor in the Workforce Funding Performance and Review Unit at the Victorian Department of Health and Human Services. Desiree has a background in health promotion, evaluation, research and health economics. Her focus is on the development of evidence-based policy approaches, frameworks and initiatives to enhance efficient advanced practice pathways in the health and human services sector.

As part of the department’s workforce innovation and reform agenda, Desiree led the Partnered Pharmacy Medication Charting Program which aims to assist hospitals to strategically position themselves to build allied health work force capacity into the future in a sustainable way.

Feasibility of increasing the dosage of inpatient movement rehabilitation with additional self-directed independent exercise: “My Therapy”

Dr Tash Brusco1,2, Ms Louise Tilley1, Ms Brianna Walpole1, Ms Helen Kugler1, Mr Ran Li1, Ms Emma Kennedy1, Professor Meg Morris1,2

1Centre for Allied Health Research and Education (CAHRE), Cabrini, Melbourne, Australia, 2La Trobe Centre for Sport and Exercise Medicine Research, School of Allied Health, La Trobe University, Melbourne, Australia

Abstract:

Aim:
To determine the feasibility of implementing My Therapy in addition to rehabilitation inpatient usual care, for musculoskeletal and frail older patients.

Methods:
A two-group quasi-experimental pre-post design examined the feasibility of delivering My Therapy in addition to usual care, compared to usual care. My Therapy comprised independent self-directed exercises prescribed by physiotherapists and occupational therapists. The primary outcome was My Therapy implementation feasibility, to achieve at least 70% adherence. Secondary outcomes were self-reported daily My Therapy participation (minutes), total daily movement rehabilitation participation (minutes), adverse events, length of stay, 10 metre walk speed, FIM scores and discharge home.

Results:
My Therapy participation was achieved by 72% (83/116) of the My Therapy group, averaging 14 minutes (SD 14) of extra practice per day. Total participation was 177 minutes (SD 47) for the My Therapy group (n=116) and 148 minutes (SD 88) for the usual care group (n=89), mean difference of 30 minutes (p=0.00). A minimal clinically important difference in FIM was achieved for significantly more My Therapy participants (22%, n=26) compared to usual care (10%, n=9; p=0.02). There were no safety concerns or group differences for other outcomes.

Significance of the findings to allied health:
My Therapy is a feasible and safe way to increase the amount of allied health therapy in hospitalised older people with musculoskeletal conditions or frailty to achieve an additional 14 minutes of daily practice alongside usual care rehabilitation.

 

The STAT model improves access to sub-acute rehabilitation and outpatient services: A stepped wedge randomised controlled trial

Dr Katherine Harding1

1Eastern Health / La Trobe University, Box Hill, Australia

Abstract:

Aim:
Long wait lists for allied health services in ambulatory and community settings have negative health consequences. The STAT model (Specific Timely Appointments for Triage) was designed to improve access to these services using initial targeted strategies to reduce the existing wait list coupled with protected appointments for new patients that aim to maintain flow at the rate of demand.

This trial aimed to determine whether the STAT model could work beyond isolated pilot trials to reduce waiting time in a fully powered stepped wedge trial with multiple sites.

Method:
We conducted a stepped wedge cluster randomised controlled trial involving 8 sites (n=3116 patients), registered prospectively (ACTRN no. 12615001016527). The primary outcome was time from referral to first appointment; secondary outcomes included time to second appointment, rate of discharge at 12 weeks and number of appointments provided.

Results:
Median time from referral to first appointment reduced from 60 days pre-intervention to 36 days in the post-intervention period across all sites (IRR 0.66, 95% CI 0.52 to 0.85) with no change in secondary outcomes. Variation in waiting time was also reduced.

Significance of findings for Allied Health:
Allied Health professionals frequently provide services in community health and ambulatory settings with long waiting lists. Improvements in access to these services can be achieved by addressing inefficiencies and encouraging service providers to make priority decisions about service delivery in the context of demand.

Biography:

Katherine began her working life as an Occupational Therapist before completing a PhD in and shifting focus to the world of health services research.  She is a  Research Fellow with the Allied Health Research Office at Eastern Health, where she provides research support for allied health clinicians, promotes research activity and leads a range of projects. Katherine also holds an an adjunct position with La Trobe University and serves on the Executive Committee of the Health Services Research Association of Australia and New Zealand.

