Journal articles on the topic 'Hospital care Victoria'
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1
Ansari, Zahid, Norman Carson, Adrian Serraglio, Toni Barbetti, and Flavia Cicuttini. "The Victorian Ambulatory Care Sensitive Conditions Study: reducing demand on hospital services in Victoria." Australian Health Review 25, no. 2 (2002): 71. http://dx.doi.org/10.1071/ah020071.
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Ambulatory Care Sensitive Conditions (ACSCs) are those for which hospitalisation is thought to be avoidable ifpreventive care and early disease management are applied, usually in the ambulatory setting. The Victorian ACSCs study offers a new set of indicators describing differentials and inequalities in access to the primary healthcare systemin Victoria. The study used the Victorian Admitted Episodes Dataset (1999-2000) for analysing hospital admissions for diabetes complications, asthma, vaccine preventable influenza and pneumococcal pneumonia. The analyses were performed at the level of Primary Care Partnerships (PCPs). There were 12 100 admissions for diabetes complicationsin Victoria. There was a 12-fold variation in admission rates for diabetes complications across PCPs, with 13 PCPs having significantly higher rates than the Victorian average, accounting for just over half of all admissions (6114) and39 per cent total bed days. Similar variations in admission rates across PCPs were observed for asthma, influenza and pneumococcal pneumonia. This analysis, with its acknowledged limitations, has shown the potential for using theseindicators as a planning tool for identifying opportunities for targeted public health and health services interventions in reducing demand on hospital services in Victoria.
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Penney, Randy. "Hemodialysis Unit at Renfrew Victoria Hospital." Healthcare Management Forum 8, no. 2 (July 1995): 5–10. http://dx.doi.org/10.1016/s0840-4704(10)60902-7.
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In June 1994, the Renfrew Victoria Hospital was selected as the first-ever recipient of the Health Care Quality Team Award in the “Small and Rural Provider” category. This award, offered by the Canadian College of Health Service Executives and 3M Health Care, was established to recognize health care organizations that have sustained measurable improvements in their network of services, and have done so through the use of a team. Renfrew Victoria Hospital's entry focused on the establishment of a hemodialysis unit for the residents of Renfrew County. This article summarizes the parameters of this award, as presented in our submission.
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Sharwood, Penny, and Bernadette O'Connell. "Assessing the relationship between inpatient and outpatient activity:a clinical specialty analysis." Australian Health Review 23, no. 3 (2000): 137. http://dx.doi.org/10.1071/ah000137a.
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General and specialist services in public acute hospital outpatient departments play a key role in the health care systemand represent a vital interface between inpatient and community care. Typically outpatient services involve millionsof patient visits within a very short time frame and in Victoria alone between 8-10 million outpatient occasions ofservice are provided each year. Drawing on the first full year of data from the Victorian Ambulatory ClassificationSystem (VACS) this paper examines the patterns underlying the distribution of inpatient separations and outpatientencounters at 16 major Victorian public hospitals and assesses the relationship between inpatient and outpatientactivity at the clinical specialty level.
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Mercier, Eric, Peter A. Cameron, Karen Smith, and Ben Beck. "Prehospital trauma death review in the State of Victoria, Australia: a study protocol." BMJ Open 8, no. 7 (July 2018): e022070. http://dx.doi.org/10.1136/bmjopen-2018-022070.
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IntroductionRegionalised trauma systems have been shown to improve outcomes for trauma patients. However, the evaluation of these trauma systems has been oriented towards in-hospital care. Therefore, the epidemiology and care delivered to the injured patients who died in the prehospital setting remain poorly studied. This study aims to provide an overview of a methodological approach to reviewing trauma deaths in order to assess the preventability, identify areas for improvements in the system of care provided to these patients and evaluate the potential for novel interventions to improve outcomes for seriously injured trauma patients.Methods and analysisThe planned study is a retrospective review of prehospital and early in-hospital (<24 hours) deaths following traumatic out-of-hospital cardiac arrest that were attended by Ambulance Victoria between 2008 and 2014. Eligible patients will be identified from the Victorian Ambulance Cardiac Arrest Registry and linked with the National Coronial Information System. For patients who were transported to hospital, data will be linked the Victoria State Trauma Registry. The project will be undertaken in four phases: (1) survivability assessment; (2) preventability assessment; (3) identification of potential areas for improvement; and (4) identification of potentially useful novel technologies. Survivability assessment will be based on predetermined anatomical injuries considered unsurvivable. For patients with potentially survivable injuries, multidisciplinary expert panel reviews will be conducted to assess the preventability as well as the identification of potential areas for improvement and the utility of novel technologies.Ethics and disseminationThe present study was approved by the Victorian Department of Justice and Regulation HREC (CF/16/272) and the Monash University HREC (CF16/532 – 2016000259). Results of the study will be published in peer-reviewed journals and reports provided to Ambulance Victoria, the Victorian State Trauma Committee and the Victorian State Government Department of Health and Human Services.
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Pugh, Janet, and Malu Campolo. "Mornington Peninsula Hospital Intensive Care Unit, Victoria, Australia." Australian Critical Care 8, no. 4 (December 1995): 8–9. http://dx.doi.org/10.1016/s1036-7314(95)70291-0.
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Rezaei-Darzi, Ehsan, Janneke Berecki-Gisolf, and Dasamal Tharanga Fernando. "How representative is the Victorian Emergency Minimum Dataset (VEMD) for population-based injury surveillance in Victoria? A retrospective observational study of administrative healthcare data." BMJ Open 12, no. 12 (December 2022): e063115. http://dx.doi.org/10.1136/bmjopen-2022-063115.
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ObjectiveThe Victorian Emergency Minimum Dataset (VEMD) is a key data resource for injury surveillance. The VEMD collects emergency department data from 39 public hospitals across Victoria; however, rural emergency care services are not well captured. The aim of this study is to determine the representativeness of the VEMD for injury surveillance.DesignA retrospective observational study of administrative healthcare data.Setting and participantsInjury admissions in 2014/2015–2018/2019 were extracted from the Victorian Admitted Episodes Dataset (VAED) which captures all Victorian hospital admissions; only cases that arrived through a hospital’s emergency department (ED) were included. Each admission was categorised as taking place in a VEMD-contributing versus a non-VEMD hospital.ResultsThere were 535 477 incident injury admissions in the study period, of which 517 207 (96.6%) were admitted to a VEMD contributing hospital. Male gender (OR 1.13 (95% CI 1.10 to 1.17)) and young age (age 0–14 vs 45–54 years, OR 4.68 (95% CI 3.52 to 6.21)) were associated with VEMD participating (vs non-VEMD-participating) hospitals. Residing in regional/rural areas was negatively associated with VEMD participating (vs non-VEMD participating) hospitals (OR=0.11 (95% CI 0.10 to 0.11)). Intentional injury (assault and self-harm) was also associated with VEMD participation.ConclusionsVEMD representativeness is largely consistent across the whole of Victoria, but varies vastly by region, with substantial under-representation of some areas of Victoria. By comparison, for injury surveillance, regional rates are more reliable when based on the VAED. For local ED-presentation rates, the bias analysis results can be used to create weights, as a temporary solution until rural emergency services injury data is systematically collected and included in state-wide injury surveillance databases.
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Bagot, Kathleen L., Christopher F. Bladin, Michelle Vu, Joosup Kim, Peter J. Hand, Bruce Campbell, Alison Walker, Geoffrey A. Donnan, Helen M. Dewey, and Dominique A. Cadilhac. "Exploring the benefits of a stroke telemedicine programme: An organisational and societal perspective." Journal of Telemedicine and Telecare 22, no. 8 (October 30, 2016): 489–94. http://dx.doi.org/10.1177/1357633x16673695.
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We undertook a qualitative analysis to identify the broader benefits of a state-wide acute stroke telemedicine service beyond the patient-clinician consultation. Since 2010, the Victorian Stroke Telemedicine (VST) programme has provided a clinical service for regional hospitals in Victoria, Australia. The benefits of the Victorian Stroke Telemedicine programme were identified through document analysis of governance activities, including communications logs and reports from hospital co-ordinators of the programme. Discussions with the Victorian Stroke Telemedicine management were undertaken and field notes were also reviewed. Several benefits of telemedicine were identified within and across participating hospitals, as well as for the state government and community. For hospitals, standardisation of clinical processes was reported, including improved stroke care co-ordination. Capacity building occurred through professional development and educational workshops. Enhanced networking, and resource sharing across hospitals was achieved between hospitals and organisations. Governments leveraged the Victorian Stroke Telemedicine programme infrastructure to provide immediate access to new treatments for acute stroke care in regional areas. Standardised data collection allowed routine quality of care monitoring. Community awareness of stroke symptoms occurred with media reports on the novel technology and improved patient outcomes. The value of telemedicine services extends beyond those involved in the clinical consultation to healthcare funders and the community.
