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Lal PB, Ward EC, Wishart LR, Schwarz M, Seabrook M, Coccetti A. Nature and timeliness of dysphagia management within an emergency setting. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:233-243. [PMID: 37306536 DOI: 10.1080/17549507.2023.2210266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE To examine referral pathways, clinical demographics, and timeliness of dysphagia management within an emergency department (ED) setting utilising both ED staff and speech-language pathology (SLP) initiated referral pathways. METHOD Six-month retrospective service review of patients who received dysphagia assessment by SLP within a major Australian ED. Data were collected on demographics, referral information, and SLP assessment and service outcomes. RESULT Three hundred and ninety-three patients were assessed by SLP staff in the ED, consisting of 200 stroke and 193 non-stroke referrals. In the stroke cohort, 57.5% of referrals were initiated by ED staff, while 42.5% were SLP initiated. ED staff initiated 91% of non-stroke referrals, with few (9%) proactively identified by SLP staff. SLP staff identified a higher proportion of non-stroke patients within 4 hr of presentation compared to ED staff. Stroke patients identified by SLP staff were more likely to have assessments completed within 8 hr compared to the ED referral pathway. Collectively, 51% of patients required ongoing dysphagia management following initial assessment. CONCLUSION Findings provide an overview of SLP services and referral pathways in an ED context. The SLP initiated referral pathway facilitated early assessment of stroke patients, and collaboration with ED staff was integral in referring other at risk populations. SLP/ED synergy is needed for appropriate and timely dysphagia management practices in an ED.
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Affiliation(s)
- Pranika B Lal
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Australia
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Brisbane, Australia
- Bayside Health Service, Metro South Hospital & Health Service, Brisbane, Australia; and
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Brisbane, Australia
| | - Laurelie R Wishart
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Brisbane, Australia
| | - Maria Schwarz
- Bayside Health Service, Metro South Hospital & Health Service, Brisbane, Australia; and
| | - Marnie Seabrook
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Brisbane, Australia
| | - Anne Coccetti
- Bayside Health Service, Metro South Hospital & Health Service, Brisbane, Australia; and
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Lal PB, Wishart LR, Ward EC, Schwarz M, Seabrook M, Coccetti A. Understanding barriers and facilitators to speech-language pathology service delivery in the emergency department. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:509-522. [PMID: 35579003 DOI: 10.1080/17549507.2022.2071465] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Timely speech-language pathology (SLP) involvement with dysphagic patients in the Emergency Department (ED) may improve patient outcomes. This study utilised qualitative interviews to understand current models and explore factors which have influenced establishment and current dysphagia service provision in Australian EDs. METHOD Semi-structured interviews were conducted with representatives from 12 acute hospital facilities with a SLP ED service. Interview transcripts were analysed using plain content analysis to identify key themes. Sub-analysis using the Consolidated Framework for Implementation Research (CFIR) model was undertaken for facilities with more "expanded" models (n = 4). RESULT SLP ED service models ranged from referral-only services, to models with referral-only and proactive SLP-led screening procedures (classified as "expanded"). Patient-related factors, the ED setting, SLP service factors and perceptions of dysphagia management were key themes reported to impact service delivery. With expanded models, 14 CFIR constructs (innovation source, external policy and incentives, networks and communications, stakeholders and relative priority) were identified as facilitators, while four constructs (adaptability, cost, compatibility, available resources) were barriers to services. CONCLUSION There are service-specific issues with providing SLP care within the ED. Factors related to the unique ED environment must be considered by SLP departments when establishing/optimising dysphagia management within the ED.
