A Private Healthcare Journey through Quality and Research

Mr Andrew Currie1

1 Healthscope, Vic/Tas

Allied health clinicians play an integral role in ensuring high quality, evidence based practice in private hospitals throughout Australia. There are more than 45,000 allied health clinicians in Australia and more than 20 allied health disciplines.  Across Healthscope’s 45 hospitals in Australia there are currently 2,500 allied health clinicians, with many physiotherapists, psychologists, dieticians, social workers, occupational therapists, podiatrists and speech pathologists. The majority of patients in the private sector are funded by an insurance fund. Increasingly they are focused on improved patient outcomes. Healthscope has been a leader in publishing patient outcome indicators on its myhealthscope.com.au web site, for each of its hospitals. There is a large role for the allied health workforce to work with other Healthscope clinicians in order to improve the quality of our patient care, and resultant outcomes. This presentation will explore the quality journey Healthscope has taken to date to improve its indicators. In order to drive quality further than simple comparative indicators, Healthscope is working with key research programs to drive evidence based approaches to our care delivery, again designed to improve our quality outcomes. This presentation explores how managers and clinicians can foster and support evidence-based practice, through quality indicators and a research focus, and how this can positively impact patient outcomes, efficiency and reputation.

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.

Suicide Prevention : The development of an evidence based intervention as a response to self-harm

Professor Lynette Joubert1

1 Melbourne School of Health Sciences, University of Melbourne

Suicide prevention has focused on self-harm and suicide attempts.

This presentation will look at the issue of suicide by focusing on individuals who have attempted suicide, have a history of self-harm behaviour and who come in contact with emergency departments or public mental health services. It will report on how people in a state of crisis see themselves and analyse the precipitating issues that brought them to emergency .

In particular the clinical and service outcomes of a randomised control trial of a psychosocial intervention to reduce suicidal ideation and emergency ( ED) representations in an identified at risk and vulnerable group of people who presented at emergency in the western metropolitan area of Melbourne, Australia will be presented. The psychosocial intervention consisted of psychosocial assessment, engagement with the team, brief client-centred psychotherapy and community linkage. At six-weeks, as compared with those who did not receive the Suicide Prevention in the Emergency Department (SPED) intervention, those who received SPED’s intervention demonstrated improvements in all aspects of general health status (as measured by the General Health Questionnaire – GHQ-28), psychological well-being, illness, social relationships and health-related quality of life (as measured by the Assessment of Quality of Life – AQoL). Overall, those people who received SPED’s intervention placed a higher importance on wanting to stay alive than those that did not receive the intervention, and had half the number of re-presentations to ED in the following six-months.

Recommendations for service implementation will be discussed.

Enabling participation in paediatric rehabilitation: challenges and opportunities

Professor Christine Imms1

1 Professor Of Occupational Therapy, Australian Catholic University

The importance of positive participation outcomes for those experiencing childhood-onset disability is well established. The introduction of the National Disability Insurance Scheme in Australia has further endorsed the primacy of participation as a health and human services outcome. However, until recently, lack of clarity about what constitutes participation, as distinct to activity performance, has reduced our capacity to build effective intervention models and practices, and to assess whether what we do changes participation outcomes.

The aim of this presentation is to use the recently published family of Participation Related Constructs (fPRC) as a framework to interpret participation research findings in childhood disability and highlight challenges and opportunities for practice and research.

The fPRC was developed following a series of systematic reviews of participation intervention research, culminating in a conceptual paper describing the framework. In the fPRC, participation is defined as having two central constructs: being there (attendance) and involvement. Using systematic review methods, measures purporting to assess participation in childhood disability were identified and mapped to the fPRC, highlighting the frequent disconnect between what was measured and the construct of participation.

Research focused on enhancing participation outcomes, rather than describing participation patterns, is needed. Opportunities to develop and implement theoretically informed intervention models, and to test them using valid measures, rely on those designing, delivering and funding health and human services having a shared and conceptually clear understanding of the construct of participation. The fPRC offers a mechanism to support this goal.

Improving care for arthritis through allied health-led translational research

Ilana Ackerman1

Monash University, Victoria

Allied health researchers have a unique opportunity to (a) identify research questions arising from clinical practice and leadership positions and (b) address these in order to effect real change in delivery of care and achieve better patient outcomes.

