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A. Martin1, L. Laakso1,2, M. Sowa3, T. Green3,2,4, A. McCarthy1
1Mater Research Institute - University of Queensland, Brisbane, Australia, 2Griffith University, Brisbane, Australia, 3The University of Queensland, Brisbane, Australia, 4University of Calgary, Calgary, Canada
Background: A transdisciplinary clinician is a professional who has completed additional training to develop competencies in tasks or skills usually outside their scope of practice. An example is a physiotherapist who is skilled to administer a language assessment. A transdisciplinary neurological assessment was developed at Mater Hospital Brisbane in response to patient and staff feedback that allied health stroke assessments were repetitive. Factors related to patient safety, clinician confidence and competence were evaluated over 22 months.
Purpose: To reduce assessment duplication by developing and implementing a transdisciplinary assessment on the acute stroke unit. Aim: To measure clinician confidence, competence, and patient safety using the transdisciplinary assessment, compared to usual assessments.
Methods: Fit-for-purpose surveys were used to measure staff confidence before and after completing transdisciplinary training, and at monthly intervals. Patients admitted to the acute stroke unit were recruited and allocated to the consecutive usual care (Phase 1, N = 52) and transdisciplinary (Phase 2, N = 55) assessment groups. Clinician competence was measured by competency assessments and audit of completed transdisciplinary assessments. Medical chart audits were completed to obtain patient safety data, including number of falls, adverse events, missed allied health referrals, and unplanned hospital readmissions. Data was analysed using descriptive statistics and comparing group differences.
Results:Clinician confidence:Overall confidence started at 5.55 (out of 10) and improved to 8.85/10 after training. Transdisciplinary clinician confidence improved over time, rating 9/10 at 9-months after roll-out of transdisciplinary training.
Clinician competence: All 10 physiotherapists and 4 occupational therapists passed the competency assessment. One physiotherapist required further training for the language component. For 95% of transdisciplinary assessments completed, clinicians filled out >85% of the assessment.
Patient safety: Medical chart audits showed no change in patient safety indicators between usual care and transdisciplinary groups. Both groups recorded <10% incidence of missed allied health referrals, <6% incidence of hospital readmissions within 30 days, 0 patient falls, and 0 adverse events of hospital acquired pressure injuries or aspiration pneumonia.
Clinician competence: All 10 physiotherapists and 4 occupational therapists passed the competency assessment. One physiotherapist required further training for the language component. For 95% of transdisciplinary assessments completed, clinicians filled out >85% of the assessment.
Patient safety: Medical chart audits showed no change in patient safety indicators between usual care and transdisciplinary groups. Both groups recorded <10% incidence of missed allied health referrals, <6% incidence of hospital readmissions within 30 days, 0 patient falls, and 0 adverse events of hospital acquired pressure injuries or aspiration pneumonia.
Conclusions: To our knowledge, this is the first study to measure transdisciplinary clinician confidence, competence, and patient safety. Results indicate that training and peer-reviewed practice is important to foster transdisciplinary clinician confidence. After training, clinicians were competent to consistently administer all sections of the transdisciplinary assessment. Patient safety results suggest that trained physiotherapists and occupational therapists can safely work as transdisciplinary clinicians on acute stroke units. Generalisability of results beyond the current setting is unknown. Future studies should measure patient safety, clinician confidence and competence when transdisciplinary assessments and training are implemented in other healthcare settings.
Implications: We have demonstrated that trained physiotherapists and occupational therapists can work as transdisciplinary clinicians on acute stroke units. We suggest provision of training prior to working as a transdisciplinary clinician should be included in organisation position statements, work instructions, future research, or clinical projects. We are exploring avenues to share the transdisciplinary training developed at Mater Hospital Brisbane.
Funding acknowledgements: Aleysha Martin received funding from The University of Queensland, National Health and Medical Research Council, Mater Misericordiae Ltd, Queensland Health.
Keywords:
Transdisciplinary
Confidence
Competence
Transdisciplinary
Confidence
Competence
Topics:
Professional practice: other
Education: clinical
Globalisation: health systems, policies & strategies
Professional practice: other
Education: clinical
Globalisation: health systems, policies & strategies
Did this work require ethics approval? Yes
Institution: Mater Misericordiae Ltd
Committee: Mater Misericordiae Ltd Human Research Ethics Committee
Ethics number: HREC/MML/66933
All authors, affiliations and abstracts have been published as submitted.
