Ms Hilda Griffin1, Ms. Abbey Begeman1, Ms Cassie Plant1, Ms Meg Allen1, Mr Joeseph Cobbledick1, Ms Claire Anderson2, A/Prof Douglas Johnson2,3,4, Dr Aruska D'Souza1
1Department of Allied Health, Royal Melbourne Hospital, Melbourne, Australia, 2Department of General Medicine, Royal Melbourne Hospital, Melbourne, Australia, 3Department of General Medicine and Infectious Diseases, Royal Melbourne Hospital, Melbourne, Australia, 4Department of Medicine and Infectious Diseases, University of Melbourne., Melbourne, Australia
Biography:
Hilda Griffin is the Nutrition Manager and Allied Health Manager lead for Medical Services at the Royal Melbourne Hospital. Her research interests are focused on safety and effectiveness of intervention in dynamic healthcare environments including workforce design and novel models of care.
Abstract:
Background:
The Royal Melbourne Hospital implemented a seven-day model of care in general medicine with additional allied health staffing (including senior staff) to provide timely access to care. This pre–post observational study aims to evaluate the impact on allied health clinical service delivery as well as patient and health service outcomes.
Methodology:
Data were collected across a three-month period pre- and post- implementation and included number of admissions, patient demographics, allied health response time, encounters, unmet demand, length of stay (LOS), discharge destination, in-hospital mortality, ICU admission and 28-day readmission.
Results:
Patient admissions increased by 22% post implementation (n=567 to 692) with similar demographics across timepoints and eligibility for inclusion at 78% (n=442) and 82 % (n=655) respectively. Allied health activity increased by 59% (n=2972 to n=4728 encounters, p<0.009) on weekdays and 194% (n=266 to n=782, p <0.001) on weekends. Improvements occurred in responsiveness (74 [IQR 23.0 – 86.0] to 50 [IQR 23.0 – 86.0] hours, p<0.001) and total patient encounter time (180 [IQR 76.3-349.50] to 265 [IQR 115.3 -576.3] minutes, p <0.001). Unmet clinical demand for highest priority patients decreased from 24% (n=98/411) to 15% (n=103/703). LOS reduced by 7% (5.3 [IQR 2.9-10.9] days to 4.86 days [2.8-9.0] days, p=0.214). There was no change in ICU admission, mortality, 28-day readmission or discharge destination.
Conclusion:
A seven-day allied health model of care in general medicine demonstrated improvements in allied health clinical service delivery without compromising patient outcomes, despite an overall increase in patient admissions.