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.

A co-located physiotherapist and sonographer led hip dysplasia clinic can improve family satisfaction, staff satisfaction, and reduce burden of care in infants with developmental dysplasia of the hips

Mr David Harding1, Ms Glenda McLean1,2, Ms Janet Hough1

1Monash Children’s Hospital, Monash Health, Clayton, Australia

2Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Monash University, Melbourne, Australia

 

Aims

  1. To improve family satisfaction
  2. To improve staff job satisfaction
  3. To reduce the burden of care by reducing the number of hospital visits required by families with children who are braced for developmental dysplasia of the hips
  4. To evaluate the the professional interaction between staff in the co-located clinic and to determine how it may enable them to perform their roles better

 

Methods

  1. Family satisfaction surveys were completed by families in this service and our conventional service
  2. Staff satisfaction surveys were completed prior to the service commencing and after six months of the service operating
  3. The number of appointments required by famlies during the treatment phase was counted and compared to the number of appointments required by famlies being treated in our conventional service
  4. Professional interaction was recorded by physiotherapists and sonographers for the first 100 patients treated in this clinic

 

Results

  1. Families were overwhelming positive and supportive of the new service. Families were happy with the usual service. There was a significant improvement in waiting times, and families appreciated the ability to attend on one occasion for the hip ultrasound and clinical assessment in the new service.
  2. Improved staff satisfaction
  3. Reduced burden of care with average of 2 less appointments required in the new service
  4. Positive professional interaction enable staff to perform their roles more effectively

 

Significance of findings to Allied Health

There were significant benefits for families in reducing burden of care.

The professional interaction between staff working closely is beneficial to both professions

This model can be replicated to suit health service needs

Defining the role of an allied health assistant in hand therapy

Miss Laura Isherwood1

1Barwon Health, Geelong, Australia

 

Aim:

To clearly define the role of an Allied Health Assistant (AHA) within the Hand Therapy Department at Barwon Health.

 

Method:

A qualitative survey was conducted among AHA’s and Hand Therapists, to determine how staff felt the role of the AHA within the Department was currently defined, the efficiency of the role and communication methods, and the current system for the recording of completed tasks. The results were then collated and analysed, and used to create a prioritized list of tasks with a description of each. Once reviewed and approved, an orientation was provided to AHA’s, and the Task List was used during each shift.

 

Results:

The initial survey completed showed that although AHA presence in Hand Therapy was valuable, their role was not clearly defined. As a result, many tasks were not completed. Staff also reported that there was no clear method for communication or handover between AHA’s and therapists, which was impacting the service. These results were therefore used to help to develop the Task List.

The refined AHA Program within Hand Therapy is currently being trialled. Preliminary feedback from staff has been that channels of communication for handover are clearer, and that there is a greater understanding of the scope of the AHA role, which is contributing to greater job satisfaction and therefore a more efficient AHA program.

 

Significance for Allied Health:

This project will define the role of the AHA within Hand Therapy, and assist with the future direction of the AHA role in Hand Therapy.

Profiling the general medicine physiotherapy service delivery models across major acute metropolitan hospitals within Australia

Ms Hannah Davies1, Ms Catherine  Granger1

1The Royal Melbourne Hospital, Macleod, Victoria, Australia

 

Aim:

Physiotherapy is vital in the management of General Medical patients; however it is often felt physiotherapy services are understaffed resulting in busy caseloads, potential for inadequate delivery of physiotherapy, staff fatigue and burn out. This study aimed to investigate 1) physiotherapy service delivery for General Medical patients in Australian hospitals and 2) staff satisfaction in this area.

 

Method:

Australian metropolitan hospitals with a General Medical Unit were eligible. Physiotherapy managers were approached and those interested completed a 40-item online survey.

 

Results:

45/54 hospitals were able to be contacted and 32 responded (71% response rate). The mean (SD) number of funded beds allocated to General Medical patients was 90±53.7, however respondents reported numbers frequently flexed up despite nil additional physiotherapy funding. Physiotherapy staffing was perceived to be ‘inadequate’ or ‘very inadequate’ by 38% of responders. 69% reported they did not have a recommended clinical care ratio for staff and only 34% had a weekend General Medical Physiotherapy Service. Skills most frequently performed were gait assessment/retraining, discharge planning and respiratory assessment, with only 15% providing group therapy. 80% of respondents reported being ‘satisfied’ or ‘very satisfied’ with their job, despite 62% reporting they receive negative feedback with regard to their staffing levels and capacity to service patients.

 

Significance:

This project has established the profile of Physiotherapy service delivery models across major metropolitan hospitals within Australia. Physiotherapists in this area experience job satisfaction despite evidence of challenges including inadequate staffing and equipment. Further work needs to be completed to determine the optimal service delivery model.

Profiling the general medicine physiotherapy service delivery models across major acute metropolitan hospitals within Australia

Ms Hannah Davies1, Ms Catherine  Granger1

1The Royal Melbourne Hospital, Parkville, Melbourne , Australia

 

Aim:

Physiotherapy is vital in the management of General Medical patients; however it is often felt physiotherapy services are understaffed resulting in busy caseloads, potential for inadequate delivery of physiotherapy, staff fatigue and burn out. This study aimed to investigate 1) physiotherapy service delivery for General Medical patients in Australian hospitals and 2) staff satisfaction in this area.

