Allied Health - austin.org.au

Allied Health These posters or presentations are available at the padlet https://padlet.com/ResearchFest/2021_AlliedHealth The numbers in the left column are the position of the work in the display. Authors Title of abstract keywords AH01 Hoang K Luong, Pasquale Roberge, Martin D Provencher, Sean P A

Drummond, Peter J Norton What, Who and When? Demystifying the Alliance in Cognitive Behavior Therapy for Anxiety Disorders

anxiety disorders, cognitive behavior therapy, psychotherapeutic processes, therapeutic alliance, group cohesion

AH02 Hoang K Luong, Sean P A Drummond, Peter J Norton Can You See What I See? A Comparison of Client and Observer Perspectives of the Alliance and Group Cohesion in CBT

cognitive behaviour therapy; therapeutic alliance; psychotherapeutic processes; group cohesion; anxiety disorders

AH03 Hoang K Luong, Sean P A Drummond, Peter J Norton Elements of the Therapeutic Relationship in CBT for Anxiety Disorders: A Systematic Review

anxiety disorders, cognitive behavior therapy, psychotherapeutic processes

AH04 Dipnall, Lilly, Robinson, Tony, Gook, Emma, Ryan, Michelle & Shafik-Eid, Rosalin

8-week CASEA program improves social-emotional functioning in primary school aged children

Early intervention, primary school children, group program, parenting, social-emotional skills

AH05 Retica, S, Burgess, N, Dionysus, A, Capron, K, Berney, S, Berlowitz, D.J , Graco, M.

Understanding the determinants of exercise behaviours for patients undergoing cancer treatment in a specialised cancer hospital.

Physiotherapy, exercise, cancer treatment

https://padlet.com/ResearchFest/2021_AlliedHealth

AH06 Scott E, Blennerhassett JM, Marquez J, Janssen H Association between stroke survivor characteristics and inactivity observed during an environmental enrichment study within rehabilitation.

Stroke, Rehabilitation, Environmental enrichment, patient activity

AH07 Steventon A, Ravi A, Maguire R Introduction of a Patient Focused Booking System (PFBS) for Non Urgent Physiotherapy Outpatient Referrals

Patient focused booking system, Physiotherapy, Outpatients

AH08 Blennerhassett JM, Hunter S, Vogel K, Austin C, Ma R What does an inpatient episode for stroke cost?

Stroke, Exercise, Prevention, Allied health, Clinical costs

AH09 Natalie Thorp, Nadia Mouchaileh Austin Health Cross-Campus Medication Reconciliation Audit

AH10 Simone Taylor, The-Phung To, Ayat Abdullah, Nur Abdullah, Kerry Huang, Naemah Khan, Sakinah Shirzad, Huda Elmi, Iman Zayegh

Medication management practices of Muslim patients hospitalised prior to or during Ramadan: an observational study

Medication safety, Ramadan, Islam, Diversity

AH11 Stephanie Jones, Phung To, Rohan Elliott A retrospective audit of doses omitted inappropriately for medications with directions specifying take 'with or after food' in patients fasting for a procedure.

AH12 The-Phung To, Simone Taylor, Ayat Abdullah, Nur Abdullah, Kerry Huang, Naemah Khan, Sakinah Shirzad, Huda Elmi, Iman Zayegh

Qualitative exploration of Australian Muslim patients' perceptions and experiences regarding medication management during Ramadan

Medication safety, Ramadan, Islam, Diversity

AH13 Lisa Phan, Nadia Mouchaileh, Rohan Elliott An evaluation of the documentation of patients' pre-admission levodopa regimens and the frequency of levodopa admission prescribing errors in patients with Parkinson's disease.

Parkinson's disease, levodopa, prescribing errors, documentation

AH14 Olivia Reid, Janet Ngo, Rohan Elliott, Samanta Lalic, Elizabeth Su Are we overdosing older people with paracetamol in hospital?

paracetamol, acetaminophen, geriatric, older, medicines, medications,

analgesics, analgesia

AH15 Kate Lowe, Catherine Wood, Lisa Ho, Amanda Ting, Emily McCormack, Jasmine Lau, Emily Ferraro, Beth Veevers, Shari Antoine, Deborah Stevens, Sarah McKernin, Katrina Capell, Simone Taylor

Feasibility of a smoking cessation program to support hospitalised respiratory and cardiology patients across the continuum of care

Smoking cessation; public health; quality improvement

AH16 Cimoli, M., Oates, J., McLaughlin, E., Langmore, S.E, Validation of the Austin Swallowing Ability Profile for FEES (ASAP-FEES)

dysphagia, endoscopy, validity, speech pathology

AH17 Ukovic B, Chapman B, Choy M, De Cruz P Novel use of the Crohn's disease exclusion diet plus partial enteral nutrition for the treatment of Crohn's disease during pregnancy: a case study

AH18 Dimitroff C, Wong D, Gilmore R, Srinivasan A, Li Wai Suen C, De Cruz P Use of the Crohn's disease exclusion diet (CDED) in adults - a real-world experience

Nutrition, Crohn's Disease, Chron's Disease Exclusion Diet

AH19 King S, Rubin M, Smith N, Digpaul-Ghose M, Inguanti G, Davis I, Bijo B, Flude J, Desneves K, Lassemillante A

Novel insights into transforming food service at Austin Health to improve patient mealtime experience

mealtime experience

AH20 King S, Cameron I, Vadiveloo C, Vallance M, Lassemillante A Exploring patient and staff perspectives on mealtime experience and their preferences for providing feedback

mealtime experience

AH21 Desneves, KJ , Panisset, MG , Galea, MP , Kiss, N , Daly, RM , Ward, LC Comparison of segmental lean tissue mass in individuals with spinal cord injury measured by dual energy X-ray absorptiometry and predicted by bioimpedance spectroscopy

body composition, lean tissue mass, spinal cord injury

AH22 Kellie Draffin, Jessica Hamilton, Shea Godsil, Suba Rudolph, Tim Crowe and Richard Newton

Comparison of carbohydrate intake on refeeding hypophosphatemia in adolescents with anorexia nervosa: a pilot randomised controlled trial.

carbohydrate, refeeding hypophosphatemia, anorexia nervosa

AH23 Minter, Ella-Rose; Cubis, Lee.; Winkler, Di; Douglas, Jacinta; Roseingrave, Eve; Topping, Megan; Bec Jamwal; & Kate Harradine

Hospital to Home: Evaluating the Discharge Planning Process and Lived

Discharge, NDIS, lived experience,

Experience of People with Acquired Disability

barriers, facilitators

AH24 Hirth MJ. Hunt I, Briody K, Milner Z, Sleep K, Chu A, Donovan E, O'Brien L

Comparison of two relative motion extension orthotic programs following zones V-VI extensor tendon repairs: A randomized equivalence trial

Extensor tendon, hand therapy, relative motion, orthosis, splint, RCT

AH25 Hirth MJ, Howell JW, Brown T, O'Brien L Relative motion extension management of zones V and VI extensor tendon repairs: Does international practice align with the current evidence?

Extensor tendon, hand therapy, relative motion, orthosis, splint, survey

AH26 Hirth MJ, Howell JW, Feehan LM, Brown T, O'Brien L Postoperative hand therapy management of zones V and VI extensor tendon repairs of the fingers: An international inquiry of current practice

Extensor tendon, hand therapy, relative motion, orthosis, splint, survey

AH27 Hahn, J, Jamwal, R & Hirth, M Patient satisfaction with the practical component of telehealth hand therapy services during the COVID-19 pandemic

AH28 Charissa J. Zaga, Vinciya Pandian, Martin B. Brodsky, Sarah Wallace, Tanis S. Cameron, Caroline Chao, Lisa Ann Orloff, Naomi E. Atkins, Brendan A. McGrath, Cathy L. Lazarus, Adam P. Vogel & Michael J. Brenner

Speech-Language Pathology Guidance for Tracheostomy during the COVID-19 Pandemic:

An International Multidisciplinary Perspective

AH29 Ms Charissa J Zaga, Ms Bridie Cigognini, Associate Professor Adam P Vogel & Associate Professor Sue Berney

Outcome Measurement Tools for Communication, Voice and Speech Intelligibility in the ICU and their Clinimetric Properties: A Systematic Review

AH30 Charissa J. Zaga, Sue Berney, Tanis S. Cameron, Sonia Baker, Charles Giddings, Mark E. Howard, Rinaldo Bellomo & Adam P. Vogel

Tracheostomy clinical practices and patient outcomes in three tertiary metropolitan hospitals in Australia

AH31 Clare Morris, Mandy Ip, Joanne Sweeney Delegation of a Speech Pathology Allied Health Assistant task in accordance with a delegation framework

AH32 Harrison AL, Taylor NF, Frawley HC, Shields N A consumer co-created infographic improves exercise knowledge and self-efficacy in women with GDM: a randomised trial

Consumer engagement; Physical activity; Gestational diabetes

AH33 Jennifer Jones, Zudin Puthucheary, Amalia Karahalios, Michael Berry, D. Clark Files, David Griffith, Luke McDonald, Peter Morris, Marc Moss,Amy Nordon-Craft, Timothy Walsh, Linda Denehy, Sue Berney

Searching for the responder: Do patient characteristics modify rehabilitation outcomes of adults with critical illness?

critical illness, rehabilitation

Hoang K Luong1, Pasquale Roberge2, Martin D Provencher3, Sean P A Drummond1, Peter J Norton4

What, Who and When? Demystifying the Alliance in Cognitive Behavior Therapy for Anxiety Disorders

1. Turner Institute for Brain and Mental Health, School of PsychologicalSciences, Monash University, Victoria, Australia

2. Department of Family Medicine and Emergency Medicine, Faculty ofMedicine and Health Sciences, Université de Sherbrooke, Québec, Canada

3. École de Psychologie, Laval University, Québec, Canada4. The Cairnmillar Institute, Hawthorn East, Victoria, Australia

Aim The evidence for the effect of alliance in cognitive behaviour therapy (CBT) for anxiety disorders is inconsistent and unclear. Identifying whether the alliance-outcome relationship depends on (1) what components are assessed, (2) who is measuring the alliance, and (3) when the alliance is measured, will help to clarify the role of the client-therapist relationship in therapy. The present study explored the effects of alliance component (agreement versus bond), rater perspective (client versus therapist), and timing (early versus late therapy) on the alliance-outcome relationship.

Methods Data were drawn from a previously published pragmatic trial of a 12-week transdiagnostic group CBT1. Anxiety symptoms were self-assessed at pre-treatment and post-treatment. Client and therapist ratings of alliance were completed at session 3 (early treatment) and session 9 (late treatment). Correlations and hierarchical multiple regressions were used to analyse variable relationships.

