Frameworks for Embedding a Research Culture in Allied Health Practice

Dr Susan Slade1, Ms Kathleen Philip2, Prof Meg Morris1,3

1La Trobe University, Bundoora, Australia, 2Department of Health and Human Services, Melbourne, Australia, 3Healthscope Northeastern  Rehabilitation Centre, Ivanhoe, Australia

Abstract:

Aim:
Embedding a culture of research within public and private health systems remains challenging. A rapid review was conducted to evaluate frameworks designed to create and embed research into routine allied health practice.

Method:
Full text English-language, peer-reviewed publications or Government reports were included. Eight electronic databases and four government websites were searched. Two independent researchers conducted all review stages and used content and thematic data analysis.

Results:
Sixteen frameworks papers were included. Content analysis identified 44 system and regulatory level items that informed research frameworks, 125 healthcare organisation items and 76 individual clinician items. Thematic analysis identified four major themes: (1) sustainable change requires allied health research policies, regulation and organizational structures; (2) research literacy of policy makers and managers are essential; (3) a whole-of-organisation approach facilitates a research culture; and (4) individual clinician attributes, such as motivation and research skills, are essential. Theoretical frameworks were identified that informed processes to embed a culture of allied health research into healthcare services. Research-led and evidence-informed allied health practice enables optimisation of workforce capability and high quality care.

Significance of the findings to allied health:
Sustainable change requires allied health research policies, regulation and organizational structures that support evidence-based practice. Research advocacy and literacy of managers are key to successful implementation. Organisational factors that facilitate a research culture include dedicated research positions, professional education, infrastructure and university partnerships. “Research ready” graduates and clinicians are essential to embedding research into practice.

Biography:

Dr Susan Slade is a La Trobe University postdoctoral research fellow, provisional fellow of the Australian College of Physiotherapy and musculoskeletal physiotherapist. Dr Slade has over 40 peer-reviewed publications and has presented at 20 international conferences. She has strong collaborative networks including the University of Southern Denmark and Warwick University and is member of the Cochrane back and neck and qualitative and implementation review groups. Her research expertise is in systematic reviews, qualitative research and exercise prescription. Her research interests are chronic health conditions, translation and implementation into clinical practice, reporting guidelines and method quality assessment.

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.

Guardianship in Hospitals: A Health Services/OPA Pilot Project

Dr Rob Hoffman1, Sally Costar1, Tass Kostopoulos2, Justine Little3, Aaron Livingstone4, Fiona McAlinden3, Paul Newland4, Jacinta Re3, Dina Watterson1, Prof Terry Haines5

1Alfred Health, Melbourne, Australia, 2Eastern Health, Melbourne, Australia, 3Monash Health, Melbourne, Australia, 4Office of the Public Advocate (Victoria), Melbourne, Australia, 5Monash University, Melbourne, Australia

Abstract:

Aim:
This collaborative project between three metropolitan health services and the Office of Public Advocate Victoria (OPA) explores the impact of increased availability of advocate guardians delegated by the Public Advocate on healthcare system sustainability and outcomes.

The pilot targets a particularly-vulnerable group: hospital-based recipients of VCAT guardianship orders, made on evidence of a cognitive impairment indicating a lack of capacity to make important lifestyle and personal decisions.

The primary aim of the pilot is to reduce the time these patients spend waiting for allocation of a guardian, decreasing patient risk and releasing healthcare system resources.

Method:
A multi-institutional, cross-sectional pilot program created a dedicated hospital guardian team within OPA, funded by the partner health services, to reduce the time to guardian allocation for patients within these services.

The impact of the pilot was measured through an historical control group design, with initial data collection over 12 months, followed by yearly cohorts of post-implementation patients.

Results:
Under this pilot the time from guardianship order lodgement to guardian allocation has significantly decreased from 46.5 to 23.1 days, halving the average time hospital-based patients spend waiting for a guardian. Estimated cost savings are $15,355 per patient, or over $5 of healthcare system resources released per $1 spent on increased staffing.

Significance of the findings to allied health:
These findings demonstrate how collaboration and investment by healthcare providers in non-health areas can deliver substantial benefits for healthcare system sustainability in an area of patient vulnerability and growing demand.

Biography:

Dina Watterson is Associate Director of Allied Health at Alfred Health in Melbourne, Victoria.

Tass Kostopoulos is Director of Social Work and Associate Program Director of Allied Health at Eastern Health in Melbourne, Victoria.

Fiona McAlinden is Director of Sub Acute Care and Community Health at Monash Health in Melbourne, Victoria.