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Affiliation(s)
- Pranika B Lal
- School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Queensland, Australia, and
| | - Laurelie R Wishart
- School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Queensland, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Queensland, Australia
| | - Maria Schwarz
- Bayside Health Service, Metro South Hospital & Health Service, Queensland, Australia
| | - Marnie Seabrook
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Queensland, Australia, and
| | - Anne Coccetti
- Bayside Health Service, Metro South Hospital & Health Service, Queensland, Australia
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Trenholm JR, Warner DG, Eagles DD. Occupational Therapy in the Emergency Department: Patient Frailty and Unscheduled Return Visits. The Canadian Journal of Occupational Therapy 2021; 88:395-406. [PMID: 34693736 DOI: 10.1177/00084174211051165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Occupational therapy facilitates care for complex frail emergency department (ED) patients who may have unscheduled return visits (URVs). Purpose. To determine the prevalence of frailty amongst ED patients referred to occupational therapy and if frailty affected the rates and reasons for URVs. Methods. A mixed-methods health records review was conducted of older adults referred to an ED-based occupational therapy program. Findings. Most patients were frail (60.6%). 31.0% of patients discharged home had a URV within 30 days, with no difference in URV rates between frail and non-frail populations. Providing occupational therapy education reduced the frequency of URVs. Frail patients had complex reasons for their URVs, including functional, social/environmental, safety concerns, and/or "failure to thrive". Occupational therapy ED patients were typically vulnerable to moderately frail, dependent in some activities of daily living, and complex. Implications. ED-based occupational therapists must be aware of their patient's frailty and risk of URVs.
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Jones L, Fowler D, Bialocerkowski A, Sheeran N. Learning how to work in an interprofessional environment: how students transition to allied health professionals working interprofessionally. J Interprof Care 2021; 36:419-427. [PMID: 34369251 DOI: 10.1080/13561820.2021.1950130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Allied health professionals (AHPs) often work with other health professions to provide specialized support so that patients receive optimal care. Therefore, new graduate AHPs need to be able to engage collaboratively with various health professionals in the provision of health care services. This study examines new AHP graduates' experiences and reflections on the transition to working in an interprofessional environment. Participants were new graduates (n = 18) from different universities, working in a hospital context, from occupational therapy, speech pathology, social work, pharmacy, and physiotherapy. Qualitative data were collected via two semi-structured interviews conducted over 12 months. The data were analyzed using thematic analysis, with three key themes emerging: (a) The role of the work context, 2) Learning to work interprofessionally, and 3) Developing an interprofessional identity. We discuss the implications for universities and workplaces in enhancing interprofessional practice and learning opportunities among new graduates.
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Affiliation(s)
- L Jones
- School of Applied Psychology, Griffith University, Mt Gravatt, Australia
| | - D Fowler
- School of Applied Psychology, Griffith University, Mt Gravatt, Australia
| | - A Bialocerkowski
- Micro-credentialing and Professional Development (Health), Griffith University, Gold Coast, Australia
| | - N Sheeran
- School of Applied Psychology, Griffith University, Mt Gravatt, Australia
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Lal PB, Wishart LR, Ward EC, Schwarz M, Seabrook M, Coccetti A. Understanding speech pathology and dysphagia service provision in Australian emergency departments. SPEECH, LANGUAGE AND HEARING 2020. [DOI: 10.1080/2050571x.2020.1833469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Pranika B. Lal
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Brisbane, Australia
| | - Laurelie R. Wishart
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Brisbane, Australia
| | - Elizabeth C. Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Brisbane, Australia
| | - Maria Schwarz
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Brisbane, Australia
| | - Marnie Seabrook
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Brisbane, Australia
| | - Anne Coccetti
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Brisbane, Australia
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Watterson D, Walter K, O'Brien L, Terrill D, Philip K, Swan I, Somerville L. Trans-disciplinary advanced allied health practitioners for acute hospital inpatients: a feasibility study. Int J Qual Health Care 2019; 31:103-109. [PMID: 29912467 DOI: 10.1093/intqhc/mzy127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 01/16/2018] [Accepted: 05/23/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To explore cost-efficiency, safety and acceptability of trans-disciplinary advanced allied health (AH) practitioners for acute adult general medicine inpatients. DESIGN Quasi-experimental feasibility study. SETTING Three acute general medical units in an Australian urban hospital. PARTICIPANTS Two hundred and fifty-six acute hospital inpatients. MAIN OUTCOME MEASURES Cost-efficiency measures included AH service utilization and length of stay (LOS). Patient outcomes were functional independence, discharge destination, adverse events, unplanned admissions within 28 days, patient satisfaction and quality of life data on admission, and 30 days post-discharge. Ward staff were surveyed regarding satisfaction with the service model, and advanced health practitioners (AHPs) rated their confidence in their own ability to meet the performance standards of the role. RESULTS Patients allocated to AHPs (n = 172) received 0.91 less hours of AH intervention (adjusted for LOS) (95% confidence intervals (CI): -1.68 to -0.14; P = 0.02) and had 1.76 days shorter LOS relative to expected (95%CI: 0.18-3.34; P = 0.03) compared with patients receiving standard AH (n = 84). There were no differences in patient outcomes or satisfaction. AHPs demonstrated growth in job satisfaction and skill confidence. CONCLUSIONS Trans-disciplinary advanced AH roles may be feasible and cost-efficient compared with traditional roles for acute general medical inpatients. Further development of competency frameworks is recommended.
