Review of dietetic documentation and clinical handover processes at Peninsula Health

Ms Alice Goodman1, Ms Karen Edis1

1Peninsula Health , Frankston, Australia

Aim: To streamline documentation and clinical handover processes for dietitian.

Method: A Clinicians in Redesign project obtained feedback from Allied Health (AH), Medical and Nursing staff regarding current AH documentation processes. Issues identified included duplication, over documentation, excessive time spent documenting and variable approaches to clinical handover. In response, a working group was formed to undertake a review of dietetic documentation and clinical handover practices. A collaborative approach was utilised to create new processes which were ‘product tested’ by dietitians over a trial period.  At its conclusion, feedback informed finalisation of a guideline and templates for these new processes.

Results: A new Documentation Clinical Practice Guideline, revised formats for initial assessment and review ‘entries’, and a new clinical handover template were developed. There was a shift away from the traditional approach to documentation, particularly in relation to the content and frequency of ‘entries’ while ensuring adherence to professional and organisational requirements. Practical examples of completed templates and file ‘entries’ were included in the guideline to assist staff in transitioning to the new process. A documentation audit tool was developed and embedded into Performance Development Review and clinical supervision sessions as a means of providing feedback and monitoring compliance to the new processes.

Significance of the findings to allied health: Implementation of new documentation and clinical handover processes will enable PH dietitians to have a more efficient and consistent approach to documentation. This review process and associated outcomes could be rolled out across other AH disciplines to achieve similar results.

An advanced practice women’s health clinic improves access to conservative management for continence and prolapse

Ms Caitlin Farmer1, Mrs Sally Schwarz1, Mr  Paul  Howat1

1Northern Health, Epping, Australia

 

Aim: To evaluate the effects of introducing an Advanced Practice Women’s Health Clinic on the gynaecology waiting list, patient satisfaction and conversion to surgery rates.

 

Methods: Through a Victorian Government grant, a pilot project was established assessing women on the Gynaecology waiting list with incontinence and prolapse conditions for suitability for a trial of conservative management. Due to significant demand for other Women’s Health physiotherapy services, the Advanced Practice Clinician also performed the conservative management for each patient where indicated. Outcomes of each appointment including discharge or onward referral and subsequent management were recorded for the period of the trial. Patient satisfaction surveys were given to a sample of convenience.

 

Results: From August 2015 until March 2016 (7 months) ninety-two new patients were assessed, of which 46 required conservative management only. Eighteen were managed in conjunction with the gynaecology team, and 12 in conjunction with their local doctor. In total, 298 appointments were offered in the clinic. The average wait time from referral to assessment decreased from 518 days to 60 days over the period of the grant.

Of patients sent to the gynaecology team, 77% went on to surgical intervention, indicating high levels of agreement between the medical and physiotherapy clinicians. All patients surveyed were extremely satisfied with their management in the advanced practice physiotherapy clinic.

 

Significance to Allied Health: Physiotherapy-led women’s health and continence clinics are an important, cost-effective and highly evidence-based method of managing demand for gynaecology services. There are also opportunities to expand the scope of Advanced Practice Women’s Health Physiotherapists further to include areas such as pessary management.

 

A physiotherapy-led soft tissue injury review service reduces emergency department length of stay

Ms Caitlin Farmer1, Mr  Jonathon Gill1

1Northern Health, Epping, Australia

 

Aim: To evaluate the effects of introducing a Physiotherapy-Led Soft Tissue Injury review service on ED Key Performance Indicators, as well as staff and patient satisfaction.

 

Methods: Through a Victorian Government grant, a pilot project was established which allowed ED treating clinicians the ability to directly book a review appointment with an Advanced Practice physiotherapist for their patient within an evidence-based timeframe for soft tissue injury management. Data regarding waiting time to appointment, injury type and site, investigations arranged and outcomes was obtained, along with data from ED regarding length of stay and discharge within four hours from ED. The data regarding patients referred to the Soft tissue injury review clinic was compared with patients of similar acuity who were not referred.

