Transdisciplinary care within the emergency department: reflections from a speech pathology pilot.

Abstract

Background: In the face of escalating pressure on the health care system, providers are seeking innovative solutions to improve efficiency of care. Since their inception in 2004, Emergency Department (ED) Care Coordination (CC) teams have sought to assist patient flow through the completion of holistic assessment, prescription of equipment and onward referring to appropriate community services to facilitate a safe and timely discharge. CC teams traditionally comprise of Occupational therapy, Physiotherapy, Social Work and Nursing team members and their respective traditional areas of practice. The absence of Speech Pathology (SP) is striking given high SP service demand within Monash Medical Centre. SPs employed in transdisciplinary roles is not a novel concept, existing in the mental health and paediatric settings. The early success of a trial to incorporate podiatry in the CC team, sparked expansion to include SP. Aim: The novel profession pilot set out to establish the feasibility the inclusion of the SP profession within the ED CC team. Method: Activity data was collect from the electronic medical record and qualitative data was obtained pre and post pilot by a series of surveys and semi-structured interviews from the participant and wider team. Results: Clinical competency: Minor differences in the number of shifts required to complete transdisciplinary competencies Clinical efficiency: No difference in average occasions of service (OOS) or the average OOS time. Clinical effectiveness: No difference in referral ‘action’ and ‘completion’ times. No difference in referral outcomes. Patient outcomes: No reported incidents. Conclusion:1) SPs can take on the role of ED Care Coordinators. 2) Orientation and competency packages are essential for the development of transdisciplinary skills. 3) Clinician-specific factors, such as work history and personal attributes, have a significant impact on success within the role