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Thwaites C, Shaw L, Lui R, Kiegaldie D, Heng H, McKercher JP, Volpe D, Hill AM, Knight M, Morris ME. Boosting hospital falls prevention using health assistant staff alongside usual care. PATIENT EDUCATION AND COUNSELING 2024; 130:108464. [PMID: 39418674 DOI: 10.1016/j.pec.2024.108464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 09/21/2024] [Accepted: 10/06/2024] [Indexed: 10/19/2024]
Abstract
OBJECTIVES Patient education is crucial for preventing hospital falls, yet workforce constraints can hinder targeted delivery. Utilising supervised healthcare assistants can enhance standard care. This study sought to understand factors that impact the feasibility of supplementing usual care with patient falls education delivered by supervised allied health assistants. METHODS In a qualitative study nested within a randomised controlled trial, focus groups and interviews were conducted with twelve health assistants, seven allied health professionals and two managers from the participating hospital. This elicited insights on barriers and facilitators to implementing workforce redesign to deliver tailored patient falls education. An inductive approach was used to thematically analyse the data. RESULTS Three key themes emerged: (i) it was feasible for health assistants to deliver hospital patient education; (ii) patients engaged with hospital falls prevention education delivered by assistants; (iii) hospital workforce redesign can be successfully implemented provided there is system-wide buy-in. CONCLUSIONS Health assistants can be trained to successfully deliver hospital falls prevention education provided they have adequate supervision, training, and resources. PRACTICE IMPLICATIONS Sustained implementation requires dedicated staffing hours for service delivery and staff education.
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Affiliation(s)
- Claire Thwaites
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Melbourne, Australia; Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Melbourne, Australia.
| | - Louise Shaw
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Rosalie Lui
- Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Melbourne, Australia
| | - Debra Kiegaldie
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Hazel Heng
- Northern Health Academic and Research Collaborative in Health (ARCH), La Trobe University, Melbourne, Australia; Northern Health, Epping, Australia
| | - Jonathan P McKercher
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Melbourne, Australia; Care Economy Research Institute (CERI), La Trobe University, Melbourne, Australia
| | - Daniele Volpe
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, Italy
| | - Anne-Marie Hill
- School of Allied Health, WA Centre for Health & Ageing, University of Western Australia, Perth, Australia
| | - Matthew Knight
- Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Melbourne, Australia
| | - Meg E Morris
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Melbourne, Australia; Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Melbourne, Australia; Care Economy Research Institute (CERI), La Trobe University, Melbourne, Australia
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Snowdon DA, Vincent P, Callisaya ML, Collyer TA, Brusco NK, Wang YT, Taylor NF. Allied health assistant management of people with hip fracture is feasible and may improve patient adherence to hip fracture mobilisation guidelines: a feasibility randomised controlled trial. Physiotherapy 2024; 124:51-64. [PMID: 38870622 DOI: 10.1016/j.physio.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 03/03/2024] [Accepted: 05/06/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES Determine the feasibility of allied health assistant (AHA) management of people with hip fracture an acute hospital. DESIGN Assessor-blind, parallel, feasibility randomised controlled trial with qualitative component. SETTING Acute orthopaedic ward. PARTICIPANTS People with surgically-managed hip fracture, who walked independently pre-fracture and had no cognitive impairment. INTERVENTIONS Rehabilitation from an AHA, under the supervision of a physiotherapist, compared with rehabilitation from a physiotherapist. MAIN OUTCOME MEASURES Feasibility was evaluated according to focus areas of demand, acceptability, practicality and implementation. Secondary outcomes included estimates of effect of adherence to hip fracture mobilisation guidelines, discharge destination, 30-day readmission, functional activity, and length of stay. RESULTS Fifty people were allocated to receive rehabilitation from an AHA (n = 25) or physiotherapist (n = 25). AHA rehabilitation had high demand with 60% of eligible participants recruited. Satisfaction with AHA rehabilitation was comparable with physiotherapy rehabilitation (acceptability). The AHA group received an average of 11 min (95% CI 4 to 19) more therapy per day than the physiotherapy group (implementation). The AHA group may have had lower cost of acute care (MD -$3 808 95% CI -7 651 to 35) and adverse events were comparable between groups (practicality). The AHA group may have been 22% (HR 1.22, 95% CI 0.92 to 1.61) more likely to walk on any day and may have had a shorter length of stay (MD -0.8 days, 95% CI -2.3 to 0.7). CONCLUSIONS AHA management of patients with hip fracture was feasible and may improve adherence to mobilisation guidelines and reduce cost of care and length of stay. CLINICAL TRIAL REGISTRATION NUMBER ACTRN12620000877987. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- David A Snowdon
- Peninsula Clinical School, Monash University, Frankston Australia; National Centre for Healthy Ageing, Melbourne, Australia; Academic Unit, Peninsula Health, Frankston Australia.
| | - Peggy Vincent
- Physiotherapy Department, Peninsula Health, Frankston, Australia
| | - Michele L Callisaya
- Peninsula Clinical School, Monash University, Frankston Australia; National Centre for Healthy Ageing, Melbourne, Australia; Academic Unit, Peninsula Health, Frankston Australia
| | - Taya A Collyer
- Peninsula Clinical School, Monash University, Frankston Australia; National Centre for Healthy Ageing, Melbourne, Australia
| | - Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia
| | - Yi Tian Wang
- Physiotherapy Department, Peninsula Health, Frankston, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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Etty S, Snaith B, Hinchcliffe D, Nightingale J. The Deployment and Utilization of the Allied Health Professions Support Workforce: A Scoping Review. J Multidiscip Healthc 2024; 17:2251-2269. [PMID: 38765615 PMCID: PMC11102120 DOI: 10.2147/jmdh.s460543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/26/2024] [Indexed: 05/22/2024] Open
Abstract
The demand for healthcare services internationally continues to increase, exacerbated by patient backlogs resulting from the COVID-19 pandemic and the difficulties in recruiting and retaining healthcare staff. These difficulties have led to increased interest in workforce redesign, and the upskilling of existing staff in all areas of healthcare, including within the Allied Health Professions (AHP). Clinical support staff are a key component of workforce redesign, yet little has been documented on the utilization of this workforce across the wide range of professions that collectively form the AHP workforce. Existing research is also unclear due to the variety of titles used to describe them (eg, allied health assistants, therapy assistants, etc). This study aimed to review how Support Workers and Assistant Practitioners (SWAPs) are utilized within the AHP professions. Electronic databases (MEDLINE, CINAHL complete, Scopus, and Google Scholar) were searched to find English Language primary research articles that explored the deployment of clinical support staff within Allied Health. Following the scoping review methodology, data from each study were analyzed in terms of design, key findings, and implications. A quality assessment was also completed. Thirty-nine articles met the eligibility criteria. Studies were undertaken in Australia, UK, and USA, and covered a range of AHPs and methodological approaches. Most articles employed qualitative methods, with highly variable research quality identified. Key findings were that cost-effectiveness of this workforce has not been formally evaluated in any setting or AHP discipline, and that support workers are a largely underutilized staff group potentially due to inconsistencies in their deployment and scope of practice, and the lack of a clear career pathway. Rigorous, quantitative, and mixed methods research into the deployment and impact of this staff group is needed in order to gain a clearer understanding of how they are optimally utilized across the different AHP disciplines.
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Affiliation(s)
- Sarah Etty
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - Beverly Snaith
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Department of Radiology, Mid Yorkshire Teaching NHS Trust, Wakefield, UK
| | | | - Julie Nightingale
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
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Snowdon DA, Wang YT, Callisaya ML, Collyer TA, Jolliffe L, Johns N, Vincent P, Pragash N, Taylor NF. Staying Active with Multimorbidity In Acute hospital settings (StAMInA) trial: protocol for a feasibility randomised controlled trial of allied health assistant mobility rehabilitation for patients with multimorbidity. BMJ Open 2024; 14:e078843. [PMID: 38216182 PMCID: PMC10806632 DOI: 10.1136/bmjopen-2023-078843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/18/2023] [Indexed: 01/14/2024] Open
Abstract
INTRODUCTION Key to improving outcomes for patients with multimorbidity is increasing mobility through prescription of a physical activity programme, but this can be difficult to achieve in acute hospital settings. One approach that would assist physiotherapists to increase levels of physical activity is delegation of rehabilitation to allied health assistants. We aim to conduct a randomised controlled trial to determine the feasibility of an allied health assistant providing daily inpatient mobility rehabilitation for patients with multimorbidity. METHODS AND ANALYSIS Using a parallel group randomised controlled design, participants will be allocated to allied health assistant mobility rehabilitation or physiotherapist mobility rehabilitation. Adult inpatients (n=60) in an acute hospital with a diagnosis of multimorbidity who walked independently preadmission will be included. The experimental group will receive routine mobility rehabilitation, including daily mobilisation, from an allied health assistant under the supervision of a physiotherapist. The comparison group will receive routine rehabilitation from a physiotherapist. Feasibility will be determined using the following areas of focus in Bowen's feasibility framework: Acceptability (patient satisfaction); demand (proportion of patients who participate); implementation (time allied health assistant/physiotherapist spends with participant, occasions of service); and practicality (cost, adverse events). Staff involved in the implementation of allied health assistant rehabilitation will be interviewed to explore their perspectives on feasibility. Secondary outcomes include: Physical activity (daily time spent walking); daily mobilisation (Y/N); discharge destination; hospital readmission; falls; functional activity (Modified Iowa Level of Assistance Scale); and length of stay. Descriptive statistics will be used to describe feasibility. Secondary outcomes will be compared between groups using Poisson or negative binomial regression, Cox proportional hazards regression, survival analysis, linear regression or logistic regression. ETHICS AND DISSEMINATION Ethics approval was obtained from Peninsula Health (HREC/97 431/PH-2023). Findings will be disseminated in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trial Registry ACTRN12623000584639p.