Results A sample of 78 individuals were included for early therapy analyses and 57 at late therapy analyses. Results showed that greater client-rated agreement significantly predicted improved outcomes throughout the course of therapy. Unexpectedly, greater levels of client-rated bond later in therapy predicted reduced treatment gains. In contrast, therapist alliance did not predict post-treatment outcomes at any point in therapy.

Conclusion Overall, these findings highlight the importance of prioritizing the client’s perception of the relationship in CBT for anxiety disorders, as well as parsing the effects of component, rater, and timing in future studies. This study also shows for the first time that client perceptions of a strong alliance with their therapist later in treatment may be an indicator of poorer treatment outcomes.

References 1. Roberge P, Provencher MD, Gaboury I, Gosselin P, Vasiliadis HM, Benoît A, Carrier N,

Antony MM, Chaillet N, Houle J, Hudon C, Norton PJ. Group transdiagnostic cognitive-behavior therapy for anxiety disorders: a pragmatic randomized clinical trial.Psychological Medicine. 2020 Dec 2:1-1.

ResearchFest 2021 AH1

Hoang K Luong1, Sean P A Drummond1, Peter J Norton2 Can You See What I See? A Comparison of Client and Observer Perspectives of the Alliance and Group Cohesion in CBT 1. Turner Institute for Brain and Mental Health, School of Psychological

Sciences, Monash University, Victoria, Australia 2. The Cairnmillar Institute, Hawthorn East, Victoria, Australia Aim Both the therapeutic alliance and group cohesion have been identified as “active ingredients” of therapy. However, the majority of process-outcome research has relied on clients as raters of therapeutic relationships. A lack of convergence between client, therapist, and observer perspectives has raised questions regarding how best to measure relationships in therapy. This study aimed to compare the predictive validity of client and observer ratings of the alliance (agreement and bond) and group cohesion in cognitive behaviour therapy (CBT) for anxiety disorders. Methods Data and video-recordings of sessions of group transdiagnostic CBT for anxiety disorders were sourced from three previously published clinical trials1-3. Trained observers viewed video recordings of treatment sessions and provided ratings of alliance and group cohesion. These scores were then compared with client self-ratings of alliance and cohesion. Baseline and outcome data were assessed using self-rated anxiety symptom measures. Correlations and hierarchical regressions were used to examine relationships between variables. Results A sample of 43 participants were included for alliance analyses and 28 for cohesion. Results showed that client and observer ratings of process were not significantly correlated. Regarding the alliance, only client-rated agreement predicted treatment gains. In contrast, both client and observer-ratings of cohesion were found to uniquely contribute to treatment outcomes. Conclusion These findings suggest that assessments of group cohesion from perspectives of both client and observers may provide unique and meaningful information about therapeutic processes in treatment. Conversely, observer measures of alliance require further investigation and development in order to clarify the possible utility and validity of these scales. References 1. Norton PJ. An open trial of a transdiagnostic cognitive-behavioral group therapy for

anxiety disorder. Behavior Therapy. 2008 Sep 1;39(3):242-50. 2. Norton PJ. A randomized clinical trial of transdiagnostic cognitve-behavioral treatments

for anxiety disorder by comparison to relaxation training. Behavior Therapy. 2012 Sep 1;43(3):506-17.

3. Norton PJ, Barrera TL. Transdiagnostic versus diagnosis-specific CBT for anxiety disorders: A preliminary randomized controlled noninferiority trial. Depression and anxiety. 2012 Oct;29(10):874-82.


Hoang K Luong1, Sean P A Drummond1, Peter J Norton2 Elements of the Therapeutic Relationship in CBT for Anxiety Disorders: A Systematic Review 1. Turner Institute for Brain and Mental Health, School of Psychological

Sciences, Monash University, Victoria, Australia 2. The Cairnmillar Institute, Hawthorn East, Victoria, Australia Aim To optimise the effects of cognitive behaviour therapy (CBT) for the treatment of anxiety disorders, it is necessary to understand mechanisms of change. Specifically, the therapeutic relationship has been identified as a potential “active ingredient” in treatment. This study aims to evaluate the evidence for the effects of eleven elements of the therapeutic relationship (alliance, collaboration, goal consensus, group cohesion, empathy, positive regard, feedback, emotional expression, outcome expectations, treatment credibility, alliance rupture-repair) on treatment outcomes in CBT for anxiety disorders. Methods A systematic review of the literature was conducted. Articles were sourced using PsycINFO, PubMed, and Scopus, and search strings were generated using terms related to anxiety disorders, cognitive behaviour therapy, and therapeutic relationship elements. Articles were screened against inclusion/exclusion criteria to determine eligibility for the present study. Fifty unique studies were included in the review, and findings were qualitatively reviewed and summarised. Results Results revealed consistent and sizeable evidence indicating that greater group cohesion and positive treatment expectations predict improved outcomes for CBT for anxiety disorders. There was emerging evidence for the effects of collaboration, empathy, and alliance rupture-repair on treatment outcomes. However, the evidence for goal consensus and credibility on outcomes was limited. Notably, review of the alliance literature revealed substantial inconsistencies across studies. No studies were identified for positive regard, feedback, and emotional expression. Conclusion Overall, evidence suggests that specific elements of the therapeutic relationship may play an important role in determining the efficacy of CBT for anxiety disorders. However, further research is needed to clarify the potential function and impacts of these elements in treatment. These findings will contribute to the conceptual integration of therapeutic relationship constructs in cognitive behavioural models, and help to improve treatments and outcomes for individuals with anxiety disorders.


Dipnall, L 1, 2, Robinson.T 1, Gook. E 1, Ryan. M 1, Shafik-Eid.R1

8-week CASEA Program Improves Socio-emotional functioning in Primary School Children 1. CYMHS & Schools Early Action (CASEA), Department of Mental Health, Austin Hospital Heidelberg, Vic., Australia; 2. Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, Vic., Australia Aim This quality improvement project aims to assess the effectiveness of the CYMHS & Schools Early Action (CASEA) program. This 8-week school-based, multi-systemic early intervention program incorporates an emotion and behaviour focused parenting program, alongside a social and emotion focussed child group program. The CASEA program aims to work with children exhibiting social, emotional, and behavioural challenges in grades prep to 3. Methods Data from 39 socio-economically diverse schools was analysed to assess the effectiveness of the CASEA program on a battery of measures, including child social-emotional functioning, parenting practices and parent and teacher reported conduct problems, hyperactivity, peer relationship problems and prosocial behaviour. The cohort consisted of 312 (66% male) primary school children (Mage=6.96 years; SD=1.04) clustered within schools. Following exploratory analysis, mixed-effects modelling (MEM) was performed on all pre- and post-intervention measures, with school accounting for random effects, and time representing the CASEA program. To assess whether sex moderated the relationship between time and child and parent outcomes, an interaction term between sex and time was included in each model. Results Results revealed significant relationships between time and most measures. This included significant positive relationships between time and measures of child social-emotional functioning, as well as significant negative relationships between social, emotional, and behavioural difficulties. Modelling also yielded significant negative linear relationships between time and harsh and dismissive parenting. Contrary to expectation, significant negative relationships were seen between time and measures of parenting confidence and attachment, while no significant findings were found in relation to teacher reported measures. The random effect of school was not significant, and sex did not moderate any of the relationships investigated. Conclusion These results support implementation of school-based emotion- and behaviour-focussed early intervention to improve social/emotional functioning in children, as well as upskilling and enhancing parenting practices. Further exploration of changes to parenting confidence and attachment following CASEA program is needed.

Retica, S1,4, Burgess, N1.4, Dionysus, A5, Capron, K2,4, Berney, S3,4, Berlowitz, D.J , 1,3,4 Graco, M.1,3

Understanding the determinants of exercise behaviours for patients undergoing cancer treatment in a specialised cancer hospital. 1. Institute for Breathing and Sleep, Heidelberg, Vic., Australia 2. Olivia Newton John Cancer Wellness and Research Centre, Heidelberg, Vic., Australia; 3. Department of Physiotherapy, University of Melbourne 4. Department of Physiotherapy, Austin Health 5. School of Humanities and Social Sciences, Latrobe University, Bundoora Background Clinical practice guidelines strongly recommend exercise during cancer treatment however evidence suggests that people undergoing treatment for cancer are not meeting these recommendations. Aims To explore the factors that influence the ability of people undergoing active cancer treatment to meet the current exercise recommendations. This knowledge will support the development of a video aiming to increase exercise in people undergoing treatment for cancer. Methods Focus group were conducted with 16 participants undergoing active cancer treatment at the Olivia Newton-John Centre. Four focus groups were held online. Data were analysed thematically using a theoretical framework commonly used in behaviour change research (COM-B model). Common beliefs were identified and summarised as belief statements. Results 16 belief statements representing all 3 domains of the COM-B model (capability, opportunity & motivation) were generated. Participants identified a lack of opportunities and resources to encourage exercise behaviours. Most wanted exercise information, prescription and support to be integrated into their cancer treatment plan. They reported that the information they received about exercise was inadequate and identified the need for more consistent information about exercise and access to an exercise professional early in their treatment journey. Participants also identified that their oncologists, family and friends and other cancer patients were powerful influencers to encourage positive exercise behaviours. Conclusion This study highlights the need for specialised cancer services to integrate exercise into the treatment plans of people undergoing treatment for cancer. People with cancer want tailored and consistent exercise information and access to an exercise professional for support and guidance.


Scott E,1 Blennerhassett JM,2,3 Marquez J,1 Janssen H1,4

Title. Association between stroke survivor characteristics and inactivity observed during an environmental enrichment study within rehabilitation.

1. School of Health Sciences, University of Newcastle, 2. Physiotherapy Department, Division of Allied Health, Austin Health. 3. Health Independence Program, Austin Health. 4. Hunter New England Local Health District.

Background. The overarching trial “AREISSA” was a pre-post phase multi-center study (N=4) that observed patient activity (n=173) within rehabilitation settings (Mellor unit at Royal Talbot Campus was a participating site). During the post-phase, a patient-driven model of environmental enrichment was embedded into usual care, contributing to stroke survivors (i.e., intervention cohort) spending 7% (95% CI 0 to 14) less time inactive relative to those without access to the model during the pre-phase (i.e., control cohort). Stroke survivors with higher levels of activity appeared to engage more with the model than those with relatively lower levels of activity.

Aim. Determine a) stroke survivor characteristics associated with being inactive within a rehabilitation setting; and b) differences between characteristics of stroke survivors who did and did not engage with the model.

Methods. Linear regression (adjusted for treatment group) analysed association between participant characteristics and inactivity (n=173). Further linear regression examined the differences between characteristics of participants from the post-phase who did (n=19) and did not (n=21) engage with the model of environmental enrichment. Results: Age (0.3, p=0.003), functional mobility (-0.99, p=0.004), level of education (tertiary or non-tertiary; 4%, p= 0.042) and presence of post-stroke fatigue (4%, p= 0.006) of stroke survivors were significantly associated with degree of inactivity. Stroke survivors who engaged with the model of environmental enrichment were younger (10 years, 95% CI -19 to 0.4), mobilised better (2.6 points on the Rivermead Mobility Index, 95% CI 0 to 5.4), and reported less fatigue (35%, 95% CI -64 to 2) or boredom (27%, 95% CI, -4 to 54).

