Embedding an allied health service in the Nelson hospital emergency department: A retrospective report of a six month pilot project

Abstract

Embedding allied health into the emergency department (ED) was considered the best option by a 2011 Nelson Marlborough District Health Board (NMDHB) strategic planning group exploring innovative ways to bridge the gap between primary care and the ED and thus enhance the service. A six month pilot project implemented in 2012 aimed to provide a more timely multidisciplinary approach to patient care, facilitate safe discharge and linkages into the primary care sector, reduce multiple presentations and keep within ED designated time frames. Physiotherapy and social work practitioners worked as part of an inter-disciplinary team to comprehensively assess clients' specific needs. The establishment of primary physiotherapy contact, where appropriate patients were identified directly from initial presentation, solely assessed and treated by the physiotherapist improved patient flow for lower triage presentations and made full use of staffing resources. Data collection over the first 22 weeks showed the allied health practitioners in ED had 749 new patient contacts, including 120 primary physiotherapy contacts. ED patients found the service extremely helpful. Survey responses from key stakeholders and ED staff highlighted the benefit of allied health interventions in improving safety of ED discharges, and the value of comprehensive client centred patient care. The Executive Leadership Team of the NMDHB unanimously endorsed the continuation of the allied health service in the emergency department from December 2012.

Methods and Effectiveness of Communication Between Hospital Allied Health and Primary Care Practitioners: a Systematic Narrative Review

“…None of the included studies speci cally investigated the methods of communication or evaluated the effectiveness of communication between hospital allied health professionals and primary care practitioners. Twelve of the 24 studies, however, described programs or processes that indirectly addressed components of communication between hospital allied health professionals and primary care practitioners [5,8,[36][37][38][39][40][41][42][43][44][45]. Narrative synthesis of each study included exploration of these 12 interventions within the context of their relationship to some guiding theoretical models of care, namely the chronic care model [46], the collaborative care model [47] and the integrated care model [48].…”

“…Chronic care management has evolved to incorporate a collaborative care model, which includes the active engagement of hospital and primary care providers in the shared care of patients beyond usual discharge summaries [47]. All 12 of the interventions identi ed in the literature [5,8,[36][37][38][39][40][41][42][43][44][45] included features consistent with a collaborative model of care in their initiatives to improve hospital discharge planning and continuity of care, even though they did not all reference a theoretical basis. A collaborative care model may have formed the theoretical framework for the 'Accountable Care in Transitions Program' [5] described by Hawes et al (2017), however was not speci cally named.…”

“…Improved communication between the hospital and primary care providers was also attributed to hospital allied health professionals, in a retrospective report by Holmes et al in 2017, describing the trial of a new allied health service in an emergency department [39]. The pilot project indicated that the inclusion of a combined social work and physiotherapy service increased patient links to primary care after hospital discharge.…”

“…The pilot project indicated that the inclusion of a combined social work and physiotherapy service increased patient links to primary care after hospital discharge. Stakeholder and staff feedback via a questionnaire suggested communication had improved between the hospital and primary care [39], however objective data was not provided so the ndings need to be interpreted with caution.…”

“…Multidisciplinary care plans were important components of the 12 interventions aiming to improve communication processes between hospitals and primary care [5,8,[36][37][38][39][40][41][42][43][44][45]. The remaining 12 studies [49][50][51][52][53][54][55][56][57][58][59][60] assumed or suggested that multidisciplinary care plans were a means of facilitating healthcare communication, as outlined in Table 4.…”