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Affiliation(s)
- David A Snowdon
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
- Academic Unit, Peninsula Health, Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
| | - Yi Tian Wang
- Department of Physiotherapy, Peninsula Health, Frankston, Victoria, Australia
| | - Michele L Callisaya
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
| | - Taya A Collyer
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
| | - Laura Jolliffe
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
- Academic Unit, Peninsula Health, Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
| | - Nathan Johns
- Department of Rehabilitation Medicine, Peninsula Health, Frankston, Victoria, Australia
| | - Peggy Vincent
- Department of Physiotherapy, Peninsula Health, Frankston, Victoria, Australia
| | - Nandhinee Pragash
- Academic Unit, Peninsula Health, Frankston, Victoria, Australia
- Department of Physiotherapy, Peninsula Health, Frankston, Victoria, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
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Walsh W, Meyer C, Cyarto EV. Home care worker-supported exercise program to address falls: a feasibility study. Aust J Prim Health 2023; 29:650-660. [PMID: 37323031 DOI: 10.1071/py22248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/16/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Falls are a major concern for community-dwelling older adults. The Otago Exercise Program (OEP) is an evidence-based home program that reduces risk of falls. Exercise participation and program adherence can be challenging. Home care workers (HCWs) are well positioned to provide support for older adults. METHODS This feasibility study included: HCW training; HCW in-home support of a physiotherapist-tailored OEP; online physiotherapy consultations; older participant questionnaires and functional outcome measures; and HCW and older participant interviews. RESULTS Twelve older adults, eight HCWs and one physiotherapist participated. A small falls risk reduction, and improvement in falls efficacy, quality of life and functional improvement were noted. Thematic analysis showed formal and informal support was valued by older adults and HCWs. A role-ordered matrix synthesis highlighted variable ongoing independent program participation. CONCLUSIONS By Your Side, a physiotherapist-led and home care worker-supported modified OEP provides a feasible and acceptable option for falls prevention in home care services. Collaborative teamwork, and both formal and informal support, are key aspects to optimising engagement and benefits.
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Affiliation(s)
- Willeke Walsh
- At Home Support, Bolton Clarke, Melbourne, Vic. 3023, Australia; and Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Vic. 3199, Australia
| | - Claudia Meyer
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Vic. 3199, Australia; and Bolton Clarke Research Institute, Bolton Clarke, Melbourne, Vic. 3131, Australia; and College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia; and Centre for Health Communication and Participation, La Trobe University, Melbourne, Vic. 3086, Australia
| | - Elizabeth V Cyarto
- Bolton Clarke Research Institute, Bolton Clarke, Melbourne, Vic. 3131, Australia; and Faculty of Health, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Qld 4059, Australia; and Faculty of Health and Behavioural Sciences, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Qld 4067, Australia
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Sutton C, Prowse J, McVey L, Elshehaly M, Neagu D, Montague J, Alvarado N, Tissiman C, O'Connell K, Eyers E, Faisal M, Randell R. Strategic workforce planning in health and social care - an international perspective: A scoping review. Health Policy 2023; 132:104827. [PMID: 37099856 DOI: 10.1016/j.healthpol.2023.104827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/06/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023]
Abstract
Effective strategic workforce planning for integrated and co-ordinated health and social care is essential if future services are to be resourced such that skill mix, clinical practice and productivity meet population health and social care needs in timely, safe and accessible ways globally. This review presents international literature to illustrate how strategic workforce planning in health and social care has been undertaken around the world with examples of planning frameworks, models and modelling approaches. The databases Business Source Premier, CINAHL, Embase, Health Management Information Consortium, Medline and Scopus were searched for full texts, from 2005 to 2022, detailing empirical research, models or methodologies to explain how strategic workforce planning (with at least a one-year horizon) in health and/or social care has been undertaken, yielding ultimately 101 included references. The supply/demand of a differentiated medical workforce was discussed in 25 references. Nursing and midwifery were characterised as undifferentiated labour, requiring urgent growth to meet demand. Unregistered workers were poorly represented as was the social care workforce. One reference considered planning for health and social care workers. Workforce modelling was illustrated in 66 references with predilection for quantifiable projections. Increasingly needs-based approaches were called for to better consider demography and epidemiological impacts. This review's findings advocate for whole-system needs-based approaches that consider the ecology of a co-produced health and social care workforce.
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Affiliation(s)
- Claire Sutton
- Workforce Observatory, University of Bradford, UK; Faculty of Health Studies, University of Bradford, Bradford, UK.
| | - Julie Prowse
- Workforce Observatory, University of Bradford, UK; Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Lynn McVey
- Workforce Observatory, University of Bradford, UK; Faculty of Health Studies, University of Bradford, Bradford, UK; Wolfson Centre for Applied Health Research, Bradford, UK
| | - Mai Elshehaly
- Workforce Observatory, University of Bradford, UK; Wolfson Centre for Applied Health Research, Bradford, UK; Faculty of Engineering and Informatics, University of Bradford, Bradford, UK
| | - Daniel Neagu
- Workforce Observatory, University of Bradford, UK; Faculty of Engineering and Informatics, University of Bradford, Bradford, UK
| | - Jane Montague
- Workforce Observatory, University of Bradford, UK; Faculty of Health Studies, University of Bradford, Bradford, UK; Wolfson Centre for Applied Health Research, Bradford, UK
| | - Natasha Alvarado
- Workforce Observatory, University of Bradford, UK; Faculty of Health Studies, University of Bradford, Bradford, UK; Wolfson Centre for Applied Health Research, Bradford, UK
| | | | | | - Emma Eyers
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Muhammad Faisal
- Workforce Observatory, University of Bradford, UK; Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Rebecca Randell
- Workforce Observatory, University of Bradford, UK; Faculty of Health Studies, University of Bradford, Bradford, UK; Wolfson Centre for Applied Health Research, Bradford, UK
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Pinson J, King OA, Dennett AM, Davis A, Williams CM, Snowdon DA. Exploring the role of medical imaging assistants in Australian medical imaging departments: A mixed-methods study. J Med Radiat Sci 2023; 70:46-55. [PMID: 36261173 PMCID: PMC9977652 DOI: 10.1002/jmrs.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/09/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Allied health assistants are support staff who assist medical imaging professionals in their clinical and non-clinical role. Assistants can improve efficiency of medical imaging services; however, little is known about the specific tasks they perform. METHOD A two-phase explanatory, sequential mixed-methods study design comprising a time motion survey and qualitative interviews was conducted across three health services in Victoria, Australia. Participants were medical imaging assistants supporting medical imaging professionals. Participants recorded tasks completed on a time motion proforma across two working days. Time spent on tasks was categorised into patient related and non-patient related tasks. Semi-structured interviews were conducted to explore assistants' perspectives about tasks, their roles and any responsibilities. Time motion data was descriptively analysed. Qualitative data were audiotaped, transcribed verbatim and analysed using the framework analysis method. Quantitative and qualitative findings were integrated using data triangulation. RESULTS Four medical imaging assistants participated, providing 4170 min of time motion data and 138 min of interview data. Integration of time motion and interview data revealed the medical imaging assistant role is predominantly non-patient facing; autonomous and critical to workflow; diverse and requires flexibility; has the potential to expand into a more patient-facing role. CONCLUSIONS Medical imaging assistants make significant contributions to workflow management. Their role is predominantly non-patient facing but there appear opportunities for the clinical role to expand. Realizing these opportunities will require careful consideration of the challenges and benefits of extending their scope of practice.