 

Results: In the six month period of the project, a total of 348 appointments were booked for the soft tissue clinic, the majority of which were for lower limb injuries. The median wait time to appointment was eight days. Of patients assessed, 49% were referred for ongoing physiotherapy with 11% referred to the Orthopaedic team. Patients referred to the Physiotherapy-Led Soft Tissue Injury Clinic stayed in ED 49 minutes less on average than similar patients who were not referred, and were 2.5 times more likely to be assessed and discharged within four hours. Patient satisfaction was high with 95% of patients very satisfied with their experience.

 

Significance: The introduction of a Physiotherapy-Led Soft Tissue Review Clinic resulted in early outpatient review for patients with soft tissue injuries presenting to the Emergency Department with most patients managed independently. Patients referred to the clinic stayed in ED less time, and were more likely to meet the target timeframes for discharge. Advanced Musculoskeletal Physiotherapy clinics are likely to have impacts beyond the immediate assessment and management of patients and waiting lists.

FLEXAR: deFining Lumbar Extension, FleXion And Rotation in the workplace

Ms Georde Vuillermin1,2, Dr Cylie Williams1,2, Dr Ross Iles2, Dr  Kelly-Ann Bowles2

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

Aim:

To identify lumbar movement patterns and the prevalence of low back pain for 160 health professionals within a standard work day at Peninsula Health.

Method:

Allied health professionals were recruited as part of a larger study on low back movement pattern within the health care network. Participants wore a movement monitoring system (Vi-Move) which recorded lumbar movement and muscle activity in real time. At the beginning and end of the work period participants completed a visual analogue scale (VAS) on the intensity of low back pain. The means (SD) and frequencies per hour and medians (IQR) were used to describe the data.

Results

To date, 92 allied health professionals from 13 professions have participated. Physiotherapist/Exercise Physiologists recorded the largest mean number of flexions (Mean=9,SD=5). Podiatrists recorded the largest amount of sustained flexions (Mean=2,SD=1). These sustained events were defined as posture held for greater than 30 seconds, with the majority considered low range flexion between 20°-40°(Mean=9 SD=7 per day). Allied Health Assistants recorded the greatest time in dynamic movement (Mean=1.4 hours SD=1.1) and Speech Pathologists recording the greatest time sitting (Mean=4.7 hours, SD=1.6). Radiographers recorded the greatest back pain on the VAS at the end of the day (Median=2 IQR=1,2.25).

Significance to Allied Health

This is the first known research to quantify real time lumbar movement patterns of allied health professionals over a work day. This data will be used to assist allied health disciplines to better identify “at risk” movements that may lead to future low back injuries.

 

 

The SWIFT Collaboration: Piloting social work trauma informed care in paediatric settings at three Victorian health services – the first six months

Dr Anita Morris1, Ms Nicole Lind1, Ms Jacinta Bourke2, Ms Mary Harty3, Ms Karen Todd2, Ms Debra Leahy3, Dr Kristin Diemer4, Ms Kirsty Forsdike-Young4

1Western Health, St Albans, Australia, 2Barwon Health, Geelong, Australia, 3Austin Health, Heidelberg, Australia, 4University of Melbourne, Parkville, 3010

AIM

The SWIFT Collaboration, a multi-site social work model of care pilot has been funded by a Department of Health and Human Services Advanced Practice Workforce Grant 2016/17and is being evaluated by the University of Melbourne. The aim is to introduce and embed a social work trauma informed model of care in paediatric settings at three Victorian public hospitals.

METHOD

All consenting patients referred to the SWIFT service receive the trauma informed model of care. The pilot utilises a mixed methods approach that includes a 25 item questionnaire to identify patient and caregiver adverse childhood experiences and protective factors. A brief intervention reveals risk and trauma, provides validation and supportive counselling, introduces psychoeducation, facilitates safety planning and incorporates referral to trauma specific services.

RESULTS

Preliminary data will illustrate patient and caregiver profiles, presenting issues, adverse childhood experiences and protective factors, discharge destinations and referral pathways. The results will be compared with baseline and will highlight clinician reflections on implementing a new model of care.