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Clapperton, Angela, Jeremy Dwyer, Ciara Millar, Penny Tolhurst, and Janneke Berecki-Gisolf. "Sociodemographic characteristics associated with hospital contact in the year prior to suicide: A data linkage cohort study in Victoria, Australia." PLOS ONE 16, no. 6 (June 3, 2021): e0252682. http://dx.doi.org/10.1371/journal.pone.0252682.
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Aims The aims of this study were to examine the prevalence of hospital contact in the year prior to suicide in Victoria, Australia, and to compare characteristics among those who did and did not have contact in the year prior to suicide. Methods The study was a data linkage cohort study of 4348 Victorians who died by suicide over the period 2011–2017. Data from the Victorian Suicide Register (VSR) was linked with hospital separations and Emergency Department (ED) presentations datasets by the Centre for Victorian Data Linkages (CVDL). The main outcomes were: (1) hospital contact for any reason, (2) hospital contact for mental-health-related reasons, and (3) hospital contact for intentional self-harm. Unadjusted and adjusted odds ratios were calculated as the measures of association. Results In the year prior to suicide, half of the decedents (50.0%) had hospital contact for any reason (n = 2172), 28.6% had mental-health-related hospital contact (n = 1244) and 9.9% had hospital contact for intentional self-harm (n = 432). In the year prior to suicide, when compared with males aged 25–49 years (the reference group):males aged 75+ years and females of all ages were significantly more likely to have hospital contact for any reasonfemales aged 10–24 years and 25–49 years were significantly more likely to have mental-health-related hospital contactfemales aged 10–24 years and 25–49 years had 3.5 times and 2.4 times the odds of having hospital contact for intentional self-harm. Conclusions The comparatively high proportion of female decedents with mental-health related hospital contact in the year prior to suicide suggests improving the quality of care for those seeking help is an essential prevention initiative; this could be explored through programs such as the assertive outreach trials currently being implemented in Victoria and elsewhere in Australia. However, the sizeable proportion of males who do not have contact in the year prior to suicide was a consistent finding and represents a challenge for suicide prevention. Programs to identify males at risk in the community and engage them in the health care system are essential. In addition, promising universal and selective interventions to reduce suicide in the cohort who do not have hospital contact, include restricting access to lethal means and other public health interventions are also needed.
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Samaroo, Bethan. "Assessing Palliative Care Educational Needs of Physicians and Nurses: Results of a Survey." Journal of Palliative Care 12, no. 2 (June 1996): 20–22. http://dx.doi.org/10.1177/082585979601200205.
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The Greater Victoria Hospital Society (GVHS) Palliative Care Committee surveyed medical and nursing staff from four hospitals and The Victoria Hospice Society in February, 1993. The purpose of the survey was to identify physicians’ and nurses’ perceived educational needs related to death and dying. Programs that focus on the dying process; patient pain, symptom, and comfort control; and patient and family support were identified as necessary to meet the educational needs of physicians and nurses in providing quality palliative care. Physicians and nurses identified communication skills as being paramount. Communications concerning ethical issues were highlighted as the most difficult to cope with.
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Farrell, Maureen. "Health care leadership in an age of change." Australian Health Review 26, no. 1 (2003): 153. http://dx.doi.org/10.1071/ah030153.
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This study examined the leadership practices of a sample of network and hospital administrators in metropolitan Victoria, Australia. It was undertaken in the mid-1990s when the State Liberal-National (Coalition) Government in Victoria established Melbourne's metropolitan health care networks. I argue that leadership,and the process of leading, contributes significantly to the success of the hospital in a time of turmoil and change.The sample was taken from the seven health care networks and consisted of 15 network and hospital administrators. Bolman and Deal's frames of leadership - structural, human resource, political and symbolic - were used as a framework to categorize the leadership practices of the administrators. The findings suggest a preference for the structural frame - an anticipated result, since the hospital environment is more conducive to a style of leadership that emphasizes rationality and objectivity. The human resource frame was the second preferred frame,followed by the political and symbolic. These findings suggest that network and hospital administrators focus more on intellectual than spiritual development, and perhaps this tendency needs to be addressed when educating present and future hospital leaders.
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Pilcher, David V., Graeme Duke, Melissa Rosenow, Nicholas Coatsworth, Genevieve O’Neill, Tracey A. Tobias, Steven McGloughlin, et al. "Assessment of a novel marker of ICU strain, the ICU Activity Index, during the COVID-19 pandemic in Victoria, Australia." Critical Care and Resuscitation 23, no. 3 (September 6, 2021): 300–307. http://dx.doi.org/10.51893/2021.3.oa7.
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OBJECTIVES: To validate a real-time Intensive Care Unit (ICU) Activity Index as a marker of ICU strain from daily data available from the Critical Health Resource Information System (CHRIS), and to investigate the association between this Index and the need to transfer critically ill patients during the coronavirus disease 2019 (COVID-19) pandemic in Victoria, Australia. DESIGN: Retrospective observational cohort study. SETTING: All 45 hospitals with an ICU in Victoria, Australia. PARTICIPANTS: Patients in all Victorian ICUs and all critically ill patients transferred between Victorian hospitals from 27 June to 6 September 2020. MAIN OUTCOME MEASURE: Acute interhospital transfer of one or more critically ill patients per day from one site to an ICU in another hospital. RESULTS: 150 patients were transported over 61 days from 29 hospitals (64%). ICU Activity Index scores were higher on days when critical care transfers occurred (median, 1.0 [IQR, 0.4–1.7] v 0.6 [IQR, 0.3–1.2]; P < 0.001). Transfers were more common on days of higher ICU occupancy, higher numbers of ventilated or COVID-19 patients, and when more critical care staff were unavailable. The highest ICU Activity Index scores were observed at hospitals in north-western Melbourne, where the COVID-19 disease burden was greatest. After adjusting for confounding factors, including occupancy and lack of available ICU staff, a rising ICU Activity Index score was associated with an increased risk of a critical care transfer (odds ratio, 4.10; 95% CI, 2.34–7.18; P < 0.001). CONCLUSIONS: The ICU Activity Index appeared to be a valid marker of ICU strain during the COVID-19 pandemic. It may be useful as a real-time clinical indicator of ICU activity and predict the need for redistribution of critical ill patients.
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Cooper, Genevieve. "Hospital in the Home in Victoria: Factors Influencing Allocation Decisions." Australian Journal of Primary Health 5, no. 1 (1999): 60. http://dx.doi.org/10.1071/py99007.
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There is a question surrounding the funding of Hospital in the Home (HITH) as to whether the allocation policy was driven by customer service preference or was largely a financial imperative. HITH has the capacity to increase the throughput and therefore the efficiency of acute care facilities which is attractive to Government and Health Service Managers. There is insufficient evidence to indicate that this is true in all circumstances. Hospital in the Home is a desirable and safe option for some clients. Hospital in the Home has the potential to provide a more cost effective mode of delivery of acute care than hospital facilities. However, there is a need for identification of which clients, with which conditions and care needs, will benefit from being part of a HITH program in emotional, health and financial terms. Health professionals are still grappling with the impact that HITH has on their roles and relationships with other health care providers. More qualitative and quantitative research needs to be undertaken to identify the best models of HITH in both organisational and financial tems, and its impact on the wellbeing of clients and carers.
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Doherty, Zakary, Rebecca Kippen, David Bevan, Graeme Duke, Sharon Williams, Andrew Wilson, and David Pilcher. "Long-term outcomes of hospital survivors following an ICU stay: A multi-centre retrospective cohort study." PLOS ONE 17, no. 3 (March 28, 2022): e0266038. http://dx.doi.org/10.1371/journal.pone.0266038.
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Background The focus of much Intensive Care research has been on short-term survival, which has demonstrated clear improvements over time. Less work has investigated long-term survival, and its correlates. This study describes long-term survival and identifies factors associated with time to death, in patients who initially survived an Intensive Care admission in Victoria, Australia. Methods We conducted a retrospective cohort study of adult patients discharged alive from hospital following admission to all Intensive Care Units (ICUs) in the state of Victoria, Australia between July 2007 and June 2018. Using the Victorian Death Registry, we determined survival of patients beyond hospital discharge. Comparisons between age matched cohorts of the general population were made. Cox regression was employed to investigate factors associated with long-term survival. Results A total of 130,775 patients from 23 ICUs were included (median follow-up 3.6 years post-discharge). At 1-year post-discharge, survival was 90% compared to the age-matched cohort of 98%. All sub-groups had worse long-term survival than their age-matched general population cohort, apart from elderly patients admitted following cardiac surgery who had better or equal survival. Multiple demographic, socio-economic, diagnostic, acute and chronic illness factors were associated with long-term survival. Conclusions Australian patients admitted to ICU who survive to discharge have worse long-term survival than the general population, except for the elderly admitted to ICU following cardiac surgery. These findings may assist during goal-of-care discussions with patients during an ICU admission.