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Affiliation(s)
- Jo‐Anne Pinson
- Department of Medical ImagingPeninsula HealthFrankstonVictoriaAustralia,Department of Medical ImagingMonash HealthClaytonVictoriaAustralia,Department of Medical Imaging and Radiation SciencesMonash UniversityClaytonVictoriaAustralia
| | - Olivia A. King
- Allied HealthBarwon HealthGeelongVictoriaAustralia,Allied HealthSouthwest HealthcareWarrnamboolVictoriaAustralia,Monash Centre for Scholarship in Health EducationFaculty of Nursing and Health SciencesClaytonVictoriaAustralia
| | - Amy M. Dennett
- Allied Health Clinical Research OfficeEastern HealthBox HillVictoriaAustralia,School of Allied HealthHuman Services and SportLa Trobe UniversityBundooraVictoriaAustralia
| | - Annette Davis
- Allied Health Workforce Innovation Strategy Education and Research unit (WISER)Monash HealthClaytonVictoriaAustralia
| | - Cylie M. Williams
- School of Primary and Allied Health CareMonash UniversityFrankstonVictoriaAustralia,Academic UnitPeninsula HealthFrankstonVictoriaAustralia
| | - David A. Snowdon
- Academic UnitPeninsula HealthFrankstonVictoriaAustralia,Peninsula Clinical SchoolCentral Clinical SchoolMonash UniversityFrankstonVictoriaAustralia,National Centre for Healthy AgeingFrankstonVictoriaAustralia
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King OA, Pinson J, Dennett A, Williams C, Davis A, Snowdon DA. Allied health assistants' perspectives of their role in healthcare settings: A qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4684-e4693. [PMID: 35689419 PMCID: PMC10084421 DOI: 10.1111/hsc.13874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/05/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
Allied health assistants (AHAs) are important members of the health workforce and key to meeting population health needs. Previous studies exploring the role and utility of AHAs from multiple stakeholder perspectives suggest AHAs remain poorly utilised in many healthcare settings. This qualitative study explores the experiences and perspectives of AHAs working in healthcare settings to determine the contextual factors influencing their role, and mechanisms to maximise their utility. We conducted semi-structured interviews using purposive sampling with 21 AHAs, from one regional and three metropolitan health services in Australia, between February and July 2021. We used a team-based framework approach to analyse the data. Four major themes were identified: 1) AHAs' interpersonal relationships, 2), clarity and recognition of AHA roles and role boundaries, 3) AHAs accessing education and professional development, and 4) the professional identity of the AHA workforce. Underpinning each of these themes were relationships between AHAs and other healthcare professionals, their patients, health services, and the wider AHA workforce. This study may inform initiatives to optimise the utility of AHAs and increase their role in, and impact on, patient care. Such initiatives include the development and implementation of guidelines and competencies to enhance the clarity of AHAs' scope of practice, the establishment of standardised educational pathways for AHAs, and increased engagement with the AHA workforce to make decisions about their scope of practice. These initiatives may precede strategies to advance the AHA career structure.
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Affiliation(s)
- Olivia A. King
- Barwon HealthGeelongVicAustralia
- Monash Centre for Scholarship in Health EducationMonash UniversityClaytonVicAustralia
| | - Jo‐Anne Pinson
- Monash Health, Department of Medical ImagingClaytonVicAustralia
- Peninsula Health, Department of Medical ImagingFrankstonVicAustralia
- Department of Medical Imaging and Radiation SciencesMonash UniversityClaytonVicAustralia
| | - Amy Dennett
- Allied Health Clinical Research OfficeEastern HealthBox HillVicAustralia
- School of Allied Health Human Services and SportLa Trobe UniversityBundooraVicAustralia
| | - Cylie Williams
- School of Primary and Allied Health CareMonash UniversityFrankstonVicAustralia
- Academic Unit, Peninsula HealthFrankstonVicAustralia
| | - Annette Davis
- Allied Health Workforce Innovation Strategy Education Research (WISER) UnitMonash HealthClaytonVicAustralia
| | - David A. Snowdon
- Academic Unit, Peninsula HealthFrankstonVicAustralia
- Peninsula Clinical School, Central Clinical SchoolMonash UniversityFrankstonVicAustralia
- National Centre for Healthy AgeingFrankstonVicAustralia
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Snowdon DA, King OA, Dennett A, Pinson JA, Shannon MM, Collyer TA, Davis A, Williams CM. Delegation of patient related tasks to allied health assistants: a time motion study. BMC Health Serv Res 2022; 22:1280. [PMID: 36280846 PMCID: PMC9590386 DOI: 10.1186/s12913-022-08642-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 10/06/2022] [Indexed: 12/04/2022] Open
Abstract
Background Allied health assistants (AHAs) are support staff who complete patient and non-patient related tasks under the delegation of an allied health professional. Delegating patient related tasks to AHAs can benefit patients and allied health professionals. However, it is unclear whether the AHA workforce is utilised optimally in the provision of patient care. The purpose of this study was to determine the proportion of time AHAs spend on patient related tasks during their working day and any differences across level of AHA experience, clinical setting, and profession delegating the task. Methods A time motion study was conducted using a self-report, task predominance work sampling method. AHAs were recruited from four publicly-funded health organisations in Victoria, Australia. AHAs worked with dietitians, occupational therapists, physiotherapists, podiatrists, social workers, speech pathologists, psychologists, and exercise physiologists. The primary outcome was quantity of time spent by AHAs on individual task-categories. Tasks were grouped into two main categories: patient or non-patient related activities. Data were collected from July 2020 to May 2021 using an activity capture proforma specifically designed for this study. Logistic mixed-models were used to investigate the extent to which level of experience, setting, and delegating profession were associated with time spent on patient related tasks. Results Data from 51 AHAs showed that AHAs spent more time on patient related tasks (293 min/day, 64%) than non-patient related tasks (167 min/day, 36%). Time spent in community settings had lower odds of being delegated to patient related tasks than time in the acute hospital setting (OR 0.44, 95%CI 0.28 to 0.69, P < 0.001). Time delegated by exercise physiologists and dietitians was more likely to involve patient related tasks than time delegated by physiotherapists (exercise physiology: OR 3.77, 95% 1.90 to 7.70, P < 0.001; dietetics: OR 2.60, 95%CI 1.40 to 1.90, P = 0.003). Time delegated by other professions (e.g. podiatry, psychology) had lower odds of involving patient related tasks than physiotherapy (OR 0.37, 95%CI 0.16 to 0.85, P = 0.02). Conclusion AHAs may be underutilised in community settings, and by podiatrists and psychologists. These areas may be targeted to understand appropriateness of task delegation to optimise AHAs’ role in providing patient care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08642-7.
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Affiliation(s)
- David A Snowdon
- grid.1002.30000 0004 1936 7857Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC Australia ,grid.466993.70000 0004 0436 2893Academic Unit, Peninsula Health, Frankston, VIC Australia ,National Centre for Healthy Ageing, Melbourne, VIC Australia
| | - Olivia A King
- grid.1002.30000 0004 1936 7857Monash Centre for Scholarship in Health Education, Monash University, Clayton, VIC Australia ,grid.414257.10000 0004 0540 0062Allied Health Department, Barwon Health, Geelong, VIC Australia
| | - Amy Dennett
- grid.414366.20000 0004 0379 3501Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC Australia ,grid.1018.80000 0001 2342 0938School of Allied Health Human Services and Sport, La Trobe University, Bundoora, VIC Australia
| | - Jo-Anne Pinson
- grid.419789.a0000 0000 9295 3933Medical Imaging Department, Monash Health, Clayton, VIC Australia ,grid.1002.30000 0004 1936 7857Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, VIC Australia ,grid.466993.70000 0004 0436 2893Medical Imaging Department, Peninsula Health, Frankston, VIC Australia
| | - Michelle M Shannon
- grid.1002.30000 0004 1936 7857Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC Australia ,grid.466993.70000 0004 0436 2893Academic Unit, Peninsula Health, Frankston, VIC Australia
| | - Taya A Collyer
- grid.1002.30000 0004 1936 7857Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC Australia ,grid.466993.70000 0004 0436 2893Academic Unit, Peninsula Health, Frankston, VIC Australia ,National Centre for Healthy Ageing, Melbourne, VIC Australia
| | - Annette Davis
- grid.419789.a0000 0000 9295 3933Allied Health Workforce Innovation Strategy Education Research (WISER) unit, Monash Health, Clayton, VIC Australia
| | - Cylie M Williams
- grid.466993.70000 0004 0436 2893Academic Unit, Peninsula Health, Frankston, VIC Australia ,grid.1002.30000 0004 1936 7857School of Primary and Allied Health Care, Monash University, Frankston, VIC Australia
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Summers BE, Laver KE, Nicks RJ, Andrew NE, Barr CJ, Jolliffe L, Lannin NA. Patient functional independence and occupational therapist time-use in inpatient services: Patient demographic and clinical correlates. Hong Kong J Occup Ther 2022; 34:73-82. [PMID: 34987345 PMCID: PMC8721581 DOI: 10.1177/15691861211018758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 04/30/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Health care expenditure has rapidly increased in Australia. Effective management of occupational therapy services is required to meet clinical demand. Improving our understanding of factors which influence occupational therapy service delivery is a vital step to manage workload distribution and optimise service efficiency. This study aims to examine the influence of patient sociodemographic characteristics, diagnosis and functional independence on the utilisation of occupational therapy resources in hospital inpatients over 18 years old. Methods Prospective, cross-sectional, observational cohort study of 4549 inpatients from three hospital sites in Melbourne, Australia. Data extracted from organisational databases and included in this study were: patient demographics, diagnosis, functional level assessed using the SMAF (Functional Autonomy Measurement System) and occupational therapy time-use. Data were analysed using univariable and multivariable modelling. Results Occupational therapy time-use was significantly associated with all variables included in analysis (p < 0.05). For each variable the amount and direction of effect differed between hospital sites. The SMAF was the only variable consistently associated with occupational therapy time-use. Higher occupational therapy time-use was associated with lower functional independence (leading to a 3.5 min increase in median occupational therapy time for every unit decrease in SMAF score). Conclusions Management of resources within busy hospitals require knowledge of factors associated with occupational therapist time-use. This study identified that time-use could in part be predicted by functional independence, diagnosis and sociodemographic characteristics. Occupational therapy managers can use this information to support decision making while acknowledging other patient and therapist level factors also influence time-use.