Early Rehabilitation Team (ERT): patient and service outcomes evaluation

Freya Coker1, Amy Stichling2, Rebekah Clutterbuck2, Dr Cylie Williams1, Professor Terry Haines1

1Monash University, Peninsula, Australia, 2Monash Health, , Australia

Abstract:

Aim:
To understand the Early Rehabilitation Team’s (ERT) impact on patient and service outcomes in acute and subacute at Monash Health.

Method:
Whole of service length of stay (LOS), readmission and costing data were extracted. Data extracted were within 2017 (ERT implementation) and compared to 2015-2016 for equivalent time points. Staff perspectives were sought through interview and online survey. Regression analyses were used to compare outcomes between time points, clustering by patient UR. Qualitative data were thematically analysed.

Results:
During 2017, when compared against 2015-2016 combined, patients had a statistically significant higher likelihood of admission to subacute (OR=1.34,95%CI=1.22 to 1.47, p<0.01), greater LOS in acute (Coef=0.12,95%CI=0.09 to 0.14, p<0.001) and greater total length of hospital stay for patients admitted to acute and subacute (Coef=0.15,95%CI=0.12 to 0.18, p<0.001). There was no significant difference in subacute LOS between time points (Coef=0.05,95%CI= -0.03 to 0.13, p=0.245). Cost analyses for the three years indicated a difference in funding (favouring increasing costs each year) for total costs (Coef=461.02,95%CI=178.80 to 743.24, p=0.001), acute only costs (Coef=260.26,95%CI=29.27 to 491.45, p=0.027) and subacute only costs (Coef=200.76,95%CI=80.10 to 321.43, p=0.001). Average total cost increased each year from 2015, even with CPI adjustment. This was expected given the differences in LOS. Qualitative findings indicated challenges that may have contributed to a finding of no health service change in outcomes.

Significance of the findings to allied health: It appears this particular model of care did not have patient or service impact.

Biography:

Freya Coker is an occupational therapist and currently completing her PhD with Monash University. Today she is presenting the Early Rehabilitation Team: patient and service outcomes evaluation.

Improved discharge planning through a community & ambulatory in-reach model

Mrs Haria Lambrou1, Mr David Harrower1, Mr  John  Ashfield1, Ms Ilanit Whitemnan1

1Alfred Health, Caulfield , Australia

Abstract:

Aim:
A model was developed for community and ambulatory services to routinely in-reach into sub-acute wards with the aim of improving discharge planning.

Methods:
A quality improvement activity was undertaken on two sub-acute inpatient wards to determine the effect of introducing an in-reach model on discharge planning. An intake worker from the community and ambulatory team attended journey board meetings on two pilot wards to act as a resource for clinicians and assist in discharge planning. The model was implemented for 6 months and outcome measures included length of stay, unplanned readmission rates and impact on the timeliness and quality of referrals from inpatient wards to community & ambulatory services. Staff satisfaction with the in-reach model was also measured.

Results:
In comparison to the non-trial wards, the in-reach model demonstrated a 25% – 39% reduction in unplanned readmissions on the trial wards but did not reduce length of stay. Improved timeliness and appropriateness of referrals from the trial wards to community and ambulatory services was also seen.

Significance of findings to Allied health:
The in-reach model can help reduce unplanned hospital readmissions through improved discharge planning, which can result in improved efficiency within the hospital and increased availability of hospital beds. Length of stay was not reduced, but the trial was able to demonstrate an improved awareness of discharge resources in clinicians, as well as an improvement in the quality and timeliness in referrals to community and ambulatory services.

Biography:

Haria has a clinical background in Physiotherapy and has worked in public health for 21 years, mostly as a musculoskeletal physiotherapist. Her role over the last 2 years has been as a team leader as part of the Caulfield Community Health Service, where she leads a team of clinicians responsible for the intake of referrals to community & ambulatory services.

Up and Active: preventing functional decline for older people in general medicine wards

Ms Melanie Haley1, Ms Katherine Lawler1, Ms Anatole Jasonides1, Ms Rhiannon Pendleton1, Ms Anne Pagram1, Mr Timothy Albiston1, Ms Susan Parslow1, Mr Christopher Sloan1

1Eastern Health, Mont Albert North, Australia

Abstract:

Aim:
To test the feasibility and effectiveness of a model of care in general medicine incorporating exercise groups and a focus on reducing functional decline.

