Mind the (33%) gap! Measuring the unmet clinical demand across allied health in inpatient general medicine – an audit of patient episodes of care and complexity
Aruska D’Souza1, Bridget Agius1, Alisha da Silva1, Jenni Medland1, Hilda Griffin1 1The Royal Melbourne Hospital, Parkville, Victoria, Australia
Abstract
Aim
General medicine inpatient caseloads are patient-intensive and complex. This study aimed to: 1) quantify allied health patient episodes actioned and not actioned according to allied health clinician identified need in the Acute Medical Unit (AMU) and general medical units; and 2) to identify actioned allied health encounters requiring >60 minutes as an indicator of patient complexity.
Method
A clinician survey measured the number of general medical and AMU patients actioned and not actioned by all allied health clinicians (clinical psychologists, dieticians, neuropsychologists, occupational therapists, physiotherapists, podiatrists, social workers and speech pathologists) from 10-21st October, 2022 at The Royal Melbourne Hospital. All encounters were clinician reported and categorised using discipline-specific priority matrices with “Priority 1” being the highest clinically priority. Clinicians also recorded the number of actioned encounters of >60 minutes.
Results
There were a total of 2211 patient episodes identified, of which allied health clinicians actioned 1473 (67%). The majority of “Priority 1” encounters (n=491, 75%) were actioned appropriately. Unmet clinical demand (n=738, 33%) was variable across the allied health professions. There were 178 (8%) encounters requiring >60 minutes of clinician time. The most common reason for this was discharge planning (n=103, 58%).
Discussion
The findings quantify the unmet allied health clinical demand across in general medicine at The Royal Melbourne Hospital and will be used to inform future service development. Encounters requiring >60 minutes of intervention were minimal (8%) but if this is required regularly, this may substantially impact the overall number of episodes actioned.
Biography
Dr D’Souza is an early-career researcher and physiotherapist with over 11 years of clinical experience in acute care. She was awarded her PhD in 2023 (Predicting Discharge Destination in Acute General Medicine). Dr D’Souza has published four papers and obtained over $160,000 in competitive grant funding. She currently works as the Allied Health Knowledge and Research Translation lead at the Royal Melbourne Hospital and leads multi-disciplinary projects across allied health that investigate a broad range of important clinical areas including Outcome Measurement in acute, COVID-19, Trauma, LGBTQIA+ Patient Liaison Service, General Medicine and Staff Digital Health capability.