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Affiliation(s)
| | | | | | | | | | - Laura Jolliffe
- Alfred Health, Australia.,La Trobe University, Australia
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11
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Snowdon DA, Vincent P, Callisaya ML, Collyer TA, Wang YT, Taylor NF. Feasibility of allied health assistant management of people with acute hip fracture: protocol for a feasibility randomised controlled trial. BMJ Open 2021; 11:e054298. [PMID: 34815289 PMCID: PMC8611436 DOI: 10.1136/bmjopen-2021-054298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Guidelines for hip fracture care state that patients with hip fracture should be mobilised on the day after surgery and at least once a day thereafter. However, compliance with these guidelines is poor. One approach that would assist physiotherapists to meet mobility guidelines after hip fracture is to delegate the provision of daily mobilisation to allied health assistants under their supervision. Therefore, we plan to conduct a randomised controlled trial to determine the feasibility of an allied health assistant providing daily inpatient rehabilitation to patients with hip fracture. METHODS AND ANALYSIS Using a parallel group randomised controlled design with one-to-one allocation, participants will be randomly allocated to an experimental group (allied health assistant management) or a comparison group (physiotherapist management). Inclusion criteria are: adult with diagnosis of hip fracture; inpatient in acute hospital; walked independently pre-hip fracture and able to communicate in conversational English. The experimental group will receive routine physiotherapy rehabilitation, including daily mobilisation, from an allied health assistant following initial physiotherapist assessment. The comparison group will receive routine rehabilitation from a physiotherapist. The primary outcome will be the feasibility of allied health assistant management of patients with hip fracture. Feasibility will be determined using the following areas of focus in Bowen's feasibility framework: acceptability (patient satisfaction), demand (proportion of patients who participate), implementation (time allied health assistant/physiotherapist spends with participant, occasions of service) and practicality (cost, adverse events). Staff involved in the implementation of allied health assistant care will be interviewed to explore their perspectives on feasibility. Secondary outcomes include compliance with daily mobilisation guidelines, discharge destination, hospital readmission, falls, functional activity and length of stay. We aim to recruit 50 participants. Descriptive statistics will be used to describe feasibility and mobilisation rates will be calculated using Cox proportional hazards regression to compare compliance with mobilisation guidelines. ETHICS AND DISSEMINATION Ethics approval was obtained from the Peninsula Health human research ethics committee (HREC/63 005/PH-2020). The findings will be disseminated in peer-reviewed journals and conference presentations. TRAIL REGISTRATION NUMBER Australian and New Zealand Clinical Trial Registry; ACTRN12620000877987; Pre-results.
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Affiliation(s)
- David A Snowdon
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
- Academic Unit, Peninsula Health, Frankston, Victoria, Australia
| | - Peggy Vincent
- Physiotherapy Department, Peninsula Health, Frankston, Victoria, Australia
| | - Michele L Callisaya
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
- Academic Unit, Peninsula Health, Frankston, Victoria, Australia
| | - Taya A Collyer
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - Yi Tian Wang
- Physiotherapy Department, Peninsula Health, Frankston, Victoria, Australia
| | - Nicholas F Taylor
- College of Science Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
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12
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Huglin J, Whelan L, McLean S, Greer K, Mitchell D, Downie S, Farlie MK. Exploring utilisation of the allied health assistant workforce in the Victorian health, aged care and disability sectors. BMC Health Serv Res 2021; 21:1144. [PMID: 34686210 PMCID: PMC8540135 DOI: 10.1186/s12913-021-07171-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/08/2021] [Indexed: 11/28/2022] Open
Abstract
Background Allied health assistants (AHAs) support allied health professionals (AHPs) to meet workforce demands in modern healthcare systems. Previous studies have indicated that AHAs may be underutilised in some contexts. This study aims to identify factors contributing to the effective utilisation of AHAs across health, aged care and disability sectors and possible pathway elements that may optimise AHA careers in Victoria. Methods Using an interpretive description approach data collection included a workforce survey and semi structured interviews (individual and group). Data analysis included descriptive statistics, independent t-tests and thematic analysis. Participants included allied health assistants, allied health professionals and allied health leaders in the health, aged care or disability sectors; educators, managers or student of allied health assistance training; and consumers of Victorian health, disability or aged care services. Results The literature scan identified numerous potential barriers to and enablers of AHA workforce utilisation. A total of 727 participants completed the survey consisting of AHAs (n = 284), AHPs & allied health leaders (n = 443). Thirteen group and 25 individual interviews were conducted with a total of 119 participants. Thematic analysis of the interview data identified four interrelated factors (system, training, individual and workplace) in pre-employment training and workplace environments. These factors were reported to contribute to effective utilisation of the AHA workforce across health, aged care and disability sectors. Study findings were also used to create a conceptual diagram of potential AHA career pathway elements. Conclusion This study identified pre-employment and workplace factors which may contribute to the optimal utilisation of the AHA workforce across Victorian health, aged care and disability sectors. Further study is needed to investigate the transferability of these findings to national and global contexts, and testing of the conceptual model. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07171-z.
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Affiliation(s)
- J Huglin
- Allied Health Workforce Innovation, Strategy, Education & Research (WISER) Unit, Monash Health, 400 Warrigal Road, Cheltenham, VIC, 3192, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, 27 Rainforest Walk, Clayton, VIC, 3168, Australia
| | - L Whelan
- Allied Health Workforce Innovation, Strategy, Education & Research (WISER) Unit, Monash Health, 400 Warrigal Road, Cheltenham, VIC, 3192, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, 27 Rainforest Walk, Clayton, VIC, 3168, Australia
| | - S McLean
- Allied Health Workforce Innovation, Strategy, Education & Research (WISER) Unit, Monash Health, 400 Warrigal Road, Cheltenham, VIC, 3192, Australia
| | - K Greer
- Allied Health Workforce Innovation, Strategy, Education & Research (WISER) Unit, Monash Health, 400 Warrigal Road, Cheltenham, VIC, 3192, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, 27 Rainforest Walk, Clayton, VIC, 3168, Australia
| | - D Mitchell
- Allied Health Workforce Innovation, Strategy, Education & Research (WISER) Unit, Monash Health, 400 Warrigal Road, Cheltenham, VIC, 3192, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, 27 Rainforest Walk, Clayton, VIC, 3168, Australia
| | - S Downie
- Faculty of Medicine, Nursing and Health Sciences, Monash University, 27 Rainforest Walk, Clayton, VIC, 3168, Australia.,Department of Health, Victoria State Government, Lonsdale Street, Melbourne, VIC, 3000, Australia
| | - M K Farlie
- Faculty of Medicine, Nursing and Health Sciences, Monash University, 27 Rainforest Walk, Clayton, VIC, 3168, Australia.
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13
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Foley K, Attrill S, Brebner C. Co-designing a methodology for workforce development during the personalisation of allied health service funding for people with disability in Australia. BMC Health Serv Res 2021; 21:680. [PMID: 34243765 PMCID: PMC8272260 DOI: 10.1186/s12913-021-06711-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background Internationally, health and social services are undergoing creative and extensive redesign to meet population demands with rationed budgets. This has critical implications for the health workforces that serve such populations. Within the workforce literature, few approaches are described that enable workforce development for health professions in the service contexts that emerge from large scale service redesign in times of industry shift. We contribute an innovative and robust methodology for workforce development that was co-designed by stakeholders in allied health during the personalisation of disability funding in Australia (the introduction of the National Disability Insurance Scheme). Methods In the context of a broad action research project, we used program logic modelling to identify and enact opportunities for sustainable allied health education and workforce integration amidst the changed service provision context. We engaged with 49 industry stakeholders across 92 research engagements that included interviews (n = 43), a workshop explicitly for model development (n = 8) and a Project Advisory Group (n = 15). Data from these activities were inductively coded, analysed, and triangulated against each other. During the program logic modelling workshop, we worked with involved stakeholders to develop a conceptual model which could be used to guide trial and evaluation of allied health education which was fit-for-purpose to emerging workforce requirements. Results Stakeholder interviews showed that drivers of workforce design during industry shift were that (1) service provision was happening in turbulent times; (2) new concerns around skills and professional engagement were unfolding for AHP in the NDIS; and (3) impacts to AHP education were being experienced. The conceptual model we co-designed directly accounted for these contextual features by highlighting five underpinning principles that should inform methodologies for workforce development and AHP education in the transforming landscape: being (1) pedagogically sound; (2) person- or family-centred; (3) NDIS compliant; (4) informed by evidence and (5) having quality for all. We use a case study to illustrate how the co-designed conceptual model stimulated agility and flexibility in workforce and service redesign. Conclusions Proactive and situated education of the emerging workforce during policy shift is essential to realise future health workforces that can appropriately and effectively service populations under a variety of changing service and funding structures – as well as their transitions. We argue that collaborative program logic modelling in partnership with key stakeholders including existing workforce can be useful for broad purposes of workforce (re)design in diverse contexts. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06711-x.