This presentation covers two programs of translational research that have led to improvements in the way we care for patients with arthritis. The first program of research involved a longitudinal study of patients waiting for joint replacement surgery in the public hospital system. The findings from this study were the stimulus for the development of the Osteoarthritis Hip and Knee Service, which has now been implemented in Victorian public hospitals as part of routine care.

The second program of research aimed to better understand the information needs of women with rheumatoid arthritis around pregnancy, breastfeeding and post-natal care. This work has led to the development of new resources for health professionals caring for women with rheumatoid arthritis, including cross-discipline consensus statements regarding key educational messages and clinical practices.

Improving clinical management and quality of life in mid to late stage Huntington’s disease: How research can inform clinical practice and vice versa

 Caroline A. Fisher, Anahita Brown, Katherine Sewell and Bronwyn Moorhouse

Thematic Overview

Utilising the research literature is an important part of clinical practice as implemented interventions should be evidence-based, wherever possible. However, in some areas a strong research evidence base may be lacking. Under these circumstances there is often much that can be achieved through clinical research to improve knowledge and evaluate practice and outcomes. Thorough practice evaluation and clinical audit data can be used to formulate new management guidelines to improve both patient care and quality of life.

Content Overview

This presentation will focus on the driving factors behind, and results of, five papers recently published by the multidisciplinary research team from the Brain Disorders Program at Austin Health. The research focussed on two areas of concern in the care of patients with mid-to-late Huntington’s disease: aggression and the long-term use of modified diets. The clinical implications of this research will be discussed, including how the results can be used to inform and improve clinical practice into the future.

Background

Huntington’s disease (HD) is an autosomal dominant genetic disorder. The three defining features are a movement disorder, psychiatric symptoms and cognitive impairment. The onset of HD symptoms generally occurs in mid to late adulthood, then progress over a 10 to 20 year period to be eventually fatal. In addition to psychiatric disturbance, behaviour problems are also common in HD, particularly aggression. Despite previous studies indicating that rates of aggression are high, little was previously known about causative or antecedent contributors to aggressive behaviour in HD sufferers. There was also little published empirical data regarding treatment methods for this problematic behaviour. A second issue of clinical concern in this population is the prescription of the long-term use of modified (pureed) diets, necessitated by swallowing problems as a result of the progressive movement disorder. Concerns included the sensory deprivation of ingesting a pureed diet for many years, disconnection from food in its standard form, taste fatigue and reduced dietary enjoyment.

Methods

Members of the clinical team (Occupational Therapy, Speech Pathology and Neuropsychology) on the Brain Disorders Unit (BDU) thoroughly reviewed the research literature in the areas of aggression and the use of long-term modified diets in HD. These reviews then formed the basis for a series of clinical research initiatives aimed at improving knowledge and patient care. Varying research methodologies were utilised, as appropriate, including systematic review, practice analysis, empirical clinical case studies, and a large scale clinical data audit.

Results and Outcomes

This series of papers was instrumental in improving knowledge about aggression in mid-to-late stage HD sufferers. It revealed that rates of aggression in this population are very high (90% in the inpatient BDU sample), and that both verbal and physical aggression are common. It further revealed that personal care is the most common antecedent trigger for aggressive behaviour, but that there is a degree of inter-individual heterogeneity of triggers for aggressive behaviour. Additional outcomes indicated that sensory sensitivities may contribute to behaviour disturbance and that individual sensory modulation programs can be effective for reducing aggression, particularly when combined with behaviour modification plans. Multiple treatment recommendations to reduce distress and rates of aggression were developed as a result of this research. These included modifications to personal care routines such as taking extra care to ensure the HD sufferer feels comfortable, unrushed and forewarned of upcoming tasks during personal care, conducting sensory processing assessments and utilising sensory modulation equipment and techniques, such as the use of individualised comfort items (soft pillow, blankets) and/or distraction (click-clack balls, hand-held massagers, playing music to the client) during personal care and other activities, and the use of behaviour assessments and individualised behaviour support plans to target known antecedents for aggression in individual clients.