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Affiliation(s)
| | | | - Lisa O'Brien
- Department of Occupational Therapy, Monash University, Melbourne, Australia
| | - Desiree Terrill
- Department of Health and Human Services, Victoria, Australia
| | - Kathleen Philip
- Department of Health and Human Services, Victoria, Australia
| | - Indi Swan
- Allied Health, Alfred Health, Melbourne, Australia
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Haines TP, Bowles KA, Mitchell D, O’Brien L, Markham D, Plumb S, May K, Philip K, Haas R, Sarkies MN, Ghaly M, Shackell M, Chiu T, McPhail S, McDermott F, Skinner EH. Impact of disinvestment from weekend allied health services across acute medical and surgical wards: 2 stepped-wedge cluster randomised controlled trials. PLoS Med 2017; 14:e1002412. [PMID: 29088237 PMCID: PMC5663333 DOI: 10.1371/journal.pmed.1002412] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 09/21/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Disinvestment (removal, reduction, or reallocation) of routinely provided health services can be difficult when there is little published evidence examining whether the services are effective or not. Evidence is required to understand if removing these services produces outcomes that are inferior to keeping such services in place. However, organisational imperatives, such as budget cuts, may force healthcare providers to disinvest from these services before the required evidence becomes available. There are presently no experimental studies examining the effectiveness of allied health services (e.g., physical therapy, occupational therapy, and social work) provided on weekends across acute medical and surgical hospital wards, despite these services being routinely provided internationally. The aim of this study was to understand the impact of removing weekend allied health services from acute medical and surgical wards using a disinvestment-specific non-inferiority research design. METHODS AND FINDINGS We conducted 2 stepped-wedge cluster randomised controlled trials between 1 February 2014 and 30 April 2015 among patients on 12 acute medical or surgical hospital wards spread across 2 hospitals. The hospitals involved were 2 metropolitan teaching hospitals in Melbourne, Australia. Data from n = 14,834 patients were collected for inclusion in Trial 1, and n = 12,674 in Trial 2. Trial 1 was a disinvestment-specific non-inferiority stepped-wedge trial where the 'current' weekend allied health service was incrementally removed from participating wards each calendar month, in a random order, while Trial 2 used a conventional non-inferiority stepped-wedge design, where a 'newly developed' service was incrementally reinstated on the same wards as in Trial 1. Primary outcome measures were patient length of stay (proportion staying longer than expected and mean length of stay), the proportion of patients experiencing any adverse event, and the proportion with an unplanned readmission within 28 days of discharge. The 'no weekend allied health service' condition was considered to be not inferior if the 95% CIs of the differences between this condition and the condition with weekend allied health service delivery were below a 2% increase in the proportion of patients who stayed in hospital longer than expected, a 2% increase in the proportion who had an unplanned readmission within 28 days, a 2% increase in the proportion who had any adverse event, and a 1-day increase in the mean length of stay. The current weekend allied health service included physical therapy, occupational therapy, speech therapy, dietetics, social work, and allied health assistant services in line with usual care at the participating sites. The newly developed weekend allied health service allowed managers at each site to reprioritise tasks being performed and the balance of hours provided by each professional group and on which days they were provided. Analyses conducted on an intention-to-treat basis demonstrated that there was no estimated effect size difference between groups in the proportion of patients staying longer than expected (weekend versus no weekend; estimated effect size difference [95% CI], p-value) in Trial 1 (0.40 versus 0.38; estimated effect size difference 0.01 [-0.01 to 0.04], p = 0.31, CI was both above and below non-inferiority margin), but the proportion staying longer than expected was greater with the newly developed service compared to its no weekend service control condition (0.39 versus 0.40; estimated effect size difference 0.02 [0.01 to 0.04], p = 0.04, CI was completely below non-inferiority margin) in Trial 2. Trial 1 and 2 findings were discordant for the mean length of stay outcome (Trial 1: 5.5 versus 6.3 days; estimated effect size difference 1.3 days [0.9 to 1.8], p < 0.001, CI was both above and below non-inferiority margin; Trial 2: 5.9 versus 5.0 days; estimated effect size difference -1.6 days [-2.0 to -1.1], p < 0.001, CI was completely below non-inferiority margin). There was no difference between conditions for the proportion who had an unplanned readmission within 28 days in either trial (Trial 1: 0.01 [-0.01 to 0.03], p = 0.18, CI was both above and below non-inferiority margin; Trial 2: -0.01 [-0.02 to 0.01], p = 0.62, CI