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14
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Cartwright AK, Pain T, Heslop DJ. Substitution, delegation or addition? Implications of workforce skill mix on efficiency and interruptions in computed tomography. AUST HEALTH REV 2021; 45:382-388. [PMID: 33691082 DOI: 10.1071/ah20118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/08/2020] [Indexed: 11/23/2022]
Abstract
Objectives This study evaluated multiple computed tomography (CT) workforce models to identify any implications on efficiency (length of stay, scan frequency and workforce cost) and scanning radiographer interruptions through substituting or supplementing with a trained CT assistant. Methods The study was conducted in a CT unit of a tertiary Queensland hospital and prospectively compared four workforce models, including usual practice: Model 1 used an administrative assistant (AA) and one radiographer; Model 2 substituted a medical imaging assistant (MIA) for the AA; Model 3 was usual practice, consisting of two radiographers; and Model 4 included two radiographers, with a supplemented MIA. Observational data were collected over 7 days per model and were cross-checked against electronic records. Data for interruption type and frequency, as well as scan type and duration, were collected. Annual workforce costs were calculated as measures of efficiency. Results Similar scan frequency and parameters (complexity) occurred across all models, averaging 164 scans (interquartile range 160-172 scans) each. The median times from patient arrival to examination completion in Models 1-4 were 47, 35, 46 and 33min respectively. There were between 34 and 104 interruptions per day across all models, with the 'assistant role' fielding the largest proportion. Model 4 demonstrated the highest workforce cost, and Model 2 the lowest. Conclusion This study demonstrated that assistant models offer similar patient throughput to usual practice at a reduced cost. Model 2 was the most efficient of all two-staff models (Models 1-3), offering the cheapest workforce, slightly higher throughput and faster examination times. Not surprisingly, the additional staff model (Model 4) offered greater overall examination times and throughput, with fewer interruptions, although workforce cost and possible role ambiguity were both limitations of this model. These findings may assist decision makers in selecting the optimal workforce design for their own individual contexts. What is known about the topic? Innovative solutions are required to address ongoing health workforce sustainability concerns. Workforce substitution models using trained assistants have demonstrated numerous benefits internationally, with translation to the Australian allied health setting showing promise. What does this paper add? Building on existing research, this study provides clinical workforce alternatives that maintain patient throughput while offering cost efficiencies. This study also quantified the many daily interruptions that occur within the CT setting, highlighting a potential clinical risk. To the best of our knowledge, this study is the first to empirically test the use of allied health assistants within CT. What are the implications for practitioners? Role substitution in CT may offer solutions to skills shortages, increasing expenditure and service demand. Incorporating appropriate assistant workforce models can maintain throughput while demonstrating implications for efficiency and interruptions, potentially affecting staff stress and burnout. In addition, the assistant's scope and accepted level of interruptions should be considerations when choosing the most appropriate model.
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Affiliation(s)
- Andrew K Cartwright
- Medical Imaging Department, Townsville University Hospital, Douglas, Qld 4814, Australia; and College of Medicine and Dentistry, James Cook University, Townsville, Qld 4810, Australia; and School of Population Health, Faculty of Medicine, UNSW Sydney, NSW 2052, Australia. ; and Present address: University of Notre Dame Fremantle, School of Medicine, Fremantle, WA 6160, Australia; and Corresponding author.
| | - Tilley Pain
- Townsville University Hospital, 100 Angus Smith Drive, Douglas, Qld 4814, Australia. ; and College of Public Health, Medical and Veterinary Sciences, James Cook University, 1 James Cook Drive, Douglas, Townsville, Qld 4811, Australia
| | - David J Heslop
- School of Population Health, Faculty of Medicine, UNSW Sydney, NSW 2052, Australia.
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15
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Hall K, Maxwell L, Cobb R, Steele M, Chambers R, Roll M, Bell SC, Kuys S. Physiotherapy service provision in a specialist adult cystic fibrosis service: A pre-post design study with the inclusion of an allied health assistant. Chron Respir Dis 2021; 18:14799731211017895. [PMID: 34142582 PMCID: PMC8216416 DOI: 10.1177/14799731211017895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
What is the impact of including an allied health assistant (AHA) role on physiotherapy service delivery in an acute respiratory service? A pragmatic pre-post design study examined physiotherapy services across two 3-month periods: current service delivery [P1] and current service delivery plus AHA [P2]. Clinical and non-clinical activity quantified as number, type and duration (per day) of all staff activity categorised for skill level (AHA, junior, senior). Physiotherapy service delivery increased in P2 compared to P1 (n = 4730 vs n = 3048). Physiotherapists undertook fewer respiratory (p < 0.001) and exercise treatments (p < 0.001) but increased reviews for inpatients (p < 0.001) and at multidisciplinary clinics in P2 (56% vs 76%, p < 0.01). The AHA accounted for 20% of all service provision. AHA activity comprised mainly non-direct clinical care including oversight of respiratory equipment use (e.g. supply, set-up, cleaning, loan audits) and other patient-related administrative tasks associated with delegation handovers, supervision and clinical documentation (72%), delegated supervision of established respiratory (5%) and exercise treatments (10%) and delegated exercise tests (3%). The AHA completed most of the exercise tests (n = 25). AHA non-direct clinical tasks included departmental management activities (11%). No adverse events were reported. AHA inclusion in an acute respiratory care service changed physiotherapy service provision. The AHA completed delegated routine clinical and non-clinical tasks. Physiotherapists increased clinic activity and annual reviews. Including an AHA role offers sustainable options for enhancing physiotherapy service provision in acute respiratory care.
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Affiliation(s)
- Kathleen Hall
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia.,Physiotherapy, The Prince Charles Hospital, Chermside, Queensland, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Lyndal Maxwell
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia
| | - Robyn Cobb
- Physiotherapy, The Prince Charles Hospital, Chermside, Queensland, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Michael Steele
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia.,Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Rebecca Chambers
- Physiotherapy, The Prince Charles Hospital, Chermside, Queensland, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Mark Roll
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Scott Cameron Bell
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Chermside, Queensland, Australia.,Translational Research Institute, Woolloongabba, Queensland, Australia.,Children's Health Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Suzanne Kuys
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia
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16
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Rushton A, Young A, Keller H, Bauer J, Bell J. Delegation Opportunities for Malnutrition Care Activities to Dietitian Assistants-Findings of a Multi-Site Survey. Healthcare (Basel) 2021; 9:446. [PMID: 33920280 PMCID: PMC8068993 DOI: 10.3390/healthcare9040446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/29/2021] [Accepted: 04/08/2021] [Indexed: 01/04/2023] Open
Abstract
Approximately one-third of adult inpatients are malnourished with substantial associated healthcare burden. Delegation frameworks facilitate improved nutrition care delivery and high-value healthcare. This study aimed to explore knowledge, attitudes, and practices of dietitians and dietitian assistants regarding delegation of malnutrition care activities. This multi-site study was nested within a nutrition care implementation program, conducted across Queensland (Australia) hospitals. A quantitative questionnaire was conducted across eight sites; 87 dietitians and 37 dietitian assistants responded and descriptive analyses completed. Dietitians felt guidelines to support delegation were inadequate (agreement: <50% for assessment/diagnosis, care coordination, education, and monitoring and evaluation); dietitian assistants perceived knowledge and guidelines to undertake delegated tasks were adequate (agreement: >50% food and nutrient delivery, education, and monitoring and evaluation). Dietitians and dietitian assistants reported confidence to delegate/receive delegation (dietitian agreement: >50% across all care components; dietitian assistant agreement: >50% for assessment/diagnosis, food and nutrient delivery, education, monitoring and evaluation). Practice of select nutrition care activities were routinely performed by dietitians, rather than assistants (p < 0.001 across all nutrition care components). The process for care delegation needs to be improved. Clarity around barriers and enablers to delegation of care prior to implementing reforms to the current models of care is key.
