Study protocol for two randomized controlled trials examining the effectiveness and safety of current weekend allied health services and a new stakeholder-driven model for acute medical/surgical patients versus no weekend allied health services

Haines, Terrence Peter; O’Brien, Lisa; Mitchell, Debra; Bowles, Kelly‐Ann; Haas, Romi; Markham, Donna; Plumb, Samantha; Chiu, Timothy; May, Kerry; Philip, Kathleen; Lescai, David; McDermott, Fiona; Sarkies, Mitchell; Ghaly, Marcelle; Shaw, Leonie; Juj, Genevieve; Skinner, Elizabeth H

doi:10.1186/s13063-015-0619-z

Cited by 30 publications

(43 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Studies such as the current study represent the first two steps in a four-step implementation process [26], that is specifying who needs to do what differently and understanding the barriers and enablers to change that need to be addressed using a theoretical approach. This study builds on existing literature demonstrating low uptake of this intervention delivery in ICUs [7][8][9] despite Level 1 evidence of benefit [5,50].…”

Section: Accepted Manuscriptmentioning

confidence: 98%

“…However, mobilization is not widely practiced [6][7][8][9] despite Level 1 evidence [5], with recent data suggesting that mobilization occurs on only 17% of opportunities to provide it [9], despite a high proportion of staff reporting that this forms part of their practice [10].…”

Section: Introductionmentioning

confidence: 99%

“…However, most studies describing attitudes and barriers to mobilization, or the factors used in prescribing exercise in the ICU, have been based on observational audit or survey data [9][10][11]33]. Although several studies have reported efforts to implement evidence-based A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT 8 practice in this area, including the ABCDE bundle [34], none have used a structured theoretical framework [26,28].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Mobilization of ventilated patients in the intensive care unit: An elicitation study using the theory of planned behavior

Holdsworth

Haines

Francis

et al. 2015

Journal of Critical Care

View full text Add to dashboard Cite

Section: Accepted Manuscriptmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Mobilization of ventilated patients in the intensive care unit: An elicitation study using the theory of planned behavior

Holdsworth

Haines

Francis

et al. 2015

Journal of Critical Care

View full text Add to dashboard Cite

“…Research attempting to capture this evidence in a more formal way is currently underway in a large multisite study in Victoria funded by the National Health and Medical Research Council. 12 Allied health plays an even greater role in chronic disease and multimorbidity management through prevention, early intervention and preventative care, maintaining people's wellness, preventing deterioration and reducing acute episodes requiring hospitalisation. In the community, allied health also optimises people's function, independence and wellness to keep them in their homes.…”

Section: Issuesmentioning

confidence: 99%

“…exercise, nutrition, good foot health and mental health) on chronic disease such as diabetes, cardiac and respiratory health and hospital admissions. [12][13][14][15][16] Existing services through community health centres are overwhelmed by demand. Geographically related acute hospital allied health staff are limited in the services they can provide to community patients because of their workload.…”

Section: Issuesmentioning

confidence: 99%

Allied health: untapped potential in the Australian health system

Philip¹

2015

Aust. Health Review

Self Cite

View full text Add to dashboard Cite

Although comprising around 20 per cent of Australia's health care workforce, allied health and its contribution to improving health outcomes remains poorly understood and largely invisible in the Australian health policy and reform environment. There is strong evidence demonstrating the benefits of allied health in improving patient outcomes, minimising risk and harm from illness and improving health system efficiency and capacity to meet increased demand cost effectively. Despite this, the existing health model, funding and culture prevent us from effectively accessing these benefits at a system level. The untapped potential of allied health represents a major underutilised resource to address many of the challenges facing Australia's health system today. A transformational change in the Australian health system in how, where and by whom care is provided is necessary. Australia's health model and culture needs to shift, to genuinely involve the consumer and make full use of all three pillars of the patient care workforce. IntroductionAllied health, medicine and nursing together constitute the patient care workforce, each workforce element bringing unique and necessary skills to provide high-quality, patientcentred care. The three workforces can be considered as the three pillars of the patient care workforce, each being equally necessary for the stability, functioning and outcomes of the whole. Despite this, the allied health pillar is largely overlooked at a systems level in Australia. The unrealised potential of allied health represents a major underutilised resource to address many of the challenges facing our health system today. Better use of the allied health workforce can improve health outcomes and reduce overall health system costs by reducing demand and utilisation of acute health facilities.1 Despite the solutions inherent in this resource, our health system remains unable to access them due to the health system's traditional medical model and focus on acute, episodic care. The health system must adapt in order to meet its core purpose of improving health outcomes and meeting the Australian community's health care needs in a sustainable way. The solutions lie in being clever in using the resources at its disposal, including allied health, to best effect.