Paul Newland is Manager of Advocacy and Guardianship at the Office of the Public Advocate in Melbourne, Victoria.

“Communicate, communicate, communicate”: Advanced Musculoskeletal Physiotherapy services, enabling factors for multi-site implementation

Ms Bridget Shaw1, Ms Sophie Heywood1, Ms Carolyn Page1, Mr Uyen Phan2, Dr Paula Harding3, Ms Kerrie Walter3, Ms Desiree Terrill4, Dr Catherine  Granger2,5

1Department of Physiotherapy, St Vincent’s Hospital Melbourne, Fitzroy, Australia, 2Department of Physiotherapy, Royal Melbourne Hospital, Parkville, Australia, 3Department of Physiotherapy, The Alfred, Prahran, Australia, 4Health and Wellbeing Workforce Reform, Department of Health and Human Services, Melbourne, Australia, 5Department of Physiotherapy, The University of Melbourne, Parkville, Australia

Abstract:

Aim:
To identify the enablers to implementation of 12 Advanced Musculoskeletal Physiotherapy (AMP) services from the perspective of clinical staff.

Method:
12 participants (physiotherapists) from 12 different healthcare networks in Victoria (seven metropolitan, three regional, two rural) consented to be involved in this qualitative study using a structured survey. The networks implemented AMP services (orthopaedics postoperative joint replacement review n=10, general orthopaedics n=1, emergency n=1 and neurosurgery n=1) over a 12 month period. Thematic analysis was used and mapped to the validated Theoretical Domains Framework.

Results:
Motivation domain enablers included offering a solution to access blocks in specialist clinics; improving patient outcomes; reducing costs and improving efficiency; maximising early and open dialogue with all stakeholders, especially engagement of medical staff; ensuring stakeholders’ knowledge of the AMP clinicians and services; an efficient model of care with clear scope of practice to minimise risk as well as multiple staff willing to further knowledge and skills. Opportunity enablers included regular communication with and support from stakeholders; clear referral processes; time and also the initial restriction of clinic capacity. Capability domain enabling factors included a detailed, relevant, thorough, well-structured learning and assessment framework with a known credentialing standard, supported by senior medical staff; understanding key organisational issues and also having a pool of appropriately skilled, experienced, flexible and dedicated physiotherapists with strong communication skills.

Significance of the finding:
Communication and relationships with stakeholders emerged as critical for successful implementation and should be prioritised along with developing and supporting knowledgeable, adaptable AMP clinicians.

Biography:

Bridget Shaw has been working in Advanced Scope Physiotherapy roles for 10 years and has been the Advanced Scope Physiotherapy Clinical Leader at St Vincent’s Hospital in Melbourne for the last three years. Bridget has a Masters of Manipulative Physiotherapy. Bridget was a member of the team of the DHHS funded Advanced Musculoskeletal Physiotherapy Implementation project from which this research arose.

Improving efficiency of referral triage for ambulatory pain management service for improved patient access and flow

Mrs Swapna Gokhale1

1Eastern Health, Glen Waverley, Australia

Abstract:

Aim:
Evidence suggests that delays in access to treatment for chronic pain are associated with deterioration in health-related quality of life and psychological well-being. The aim of this project was to improve the efficiency of referral triage for the EH APMS by addressing problems with access, scheduling, and management of patient flow through the service.

Method:
Service data was collected and analyzed to identify validated root causes and understand supply and demand. Interventions were targeted at reducing double handling by redesigning the referral process, standardising processes to create efficiency, and a brief referral triage tool was developed to direct patients to the most appropriate clinical pathway.

Results:
Outcome measures used were referral waiting times, on task referral processing times and levels of clinician confidence in various aspects of referral triage. At four months post implementation, project evaluation revealed 70% reduction in wait times to access the service (from 32.1 to 9.5 days), 42% reduction in on task referral processing times (from average 67 mins/referral to 39 mins/referral).

Significance to Allied Health:
This project has demonstrated that significant improvements in access to pain management services can be achieved with improving efficiency of referral processes and using the STAT principles of providing early face to face appointments and combining triage and early assessment to provide patient centred care.

Biography:

Swapna is the Team leader and Senior Physiotherapist who looks after the Ambulatory Pain Service in Eastern Health

Swapna believes that being compassionate and having an open mind is crucial to delivering innovative client centred care. Swapna has recently completed the BCV Clinician in Redesign Internship and is currently evaluating her project addressing the triage issues affecting patient access and flow in her service.