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Ong, Kevin, Andrew Carroll, Shannon Reid, and Adam Deacon. "Community Outcomes of Mentally Disordered Homicide Offenders in Victoria." Australian & New Zealand Journal of Psychiatry 43, no. 8 (January 1, 2009): 775–80. http://dx.doi.org/10.1080/00048670903001976.
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Objective: The aim of the present study was to describe characteristics and post-release outcomes of Victorian homicide offenders under the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 (and/or its forerunner legislation) released from forensic inpatient psychiatric care since the development of specialist forensic services. Method: A legal database identified subjects meeting inclusion criteria: hospitalized in forensic psychiatric care due to finding of mental impairment or unfitness to stand trial for homicide in Victoria; released into the community; and released between 1 January 1991 and 30 April 2002. Using clinical records, demographics, index offence, progress in hospital, diagnosis, psychosocial and criminological data were obtained. Outcomes (offending or readmission into secure care) were obtained from the clinical records. Results: Of the 25 subjects, 19 (76%) were male. Primary diagnoses on admission to forensic hospital care were schizophrenia, n = 16 (64%); other psychotic disorder, n = 5 (20%); depression, n = 3 (12%); and personality disorder, n = 1 (4%). Mean time in custodial supervision was 11 years and 2 months, less for those whose offence occurred after the development of forensic rehabilitation services. In the first 3 years after release, there was a single episode of criminal recidivism, representing a recidivism rate of 1 in 25 (4%) over 3 years. Twelve subjects (48%) were readmitted at some point in the 3 year follow up. Conclusion: There was a very low rate of recidivism after discharge, but readmissions to hospital were common. Lengths of custodial care were reduced after the introduction of forensic rehabilitation facilities. Recidivism is low when there are well-designed and implemented forensic community treatment programmes, consistent with other data suggesting a reciprocal relationship between safe community care and a low threshold for readmission to hospital, lessening re-offending at times of crisis. Further research should be directed at timing of release decisions, based on reducing identified risk factors to acceptable levels.
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Ofori-Asenso, Richard, Danny Liew, Johan Mårtensson, and Daryl Jones. "The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia." Journal of Clinical Medicine 9, no. 9 (September 22, 2020): 3055. http://dx.doi.org/10.3390/jcm9093055.
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Background: Limited available evidence suggests that a small proportion of inpatients undergo prolonged hospitalization and use a disproportionate number of bed days. Understanding the factors contributing to prolonged hospitalization may improve patient care and reduce the length of stay in such patients. Methods: We undertook a retrospective cohort study of adult (≥20 years) patients admitted for at least 24 h between 14 November 2016 and 14 November 2018 to hospitals in Victoria, Australia. Data including baseline demographics, admitting specialty, survival status and discharge disposition were obtained from the Victorian Admission Episode Dataset. Multivariable logistic regression analysis was used to identify factors independently associated with prolonged hospitalization (≥14 days). Cox proportional hazard regression model was used to examine the association between various factors and in-hospital mortality. Results: There were almost 5 million hospital admissions over two years. After exclusions, 1,696,112 admissions lasting at least 24 h were included. Admissions with prolonged hospitalization comprised only 9.7% of admissions but utilized 44.2% of all hospital bed days. Factors independently associated with prolonged hospitalization included age, female gender, not being in a relationship, being a current smoker, level of co-morbidity, admission from another hospital, admission on the weekend, and the number of admissions in the prior 12 months. The in-hospital mortality rate was 5.0% for those with prolonged hospitalization compared with 1.8% in those without (p < 0.001). Prolonged hospitalization was also independently associated with a decreased likelihood of being discharged to home (OR 0.53, 95% CI 0.52–0.54). Conclusions: Patients experiencing prolonged hospitalization utilize a disproportionate proportion of bed days and are at higher risk of in-hospital death and discharge to destinations other than home. Further studies are required to identify modifiable factors contributing to prolonged hospitalization as well as the quality of end-of-life care in such admissions.
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SUNDARARAJAN, V., T. KORMAN, C. MACISAAC, J. J. PRESNEILL, J. F. CADE, and K. VISVANATHAN. "The microbiology and outcome of sepsis in Victoria, Australia." Epidemiology and Infection 134, no. 2 (August 19, 2005): 307–14. http://dx.doi.org/10.1017/s0950268805004796.
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We analysed data from 33741 patients with ICD-10-AM-defined sepsis from an Australian hospital morbidity dataset to investigate the relationships between specific types of organisms, potential risk factors for infection, organ dysfunction, ICU utilization and hospital mortality. A total of 24% of patients received some of their care in an intensive care unit, and the overall hospital mortality rate was 18%. Gram-positive bacteria were isolated in 27% of cases and Gram-negative bacteria in 20%. Sepsis due to Staphylococcus aureus was associated with vascular and joint devices whereas Pseudomonasaeruginosa and Gram-negative rods were more common with genitourinary devices and lymphoproliferative disease. Sepsis-associated organ dysfunction most commonly involved the respiratory system, followed by the renal and circulatory systems. These patterns may provide useful clues to the pathogenesis and therapy of this often fatal syndrome which is a major ongoing problem for hospitalized patients.
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Turbitt, Erin, and Gary Lee Freed. "Paediatric emergency department referrals from primary care." Australian Health Review 40, no. 6 (2016): 691. http://dx.doi.org/10.1071/ah15211.
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Background Over the last decade, paediatric referrals from general practitioners (GPs) to the emergency department (ED) have increased by 60% in Australia. Objective To investigate the characteristics of Victorian children referred by GPs to the ED with lower-urgency conditions. Method Data were collected from four hospital EDs in Victoria, May–November 2014. Parents attending the ED with their child triaged as lower urgency were surveyed. Descriptive, frequency, and bivariate analyses were performed. Results Of the 1150 responses, 28% (320) visited their GP before attending ED. Of these 66% (212), were referred by their GP. A greater proportion with injury than illness (84% vs 59%; P < 0.0001) was referred to the ED if they had first visited their GP. Conclusion Motivations of GPs to send lower-urgency injured and ill children to ED are not well understood. The high number of referrals from GPs to the ED for lower urgency conditions suggests attention by policy makers and health professionals must be paid to the current patterns of care of children in general practice. What is known about the topic? Paediatric referrals in Australia from GPs to EDs have increased in the last decade, along with the absolute number of children in Victoria presenting to the ED. What does this paper add? A significant number of children (66%) who attend the GP before visiting the ED are referred to the ED for their lower urgency condition. What are the implications for practitioners? It may be appropriate for GPs to be further supported to manage lower urgency conditions, through better resources or education.
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Ore, Timothy. "Trends and disparities in sepsis hospitalisations in Victoria, Australia." Australian Health Review 40, no. 5 (2016): 511. http://dx.doi.org/10.1071/ah15106.
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Objective The aim of the present study was to determine the clinical and epidemiological characteristics of patients with sepsis admitted to hospitals in Victoria, Australia, during the period 2004–14. The data include incidence, severity and mortality. Methods In all, 44 222 sepsis hospitalisations were identified between 2004–05 and 2013–14 from the Victorian Admitted Episodes Dataset. The dataset contains clinical and demographic information on all admissions to acute public and private hospitals. Using the International Classification of Diseases (10th Revision) Australian Modification codes, incidence rates, severity of disease and mortality were calculated. Results Sepsis hospitalisation rates per 10 000 population increased significantly (P < 0.01) over the period, from 6.9 (95% confidence interval (CI) 5.6–7.8) to 10.0 (95% CI 9.1–11.1), an annual growth rate of 3.8%. The age-standardised in-hospital death rates per 100 000 population grew significantly (P < 0.01) from 9.2 (95% CI 7.8–10.4) in 2004–05 to 13.0 (95% CI 11.7–14.6) in 2013–14, an annual growth rate of 3.1%. Among people under 45 years of age, the 0–4 years age group had the highest hospitalisation rate (3.0 per 10 000 population; 95% CI 2.7–3.4). Nearly half (46.2%) of all sepsis hospitalisations were among patients born overseas, with a rate of 14.5 per 10 000 population (95% CI 12.4–16.2) in that group compared with a rate of 5.9 per 10 000 population (95% CI 5.3–6.7) for patients born in Australia. The age-standardised sepsis hospitalisation rate was 2.6-fold greater in the lowest compared with highest socioeconomic areas (12.7 per 10 000 population (95% CI 11.2–13.8) vs 4.8 per 10 000 population (95% CI 4.1–5.7), respectively). Conclusion This paper shows a significant upward trend in both sepsis separation rates and in-hospital death rates over the period; unlike sepsis, in-hospital death rates from all diagnoses fell over the same period. The results can be used to stimulate review of clinical practice. Greater understanding of the epidemiology of sepsis could improve care quality and outcomes. What is known about the topic? Sepsis is associated with high mortality rates and severe sepsis is the most common cause of death in intensive care units (ICU). The last published study of sepsis in Victoria (in 2005) showed a gradual rise in rates; since then, there is little information as to whether there has been any significant improvement in treatment outcomes. What does this paper add? This paper provides new information by analysing trends and variations in sepsis hospitalisations in Victoria by several demographic groups from 2004–05 to 2013–14. What are the implications for practitioners? Patients with severe sepsis consume approximately half the ICU resources. Reliable and recent data on the growth of this disease are important for prevention, allocation of resources and to track the effectiveness of care. A key area for intervention is promoting greater adherence to clinical guidelines.
