Recruitment in the Regions – Sourcing Allied Health staff

Rebecca Woodland1, Fiona Rawson1, Deanne McKendry1
Gippsland Lakes Complete Health1

ABSTRACT

Background or Problem/ Issue:

The recruitment of Allied Health staff to regional areas is difficult. Sourcing appropriately qualified and experienced staff in order to meet local community needs is problematic, particularly when there is high demand and low supply of Allied Health graduates. Encouraging professionals to move to a regional area away from professional and personal support networks is a continual challenge. The further away from Melbourne the regional location is, the more barriers there are to overcome in terms of distance, both actual and perceived, when recruiting staff.

Method or What you did?

GLCH focused on two key areas – recruitment and induction.

Recruitment:

We advertised our vacancies through our normal channels, i.e. the local papers and our website. We added to this a customised promotional video which we promoted through our networks and social media channels. We also partnered with RWAV to utilise their networks and source applications through them, which has been very successful.

Induction:

Once we had successful candidates, we supported them extensively through the onboarding process. Support, information and advice was offered to ease every aspect of the transition to regional living and to GLCH. The STEP (Support, Therapies, Education and Prevention) unit that the Allied Health staff work in is a close, supportive and engaged one. They hold regular social events outside work to engage staff, they have strong pastoral support and welfare in the workplace, and they provide a workplace environment conducive to easing the transition to a new workplace.

Results or Outcomes:

Over the past 6 months or so we have successfully recruited;

  • Speech Pathologist (Rachel Masin)
  • Occupational Therapist (Jess Moller, Kelsey Leggatt, Mikhaila Carroll, Paulien Long)
  • Health Promotion Officer (Melanie Fuller)
  • Exercise Physiologist (Nara Venkatesan)
  • Podiatrist (Nuala Rooney, Ashley Donoghue)
  • Physiotherapist (Jessica James)
  • Allied Health Assistants (Nic Chila, Kristina Stafford, Steph Matthews)

Conclusions or Practice Implications:

Successful recruitment of Allied Health staff requires varied recruitment methods, and also extensive support during the onboarding and induction phases.


BIOGRAPHY

Rebecca Woodland is currently the Human Resources Manager at Gippsland Lakes Complete Health, with a background in Medical and Allied Health Staff Management, Quality and Governance, and Tertiary Education. She has a keen interest in workforce planning and workforce development.

Prehabilitation: Implementing a new multidisciplinary program to prepare patients for Total Hip and Knee Replacement surgery.

Sally Wilson1
West Gippsland Healthcare Group1

ABSTRACT

Issue:

In 2018/19 in Victoria it took 301 and 265 days for 90% of patients to be admitted for elective Total Knee and Total Hip replacement surgery respectively, and 4.6% and 2.7% (respectively) waited for more than 365 days.

Studies have shown that patients with lower preoperative function and pain did not improve postoperatively to the same levels as those with higher preoperative function. The longer a patient waits for their surgery, the greater the potential for functional decline and deconditioning which also leads to a longer postoperative recovery.

What you did?

A multidisciplinary working group was formed to implement a Prehabilitation Program, ensuring all stakeholders were involved from the beginning. This included:

  • designing how the program would be delivered (Pre-admission Clinic/Nursing, Physiotherapy, Occupational Therapy, Dietetics, Diabetes Education, Allied Health Assistance),
  • the reporting and clinic set-up to maximise funding,
  • referral processes and communication across disciplines and units,
  • developing forms and templates for documentation, and
  • embedding evaluation into the program.

Program delivery commenced in August 2018 which included a 4 week physiotherapy exercise program and OT education sessions. Input from a Dietitian or Diabetes Educator was determined by screening embedded in the referral tool.

Regular meetings continued with multidisciplinary clinical team meetings discussing ‘ready for care’ issues, and ‘process’ meetings allowing for evaluation and continuous improvement.

Outcomes:

Following 12 months of program delivery 3 people did not progress to surgery, with 2 more waiting to ensure benefits are sustained. Improved efficiencies have been reported on the Surgical Unit, with patients ready to participate and more prepared for discharge. The program helped to improve how patients managed daily activities prior to surgery in 92%, mobility in 86% and the management of their weight or nutrition in 54%.