 

The research also revealed the paucity of studies into the long-term use of modified diets in any population, not just HD. The clinical practice analyses undertaken indicated that it was possible to make changes to clinical practice to improve the gastronomical and social experience of mid-to-late stage HD sufferers, via improving the texture of food, the range of food choices available for clients and participation in food preparation and meal groups.

 

Students’ responses to a simulated interprofessional education intervention to teach falls prevention

C Williams1,2, D Kiegaldie3, D Nestel2, E Pryor1, R Wotherspoon1, J Kaplonyi1, KA Bowles1,2, S Maloney2, T Haines2

1Peninsula Health, Frankston, VIC
2Monash University, VIC
3Holmesglen Institute, VIC

Aim

To determine the impact of simulated inter-professional education (IPE) on students’ falls prevention knowledge, confidence and motivation to undertake a preventive communication intervention.

Method

This study was nested within a cluster, cross-over randomised controlled trial. IPE was undertaken within a 4-hour session with a trained actor patient teaching the Safe Recovery Program.  Three pair-wise comparisons were made, pre versus post-IPE, post-simulation versus post-placement, and post-placement (IPE) versus untrained students. Regression analysis was undertaken to identify differences within each pairwise comparison.

Results

There were 171 (82% female) students trained and 86 untrained students respond to post-placement surveys. Following IPE, students increased falls knowledge(p<0.05) and correctly identified strategies which were/were not supported by evidence except bedrail use(p=0.013) and patient sitters(p=0.004). Students increased confidence about falls communication and role in falls prevention(p<0.05).

Following placement, fewer IPE students correctly identified evidence surrounding bed alarm use(p=0.003). IPE Students were less confident and motivated(p<0.05) to communicate and play a role in falls prevention following placement.

IPE students had better falls knowledge(p<0.05) than untrained students, but no there were knowledge differences in the evidence supporting face-to-face communication(p>0.05). IPE students were more confident to communicate(p<0.001) but not in their role to prevent falls(p>0.005). There were no differences between groups in motivation(p>0.05) however more student without IPE were motivated to support a patient setting goals to reduce risk of falling(p=0.044)

Significance of findings

Simulated IPE may be a useful strategy to teach falls prevention knowledge and communication to students. Placements impacted knowledge, confidence and motivation to use learnings.

 

What lies beneath: The power of consumer collaboration

Ms Katherine Lawler1

Grade 4 Physiotherapist – Aged & Complex Care, Eastern Health, VIC

Many of us hold ideals about involving patients in their care. We like to think of ourselves as person-centred clinicians, providing treatment and care to patients with their best interests at heart. But working in health comes with all sorts of pressures, meaning truly engaging with patients and their families can be challenging.
In public hospitals we have seen, with the introduction of the National Safety and Quality Health Service Standards in 2013, a flurry of activity around partnering with consumers to develop and design quality health care. But how we partner with consumers in day to day clinical activity often remains caught in a traditional model of “health professional knows best”.
This presentation aims to provoke thought, debate and personal reflection about how we as health professionals connect meaningfully with the patients and families we encounter in our workplaces. It will explore the application of person centred care and consumer collaboration to clinical practice, drawing largely on findings from research conducted with patients and their families in the Transition Care Program. Outcomes of a qualitative research project exploring involving families in physiotherapy for older people in Transition Care will be shared, as well as preliminary findings of a current randomised controlled trial being conducted at Eastern Health and Northern Health.

Improving care for arthritis through allied health-led translational research

Ilana Ackerman1

Senior Musculoskeletal Researcher, Monash University, VIC 

Allied health researchers have a unique opportunity to (a) identify research questions arising from clinical practice and leadership positions and (b) address these in order to effect real change in delivery of care and achieve better patient outcomes.

This presentation covers two programs of translational research that have led to improvements in the way we care for patients with arthritis. The first program of research involved a longitudinal study of patients waiting for joint replacement surgery in the public hospital system. The findings from this study were the stimulus for the development of the Osteoarthritis Hip and Knee Service, which has now been implemented in Victorian public hospitals as part of routine care.

The second program of research aimed to better understand the information needs of women with rheumatoid arthritis around pregnancy, breastfeeding and post-natal care. This work has led to the development of new resources for health professionals caring for women with rheumatoid arthritis, including cross-discipline consensus statements regarding key educational messages and clinical practices.

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