Conclusions: Being older, less mobile, having a tertiary education or reporting post-stroke fatigue were associated with being inactive within a rehabilitation setting. Stroke survivors who responded to the patient-driven model of environmental enrichment were younger, more mobile, and reported less post-stroke fatigue and boredom than those whom did not.

Reference: Janssen H, et al, Altering the rehabilitation environment to improve stroke survivor activity (AREISSA): A Phase II trial. Int J Stroke. 2021 Apr 13:17474930211006999. doi: 10.1177/17474930211006999.


Steventon A 1, Ravi A1 , Maguire R¹,

Introduction of a Patient Focused Booking System (PFBS) for Non Urgent Physiotherapy Outpatient Referrals

1. Mercy Hospital for Women, Heidelberg, Vic., Australia;

There has been an increase of 24% in outpatient (OP) non urgent referrals to Physiotherapy at The Mercy Hospital for Women in the last 5 years. Resulting in an increased waiting time for an initial physiotherapy appointment, up to twelve months. A DNA (Did not attend) rate of 40 % for these referrals suggests reduced patient engagement.

Aims: • Reduce waiting time/DNA rate for an initial physio appointment • Promote patient choice/ control of healthcare • Improve patient/staff satisfaction • Reduce appointment rescheduling

Methodology: This project was designed with consumer input at four timepoints. Outpatient satisfaction surveys suggested patient desire for reduced waiting times and improved control of appointment bookings. Consumer input surveys during project design requested referral acknowledgment correspondence, reduced waiting times/appointment rescheduling, plus the ability to choose appointments. A 6 month trial of PFBS commenced in April 2021.This scheduling system is considered best practice¹. Appointments are offered to patients on the waiting list, by date of referral receipt. Patients are invited to contact MHW Physiotherapy for an appointment and have choice of times, rather than an appointment being allocated without consultation. Promoting timely access to appropriate care, improving patients’ choice and control of their healthcare

Results: After 3 months, waiting times for initial appointments reduced from 12 to 3 months. The DNA rate for non-urgent referrals reduced from 40 % to 0% of total OP DNA rate ie all initial appointments booked under this system have been attended Conclusion Early results suggest a PFBS has significantly reduced initial appointment waiting times and DNA rates of non-urgent physiotherapy referrals at MHW.

References 1.SCAP Draft Doc 2019/ Specialist clinic service improvement guide, DoH 2013


Blennerhassett JM,1,2 Hunter S,1 Vogel K,1 Austin C,1 Ma R3,4

Title: What does an inpatient episode for stroke cost? 1. Health Independence Program, Community Rehabilitation Service, Austin Health. 2. Physiotherapy Department, Division of Allied Health, Austin Health. 3. Clinical Costings, Finance Department, Austin Health. 4. Department of Medicine, the University of Melbourne. Aim To collate the clinical costs incurred by Austin Health to deliver an inpatient episode for stroke [including Transient Ischaemic Attack (TIA)]. We also examined if costs and length of stay differed for the first and recurrent presentation(s) for stroke. As recurrent stroke can lead to higher levels of disability, we hypothesised that recurrent episodes would require higher costs and more time in hospital than the first presentation for stroke. Methods We randomly selected 31 people who had repeated presentations for stroke at Austin Health between January 2016 to February 2020. For each episode of care, we audited the inpatient (acute and subacute) journey from emergency department to hospital discharge, and collated indirect and direct costs from Austin’s Clinical Costing database. Data were collated descriptively, and then analysed for differences between the first and recurrent stroke episodes. Results For the 4-year period sampled, 11% of episodes for stroke were by people with multiple presentations for stroke. The audit of 31 patients (9 females, 22 males, mean age 66, SD 10.9) captured 73 episodes, including 26 episodes for their first episode of stroke or TIA. The patient journey included inpatient rehabilitation (25/73 episodes) with referral to community rehabilitation (29/73 episodes). The discharge outcome was home (66/73), residential aged care facility (5/73) and death (2/73). Length of inpatient stay ranged from 1 to 64 days, (mean 15 days, median 2.7 days). Clinical costs for inpatient stay ranged from $160 to $91,217 (mean $18560, median $6257). First stroke and recurrent stroke episodes were similar in diversity and were not significantly different for cost (mean $21436 and $16932 respectively, p=0.41) or length of stay (17.9 and 13.4 days respectively, p =0.40). Conclusion

At Austin Health, an average inpatient presentation for stroke costs $18,500 and takes 15 days. While there were no differences for cost nor length of stay between first and recurrent stroke, our data supports that secondary stroke prevention offers potential savings in terms of clinical costs and use of hospital beds.


Thorp N 1, Mouchaileh N,1,2

Austin Health Cross-Campus Medication Transcription Errors 1. Pharmacy Department, Austin Health, Heidelberg, Vic., Australia; 2. Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkvile, Vic., Australia. Background Medication transcription errors are a well-documented and widespread problem across a multitude of healthcare settings. At Austin Health, when inpatients are transferred between campuses, electronic medication administration records (MARs) are discontinued and reordered, introducing the risk of transcriptions errors. Aim to determine the frequency, type and severity of transcriptions errors in patients who encountered a transfer of care from an acute to subacute campus. Methods A prospective audit of subacute MARs following inpatient transfer was undertaken from March to May 2020. Pharmacists conducted a reconciliation of the MARs and documented transcription errors. A senior clinical pharmacist retrospectively verified the data and assessed error severity. The primary endpoint was to determine the frequency, type and severity of transcription errors. Secondary endpoints were to evaluate the time taken for the MAR to be transcribed and to determine the proportion of patients who missed medication doses due to a prescribing delay or error. Results 159 encounters across 5 subacute wards were included. 213 transcription errors occurred with 65% of patient encounters having at least one error. The types of errors included: incorrect order detail including incorrect medication, dose, frequency, route, formulation or start/stop date (160/213, 75%), unintentional omission of a medication (43/213, 20%) and unintentional recommencement of a ceased medication (10/213, 5%). MARs were ordered on average 2.12 hours following subacute admission with 53% of patients missing at least one medication dose due to a prescribing delay or error. 40% of errors or missed doses were classified as moderate or high risk.

Conclusion Medication transcription errors occurred in the majority of episodes and most patients missed at least one medication dose. These errors pose a concerning risk to patient safety. The continuation of MARs cross-campus would eradiate the errors entirely and would minimise missed doses during transfer of care.


Simone Taylor,1 The-Phung To,1 Ayat Abdullah,2 Nur Abdullah,2 Kerry Huang,2

Naemah Khan,2 Sakinah Shirzad,2 Huda Elmi,1 Iman Zayegh3

Medication management practices of Muslim patients hospitalised prior to or

during Ramadan: an observational study.

1. Pharmacy Department, Austin Health, Heidelberg, Vic, Australia;

2. Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville,

Vic, Australia;

3. Pharmacy 4 Less Ringwood, Ringwood, Vic, Australia

Background Many Muslims fast during the Islamic month of Ramadan which may impact their medication regimen routines. There is a paucity of Australian literature investigating medication taking practices of Muslim patients during Ramadan.

Aim To describe the medication-related practices of Muslim patients and how they alter their medication regimen due to fasting during Ramadan.

Method A cross-sectional observational study was undertaken of adult Muslim patients admitted to a tertiary-referral Melbourne hospital in the 10 weeks prior to or during Ramadan 2021. Patients admitted for at least 24 hours and taking one or more medications were interviewed via telephone or face-to-face.

Results Overall, 103 patients were included: mean (SD) age 54.3 (18.3) years, 54 (52.4%) were male and the median number of regular medications was six. Eighty-one patients (78.6%) were born overseas, and 32 (31.1%) interviews were conducted in a language other than English. Twenty-nine (28.2%) patients were diabetic, 13 (12.6%) had acute or chronic pain, several requiring as-needed analgesics.

Forty-nine (47.6%) patients reported fasting during Ramadan 2021. Of these patients who fasted, 41 (83.7%) altered how they took their regular medications due to fasting and, of these, 28 (68.3%) altered their medication regimen during Ramadan 2021 without input from their healthcare professionals. The most common alterations were taking morning/daily doses before sunrise, and some delayed taking as-needed doses. Ten (9.7%) patients reported experiencing medication adverse events associated with fasting during Ramadan this year or previously, including hyper/hypoglycaemia, hypotension and nocturia.

Conclusion Fasting and altering medications during Ramadan is common practice and some patients experience adverse medication events. Some patients alter their medications without the input of healthcare professionals. Therefore, healthcare professionals need to partner with their Muslim patients to deliver optimal health outcomes.


Jones S, 1,2 To P,1 Elliott R, 1,2 A retrospective audit of doses omitted inappropriately for medications with directions specifying take ‘with or after food’ in patients fasting for a procedure. 1. Pharmacy Department, Austin Health 2. Faculty of Pharmacy and Pharmaceutical Sciences, Monash University Aim To determine how often medication doses that are charted with directions specifying to take ‘with or after food’ are inappropriately omitted when medical inpatients are fasting for a procedure. Methods A retrospective audit was undertaken on four general and specialist medical wards at Austin Health. The audit reviewed patients who were fasting for a diagnostic or surgical procedure between 1st January and 30th June 2021 and had one or more ‘with or after food’ medication order. All omitted medication orders that were charted with instructions of ‘with or after food’ within the patients’ fasting period were reviewed for appropriateness of the decision to omit doses. Results One hundred and nine patients were included. Sixty-five ‘with or after food’ medication doses were omitted during the fasting period for 39 (35.8%) patients. Of these 43% (28/65), for 21 (53.8%) patients, were considered inappropriate to omit. Medications doses that were commonly omitted included oral supplements such as magnesium, potassium and calcium. Other medications inappropriately omitted included antibiotics, corticosteroid, hydroxychloroquine, antidepressants, immunosuppressants (for auto-immune diseases) and urate lowering medications. Conclusion More than half of the patients who had 'with or after food' medications omitted had one or more doses withheld inappropriately. This demonstrates that this is an area that requires further investigation and intervention to help guide nursing staff on what ‘with or after food’ medications should be given preoperatively when patients are fasting.


The-Phung To1, Simone Taylor1, Ayat Abdullah2, Nur Abdullah2, Kerry Huang2,

Naemah Khan2, Sakinah Shirzad2, Huda Elmi1, Iman Zayegh3

Qualitative exploration of Australian Muslim patients’ perceptions and

experiences regarding medication management during Ramadan

1. Pharmacy Department, Austin Health, Heidelberg, Vic, Australia;

2. Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Vic,

Australia;

3. Pharmacy 4 Less Ringwood, Ringwood, Vic, Australia

Aim To explore Australian Muslim patient perceptions and experiences regarding medication management practices during Ramadan.