Between 60-80% of patients either improved or maintained status quo in outcome measures (10mwt, TUG, HOOS/KOOS score) taken prior to the program and prior to surgery.
Ongoing review has resulted in quality improvements including the introduction of a ‘Booster Group’ and expanded malnutrition screening.

Future directions and practice implications:

Now two and a half years down the track, the Prehab team will be doing a full review of outcome measures used. Implementation of a delirium/frailty screen within pre-admission is planned.

Thorough planning prior to implementation is vital, with input from all stakeholders. Ongoing, regular ‘process’ meetings have been extremely beneficial to ensure continuous improvement in response to feedback from both staff and patients.


BIOGRAPHY

Sally is a Senior Clinician Physiotherapist with 19 years of experience in public hospitals. She has worked in all clinical areas, as well as Clinical Education and Quality and Safety.

An evaluation of Dietetic Service in Functional dyspepsia: comparison of Low FODMAP diet with standard dietetic advice.

Christopher Duff, Dr Bradley Kendall, Prof Gerald Holtmann, Amy Nevin, Dr Heidi Staudacher
Bond University, Princess Alexandra Hospital, University of Queensland, Gippsland Southern Health Service

ABSTRACT

Background or Problem/ Issue:

Functional dyspepsia (FD) is a gastrointestinal disorder characterised by symptoms including postprandial pain and early satiety. Observational data suggests certain foods and/or dietary constituents may provoke symptoms. Data for effective dietary approaches for FD is lacking, although a diet low in fermentable carbohydrates (low FODMAP diet) is often recommended in clinical practice.

Method or What you did?

We performed an observational study to compare the effectiveness of low FODMAP dietary advice (LFD) with standard dietary advice (STD; e.g. healthy eating, reduce intake of caffeine/alcohol) in patients referred with FD. At interim analysis, complete symptom data from 35 patients with FD attending an initial and review dietetic gastroenterology outpatient appointments at Princess Alexandra Hospital were available. Of these, 25 patients received LFD advice and 10 received STD advice. The 22-item Structured Assessment of Gastrointestinal Symptoms (SAGIS) questionnaire (1) was completed at each visit and epigastric score (max 28 points) and total SAGIS score (max 88 points) calculated. Adherence to dietary advice was recorded.

Results or Outcomes:

Patients receiving LFD advice demonstrated a greater reduction in epigastric domain score (-4.1 vs + 0.7, p =0.015) and total SAGIS score (-10.4 vs – 1.55, p =0.031) compared with STD. A greater proportion of patients receiving LFD advice achieved a 30% reduction in epigastric score compared with STD (52% vs 10%, p=0.024). Adherence to advice did not differ between LFD and STD (76% vs 60%, p=0.292).

Conclusions or Practice Implications:

These findings suggest LFD may be beneficial for improving upper gastrointestinal symptoms in FD. A randomised controlled trial is required to substantiate these findings.


BIOGRAPHY

Chris conducted a part of this study as a component of his Masters program in his final year. The study has since continued and he is still heavily involved. He has a keen interest in the dietary management of gastrointestinal symptoms. Chris is now working in regional Victoria, across several areas of dietetics.

The effectiveness of Total Contact Cast Technique to control infection and treat DFU to prevent late presentation and amputation in a rural and isolated setting. An experience from the Solomon Islands.

Amelia Tobias1
Ortho Advantage1

ABSTRACT

Background or Problem/ Issue:

Centralised multidisciplinary healthcare is the preferred model for treating Diabetic Foot Ulcers (DFU). Separation from customary lands and people, cost of transport and accommodation are major barriers faced by indigenous people living in isolated communities located between 2-6 days from a treating healthcare centre. Consequently, patients are presenting late with chronic and often infected DFU, resulting in preventable amputation, causing further lifelong implications affecting lower limb function and quality of life. This case series investigates the effectiveness of training healthcare practitioners in using low cost dressings and Total Contact Cast (TCC) to control infection and treat DFU.

Method or What you did?