Method:
This observational study compared routinely collected data of patients ≥65 years from an intervention ward with two usual-care wards during a 6-week period.  The intervention was a thrice-weekly exercise group and a physiotherapy service that prioritised prevention of functional decline. Outcomes were length of stay, discharge destination and change in mobility status (categorical variable improved/did not improve). Length of stay was analysed using independent t tests, change in mobility status using odds ratio and discharge destination data using z tests.

Results:
Data from 369 patients were collected (Intervention n=127, Usual Care n=242).  The odds of patient mobility status improving was significantly higher on the intervention ward compared with the usual care wards (OR 2.47 (1.54-3.95) p<0.001).  There was no difference between the intervention and usual care wards for length of stay in hospital (Mean 14.0 days [SD 17.9] v Mean 11.6 days [SD 15.2] p=0.173). There was no difference in proportion discharged home (60.6% v 67.4% p=0.939), to sub-acute wards (25.2% v 19.0% p=0.167) or to new residential care (1.6% v 5.0% p=0.1065). No adverse events were experienced by patients participating in exercise groups.

Significance of the findings to allied health:
This model of physiotherapy care was feasible and improved the odds of improving mobility status but did not impact length of stay or discharge destination.

Biography:

Melanie Haley is an Aged and Complex Care physiotherapist at Eastern Health.  She has completed her Masters in Gerontology at La Trobe University, including a minor thesis on frailty in the sub-acute setting.  She is a current member of the Safer Care Victoria Care of Older People governance committee and has research interests in prevention of hospital functional decline, frailty and delirium.

Allied Health and Rotary Equipment Reissue Program for Hardship

Mrs Angela Mucic1, Mr Brad Wilson1

1Western Health, St Albans, Australia

Abstract:

Aim:
The primary aim of this project was to facilitate the provision of re-issue equipment at no cost to Western Health patients experiencing hardship, in a responsive and sustainable manner.

Method:
Western Health Allied Health engaged Western Health Sustainability and Keilor Rotary to design the Reissue Program. Consumers were consulted during this design phase. Equipment is covered by a Rotary Deed of Donation, which states that equipment is provided with no guarantee or warranty. Equipment is available to patients experiencing hardship, and being treated by a Western Health occupational therapist or physiotherapist. Equipment is stored onsite and a volunteer manages the Reissue storage room. A sticker is now placed on all equipment sold or donated to patients, encouraging them to donate the equipment to Rotary once they no longer need it.

Results:
In the first three months (August – October 2018), 42 items have been distributed to patients in need at Sunshine Hospital. The most popular items were 4 wheel frames and shower chairs. Twelve items have been directly received by Sunshine Hospital, donated by patients and staff, with more items donated directly to Rotary. Further evaluation is underway examining consumer feedback and exploring financial implications on the hospital.

Significance of the findings to allied health:
This program has enabled the redistribution of equipment to patients in need. This serves to provide patients with much needed support for their health, and supports environmentally sustainable practice.

Biography:

Angela is the Allied Health Education Lead for Workforce at Western Health.  Angela’s interest is in building leadership capacity within allied health and building skills in consumer engagement among staff. Angela has completed many consumer focused projects including contributing to the Minimising Functional Decline publication (DHS, Victoria) and developing the AH Consumer Engagement Committee at Western Health.

Complex regional pain syndrome: a new model of care

Miss Zoe Milner1, Assoc Professor Malcolm  Hogg1, Miss Hayley O’Sullivan1, Mrs Beth White1

1Royal Melbourne Hospital, Parkville, Australia

Abstract:

Background:
CRPS literature indicates <50% of patients diagnosed with CRPS will return to the workforce. Clinical opinion and current literature indicates early recognition of CRPS improves patient outcomes. Patients presenting with CRPS within Royal Melbourne Hospital (RMH) were frequently not identified, resulting in multiple emergency department presentations and high healthcare utilisation. Care was provided in silos and lacked co-ordination, resulting in persistent symptoms and long term healthcare needs.

Aims:

  • Facilitate early access to assessment and intervention
  • Provide intervention in a co-ordinated, evidence based and well-supported approach, reducing variation in care, reducing healthcare utilisation and improving outcomes

Methods:

  • Received Department of Health & Human Services Advanced practice grant
  • Developed and implemented clinician resources including identification tool and clinical algorithm
  • Established direct referral pathway to assist clinicians in key hospital areas to identify patients

Results:
65 patients were referred in the first 12 months  with the following results achieved:

  • Statically significant reductions in health care utilization
  • 90% of patients have returned to their pre-injury workplace
  • Statically significant improvements in function

Significance of the findings to allied health:
This innovative clinical approach led by allied health provides a single point of contact and enables patients to access the right care at the right time. Effectiveness has been demonstrated by reducing health care utilisation, improving patient access to care, whilst also improving patient outcomes.