Methods Adult Muslim patients admitted to a tertiary referral hospital in the ten weeks before, or hospitalised during Ramadan 2021, were interviewed by telephone or face-to-face in their preferred language about medications and Ramadan fasting practices. Qualitative data comprised comments documented during these mixed-methods interviews.

Data were analysed using thematic analysis in Microsoft Excel. Comments were coded inductively, and subthemes and themes were developed, assisted by pivot tables and mind mapping. The coding, subtheme and theme development was an iterative process.

Results Eighty-eight patients contributed comments: 52% male, mean age 54.6 years and born in 23 different countries. Many had co-morbidities, including diabetes and hypertension. Themes included: 1. Altering medication regimens to facilitate fasting – many patients reported doing

this for Ramadan. 2. Interpretation of Ramadan – opinions differed regarding what constitutes breaking

the fast, especially around medication types and/or routes of administration. Some patients cited health and/or medication needs as reasons for not fasting, while others fast regardless. Fasting decisions were also influenced by identity and family traditions.

3. Patient perceptions of healthcare professionals – healthcare professionals were advocates to support and advise on medication management for Ramadan fasting for some patients, but were barriers to patients’ desire to fast for others. Patients’ perceptions and experiences with healthcare professionals influenced whether advice was sought about managing medication. Some advice was ignored and/or patients managed medications themselves, sometimes inappropriately.

Conclusion This exploration of Australian Muslim patients found diverse views and experiences around medication practices during Ramadan; some such practices were influenced by past relationships with healthcare professionals. As there are ramifications for physical, spiritual and family wellbeing, it is imperative that healthcare professionals partner with their Muslim patients to optimise medication management and health outcomes during Ramadan.


Phan L1,2, Mouchaileh N1,2, Elliott R1,2

An evaluation of the documentation of patients’ pre-admission levodopa regimens and the frequency of levodopa admission prescribing errors in patients with Parkinson’s disease. 1. Pharmacy Department, Austin Health, Heidelberg, Australia 2. Faculty of Pharmacy and Pharmaceutical Sciences, Monash University Background: When patients with Parkinson’s disease (PD) are admitted to hospital, inadequate documentation of their pre-admission levodopa regimen and admission prescribing errors can increase the risk of complications such as worsening PD symptoms. Aim: To determine whether pre-admission levodopa regimens are adequately documented by pharmacists and accurately charted by doctors for inpatients with PD. Methods: A retrospective audit of inpatients between September 2020 to February 2021 was conducted. Pharmacist medication reconciliation forms (MRFs) and the initial charting of levodopa by doctors were reviewed. Included patients were admitted to ED or an inpatient ward, on levodopa therapy and had a completed MRF. The primary endpoints were: 1. The proportion of admissions with adequate documentation of levodopa information (levodopa-decarboxylase inhibitor combination, dose, dose-form, formulation, strength, frequency, exact timing, food details) on their MRF, and 2. The frequency of levodopa prescribing errors on admission in comparison to the MRF. MRF documentation was deemed inadequate if any of the aforementioned levodopa details were missing. Prescribing errors were defined as one or more difference in the levodopa regimen compared to the MRF (excluding intentional changes). Results: 80 admissions, for 59 patients (mean age 81.7 years) were included. A total of 99 levodopa-containing medications were assessed. All MRFs were missing one or more levodopa details. Details of dosing in relation to meals were infrequently documented (1/99, 1%) whereas the frequency and exact times were mostly documented, at 97% and 78% respectively. A prescribing error occurred in 63% of episodes. Conclusion: Although most MRFs contained details of dose times, food administration details were rarely documented. The majority of episodes had prescribing errors. This highlights the need for strategies to improve adequacy of levodopa documentation and accuracy of prescribing in hospitalised patients with PD.


Olivia Reid, 1 Janet Ngo1, Rohan Elliott1,2, Samanta Lalic2, Elizabeth Su1

Title: Are we overdosing older people with paracetamol in hospital?

1. Pharmacy Department, Austin Health;

2. Centre for Medicine Use and Safety, Monash University.

Background:

Paracetamol can cause hepatic injury when used in excessive doses. Older people

may be at increased risk due to altered pharmacokinetics. Some guidelines

recommend a maximum paracetamol dose of 3000mg for frail older patients and

60mg/kg/day for older people who weigh less than 50kg.1,2

Aim:

To determine whether older hospital inpatients who are frail or weigh <50kg are

prescribed potentially excessive paracetamol doses.

Method:

Inpatients aged ≥70 years admitted between August and December 2018 with

length-of-stay >72 hours, who had weight <50kg or Frailty Index based on laboratory

data (FI-Lab) score ≥0.3 and were prescribed paracetamol were included in this

retrospective audit. Medication data, including inpatient and discharge paracetamol

dosing, were extracted from electronic medical records. The primary endpoint was

the percentage of patients who received a potentially excessive paracetamol dose.

Results:

229 patients (mean age 84.7, 69.2%female) received paracetamol during 240

admissions. There were 120 admissions where patient weight was <50kg and 120

where patient weight was >50kg and FI-Lab ≥0.3. The mean number of medications

charted was 10.1 (range 1-23). 77/120 (64.2%) patients weighing <50kg and 74/120

(61.7%) frail patients received potentially excessive doses of paracetamol. On

discharge, 112/138 (81.2%) discharge orders for the combined cohort were for

potentially excessive doses. The majority of paracetamol orders (97/138, 70.3%)

were for regular administration.

Conclusion:

More than 60% of older inpatients with low body weight or frailty received potentially

excessive paracetamol doses. Strategies to raise awareness of the need to reduce

paracetamol dosing in older low-weight and frail patients are required.

References:

1. Paracetamol use: a position statement of the NSW Therapeutic Advisory Group Inc. 2008.

Available from: http://www.nswtag.org.au/wp-content/uploads/2017/07/paracetamol-use-dec-

2008.pdf

2. Safe paracetamol use guideline. Queensland Health. 2014. Available from:

https://www.health.qld.gov.au/__data/assets/pdf_file/0030/147666/qh-gdl-415.pdf


http://www.nswtag.org.au/wp-content/uploads/2017/07/paracetamol-use-dec-2008.pdf

http://www.nswtag.org.au/wp-content/uploads/2017/07/paracetamol-use-dec-2008.pdf

Kate Lowe1, Catherine Wood1, Lisa Ho1, Amanda Ting1, Emily McCormack1, Jasmine Lau1, Emily Ferraro1, Beth Veevers2, Shari Antoine2, Deborah Stevens2, Sarah McKernin2, Katrina Capell3, Simone Taylor1

Feasibility of a smoking cessation program to support hospitalised respiratory and cardiology patients across the continuum of care 1. Pharmacy Department, Austin Health, Heidelberg, Vic., Australia; 2. Medication Management – Hospital Independence Program, Austin Health,

Heidelberg, Vic., Australia; 3. Cardiac Coach - Hospital Independence Program, Austin Health, Heidelberg, Vic.,

Australia.

Aim Hospitalisation in a smoke-free environment provides a potentially teachable moment for nicotine dependent patients to undertake a quit attempt. Whilst our hospital has long-standing policies for nurse/pharmacist-initiated nicotine replacement therapy (NRT), uptake has waned. Our hospital has no specific smoking cessation outpatient clinic and processes to handover support to community healthcare providers are not well established.

This project aims to develop and evaluate the feasibility of incorporating smoking cessation support into ward pharmacists’ routine practice, with post-discharge telehealth follow-up provided by hospital-based transition-of-care teams, to facilitate handover to community-based supports. To facilitate sustainability of the program, ward and telehealth workflows have been established and documentation in medical discharge summaries and telehealth medical records has been standardised.

Methods During the ward pharmacist admission interview on respiratory and cardiology wards, patients are being invited to undertake a quit attempt and receive ongoing post-discharge support. Ward pharmacists are initiating NRT, providing motivational interviewing, facilitating NRT prescribing on discharge, documenting in the medical discharge summary, and making a referral on Cerner to the Medication Management or Cardiac Coach teams. Patients are receiving post-discharge telehealth support at 1-week and some at 1-month post-discharge. The program is being evaluated via a medical record audit, a 6-month post discharge patient telephone interview and a survey of staff providing the program, to assess the feasibility of incorporating the program into their routine roles.

Results In the first month, 15 hospitalised patients were invited to participate. Of the ten patients who have received their 1-week follow-up, three have remained smoke-free and five have reduced the number of cigarettes smoked per day.

Conclusion This pilot smoking cessation program has been established through flexibility and collaboration across the organisation. Where possible, processes and documentation have been standardised. Early outcomes are promising, and recruitment is continuing.


M. Cimoli1,2, J. Oates2, E. McLaughlin2,3& S. Langmore4

Validation of the Austin Swallowing Ability Profile for FEES (ASAP-FEES) 1. Austin Health, Speech Pathology Department, Heidelberg, Victoria, Australia 2. La Trobe University, School of Allied Health, Human Services & Sport, Discipline of Speech Pathology, Melbourne, Victoria, Australia 3. Castlemaine Health, Speech Pathology Department, Castlemaine, Victoria, Australia 4. Boston University, School of Medicine, Department of Otolaryngology, Boston, Massachusetts, USA Aim The aims of this research were to develop and validate a new assessment tool for Flexible Endoscopic Evaluation of Swallowing (FEES). Methods Modern validity theory provided the framework for developing the new tool and evaluating evidence to support the intended use of ratings: (a) evidence based on the tool’s content, and (b) evidence based on intra- and inter-rater reliability. A logical, iterative process was followed to generate and select rating items used in the tool. Provisional versions of the tool were pilot tested in clinical and training contexts. Classical Test Theory was applied to examine intra- and inter-rater reliability. Five speech pathologists (SPs) reviewed 30 FEES video recordings of patients treated with radiotherapy for head and neck cancer and rated the video recordings using the new tool. Usability of the tool was also explored. Gwet’s AC1 statistic1 was used to calculate reliability coefficients. Results Evidence based on content: A 13 item FEES assessment tool was created. The Austin Swallowing Ability Profile for FEES (ASAP-FEES) comprises two components: (1) Anatomic-Physiologic assessment, and (2) Swallow Assessment. A conceptual model was created which helped specify the intended use of ratings. Evidence based on intra- and inter-rater reliability: Of a possible 6000 ratings, 5960 (99.33%) were available for analyses. Ratings were completed in a median time of 3.60 minutes (Anatomic-Physiologic Assessment) and 9.33 minutes (Swallow Assessment). Inter- and intra-reliability coefficients varied between 0.21 to 0.97. Most reliability coefficients were at least ‘substantial’ according to a traditional method for benchmarking. Conclusion This research supports the use of the ASAP-FEES for making clinical judgments and decisions about a person’s swallowing. The variability in reliability coefficients across ASAP-FEES items highlights that SPs need to understand the potential sources of error and bias that may affect their clinical decision making when using this tool. References 1. Gwet K. L. Computing inter-rater reliability and its variance in the presence of high

agreement. Brit J Math Stat Psy. 2008;61(1):29-48


Ukovic B,1 Chapman B,1 Choy M,2,3 De Cruz P.2,3

Novel use of the Crohn’s disease exclusion diet plus partial enteral nutrition for the treatment of Crohn’s disease during pregnancy: a case study