Seven patients of Melanesian origins from various isolated communities were selected with the following criteria; SINBAD score >4, late presentation due to geography and income, >1 surgical debridement, and below knee amputation scheduled <1 week. Treatment commenced when a Doctor reviewed the patient. On every treatment occasion, DFU was debrided, cleaned and dressed by a Nurse then a TCC was applied by the Author or a local healthcare practitioner under the Author’s supervision. The DFU was packed to the level of the epidermis followed by a TCC enclosed distally to reduce the sheer and direct forces and control infection. The TCC was changed every two days until the DFU was not infected. The inpatients were then discharged and the TCC was changed as an outpatient between 3-10 days. The patients were non-weight bearing for the total treatment period. Major and minor complications were defined by ones interfering and not interfering with treatment.

Results or Outcomes:

TCC treatment prevented amputation for all seven patients. The data from one patient was excluded due to a regional transfer where treatment proceeded but wasn’t recorded. Local clinicians applied 29% of the casts, no-one caused any major complications. Days to complete skin coverage µ70.1, range 39-89. TCC’s applied per patient µ8, range 3-10. All patients had minor complications, most common were delayed inpatient discharge due to availability of assistive ambulatory devices and accommodation.

Conclusions or Practice Implications:

TCC is an effective treatment option for treating DFU’s in isolated clinics and prevent late presentation leading to lower limb amputation. Remote healthcare clinics have the resources required to use this method of treatment and Solomon Island health practitioners have an aptitude for TCC. However, there are limited opportunities to access the information and technical education which is required to safely apply TCC. This treatment method could be considered for other similar populations.


BIOGRAPHY

Amelia is a senior Orthotist with diverse experience in Peadiatric and Adult Public Health Service in Australia and the Solomon Islands.  She specialises in neuro-muscular conditions and orthopaedic casting with a passion for remote health and preventing amputation. Amelia has established the company Ortho Advantage providing an orthotics service to the South Gippsland Coast community and Total Contact Casting clinical education to remote practitioners.

The benefits of a Community Health exercise program during COVID-19.

Jordan McMillan1, Emma Boyes1
Latrobe Community Health Service1

ABSTRACT

Background: With the ageing population and the rise in preventable diseases and conditions in Australia, an added demand is being placed on allied health services. COVID-19 forced the health and fitness industry into chaos, with restrictions and closures, older people in the Gippsland community faced social isolation and functional decline. COVID-19 created an opportunity for the Exercise team to run more 1:1 exercise sessions while exercise groups were suspended for 12 months.

Aim: The purpose of the study was to compare outcome measures of exercise group clients who completed 1:1 exercise sessions during COVID-19 and those who completed a home exercise program (HEP) only.

Method: 85 exercise group clients were included in the data with 53 excluded due to not returning to exercise groups post COVID-19. The team collected physical outcome measure data on clients who completed 1:1 exercise sessions (22 clients)   and compared them to data collected with the clients who had only completed home exercise programs (63 clients) throughout the 12month COVID-19 exercise group suspension.

Results: The data demonstrated desirable results for the clients who attended the 1:1 exercise sessions. Of the outcome measures incorporated within the exercise groups, two physical outcomes measures (30 second sit-to-stand and the 3 minute step test) highlight improvements between the two client groups. In the sit-to-stand test there was a 13% average increase in the number of sit-to-stands the 1:1 clients achieved in 30 seconds, compared to a 7% average decrease in the HEP group. Whilst, in the 3 minute step test, there was a 36% average increase in the amount of steps the 1:1 clients achieved, compared to a 6% average decrease in those doing  home exercises.

Conclusion: The outcome measures recorded pre and post COVID-19 identified the benefits of 1:1 exercise sessions on-site, provided by the Exercise Physiologist or Allied Health Assistants, over home exercise programs alone.


BIOGRAPHY 

Jordan McMillan

Exercise Physiologist

Jordan is an Accredited Exercise Physiologist who specialises in musculoskeletal injury rehabilitation and Parkinson’s disease exercises. He has brought his passion for exercise and knowledge to shape the exercise program.

