Allied Health Transdisciplinary Models of Care in Hospital Settings: a Scoping Review Protocol

Allied health transdisciplinary models of care in hospital settings: a scoping review protocol

Abstract

Objective: The objective of the scoping review is to systematically examine and map the range, type, and outcomes of transdisciplinary models of care that have been implemented in hospital-based allied health teams.

Introduction: Healthcare frameworks and strategic plans support transdisciplinary models of care as a strategy to redesign healthcare to optimize workforce skills and efficiency. There is limited research evidence that evaluates transdisciplinary models of care in hospital-based allied health teams, and the factors that might contribute to successful implementation.

Inclusion criteria: Sources will be considered for inclusion that 1) define or describe transdisciplinary teams in any adult (>18 years of age) healthcare setting, and 2) evaluate transdisciplinary models of care in adult (>18 years of age) hospital settings, where at least two allied health professionals combine assessment, intervention and/or discharge planning to allow a single allied health professional to work beyond traditional discipline boundaries.

Methods: The databases PubMed, CINAHL, Scopus, and the Cochrane Library, and the search engine Google will be searched. Results will be limited by date (2011 – 2021) and language (English). Screening and data extraction will be completed by two independent reviews, where disagreements are resolved by discussion or a third reviewer. Data will be analysed descriptively, and key results presented in tabular format.

Protocol information

Author: Aleysha Martin

Co-authors: Professor Theresa Green, Dr Marcin Sowa, Professor Alexandra McCarthy, Dr Liisa Laakso

Contact person: Aleysha Martin, [email protected]

Protocol date: 12 January 2021

1. Introduction

Healthcare sustainability and redesign are global issues (1). There is growing demand for healthcare services due to the ageing population and higher incidence of chronic disease (2, 3). For example, in Australia the number of stroke cases diagnosed each year is >50,000, and this number is predicted to exceed 130,000 by 2050 (4). Furthermore, the volume of allied health professionals is not increasing proportionately to growing demand for services (3, 5). Key Australian healthcare frameworks and strategic plans support transdisciplinary models of care as a means of redesigning healthcare to optimise workforce skills and efficiency (6-8). It is therefore essential to understand what such models of care might look like and the advantages and/or disadvantages of transdisciplinary models of care compared to usual multidisciplinary care. There is limited research evidence that evaluates transdisciplinary models of care in hospital-based allied health teams, and the factors that might contribute to successful implementation. Furthermore, guidelines for clinical application have not yet been established. More research is needed in this space, and an opportunity for a clinical study exists at the Mater Hospital Brisbane Acute Stroke Unit. To provide important background and a clear direction for the clinical study, this proposed scoping review will examine allied health transdisciplinary models of care in adult hospital settings. In line with the potential clinical study population, paediatric populations (< 18 years old) will not be considered, and a secondary focus will be placed on Acute Stroke Units.

Definitions To situate the reader regarding the context of the scoping review, the following three sections provide definitions of terms used in this document. This context is important to establish before delving into the purpose of the scoping review which will synthesis outcomes of allied health transdisciplinary models of care in hospital settings.

Allied health disciplines As there is no universally accepted definition of allied health disciplines, different government departments and providers include different professionals under the term “allied health” (14). There is consensus that allied health disciplines are not part of the medical, dental or nursing professions (14). Moreover, an allied health professional is university qualified, trained to treat a range of health conditions, provide specialised support, and abide by the code of ethics/conduct stipulated by the governing body (14). In Australia, the allied health professionals currently registered with the Australian Health Practitioner Regulation Authority (APHRA) are occupational therapy, physiotherapy, podiatry, psychology, pharmacy, optometry, osteopathy, chiropractic, and medical radiation practice (14). Other literature also includes dietetics, speech pathology, podiatry and social work as allied health professions

(3). For the purposes of the scoping review, “allied health” will encompass all health disciplines apart from medical, dental, and nursing. An “allied health transdisciplinary model of care” is defined as where at least two allied health professionals combine assessment, intervention and/or follow-up to allow a single allied health professional to work beyond traditional discipline boundaries. In addition to two allied health professions, an “allied health transdisciplinary model of care” can also include other allied health professionals, medical, nursing, or dental professionals in recognition that these professionals can all hold a vital role in transdisciplinary healthcare teams. The focus on allied health professionals has been selected for two reasons: 1) it is recognised in the literature that allied health professionals have potential to work across discipline boundaries to reduce assessment/intervention duplication (15); and 2) the potential clinical study at Mater Hospital Brisbane will evaluate a transdisciplinary model of care in which allied health assessments are combined.