1. Nutrition & Dietetics Department, Austin Health, Heidelberg, Vic., Australia. 2. Department of Gastroenterology, Austin Health, Heidelberg, Vic., Australia. 3. Department of Medicine, Austin Academic Centre, University of Melbourne, Heidelberg, Vic., Australia. Aim Increasing evidence suggests the Crohn’s disease exclusion diet (CDED) with partial enteral nutrition (PEN) reduces inflammation and induces remission in Crohn’s disease (CD). Pregnant women with CD are commonly excluded from clinical trials, therefore, limited evidence exists on CDED during pregnancy. Active CD in pregnancy is generally treated with steroids or anti-TNF therapy which precipitate potential morbidities. This case study examines the outcome of CDED and PEN in a pregnant female with CD. Methods A 35-year-old female presented to Austin Health’s Inflammatory Bowel Disease service with newly diagnosed moderately severe ileal CD, 4kg weight loss to 51.8kg, symptoms of bowel urgency, abdominal pain and an elevated faecal calprotectin (FC) of 92ug/g. She unexpectedly became pregnant. Intestinal ultrasound (IUS) at 10/40 gestation showed an inflamed terminal ileum (Limberg 2). To mitigate safety concerns regarding new drug therapy during pregnancy dietary therapy was prescribed at 14 week’s gestation as: CDED Phase 1 with 50% PEN and CDED Phase 2 with 25% PEN for six weeks each respectively; modified to pescatarian for patient preference. Outcomes included patient-reported symptoms, FC, weight, foetal growth and Limberg IUS score. Results After six weeks of CDED (20/40) the patient was asymptomatic, body weight increased (55.6kg) and FC decreased (25.1ug/g). Active inflammation had resolved on IUS (Limberg 1) and foetal growth measured at 50th percentile. After 12 weeks CDED (26/40), the patient achieved further weight gain (58kg), maintenance of clinical remission and reduced FC (6.5 ug/g). Visual limitations precluded repeat IUS in the third trimester. Conclusion In this pregnant patient, treatment of CD with CDED and PEN achieved clinical and biochemical remission, maternal weight gain and normal foetal growth without the need for conventional medical therapy. CDED and PEN may be considered in pregnancy with careful monitoring and warrants further exploration to evaluate safety and efficacy.


Dimitroff C,1 Wong D,2 Gilmore R,2 Srinivasan A,2 Li Wai Suen C,2 De Cruz P2

¶ Use of the Crohn’s disease exclusion diet (CDED) in adults – a real-world experience ¶ 1. Nutrition and Dietetics Department, Austin Hospital, Heidelberg, Vic.,Australia; 2. Inflammatory Bowel Disease service, Austin Hospital, Heidelberg, Vic.,Australia; 3. Department of Medicine, Gastroenterology, University of Melbourne, Vic., Australia

¶ Aim The Crohn’s Disease Exclusion Diet plus Partial Enteral Nutrition (CDED+PEN) is a dietary intervention eliminating foods associated with inflammation in patients with Crohn’s Disease (CD)(1,2). We aimed to evaluate use of CDED+PEN as primary or adjunctive therapy in adults with CD.

¶ Methods Patients with active CD referred for CDED+PEN from Aug 2019 – Nov 2020 were monitored over 3 months. Clinical [Harvey Bradshaw Index (HBI)] and biochemical [(Faecal Calprotectin (FC), C-Reactive protein (CRP)] indices, and adherence were collected. Primary outcome was dietary adherence at 3 months. Secondary outcomes were: HBI ≤5; FC ≤150 and CRP ≤5 at 3 months. Treatment failure was defined as: worsening clinical or biochemical parameters or unplanned change in medical therapy.

¶ Results Of 74 patients referred, 39 commenced strict CDED+PEN; 15 followed CDED principles; 20 declined. Median age was 42 (IQR: 29-52); median disease duration was 3 years (IQR: 0-8); CDED+PEN was used as primary therapy in 14/39 (36%) and adjunctive therapy in 25/39 (64%). Fourteen patients received CDED+PEN as adjunctive therapy with no change to medical therapy and 11 patients with a planned change to medical therapy. Overall cohort: At baseline, 8/39 (21%) had clinically active disease based on HBI compared with 2/35 (6%) (p=NS); and 25/38 (66%) had biochemically active disease (FC/CRP) compared with 9/31 (29%) by 3 months (p=0.04) respectively. No patients required unplanned commencement or medication change. Primary therapy group: 11/14 (79%) adhered. 9/11 (82%) achieved clinical remission and 8/11 (72%) achieved biochemical remission by 3 months. Adjunctive therapy group: 12/25 (48%) adhered. 20/24 (83%) achieved clinical remission and 14/20 (70%) achieved biochemical remission by 3 months.

¶ Conclusion Adherence was higher among patients who used CDED+PEN as primary therapy. Use of CDED+PEN was able to avert the need for medical therapy escalation when used as primary or adjunctive therapy.

References

1. Levine, A. et al. 2019 ‘Crohn’s Disease Exclusion Diet plus Enteral Nutrition Induces Sustained Remission in a Randomised Controlled Trial’, Gastroenterology 2019; 157: 440-450

2. Sigall Boneh, R. et al. 2017 ‘Dietary Therapy with the Crohn’s Disease Exclusion Diet is a Successful Strategy for Induction of Remission in Children and Adults Failing Biological Therapy’, Journal of Crohn’s and Colitis 2017, 1205-1212


King S1, Rubin M2, Smith N2, Digpaul-Ghose M2, Inguanti G2, Davis I2, Bijo B2, Flude J2, Desneves K1, Lassemillante A2

¶ Title of abstract Novel insights into transforming food service at Austin Health to improve patient mealtime experience

¶ 1. Nutrition and Dietetics, Austin Health, Heidelberg, Vic., Australia 2. Swinburne University, Hawthorn, Vic., Australia ¶ Aim To measure patient experience and satisfaction during mealtime service using a tool designed from a previous qualitative study with patients and staff involved in provision of food. Mitigation of in-hospital malnutrition is limited by a lack of valid assessment tools which measure broad aspects of patient mealtime experience. A novel assessment tool was developed and implemented at Austin Health. ¶ Methods A cross-sectional study was conducted in November 2020. Ninety-eight participants completed the ‘Patient Mealtime Experience’ survey, which included 18 questions, covering mealtime aspects of food quality, staff interactions and assistance, environment and the food ordering system. ¶ Results Patients were sometimes, rarely or never satisfied with the overall quality (51%), visual appearance (48%) or taste and flavour of meals (53%). Over 80% patients reported staff were always or often friendly and respectful, whilst over 85% patients found the ordering system to be suitable and meal service times appropriate. Frequent mealtime interruptions by staff were reported by 15% patients. Thirty-one percent of patients regularly experienced positioning difficulties with their meal trays. Five statistically significant associations were observed. Overall enjoyment of meals was associated with visual appearance of meals (X2=60.5, p<0.001), variety in meal choices (X2=26.6, p=0.003), how patients felt on the day of the survey (X2=23.9, p=0.008), and the Austin Health site (X2=10.1, p=0.04). ¶ Conclusion These results present opportunity for simple recommendations for short-term changes. On-demand dining could be considered as a future initiative to transform foodservice to improve patient mealtime experience and satisfaction.


King S1, Cameron I2, Vadiveloo C2, Vallance M2, Lassemillante A2

¶ Title of abstract Exploring patient and staff perspectives on mealtime experience and their preferences for providing feedback

¶ 1.Nutrition and Dietetics, Austin Health, Heidelberg, Vic., Australia 2.Swinburne University, Hawthorn, Vic., Australia ¶ Aim To gather patient and staff perspectives on inpatients mealtime experience, which will be used to inform the development of a tool at Austin Health. Malnutrition remains a significant issue in hospitals. Expanding research suggests that organisational, physical and social factors are contributing to a negative meal experience and consequently, reducing a patient’s dietary intake. A patient-centred food service model, that allows consumer involvement and feedback, may improve patient mealtime experiences and inadvertently improve clinical outcomes. There is therefore a need to design a mealtime experience measurement tool that incorporates best practice evidence and consumers perspective. ¶ Methods This was a qualitative phenomenological study that adopted a two-phase design over a five-month period. Thirty-six participants (patients (n= 21) and staff (n=15), located across three sites, were interviewed about their perspective on mealtime experience and preferences for providing feedback. Responses to mealtime experiences were analysed thematically and feedback preferences were analysed using content analysis. ¶ Results Two main themes emerged: (i) patient-centred care and (ii) dining environment: “enjoyment of eating.” Within patient-centred care, the subthemes were wanting to be heard, importance of feedback and giving feedback. The subthemes within dining environment included mealtime environment, quality of food, staff interactions/assistance and expectation vs reality. Patients preferred to give verbal feedback and staff preferred feedback to be administered on a quarterly basis. ¶ Conclusion Findings provide insight about mealtime experiences and the components of meal service that are important to patients. Results were used to develop an innovative quantitative tool to measure inpatient mealtime experiences.