 

Method:

Australian metropolitan hospitals with a General Medical Unit were eligible. Physiotherapy managers were approached and those interested completed a 40-item online survey.

 

Results:

45/54 hospitals were able to be contacted and 32 responded (71% response rate). The mean (SD) number of funded beds allocated to General Medical patients was 90±53.7, however respondents reported numbers frequently flexed up despite nil additional physiotherapy funding. Physiotherapy staffing was perceived to be ‘inadequate’ or ‘very inadequate’ by 38% of responders. 69% reported they did not have a recommended clinical care ratio for staff and only 34% had a weekend General Medical Physiotherapy Service. Skills most frequently performed were gait assessment/retraining, discharge planning and respiratory assessment, with only 15% providing group therapy. 80% of respondents reported being ‘satisfied’ or ‘very satisfied’ with their job, despite 62% reporting they receive negative feedback with regard to their staffing levels and capacity to service patients.

 

Significance:

This project has established the profile of Physiotherapy service delivery models across major metropolitan hospitals within Australia. Physiotherapists in this area experience job satisfaction despite evidence of challenges including inadequate staffing and equipment. Further work needs to be completed to determine the optimal service delivery model.

Leading the way for advanced practice in occupational therapy: Implications of a scoping review and workshop

Ms Annette Leong2, Ms Susan Giles1, Ms Jude  Boyd2, Ms  Alison Lunt3, Associate Professor Ted Brown5, Ms  Lisa Vale6, Ms Kim Mestroni8, Ms Janice  McKeever4, Ms Claire Lynch7

1Western Health, Footscray, Australia,

2Eastern Health, Box Hill, Australia,

3Peninsula Health, Frankston, Australia,

4Monash Health, Clayton, Australia,

5Monash University, Frankston, Australia,

6Splash Occupational Therapy, Werribee, Australia,

7St Vincent’s Private Hospital, Fitzroy, Australia,

8Occupational Therapy Australia, Fitzroy, Australia

 

Background: With lack of clarity regarding potential occupational therapy advanced practice roles (OTAPRs), other than in recognised specialty practice areas such as Hand Therapy, it is imperative for the occupational therapy profession to identify, define and operationalise suitable functions and responsibilities so that it is positioned to effectively respond to strategic opportunities as they arise. The development of a flexible, cost effective, responsive allied heath workforce is a priority for many funders of health care services.  There is evidence that advanced practice roles (such as OTAPRs) have the potential to improve service efficiency, effectiveness, patient satisfaction and outcomes, costs reduction, hospital admission rates and provide expanded career pathways for clinicians.

 

Aim: To identify and review issues related to OTAPRs including competency/credentialing frameworks, trends in the empirical literature, and the measurement of advance practice role efficacy.

 

Method: A workshop was held with expert clinicians from eight key occupational therapy practice areas. Participants identified potential OTAPRs relevant to their practice areas. Each group generated a specific work plan. A scoping review of the related empirical literature was also completed.

 

Results: Several OTAPRs were identified, with specific competencies and credentialing processes developed. These have been endorsed by the OTA Victorian Divisional Council, and will facilitate spread and sustainability of robust effective professional roles.

 

Significance of the findings to allied health: This process can be used to identify appropriate advanced practice roles, across allied health disciplines, and multi-disciplinary teams. OTAPRs will be described and findings from the scoping review will be presented.

Advanced musculoskeletal physiotherapy and telehealth – improving access for patients following joint arthroplasty

Ms Stephanie Carroll1, Ms  Carolyn  Page1, Ms Belinda Cary1, Mr Colin Laurie1

1St Vincent’s Hospital, Victoria, Fitzroy, Australia

 

Aim:To scope, develop and implement a Telehealth service within the established orthopaedic post arthroplasty review (PAR) clinic, that  improves clinic efficiency and increases access to care.

Method: Phase 1: Scoping  – A literature review and benchmarking of Telehealth services in Victoria and survey of 100 patients attending the Elective Surgery Access Service (ESAS) to ascertain interest in utilising Telehealth and potential barriers. Patient eligibility criteria developed based on literature, consumer engagement and orthopaedic surgeon consultation.  Phase 2: Pilot  – Broad stakeholder engagement, telehealth clinic processes developed, technology interface established (Blue Jeans), online access to radiology secured for external sites, telehealth trialled on a small cohort of patients and processes modified following patient feedback. Phase 3: Integration  – Operational guidelines developed, patients triaged and invited to use Telehealth, evaluation of service, training of other Advanced Musculoskeletal Physiotherapists (AMPs) and orthopaedic surgeons to ensure sustainability of service and webinar education delivered to 10 public healthcare organisations across Victoria to share learnings.