Transdisciplinary models of care The way healthcare is delivered is defined by the model of care used by the healthcare team. A model of care is typically defined by the way healthcare professionals interact and work together to provide patient care. Transdisciplinary models of care involve transcending discipline boundaries, sharing skills and integrating healthcare to allow a single clinician to use a shared conceptual framework to complete a variety of clinical assessments and tasks (3, 8, 11). This is not the same as multidisciplinary models of care, where multiple clinicians work in parallel or sequentially within a defined scope of practice to complete discipline-specific assessments and tasks (3). Nor is it interdisciplinary and interprofessional models of care. A discipline refers to a body of scientific knowledge; whereas, a profession is an organisational body with people who are educated with specific knowledge (12). Interdisciplinary means multiple clinicians working together and combining their scientific knowledge and disciplinary perspectives to address a common problem (8, 11, 13); whereas, an interprofessional team consists of healthcare professionals who separately offer their unique knowledge and services to the patient (12). In summary, transdisciplinary models of care move health service delivery away from the traditional and discrete roles that are central to multidisciplinary, interdisciplinary, and interprofessional models (3). As a result, health professionals work in an expanded scope of practice and across traditional boundaries, sharing knowledge, skills and responsibilities to allow any single allied health profession to provide comprehensive intervention, assessment and/or follow up (11, 13). All health professions (i.e., allied health, nursing, doctors and dental professions) have opportunities to operate under transdisciplinary models of care. This scoping review will focus on allied health transdisciplinary models of care as it has been recognised in the literature that allied health professionals have potential to work across discipline

boundaries to reduce assessment/intervention duplication (15). Additionally, the focus on allied health transdisciplinary model of care is of interest for the potential clinical study at Mater Hospital Brisbane.

Hospital settings Hospitals are healthcare facilities authorised to provide treatment and/or care to patients (9). A hospital provides a range of general and/or specialised services for patients of various age groups and with various conditions, with the primary purpose to restore, maintain or promote health (10). For the purposes of the scoping review, hospital settings encompass emergency departments, acute wards (for example general medical wards and Acute Stroke Units), rehabilitation wards and hospital-based specialist clinics, with/without the organisation or provision of community follow-up; and the aspects of healthcare provided in hospitals include assessment and re-assessment, intervention and treatment, discharge planning and decision making, and hospital-based follow-up appointments. A secondary focus will be placed on Acute Stroke Units, as this is the specific hospital setting of the potential clinical study at Mater Hospital Brisbane.

Outcomes of allied health transdisciplinary models of care Allied health transdisciplinary models of care are an emerging field in research and healthcare. Some early observational studies and one single-blind randomised controlled trial based in medical wards and emergency departments show promising time efficiency gains, encouraging quality of care results and positive patient outcomes. Observational studies are the most common study design in the literature due to pragmatic factors in clinical settings. Compared to usual practice, a transdisciplinary care group received assessment 11 hours earlier, spent 3 days less in hospital and AUD$112.66 in allied health hours was saved per patient (3, 5). An advantage of reduced length of stay and earlier assessment is reduced patient risk of hospital-acquired complications such as nosocomial infections and medication errors (16, 17). Another advantage of transdisciplinary approaches is improved quality of care that is evaluated by quantitative outcome measures as well as stakeholder perspectives including patient satisfaction (6, 18). Limited rigorous research has specifically evaluated the advantages and/or disadvantages of an allied health transdisciplinary approach in an Acute Stroke Unit. One observational clinical project combined aspects of occupational therapy, physiotherapy, speech pathology, social work, dietetics and psychology into transdisciplinary assessment, intervention, and community follow-up. The allied health transdisciplinary model of care was associated with a reduced hospital length of stay of 33.9 hours (15). The observational pre-post study, however, did not account for potential confounders in the study design or the basic data analysis performed (15). Furthermore, the study did not define

what aspects of the allied health disciplines were combined across assessment, intervention and follow- up (15). The scoping review will synthesise the outcomes of transdisciplinary studies, with a specific focus on Acute Stroke Units to inform the potential clinical study at the Mater Hospital Brisbane Acute Stroke Unit.