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Affiliation(s)
- Alita Rushton
- Department of Nutrition and Dietetics, The Prince Charles Hospital, Chermside, QLD 4032, Australia;
| | - Adrienne Young
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD 4072, Australia; (A.Y.); (J.B.)
- Department of Nutrition and Dietetics, Royal Brisbane Women’s Hospital, Herston, QLD 4029, Australia
| | - Heather Keller
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON N2L 3G1, Canada;
| | - Judith Bauer
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD 4072, Australia; (A.Y.); (J.B.)
| | - Jack Bell
- Department of Nutrition and Dietetics, The Prince Charles Hospital, Chermside, QLD 4032, Australia;
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD 4072, Australia; (A.Y.); (J.B.)
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17
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Sarigiovannis P, Jowett S, Saunders B, Corp N, Bishop A. Delegation by Allied Health Professionals to Allied Health Assistants: a mixed methods systematic review. Physiotherapy 2020; 112:16-30. [PMID: 34020200 DOI: 10.1016/j.physio.2020.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Delegation by Allied Health Professionals (AHPs) to Allied Health Assistants (AHAs) was introduced in response to various challenges affecting modern health care delivery. However, the clinical and cost-effectiveness of using AHAs is relatively unexplored. OBJECTIVES The aim of this review was to synthesise the available evidence on; firstly, the clinical and cost-effectiveness of interventions delegated by AHPs to AHAs and secondly, AHPs', AHAs' and patients' attitudes and beliefs towards delegation. DATA SOURCES MEDLINE, AMED, CINAHL, Cochrane Library, PsycINFO, PEDro, OTseeker and Web of Science databases were searched from inception until January 2019 without restrictions. STUDY SELECTION Primary studies investigating the clinical and cost-effectiveness of any intervention delegated by an AHP, across the spectrum of clinical areas in relation to adult patients, as well as AHPs', AHAs' and patients' attitudes and beliefs about delegation. DATA EXTRACTION & SYNTHESIS Data were extracted by pairs of reviewers. Thematic analysis and synthesis of descriptive and analytical themes was conducted. RESULTS Thirteen publications of variable methodological quality were included. Three studies reported quantitative research and ten qualitative research. No study explored the cost-effectiveness. Only one study investigated clinical effectiveness. Training for both AHPs and AHAs and having clear processes in place were identified as important facilitators of delegation. CONCLUSION AND IMPLICATIONS OF KEY FINDINGS Delegation is not standardised across AHPs or within each profession. There are clear knowledge gaps regarding the clinical and cost-effectiveness of delegation by AHPs and patients' attitudes and preferences. Further research is needed to facilitate the standardisation of delegation. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019119557.
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Affiliation(s)
- P Sarigiovannis
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire ST5 5BG, United Kingdom; Midlands Partnership NHS Foundation Trust, Newcastle under Lyme, Staffordshire ST5 2BQ, United Kingdom.
| | - S Jowett
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire ST5 5BG, United Kingdom; Health Economics Unit, Institute of Applied Health Research, IOEM Building, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - B Saunders
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire ST5 5BG, United Kingdom
| | - N Corp
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire ST5 5BG, United Kingdom
| | - A Bishop
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire ST5 5BG, United Kingdom
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18
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Schwarz M, Ward EC, Cornwell P, Coccetti A. Dysphagia screening using an allied health assistant delegation model: service considerations for implementation. Disabil Rehabil 2020; 44:1275-1283. [PMID: 32780603 DOI: 10.1080/09638288.2020.1800109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Three facilities, involved in introducing a model of Allied Health Assistant (AHA) delegated dysphagia screening, examined barriers and facilitators to service implementation. MATERIALS AND METHODS The 3 facilities varied in size, services and location. AHAs (n = 4) and speech-language therapists (SLTs; n = 4) directly involved in implementation at each site completed semi-structured interviews exploring the implementation experience. Analysis was guided by the Consolidated Framework for Implementation Research (CFIR). RESULTS There was differential implementation across the sites. Facilitators to implementation fell within the CFIR Innovation Characteristic domain, with the "relative advantage" of the model and "design, quality and packaging" of the training and implementation resources being key facilitators. Barriers related to the Innovation Characteristic domain, regarding the tool's "adaptability" in terms of screening tools selected and the implementation environment. Issues with the Inner Setting domain, specifically the "structural characteristics," the "compatibility" of the model and the "relative priority" of the model's implementation within other organizational priorities were also barriers. CONCLUSIONS Although the service model was perceived to have relative advantage, compatibility with local work-flow priorities and service needs must be thoroughly considered if AHA delegated dysphagia screening is to be beneficial as a service model to address increasing dysphagia referral demands.IMPLICATIONS FOR REHABILITATIONDysphagia is a disabling condition which may result in medical, social and operational complications.The demands of screening, assessing, managing and providing rehabilitation for dysphagia are increasing, therefore alternative models of service delivery including delegation are increasingly being considered and implemented.This study provides evidence regarding the context and facilitators of successful AHA dysphagia screening model implementation.This evidence contributes to a growing knowledge base of delegation practices for the management of staffing resources and building of capacity for rehabilitation service delivery.
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Affiliation(s)
- Maria Schwarz
- Speech Pathology and Audiology Department, Logan Hospital, Meadowbrook, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,Centre for Functioning and Health Research, Queensland Health, Brisbane, Australia
| | - Petrea Cornwell
- Menzies Health Institute, School of Allied Health Sciences, Griffith University, Mount Gravatt, Australia
| | - Anne Coccetti
- Speech Pathology and Audiology Department, Logan Hospital, Meadowbrook, Australia
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Brice-Leddy L, Park D, Bateman W, Drysdale J, Ratushny L, Musse S, Nixon SA. Enabling Access to Rehabilitation in Acute Care: Exploring Physiotherapists' and Occupational Therapists' Perspectives on Patient Care When Assistants Become the Primary Therapy Providers. Physiother Can 2020; 72:169-176. [PMID: 32494101 DOI: 10.3138/ptc-2018-0073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The aim of this study was to explore physiotherapists' and occupational therapists' perspectives on how the implementation of a new model of care in the acute medicine setting has affected their practice and patient care outcomes. Method: A qualitative case study was used to gain an in-depth understanding of therapists' experiences. Semi-structured, in-person interviews (45-60 min long) were conducted with eight clinicians (four occupational therapists and four physiotherapists). We used an iterative process of discussion and questioning to interpret the themes emerging from the data. Results: The findings are grouped into four categories - change in the therapist-patient relationship, change in therapists' access to first-hand patient information, developing processes to enhance information exchange, and developing processes to support patient care delivery - and two themes - therapists' expectations of patient care outcomes and redefining the value of the occupational therapists' and physiotherapists' role in contributing to patient care. Conclusions: Participants described the process of adapting their professional skills and behaviours as they evolved into the role of manager of therapy care. Occupational therapists and physiotherapists recognized the potential for occupational therapist assistants (OTAs) and physiotherapist assistants (PTAs) to provide more frequent and consistent care. The therapists highlighted the necessity of ensuring that effective working processes and interactions between the therapist and the OTAs and PTAs were in place to ensure high-quality patient care.
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Affiliation(s)
| | | | | | | | | | - Suad Musse
- Perth Physiotherapy Wellness Centre, Perth
| | - Stephanie A Nixon
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ont
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20
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Snowdon DA, Storr B, Davis A, Taylor NF, Williams CM. The effect of delegation of therapy to allied health assistants on patient and organisational outcomes: a systematic review and meta-analysis. BMC Health Serv Res 2020; 20:491. [PMID: 32493386 PMCID: PMC7268306 DOI: 10.1186/s12913-020-05312-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 05/08/2020] [Indexed: 12/28/2022] Open
Abstract
Background Allied health assistants (AHAs) are support staff who complete clinical and non-clinical tasks under the supervision and delegation of an allied health professional. The effect of allied health professional delegation of clinical tasks to AHAs on patient and healthcare organisational outcomes is unknown. The purpose of this systematic review was to investigate the effect of allied health professional delegation of therapy to AHAs on patient and organisational outcomes. Methods A systematic review and meta-analysis was conducted. Databases MEDLINE (Ovid), Embase (Ovid), Informit (all databases), Emcare (Ovid), PsycINFO (Ovid), Cumulative Index to Nursing and Allied Health Literature [CINAHL] (EbscoHost) and the Cochrane Database of Systematic Reviews were searched from earliest date available. Additional studies were identified by searching reference lists and citation tracking. Two reviewers independently applied inclusion and exclusion criteria. The quality of the study was rated using internal validity items from the Downs and Black checklist. Risk ratios (RR) and mean differences (MD) were calculated for patient and organisational outcomes. Meta-analyses were conducted using the inverse variance method and random-effects model. Results Twenty-two studies met the inclusion criteria. Results of meta-analysis provided low quality evidence that AHA supervised exercise in addition to usual care improved the likelihood of patients discharging home (RR 1.28, 95%CI 1.03 to 1.59, I2 = 60%) and reduced length of stay (MD 0.28 days, 95%CI 0.03 to 0.54, I2 = 0%) in an acute hospital setting. There was preliminary evidence from one high quality randomised controlled trial that AHA provision of nutritional supplements and assistance with feeding reduced the risk of patient mortality after hip fracture (RR 0.41, 95%CI 0.16 to 1.00). In a small number of studies (n = 6) there was no significant difference in patient and organisational outcomes when AHA therapy was substituted for therapy delivered by an allied health professional. Conclusion We found preliminary evidence to suggest that the use of AHAs to provide additional therapy may be effective for improving some patient and organisational outcomes. Review registration CRD42019127449.