Emma Boyes

Allied Health Assistant

Emma has years of experience working in the fitness industry, perfecting her craft and knowledge. Emma has been vital to the successful delivery of the exercise program at LCHS.

At what rate are oral nutritional supplements delivered and what factors may explain non-delivery?

Karen Lee1
Bairnsdale Regional Health Service1

ABSTRACT

Background: Malnutrition amongst hospital patients continues to be a problem with up to 40% of patients presenting as malnourished on admission or are at-risk of developing hospital-acquired malnutrition. An important strategy in treating and reducing the prevalence of malnutrition is through interventions such as dietitian-prescribed oral nutritional supplements (ONS). ONS can improve patient outcomes by preventing further loss of weight, reducing risk of complications, and reducing length of stay. Despite the well-recognised benefits of ONS, their effectiveness can be limited by the success of ONS delivery.

Aim: To investigate the delivery rate of ONS and identify potential barriers to successful delivery.

Method: This observational study was conducted across three wards at Bairnsdale Regional Health Service on randomised days across a six month period. The study consisted of two components. The first component involved the researcher and/or Dietetics Allied Health Assistant physically tracking and auditing the delivery of ONS across all six meal periods, and recording whether or not ONS was delivered. The second component involved Food Service Assistants (FSA) completing a survey which assessed perceptions of ONS and perceived barriers to successful delivery.

Results: Preliminary results based on 444 data points (n = 90) show that overall 17.8% of ONS were not delivered. While there were some differences in non-delivery rates of ONS between morning tea and afternoon tea (11.8% and 23.6%, respectively), there were no other significant associations between ONS delivery and meal periods. The analysis of the type of supplements delivered showed that nutritionally complete supplements are 12.9% more likely to be delivered than non-nutritionally complete supplements which had a non-delivery rate of 25.4%. The FSA survey (currently in progress) may help to explain these findings.

Conclusion: Preliminary data suggest that there is no causative relationship between ONS delivery and meal periods. However, other factors such as Food Service Systems, and FSA perceptions and understanding of dietitian-prescribed ONS, whether nutritionally complete or non-nutritionally complete, may influence ONS delivery rate.


BIOGRAPHY

Karen graduated in 2019 with a Master of Dietetic Practice from La Trobe University and is employed at Bairnsdale Regional Health Service as a Grade 1 dietitian. She is passionate about promoting nutritional therapy and providing positive clinical outcomes to patient; optimising long-term health and wellbeing beyond their hospital admission.

A Change of ‘Heart’: Getting ‘Pumped’ for Telehealth Rehab

Eilis O’Haire1
Bairnsdale Regional Health Service1

ABSTRACT 

Background:

We can all agree that there was not an area of healthcare that was not affected by or remains affected by COVID-19. Sadly, even in the face of COVID-19, the people of East Gippsland still had cardiac events, cardiac surgeries and were diagnosed with new cardiac conditions.

Pre- COVID the Cardiac Rehabilitation group at Bairnsdale Regional Health Service (BRHS), comprised of face-to-face sessions. Due to physical distance restrictions with COVID, the program converted to the online world.

Aim:

The objective of our online telehealth program was the same as previous face-to-face sessions – provide ongoing support for those following a cardiac event, help make long-term lifestyle changes, lower the chance of future cardiac events and live a longer, healthier life.

Method:

Our Cardiac Rehabilitation Telehealth Exercise program was freely accessible to all eligible patients. Each weekly telehealth session was run completely online by a physiotherapist and allied health assistant. The sessions included a safety brief, warm up/cool down, exercise, support and motivation! The exercises remained tailored to the individual with modifications demonstrated so that there was something for everyone.

Ongoing technology support was provided each week. Participants required a device with internet access and preferably an email to access resources that were provided.

Outcome/Conclusion:

This program allowed us to continue to provide a much needed service to our community – as without this patients would have missed out on evidence based health care post cardiac event.  Whilst knowing that telehealth won’t work for everybody, we knew that something was definitely better that nothing and we had an opportunity to embrace change in such uncertain times.

The telehealth program has had an ongoing ripple effect with care provision and servicing for the wider community.  Broader application to post COVID-19 times has been discussed and telehealth will remain a part of the program at BRHS.  This will allow services to reach people in the broader rural community who for whatever reason, such as transport, illness, or reduced mobility, are unable to attend face to face sessions.