completely below non-inferiority margin). There was no difference between conditions in the proportion of patients who experienced any adverse event in Trial 1 (0.01 [-0.01 to 0.03], p = 0.33, CI was both above and below non-inferiority margin), but a lower proportion of patients had an adverse event in Trial 2 when exposed to the no weekend allied health condition (-0.03 [-0.05 to -0.004], p = 0.02, CI completely below non-inferiority margin). Limitations of this research were that 1 of the trial wards was closed by the healthcare provider after Trial 1 and could not be included in Trial 2, and that both withdrawing the current weekend allied health service model and installing a new one may have led to an accommodation period for staff to adapt to the new service settings. Stepped-wedge trials are potentially susceptible to bias from naturally occurring change over time at the service level; however, this was adjusted for in our analyses. CONCLUSIONS In Trial 1, criteria to say that the no weekend allied health condition was non-inferior to current weekend allied health condition were not met, while neither the no weekend nor current weekend allied health condition demonstrated superiority. In Trial 2, the no weekend allied health condition was non-inferior to the newly developed weekend allied health condition across all primary outcomes, and superior for the outcomes proportion of patients staying longer than expected, proportion experiencing any adverse event, and mean length of stay. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12613001231730 and ACTRN12613001361796.
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Affiliation(s)
- Terry P. Haines
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
- Allied Health Research Unit, Monash Health, Cheltenham, Victoria, Australia
- * E-mail:
| | - Kelly-Ann Bowles
- Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia
| | - Deb Mitchell
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
- Allied Health Research Unit, Monash Health, Cheltenham, Victoria, Australia
| | - Lisa O’Brien
- Allied Health Research Unit, Monash Health, Cheltenham, Victoria, Australia
- Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia
| | - Donna Markham
- Monash Medical Centre, Allied Health, Monash Health, Clayton, Victoria, Australia
| | - Samantha Plumb
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kerry May
- Monash Medical Centre, Allied Health, Monash Health, Clayton, Victoria, Australia
| | - Kathleen Philip
- Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Romi Haas
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
- Allied Health Research Unit, Monash Health, Cheltenham, Victoria, Australia
| | - Mitchell N. Sarkies
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
- Allied Health Research Unit, Monash Health, Cheltenham, Victoria, Australia
| | - Marcelle Ghaly
- Department of Physiotherapy, Footscray Hospital, Western Health, Footscray, Victoria, Australia
| | - Melina Shackell
- Department of Physiotherapy, Footscray Hospital, Western Health, Footscray, Victoria, Australia
| | - Timothy Chiu
- Footscray Hospital, Western Health, Footscray, Victoria, Australia
| | - Steven McPhail
- Institute of Biomedical Innovation, Queensland University of Technology and Centre for Functioning and Health Research, Buranda, Queensland, Australia
| | - Fiona McDermott
- Department of Social Work, Monash Medical Centre, Monash Health and Monash University, Clayton, Victoria, Australia
| | - Elizabeth H. Skinner
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
- Department of Physiotherapy, Footscray Hospital, Western Health, Footscray, Victoria, Australia
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Lloyd C, Hilder J, Williams PL. Emergency department presentations of people who are homeless: The role of occupational therapy. Br J Occup Ther 2017. [DOI: 10.1177/0308022617706679] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction This project had two aims: to gain an understanding of the profile and expressed needs of people seen by the Homeless Emergency Department Liaison Officer in the emergency department in comparison to general hospital presentations, and to explore the potential role for occupational therapy to respond to this population. Method The Emergency Department Information Systems database and Homeless Emergency Department Liaison Officer files were examined to gather data on all individuals who presented to the hospital emergency department over a 16-month period. The viability of a discipline-specific role to respond to this population was then considered by senior occupational therapists. Results The results revealed that the majority of homeless people seen were male and in the early middle age group, with more than half arriving at the emergency department by way of ambulance services. The most common reasons for presentation were medical, mental health and drug- and alcohol-related issues. Conclusion It was found that a large percentage of people seen in the emergency department were discharged back to the streets. Senior occupational therapists have the potential to provide brief assessments and interventions that could reduce the ongoing demand on emergency department resources by people who are homeless.