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Affiliation(s)
- David A Snowdon
- Professional Academic Unit, Peninsula Health, Monash University, Frankston, VIC, 3199, Australia.
| | - Beth Storr
- Department of Physiotherapy, Peninsula Health, Monash University, Frankston, VIC, 3199, Australia
| | - Annette Davis
- Allied Health Workforce Innovation Strategy Education Research (WISER) unit, Monash Health, Clayton, VIC, 3168, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Box Hill, 3128, Australia.,College of Science, Health and Engineering, La Trobe University, Bundoora, 3083, Australia
| | - Cylie M Williams
- Department of Physiotherapy, Peninsula Health, Monash University, Frankston, VIC, 3199, Australia
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Schwarz M, Ward EC, Cornwell P, Coccetti A. Delegation models in dysphagia management: Current policy, clinical perceptions and practice patterns. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 22:163-173. [PMID: 31262204 DOI: 10.1080/17549507.2019.1632932] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose: Delegation to Allied Health Assistants (AHAs) is an effective workforce solution in a number of areas of adult speech-language pathology (SLP) practice. However, reports of AHA delegation in the area of dysphagia management are limited. The aim of this study was to synthesise information from policy documents and current clinical practice to examine the nature of AHA delegation in dysphagia management.Method: A mixed method design involving a document review of 13 policy documents on AHA delegation, and a survey of 44 SLP managers regarding current delegation models.Result: Policy and current practice were largely congruent. Despite policy support for AHA delegation, 77% reported using delegation models but only 26% used them fairly often/very often in dysphagia management. Both policy and survey findings support AHA training prior to task delegation, however, the nature of training was unspecified. Good governance is integral to successful delegation and managers recognised the need to increase standardisation of AHA capability assessment.Conclusion: AHA delegation in dysphagia management is supported by policy and is being implemented in clinical services. However further work detailing governance and training requirements is needed, as well as systematic evaluation of the safety and benefits of these models.
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Affiliation(s)
- Maria Schwarz
- Speech Pathology and Audiology Department, Logan Hospital, Metro South Hospital and Health Service, Meadowbrook, Queensland, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Petrea Cornwell
- Menzies Health Institute, School of Allied Health Sciences, Griffith University, Queensland, Australia
| | - Anne Coccetti
- Speech Pathology and Audiology Department, Logan Hospital, Metro South Hospital and Health Service, Meadowbrook, Queensland, Australia
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22
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Anderson S, Stuckey R, Fortington LV, Oakman J. Workplace injuries in the Australian allied health workforce. AUST HEALTH REV 2019; 43:49-54. [PMID: 28870281 DOI: 10.1071/ah16173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 07/22/2017] [Indexed: 11/23/2022]
Abstract
Objective This study aims to identify the number, costs and reported injury mechanisms of serious injury claims for allied health professionals. Methods Using Australian Workers' Compensation injury data, the number, mechanism, and costs of injury claims were calculated for eight groups of allied health professions (chiropractors and osteopaths, speech pathologists and audiologists, occupational therapists, physiotherapists, psychologists, podiatrists, social workers and prosthetists/orthotists) between the 2000-01 and 2013-14 financial years. Workforce injury rates were calculated using the 2011 Australian Census Workforce data (denominator) and 2011 Workers' Compensation Statistics claims data (numerator). Results Across the allied health professions, 7023 serious injuries (minimum 5 days absence from work) were recorded with an associated total compensation cost of A$201970000. Fewer than 1.5% of each allied health professional group had an injury claim, with the exception of prosthetists/orthotists who had a rate of 25.9% serious injury claims (95% confidence interval 21.9-30.4). The average cost per claim varied across the allied health professions, from the lowest cost of A$19091 per injury for occupational therapists to the highest of A$48466 per claim in chiropractic and osteopathy. Body stressing followed by mental stress were the most common mechanisms of injury. Conclusions Mechanism of injury, both physical and psychosocial, were identified. Prosthetists/orthotists are at the highest risk of workplace injury of all allied health professions. This suggests the need for further investigation and development of appropriately targeted injury prevention programs for each allied health profession. What is known about this topic? Retention of allied health professionals is a significant issue, with workplace injuries identified as one contributing factor to this problem. Healthcare workers are potentially at high risk of injury as they are exposed to a range of physical and psychosocial hazards in their workplace. What does this paper add? This paper is the first to report on serious injuries, minimum 5 days absence from work, from Australian Workers' Compensation data, across a range of allied health professions. Various allied health professions were examined to identify the number, mechanism and cost of serious workplace injuries finding there is an average of 500 serious claims per year at a cost of A$14million. Prosthetists/orthotists were identified as having the highest proportion of claims per workforce population. What are the implications for practitioners? These results suggest highly varied injury rates across allied health professions. Compensation data does not enable accurate identification of causal factors. Further work is required to identify relevant causal factors so that targeted risk reduction strategies can be developed to reduce workforce injuries.
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Affiliation(s)
- Sarah Anderson
- Centre for Ergonomics and Human Factors, School of Psychology and Public Health, La Trobe University, Bundoora Vic. 3086, Australia.
| | - Rwth Stuckey
- Centre for Ergonomics and Human Factors, School of Psychology and Public Health, La Trobe University, Bundoora Vic. 3086, Australia.
| | - Lauren V Fortington
- Australian Centre for Research into Injury in Sport and its Prevention, Federation University Australia, SMB Campus Ballarat, Vic. 3350, Australia. Email
| | - Jodi Oakman
- Centre for Ergonomics and Human Factors, School of Psychology and Public Health, La Trobe University, Bundoora Vic. 3086, Australia.
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Stanton R, Rosenbaum S. Temporal trends in exercise physiology services in Australia-Implications for rural and remote service provision. Aust J Rural Health 2019; 27:514-519. [PMID: 31713303 DOI: 10.1111/ajr.12563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/17/2019] [Accepted: 07/30/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess temporal trends in service provision by Accredited Exercise Physiologists based on remoteness classification using Australian Bureau of Statistics remoteness classifications of Major Cities, Inner Regional, Outer Regional, Remote and Very Remote. DESIGN AND PARTICIPANTS Cross-sectional analysis of publicly available Medicare Benefits Schedule datasets, for Medicare item number 10953 from 2012-2013 to 2016-2017. MAIN OUTCOME MEASURE(S) Number of claims, benefits paid, fees charges and number of providers for Medicare item number 10953. RESULTS Accredited Exercise Physiologist service delivery demonstrates growth across all areas of remoteness classification. Rebates and fees mirror service delivery trends. The rate of service growth was significantly greater in Major Cities compared with all other remoteness classifications. Provider numbers show a steady increase from 2012-2013 to 2016-2017 but number remains higher in Major Cities compared with all other remoteness locations. CONCLUSION Given the high proportion of chronic and complex illness in rural and remote areas, and the limited access to allied health care services, we propose more needs to be done to position Accredited Exercise Physiologists in these regions of increasing need. These findings have implications for future development of the Accredited Exercise Physiologist profession.
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Affiliation(s)
- Robert Stanton
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Qld, Australia.,Appleton Institute, Central Queensland University, Adelaide, SA, Australia
| | - Simon Rosenbaum
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia
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Somerville L, Davis A, Milne S, Terrill D, Philip K. Exploration of an allied health workforce redesign model: quantifying the work of allied health assistants in a community workforce. AUST HEALTH REV 2019; 42:469-474. [PMID: 28738968 DOI: 10.1071/ah16266] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 05/03/2017] [Indexed: 11/23/2022]
Abstract
The Victorian Assistant Workforce Model (VAWM) enables a systematic approach for the identification and quantification of work that can be delegated from allied health professionals (AHPs) to allied health assistants (AHAs). The aim of the present study was to explore the effect of implementation of VAWM in the community and ambulatory health care setting. Data captured using mixed methods from allied health professionals working across the participating health services enabled the measurement of opportunity for workforce redesign in the community and ambulatory allied health workforce. A total of 1112 AHPs and 135 AHAs from the 27 participating organisations took part in the present study. AHPs identified that 24% of their time was spent undertaking tasks that could safely be delegated to an appropriately qualified and supervised AHA. This equates to 6837h that could be redirected to advanced and expanded AHP practice roles or expanded patient-centred service models. The VAWM demonstrates potential for more efficient implementation of assistant workforce roles across allied health. Data outputs from implementation of the VAWM are vital in informing strategic planning and sustainability of workforce change. A more efficient and effective workforce promotes service delivery by the right person, in the right place, at the right time.