Results: This patient focused service demonstrated high patient satisfaction and cost savings to individual patients and the organisation.  Telehealth also demonstrated improvements in clinic efficiency with quicker consultation times and fewer ‘Did Not Attends’ (DNAs). Telehealth was shown to be a safe and innovative service delivery model that can improve system capacity and offer patients greater choice in their care delivery.

Significance of the findings to allied health: Telehealth has wide applicability for Allied Health as an innovative model of service delivery that can increase access for patients and result in cost savings for patients and health services.

Consumer preferences regarding physiotherapy practitioners in emergency departments – a qualitative investigation

Dr Stephen Gill1, Dr Julian Stella1, Dr Luke McManus1, Mr Peter Schoch1

1Barwon Health, Geelong, Australia

Aim: Investigate consumer opinions and preferences regarding Physiotherapy Practitioners (PP) in Emergency Departments (ED).

Method: Twenty-two members of the organisation’s Consumer Representative Program participated in focus groups which were audio-recorded and transcribed verbatim. Data were extracted using an emergent-systematic design and analysed using thematic analysis.

Results: Four themes were identified. 1) Consumers accepted that reform is necessary to improve care, make better use of resources and create sustainable services for the future. 2) Consumer preferences varied regarding who they wanted as their primary clinician. Some consumers did not mind who provided their care, as long as they received appropriate care. Others thought doctors would provide superior care and wanted to see a doctor first. A third group indicated that not everyone who presented to ED needed to see a doctor; care could be provided by PPs for certain conditions. 3) Consumers identified a core set of desirable attributes that applied to all staff members, regardless of their role. The expression of these attributes will vary according to circumstances and each staff member’s scope of practice. 4) Consumers expected effective governance so that every staff member was safe, effective and adequately supervised.

Significance of the findings to allied health: Consumers endorse reform. The design and implementation of advance practice roles should recognise that consumers have common expectations for the content and governance of care, but individuals’ preferences vary regarding who provides care.

 

The impact on increasing workloads on allied health. What are they and what can be done?

Ms Janice Mc Keever1

1Monash Health, Australia

 

Aim: Health workers are experiencing increasing workloads and task demands with the ageing population and a rise in chronic diseases. It is widely recognised that increasing work load and task demands contributes to feelings of stress and ill health. However, despite the anecdotal reports that Allied Health professionals (AHP) experience similar ill effects, the evidence base for this important workforce is lacking.

 

Method: A rapid review of the literature was conducted to investigate workload issues in Allied Health. The aim was to identify key outcomes of increasing workloads and to identify strategies to buffer the negative impact of workloads on AHP.

Results: Literature identified a number of ill effects of increasing workloads on AHP such as burnout, attrition, depression and stress. There were no common professional groups, work areas or caseloads that experienced these more than others. The literature available on workload in Allied Health were descriptive pieces with no investigative studies on methods to moderate the impact of rising workload. However there is consensus around possible solutions such as reward and recognition systems, support structures and enabling control over workload that can protect staff from feelings of stress and burnout. These could easily be implemented for the AHPs.

 

Significance of findings to allied health:  It is clear from the evidence that the strains of system is negatively impacting on staff. The causes of increased workload are multiple, as are the solutions. However, prudent management practices and union bargaining can have positive effects for the employee and the system. It is imperative that efforts to address the harmful psychosocial working conditions are implemented.

The validity, reliability and responsiveness of the modified Iowa Level of Assistance scale in hospitalised older adults

Dr Sze-ee Soh1,2, Ms Melissa Raymond2, Ms Lara Kimmel1,2, Professor Anne Holland2,3

1Monash University, Frankson, Australia

2Alfred Health, Caulfield, Australia

3La Trobe University, Bundoora, Australia

 

Aim:

To assess the psychometric properties of the modified Iowa Level of Assistance (mILOA) scale in hospitalised older adults.

 

Method:

Patients undergoing rehabilitation at a subacute rehabilitation hospital in metropolitan Melbourne were included if they were over 65 years, able to provide informed consent and medically stable to participate in two physiotherapy sessions within 24 hours. Interrater reliability was established by having two physiotherapists independently assess each participant within 24 hours of each other. Construct validity was established using ‘known-groups’ validity, whilst responsiveness was assessed by examining the difference in mILOA scores from admission to discharge.

 

Results:

The mean age of participants in the reliability phase of the study was 81.3 years (SD 7.8) with an average mILOA score of 12 points. The inter-rater reliability was excellent (intraclass correlation coefficient [2,1] 0.96; 95%CI 0.93, 0.98) with a mean difference between scores of 0.23 and limits of agreement of +4.96. The mILOA score displayed a mean difference between two known groups of 11.4 points (p<0.05). The scores also correlated significantly and negatively with the Elderly Mobility Scale (Spearman’s rho -0.90; p<0.01). Responsiveness was demonstrated with a minimal detectable change of 4.0 points.

 

Significance of the findings to allied health:

This study has provided an insight into the reliability, validity and responsiveness of the mILOA tool in the subacute care setting. This can help to provide invaluable information regarding patient outcomes and allow for benchmarking of services across departments and organisations.