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Qu, Liang G., Tatenda Nzenza, Kevin McMillan, and Shomik Sengupta. "Delays in prostate cancer care within a hospital network in Victoria, Australia." ANZ Journal of Surgery 89, no. 12 (November 30, 2019): 1599–604. http://dx.doi.org/10.1111/ans.15554.
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McDermott, Francis T., Gregory J. Cooper, Philip L. Hogan, Stephen M. Cordner, and Ann B. Tremayne. "Evaluation of the Prehospital Management of Road Traffic Fatalities in Victoria, Australia." Prehospital and Disaster Medicine 20, no. 4 (August 2005): 219–27. http://dx.doi.org/10.1017/s1049023x00002570.
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AbstractIntroduction:This study was undertaken to identify prehospital system and management deficiencies and preventable deaths between 01 January 1997 and 31 December 1998 in 243 consecutive Victorian road crash victims with fatal outcomes.Methods:The complete prehospital and hospital records, the deposition to the coroner, and autopsy findings were evaluated by computer analysis and peer group review with multidisciplinary discussion.Results:One-hundred eighty-seven (77%) patients had prehospital errors or inadequacies, of which 135 (67%) contributed to death. Three-hundred ninety-four (67%) related to management and 130 (22%) to system deficiencies. Technique errors, diagnosis delays, and errors relatively were infrequent. One of 24 deaths at the crash scene or en route to hospital was considered to be preventable and two potentially preventable.Conclusion:The high prevalence of prehospital deficiencies has been addressed by a Ministerial Task Force on Trauma and Emergency Services and followed by the introduction of a new trauma care system in Victoria.
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Ansari, M. Z., D. Simmon s, W. G. Hart, F. Cicuttin i, N. J. Carson, N. I. A. G. Brand, M. J. Ackland, and D. J. Lang. "Preventable Hospitalisations for Diabetic Complications in Rural and Urban Victoria." Australian Journal of Primary Health 6, no. 4 (2000): 261. http://dx.doi.org/10.1071/py00060.
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The objective of the study was to describe and explain variations in rates of hospital admissions for long-term complications of diabetes mellitus in rural and urban Victoria as an indicator of the adequacy of ambulatory care services. The Victorian Inpatient Minimum Database (VIMD), Health Insurance Commission data for 1998, Medical Labour Force Annual Survey 1998, Socioeconomic Indexes for Areas 1996 (SEIFA) and Accessibility/Remoteness Index of Australia (ARIA) were merged to determine the extent to which hospitalisation for complications of diabetes can be predicted from accessibility and utilisation of general practitioner services. The rural and urban differentials for long-term diabetic complications and their strong relationship with GP services, the degree of remoteness, lack of insurance, and Aboriginality reflect issues related to equity and access, patient and GP education, and inclination to seek care, all of which have implications for planning of primary health services in rural areas. This study describes a model for the analysis of ambulatory care sensitive conditions, and illustrates the important use of routine databases combined with other sources of information in quantifying the impact of factors related to primary care services.
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Peck, Blake, Daniel Terry, and Kate Kloot. "The Socioeconomic Characteristics of Childhood Injuries in Regional Victoria, Australia: What the Missing Data Tells Us." International Journal of Environmental Research and Public Health 18, no. 13 (June 30, 2021): 7005. http://dx.doi.org/10.3390/ijerph18137005.
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Background: Injury is the leading cause of death among those between 1–16 years of age in Australia. Studies have found that injury rates increase with socioeconomic disadvantage. Rural Urgent Care Centres (UCC) represent a key point of entry into the Victorian healthcare system for people living in smaller rural communities, often categorised as lower socio-economic groups. Emergency presentation data from UCCs is not routinely collated in government datasets. This study seeks to compare socioeconomic characteristics of children aged 0–14 attending a UCC to those who attend a 24-h Emergency Departments with an injury-related emergency presentation. This will inform gaps in our current understanding of the links between socioeconomic status and childhood injury in regional Victoria. Methods: A network of rural hospitals in South West Victoria, Australia provide ongoing detailed de-identified emergency presentation data as part of the Rural Acute Hospital Data Register (RAHDaR). Data from nine of these facilities was extracted and analysed for children (aged 0–14 years) with any principal injury-related diagnosis presenting between 1 February 2017 and 31 January 2020. Results: There were 10,137 injury-related emergency presentations of children aged between 0–14 years to a participating hospital. The relationship between socioeconomic status and injury was confirmed, with overall higher rates of child injury presentations from those residing in areas of Disadvantage. A large proportion (74.3%) of the children attending rural UCCs were also Disadvantaged. Contrary to previous research, the rate of injury amongst children from urban areas was significantly higher than their more rural counterparts. Conclusions: Findings support the notion that injury in Victoria differs according to socioeconomic status and suggest that targeted interventions for the reduction of injury should consider socioeconomic as well as geographical differences in the design of their programs.
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Hoare, Connie D., Dickran A. Malatjalian, Bernard W. Badley, Joseph J. Sidorov, and C. Noel Williams. "Acute Fatty Liver of Pregnancy: A Review of Maternal Morbidity in 13 Patients Seen Over 12 Years in Nova Scotia." Canadian Journal of Gastroenterology 8, no. 2 (1994): 81–87. http://dx.doi.org/10.1155/1994/357397.
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OBJECTIVE: To review the maternal and fetal survival in all cases of acute fatty liver of pregnancy seen by the Division of Gastroenterology at Grace Maternity Hospital and the Victoria General Hospital from 1979-91.DESIGN: A retrospective review of the clinical data obtained from the medical charts of 13 patients with a liver biopsy-based histopathological diagnosis of acute fatty liver of pregnancy.SETTING: Grace Maternity Hospital, a tertiary care centre serving d1e Atlantic provinces. Twelve patients were subsequently transferred to Victoria General Hospital for postpartum management in the setting of the medical intensive care unit.MAIN OUTCOME MEASURES: Classically, acute fatty liver of pregnancy is complicated by over 70% maternal and fetal mortality rate. Recent reports have indicated significantly improved maternal and fetal survival because of more awareness, improved management and the identification of milder forms of the disease.RESULTS: In this study of 13 cases of acute fatty liver of pregnancy, maternal survival was 100% and fetal survival was 93%.CONCLUSION: The excellent maternal and fetal survival in this series is attributed co awareness, close collaboration between obstetricians and gastroenterologists, prompt diagnosis and delivery and the management of postpartum patients in an intensive care unit setting.
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O'Hara, Denise, and Chris Brook. "The utilisation of public and private hospitals in Victoria: An issue of access?" Australian Health Review 19, no. 3 (1996): 40. http://dx.doi.org/10.1071/ah960040b.
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Consumers regard access to hospital services as one of the key components of qualityin health care delivery. A mixed public/private system operates in Victoria, but amorbidity collection from private hospitals was commenced only relatively recently.In 1993?94 the collection covered 82- per cent of private hospital separations, andit was considered timely to examine the utilisation patterns in the private system andcompare them with those in the public system. Medical and surgical emergencies andother complex conditions and procedures are serviced largely in the public sector,whereas private hospitals are utilised for elective and less complex surgery and non-urgentconditions. Occupancy rates are around 79- per cent in public hospitals and67- per cent in private hospitals. Elective surgery waiting list data suggest that whileurgent cases are treated within a month, significant proportions wait six months ormore for non-urgent surgery. Private health insurance is the main factor indetermining access to and the utilisation private hospitals. The current MedicareAgreement and the move to separate the role of purchaser and provider may allowthe maximal utilisation of private hospitals and diminish the burden of chronicillness.
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Cox, Shelley, Rohan Martin, Piyali Somaia, and Karen Smith. "The development of a data-matching algorithm to define the ‘case patient’." Australian Health Review 37, no. 1 (2013): 54. http://dx.doi.org/10.1071/ah11161.