Desneves, KJ 1,2, Panisset, MG 3, Galea, MP 3, Kiss, N 2, Daly, RM 2, Ward, LC 4 ¶ Title of abstract Comparison of segmental lean tissue mass in individuals with spinal cord injury measured by dual energy X-ray absorptiometry and predicted by bioimpedance spectroscopy

¶ 1. Nutrition and Dietetics Department, Austin Health, Heidelberg, Vic., Australia; 2. Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), Deakin University; 3. Department of Medicine, Royal Melbourne Hospital, The University of Melbourne; 4. School of Chemistry and Molecular Biosciences, The University of Queensland ¶ Aim To compare two methods for predicting segmental (arms, legs, trunk) lean tissue mass (LTM: non-bone fat free mass) from bioimpedance spectroscopy (BIS) against LTM measured from dual energy X-ray absorptiometry (DXA) in individuals with acute spinal cord injury (SCI).¶ Methods Fourteen participants (two female), within 8 weeks of traumatic SCI had BIS measured following an overnight fast and within 24-h of DXA scanning. Total body fat free mass (FFM, body weight minus fat mass) and segmental LTM were predicted from BIS using manufacturer’s proprietary software and a previously established SCI-specific prediction1 method. Appendicular LTM (ALM) was calculated from the sum of the LTM of the arms and legs. Agreement and strength of relationships with DXA for predicted LTM measures using both approaches were assessed using Lin’s concordance coefficient and limits of analysis agreement (LOA). ¶ Results The BIS proprietary method performed better than the SCI-specific prediction method in predicting DXA LTM, demonstrating substantial concordance for total body FFM (rc = 0.80), ALM (rc = 0.78), arm (rc= 0.76) and leg LTM (rc = 0.65) and a smaller bias and LOA for ALM (+0.8 vs. -3.4 kg; LOA -4.9 – 6.4 vs. -11.9 – 5.1 kg), arm (+0.02 vs. -0.3 kg; LOA -1.1 – 1.1 kg vs. -2.2 – 1.6 kg) and leg (+0.4 vs. -1.4 kg; LOA -2.0 -2.8 vs. -5.6 – 2.8) LTM. ¶ Conclusion BIS can be used to accurately predict total body FFM, segmental LTM and ALM in individuals with acute SCI.

References Cirnigliaro CM, La Fountaine MF, Emmons R, Kirshblum SC, Asselin P, Spungen AM, et al. Prediction of limb lean tissue mass from bioimpedance spectroscopy in persons with chronic spinal cord injury. J Spinal Cord Med. 2013;36(5):443-53.


Draffin K,1 Hamilton J,1 Godsil S,1 Rudolph S,1 Crowe T, 1 Newton R2

Comparison of carbohydrate intake on refeeding hypophosphatemia in

adolescents with anorexia nervosa: a pilot randomised controlled trial.

1. Nutrition and Dietetics Department, Austin Health, Heidelberg, Vic. Australia.

2. Peninsula Health, Frankston, Vic. Australia.

Aim

The aim of this pilot study was to compare the effect of a low and a standard carbohydrate feeding

protocol on serum phosphate levels in children and adolescents with anorexia nervosa.

Nutritional rehabilitation for patients with anorexia nervosa (AN) involves balancing weight gain

whilst mitigating the risk of refeeding syndrome. Restriction of calories from carbohydrate has

been used to minimise the risk of developing refeeding syndrome, however little evidence

supports these practices.1,2

Methods

A pilot study of 23 children and adolescents with anorexia nervosa admitted for medical

stabilisation to the adolescent ward of a tertiary hospital was undertaken. Participants were

commenced on an oral feeding protocol and were randomly allocated to isocaloric meal plans

that were either low carbohydrate (<40% total energy from carbohydrate) or standard

carbohydrate (50-60% total energy from carbohydrate). Serum phosphate levels were monitored

daily across the first week and twice weekly thereafter. Clinical status, including weight gain, was

monitored throughout admission.

Results

Fifty-two percent (n=12) of participants were allocated to the low carbohydrate group and 48%

(n=11) were allocated to the standard carbohydrate group. No patients in either of the diet groups

developed refeeding hypophosphatemia in the first seven days of admission. Weight gain during

the first week was significantly higher in the standard carbohydrate diet (1.4±0.5 kg/wk) compared

to the low carbohydrate diet (0.6±0.9 kg/wk), (p= 0.03). Participants from both diet groups were

largely orally fed with less than 10% of the total number of meals and/or snacks across both

groups provided as nutrition supplement drinks, either orally or enterally.

Conclusion

This pilot study supports that a standard carbohydrate intake (providing 50-60% of total energy

from carbohydrate) optimises nutritional rehabilitation without increasing the risk of refeeding

hypophosphatemia in adolescent inpatients with anorexia nervosa.

References

1. Garber A, Sawyer S, Golden N, Guarda A, Katzman D, Kohn M et al. A Systematic Review

of Approaches to Refeeding in Patients with Anorexia Nervosa. Int J Eat Disord. 2016

Mar;49(3):293-310.

2. Royal College of Psychiatrists. Junior MARSIPAN: Management of Really Sick Patients

under 18 with Anorexia Nervosa. Royal College of Psychiatrists London. College Report

CR168. 2012 Jan.


Leaving Hospital Well: Evaluating the Discharge Trajectory for People with Disability and

Complex Needs. Authors: Minter, Ella-Rose1,2; Cubis, Lee. 1,2; Winkler, Di.1,2; Douglas, Jacinta.1,2; Roseingrave,

Eve.1,2Topping, Megan1,2; Bec Jamwal2,3; & Kate Harradine3

1Summer Foundation Ltd, Melbourne, VIC, Australia 2Living with Disability Research Centre, La Trobe University, Melbourne, VIC, Australia 3 Austin Health, Melbourne, VIC, Australia

Aim: Young people with disability and complex needs are at an increased risk of lengthy

discharge delays and admission to Residential Aged Care (RAC) after being discharged from hospital. The purpose of this study was to explore the discharge process of people with acquired disability and complex support needs to identify facilitators and barriers to effective discharge. Specifically, this mixed methods study aimed to: 1) collect data to record time frames of hospital and National Disability Insurance Scheme (NDIS) processes and patient outcomes; and 2) qualitatively explore the barriers and enablers to hospital discharge from the perspectives of people with disability, close others and discharge planners.

Method: Phase 1 of the study involved the collection of administrative data from patients admitted to Austin Health (N = 193) between 2016-2021. Phase 2 of the study involved qualitative semi-structured interviews with individuals with disability (n = 12), close others (n = 2) and discharge planners (n =11).

Results: Forty-three percent of patients experienced a delay to discharge with the main barriers to discharge identified as NDIS related delays, difficulties sourcing housing and difficulties sourcing disability supports. Median days delayed in hospital was 90 (IQR=42-175), with a range of 4-622 days. Regarding health and NDIS timeframes, median days taken for health to identify patients as NDIS eligible was 22 (IQR=10-52) with a range of 0-322. Once patients were identified as eligible, median days taken to contact NDIS for the ARF was nine (IQR=2-17) with a range of 0-90 days. Median days from NDIS eligibility approved to discharge was 112 (65-180) with a range of 0-737 days. Over time, days delayed in hospital and NDIS time frames either reduced or saw less variability and extreme scores. Qualitative analysis revealed challenges navigating the health, NDIS and housing interfaces with variability according to disability type.

Conclusions: Despite improvements, prevalence of discharge delays remained substantial and were often attributable to NDIS processes and difficulties with sourcing housing, equipment, and formal supports. Timely identification of NDIS eligible patients and initiation of NDIS access may reduce unnecessary time spent in hospital.


Hirth MJ1,2,3, Hunt I4, Briody K5, Milner Z6, Sleep K2, Chu A1, Donovan E7, O’Brien L3

Comparison of two relative motion extension orthotic programs following zones V-VI extensor tendon repairs: A randomized equivalence trial 1. Occupational Therapy Department, Austin Health, Heidelberg, VIC., Australia; 2. Malvern Hand Therapy, Malvern, VIC; 3. Department of Occupational Therapy, Monash University, Frankston, VIC; 4. TIA College of Sciences and Engineering, University of Tasmania, TAS; 5. Occupational Therapy Department, Monash Health, Dandenong, VIC; 6. Occupational Therapy Department, Melbourne Health, Parkville, VIC. 7. Occupational Therapy Department, Western Health, Footscray, VIC; Aim Relative motion extension (RME) orthoses are widely used in the postoperative management of finger extensor tendon repairs in zones V-VI. Variability in orthotic additions to the RME only (without a wrist orthosis) approach has not been verified in clinical studies. The aim of this study is to examine if two RME only approaches (with or without an additional overnight wrist-hand-finger orthosis) yields clinically similar outcomes. Methods Thirty-two adult (>18 years) participants (25 males, 7 females) were randomised to one of two intervention groups receiving either: i) a relative motion extension orthosis for day wear and an overnight wrist-hand-finger orthosis ('RME Day' group), or ii) a relative motion extension orthosis to be worn continuously ('RME 24-Hr' group); both groups for a period of four postoperative weeks. Results Using a series of linear mixed models, we found no differences between the intervention groups for the primary (Range of motion including total active motion (TAM), TAM as a percentage of the contralateral side [%TAM], and Millers Criteria) and secondary outcome measures of grip strength, QuickDASH and PRWHE scores. The models did identify several covariates that are correlated with outcome measures. The covariate ‘Age’ influenced TAM (P = .006) and %TAM (P = .007), with increasing age correlating with less TAM motion and recovery of TAM compared to the contralateral digit. 'Sex' and 'Contralateral TAM' are also significant covariates for some outcomes. Discussion With similar outcomes between both intervention groups, the decision to include an additional supplementary night orthosis should be individually tailored for patients rather than protocol based. As the covariates of ‘Age’ and ‘Sex’ influenced outcomes, these should be considered in clinical practice. Conclusion A Relative motion extension only approach with or without an additional overnight wrist-hand-finger orthosis yielded clinically similar results whilst allowing early functional hand use, without tendon rupture.


Hirth MJ1,2,3, Howell JW4, Brown T3, O’Brien L3

Relative motion extension management of zones V and VI extensor tendon repairs: Does international practice align with the current evidence?

1. Occupational Therapy Department, Austin Health, Heidelberg, Vic., Australia; 2. Malvern Hand Therapy, Malvern, Vic., Australia; 3. Department of Occupational Therapy, Monash University – Peninsula

Campus, Frankston, Vic, Australia; 4. Self-employed, Saint Joseph, MI, USA.

Aim Therapists participating in an international survey selected relative motion extension (RME) as the “most used” approach for managing zones V-VI extensor tendon repairs.1 Respondents identifying RME as their preferred approach were asked about their routine RME practices to capture this data and compare with the published RME evidence.

Methods An English-language survey was distributed to 36 International Federation of Societies for Hand Therapy (IFSHT) full-member countries. Participation required therapists to have managed at least one extensor tendon repair within the previous year. Those who selected RME as their “most used” approach were asked to identify which variation of the RME approach they favoured: RME plus (with wrist orthosis), RME only, or “both” RME plus and RME only, and then were directed to additional questions related to their choice.

Results Respondents from 28 IFSHT full-member countries completed the survey. RME users (N= 368; 41.5% of total sample) contributed to this secondary data. Respondents favoured the RME variation “RME plus” (47%), followed by “both” (44%), then “RME only” (9%) with most managing single digit/simple injuries (n= 287, 81%) versus multiple digit/complex injuries (n= 96, 27%), and partial tendon repairs (n= 278, 79%).

Discussion Practices not aligning with limited level II-IV evidence includes half of RME only users not adding/substituting an overnight orthosis; use of RME plus versus RME only for both repairs of independent extensor tendons and repairs proximal to the juncturae tendinum; fabrication of three not four finger orthotic design; and restricting the RME approach only to repairs of one or two fingers.