Allied health can lead patient intervention and patient pathways to provide streamlined care which provides benefits to both patients and the organisation.

Biography:

Zoe Milner is the clinical lead in hand therapy at Royal Melbourne Hospital. She has led two advanced practice projects with a focus of improving patient access to early intervention.

Allied Health innovation: Thinking strategically and differently

CaraJane H. Millar1, BHSc (SP), MHA

1 Allied Health Manager -Language Services and Workforce Innovation.  Alfred Health.  

In many daily situations people have problems to solve, many decision are quick, easy and efficient, “Which shoes to wear, what to have for breakfast?” others are more complex “What patients fit the prioritisation tool, which way do I react/respond to my partner/colleague or friend?” and some seem insurmountable, “How on earth will I fit everything into my time today?” Do you feel you need to solve a problem but can’t at the moment?

There are many things that will make issues/problems seem insurmountable and there is nothing like tight resources to make one think differently.  Hopefully you will find an alternative resolution –you can become more “innovative”.

This session will ask some of the key questions to identify a problem that could be considered in a different or innovative way.  The problem will be defined and key questions will be provided to consider:

  • Is the organisation ready for change?
  • Does this change fit with professional scope of practice AHPRA or professional association requirements?
  • How as clinicians can you be more daily-efficient to find the time release to try a new way of working?
  • How to evaluate, report and get the ‘word-out’ about this innovation?
  • How do you ensure good governance.

Thomas Edison was one of the first inventors to apply the principles of mass production and large-scale teamwork to the process of invention, hence he was innovative, he though differently and efficiently this session will encourage you to think like Edison and allow a safe space for innovation.

The global tracheostomy collaborative: A multi-disicplinary quality initiative improving the lives of children and adults who have a tracheostomy around the world

Ms Tanis  Cameron1,2, Ms  Charissa Zaga1,2, Ms Kristy McMurray1,2, Ms  Jack Ross1, Dr  David Roberson2,3,4

1Tracheostomy Review and Management Service (TRAMS) Austin Health , 2Global Tracheostomy Collaborative, 3Department of Otolaryngology, Boston Children’s Hospital, 4Department of Otology and Laryngology, Harvard Medical School

Aim: The Global Tracheostomy Collaborative (GTC), founded in 2012, is an international multi-disciplinary Quality Improvement (QI) collaborative which strives to improve outcomes in both paediatric and adult tracheostomy care (www.globaltrach.org). Dr David Roberson, ENT Specialist, Boston Children’s Hospital and Harvard is the lead in this world first tracheostomy QI . The GTC works through the following key drivers: Patient and family participation, multi-disciplinary tracheostomy care, a HIPAA-compliant REDCap database to track and benchmark outcomes among member hospitals, creation of institution wide tracheostomy policies and protocols, and coordinated interdisciplinary education for all providers. The aim of this study is to report on the process, outcomes, future directions of this tracheostomy quality collaborative. Austin Health in Melbourne Victoria is a founding member and the Australasian lead site for the GTC with a team led by allied health professionals, nurses and doctors.

Method: Establishing mission and vision, international clinical governance, committee structure, website formation, creation of and reports from international HIPAA-compliant REDCap database, 4 international kick-offs and ongoing global recruitment.

Results: Since April 2014, over 50 hospitals in the United Kingdom, Sweden, United States, Singapore, Qatar, and Australia have joined the collaborative. 770 individuals from 125 institutions attended GTC launch meetings in Boston (April 2014), London (July 2014) Melbourne (October 2014); and Baltimore (April 2016). 1000 additional individuals from over 20 countries attended virtually. All disciplines (anesthesia, critical care, pulmonary, respiratory care, physiotherapy, speech pathology, nursing, social work, and hospital management) were represented at the meetings. Data collection has been successful with 1500 new tracheostomy cases entered into the database by 19 institutions and counting.

Significance of the findings to allied health: This world first global initiative has strong allied health leadership  and membership.  Allied health are key to this specialist healthcare community.