Labour and capital cost implications of implementing allied health transdisciplinary models of care From the initial limited search of the evidence, only one study included a cost-effectiveness evaluation of transdisciplinary models of care. In the study, compared to usual practice, a transdisciplinary care group saved AUD$112.66 in allied health hours per patient (5). Despite the limited research of the labour and capital cost implications, it is suggested that a transdisciplinary model of care is a cost- effective solution and future research should include economic analysis (19).

Factors influencing successful implementation of allied health transdisciplinary models of care Transdisciplinary models of care might be successful or unsuccessful, depending on contextual factors and the allied health professional team. For example, allied health professionals might perceive a transdisciplinary model as a threat to discipline-specific knowledge, skills and roles (3). This could lead to ambiguous role definitions, “turf-wars” and interprofessional distrust when sharing profession- specific tasks (13, 20). Conversely, some health professionals might find it liberating to move away from discipline boundaries, the notion of expertise, discipline-specific language and stereotyped roles (3). These professionals could appreciate increased knowledge, skills and professional growth (13). Another facilitating factor could be improved teamwork, associated with cohesiveness and worker flexibility, which might lead to important outcomes including a more holistic perspective by team members, improved patient management and improved patient outcomes (3, 13). Conversely, skill sharing could be perceived to be unsafe and pose new risks for patients and clinicians (3), and financial risks to the organisation. Lastly, depending on the context, healthcare professionals might find that transdisciplinary models of care lead to more equal distribution or inequitable distribution of responsibilities among team members (13). Overall, various barriers and facilitators could contribute to implementation of transdisciplinary models of care and are important concepts to analyse in the scoping review.

Conclusion and statement of research aim A preliminary search of the literature and existing reviews on the topic has been undertaken. Databases searched included PubMed, CINAHL, Scopus, and the Cochrane Library. As literature evaluating

transdisciplinary models of care is in its infancy, the Google search engine was used to search for relevant grey literature. From all the platforms, relevant literature was found, but no scoping review has previously been completed on the topic. In response to this evidence gap, the scoping review will systematically examine and map the range, type, and outcomes of transdisciplinary models of care that have been implemented in hospital-based allied health teams.

2. Objective

The objective of this scoping review is to systematically examine and map the range, type, and outcomes of transdisciplinary models of care that have been implemented in hospital-based allied health teams.

3. Review questions

Primary question In hospital-based allied health teams, what transdisciplinary models of care have been evaluated and what were the outcomes (compared to usual multidisciplinary care)?

Secondary question 1 What allied health disciplines are involved in hospital-based transdisciplinary models of care?

Secondary question 2 What are the outcomes of implementing an allied health transdisciplinary model of care on an Acute Stroke Unit?

Secondary question 3 What are the labour and capital cost implications of implementing an allied health transdisciplinary model of care in hospital settings?

Secondary question 4 What are the factors influencing successful implementation of allied health transdisciplinary models of care in hospital settings?

4. Inclusion criteria

The inclusion criteria are designed to address the research objective and research questions (see sections 2 and 3).

Population The scoping review will consider transdisciplinary models of care broadly, not a specific medical condition or patient population. A secondary focus will be placed on transdisciplinary models of care for adults (i.e. ≥ 18 years of age), especially adults who have admitted to hospital with a stroke (cerebrovascular accident). No diagnosis will be excluded from the review. Another secondary focus will be placed on allied health disciplines (i.e. health professionals other than medical, nursing, and dental) involved in transdisciplinary models of care. When the transdisciplinary model of care involves allied health professionals as well other professionals (e.g. medical, nursing, and dental), such models will also be included.