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Affiliation(s)
- Chris Lloyd
- Senior Research Fellow, Griffith University, Gold Coast, Queensland, Australia
| | - Joanne Hilder
- Homeless Emergency Department Liaison Officer, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Philip Lee Williams
- Operations and Performance Manager, Headspace Youth Early Psychosis Program, Southport, Lives Lived Well, Queensland, Australia
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Chu MML, Fong KNK, Lit ACH, Rainer TH, Cheng SWC, Au FLY, Fung HKK, Wong CM, Tong HK. An Occupational Therapy Fall Reduction Home Visit Program for Community-Dwelling Older Adults in Hong Kong After an Emergency Department Visit for a Fall. J Am Geriatr Soc 2016; 65:364-372. [PMID: 27858951 DOI: 10.1111/jgs.14527] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the effects of an occupational therapy fall reduction home visit program for older adults admitted to the emergency department (ED) for a fall and discharged directly home. DESIGN Single-blind, multicenter, randomized, controlled trial. SETTINGS EDs in three acute care hospitals in Hong Kong. PARTICIPANTS Individuals aged 65 and older who had fallen (N = 311). INTERVENTIONS After screening for eligibility, 204 consenting individuals were randomly assigned to an intervention group (IG) and received a single home visit from an occupational therapist (OT) within 2 weeks after discharge from the hospital or a control group (CG) and received a well-wishing visit from a research assistant not trained in fall prevention. MEASUREMENTS Both groups were followed for 12 months through telephone calls made every 2 weeks by blinded assessors with a focus on the frequency of falls. Another blinded assessor followed up on their status with telephone calls 4, 8, and 12 months after ED discharge. Prospective fall records on hospital admissions were retrieved from electronic databases; 198 individuals were followed for 1 year on an intention-to-treat basis. RESULTS The percentage of fallers over 1 year was 13.7% in the IG (n = 95) and 20.4% in the CG (n = 103). There were significant differences in the number of fallers (P = .03) and the number of falls (P = .02) between the two groups over 6 months. Significant differences were found in survival analysis for first fall at 6 months (log-rank test 5.052, P = .02) but not 9 or 12 months. CONCLUSION One OT visit after a fall was more effective than a well-wishing visit at reducing future falls at 6 months. A booster OT visit at 6 months is suggested.
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Affiliation(s)
- Mary Man-Lai Chu
- Department of Occupational Therapy, Queen Mary Hospital, Hong Kong
| | - Kenneth Nai-Kuen Fong
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | | | | | | | | | | | - Chit-Ming Wong
- Department of Community Medicine, University of Hong Kong, Hong Kong
| | - Hon-Kuan Tong
- Accident and Emergency Department, Queen Mary Hospital, Hong Kong
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James K, Jones D, Kempenaar L, Preston J, Kerr S. Occupational therapy and emergency departments: A critical review of the literature. Br J Occup Ther 2016. [DOI: 10.1177/0308022616629168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Occupational therapy is emerging as a profession within the context of emergency care, specifically within emergency departments. Emerging professional practice should be underpinned by an evidence base supported by research. As such, this critical review examines, analyses and summarises published and unpublished research concerning occupational therapy in Emergency Departments in order to support emerging practice. Method Research evidence was sought from database platforms, the Internet and grey sources by searching using key words and search terms. Critical analysis of each piece of evidence was undertaken and the analyses were synthesised into a critical review of the literature. Results Twenty-three potentially relevant papers were found, 16 met the criteria for further inclusion and seven were critically analysed. The quality of the papers varied and often lacked sufficient methodological detail for robust review. Although not all study sample sizes were small, variable methodological quality means findings can only be taken into professional practice with caution. Conclusion Based on current evidence, there can only be a limited understanding of occupational therapy, including practice models and efficacy, within emergency departments at this time. There is a need for large-scale, well-designed research studies of occupational therapy within emergency departments.