SIGNIFICANCE OF THE FINDINGS TO ALLIED HEALTH

Our experience has indicated that strong stakeholder insight, engagement and commitment are essential.The model has benefited from a strong evidence base, credentialing of SWIFT clinicians and broader staff education about trauma informed care. The authors will provide insights and recommendations for those seeking to establish a trauma informed model of care in public hospital settings.

“Right fit, right job, right time”: A new recruitment model for allied health in public health settings

Genevieve Juj1, Tamilla Azi1

1The Royal Melbourne Hospital, Melbourne, Australia

Introduction:

Recruiting clinicians who have the behaviours and attitudes that align with the culture, ethics, values and strategic intent of an organisation is critical to growing the public health workforce in allied health. Traditional interview methods focus on clinical skills and competency. Private industry utilises different approaches to recruitment. A new recruitment model was trialled in Allied Health over a 12 month period using a telephone screening process, chronological in depth structured interview, consumer connection and an emphasis on reference checks throughout the process based on the New Balance methodology.

Methods:

Pre data was collated to indicate the current state of recruitment in Allied Health. A new critical model with a value based conversation was designed, incorporating a pre-screening telephone call for clinical skill, narrative face to face in depth conversation with 1-2 applicants per position, use of consumers on panels and reference checks spoken of throughout the process.

All recruiting managers undertook training in the new model. During implementation, monitoring of adherence to model and focus groups occurred.

The model was implemented for 12 months and reassessed using the same indicators from the pre data collection.

Results:

The 12 month trial will be completed in June 2016.

A mixed methods evaluation will be used to explore the benefits and limitations of the model, incorporating (1) quantitative data on employee suitability (interview rate, acceptance rates, retention, and performance management), (2) qualitative analysis of the experiences of applicants (3) qualitative analysis of the feedback from allied health managers performing recruitment compared to pre implementation data.

Expanding the scope of Advanced Practice Physiotherapist (APP) in diagnostic imaging: Results of an implementation study and ramifications for widespread adoption

Mr Adam De Gruchy1

1Melbourne Health, Melbourne, Australia, 2University of Melbourne, Melbourne, Australia, 3La Trobe University, Melbourne, Australia

 

Aim:

To report outcomes of a study into implementation of independent ordering of diagnostic imaging by APP, the legal and funding arrangements that enabled implementation and how this may limit a state wide adoption.

 

Method:

A study was carried out on APP independent ordering of diagnostic imaging within defined pathways.

Retrospective data was collected to identify time spent in discussion and agreement between medical staff and APP, and number and type of imaging requests.

Working groups representing Orthopaedics, Neurosurgery, Allied Health, Imaging and Legal departments constructed pathways defining scope of practice for APP independent ordering of diagnostic imaging.

Prospective data was collected in order to identify number and type of APP imaging requests, whether pathways had been adhered to and outcome of imaging investigations, including adverse events.

 

Results:

Independent ordering of imaging by the APP was implemented in 3 clinics: Orthopaedic Spinal , Orthopaedic Shoulder and Neurosurgical Spinal. Clinics had specific pathways developed defining scope of practice and Medicare billing under a nominated Consultant.

There was high agreement (95%) between the APP and medical staff in regards to imaging requests. Projected time savings of continuing independent ordering in 3 clinics is 2464 minutes per annum, representing 82 patient appointments, equivalent to running 13 extra APP clinic sessions per annum.

There was no breach of scope during the implementation period and no adverse events.

Significance of the findings to allied health:

Independent ordering of Imaging by an APP may result in cost and time savings in outpatient clinics but there are major legal and funding issues that remain poorly defined and must be resolved to enable widespread adoption of such a model both within public and private health sectors.

Perceived effectiveness of allied health clinical supervision: a cross sectional survey

Mr Marcus Gardner1, Dr  Carol McKinstry2, Dr Byron Perrin2

1Bendigo Health; La Trobe University, Bendigo, Australia, 2La Trobe University, Bendigo, Australia

 

 

Aim:

Whilst there is general support for the value of clinical supervision (CS) and it is widely utilised by allied health (AH) professionals there is limited research evidence, particularly related to rural and regional settings.  The aim of this study was to determine the effectiveness of CS for AH professionals at a regional health service from a supervisee’s perspective.  A secondary aim was to investigate any differences between AH disciplines in the effectiveness of supervision.