Concept

Intervention The scoping review will examine hospital-based allied health transdisciplinary models of care. “Hospital- based" includes emergency departments, acute wards (for example general medical wards and Acute Stroke Units), rehabilitation wards/units and hospital-based specialist clinics. Hospital-based transdisciplinary models of care can also include organisation or provision of community follow-up. “Allied health” will encompass all health disciplines apart from medical, dental, and nursing, where an “allied health transdisciplinary model of care” must comprise at least two allied health disciplines, and where there is evidence or role blurring and/or at least one element of healthcare is delivered by a single professional. Role blurring is when a professional works beyond traditional discipline boundaries to complete an assessment, task, or intervention for which a different discipline would usually be responsible. When the transdisciplinary model of care involves allied health professionals as well other professionals (e.g. medical, nursing, and dental), such models will also be included. “Element of healthcare” will include assessment and re-assessment, intervention and treatment, discharge planning and follow-up.

Comparison The comparison will be “usual care”, which will be any model of care apart from a transdisciplinary model of care. This means that usual care can be a multidisciplinary, interdisciplinary or

interprofessional model of care (as per the definitions provided in section 1 of the scoping review protocol).

Team-based healthcare In addition to the literature that evaluates hospital-based allied health transdisciplinary models of care, a secondary focus will be placed on:

• outcomes of implementing transdisciplinary models of care on an Acute Stroke Unit; • factors influencing successful implementation of transdisciplinary models of care; • interprofessional trust; • allied health/transdisciplinary/multidisciplinary/interdisciplinary definitions; • team based healthcare considering national priorities and/or legislation.

Context All literature must be relevant to healthcare settings. Furthermore, the sources evaluating allied health transdisciplinary models of care must be hospital-based. “Hospital-based" includes emergency departments, acute wards (for example general medical wards and Acute Stroke Units), rehabilitation wards/units and hospital-based specialist clinics. Hospital-based transdisciplinary models of care can also include organisation or provision of community follow-up. The geographical context will not be a limiting parameter, and all literature will be considered from Australia and internationally.

Types of evidence sources The types of evidence sources included must be broad, due to the limited and emerging nature of the literature pertaining to the scoping review topic. Any design of qualitative, quantitative or review articles will be considered, where the study objective was to evaluate a transdisciplinary model of care in a hospital setting, and/or evaluate team-based healthcare. Grey literature including official healthcare websites/pdf documents, official government websites/pdf documents, clinical projects, conference presentations, conference abstracts, and conference posters will also be considered, due to the clinical relevance. Other grey literature will be excluded as it is anticipated it will lack formal quality assessment and/or clinical relevance, which might impact the significance and utility of the findings of the proposed scoping review.

Summary of inclusion criteria As described in detail above, the following sources will be included in the review.

Sources that define, describe, and/or evaluate at least one of the following:

• A hospital-based allied health transdisciplinary model of care, where: o Hospital-based includes emergency departments, acute wards, rehabilitation wards/units and hospital-based specialist clinics (with/without community follow-up); o Allied health includes any health discipline apart from medical, dental and nursing; o Allied health transdisciplinary model of care is the combination of at least two allied health disciplines with evidence of role blurring where at least one element of healthcare (assessment, intervention, discharge) is delivered by a single professional; o Outcome measures are reported that include labour and capital cost implications, factors influencing successful implementation, perceptions. • Team-based health care, which defines, describes, and/or evaluates: o Allied health; o Transdisciplinary/multidisciplinary/interdisciplinary/interprofessional/interprofessional collaboration; o Interprofessional trust; o National healthcare priorities or legislation.

Quality of sources:

• Any type of qualitative, quantitative or review article; • Grey literature in the formats of official healthcare websites/pdfs, official government websites/pdfs, clinical projects, conference presentations, conference abstracts, and conference posters; • Full text articles are available electronically; • No geographical restrictions; • Published in the English language; • Published in the last 10 years (2011 – 2021).

Summary of exclusion criteria As described in detail above, the following sources will be excluded from the review.

Sources that define, describe, and/or evaluate transdisciplinary models of care:

• solely in a community setting, primary health care setting, or private practice;

• outside of a healthcare setting; • with no reference to allied health (i.e., nursing, medical or dental only); • in relation to interprofessional education; • in relation to paediatrics (i.e. <18 years of age).