Conclusion RME plus and RME only are used interchangeably depending on surgeon preferences and patient/tendon factors. Compared with RME plus, from this survey, it appears that the RME only approach yields similar uncomplicated, early return of motion and hand function.

Reference: 1Hirth MJ, Howell JW, Feehan LM, Brown T, O’Brien L. Postoperative hand therapy management of zones V and VI extensor tendon repairs of the of the fingers: An international inquiry of current practice. Journal of Hand Therapy, 2021; 34(1):58-75.


Hirth MJ1,2,3, Howell JW4, Feehan LM5, Brown T3, O’Brien L3

Postoperative hand therapy management of zones V and VI extensor tendon repairs of the fingers: An international inquiry of current practice

1. Occupational Therapy Department, Austin Health, Heidelberg, Vic., Australia; 2. Malvern Hand Therapy, Malvern, Vic., Australia; 3. Department of Occupational Therapy, Monash University – Peninsula

Campus, Frankston, Vic, Australia; 4. Self-employed, Saint Joseph, MI, USA; 5. Department of Physiotherapy, University of British Columbia, Vancouver,

British Columbia, Canada.

Aim Evidence supports early motion over immobilisation for postoperative extensor tendon repair management.1 Various early motion programs and orthoses are used, with no single approach recognised as superior. It remains unknown if and how early motion is used by hand therapists worldwide. The purpose of this study was to determine if there is a preferred approach and identify practice patterns for constituents of International Federation of Societies for Hand Therapy (IFSHT) full member countries.

Methods Participation in this English-language survey required respondents to have postoperatively managed at least one extensor tendon repair within the previous year. Approaches surveyed included programs of immobilisation, early passive (EPM), and early active (EAM) with motion delivered by resting hand, dynamic, palmar/interphalangeal joints (IPJs) free, or relative motion extension (RME) orthoses. Survey flow depended on the respondent’s answer to their “most used” approach in the previous year.

Results There were 992 individual responses from 28 IFSHT member countries including 887 eligible responses with an 81% completion rate. The order of most used program was EAM (83%), EPM (8%), and immobilization (7%). The two most used orthoses for delivery of EAM were RME (43%) and palmar/IPJs free (25%). The RME orthosis was preferred for earlier recovery of hand function and motion. Barriers to therapists wanting to use the RME/EAM approach related to preference of surgeon (70%) and clinic (24%).

Discussion In practice, many therapists select from multiple approaches to manage zone V and VI extensor tendon repairs. Therapists believed total active motion achieved with the RME/EAM approach was superior to the other approaches. Contrary to the literature, in practice, many therapists modify forearm-based palmar/IPJs free orthoses to exclude the wrist to manage this diagnosis.

Conclusion The RME/EAM approach was identified as the favoured approach. Practice patterns and evidence did not always align. Reference: 1Collocott SJ, Kelly E, Ellis RF. Optimal early active mobilisation protocol after extensor tendon repairs in zones V and VI: a systematic review of literature. Hand Therapy. 2018;23(3):3-18.


Hahn, Jodie, 1, Jamwal, Rebecca,1 & Hirth, Melissa1 Patient satisfaction with the practical component of telehealth hand therapy services during the COVID-19 pandemic 1. Occupational Therapy Department, Austin Health, Melbourne, Australia Aim The COVID-19 pandemic necessitated a rapid transition from face-to-face patient care to telehealth across a range of healthcare settings, including outpatient services at Austin Health. This study aimed to understand the patient experience of hand therapy services delivered via telehealth, including any perceived benefits and challenges associated with this method of service delivery. Methods Participants were recruited from a cohort of patients referred with a hand injury/condition to outpatient hand therapy in the Occupational Therapy Department, Austin Health. Over a three-month period, (March-May 2021) at the conclusion of their telehealth appointment, participants were invited to complete an online survey regarding their experience. Data collected included demographics, information surrounding the practical experience of the telehealth appointment, and part three of the Patient Evaluation Measure1 to measure the participants overall satisfaction with treatment and recovery. Results From the 423 individual telehealth appointments that took place during the data collection period, 123 survey responses were received (29% response rate). Eighty percent of participants were receiving therapy for an acute injury. Fifty-three percent reported saving between 10-29 minutes of travel time each way by attending a telehealth appointment, while 36% saved 30 minutes or more. Almost all respondents (97%) reported that telehealth should be used in the future, with 81% reporting no challenges using telehealth. Most commonly cited challenges included the therapist not being able to provide hands on treatment (12%) and getting the technology to work (7%). The majority of participants were very satisfied with the treatment they received, with 62% reporting they felt their stage of recovery was better than expected. Conclusion Participant responses indicate several benefits and minimal challenges associated with telehealth services, that support its continuation in outpatient hand therapy into the future. Subsequent research investigating the outcomes of face-to-face versus telehealth service delivery is warranted.

References 1Dias JJ, Bhowal N, Wildin CJ, Thompson JR. Assessing the outcome of disorders of the hand. Is the patient evaluation measure reliable, valid, responsive and without bias? J Bone Joint Surg, 2001;83(2):235-240.


Charissa J. Zaga1-3, Vinciya Pandian4, Martin B. Brodsky5, Sarah Wallace6, Tanis S. Cameron3, Caroline Chao3,7, Lisa

Ann Orloff8, Naomi E. Atkins9, Brendan A. McGrath10, Cathy L. Lazarus11, Adam P. Vogel12,13 & Michael J. Brenner14

Speech-Language Pathology Guidance for Tracheostomy during the COVID-19 Pandemic:

An International Multidisciplinary Perspective

Authors’ affiliations:

1 Department of Speech Pathology, Austin Health, Melbourne, Australia

2 Centre for Neuroscience of Speech, University of Melbourne, Melbourne, Australia

3 Tracheostomy Review and Management Service, Austin Health, Melbourne, Australia

4 Department of Nursing Faculty, Johns Hopkins University, Baltimore, Maryland, United States

5Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, United States

6Department of Speech Voice and Swallowing, Manchester University NHS Foundation Trust, National Tracheostomy Safety Project, Manchester, United Kingdom

7Department of Physiotherapy, Austin Health, Melbourne, Australia

8Department of Otolaryngology – Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, United States

9Department of Respiratory Medicine, Austin Health, Melbourne, Australia

10Anaesthetics & Intensive Care Medicine, Manchester University, NHS Foundation Trust, National Tracheostomy Safety Project

11Department of Otolaryngology—Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States 12Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Tübingen, Germany 13Redenlab, Melbourne, Australia

14Department of Otolaryngology – Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States

Aim: As the COVID-19 pandemic has unfolded, there has been growing recognition of risks to frontline healthcare

workers. When caring for patients with tracheostomy, speech-language pathologists have significant exposure to

mucosal surfaces, secretions, and aerosols that may harbor the SARS-CoV-2 virus. This tutorial provides guidance on

practices for safely performing patient evaluation and procedures, thereby reducing risk of infection.

Methods: Data were collated through review of literature, guidelines, and consensus statements relating to COVID-19

and similar high-consequent infections, with a focus on mitigating risk of transmission to healthcare workers. Particular

emphasis was placed on speech-language pathologists, nurses, and other allied health professionals. A multinational

interdisciplinary team then analyzed findings, arriving at recommendations through consensus via electronic

communications and video conference.

Results: Reports of transmission of infection to healthcare workers in the current COVID-19 pandemic and previous

outbreaks substantiate the need for safe practices. Many procedures routinely performed by speech-language

pathologists have a significant risk of infection due to aerosol generation. COVID-19 testing can inform level of

protective equipment, and meticulous hygiene can stem spread of nosocomial infection. Modifications to standard

clinical practice in tracheostomy are often required. Personal protective equipment, including either PAPR or N95 mask,

gloves, goggles, and gown, are needed when performing aerosol-generating procedures in patients with known or

suspected COVID-19 infection.

Conclusions: Speech-language pathologists are often called on to assist in the care of patients with tracheostomy and

known or suspected COVID-19 infection. Appropriate care of these patients is predicated on maintaining the health and

safety of the healthcare team. Careful adherence to best practices can significantly reduce risk of infectious

transmission.


Ms Charissa J Zaga1,2,, Ms Bridie Cigognini1, Associate Professor Adam P Vogel2,3,4 & Associate

Professor Sue Berney5,6

Outcome Measurement Tools for Communication, Voice and Speech Intelligibility in the ICU and

their Clinimetric Properties: A Systematic Review

1. Department of Speech Pathology, Austin Health, Melbourne Australia

2. Centre for Neuroscience of Speech, University of Melbourne, Melbourne, Australia

3. Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Tübingen, Germany

4. Redenlab, Melbourne, Australia

5. Department of Physiotherapy, Austin Health, Melbourne, Australia

6. Department of Physiotherapy, School of Health Sciences, University of Melbourne, Melbourne, Australia

Aim: To identify outcome measurement tools used to evaluate communication, voice and speech intelligibility in

the mechanically ventilated Intensive Care Unit (ICU) population. Secondly, to evaluate, synthesise and compare

the clinimetric properties of the tools identified.

Methods: A systematic review of articles was undertaken via electronic databases in two parts. Eligibility criteria

for selection: part one – quantitative or mixed methods studies which assessed communication, voice or speech

intelligibility; part two – studies which evaluated a clinimetric property for one of the tools identified in part one. Two

independent reviewers assessed articles for inclusion and used the consensus-based standards for health status

measurement instruments (COSMIN) risk of bias checklist(1,2).

Results: The part one search yielded five included studies comprised of eight outcome measurement tools. The

part two search yielded twenty-two included studies comprised of nine tools. Few studies had adequate reliability

and measurement error properties. No studies established responsiveness. A notable proportion of studies utilised

tools that have no clinimetric properties.

Conclusions: There are a relatively small number of studies which have established clinimetric properties for

outcome measurement tools that evaluate communication, voice and/or speech intelligibility, and a fewer number

which have done so in the mechanically ventilated ICU population.

References:

1. Mokkink L, Terwee, CB, Patrick, DL, Alonso, J, Stratford, PW, Knol, DL, Bouter, LM & de Vet, HCW. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res. 2010;19:539-49.

2. 9. Mokkink L, de Vet, HCW, Prinsen, CA, Patrick, DL, Alonso, J, Bouter, LM & Terwee, CB. COSMIN Risk of Bias checklist for systematic review of Patient-Reported Outcome Measures. Qual Life Res. 2018;27:1171-9.