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Affiliation(s)
- Kirstin James
- Lecturer and Occupational Therapist, School of Health, Nursing and Midwifery, University of the West of Scotland, Paisley, UK
| | - Derek Jones
- Academic Co-ordinator, Centre for Medical Education, University of Edinburgh, Edinburgh, UK
| | | | - Jenny Preston
- Consultant Occupational Therapist, Glasgow Caledonian University, Glasgow, UK
| | - Susan Kerr
- Reader in Public Health, Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, UK
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Spang L, Holmqvist K. Occupational therapy practice in emergency care: Occupational therapists’ perspectives. Scand J Occup Ther 2015; 22:345-54. [DOI: 10.3109/11038128.2015.1033455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Haines TP, O'Brien L, Mitchell D, Bowles KA, Haas R, Markham D, Plumb S, Chiu T, May K, Philip K, Lescai D, McDermott F, Sarkies M, Ghaly M, Shaw L, Juj G, Skinner EH. Study protocol for two randomized controlled trials examining the effectiveness and safety of current weekend allied health services and a new stakeholder-driven model for acute medical/surgical patients versus no weekend allied health services. Trials 2015; 16:133. [PMID: 25873250 PMCID: PMC4403707 DOI: 10.1186/s13063-015-0619-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 02/24/2015] [Indexed: 12/22/2022] Open
Abstract
Background Disinvestment from inefficient or ineffective health services is a growing priority for health care systems. Provision of allied health services over the weekend is now commonplace despite a relative paucity of evidence supporting their provision. The relatively high cost of providing this service combined with the paucity of evidence supporting its provision makes this a potential candidate for disinvestment so that resources consumed can be used in other areas. This study aims to determine the effectiveness, cost-effectiveness and safety of the current model of weekend allied health service and a new stakeholder-driven model of weekend allied health service delivery on acute medical and surgical wards compared to having no weekend allied health service. Methods/Design Two stepped wedge, cluster randomised trials of weekend allied health services will be conducted in six acute medical/surgical wards across two public metropolitan hospitals in Melbourne (Australia). Wards have been chosen to participate by management teams at each hospital. The allied health services to be investigated will include physiotherapy, occupational therapy, speech therapy, dietetics, social work and allied health assistants. At baseline, all wards will be receiving weekend allied health services. Study 1 intervention will be the sequential disinvestment (roll-in) of the current weekend allied health service model from each participating ward in monthly intervals and study 2 will be the roll-out of a new stakeholder-driven model of weekend allied health service delivery. The order in which weekend allied health services will be rolled in and out amongst participating wards will be determined randomly. This trial will be conducted in each of the two participating hospitals at a different time interval. Primary outcomes will be length of stay, rate of unplanned hospital readmission within 28 days and rate of adverse events. Secondary outcomes will be number of complaints and compliments, staff absenteeism, and patient discharge destination, satisfaction, and functional independence at discharge. Discussion This is the world’s first application of the recently described non-inferiority (roll-in) stepped wedge trial design, and the largest investigation of the effectiveness of weekend allied health services on acute medical surgical wards to date. Trial registration Australian New Zealand Clinical Trials Registry. Registration number: ACTRN12613001231730 (first study) and ACTRN12613001361796 (second study). Was this trial prospectively registered?: Yes. Date registered: 8 November 2013 (first study), 12 December 2013 (second study). Anticipated completion: June 2015. Protocol version: 1. Role of trial sponsor: KP and DL are directly employed by one of the trial sponsors, their roles were: KP assisted with overall development of research design and assisted with overall project management; DL contributed to project management, administration and communications strategy. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0619-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Terry P Haines
- Allied Health Research Unit, Monash Health and Physiotherapy Department, Monash University, Melbourne, Victoria, Australia.
| | - Lisa O'Brien
- Allied Health Research Unit, Monash Health and Physiotherapy Department, Monash University, Melbourne, Victoria, Australia. .,Department of Occupational Therapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Melbourne, Victoria, Australia.
| | - Deb Mitchell
- Allied Health Research Unit, Monash Health and Physiotherapy Department, Monash University, Melbourne, Victoria, Australia. .,Allied Health, Monash Health, Melbourne, Victoria, Australia.