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Affiliation(s)
| | - Annette Davis
- Workforce Innovation, Strategy, Education and Research Unit, Monash Health, 246 Clayton Road, Clayton, Vic. 3168, Australia. Email
| | - Sarah Milne
- Physiotherapy, Monash Health, 246 Clayton Road, Clayton, Vic. 3168, Australia
| | - Desiree Terrill
- Department of Health and Human Services, Level 9, 50 Lonsdale Street Melbourne, Vic. 3000, Australia.
| | - Kathleen Philip
- Department of Health and Human Services, Level 9, 50 Lonsdale Street Melbourne, Vic. 3000, Australia.
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Bastick EK, O'Keeffe DD, Farlie MK, Ryan DT, Haines TP, Katz N, Knight JL, Keely LK, Saber KJ, Sturgess TR, Skinner EH. Postgraduate clinical physiotherapy education in acute hospitals: a cohort study. Physiother Theory Pract 2018; 36:157-169. [PMID: 29913072 DOI: 10.1080/09593985.2018.1479906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Background: Junior physiotherapists require satisfactory clinical skills to work effectively within the acute hospital setting for service quality and consistency. Objective: To investigate the effects of stream-specific clinical training on junior physiotherapist self-efficacy, self-rated confidence, and self-rated ability to work independently during weekend shifts. Design: Prospective cohort study. Participants: Eighteen junior physiotherapists. Methods: Physiotherapists undertook 8 h of stream-specific education in: pediatrics, women's health, neuro-medical, musculoskeletal, cardiorespiratory, and critical care over 8 weeks. Learning objectives were evaluated using a self-efficacy (0-100) scale and self-rated confidence was measured with a 4-point Likert scale (not confident to independent). Self-rated ability to independently work weekend shifts was measured dichotomously (yes/no). Results: Participants completed an average of three stream-specific programs in the study period. Post-training, mean improvement in self-efficacy across objectives ranged from 2.9 (95% CI -8.7 to 14.5) to 43.3 (95% CI 4.8-81.8) points, p < 0.05 for 80% of objectives. Self-rated confidence scores improved for 45.6% of stream-specific learning objectives; 52.8% were unchanged and 1.7% reported a decrease in confidence. Self-rated ability to work stream-specific weekend shifts increased from 56-70%, but no stream achieved a significant increase in staff able to independently work weekend shifts (p range 0.10 to 1.0). Conclusions: A stream-specific education program increased junior physiotherapists' self-efficacy and self-rated confidence but not perceived ability to work independently on weekends. Results were non-randomized and actual practice change was not assessed. Future studies could investigate different educational structures in a blinded, randomized manner on clinical practice change.
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Affiliation(s)
- Emma K Bastick
- Department of Physiotherapy, Monash Health, Melbourne, Australia
| | - David D O'Keeffe
- Department of Physiotherapy, Monash Health, Melbourne, Australia
| | - Melanie K Farlie
- Department of Physiotherapy, Monash University, Melbourne, Australia
| | - Danielle T Ryan
- Department of Physiotherapy, Monash Health, Melbourne, Australia.,Department of Physiotherapy, Monash University, Melbourne, Australia
| | | | - Nikki Katz
- Department of Physiotherapy, Monash Health, Melbourne, Australia
| | - Jessica L Knight
- Department of Physiotherapy, Monash Health, Melbourne, Australia
| | - Laura K Keely
- Department of Physiotherapy, Monash Health, Melbourne, Australia
| | - Kelly J Saber
- Department of Physiotherapy, Monash Health, Melbourne, Australia
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Tarrant BJ, Holland A, Le Maitre C, Robinson R, Corbett M, Bondarenko J, Button B, Thompson B, Snell G. The timing and extent of acute physiotherapy involvement following lung transplantation: An observational study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018. [PMID: 29528538 DOI: 10.1002/pri.1710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE Physiotherapy "standard care" for the acute post lung transplant recipient has not yet been documented. We aimed to analyse how soon patients commence exercise and how much time is dedicated to this during physiotherapy sessions acutely post lung transplantation. METHODS Prospective observational study of bilateral sequential and single lung transplant recipients for any indication, ≥18 years. Participants were observed during 6 physiotherapy sessions: 3 initial and 3 prior to acute inpatient discharge. Duration and content of each session was recorded, consisting of physical exercise and non-exercise tasks. RESULTS Thirty participants, 20 male, median age 58.5 (interquartile range 54.5-65.0) were observed over 173 sessions. Chronic obstructive pulmonary disease was the most common transplant indication (n = 12, 40%). Bilateral lung transplant was performed in 90% (n = 27) of participants. First time to mobilise was 2 (2-3) days. Participants received 14 (12.8-23.8) sessions over 18 (17-31) days. The mean duration of physiotherapy in the initial phase was 107.8 (standard deviation 21.8) min, with 22.9 (7.5) min spent exercising. In the final phase, exercise time increased to 28.1 (11.4) min out of 84.1 (24.6) min. Assessment was the most common non-exercise component, at 26.6 (7.9) and 22.1 (12.5) min across the three initial and final sessions. IMPLICATIONS FOR PHYSIOTHERAPY PRACTICE Lung transplant recipients spent 21-34% of observed sessions performing physical exercise beginning 48 hr following surgery. Remaining physiotherapist time was spent on assessment, respiratory interventions, education, and patient-specific duties. The use of physiotherapy assistants, structured, progressive exercise programs, and continued workplace innovation may enable a higher percentage of physiotherapist supervised physical exercise in the future.
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Affiliation(s)
- Benjamin James Tarrant
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Melbourne, Australia
| | - Anne Holland
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Melbourne, Australia
| | | | - Rebecca Robinson
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Monique Corbett
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Janet Bondarenko
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Brenda Button
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- Cystic Fibrosis Service, Alfred Health, Melbourne, Australia
- Monash University, Melbourne, Australia
| | - Bruce Thompson
- Monash University, Melbourne, Australia
- Lung Function Laboratory, Alfred Health, Melbourne, Australia
| | - Greg Snell
- Monash University, Melbourne, Australia
- Lung Transplant, Alfred Health, Melbourne, Australia
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Experiences of Physical Therapists Working in the Acute Hospital Setting: Systematic Review. Phys Ther 2016; 96:1317-32. [PMID: 27013574 DOI: 10.2522/ptj.20150261] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 03/10/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND Physical therapists working in acute care hospitals require unique skills to adapt to the challenging environment and short patient length of stay. Previous literature has reported burnout of clinicians and difficulty with staff retention; however, no systematic reviews have investigated qualitative literature in the area. PURPOSE The purpose of this study was to investigate the experiences of physical therapists working in acute hospitals. DATA SOURCES Six databases (MEDLINE, CINAHL Plus, EMBASE, AMED, PsycINFO, and Sociological Abstracts) were searched up to and including September 30, 2015, using relevant terms. STUDY SELECTION Studies in English were selected if they included physical therapists working in an acute hospital setting, used qualitative methods, and contained themes or descriptive data relating to physical therapists' experiences. DATA EXTRACTION AND DATA SYNTHESIS Data extraction included the study authors and year, settings, participant characteristics, aims, and methods. Key themes, explanatory models/theories, and implications for policy and practice were extracted, and quality assessment was conducted. Thematic analysis was used to conduct qualitative synthesis. RESULTS Eight articles were included. Overall, study quality was high. Four main themes were identified describing factors that influence physical therapists' experience and clinical decision making: environmental/contextual factors, communication/relationships, the physical therapist as a person, and professional identity/role. LIMITATIONS Qualitative synthesis may be difficult to replicate. The majority of articles were from North America and Australia, limiting transferability of the findings. CONCLUSIONS The identified factors, which interact to influence the experiences of acute care physical therapists, should be considered by therapists and their managers to optimize the physical therapy role in acute care. Potential strategies include promotion of interprofessional and collegial relationships, clear delineation of the physical therapy role, multidisciplinary team member education, additional support staff, and innovative models of care to address funding and staff shortages.
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Wallace S. Comment on 'Building allied health workforce capacity: a strategic approach to workforce innovation'. AUST HEALTH REV 2015; 40:473. [PMID: 26677794 DOI: 10.1071/ah15176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 09/25/2015] [Indexed: 11/23/2022]
Affiliation(s)
- Sonal Wallace
- Alfred Hospital, 55 Commercial Road, Melbourne, Vic. 3004, Australia. Email
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Naccarella L. Strengthening the allied health workforce: policy, practice and research issues and opportunities. AUST HEALTH REV 2015; 39:241-3. [PMID: 26629582 DOI: 10.1071/ah14071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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