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Objectives. To describe a model that matches electronic patient care records within a given case to one or more patients within that case. Method. This retrospective study included data from all metropolitan Ambulance Victoria electronic patient care records (n = 445 576) for the time period 1 January 2009–31 May 2010. Data were captured via VACIS (Ambulance Victoria, Melbourne, Vic., Australia), an in-field electronic data capture system linked to an integrated data warehouse database. The case patient algorithm included ‘Jaro–Winkler’, ‘Soundex’ and ‘weight matching’ conditions. Results. The case patient matching algorithm has a sensitivity of 99.98%, a specificity of 99.91% and an overall accuracy of 99.98%. Conclusions. The case patient algorithm provides Ambulance Victoria with a sophisticated, efficient and highly accurate method of matching patient records within a given case. This method has applicability to other emergency services where unique identifiers are case based rather than patient based. What is known about the topic? Accurate pre-hospital data that can be linked to patient outcomes is widely accepted as critical to support pre-hospital patient care and system performance. What does this paper add? There is a paucity of literature describing electronic matching of patient care records at the patient level rather than the case level. Ambulance Victoria has developed a complex yet efficient and highly accurate method for electronically matching patient records, in the absence of a patient-specific unique identifier. Linkage of patient information from multiple patient care records to determine if the records are for the same individual defines the ‘case patient’. What are the implications for practitioners? This paper describes a model of record linkage where patients are matched within a given case at the patient level as opposed to the case level. This methodology is applicable to other emergency services where unique identifiers are case based.
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Jennings, Paul, and John Pasco. "Survival from out-of-hospital cardiac arrest in the Geelong region of Victoria, Australia." Emergency Medicine 13, no. 3 (September 2001): 319–25. http://dx.doi.org/10.1046/j.1035-6851.2001.00235.x.
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Russell, Lahiru, Rachel Whiffen, Lorena Chapman, Jasmine Just, Emma Dean, Anna Ugalde, and Sarah White. "Hospital staff perspectives on the provision of smoking cessation care: a qualitative description study." BMJ Open 11, no. 5 (May 2021): e044489. http://dx.doi.org/10.1136/bmjopen-2020-044489.
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ObjectiveTo explore the perspectives of hospital staff regarding the provision of smoking cessation care.Study designA qualitative description study using focus group discussions.Study settingData were collected across metropolitan regional and rural hospitals in Victoria, Australia, between November and December 2019.ParticipantsClinical and non-clinical hospital staff.ResultsFive focus groups were conducted across four hospitals. Staff (n=38) across metropolitan regional and rural hospitals shared similar views with regards to barriers and facilitators of smoking cessation care. Four themes were present: (1) Clinical Setting wherein views about opportunity and capacity to embed smoking cessation care, relevant policies and procedures and guidelines were discussed; (2) Knowledge consisted of the need for training on the provision of pharmacotherapy and behavioural interventions, and awareness of resources; (3) Consistency represented the need for a consistently applied approach to smoking cessation care by all staff and included issues of staff smoking; and (4) Appropriateness consisted of questions around how smoking cessation care can be safely delivered in the context of challenging patient groups and different settings.ConclusionsStaff across metropolitan regional and rural hospitals experience similar views and identified shared barriers in implementing smoking cessation care. Responding to staff concerns and providing support to address smoking with patients will help to foster a consistent approach to cessation care. Clear practice guidelines for multidisciplinary clinical roles need to underpin staff training in communication skills, include priorities around smoking cessation care, and provide the authorising environment in which clinical staff actively provide smoking cessation care.
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Newman, D. "Maritime Pre-Hospital Emergency Care Primary Retrieval Team – Operational Considerations." Journal of The Royal Naval Medical Service 98, no. 1 (March 2012): 16–18. http://dx.doi.org/10.1136/jrnms-98-16.
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AbstractThis article examines the non clinical skills and training required for effective maritime pre-hospital emergency care provision within a Role Two Afloat facility, allowing for a Primary Retrieval Team to be deployed in support of boarding operations. The provision of pre-hospital emergency care and sending a retrieval team forward has been trialled in various forms. In 2010 and 2011 a R2A team was deployed aboard RFA FORT VICTORIA. This included a Primary Retrieval Team consisting of an Emergency Nurse Specialist, a Medical Assistant which can be enhanced when required by an Emergency Care or Anaesthetic Consultant. This differs from the land operations support provided by the airborne Medical Emergency Response Team (MERT) as the maritime environment requires a bespoke solution for casualty retrieval as the method of deployment and the type of casualties and their locations may be more varied, requiring greater flexibility of approach.
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Ravi, K., TM Maithili, David Mathew Thomas, and Sphoorti P. Pai. "Bacteriological profile and outcome of Ventilator associated pneumonia in Intensive care unit of a tertiary care centre." Asian Journal of Medical Sciences 8, no. 5 (August 31, 2017): 75–79. http://dx.doi.org/10.3126/ajms.v8i5.17630.
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Background: Ventilator associated pneumonia (VAP) complicates the course of 8-28% of patients receiving mechanical ventilation. Appropriate antimicrobial treatment significantly improves the outcome. Hence rapid identification of infected patients and accurate selection of antimicrobials are important clinical goals.Aims and Objectives: The present study was conducted with an aim to know the outcome of VAP and to identify pathogens, compare the bacteriological profile, duration of mechanical ventilation and length of hospitalization.Materials and Methods: Sixty patients who developed VAP during our study period of 2 years were included after meeting inclusion and exclusion criteria. Study was conducted in Victoria hospital and Bowring & Lady Curzon hospitals attached to Bangalore Medical College and Research institute.Results: Majority of patients were in the age group of 21-40 years. The occurrence of late VAP was 70 %. Klebsiella was the most common organism isolated in our study. Mortality was 13.3%. Average duration of intubation was 13.1±6.6days. Duration of hospital stay was 16.2±7.1 days.Conclusion: Our study concluded that occurrence of late VAP was more common than early VAP. Targeted strategies aimed at preventing VAP should be implemented to improve patient outcome and length of hospitalisation. Above all utmost importance must be given to prevent VAP. Asian Journal of Medical Sciences Vol.8(5) 2017 75-79
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Hanning, Brian W. T. "Impact on public hospitals if private health insurance rates in Victoria declined." Australian Health Review 28, no. 3 (2004): 330. http://dx.doi.org/10.1071/ah040330.
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The additional cost of treating acute care type Victorian private patients as public patients in Victorian public hospitals based on the current public sector payment model and rates was calculated, as was the loss of health fund income to public hospitals. If all private cases became public the net recurrent cost would be $1.05 billion assuming all patients were still treated. If private health insurance (PHI) uptake had declined to 23.3% as was projected without Lifetime Health Cover and the 30% rebate, the additional operating cost and income loss would be $385 million. This compares to the Victorian cost of the 30% rebate for acute hospital cases of $383 million. This takes no account of capital costs and possible public sector access problems. The analysis suggests that 31 extra operating theatres would be needed in the public sector (had the transfer of surgical patients from the public sector to the private sector not occurred). This analysis suggests that without the PHI rebate the current stresses on Victorian public hospitals would be increased, not decreased.
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Biro, Mary Anne, Jane S. Yelland, Stephanie J. Brown, and Georgina A. Sutherland. "Women’s experience of domiciliary postnatal care in Victoria and South Australia: a population-based survey." Australian Health Review 36, no. 4 (2012): 448. http://dx.doi.org/10.1071/ah11128.
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Objective. Despite the expansion of postnatal domiciliary services, we know little about the women receiving visits and how they regard their care. The aim of this study is to examine the provision of postnatal domiciliary care from a consumer perspective. Methods. All women who gave birth in September–October 2007 in South Australia and Victoria were mailed questionnaires 6 months after the birth. Women were asked if they had received a midwifery home visit, and to rate the care they received. Results. More women in South Australia reported receiving a domiciliary visit than in Victoria (88.0% v. 76.0%) and they were more likely to rate their care as ‘very good’ (69.1% v. 63.4%). Younger women, women on a lower income, who were holding a healthcare concession card or who had not completed secondary education were less likely to receive a visit. Conclusion. Although the majority of women in public maternity care in Victoria and South Australia receive domiciliary care and rate it positively, there are significant state-based differences. Those more likely to benefit from domiciliary care are less likely to receive a visit. There is a need to further explore the purpose, aims and content of domiciliary care at individual and state-wide levels. What is known about the topic? Postnatal domiciliary services have expanded dramatically over the past decade as the postpartum hospital stay has shortened. Despite its widespread introduction, there are no mechanisms in place to monitor or evaluate whether these services are meeting women’s expectations. We know little about the women who receive domiciliary postnatal visits in the first week after discharge from hospital, and how they regard their experience of care. What does the paper add? This is the first Australian population-based survey that describes the experience of domiciliary care according to the state in which women reside and to examine the sociodemographic, obstetric and organisational factors associated with the provision of services. What are the implications for practitioners? There were state-based differences in the provision of domiciliary care and whilst the majority of women received domiciliary care and rated it positively, an inverse care law seems to apply: women who were more likely to need and derive benefit from domiciliary care were less likely to receive it. There is a need to further explore the purpose, aims and content of domiciliary care at individual and state-wide levels.