Sources that define, describe, and/or evaluate team-based healthcare:

• outside of a healthcare setting; • only in relation to interprofessional education; • only in relation to paediatrics (i.e. <18 years of age).

Quality of sources:

• All other grey literature (unless otherwise specified in the inclusion criteria) • exported URL is “not found” or “connection unsecure” or “connection not private” or “unavailable”; • published date is not available; • where the reviewer must leave the primary webpage to view or search for relevant information contained in a different webpage.

5. Methods

The following search strategy is designed to be comprehensive and identify key published/unpublished research studies, official healthcare websites, clinical project results and conference presentations. Where unpublished literature is identified, the reviewer’s intent is to contact the author for further information as relevant.

Search strategy The key words and search terms that will be used in the initial limited search include:

Search 1: (transdisciplinary OR trans-disciplinary OR transprofessional OR transdisciplinarity [Title/Abstract]) AND (medical OR hospital* OR acute OR emergency OR care OR healthcare OR health care OR stroke unit OR rehab* OR ward OR inpatient OR intervention OR assessment [Title/Abstract])

Search Term 1 Search Term 2 medical

OR hospital* OR acute transdisciplinary OR OR emergency trans-disciplinary AND OR OR healthcare transprofessional OR OR health care transdisciplinarity OR stroke unit OR Rehab* OR ward OR inpatient OR intervention OR assessment

Search 2: Interprofession* AND (staff OR employee* OR personnel* OR worker* OR team*) AND trust

Search Term 1 Search Term 2 Search Term 3 staff OR employee* OR Interprofession* AND personnel* AND trust OR worker* OR team*

Search 3: (patient* OR client* OR inpatient* OR consumer* OR carer* OR family) AND (perspective* OR experience* OR feedback OR opinion* OR satisfaction) AND (transdisciplinary OR trans-disciplinary OR transprofessional OR transdisciplinarity OR interprofessional) AND (hospital* OR healthcare OR health care OR emergency OR acute OR medical OR stroke unit OR rehab*)

Search Term 1 Search Term 2 Search Term 3 Search Term 4 patient* perspective transdisciplinary hospital* OR OR experience* OR OR

client* OR trans-disciplinary healthcare OR feedback OR OR consumer* OR transprofessional health care OR AND opinion* AND OR AND carer* OR transdisciplinarity OR satisfaction OR family interprofessional

The searches listed above have been adapted for each database:

PubMed (transdisciplinary[Title/Abstract] OR trans-disciplinary[Title/Abstract] OR transprofessional[Title/Abstract] OR transdisciplinarity[Title/Abstract]) AND (medical[Title/Abstract] OR hospital*[Title/Abstract] OR acute[Title/Abstract] OR emergency[Title/Abstract] OR care[Title/Abstract] OR healthcare[Title/Abstract] OR health care[Title/Abstract] OR rehab*[Title/Abstract] OR ward[Title/Abstract] OR inpatient[Title/Abstract] OR intervention[Title/Abstract]) Filters: 2011 – 2021, English Results: 580 (interprofession*[Title/Abstract]) AND (staff[Title/Abstract] OR employee* OR personnel*[Title/Abstract] OR worker*[Title/Abstract] OR team*[Title/Abstract]) AND (trust[Title/Abstract]) Filters: 2011 – 2021, English Results: 155 (patient*[Title] OR client*[Title] OR consumer*[Title] OR carer*[Title] OR family[Title]) AND (perspective*[Title] OR experience*[Title] OR feedback[Title] OR opinion*[Title] OR satisfaction[Title]) AND (transdisciplinary[Title/Abstract] OR transdisciplinary[Title/Abstract] OR transprofessional[Title/Abstract] OR transdisciplinarity[Title/Abstract] OR interprofessional[Title/Abstract]) AND (hospital*[Title/Abstract] OR healthcare[Title/Abstract] OR health care[Title/Abstract]) Filters: 2011 – 2021, English Results: 110 CINAHL ( TI ( transdisciplinary OR trans-disciplinary OR transprofessional OR transdisciplinarity ) OR AB ( transdisciplinary OR trans-disciplinary OR transprofessional OR transdisciplinarity ) ) AND ( TI ( medical OR hospital* OR acute OR emergency OR care OR healthcare OR health care OR rehab* OR ward OR inpatient OR intervention OR assessment) OR AB ( medical OR hospital* OR acute OR emergency OR care OR healthcare OR health care OR rehab* OR ward OR inpatient OR intervention OR assessment) ) Filters: 2011 – 2021, English Results: 393 ( TI (interprofession*) OR AB (interprofession*) ) AND ( TI (staff OR employee* OR personnel* OR worker* OR team*) OR AB (staff OR employee* OR personnel* OR worker* OR team*) ) AND ( TI (trust) OR AB (trust) ) Filters: 2011 – 2021, English Results: 88 Scopus (TITLE (transdisciplinary OR trans-disciplinary OR transprofessional OR transdisciplinarity) OR ABS (transdisciplinary OR trans-disciplinary OR transprofessional OR transdisciplinarity) ) AND (TITLE (medical OR hospital* OR acute OR emergency OR care

