Can a new ward environment and intensive allied health staffing model enhance therapeutic opportunities in trauma care? A behavioural mapping study of patients’ activities and interactions

Abstract

Objective The aim of this study was to assess changes in patient activities and interactions observed in response to a new trauma ward at a level 1 trauma centre, and subsequently, a new allied health staffing model. Design Explorative case study using behavioural mapping. Setting Level 1 trauma centre in Melbourne, Australia. Participants Hospitalised trauma patients. Main measures Behavioural mapping of patients’ activities and interactions was conducted by two observers over three 4-day observation phases: (i) at baseline, (ii) on the new ward and (iii) with the new staffing model. Changes in activities and interactions were assessed via negative binomial regression models and reported as incident rate ratios. Results In total, 1264 patient observations were recorded over an 18-month period. After moving to the new ward, patients were observed performing activities of daily living at a 2.1-fold higher rate than at baseline (95% confidence interval: 1.18, 3.81) but walking/standing/climbing stairs 54% less (95% confidence interval: 0.22, 0.94). Subsequent to the new staffing model, patients were observed in the gym at a 4.1-fold higher rate (95% confidence interval: 1.60, 10.32) and interacting with allied health professionals at a 9.1-fold higher rate (95% confidence interval: 4.88, 16.98), than at baseline. After COVID-19 restrictions were introduced, patients were observed lying down 22% more (95% confidence interval: 1.04, 1.43), with 73% fewer visitor interactions (95% confidence interval: 0.17, 0.43). Conclusions Greater engagement in physical and social activities was observed following the implementation of the new allied health staffing model at a level 1 trauma centre. Whether these changes translate to improved trauma outcomes is important to investigate.

Cost-effectiveness of a purpose-built ward environment and new allied health model of care for major trauma

“…A behavioral mapping study showed that the new ward environment was associated with increases in activities of daily living by patients, addition of the AHMOC to the new ward was associated with a 4-fold increase in gym usage and a 9-fold increase in interaction with allied health clinicians. 24 The findings of this study support the benefit of the new AHMOC on outcomes and costs of major trauma patients. Nevertheless, there were limitations to the study which warrant acknowledgement.…”

“…The new ward alone was not associated with improvement in any of the outcomes of interest in this study. A behavioral mapping study showed that the new ward environment was associated with increases in activities of daily living by patients, addition of the AHMOC to the new ward was associated with a 4-fold increase in gym usage and a 9-fold increase in interaction with allied health clinicians 24 …”

A general theory of rehabilitation: Rehabilitation catalyses and assists adaptation to illness

“… 18 The broad nature of the facilitative environment is illustrated by the essential features of stroke unit care: 69 , 70 Structured assessment procedures Policies on early stages of management of common problems Policy on the ongoing rehabilitation Expertise in stroke management and rehabilitation with regular team education Multidisciplinary teamwork with regular planned team meetings Involvement of patients and families Other studies have shown that: Planned changes in the physical environment alter the behaviour of patients, increasing their activities. 71 – 74 Social factors influence adaptation; for example, after a stroke, community activity is influenced by social networks 75 and being with other people is associated with more movement of the affected arm. 76 The harm caused by inappropriate environments is also clear.…”

“…Planned changes in the physical environment alter the behaviour of patients, increasing their activities. 71 – 74 …”