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A Transdisciplinary Approach to Brain Injury Rehabilitation

Hunter New England Local Health District
Project Added:
22 March 2016
Last updated:
8 April 2016

A Transdisciplinary Approach to Brain Injury Rehabilitation

Summary

The Hunter Brain Injury Service (HBIS) developed a new process for completing community access, upper limb and activities of daily living (ADL) assessments, using a transdisciplinary rehabilitation approach.

Aim

To eliminate unwanted duplications of occupational therapy (OT) clinical assessments in the HBIS within six months.

Benefits

  • Reduces unwanted duplications in clinical assessments.
  • Maximises use of rehabilitation assistants in clinical activity.
  • Significantly reduces wait time in OT clinics.
  • Allows clinicians to deliver more efficient and coordinated clinical care.
  • Provides patients with more targeted and timely interventions.
  • Enhances collaboration between OT and other disciplines.
  • Provides training opportunities for staff, to broaden their role and maximise their scope of practice.
  • Improves staff satisfaction.
  • Reduces number of patient complaints.
  • Potentially increases cost effectiveness of service.

Background

HBIS is a multidisciplinary allied health team that provides goal-directed rehabilitation for patients. Prior to the project, rehabilitation was provided under an interdisciplinary model, where therapists work collaboratively to achieve patient goals. However, specific disciplines at HBIS tended to complete assessments and interventions relevant to their discipline.

The alternative is transdisciplinary rehabilitation, which occurs when clinicians work across traditional discipline boundaries and provide rehabilitation to the patient as a ‘whole’. Transdisciplinary practice already occurs informally in some rehabilitation services and has been shown to provide efficiency through reduced duplication, fragmentation of care and clinical intervention.

A major rehabilitation aim of HBIS is to identify meaningful, participatory goals that a patient would like to achieve.  Participatory goals are activities that a patient can participate in, which often require input from more than one discipline to achieve. For example, catching a bus to do the shopping would involve mobility, money handling, communication and cognitive applications. Traditionally in multidisciplinary teams, patient goals are broken down into specific components and addressed by each relevant discipline. However, this practice can result in a number of inefficiencies, such as fragmentation of care, duplication of assessments and treatments, and an increase in clinical time from the treating team.

A review of the HBIS model of care in 2014 highlighted key areas where unwanted duplications of clinical assessments were occurring. Patient feedback interviews conducted during 2014 also raised concerns regarding clinical duplication. Patients noted that they were undertaking the same assessments by multiple team members from different disciplines, which also created workload management issues for staff. As a result, the average time patients needed to wait for an OT assessment was longer than other teams, at 25 days.

This feedback resulted in a clinical note audit, which identified two main assessments that were being duplicated: community access and upper limb. It was determined that a transdisciplinary rehabilitation approach and an improved assessment process at HBIS would eliminate duplication and improve the patient experience.

Implementation

  • A shared care approach was established across all disciplines in HBIS, with defined roles and responsibilities for undertaking assessments.
  • New assessments were designed for use across all disciplines, as follows:
    • community access assessments that incorporated cognitive and physical aspects – used by physiotherapy and OT, as well as rehabilitation assistants when providing feedback to clinicians
    • upper limb assessments that incorporated motor, sensory and functional aspects – used by physiotherapy and OT to determine and coordinate rehabilitation treatment
    • ADL functional assessments across a number of tasks – used by OT and rehabilitation assistants when assessing a patient’s functional ability.
  • The redesigned assessments were incorporated into local models of care and relevant clinical guidelines.

Project status

Sustained - the initiative has been implemented and is sustained in standard business.

Key dates

February 2015 – January 2016

Implementation sites

Hunter Brain Injury Service, Hunter New England Local Health District

Partnerships

Executive Clinical Leadership Program

Results

  • A clinical note audit was undertaken pre-implementation (Aug-Dec 2014) and post-implementation (Aug-Dec 2015) to measure the amount of duplication occurring for the two assessments and determine the use of rehabilitation assistants in clinical practice. The audit found that:
    • unwanted duplication in upper limb assessments reduced from 50% to 0%
    • unwanted duplication in community access assessments reduced from 15% to 0%
    • use of rehabilitation assistants in clinical practice increased from 0% to 20% for community access retaining and from 27% to 43% for ADL assessments and retraining.
  • The streamlined model of care reduced OT wait times from an average of 25 days in March 2015, to an average of 0 days wait time by December 2015. This reduction in wait time has been maintained in 2016.
  • 80% of staff found the new community access and upper limb assessments ‘very helpful’.
  • 66% of staff found the ADL assessments ‘very helpful’ and 33% found them ‘somewhat helpful’.
  • Patient feedback found there were no complaints about delays to clinical access, no concerns raised about clinical decision-making or safety and no clinical incidents or adverse events following implementation of the project.

Lessons learnt

  • The project highlighted the fact that improved patient care can help drive change and sustain clinical improvements over the long term.
  • We found that clinicians who experienced the benefits of the project personally, had increased motivation and workplace satisfaction.
  • Being inclusive, listening to different perspectives and working towards a consensus helped break down resistance and increased clinician engagement.

Further reading

  • State of Victoria. Allied health: credentialing, competency and capability framework. Driving effective workforce practice in a changing health environment. Victoria: Monash Health; 2014.
  • Queensland Government. Credentialing and defining scope of clinical practice: Health Service Directive. Queensland: QLD Health; 2014.
  • Health Workforce Australia. Rural and Remote Generalist: Allied Health Project. Greater Northern Australia Regional Training Network; 2013.
  • Browner CM, Bessire GD. Developing and implementing transdisciplinary rehabilitation competencies. SCI Nursing: a publication of the American Association of Spinal Cord Injury Nurses 2004; 21(4): 198-205.
  • NSW Health. Brain Injury Rehabilitation Directorate: Diagnostic Report. Agency for Clinical Innovation; 2014.
  • NSW Health. ACI Brain Injury Rehabilitation Directorate: NSW Brain Rehabilitation Program: Case Management Model of Care. Agency for Clinical Innovation; 2015.

Contact

Chris Catchpole
Acting Service Manager
Hunter Brain Injury Service
Hunter New England Local Health District
Phone: 02 4924 5600
christopher.catchpole@hnehealth.nsw.gov.au

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