OR healthcare OR (health AND care) OR rehab* OR ward OR inpatient OR intervention OR assessment) OR ABS (medical OR hospital* OR acute OR emergency OR care OR healthcare OR (health AND care) OR rehab* OR ward OR inpatient OR intervention OR assessment)) AND ( PUBYEAR > 2010) AND ( LIMIT-TO ( SUBJAREA,"HEAL" ) ) AND ( LIMIT- TO ( LANGUAGE,"English" ) ) Filters: 2011 – 2021, English, health professionals (subject area) Results: 60 ( TITLE (interprofession*) OR ABS (interprofession*) ) AND ( TITLE (staff OR employee* OR personnel* OR worker* OR team*) OR ABS (staff OR employee* OR personnel* OR worker* OR team*) ) AND ( TITLE (trust) OR ABS (trust) ) AND ( PUBYEAR > 2010) AND ( LIMIT-TO ( LANGUAGE,"English" ) ) Filters: 2011 – 2021, English Results: 144 The (transdisciplinary OR trans-disciplinary OR transprofessional OR transdisciplinarity):ti,ab,kw AND (medical OR hospital* OR acute OR emergency OR care Cochrane OR healthcare OR health care OR rehab* OR ward OR inpatient OR intervention OR Library assessment):ti,ab,kw Results: 1 (interprofession*):ti,ab,kw AND (staff OR employee* OR personnel* OR worker* OR team*):ti,ab,kw AND (trust):ti,ab,kw Results: 9 Google Transdisciplinary care AND stroke Filters: first 100

Transdisciplinary care AND perceptions Filters: first 100 Transdisciplinary AND interprofessional trust Filters: first 100 Allied health AND national priorities Filters: first 100

Source of evidence selection Selection of evidence will be based on pre-specified inclusion criteria (see section 4). The source selection will be performed by one reviewer (Aleysha Martin), who will follow the search strategy outlined (see section 5). In every instance that the first reviewer has included or excluded a source but remains uncertain, a second reviewer (Dr Liisa Laakso) will assist in the source selection process. Any review disagreements will be discussed, and the criteria will be refined until inter-rater agreement is reached. As required, a third reviewer (Professor Theresa Green) will assist in analysis and discussion, until a consensus is reached. The results of the search will be managed using Covidence (for electronic database results), Microsoft Excel (for search engine Google results) and Endnote (for electronic database and search engine Google references). The scoping review will include a narrative description of the process and a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta Analyses)

flowchart detailing the search completed on databases/other sources, removal of duplicates, source selection, full-text retrieval, data extraction, data presentation and qualitative synthesis.

Stage 1 – Initial limited search The purpose of the initial limited search is to identify relevant studies. This will be achieved by searching electronic databases of published literature, including PubMed, CINAHL, Scopus and the Cochrane Library. These search results will be exported to Covidence. A search will also be conducted in the search engine Google to identify relevant official healthcare websites, clinical projects, and conference papers. These search results will be exported to Microsoft Excel.