| | - Kelly-Ann Bowles
- Allied Health Research Unit, Monash Health and Physiotherapy Department, Monash University, Melbourne, Victoria, Australia.
| | - Romi Haas
- Allied Health Research Unit, Monash Health and Physiotherapy Department, Monash University, Melbourne, Victoria, Australia.
| | - Donna Markham
- Allied Health, Monash Health, Melbourne, Victoria, Australia.
| | - Samantha Plumb
- Allied Health, Melbourne Health (Royal Melbourne Hospital), Parkville, Melbourne, Victoria, Australia.
| | - Timothy Chiu
- Physiotherapy Department, Western Health, Footscray, Melbourne, Victoria, Australia.
| | - Kerry May
- Allied Health, Monash Health, Melbourne, Victoria, Australia.
| | - Kathleen Philip
- Health Workforce Branch, Department of Health, Melbourne, Victoria, Australia.
| | - David Lescai
- Health Workforce Branch, Department of Health, Melbourne, Victoria, Australia.
| | - Fiona McDermott
- Department of Social Work, Monash Health and Monash University, Melbourne, Victoria, Australia.
| | | | - Marcelle Ghaly
- Physiotherapy Department, Western Health, Footscray, Melbourne, Victoria, Australia.
| | - Leonie Shaw
- Allied Health, Melbourne Health (Royal Melbourne Hospital), Parkville, Melbourne, Victoria, Australia.
| | - Genevieve Juj
- Allied Health, Melbourne Health (Royal Melbourne Hospital), Parkville, Melbourne, Victoria, Australia.
| | - Elizabeth H Skinner
- Allied Health Research Unit, Monash Health and Physiotherapy Department, Monash University, Melbourne, Victoria, Australia. .,Physiotherapy Department, Western Health, Footscray, Melbourne, Victoria, Australia.
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13
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Rice D, Campbell N, Friedman L, Speechley M, Teasell RW. The Cognistat (neurobehavioural cognitive status exam): Administering the full test in stroke patients for optimal results. Aust Occup Ther J 2015; 62:116-22. [PMID: 25703065 DOI: 10.1111/1440-1630.12182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND One of the most commonly administered tools occupational therapists use for stroke patients is the Cognistat, which was designed as a brief screening tool of cognitive functioning. Evaluations in samples of patients have identified a high false-negative rate if the Cognistat is administered using the 'screen metric' approach. Assessing the Cognistat based on its intended design can ensure consistency and accuracy among occupational therapists for this commonly administered tool. Thus, this study examined the accuracy of administering the entire Cognistat in comparison to the screen-metric approach and the factor analytic structure within stroke patients. METHODS The full Cognistat was administered to stroke patients receiving inpatient rehabilitation. RESULTS Seventy-five patients who experienced a recent stroke met inclusion criteria. An inconsistency between the screen and metric items was found for five of 10 subscales. Additionally, a principal component analysis (PCA) found the Cognistat to be a two factor structure with six of the subscales loading on Factor 1, while the remaining subscales loaded on Factor 2. CONCLUSIONS Our findings confirm that occupational therapists should administer the full Cognistat to stroke patients rather than the original screen-metric approach. A two-factor structure was also supported in our results, suggesting that occupational therapists' scoring practices should reflect this finding and use the differentiated score out of 10 rather than a global sum. However, additional research is necessary to consider the clinical and theoretical significance of the Cognistats' subscale clustering.