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Duke, Graeme J., Frank Shann, Cameron I. Knott, Felix Oberender, David V. Pilcher, Owen Roodenburg, and John D. Santamaria. "Hospital-acquired complications in critically ill patients." Critical Care and Resuscitation 23, no. 3 (September 6, 2021): 285–91. http://dx.doi.org/10.51893/2021.3.oa5.
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BACKGROUND: The national hospital-acquired complications (HAC) system has been promoted as a method to identify health care errors that may be mitigated by clinical interventions. OBJECTIVES: To quantify the rate of HAC in multiday stay adults admitted to major hospitals. DESIGN: Retrospective observational analysis of 5-year (July 2014 – June 2019) administrative dataset abstracted from medical records. SETTING: All 47 hospitals with on-site intensive care units (ICUs) in the State of Victoria. PARTICIPANTS: All adults (aged ≥ 18 years) stratified into planned or unplanned, surgical or medical, ICU or other ward, and by hospital peer group (tertiary referral, metropolitan, regional). MAIN OUTCOME MEASURES: HAC rates in ICU compared with ward, and mixed-effects regression estimates of the association between HAC and i) risk of clinical deterioration, and ii) admission hospital site (intraclass correlation coefficient [ICC] > 0.3). RESULTS: 211 120 adult ICU separations with mean hospital mortality of 7.3% (95% CI, 7.2–7.4%) reported 110 132 (42.6%) HAC events (commonly, delirium, infection, arrhythmia and respiratory failure) in 62 945 records (29.8%). Higher HAC rates were reported in elective (cardiac [50.3%] and non-cardiac [40.6%]) surgical subgroups compared with emergency medical subgroup (23.9%), and in tertiary (35.4%) compared with non-tertiary (22.7%) hospitals. HAC was strongly associated with on-admission patient characteristics (P < 0.001), but was weakly associated with hospital site (ICC, 0.08; 95% CI, 0.05–0.11). CONCLUSIONS: Critically ill patients have a high burden of HAC events, which appear to be associated with patient admission characteristics. HAC may an indicator of hospital admission complexity rather than hospital-acquired complications.
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McIntyre, Melanie L., Timothy Chimunda, Joanne Murray, Trent W. Lewis, and Sebastian H. Doeltgen. "The prevalence of post-extubation dysphagia in critically ill adults: an Australian data linkage study." Critical Care and Resuscitation 24, no. 4 (December 5, 2022): 352–59. http://dx.doi.org/10.51893/2022.4.oa5.
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OBJECTIVE: To define the prevalence of dysphagia after endotracheal intubation in critically ill adult patients. DESIGN: A retrospective observational data linkage cohort study using the Australian and New Zealand Intensive Care Society Adult Patient Database and a mandatory government statewide health care administration database. SETTING: Private and public intensive care units (ICUs) within Victoria, Australia. PARTICIPANTS: Adult patients who required endotracheal intubation for the purpose of mechanical ventilation within a Victorian ICU between July 2013 and June 2018. MAIN OUTCOME MEASURES: Presence of dysphagia, aspiration pneumonia, ICU length of stay, hospital length of stay, and cost per episode of care. RESULTS: Endotracheal intubation in the ICU was required for 71 124 patient episodes across the study period. Dysphagia was coded in 7.3% (n = 5203) of those episodes. Patients with dysphagia required longer ICU (median, 154 [interquartile range (IQR), 78–259] v 53 [IQR, 27–107] hours; P < 0.001) and hospital admissions (median, 20 [IQR, 13–30] v 8 [IQR, 5–15] days; P < 0.001), were more likely to develop aspiration pneumonia (17.2% v 5.6%; odds ratio, 3.0; 95% CI, 2.8–3.2; P < 0.001), and the median health care expenditure increased by 93% per episode of care ($73 586 v $38 108; P < 0.001) compared with patients without dysphagia. CONCLUSIONS: Post-extubation dysphagia is associated with adverse patient and health care outcomes. Consideration should be given to strategies that support early identification of patients with dysphagia in the ICU to determine if these adverse outcomes can be reduced.
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Jackson, Terri, and Petia Sevil. "Problems in counting and paying for multidisciplinary outpatient clinics." Australian Health Review 20, no. 3 (1997): 38. http://dx.doi.org/10.1071/ah970038.
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Policy-makers have always found it problematic to formulate fair and consistentcounting rules for public hospital outpatient activities. In the context of output-based funding, such rules have consequences which can affect patient care. This paper reviews the rationale for organising multidisciplinary clinics and reports on a series of focus groups convened in four Melbourne teaching hospitals to consider funding policy for such clinics. It discusses issues of targeting outpatient services, along with implications for payment policy. It evaluates counting rules in terms of intended andunintended consequences in the context of Victoria?s introduction of output-basedfunding for outpatient services.
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Johnson, Avalon. "Access to Elective Abortions for Female Prisoners under the Eighth and Fourteenth Amendments." American Journal of Law & Medicine 37, no. 4 (December 2011): 652–83. http://dx.doi.org/10.1177/009885881103700405.
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Victoria, a pregnant inmate housed in a Louisiana state prison, brought a civil rights action challenging the prison’s policy of requiring her to obtain a court order to receive an elective abortion. Although Louisiana state law purported to allow Victoria to obtain an elective abortion, Victoria was unable to obtain her abortion because of procedural delays. Victoria was released from prison before she gave birth but her pregnancy was too far along for her to legally obtain an abortion. She was therefore forced to carry her pregnancy to term and forced to place her newborn child with adoptive parents. Had she given birth in prison, she would have been shackled to her hospital bed, as Louisiana policies require.Little information regarding pregnancy, prenatal care, perinatal outcomes, and access to elective abortions for female inmates exists. We know, however, that between six and ten percent of the women entering jail or prison are pregnant and that more women may become impregnated in prison as a result of rape by prison guards.
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Boyle, Malcolm J., M. ClinEpi, Erin C. Smith, and Frank L. Archer. "Trauma Incidents Attended by Emergency Medical Services in Victoria, Australia." Prehospital and Disaster Medicine 23, no. 1 (February 2008): 20–28. http://dx.doi.org/10.1017/s1049023x00005501.
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AbstractIntroduction:International literature describing the profile of trauma patients attended by a statewide emergency medical services (EMS) system is lacking. Most literature is limited to descriptions of trauma responses for a single emergency medical service, or to patients transported to a specific Level-1 trauma hospital. There is no Victorian or Australian literature describing the type of trauma patients transported by a state emergency medical service.Purpose:The purpose of this study was to define a profile of all trauma incidents attended by statewide EMS.Methods:A retrospective cohort study of all patient care records (PCR) for trauma responses attended by Victorian Ambulance Services for 2002 was conducted. Criteria for trauma categories were defined previously, and data were extracted from the PCRs and entered into a secure data repository for descriptive analysis to determine the trauma profile. Ethics committee approval was obtained.Results:There were 53,039 trauma incidents attended by emergency ambulances during the 12-month period. Of these, 1,566 patients were in physiological distress, 11,086 had a significant pattern of injury, and a further 8,931 had an identifiable mechanism of injury. The profile includes minor trauma (n = 9,342), standing falls (n = 20,511), no patient transported (n = 3,687), and deceased patients (n = 459).Conclusions:This is a unique analysis of prehospital trauma. It provides a baseline dataset that may be utilized in future studies of prehospital trauma care. Additionally, this dataset identifies a ten-fold difference in major trauma between the prehospital and the hospital assessments.
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McLean, Karen, Harriet Hiscock, Dorothy Scott, and Sharon Goldfeld. "What is the timeliness and extent of health service use of Victorian (Australia) children in the year after entry to out-of-home care? Protocol for a retrospective cohort study using linked administrative data." BMJ Paediatrics Open 3, no. 1 (January 2019): e000400. http://dx.doi.org/10.1136/bmjpo-2018-000400.