Stage 2 – Removal of duplicates Duplicates will be removed where records have the same title, publication year and authors (electronic databases and search engine Google), and/or the same URL or webpage (search engine Google).

Stage 3 – Analysis of text words in title, abstract and full text The review process will be a two-level approach: 1) title and abstract analysis and 2) full-text analysis. For sources retrieved from electronic databases, the reviewer will analyse the text in the title and abstracts for key words and terms, as per the inclusion/exclusion criteria (see section 4). Any articles that are deemed relevant will then be included in the full-text review to determine if the inclusion criteria are met. This process will be completed using Covidence. For results obtained via the Google search engine, the reviewer will analyse the text in the title and introductory paragraph, as per the inclusion/exclusion criteria (see section 4). Any articles that are deemed relevant will then be included in the full-text review to determine if the inclusion criteria are met. These reviews will be completed using Microsoft Excel where the URL will be recorded.

Stage 4 – Analysis of reference lists For every included study, the reference lists will be searched manually by the reviewers. The purpose of this search is to identify any additional studies that might be relevant for the scoping review. For any additional study identified, stage 3 will be repeated to determine if the inclusion criteria are met.

PRISMA flow diagram The PRISMA flow diagram below details the search strategy described. The number of sources (n) has been left blank until the search is conducted.

Records identified through initial Additional records identified database searching through other sources

(n = ) (n = ) Identification

Records after duplicates removed

(n = )

Screening Records screened Records excluded (n = ) (n = )

Full-text articles assessed for Full-text articles excluded, eligibility (title/abstract) with reasons

(n = ) (n = ) Eligibility

Studies included in data extraction and qualitative synthesis Included (n = )

Data extraction To extract study characteristics, the data will be charted in tabular form according to the key information below.

Key information to extract The study characteristics to be extracted will include (but will not be limited to):

• Reference (author, year) • Source details o Publication title o Publication year o Publication country • Methods

o Research aims/objectives o Study design/evidence type o Healthcare/research setting o Participant population/characteristics • Results extracted from source of evidence o Transdisciplinary intervention o Comparator/usual care o Allied health disciplines involved in the transdisciplinary model of care o Efficiency outcomes from transdisciplinary models of care o Quality of care outcomes from transdisciplinary models of care o Cost-effectiveness outcomes of transdisciplinary models of care o Outcomes of transdisciplinary models of care on an Acute Stroke Unit o Facilitators to successful implementation of transdisciplinary models of care o Barriers to successful implementation of transdisciplinary models of care • Team based care definitions and healthcare context o Hospital definitions o Allied health definitions o Models of care (multidisciplinary/interdisciplinary/interprofessional/transdisciplinary) definitions

Example of data extraction in tabular form The data will be compiled, coded, and validated in a table in a Microsoft Excel document. The following table headings will be used to chart study characteristics, but can be refined during the scoping review process:

Source 1 Source 2 Source details Publication title Publication year Publication country Methods Research aims/objectives Study design/evidence type Healthcare/research setting Participant population/characteristics Results extracted from source of evidence

Transdisciplinary intervention Comparator/usual care Allied health disciplines involved in the transdisciplinary model of care Efficiency outcomes from transdisciplinary models of care Quality of care outcomes from transdisciplinary models of care Cost-effectiveness outcomes of transdisciplinary models of care Outcomes of a transdisciplinary model of care on an Acute Stroke Unit Stakeholder (healthcare professional, patient) perceptions of a transdisciplinary model of care Facilitators to successful implementation of transdisciplinary models of care Barriers to successful implementation of transdisciplinary models of care Other outcomes of transdisciplinary models of care Definitions and broader context Team-based healthcare context, policies Allied health definitions Multidisciplinary definitions Interdisciplinary definitions Transdisciplinary definitions Interprofessional Collaboration (IPC) Other healthcare teams definitions Interprofessional trust

Data analysis Multiple methods will be used to analyse the data including descriptive and analytical analysis, as outlined below.