show abstract

Effectiveness of a Bundled Intervention Including Adjunctive Corticosteroids on Outcomes of Hospitalized Patients With Community-Acquired Pneumonia

et al. 2019

View full text Add to dashboard Cite

for the Improving Evidence-Based Treatment Gaps and Outcomes in Community-Acquired Pneumonia (IMPROVE-GAP) Implementation Team at Western Health IMPORTANCE Community-acquired pneumonia remains a leading cause of hospitalization, mortality, and health care costs worldwide. Randomized clinical trials support the use of adjunctive corticosteroids, early progressive mobilization, antibiotic switching rules, and dietary interventions in improving outcomes. However, it is uncertain whether implementing these interventions will translate into effectiveness under routine health care conditions. OBJECTIVE To evaluate the effectiveness of a bundle of evidence-supported treatments under conditions of routine care in a representative population hospitalized for community-acquired pneumonia. DESIGN, SETTING, AND PARTICIPANTSA double-blind, stepped-wedge, cluster-randomized clinical trial with 90-day follow-up was conducted between August 1, 2016, and October 29, 2017, in the general internal medicine service at 2 tertiary hospitals in Melbourne, Australia, among a consecutive sample of patients with community-acquired pneumonia. The primary analysis and preparation of results took place between May 14 and November 25, 2018.INTERVENTIONS Treating clinical teams were advised to prescribe prednisolone acetate, 50 mg/d, for 7 days (in the absence of any contraindication) and de-escalate from parenteral to oral antibiotics according to standardized criteria. Algorithm-guided early mobilization and malnutrition screening and treatment were also implemented. MAIN OUTCOMES AND MEASURESHospital length of stay, mortality, readmission, and intervention-associated adverse events (eg, gastrointestinal bleeding and hyperglycemia).RESULTS A total of 917 patients were screened, and 816 (351 women and 465 men; mean [SD] age, 76 [13] years) were included in the intention-to-treat analysis, with 401 patients receiving the intervention and 415 patients in the control group. An unadjusted geometric mean ratio of 0.95 (95% CI, 0.78-1.16) was observed for the difference in length of stay (days) between the intervention and control groups. Similarly, no significant differences were observed for the secondary outcomes of mortality and readmission, and the results remained unchanged after further adjustment for sex and age. The study reported higher proportions of gastrointestinal bleeding in the intervention group (9 [2.2%]) compared with the controls (3 [0.7%]), with an unadjusted estimated difference in mean proportions of 0.008 (95% CI, 0.005-0.010). CONCLUSIONS AND RELEVANCEThis bundled intervention including adjunctive corticosteroids demonstrated no evidence of effectiveness and resulted in a higher incidence of gastrointestinal bleeding. Efficacy of individual interventions demonstrated in clinical trials may not necessarily translate into effectiveness when implemented in combination and may even result in net harm.TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02835040

show abstract

Study protocol for two randomized controlled trials examining the effectiveness and safety of current weekend allied health services and a new stakeholder-driven model for acute medical/surgical patients versus no weekend allied health services

Cited by 30 publications

References 40 publications

Mobilization of ventilated patients in the intensive care unit: An elicitation study using the theory of planned behavior

Mobilization of ventilated patients in the intensive care unit: An elicitation study using the theory of planned behavior

Allied health: untapped potential in the Australian health system

Effectiveness of a Bundled Intervention Including Adjunctive Corticosteroids on Outcomes of Hospitalized Patients With Community-Acquired Pneumonia

Contact Info

Product

Resources

About