A Quasi-Experimental Retrospective Cohort Study Evaluating Demand, Utilisation and Efficiency of a Pilot 7-Day Multidisciplinary Allied Health Assistant Model of Care in a Regional Australian General Medical Ward.
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Abstract
Objective: To evaluate a 7 day multidisciplinary allied health assistant (mAHA) model of care in an acute general medical setting as a strategy to support service sustainability in the context of hospital bed block.
Background: Regional and rural hospitals face challenges delivering timely allied health (AH) care due to workforce shortages, limited weekend coverage and increasing patient complexity. mAHAs may support service sustainability; however, evidence for acute 7-day models is limited.
Methods: Analysis of 1615 delegations (pilot n = 594; BAU n = 1021) compared a 5 day business-as-usual (BAU) service (1/10/2021-28/2/2022) with a pilot 7-day model (1/10/2022-28/2/2023) servicing 56 acute beds. Outcomes assessed demand, utilisation and care efficiency.
Design: A quasi-experimental evaluation of an organisational intervention.
Setting: Regional hospital.
Main outcome measures: Outcomes included measures of demand (delegations, occasions of service (OOS), therapy time), utilisation (by profession, day of week), and care efficiency (OOS/delegations per rostered day, time/OOS per delegation).
Results: The 7-day model delivered increased delegations (81.9%, p < 0.0001), occasions of service (61.2%, p < 0.0001), and therapy time (127.4%, p < 0.0001), primarily for physiotherapy. The 7-day service model improved load-levelling, reducing early-week demand. Care efficiency improved, with more OOS and delegations per rostered day (p < 0.0001), shorter time per OOS (p < 0.0001) and greater therapy time per admission (p < 0.0001). These improvements occurred without additional AH productive FTE. Utilisation remained physiotherapy-led.
Conclusions: In regional hospitals experiencing hospital bed block, a 7-day mAHA model improved access to and efficiency of AH services without the need for additional AH staffing. Limited uptake by non-physiotherapy disciplines constrained full multidisciplinary benefit and warrants further investigation.
目的：评估急性普通医疗环境中7天多学科联合健康助理（mAHA）护理模式作为支持医院床位阻塞背景下服务可持续性的策略。背景：由于劳动力短缺、周末覆盖有限和患者复杂性增加，地区和农村医院面临着及时提供联合健康（AH）护理的挑战。maha可以支持服务的可持续性；然而，急性7天模型的证据有限。方法：对1615个代表团（试点n = 594; BAU n = 1021）进行分析，比较服务56张急症病床的5天正常营业（BAU）服务（2021年10月1日至2022年2月28日）与7天试点模式（2022年10月1日至2023年2月28日）。结果评估了需求、利用和护理效率。设计：对组织干预的准实验评估。地点：地区医院。主要结果测量：结果包括需求测量（代表团、服务场合（OOS）、治疗时间）、利用（按专业、星期）和护理效率（每个登记日的OOS/代表团、每个代表团的时间/OOS）。结果：7天模式增加了代表团人数（81.9%），p结论：在经历医院床位阻塞的地区医院，7天mAHA模式在不需要增加医院人员的情况下改善了医院服务的可及性和效率。非物理治疗学科的有限吸收限制了充分的多学科益处，值得进一步研究。
期刊介绍：
The Australian Journal of Rural Health publishes articles in the field of rural health. It facilitates the formation of interdisciplinary networks, so that rural health professionals can form a cohesive group and work together for the advancement of rural practice, in all health disciplines. The Journal aims to establish a national and international reputation for the quality of its scholarly discourse and its value to rural health professionals. All articles, unless otherwise identified, are peer reviewed by at least two researchers expert in the field of the submitted paper.
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