Swapna has recently completed her Masters in Physiotherapy from La Trobe University. She has a keen interest in synergistic links between healthcare innovation and improvement methodology and research.

Allied health inpatient service provision in Australian and New Zealand hospitals

Miss Megan Jepson1, Mr  Mitchell  Sarkies1, Professor  Terry  Haines1

1Monash University , Frankston , Australia

Abstract:

Aim:
To describe current allied health service provision across acute general medical and surgical, and subacute rehabilitation hospital wards in Australia and New Zealand.

Methods:
This cross-sectional observation study was nested within a multicentre cluster randomised controlled trial, in which one-month of allied health service event data for acute and subacute wards was collected. Data included the number of service events, day of week, duration, profession, ward type, and number of beds for each ward. Allied health professions included: physiotherapy, occupational therapy, social work, dietetics, speech pathology, podiatry, orthotics and prosthetics, as well as allied health assistants.

Results:
Data was collected from a total 74 hospitals across Australia and New Zealand. A total of n=247,747 (132,350 hours) allied health service events were recorded over a one month period for acute general medical and surgical, and subacute rehabilitation wards across the 74 hospital sites. The majority of allied health service was provided on weekdays, with a mean of 5,651 (SD: 12,717) events totalling 3,153 (SD: 7,129) hours; while approximately 10% of all allied health service events occurred on the weekend, with a mean of 904 (SD: 1,894) allied health service events over 466 (SD: 1,038) hours.

Significance:
These findings form a baseline of current hospital based allied health workforce makeup; providing clinicians and management teams a like with more information on how their staff allocation and service provision compares to that of other hospitals across Australia and New Zealand.

Biography:

Megan Jepson 

Research Assistant- Department of Community Emergency Health and Paramedic Practice, Monash University. Exercise Physiologist- Physioworks Health Group.

Exercise and Sports Science accredited member.

Publications:

  1. Palmer, K., Lane, R., Paton, M., Jepson, M., Bowles, K-A., 2018.Chronic Heart Failure and Exercise: A Systematic Review and meta-analysis

 

Mitchell Sarkies (BAppSC, Phty)

PhD Candidate, Faculty of Medicine, Nursing and Health Sciences, Monash University.

Awards & Recognition

2016       Monash Health: Allied Health Research Unit Publication Award 2015

2012       Services for Australian Rural and Remote Allied Health: Allied health clinical placement scholarship

2012       Golden Key International Honours Society: Membership

2008       University of Western Sydney: Deans merit list.

Publications:

2016       Sarkies, M.N., et al. Do daily ward interviews improve measurement of hospital quality and safety indicators? A prospective observational study, Journal of Evaluation in Practice, 2016 Jun 13: doi:10.1111/jep.12543

2015       Sarkies, M.N., et al. Data Collection Methods in Health Services Research: Hospital Length of Stay and Discharge Destination, Appl Clin Inf, 2015 Feb 18;6(1):96-109

2015       Haines, T.P., et al. Study protocol for two randomized controlled trials examining the effectiveness and safety of current weekend allied health services and a new stakeholder-driven model for acute medical/surgical patients versus no weekend allied health services, Trials, 2015 Apr 2;16(1):133

2015       Haas, R., et al. Early commencement of physical therapy in the acute phase following elective lower limb arthroplasty produces favorable outcomes: a systematic review and meta-analysis examining allied health service models, Osteoarthritis and Cartilage 24 (10), 1667-1681

2016       Robinson, LS., et al. Direct, indirect and intangible costs of acute hand and wrist injuries: A systematic review, Injury 47 (12), 2614-2626

Workforce futures: towards research-informed reform

Mr Dean Raven1

Department of Health and Human Services

Health and human services in Victoria are going through an unprecedented period of transformation. Reforms such as the 10 Year Mental Health Plan, Health 2040: Advancing Health, Access and Care, Roadmap for Reform: Strong Families, Safe Children, Ending Family Violence: Victoria’s Plan for Change, and rollout of the National Disability Insurance Scheme provide opportunities for research, innovation and the embedding of evidence into learning systems and practice. This presentation will discuss how these reforms are structured and integrated, and the implications and opportunities for researchers and academics.

Allied health inpatient staffing profiles in Victorian hospitals

Ms Lyndell Keating1, Mr James Sayer1

1Healthcare Management Consultant, , Australia

Aim:

To provide information resources regarding Allied Health inpatient staffing profiles, such as the average Equivalent Full Time (EFT) per bed by profession and clinical grouping.

