INNOVATIONS IN MANAGING RISK REMOTELY IN COMPLEX DISABILITY THROUGH TELEHEALTH

E. Downey¹, A. Brown¹, K. Phillips¹

Background: Working as a physiotherapist with persons with disabilities involves planning for and managing clinical risks and incidents.  Prior to COVID-19 utilising Telehealth for purposes of assessment, management and education was not used within our private practice. As a practice, we have clear risk management procedures which needed to be adapted to meet the needs of community clients participating in telehealth during the Covid-19 pandemic.

Purpose: To determine how to prepare for and manage risk while providing physiotherapy on a Telehealth platform with persons with complex disabilities

Methods: The innovation occurred in a large multidisciplinary private practice in Melbourne, Australia. The clients are funded under Australia’s National Disability Insurance Scheme (the NDIS) and traffic accident insurance scheme. There are 14 physiotherapists working at the private practice. When COVID-19 restrictions were rolled out in Melbourne in March 2020, the practice adapted to this need by embracing Telehealth as a therapy modality to ensure that people living with complex disabilities would continue to receive the care they needed. Risk to clients and clinicians were identified by the practice’s newly formed telehealth team. Role play videos were made of each of the identified risk scenarios to rapidly upskill clinicians in managing risk through telehealth. The client risks identified were: falls, mental health, behaviours of concern and medical. Risks to clinicians were identified as behaviours of concern.

Results: A survey to the 14 physiotherapists was created to gauge confidence in delivering therapy via Telehealth. Confidence in risk management was initially rated between a 2/5 - 4/5  (mean 3) with the majority of clinicians (70%) rating their confidence as 3/5. The role play videos were implemented 1 month after the survey.
A follow up survey was then sent out 4 months later. This indicated an improvement in confidence in managing risk during telehealth intervention, with all clinicians rating their confidence as a 3/5 or 4/5 (mean 3.62) and the majority (63%) rating it as 4/5. As of September 2020, there were no incidents during telehealth sessions reported to the practice’s risk register.

Conclusion(s): Risks associated with a telehealth therapy modality are widely unknown in the literature and in clinical practice, thus services need to rapidly evolve with the changing pandemic climate in order to ensure that people living with complex needs in the community are able to access their care safely.  The results from this workplace innovation suggest that clinician’s confidence in managing risks when providing Telehealth to persons with disability improves with training videos. Simulation of real-life risk scenarios resonates with clinicians and should therefore be considered broadly as services across the globe adapt to the telehealth modality for therapy.

Implications: Telehealth delivery is often seen as too difficult or not safe enough due to the potential risks involved, such as falls. This study indicates that simulated, asynchronous video education of risk scenarios, including incident management, can increase therapist’s confidence in utilising Telehealth for therapy provision, which ultimately optimises outcomes for people living with disability in the community during this pandemic, and beyond.

Funding, acknowledgements: This work was unfunded

Keywords: disability, telehealth, risk management

Topic: Disability & rehabilitation

Did this work require ethics approval? No

Institution: N/A

Committee: N/A

Reason: This work addressed a new way of delivering staff education. No patients were included in the videos developed.