BIOGRAPHY

Eilis O’Haire (I-Lish) is an enthusiastic physiotherapist who strives to find the best outcomes available through evidence based patient centred care. She has used this difficult time through all things COVID to encapsulate the phrase “every cloud has a silver living”, embracing the use of technology in her practice

Powered Mobility Devices inside Residential Aged Care: inspiring occupational therapists to advocate autonomy and mitigate misadventure.

ABSTRACT

Background:

Powered wheelchairs and mobility scooters, collectively powered mobility devices (PMD), are highly valued by older Australians, including those in residential aged care, to facilitate community and personal mobility at the onset of mobility decline.  A PMD is a proven enabler, preserving activity levels, restoring self-esteem, and promoting wellbeing.  Supporting participation in activities of choice is fundamental to the aged care standards and this choice often includes using a PMD.  The number of PMDs in residential aged care is expected to grow proportionally with that of the wider community, as are incidents causing injury.  An incident is defined as any collision, tip or fall connected with the use of a PMD.

The challenge for the Australian residential aged care sector is to embrace increasing demand for autonomy via PMD use, whilst maintaining a safe living and working environment for all stakeholders in an equitable manner.  Occupational therapy theoretical frames of reference provide guidance to address all components of this multi-stakeholder occupational performance challenge, to achieve balance and wellbeing.  This first part of a four-part research program aimed to examine the number and circumstances around PMD related incidents within an aged care provider group, contributing evidence for subsequent comparison with the literature and review of assessment tools used by occupational therapists.

Method:

A retrospective cohort study was conducted.  Incident reports were used to determine the number and circumstances around PMD related incidents across 33 facilities over a 12-month period. Follow-up data were collected 9-12 months later.

Results:

Although no fatalities were recorded as a direct result of PMD use, analysis of the data found sufficient collisions, tips and falls to raise concern.  Only one third of residents were still using their PMD at follow-up, the remainder having died or discontinued use due to failing skills.  Examination of the circumstances around incidents highlighted trends or ‘red flags’, justifying further study of the assessment tools used within residential aged care services to determine resident ability to commence, continue or cease PMD use.

Conclusion:

Based on this study, it is estimated that thousands of incidents with potential for injury, fatality, litigation or loss of income occur annually within Australian residential aged care facilities.  Illuminating the potential risk will enable a considered review of the supports needed to promote safe PMD use in residential aged care and mitigate risk for all stakeholder groups within these environments.

School Healthy Lunch Program: Responding to the community

Angela Greenall1
West Gippsland Healthcare Group1

ABSTRACT

Background:

In 2018 Warragul Primary School (WPS) parents and staff identified a need to increase children’s consumption of healthy food and for the school community to understand the importance of good nutrition.  WPS has a below average Student Family Occupation (SFO) index of 0.62 and 7% of the student cohort identify as Aboriginal or Torres Strait Islander.

Method:
In partnership with the WPS community and Gippsland Primary Health Network (GPHN), WGHG provided the WPS community with a weekly healthy meal cooked with the assistance of paid and volunteer parent helpers and students.  Recipes were chosen that children could potentially then cook at home with only limited equipment and cooking skills. Recipes were provided in weekly online newsletters and this formed the basis for a school healthy eating social media campaign. In addition WGHG provided nutritional education to Grade 3/4 and Foundation level students which included practical student activities. Children prepared and sold healthy snacks at the local Farmer’s markets with profits being used to purchase vegetable seedlings for the school vegetable plot and this produce is being utilised in the kitchen in 2020.

