Ms Laeticia Hargreaves1, Ms Jessica Ankravs1, A/Prof Casey Peiris1,2, Ms Lauren Krol1, Ms Romy Jeong1, Ms Melanie Brash1, Ms Juliette Rowe1, A/Prof David Read1,3, Ms Kellie Gumm1, Doctor Aruska D'Souza1
1The Royal Melbourne Hospital, Melbourne, Australia, 2La Trobe University, Melbourne, Australia, 3The University of Melbourne, Parkville, Australia
Biography:
Laeticia Hargreaves is the Allied Health Manager for surgical services and the trauma division at the Royal Melbourne Hospital. With a clinical background in Speech Pathology, Laeticia has been working for 24 years in major acute hospitals both in Australia and London. She holds a Masters in Public Health and Diploma of Leadership and Management. As a passionate leader and advocate for excellence in clinical care, Laeticia led the development of the allied health seven-day model of care in trauma at the Royal Melbourne Hospital. This is her first conference submission.
Abstract:
Background:
Despite one-third of all trauma admissions occurring over the weekend in Australia, most acute trauma patients only receive allied health input within traditional Monday to Friday service models. This implementation study determined the acceptability, fidelity and feasibility of a new seven-day allied health model of care within one of Australia’s busiest trauma hospitals.
Methods:
A mixed methods study evaluated the implementation of a new model of care which introduced an additional seven full-time-equivalent, predominantly senior, allied health clinicians over seven-days.
Acceptability was evaluated through surveys completed by medical, nursing and allied health staff (n=151) working in the trauma service, pre- and post-implementation. Fidelity was evaluated by reviewing referral response time, weekend occasions of service, and at pre-implementation (n=484 patients), 6-months (n=456) and 18-months (n=532) post-implementation. Feasibility was evaluated through practicality and limited efficacy testing (changes in length of stay and Monday discharges) using the Mann-Whitney U or chi-squared tests.
Results:
Survey results indicated improved accessibility, adequacy, and continuity of staffing. Recruitment and work-life balance were cited as practical challenges. There were significant reductions in referral response times across allied health (from median 17.0 [IQR 6.0- 25.0] hours to median 12.0 [IQR 5.0-21.0] hours, p<0.001), a 53% increase in weekend occasions of service, and although length of stay remained unchanged, proportion of Monday discharges increased (13% to 18%, p=0.02).
Discussion:
A seven-day allied health trauma service was successfully implemented with findings indicating it will be sustainable. Learnings presented will be useful for scalability to other hospitals and clinical specialties.