None listed
Conditions
Brief summary
The study will evaluate benefits or drawbacks of adopting a transdisciplinary model of assessment on the Mater Hospital Brisbane (MHB) Acute Stroke Unit (ASU), through implementing a Transdisciplinary Initial Neurological Screening Assessment (TINSA). All other components of patient care will be undertaken as usual. The study will recruit patients with mild stroke/Transient Ischaemic Attack (TIA) as they are admitted to the MHB ASU. Consenting participants will receive Allied Health (AH) assessment via the existing multidisciplinary model of assessment (evaluated during Phase 1 and 3) or the novel TINSA (evaluated during Phase 2 and 4). The primary hypothesis states, compared to the existing multidisciplinary model of assessment, utilising the novel TINSA on the MHB ASU will reduce AH assessment time by at least 20 minutes in the initial occasion of service. The expected outcomes include: improved AH time efficiency (measured by time spent completing AH assessment, length of stay); improved cost-effectiveness; patient safety (measured by patient falls, readmission, outcome measures at 3-months); improved compliance to national standards (AH assessment within 48hours); improved patient/staff satisfaction and staff trust (surveys).
Interventions
Transdisciplinary Initial Neurological Screening Assessment (TINSA).
The TINSA is a new assessment which combines assessments and tasks of routine physiotherapy, occupational therapy, social work, and speech pathology assessments. It will replace discipline-specific assessments, and acts as a trigger for referrals to allied health professionals.
The TINSA has been developed and tested via task analysis, discussion with discipline experts, 2 simulation process tests, and pilot testing. The TI
Transdisciplinary Initial Neurological Screening Assessment (TINSA). The TINSA is a new assessment which combines assessments and tasks of routine physiotherapy, occupational therapy, social work, and speech pathology assessments. It will replace discipline-specific assessments, and acts as a trigger for referrals to allied health professionals. The TINSA has been developed and tested via task analysis, discussion with discipline experts, 2 simulation process tests, and pilot testing. The TINSA will be administered by a registered occupational therapist or physiotherapist, who have completed the TINSA training package (involving a manual, 9 eLearning modules and a practical assessment). The TINSA training package has been specifically designed for this study and is estimated to take a total of 4 hours to complete. The occupational therapist or physiotherapist will administer the TINSA face to face on day 1 of admission to the Acute Stroke Unit (i.e., within 24-48 hours of admission to the Acute Stroke Unit). During the study periods where the TINSA is administered (Phase 2 with mild stroke/TIA presentations and Phase 4 with moderate/severe stroke presentations), the time taken to administer will be recorded. The TINS was timed during simulations, and on the second simulation was recorded to take 35-50 minutes to complete. For patients receiving the TINSA, this means they will receive a one-on-one assessment administered by either an occupational therapist or a physiotherapist. Patients will only receive the TINSA once/admission. The TINSA involves verbal questions, a brief communication screen and a physical assessment (including a mobility assessment). After the assessment, the occupational therapist or the physiotherapist will make referrals to the wider allied health team, as per their clinical training and judgement. After the novel TINSA has been administered and subsequent AH referrals made, AH input (i.e. the treatment, re-assessment, discharge panning, follow-up) will continue as per usual care. If no further allied health is indicated after the TINSA, the assessor can discharge the patient (i.e. safe to return home). Participants will be involved in the study for a total of 3 months (i.e., from admission to hospital to the follow-up phone call at 3 months after admission to hospital). During the study, adherence to the intervention will be monitored by the primary investigator when the study data is entered into the study database. Gaps in the data will be identified as flagged to the allied health team. Also, the primary investigator will check-in with the allied health team on a fortnightly basis during the regular study meeting. This meeting will be used as a space to de-brief, problem-solve and encourage ongoing adherence to the intervention / study protocol.
Sponsors
Mater Research Institute
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
PHASES 1 & 2: Patient eligibility will be determined via the following inclusion criteria: • Consenting patients admitted to the Mater Hospital Brisbane Acute Stroke Unit (Neurosciences Ward) Level 8, Salmon Building during the study periods • Consenting patients placed on the Mater stroke pathway (i.e., those who have ‘blanket’ allied health referral as per usual care) who present with: Transient Ischaemic Attack (TIA); Possible stroke and who have not received a diagnosis via the MRI report within 24-48 hours of admission; Minor neurological signs/symptoms as determined by a review of the chart notes by the ward occupational therapist or physiotherapist (i.e., patients limb strength above grade 3/5 classification, and/or without visuospatial or sensorimotor neglect, and/or without severe aphasia, and/or who are able to follow 1 stage commands). Additional patient inclusion criterion for evaluation of novel TINSA: • Patients who have provided consent and have a Montreal Cognitive Assessment (MoCA) score of greater than or equal to 19/30 (i.e. intact cognition and recall processes) will be asked to complete the patient satisfaction survey and follow up phone call. PHASES 3 & 4: Patient eligibility will be determined via the following inclusion criteria: • Consenting patients admitted to the Mater Hospital Brisbane Acute Stroke Unit (Neurosciences Ward) Level 8, Salmon Building during the study periods • Consenting patients placed on the Mater stroke pathway (i.e., those who have ‘blanket’ allied health referral as per usual care) who present with possible (i.e., have not received a diagnosis via the MRI report within 24-48 hours of admission) or confirmed stroke with moderate to severe neurological signs/symptoms as determined by a review of the chart notes by the ward occupational therapist or physiotherapist. I.e., patients with limb strength below grade 3/5 classification, and/or with visuospatial or sensorimotor neglect, and/or with severe aphasia, and/or who are not able to follow 1 stage commands. STAFF INCLUSION CRITERIA: • All consenting Mater staff (nursing, medical and allied health) and Active Rehabilitation staff working in and caring for patients with stroke in the ASU under the transdisciplinary model of assessment.
Exclusion criteria
Patient exclusion criteria (all phases): • Patients who are admitted to the Acute Stroke Unit over a weekend (Saturday and Sunday) or on a public holiday. • Patients with stroke who are not transferred to the Acute Stroke Unit. • Patients with stroke who received allied health initial assessment before transfer to the Acute Stroke Unit and/or placed on the stroke pathway. • Patients who do not speak English where a third-party professional interpreter is unavailable to assist with translation. • Patients who have already been included in the study at an earlier time point (i.e., have been readmitted).
Outcome results
None listed