Does using a transdisciplinary assessment save staff time compared to usual allied health assessments for patients with stroke and medical conditions?

Transdisciplinary Initial Neurological Screening Assessment (TINSA): The TINSA is an assessment which combines assessments and tasks of routine physiotherapy, occupational therapy, social work, and speech pathology assessments. It has replaced discipline-specific assessments (occupational therapy, physiotherapy, speech pathology, and social work) at the Mater Hospital Brisbane, and acts as a trigger for referrals to allied health professionals. The TINSA has been tested by a clinical pre-/post- study at the Mater Hospital Brisbane, and results showed improved time-efficiency and cost savings without affecting the quality of care (patient safety and outcomes). The TINSA is administered by a trained occupational therapist or physiotherapist. For patients receiving the TINSA, this involves verbal questions, a brief communication screen and a physical assessment (including a mobility assessment). When the TINSA is used, patients will experience less duplication of assessment questions and tasks. After the assessment, the administering allied health professional (e.g., occupational therapist or 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 allied health referrals made, allied health 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). In this study, the TINSA will be modified (as necessary to suit the local setting) and implemented in the study sites, replacing discipline-specific allied health assessments. At each site, a clinical pathway will be developed, as a strategy to ensure adherence to the intervention. The TINSA will be used for all patients admitting during pre-determined time periods at each study site (during the 2 week transition period, and the post-implementation period). Usual allied health assessment will be used for all patients during the pre-implementation period. Competency training for the TINSA: 9 eLearning modules are available to health professionals via the Queensland Health learning management system (iLearn). The training modules provide information on how to perform tests, asks questions, and clinical reasoning across the domains of vision/perception, communication assessment, respiratory assessment, mood, upper/lower limbs assessment, shoulder precautions, functional mobility assessment, Timed Up and Go test, and the 10 meter walk test. Each module includes written information, videos on task/question administration, and a knowledge check quiz. These resources were developed as part of an earlier study that evaluated the TINSA at the Mater Hospital Brisbane (ACTRN12621000380897). The resources have now been transferred onto iLearn and are available for Queensland Health and external professionals. The designated allied health professional/s (e.g., occupational therapists and physiotherapists) complete the competency training before administering the TINSA with patients. The modules take approximately 10-30 minutes each and are completed when the professional is able. In the study, a 2 month transition period will be used to allow for sufficient time to complete the training. After completing the eLearning modules, the allied health professional will complete the TINSA under supervision until they are marked as 'competent' according to the competency assessment criteria (copy available online: https://doi.org/10.14264/1749adb, pp80-81). The training can be re-completed at any time, at the discretion of the allied health professional, to ensure maintenance of skills. The mandatory competency training is a strategy to ensure the TINSA is delivered in a safe and standardized way. Implementation manual: An implementation manual for transdisciplinary approaches in healthcare was developed following a previous study (ACTRN12621000380897) and is available online https://doi.org/10.14264/1749adb. The implementation manual will guide the local team to modify the TINSA to suit their local setting and patient presentations. The implementation manual involves three stages to 1) plan and prepare, 2) implement and evaluate, and 3) sustain and expand. In this study, stages 1 and 2 will be followed during weekly team meetings prior to the implementation of the TINSA. Focus Group (healthcare providers): At the end of the transdisciplinary implementation and data collection phase, acute stroke unit/medical ward staff will be invited by the local study coordinator to participate in a once-off, online, 60 minute Focus Group (via work email, staff meetings/huddles, and verbal invitations). Recruitment will occur over two weeks at each study site. It is estimated that a maximum of 20 staff will be asked to participate (i.e., all allied health, nursing, medical staff working on the ward). Interested staff will reply and nominate a suitable date/time. We are aiming to recruit a maximum of 8 Focus Group participants per site. At this point, the local study coordinator will organise the Focus Groups by sending Outlook diary invitations with a Zoom link for the Focus Group and the PICF for healthcare staff to read and consider before providing written consent. The Principal Investigator (AM) will facilitate and later transcribe the online Focus Group with healthcare staff. A Co-investigator (LL) will assist with the Focus Group. The role will be to alert the Principal Investigator of any matters that may not have been noted by the focus group facilitator and which need to be addressed before the end of the Focus Group; and to take notes of any non-verbal or other matters that may arise. This method will ensure that the Focus Group method obtains its aims and objectives. In the focus group, topics discussed will be the utility of the TINSA and the implementation experience.