Professional video to promote program

https://drive.google.com/file/d/1VWO0QoH-wsnmz4-19fSkTPm-bF9PeOcP/view?usp=sharing

https://drive.google.com/drive/folders/1KtuMgxpiGK-GWS1gF1L8n8b2W-pI__5z?usp=sharing

Photos to be supplied

Results:

Total 1500 meals were prepared for the school community (10 different recipes for 150 students per fortnight on fortnightly roster)
59/160 (37%) students involved in food preparation
48 students attended Grade 3/4 nutrition sessions and 20 Foundation students
Students showed increased level of nutritional education – 92% feel that they can make healthier choices and 85% tried eating new foods since the program began.
Staff survey results show 100% that the program has increased children’s confidence to try new foods, has been well received by the wider school community and would like program to continue.
WPS signed up to be part of the Victorian Government Healthy Schools Achievement Program – This work results in increased engagement in all areas of health and wellbeing.

Conclusions or Practice Implications:

  • Innovative practice involving partnership of school community, health service and a local social media company
  • Skills were provided by the partners and the school facilitated the weekly delivery of the lunch program
  • Engagement by the school community was vital to this health promotion program success
  • Program valued by Nutrition Australia with sharing of posts and video on social media
  • WPS investigating the viability of developing a healthy lunch canteen with students paying a low cost for meals and alternative ways to fund into the future

BIOGRAPHY

Angela Greenall is a health promotion officer at West Gippsland Healthcare Group, where she has worked for 9 years.

Surface Electromyography: Use in dysphagia rehab

Taylor Chambers1
Latrobe Regional Hospital1

ABSTRACT

Background or Problem/ Issue:

The Speech Pathology service in Gippsland (at Latrobe Regional Hospital), receive a large amount of referrals for both inpatients and outpatients who present with dysphagia. We offer swallow rehabilitation to those presenting with dysphagia from a range of aetiologies. In 2018 we found a gap in therapy resources, according to evidence based practice, for those people who may benefit from biofeedback whilst participating in swallowing therapy. Through attendance at Professional Development days and benchmarking we identified a potential solution to this gap.

Surface Electromyography (SEMG) is a cost-effective, mobile biofeedback tool which assists in the relearning of physiological swallowing patterns with the use of a visual aid. It has had high praise among many metro organisations in its success for dysphagia rehabilitation with various clienteles and should be considered in regular practice. Implementation of this resource at Latrobe Regional Hospital would allow access to these clients in Gippsland.

Method or What you did?

We sourced the NeuroTrac device and electrodes from Sportstek, installed the NeuroTrac program onto 3 accessible computers and 1 allied health laptop, provided in-services to the Speech Pathology team and developed a manual to assist with ongoing use and updates.

To use the device, electrodes are placed in a superior-inferior position on the patient’s larynx (below the thyroid notch and above the hyoid) with a controlled electrode on the wrist of the patient. The patient is instructed to swallow which transmits measures of muscle movements to the program and displays this movement in an online line graph. This graph shows muscle relaxation and peaks when a patient swallows.

The patient is instructed to initiate a saliva swallow every 30 seconds; they are given a bolus stimulus every 10 swallows to assist with saliva production.

The Speech Pathologist uses the online line graph to educate and encourage patients on different swallowing exercises, as these can be easily identifiable on the program by the patient while completing therapy.

Results or Outcomes:

The technology has been used in both inpatient rehabilitation and community outpatients at Latrobe Regional Hospital with 3 patients and is currently being used with 1.

Participant’s average age was 74 (67-80) years old and cause of dysphagia varied (brainstem strokes, aneurysm rupture, radiotherapy treatment to the Larynx, and mandibulectomy). Prior to therapy, 2 participants were NBM, 1 on teaspoons of thin fluids and 1 on mildly thick fluids.

All showed improvement to their swallow, resulting in at least 1 level of upgrade in diet or fluids. One participant was upgraded from NBM to FWD and thin fluids after 2 months of therapy.

The device not only facilitates physiological improvements to swallow but also swallow compensation for airway protection.

Conclusions or Practice Implications:

A new, effective and evidence-based rehabilitation technique is now offered to every client deemed appropriate at Latrobe Regional Hospital.


BIOGRAPHY

Taylor has been working at Latrobe Regional Hospital for 2 years now since graduating from Charles Sturt University in 2018.  Taylor has experience in most areas of Speech Pathology around the hospital including, acute, subacute, community, radiotherapy, Videofluoroscopy and paediatric care. She enjoys working with acute stroke inpatients and learning about laryngectomy care.

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