Charissa J. Zaga 1,2,3,4, Sue Berney 3,5,6, Tanis S. Cameron 2, Sonia Baker 7, Charles Giddings 8, Mark E. Howard

3,9, Rinaldo Bellomo 10,11,12,13 & Adam P. Vogel 4,14,15

Tracheostomy clinical practices and patient outcomes in three tertiary metropolitan hospitals in Australia

1. Department of Speech Pathology, Division of Allied Health, Austin Health Melbourne, Australia

2. Tracheostomy Review and Management Service, Austin Hospital, Melbourne, Australia

3. Institute of Breathing and Sleep, Austin Health, Melbourne, Australia

4. Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia

5. Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia

6. Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia

7. Department of Speech Pathology, Royal Brisbane and Women’s Hospital, Brisbane, Australia

8. Department of Ear, Nose and Throat Surgery, Monash Health, Melbourne, Australia

9. Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia

10. Department of Intensive Care, Austin Health, Melbourne, Australia

11. Department of Critical Care, University of Melbourne, Melbourne, Australia

12. Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia

13. Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia

14. Department of Neurodegeneration, Hertie Institute for Clinical Brian Research, Tübingen, Germany

15. Redenlab, Mebourne, Australia

Objectives: To examine and provide valuable baseline data for tracheostomy clinical practices and patient outcomes

across three large metropolitan Australian hospitals.

Methods: We performed a retrospective multi-site observational study to examine clinical practices and patient

outcomes from three tertiary metropolitan Australian health services who are members of the Global Tracheostomy

Collaborative. De-identified data were entered into the Global Tracheostomy Collaborative database from Jan 2016–

Dec 2019 at each site. Descriptive statistics were used for the reported outcomes of length of stay (LOS), mortality,

communication, swallowing, nutrition, tracheostomy-related adverse events and complications and decannulation.

Results: The total cohort was 380 patients. The in-hospital mortality of the study cohort was 13%. Overall LOS was 46

days. The majority of patients (70%) did not experience any tracheostomy-related adverse events or complications

during tracheostomy insertion. Decannulation occurred in 83% of patients. Few patients (8%) utilised verbal

communication methods while mechanically ventilated, compared with 80% who utilised a one-way speaking valve while

off the ventilator. Oral intake was commenced in 20% of patients prior to decannulation. Patient nutritional intake varied

prior to and at the time of decannulation.

Conclusions: This study provides valuable baseline data for tracheostomy outcomes across three large metropolitan

Australian hospitals. Most outcomes were comparable with previous international and local studies. Future research is

warranted to support earlier communication, swallowing and nutritional interventions in these patients.


Clare Morris, 1, Mandy Ip,1 Joanne Sweeney,1

Delegation of a Speech Pathology Allied Health Assistant task in accordance with a delegation framework

1. Austin Health, Speech Pathology Department, Heidelberg, Vic., Australia

Aim The allied health assistant (AHA) workforce is integral to providing high quality, safe and effective patient care including care of patients with dysphagia. AHAs are required to work under a supervision and delegation model, however Austin Health’s speech pathology procedures for delegating dysphagia tasks to AHAs were variable and not aligned with the Department of Health and Human Services (DHHS) supervision and delegation framework.

The aim of this project was to improve the consistency of delegation procedures for a dysphagia task, in order to adhere to delegation standards specified in the DHHS supervision and delegation framework.

Method A Plan-Do-Study-Act (PDSA) quality improvement methodology was applied.

• Pre-intervention adherence data collection: Retrospective audit of AHA

dysphagia task delegations in 85 medical records across three hospital

sites.

• Intervention: Dysphagia task procedure developed; education about task

and delegation requirements provided to Speech Pathology staff;

delegation template and CERNER process developed.

• Post-intervention adherence data collection: Prospective audit of AHAdysphagia task delegations in 18 medical records across two hospitalsites.

Results Speech Pathologists' adherence to the DHHS supervision and delegation framework when delegating the dysphagia task to AHAs improved from 0% to 89%.

Conclusion Speech Pathologists’ delegation procedures for the dysphagia task are consistent and adhere to the DHHS supervision and delegation framework.

Austin Health. Allied Health Assistant Workforce Guideline [intranet]. Heidelberg: Austin Health; 2021. Available from https://austinhealth.sharepoint.com/:w:/r/sites/OPPIC/Guideline/Allied%20Health%20


https://austinhealth.sharepoint.com/:w:/r/sites/OPPIC/Guideline/Allied%20Health%20Assistant%20Workforce%20Guideline.docx?d=w43cb514e48f04b1095ee892faaa0046b&csf=1&web=1&e=4qxO0n

Assistant%20Workforce%20Guideline.docx?d=w43cb514e48f04b1095ee892faaa0046b&csf=1&web=1&e=4qxO0n

Department of Health. Supervision and delegation framework for allied health assistants [internet]. Melbourne: State Government of Victoria; 2012. Available from: https://www2.health.vic.gov.au/about/publications/policiesandguidelines/Supervision-and-delegation-framework-for-allied-health-assistants



https://www2.health.vic.gov.au/about/publications/policiesandguidelines/Supervision-and-delegation-framework-for-allied-health-assistants

https://www2.health.vic.gov.au/about/publications/policiesandguidelines/Supervision-and-delegation-framework-for-allied-health-assistants

Harrison AL,1,2 Taylor NF,2,3 Frawley HC,4,5 Shields N2

Title of abstract A consumer co-created infographic improves exercise knowledge and self-efficacy in women with GDM: a randomised trial

1. Physiotherapy Dept., Werribee Mercy Hospital, Werribee, Vic., Australia;2. Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, LaTrobe University, Vic., Australia;3. Allied Health Clinical Research Office, Eastern Health, Box Hill, Vic.,Australia;4. University of Melbourne, Parkville, Vic., Australia;5. Allied Health Research, Mercy Hospital for Women and Royal Women’sHospital

Aim To engage with women with gestational diabetes mellitus to develop a consumer co-created infographic to be provided in addition to usual education about gestational diabetes mellitus to determine if this improves knowledge about physical activity and self-efficacy to exercise in women diagnosed with gestational diabetes mellitus.

Methods The design involved consumer collaboration to develop the intervention and a randomised trial with concealed allocation, a blinded assessor and intention-to-treat analysis. Prior to trial commencement, an infographic about physical activity for women diagnosed with gestational diabetes was co-created with 18 consumers and was the intervention for the trial. Participants for the trial were 69 women diagnosed with gestational diabetes mellitus. In addition to gestational diabetes education, the experimental group received a copy of the consumer co-created infographic about physical activity during a gestational diabetes pregnancy. The control group received gestational diabetes education alone. Participants completed outcome measures at baseline and again 1 week later. Knowledge of physical activity in a gestational diabetes mellitus pregnancy was assessed using a 19-item questionnaire modified reflecting physical activity guidelines, with a total score from 0% (worst) to 100% (best). Self-efficacy was measured using the nine-item Self-Efficacy for Exercise Scale, with a total score from 0 (not confident) to 10 (very confident).

Results Provision of the consumer co-created infographic led to a clinically important between-group difference in knowledge (MD 12%, 95% CI 10 to 15) and self-efficacy (MD 2.5 units, 95% CI 1.9 to 3.0).

Conclusion In women with gestational diabetes, short-term knowledge about physical activity and self-efficacy to exercise were improved when usual education was supplemented with a consumer co-created infographic that provided consumer-specific and relevant information about physical activity during a gestational diabetes mellitus pregnancy.

Jennifer Jones1,2,3, Zudin Puthucheary4,5, Amalia Karahalios5, Michael Berry7, D. Clark Files8,9, David Griffith10,11, Luke McDonald1, Peter Morris12, MarcMoss13, Amy Nordon-Craft14, Timothy Walsh10,11, Linda Denehy1, 15, 16, SueBerney1,2

Searching for the responder: Do patient characteristics modify rehabilitation outcomes of adults with critical illness?

1. Physiotherapy Department, Division of Allied Health, Austin Health,Heidelberg, Victoria, Australia

2. Physiotherapy Department, The University of Melbourne, Parkville, Victoria,Australia

3. Institute of Breathing and Sleep, Heidelberg, Victoria, Australia4. William Harvey Research Institute, Barts and The London School of

Medicine & Dentistry, Queen Mary University of London, London, England5. Adult Critical Care Unit, Royal London Hospital, Barts Health NHS Trust,

London, England6. Centre for Epidemiology and Biostatistics, Melbourne School of Population

and Global Health, The University of Melbourne, Parkville, Victoria,Australia

7. Department of Health and Exercise Science, Wake Forest University,Winston Salem, North Carolina

8. Pulmonary, Critical Care, Allergy and Immunologic Disease, Wake ForestUniversity, Winston-Salem, North Carolina

9. Wake Forest Critical Illness Injury and Recovery Research Center, WakeForest University, Winston Salem, North Carolina

10. Anaesthetics, Critical Care, and Pain Medicine, School of Clinical Sciences,Queens Medical Research Institute, University of Edinburgh, Edinburgh,Scotland

11. Edinburgh Royal Infirmary, NHS (National Health Service) Lothian,Edinburgh, Scotland

12. Division of Pulmonary, Critical Care and Sleep Medicine, University ofKentucky, Lexington, Kentucky

13. Division of Pulmonary Sciences and Critical Care Medicine, University ofColorado Denver School of Medicine, Aurora, Colorado

14. Physical Therapy Program, University of Colorado Denver School ofMedicine, Aurora, Colorado

15. Melbourne School of Health Sciences, The University of Melbourne,Parkville, Victoria, Australia

16. Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria,Australia

Aim Level one evidence supports improvement in physical function at hospital discharge following rehabilitation for critically ill adults. The effect beyond hospital discharge is unclear. In our search for who responds to rehabilitation, our primary aim was to explore if patient characteristics (comorbidity, age, sex and illness severity) of critically ill adults modify the co-primary outcomes of physical function and health-related quality of life (HRQoL).

Methods We identified trials that were eligible to contribute data of individual participants from a comprehensive search of four databases (systematic review and individual participant data meta-analysis). Rehabilitation randomised trials that included assessment of comorbidity, physical function and HRQoL with a minimum follow up period of three months were eligible. Results Four trials were identified from United States, United Kingdom and Australia totalling 810 participants. The presence of comorbidities modified the outcome of rehabilitation for the Physical Component Summary (PCS) score of HRQoL. Participants with two or more comorbidities (Functional Comorbidity Index

score 2) had PCS scores below normative values (mean 50 10) which improved following the intervention at three (effect estimate (95% CI) intervention vs control: 36.2 (34.4 to 38.1) vs 30.4 (28.3 to 32.6)) and six months (38.3 (36.4 to 40.1) vs 32.5 (30.4 to 34.6)) but not 12 months (p = 0.04, Figure 1). No other patient characteristic modified the outcome of rehabilitation for PCS score nor for any measure of physical function. Conclusion: This is the first study in the field to combine trial data of individual participants. This area, both in research and clinical practice, has previously been plagued by the heterogeneity of the patient population. The identification of a target group of critically ill patients with two or more comorbidities provides direction clinically and for future investigations into the effect of physical rehabilitation.

Documents

Allied Health - austin.org.au