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Affiliation(s)
- Danielle Rice
- Lawson Health Research Institute, St. Joseph's Health Care, London, Ontario, Canada
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14
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Bissett M, Cusick A, Lannin NA. Functional assessments utilised in emergency departments: a systematic review. Age Ageing 2013; 42:163-72. [PMID: 23328756 DOI: 10.1093/ageing/afs187] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND functional assessment is an important component of the management of older adults in the emergency department (ED) as the function level has been identified as a predictor of adverse events including ED re-presentation. A systematic review (SR) of all functional assessments utilised in EDs has not been undertaken making assessment selection, on the basis of evidence, difficult for staff. OBJECTIVE this SR: (i) identified functional assessments that have been utilised in ED settings, (ii) examined what psychometric properties analysis has been completed and (iii) established recommendations for practice. METHODS electronic database searching was completed utilising key search terms. Articles were reviewed using pre-determined inclusion criteria. Each study was appraised using quality criteria for aspects of validity and reliability in addition to clinical utility, interpretability and responsiveness. Recommendations for practice were determined on the basis of the extent of psychometric data generated in ED settings and whether or not the assessment was specifically developed for ED use. RESULTS a total of 332 articles were identified of which 43 articles utilising 14 functional assessments were retained. Psychometric testing was scarce. Functional assessment has been reported internationally and only with older adults. Following appraisal four assessments [the Identification of Seniors at Risk (ISAR), Triage Risk Stratification Tool (TRST), Older Adult Resources and Services (OARS) and Functional Status Assessment of Seniors in Emergency Departments (FSAS-ED)] were recommended for practice with moderate reservations. CONCLUSION the ISAR or TRST are suitable for fast screening, whereas the OARS or FSAS-ED are more suitable for a comprehensive understanding of functional performance. Further research is warranted and recommendations for ED assessment may change as more becomes known about psychometric properties and clinical applications of other assessments.
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Affiliation(s)
- Michelle Bissett
- Occupational Therapy, University of Western Sydney, Locked Bag 1797, Penrith South DC, New South Wales 1797, Australia.
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15
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Holm SE, Mu K. Discharge Planning for the Elderly in Acute Care: The Perceptions of Experienced Occupational Therapists. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2012. [DOI: 10.3109/02703181.2012.719601] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Stamm T, Hill J. Extended roles of non-physician health professionals and innovative models of care within Europe: results from a web-based survey. Musculoskeletal Care 2011; 9:93-101. [PMID: 21259414 DOI: 10.1002/msc.201] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND OBJECTIVE Due to the increasing prevalence of rheumatic diseases, extended roles of non-physician health professionals and innovative models of care may be important options in rheumatology in the future. Extended roles have been pioneered in the UK, Canada, USA and Australia and been found to be effective and safe. However, few data are available about mainland Europe, so the aim of this study was to explore the current status of the extended roles undertaken by health professionals within Europe, and the corresponding models of care used. METHODS Non-physician health professionals from various European countries were asked to complete a web-based survey using convenience and snowball sampling techniques. Data analysis involved calculating descriptive statistics and frequencies based on the countries where the participants currently worked. RESULTS Of the 479 health professionals who filled in the survey, 430 (92%) indicated that they were performing extended roles. Considerable differences between the 27 participating countries existed, in terms of which extended roles and which innovative models of care were being used. Barriers to performing extended roles were cited as the attitude of rheumatologists in all but eight countries, while attitudes of patients were less common barriers. Lack of knowledge, education and educational opportunities were also experienced in several countries. CONCLUSION The present study produced the first data on extended roles for non-physician health professionals and corresponding innovative models of care in rheumatology within Europe. We recommend increasing educational opportunities, as well as developing strategies to limit the barriers experienced.
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Affiliation(s)
- Tanja Stamm
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria.
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Cusick A, Johnson L, Bissett M. Continuing professional development for occupational therapy emergency department services. Aust Occup Ther J 2010; 57:380-5. [PMID: 21091703 DOI: 10.1111/j.1440-1630.2010.00874.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To explore continuing professional development (CPD) resources and needs of Australian emergency department occupational therapists. METHOD Australian websites and occupational therapy newsletters were searched to identify CPD resources/opportunities. Occupational therapists with recent clinical experience in Australian emergency departments were surveyed on strengths, weaknesses, opportunities and threats to their service, research information needs, supervision/mentor arrangements and quality assurance activity. RESULTS No Australian CPD opportunities were identified; 1.3% of the 2008 OT AUSTRALIA conference topics were emergency department specific. Forty-one Australian hospitals employed a total of 51 occupational therapists of whom 30 responded. Half were supervised by occupational therapists; 20 had occupational therapy mentors; 23 perceived that they were very independent; seven did quality assurance projects; 25 had unmet research needs; 27 thought their service was effective; and service strengths, weaknesses, opportunities and threats to service could be identified by most occupational therapists. CONCLUSION Australian occupational therapists in emergency departments need specialised CPD opportunities. The information needs and strengths, weaknesses, opportunities and threats provide a CPD topic planning guide.
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Affiliation(s)
- Anne Cusick
- School of Biomedical and Health Sciences, University of Western Sydney, Penrith South, New South Wales 1797, Australia.
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