Descriptive analysis Data extracted will be analysed and described in a narrative summary, categorised according to the study characteristics charted and/or population, intervention, and outcomes. The main data described will include, but will not be limited to:

• Hospital/allied health/models of care definitions • Research aims/objectives

• Transdisciplinary intervention • Comparator/usual care • Healthcare/research setting • Overall themes of the outcomes (e.g., efficiency, quality of care) • Outcomes of transdisciplinary models of care on an Acute Stroke Unit • Labour and capital cost implications of transdisciplinary models of care • Facilitators to successful implementation of transdisciplinary models of care • Barriers to successful implementation of transdisciplinary models of care

Analytical analysis A descriptive qualitative content analysis will also be conducted, including basic coding of data. This will provide a summary of data on keys points of information. The reviewers will complete simple frequency counts of how many sources examined:

• Publication year • Publication country • Study design/evidence type • Healthcare/research setting • Element of healthcare • Allied health disciplines involved in the transdisciplinary model of care (intervention) • Efficiency outcomes from transdisciplinary models of care (e.g., time saved in minutes) • Quality of care outcomes from transdisciplinary models of care • Cost-effectiveness outcomes from transdisciplinary models of care (i.e., costs saved in dollars)

The reviewers will count the total number of sources of evidence. The reviewers will then count the total number of sources in publication year, publication country, healthcare/research setting (including Acute Stroke Units), and element of healthcare (i.e., assessment and/or intervention and/or discharge planning/follow-up). The reviewers will also count the number of sources in which an allied health discipline (e.g., occupational therapy, physiotherapy, speech pathology, etc.) is involved in a transdisciplinary model of care. Lastly, the reviewers will count the total number of sources examining efficiency, quality of care, cost-effectiveness, facilitators to implementation and barriers to implementation. Efficiency and cost-effectiveness will also be examined as an average across the relevant sources (i.e., time saved in minutes and cost saved in dollars).

Presentation of the results The results will be presented in narrative form and diagrammatic/tabular form, as outlined below. Until the search and selection of the evidence and data extraction is conducted (see section 5), the optimal method to present the results remains undetermined.

Narrative summary The data will be presented in a narrative summary, organized by population, intervention and outcomes, with reference to results presented in diagrammatic/tabular form (see 11.2 below).

Results in diagrammatic/tabular form The following table might be used to present some results of the scoping review results, and can be refined during the scoping review process:

Parameter Results Number of Total number (N) of sources of evidence publications Total number (N) of primary sources of evidence Total number (N) of secondary sources of evidence Total number (N) of sources of evidence between 2011 – 2021 Mean number of publications every year Populations Allied health disciplines (list) identified Other healthcare professionals (list) Total number (N) of sources each allied health discipline is involved in the transdisciplinary model of care Healthcare/ research Publication countries (list) contexts identified Total number (N) of Australia-based sources Hospital settings (list) Element of healthcare (list) Total number (N) of sources examining Acute Stroke Units Key findings Total number (N) of sources examining efficiency Total number (N) of sources examining quality of care Total number (N) of sources examining cost-effectiveness Facilitators to successful implementation (list) Total number (N) of sources examining facilitators (N) Barriers to successful implementation (list) Total number (N) of sources examining barriers (N)

Additionally, the frequency counts will be presented as percentages (%) or averages. This will also be represented in tabular form, as per the below example:

Source Source Source Source Source 1 2 3 4 5 Randomised controlled trial X

Study Observational study X design/ Mixed methods study evidence Other quantitative design type Other qualitative design X Clinical research project X X Publication Australia X X X country United Kingdom X X Other Healthcare Emergency department X /research General medical ward X setting Acute Stroke Unit X Rehabilitation unit/ward X Hospital-based specialist clinics X Other Element of Assessment/re-assessment X X X X healthcare Intervention/treatment X X Discharge planning/decision making X X Follow-up X X Allied Occupational therapy X X X health Physiotherapy X X X disciplines Speech pathology X X X Social work Dietetics X Other X Time saved in transdisciplinary model of care 35 N/A 22 63 N/A (minutes) Cost saved in transdisciplinary model of care 112.10 N/A N/A N/A 80.32 (dollars)

6. Dissemination of results

The authors will seek to publish the results of the scoping review in a high-impact journal, to contribute to the growing body of transdisciplinary knowledge.

7. References

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