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IntroductionChildren entering out-of-home care have high rates of health needs across all domains of health. To identify these needs early and optimise long-term outcomes, routine health assessment on entry to care is recommended by child health experts and included in policy in many jurisdictions. If effective, this ought to lead to high rates of health service use as needs are addressed. Victoria (Australia) has no state-wide approach to deliver routine health assessments and no data to describe the timing and use of health service visits for children in out-of-home care. This retrospective cohort data linkage study aims to describe the extent and timeliness of health service use by Victorian children (aged 0–12 years) who entered out-of-home care for the first time between 1 April 2010 and 31 December 2015, in the first 12 months of care.Methods and analysisThe sample will be identified in the Victorian Child Protection database. Child and placement variables will be extracted. Linked health databases will provide additional data: six state databases that collate data about hospital admissions, emergency department presentations and attendances at dental, mental and community health services and public hospital outpatients. The federal Medicare Benefits Schedule claims dataset will provide information on visits to general practitioners, specialist physicians (including paediatricians), optometrists, audiologists and dentists. The number, type and timing of visits to different health services will be determined and benchmarked to national standards. Multivariable logistic regression will examine the effects of child and system variables on the odds of timely health visits, and proportional-hazards regression will explore the effects on time to first health visits.Ethics and disseminationEthical and data custodian approval has been obtained for this study. Dissemination will include presentation of findings to policy and service stakeholders in addition to scientific papers.
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Turbitt, Erin, Marina Kunin, Sarah Gafforini, and Gary L. Freed. "Motivators and barriers for paediatricians discharging patients." Australian Journal of Primary Health 23, no. 3 (2017): 284. http://dx.doi.org/10.1071/py16094.
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The aim of this study was to identify motivators and barriers that paediatricians face when discharging patients from outpatient specialty care. A questionnaire was administered to outpatient care paediatricians in Victoria working in one of five speciality public hospital clinics. Questions focused on how important various motivators and barriers were in respondents’ decision to discharge a patient from their clinic. Nearly all (91%, n=74) paediatricians invited to participate provided responses. The factor influencing the greatest proportion of paediatricians in their decision to discharge patients back to primary care was the potential that patients may not receive the required care from a GP. The next most highly rated barrier was that it is too complicated to arrange discharge; rated as a very important influence by one-third of paediatricians (33%, n=24). Improvements to the discharge process may encourage more paediatricians to discharge patients back to their GP, therefore freeing up appointment slots. This in turn could reduce waiting times for paediatric outpatient clinics in Victoria. The concern from paediatricians that patients may not receive the required care from a GP warrants attention and should be further investigated.
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Hanumanthaiah, Ramesh Gorghatta, Dheemantha Prasad, Panchakshari Prasanna Bangalore Krishnappa, and Sreelatha R. "Usage of blood products in emergency department at tertiary care centre." International Journal of Advances in Medicine 4, no. 4 (July 20, 2017): 903. http://dx.doi.org/10.18203/2349-3933.ijam20173096.
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Background: Blood usage in the emergency department is a formidable challenge to the treating doctor. Inadvertent use of blood can do more harm to the patient than good. Analyzing blood transfusion data will help in formulating policies for transfusion in Emergency medicine department. The present study is taken to formulate guidelines for transfusion in Emergency department of our hospital. The present study also helps us to analyze the blood requirement, utilization and wastage in Emergency department, Victoria hospital.Methods: The study done was a prospective study over a period of three months from March 2016 to May 2016. A descriptive, prospective study was conducted with a total of three hundred cases collected from the Emergency department (Casualty), Victoria hospital.Results: Commonest indication for packed red cell transfusion was anemia, for FFP was hypoproteinaemia and for platelet concentrate was viral hemorrhagic fever. Transfusion trigger for packed red cells is haemoglobin of less than 7gram/dl with no co-morbid conditions and 7-9 gram/dl when there are co-morbid conditions.Conclusions: A protocol has to be formulated to reduce the wastage and to effectively utilise blood and its products.
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Dowling, Pat. "The Discharge Brokerage Program." Australian Journal of Primary Health 2, no. 1 (1996): 134. http://dx.doi.org/10.1071/py96019.
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In response to government policies on case mix funding and Diagnosis Related Groups (DRGs), Caulfield Community Care Centre, in consultation with the Inner South Community Health Service in Victoria, made a submission for government funding to run an early discharge program. It was called a Discharge Brokerage Program rather than an early discharge program, because of not wanting patients to be anxious about leaving hospital early.
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Akhtar, Masood, Nasir Wakeel, Muhammad Asim Shafique, Saulat Sarfraz, M. Younas Varachue, and Fouzia Qayyum. "Ludwig’s Angina: Management of 32 Cases at Tertiary Care Hospital." Pakistan Journal of Medical and Health Sciences 15, no. 5 (May 30, 2021): 1090–92. http://dx.doi.org/10.53350/pjmhs211551090.
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Background: Ludwig’s angina is a rapidly expanding cellulitis involving the floor of mouth and sub mandibular space predominantly due to dental / periodontal infections. Aim: To determine the management outcomes in the patients of Ludwig’s Angina. Place and duration of study: Department of Otorhinolaryngology Bahawal Victoria Hospital Bahawalpur. Duration was two years from August 2018 to July 2020. Study design: Hospital based cross sectional descriptive type of study Methodology: Patients of any age and gender who were clinically diagnosed as Ludwig angina and required hospitalization during the study duration were included in the study. Data regarding age, gender underlying cause, mode of presentation, treatment and complications were collected and analyzed. Patients with mild infection who did not require hospital admission were excluded from the study. Results: Out of total 32 cases, 20(62.5%) were males and 12(37.5%) were females. Age range was 10 to 70 years. In 28 (87.5%) cases, the cause was dental infection. All patients presented with pain and swelling of sub mandibular region. Four (12.5%) patients were improved with conservative treatment while 28(87.5%) underwent incision and drainage. Two (6.25%) patients needed tracheostomy. One (3.1%) patient developed complication (mediastinitis) and could not revive. Conclusion: Ludwig's angina is a disease of any age and gender commonly seen among the patients of preexisting dental infection. It can be life threatening if presented late with complication. Early diagnosis and aggressive treatment decrease morbidity and mortality. Key words: Angina, Ludwing, Cellulitis, Submandibular region.
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Rutman, Deborah, and Belinda Parke. "Palliative Care Needs of Residents, Families, and Staff in Long-Term Care Facilities." Journal of Palliative Care 8, no. 2 (June 1992): 23–29. http://dx.doi.org/10.1177/082585979200800205.
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While there is growing recognition that the physical needs of LTC residents have increased markedly in the 20 years, the palliative care needs of facility residents and their families are poorly understood. There also is a dearth of information on the educational and support needs of LTC facility staff vis-a-vis palliative care. Operating from the Juan de Fuca Hospital Society (a network of extended care facilities in Victoria), our Palliative Support Team (PST) was conceived in order to act as an educational resource to JdF staff as well as to provide expert consultation on palliative care issues. As part of the evaluation of this pilot program, a sample of 74 Juan de Fuca workers were interviewed to determine their perceptions of resident, family, and staff needs in relation to palliative care. In this paper, discussion is focused on the palliative care needs identified by professional caregivers. The ways in which a palliative care consultation team can address some of these needs are also discussed.
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Funder, Jordan L., Kelly-Ann Bowles, and Linda J. Ross. "Diagnostic ability of a computer algorithm to identify prehospital STEMI." Journal of Paramedic Practice 14, no. 9 (September 2, 2022): 366–72. http://dx.doi.org/10.12968/jpar.2022.14.9.366.
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Background: Acute myocardial infarction (AMI) accounts for 43% of deaths related to ischaemic heart disease, with ST-segment elevation myocardial infarction (STEMI) accounting for 25%–40% of all AMI presentations. Given the impact of these diseases, there is a strong prehospital focus on early identification, treatment and transport of patients with acute coronary syndrome. The main aim of the STEMI system of care is to reduce the time to reperfusion of the myocardium, thereby improving morbidity and mortality rates. Therefore, the identification of STEMI by paramedics can have a dramatic effect on patients' long-term health outcomes. Ambulance Victoria paramedics play a crucial role in the care provided to AMI patients across the state, with the assistance of a computer-automated interpretation of 12-lead electrocardiograms (ECGs) to aid STEMI identification. Objectives: This study's objective is to analyse the diagnostic capability of the computer-automated interpretation to diagnose STEMI in the out-of-hospital setting. Methods: Quantitative data from January 2018 to December 2019 was sourced from the Victorian Ambulance STEMI Quality Initiative. These data were periodically matched with hospital outcome and diagnosis data from the Victorian Cardiac Outcomes Registry to compare provisional paramedic diagnoses with the final hospital diagnoses. Results: Of the 5269 cases of suspected STEMI, 765 (14.5%) could be matched with outcome data. Of these 765 cases, 88.9% were correctly identified as STEMI. The remaining 10% were categorised as either non-STEMI or unstable angina. No data were available for 1.1%. Conclusions: The diagnostic capability of the Zoll Inovise 12L interpretive algorithm to diagnose STEMI in the out-of-hospital setting appears safe and feasible. However, because of limited data matching paramedic findings with patient outcomes in hospital, no hard conclusions can be drawn. Furthermore, there is no way to ascertain how many false positives the Zoll monitor is interpreting. Further investigation is required to assess the true diagnostic capability of the Zoll Inovise 12L interpretive algorithm.