 

Method:

A quantitative cross-sectional survey was distributed to AH professionals at a regional Australian health service as a part of a participatory action research project.  Data collection was via the Manchester Clinical Supervision Scale (MCSS-26) and differences between disciplines were analysed with independent-samples t-test (t) and one-way between groups ANOVA.  One hundred and six participants responded to the survey (response rate 41%).

 

Results:

The total mean and standard deviation for MCSS-26 score across AH was 78.5 +/- 13.9, which is above the recommended threshold score for effective CS of 73.  There were statistically significant differences between total scores for occupational therapy (82.8 +/- 14.4) and physiotherapy (70.9 +/- 11.3) and in the domains relating to reflection, learning and support.

 

Significance of findings to allied health:

While CS was perceived to be effective, there were significant differences found between some disciplines.  The findings demonstrate that CS is effective when it is practised within a structured framework, however flexible models of CS across disciplines need to be explored.

Increased allied health services to general and acute medical units decreases length of stay

Ms Ellen Mills1, Ms Vicki Hume1, Dr Kathy Stiller1

Central Adelaide Local Health Network, Adelaide, Australia

 

Aim: There is little research investigating the impact of increased allied health services for medical patients in an acute hospital setting. This study evaluated the effect of increased allied health services to general and acute medical services.

Method: A quasi-experimental, mixed methods study, with a historical comparison group was undertaken. In a funding initiative, allied health staffing levels were increased by 13.0 full time equivalents for a 6-month trial period. Outcome data compared between the two time periods included hospital length of stay (LOS), occupied bed-days, adverse events and allied health service data.

Results: Mean (SD) hospital LOS significantly decreased from 7.42 (0.67) to 6.45 (0.42) days (P < 0.0001) and occupied bed-days significantly fell from 5,383.8 (238.7) to 4,572.5 (259.1) bed-days per month (P < 0.0001) following the implementation of the increased allied health services. Adverse events were infrequent, with no significant change over time. Allied health services increased, with the number of referrals to allied health per month, occasions of allied health service and allied health time per month increasing by 18%, 45% and 40% respectively, along with a faster response time to referrals.

Significance of the findings to allied health: Increased allied health staffing to general and acute medical services were associated with a significant reduction in hospital LOS and occupied bed-days. These findings resulted in ongoing permanent funding beyond the trial period. These findings will be of considerable interest to other healthcare centres, particularly those where allied health staffing levels are below benchmark figures.

Gait and lower limb observation of paediatrics (GALLOP)

Miss Simone Cranage1, Dr Helen Banwell2, Dr Cylie Williams1,2,3

1Peninsula Health, Frankston, Australia, 2School of Health Sciences, University of South Australia, Adelaide, Australia, 3School of Physiotherapy, Monash University, Melbourne, Australia

Aim: To develop a gait and lower limb standardised recording proforma guided by the literature and consensus, for assessment of the paediatric foot and lower limb in children aged 0–18 years.

Method: Expert Australian podiatrists and physiotherapists were invited to participate in a three round Delphi survey panel. The first round consisted of questions on paediatric gait and lower limb assessment developed from existing templates and a literature search of standardised lower limb assessment methods. Rounds two and three consisted of statements developed from the first round. Questions and statements were included in the final proforma if 70 % or more of the participants indicated consensus or agreement with the assessment method and if there was support within the literature for paediatric age-specific normative data with acceptable reliability of outcome measures.

Results: There were 17 of the 21 (81 %) participants who completed three rounds of the survey. Consensus was achieved for 41 statements in Round one, 54 statements achieved agreement in two subsequent rounds. Participants agreed on 95 statements relating to birth history, developmental history, hip measurement, rotation of the lower limb, ankle range of motion, foot posture, balance and gait. Assessments with acceptable validity and reliability were included within the final proforma.

Significance of the findings to allied health:  This standardised recording proforma will assist professions to collect information in a standardised format based on best evidence assessment methods whilst aiding consistency in communication between health professionals