Objectives This paper describes the development, implementation and preliminary results of a collaborative pilot project aimed at reducing the time hospital-based patients with cognitive impairments spend waiting for the allocation of legally appointed Advocate Guardian decision makers from the Office of the Public Advocate (OPA). The aim of the study was to investigate the effect of increased availability of public advocate guardians on guardian allocation waits, patient discharge outcomes and healthcare system demand. Methods A multi-institutional pilot program created a dedicated hospital guardian team within OPA, funded by the health networks, to reduce the time to guardian allocation for patients within each network. A multisite, quasi-experimental historical control group design was used, with initial data collection over 12 months, followed by study of 12-month post-implementation cohorts. Results Under the pilot program, the time from guardianship order lodgement to guardian allocation decreased significantly from 46.5 to 22.9 days, halving the average time hospital-based patients spend waiting for a guardian (difference –23.55 days, two-sample t(154) = –6.575, P < 0.0001, 95% confidence interval [–30.65, –16.48].). Mean total length of stay decreased from 163.2 to 148.5 days. The estimated value of the reduction in allocation wait time was A$15473 per patient, or A$5 of resources released per A$1 spent on increased staffing. Conclusions Direction of a small amount of resources from health services to staff within OPA appears to have created much greater savings for the health services involved. The pilot program has reduced the period of time vulnerable patients spend waiting in hospital for a guardian. What is known about the topic? Guardianship resources are under increasing stress, with demand outstripping funding and hospital-based applicants deprioritised due to assumptions of lower risk, leading to extensive wait times for guardian allocation. What does this paper add? The paper quantifies the impact of greater guardianship resourcing on access to both guardianship and healthcare resources, highlighting benefits for vulnerable patient groups, healthcare system sustainability and access to both guardianship and healthcare resources for the broader community. What are the implications for clinicians? Improving patient flow through healthcare systems may involve allocating resources to services that are managed outside the healthcare system where ‘bottlenecks’, such as wait times for guardian allocation, have been identified.
We report on a qualitative study exploring health social workers' understanding of complexity in relation to inpatients in subacute wards at three sites across a large health network in Melbourne, Australia. Findings indicate that social workers' understanding of complexity refers to five interrelated themes: multiple competing demands; uncertainty; patient and family characteristics; pending breakdown; systems challenges. Social workers with less practice experience report that complex clients present more challenges than do social workers with greater experience. Implications of these findings for advancing practitioners' capacities in working with complex patients are discussed, as are the limitations of the study.
IntroductionThis protocol considers three allied health staffing models across public health subacute hospitals. This quasi-experimental mixed-methods study, including qualitative process evaluation, aims to evaluate the impact of additional allied health services in subacute care, in rehabilitation and geriatric evaluation management settings, on patient, health service and societal outcomes.Methods and analysisThis health services research will analyse outcomes of patients exposed to different allied health models of care at three health services. Each health service will have a control ward (routine care) and an intervention ward (additional allied health). This project has two parts. Part 1: a whole of site data extraction for included wards. Outcome measures will include: length of stay, rate of readmissions, discharge destinations, community referrals, patient feedback and staff perspectives. Part 2: Functional Independence Measure scores will be collected every 2–3 days for the duration of 60 patient admissions.Data from part 1 will be analysed by linear regression analysis for continuous outcomes using patient-level data and logistic regression analysis for binary outcomes. Qualitative data will be analysed using a deductive thematic approach. For part 2, a linear mixed model analysis will be conducted using therapy service delivery and days since admission to subacute care as fixed factors in the model and individual participant as a random factor. Graphical analysis will be used to examine the growth curve of the model and transformations. The days since admission factor will be used to examine non-linear growth trajectories to determine if they lead to better model fit.Ethics and disseminationFindings will be disseminated through local reports and to the Department of Health and Human Services Victoria. Results will be presented at conferences and submitted to peer-reviewed journals. The Monash Health Human Research Ethics committee approved this multisite research (HREC/17/MonH/144 and HREC/17/MonH/547).
Purpose The purpose of this paper is to describe Monash Health’s development of a Policy and Procedure on the abuse of older people in metropolitan Australia. Monash Health is a public healthcare network that consists of six public hospitals and over 40 community health care sites throughout the South East of Melbourne. Design/methodology/approach An Action Research Action Learning approach was employed to develop a comprehensive set of policy and procedure documents to ensure that Monash Health became compliant with the State Government’s expectations around responding to the abuse of older people in a consistent manner. Findings Almost 90,000 Monash Health hospital admissions per year are older people aged over 65 years. Senior Monash Health management recognized that staff did not have adequate information, education and resources to consistently identify and respond to situations of elder abuse. What is more, the existing internal Monash Health document Supporting Older People at Risk did not meet obligations stated in the Victorian Government’s Elder Abuse Strategy (2009). Originality/value The project’s emphasis upon participatory action research, cooperative inquiry and action learning further resulted in the identification of an opportunity to develop a strategic response to violence and abuse for all patients of Monash Health, not just older people.
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