Author: Shane Pritchard BPhysio APAM Director and Musculoskeletal Curriculum Lead How do you know when it is appropriate to refer a patient to another healthcare discipline? And how do you know who is the most appropriate discipline to refer them to? These questions have been asked many, many times in our Clinical Assessment Simulation Courses so far this year. In this blog we’ll provide a summary of the health professional disciplines who routinely make up the Allied Health Professions of the Australian healthcare system, and discuss some examples of when it would be appropriate to involve other disciplines. Interprofessional collaborative practice (ICP) is extremely important “Interprofessional collaborative practice” refers to the active participation of several healthcare disciplines in the care of a patient(1) . ICP enables shared clinical decision making, continuous communication, and facilitates respect for the contributions of all providers. Practicing in this way benefits patients, family, and caregivers(2) . However, we must remember that interprofessional collaboration is not doing another professional’s job. It is about identifying areas that are outside your own skills and scope, and directing to the most appropriate practitioner. What is required of me in my APC clinical exam? The below table is taken from the Clinical Assessment Information Booklet for Simulation candidates, published by the APC. Domain 2.5 of “interpret and analyse the assessment findings” outlines what you must demonstrate in your assessment (and, for that matter, in your physiotherapy work as a clinician also!) When you're working with a patient, the “identifying” will happen either in the moment as you listen to your patient's concerns, or afterwards when you reflect on your assessment findings. You might think to yourself "physiotherapy can't help with that, but a different discipline can". This would require a referral to another health profession. You could discuss this with your patient directly. Alternatively, part of your exam involves "Oral Reporting Time", where your "assessors to seek clarification of the treatment plan and the rationale behind the intervention as some Candidates may not verbalise their actions during the assessment. Assessors can also use this time to ask the Candidate about their ongoing management plan of the patient." (Page 4). You might then discuss a referral to another health profession with your patient directly. What allied health professions are there in Australia? Here’s a summary of allied health professions who you may consider discussing a referral about, if areas are identified that are outside your own skills and expertise:
Table adapted from Allied Health Professions Australia website(3) Examples of referrals in practice Cardiorespiratory practice Our Cardiorespiratory 1 Simulation course requires participants to practice assessing and managing a person who is 68 years old, and was diagnosed with chronic obstructive pulmonary disease (COPD) 4 years ago. This patient has been in and out of hospital since her diagnosis. The scenario traverses three timepoints where she has another hospital admission for an exacerbation of her COPD, then day before discharge, and attending a pulmonary rehabilitation assessment appointment three weeks after getting home. In this scenario, you might need to consider referrals to
Our Musculoskeletal 1 Simulation course requires participants to practice assessing and managing a person who is 41 years old, and has had back pain for many years. This scenario traverses three timepoints where this person experiences a significant flare up of her pain requiring an acute hospital admission, a stint in inpatient rehabilitation, and then follow up as an outpatient after discharge home. In this scenario, you might need to consider referrals to:
Our Neurological 1 Simulation course requires participants to practice assessing and managing a person who is 63 years old, and is diagnosed as having a stroke. The scenario traverses three time points where this person is initially admitted to hospital with left-sided weakness, drooling, unable to stand, then transferred to an inpatient rehabilitation hospital and finally attending physiotherapy for outpatient rehabilitation. In this scenario, you might need to consider referrals to:
What questions do you have about referring to other health practitioners? We hope that has been a helpful summary for your understanding how different health professionals can be involved in patient care in Australia.
Do you feel that you could confidently do this both in your APC exam, but also in day to day clinical practice? Please comment below any questions or comments you have about referrals and other health professions. Additionally, if you’d like to learn more about our Clinical Assessment Simulation Courses, where you can practice your skills with a simulated patient (actor) and receive feedback on your physiotherapy performance before your exam, please click here. References
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