Method:

Victorian public hospitals with multi-day inpatients were invited to participate in macro benchmarking. Consenting hospitals completed a survey regarding the inpatient EFT per classification for each of the Allied Health therapy professions. Of 132 eligible hospitals, 55 hospitals completed the survey (22 acute only, 13 sub-acute only, 20 both acute & sub-acute beds).

Hospitals that rated activity statistics as “good” or “very good” were invited to submit Individual Patient Attributable (IPA) hours mapped to agreed clinical groupings, from which estimated EFT was derived using an established ratio. Statistics data was submitted by 16 hospitals.

Results:

Reports were provided to Allied Health leaders regarding the average EFT per 10 beds for acute and sub-acute, categorised by hospital size and acuity. The reports also outlined the percentage of hospitals with each profession, and the proportion of grades and assistants for each profession.

Further reports included the average estimated EFT per bed by profession and clinical grouping, and additional comparative information such as length of stay and percentage of patients seen.

Significance of the Findings to Allied Health:

Allied Health leaders are required to deliver effective and efficient allied health services within fiscal constraints. The staffing analysis resources have been utilised by managers to assist with decision making regarding workforce profiles, and to modify staffing levels as a result of service change, growth, and other drivers.

Improving access for foot and ankle patients on an orthopaedic waiting list

Mrs Charlotte Cooke1, Ms Julia Firth1

1Western Health, Footscray, VIC, Australia

 

Aim
This study aimed to determine the efficacy of integrating an Advanced Practice Orthopaedic Podiatry (APOP) clinic to the Orthopaedic Outpatient’s service. Pilot funding was received from DHHS.
Method
The APOP screened referrals received by the Orthopaedic Outpatient department to determine whether they required advanced practice podiatric management or surgical opinion. A clinical governance tool was developed alongside a competency package. Data collection completed October 2015– January 2016. Patients > 18 years of age were eligible. Patient centred outcomes were analysed, patient satisfaction survey, waiting list and referral analysis.
Results
Patient referrals to Orthopaedic clinic between 2013 -2015 were assessed. N = 103, 70% were managed effectively and did not require an orthopaedic opinion for their presenting musculoskeletal pathology. Most commonly assessed condition was Hallux Valgus (51%) followed by 33% with a hind foot pathology. 66% of patients were discharged completely to community providers. Overall satisfaction with APOP visit – 94% strongly agree 6% agree.
Significance of the findings to Allied Health Practice
The aim of this inter-professional model of patient care is to provide seamless movement of patients from one service to another. Shifting resources into prevention and self-management; providing patients with real choices about their treatment options, empowering them to make informed decisions about their health care. Whilst providing them with support, education and tools to improve their understanding of their journey through the health care system.

Implementation of an advanced scope of practice physiotherapist in neurosciences clinics improves patient access to community services

Ms Jan Quiney1, Ms Lucinda  Marr1, Ms Samantha  Plumb1, Mr Scott Edwards1

1Royal Melbourne Hospital, Parkville, Australia

 

AIM: To investigate if the implementation of an advanced practice physiotherapist (APP) within three neurosciences outpatient specialist clinics improves patient care by addressing unmet physical need and satisfaction.

METHOD: Prospective implementation study. APP roles were implemented in three Neurosciences specialist outpatient clinics (Stroke, Neuro Oncology and Neuromuscular). An APP worked alongside the usual specialist medical staff. Quality of care data included number of patients seen; interventions performed (including referrals to community services); and patient and medical staff satisfaction.

RESULTS: Over 4 months, 126 patients were seen by the APP across the 3 clinics (equivalent to 378 per annum). Main interventions included: patient education/advice (73-100%); exercise prescription (50-92%); linking to community services (8-56%) referral to community physiotherapy (27-56%); referral to other community Allied Health discipline (8-33%). All clinic medical staff (100%) believed the APP addressed the physical needs of their patients (rated 10/10) and were supportive for an ongoing role. Patient satisfaction was high, with 100% of respondents (n=9) reporting that the APP assessment benefited them, and addressed all identified problems (44%). Over 69 hours of medical consultant time was freed up by APP over the four months.

SIGNIFICANCE OF THE FINDINGS TO ALLIED HEALTH: The APP in specialist neurosciences clinics improved the quality of care provided through timely physiotherapy interventions and increasing linkages with community based services.  The role enables optimal use of the physiotherapy workforce to free up consultant time and provides an enriching career path for hospital physiotherapists into more senior clinical roles. Further investigations are needed to determine the efficacy on patient outcomes and health economic benefits.