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Russo, P., A. Bull, N. Bennett, C. Boardman, S. Burrell, and M. Richards. "The establishment of a statewide surveillance program for hospital-acquired infections in large acute care public hospitals in Victoria, Australia." American Journal of Infection Control 33, no. 5 (June 2005): e174-e175. http://dx.doi.org/10.1016/j.ajic.2005.04.224.
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Taylor, Ann, Mary Lynn Andriuk, Paule Langlois, and Eric Provost. "Staff Rotation: Implications for Occupational Therapy." Canadian Journal of Occupational Therapy 62, no. 4 (October 1995): 208–11. http://dx.doi.org/10.1177/000841749506200405.
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Occupational therapy departments of tertiary care hospitals can provide staff with opportunities to gain diverse clinical experience if they rotate through the various services such as surgery, medicine, geriatrics, plastic surgery and orthopedics. The system of rotation offers both advantages and disadvantages for the staff and the institution. The Royal Victoria Hospital in Montreal, a large university teaching hospital, had traditionally offered staff the opportunity to rotate. Changes in staffing and their needs however, resulted in rotation becoming an important issue within the department. This article presents the pros and the cons of rotation and non-rotation systems as identified by therapists and administrators across Canada. Staff rotation was found to have an effect on job satisfaction and a therapist's career orientation. Given these findings, administrators may want to reconsider the role of the generalist and specialist in their facilities.
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Lovell, Janaka J., Aleece MacPhail, Nicola Cunningham, Margaret Winbolt, Carmel Young, Tony Pham, and Joseph E. Ibrahim. "Junior doctors and limitation-of-care orders: perspectives, experiences and the challenge of dealing with persons with dementia." European Journal for Person Centered Healthcare 5, no. 3 (September 26, 2017): 373. http://dx.doi.org/10.5750/ejpch.v5i3.1340.
Full textAbstract:
Background/Objectives: Globally, junior doctors play a central role in completing limitation of care orders (LCOs). This study aims to guide improvement of LCO utility by ascertaining junior doctor perspectives, LCO experiences and identifying challenges encountered in LCOs for patients with dementia, a particularly complex patient group. Design/Setting/Participants: Qualitative data were collected through semi-structured interviews. Participants were registered medical practitioners who had graduated within the previous 3 years and were practicing in a hospital in Victoria, Australia. Results: Nineteen junior doctors were interviewed between December 2013 and January 2015. Junior doctors were frequently involved in discussion and decision-making around treatment limitations and end-of-life care. Participants described inconsistent support, a lack of preparedness, a vague understanding of related hospital policies and inadequate knowledge and experience when it came to completing LCOs. Although participants acknowledged the additional nuances of capacity and prognosis assessment for patients with dementia, they did not feel that the processes for completing LCOs were significantly different for these persons. Many also recognised that decisions were often made without adequate consultation with the relevant stakeholders in this patient group. Conclusion: The junior doctors in this study highlighted global challenges in providing appropriate end-of-life care, particularly when they are responsible for this role. To improve patient care and ensure the wellbeing of junior doctors, hospitals need to address gaps in training needs and supervision with respect to end-of-life care, as well as to implement policies that support consistent and informed use of LCOs.
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Dwyer, Alison, and John McNeil. "Are Clinical Registries Actually Used? The Level of Medical Staff Participation in Clinical Registries, and Reporting within a Major Tertiary Teaching Hospital." Asia Pacific Journal of Health Management 11, no. 1 (March 16, 2016): 56–64. http://dx.doi.org/10.24083/apjhm.v11i1.245.
Full textAbstract:
Clinical Registries are established to provide a clinically credible means for monitoring and benchmarking healthcare processes and outcomes, to identify areas for improvement, and drive strategies for improving patient care. Clinical Registries are used to assess changes in clinical practice, appropriateness of care and health outcomes over time. The American Heart Association Policy Statement in April 2011 called for expanding the application for existing and future Clinical Registries, with well-designed Clinical Registry programs. Concurrently, in Australia, and similarly within the United States and United Kingdom, there has been an increased focus on performance measurement for quality and patient safety. Within Victoria, the Victorian Clinical Governance Policy Framework outlines clinical effectiveness as one of the four domains of Clinical Governance
As Clinical Registries evaluate effectiveness and safety of patient care by measuring patient outcomes compared with peers, the use of Clinical Registries data to improve a health service’s quality of care seems intuitive. A mixed methods approach was utilised, involving (1) semi-structured interviews and (2) documentation audit in this study conducted at Austin Health, a major tertiary teaching hospital in North-Eastern metropolitan Melbourne, affiliated with the University of Melbourne and various research institutes within Austin LifeSciences.
Although many studies have highlighted the benefits of data collected via individual Clinical Registries, [5,6] the level of voluntary medical staff participation in Clinical Registries at a health service level is yet to be established. The aim of this study was to document the level of medical staff involvement for Clinical Registries within a major tertiary teaching hospital, and the level of reporting into Quality Committees within the organisation.
This study demonstrates that along with a very high level of medical staff participation in Clinical Registries, there is a lack of systematic reporting of Registries data into quality committees beyond unit level, and utilisation of such data to reflect upon practice and drive quality improvement.
Abbreviations: CREPS – Centre for Excellence in Patient Safety; CSU – Clinical Services Unit; HOU – Heads of Unit; VASM – Victorian Audit of Surgical Mortality.
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Knock, Marion, David Newsome, and Barbara Poole. "The Medical Information Highway: Where is the Access Ramp?" Healthcare Management Forum 8, no. 3 (October 1995): 57–61. http://dx.doi.org/10.1016/s0840-4704(10)60920-9.
Full textAbstract:
In this article, an analogy is drawn between a health care information system and a freeway transportation system. Unfinished access ramps and disconnected road sections are likened to unlinked computer information systems. It is not until there is “connectivity” between roadways that vehicles can take advantage of the efficiencies of a freeway system or until there are comrehensive, integrated information systems that quality health care can be provided. The Greater Victoria Hospital Society used quality improvement techniques to improve the medical information highway, and theories of change management to encourage physician leaders to “buy into” the information system to produce needed change in the organization and in patient care.
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Kaplow, M., S. Charest, N. Mayo, and S. Benaroya. "Managing Patient Length of Stay Better Using an Appropriateness Tool." Healthcare Management Forum 11, no. 2 (July 1998): 13–16. http://dx.doi.org/10.1016/s0840-4704(10)60640-0.
Full textAbstract:
A multidisciplinary group from two medical floors at the Royal Victoria Hospital chose the Managed Care Appropriateness Program (MCAP) to evaluate the appropriateness of the days of stay for their patients. Of 100 charts of consecutive patients examined by the nurse reviewer (comprising 1,095 patient days), 33 percent of the days were deemed inappropriate. The reasons for each of these inappropriate days were documented, and strategies were implemented to address the issues. The major outcome of the study was a change in the culture of the health professionals to a more positive approach to defining and carrying out efficient patient care.
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Kaufman, Jessica, Kathleen L. Bagot, Monsurul Hoq, Julie Leask, Holly Seale, Ruby Biezen, Lena Sanci, et al. "Factors Influencing Australian Healthcare Workers’ COVID-19 Vaccine Intentions across Settings: A Cross-Sectional Survey." Vaccines 10, no. 1 (December 21, 2021): 3. http://dx.doi.org/10.3390/vaccines10010003.
Full textAbstract:
Healthcare workers’ COVID-19 vaccination coverage is important for staff and patient safety, workforce capacity and patient uptake. We aimed to identify COVID-19 vaccine intentions, factors associated with uptake and information needs for healthcare workers in Victoria, Australia. We administered a cross-sectional online survey to healthcare workers in hospitals, primary care and aged or disability care settings (12 February–26 March 2021). The World Health Organization Behavioural and Social Drivers of COVID-19 vaccination framework informed survey design and framing of results. Binary regression results adjusted for demographics provide risk differences between those intending and not intending to accept a COVID-19 vaccine. In total, 3074 healthcare workers completed the survey. Primary care healthcare workers reported the highest intention to accept a COVID-19 vaccine (84%, 755/898), followed by hospital-based (77%, 1396/1811) and aged care workers (67%, 243/365). A higher proportion of aged care workers were concerned about passing COVID-19 to their patients compared to those working in primary care or hospitals. Only 25% felt they had sufficient information across five vaccine topics, but those with sufficient information had higher vaccine intentions. Approximately half thought vaccines should be mandated. Despite current high vaccine rates, our results remain relevant for booster programs and future vaccination rollouts.