Journal articles on the topic 'Hospital patients New South Wales Sydney'
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1
Bridges, John FP, and Ralph M. Hanson. "The importance of age and other variables in predicting paediatric patient flows in New South Wales." Australian Health Review 24, no. 1 (2001): 94. http://dx.doi.org/10.1071/ah010094.
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This research focuses upon the relationship between a child's age and the likelihood that the child was treated at aSpecialist Children's Hospital rather than at a local hospital. While it is generally regarded that younger patients aremore resource intensive, a study was required to determine whether the Specialist Children's Hospitals attractedyounger patients. The analysis is based on 42,363 children treated in Greater Metropolitan Sydney in 1996/97, andon separations classified (role delineated) as non-tertiary DRGs (defined as Level 4 activity). However, this activityis of varying degrees of severity. A number of variables were used to explain why a child was treated at either a localhospital or at a specialist children's hospital. This study clearly demonstrates that Specialist Children's Hospitals do attractyounger and more severe patients.
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Austin, D. E., B. Burns, D. Lowe, B. Cartwright, A. Clarke, M. Dennis, M. D'Souza, et al. "Retrieval of Critically Ill Adults Using Extracorporeal Membrane Oxygenation: The Nine-Year Experience in New South Wales." Anaesthesia and Intensive Care 46, no. 6 (November 2018): 579–88. http://dx.doi.org/10.1177/0310057x1804600608.
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In New South Wales, a coordinated extracorporeal membrane oxygenation (ECMO) retrieval program has been in operation since 2007. This study describes the characteristics and outcomes of patients transported by this service. We performed a retrospective observational study and included patients who were transported on ECMO to either of two adult tertiary referral hospitals in Sydney, New South Wales, between February 28, 2007 and February 29, 2016. One hundred and sixty-four ECMO-facilitated transports occurred, involving 160 patients. Of these, 118 patients (74%) were treated with veno-venous (VV) ECMO and 42 patients (26%) were treated with veno-arterial ECMO. The mean (standard deviation, SD) age was 40.4 (15.0) years. Seventy-seven transports (47%) occurred within metropolitan Sydney, 52 (32%) were from rural or regional areas within NSW, 17 (10%) were interstate transfers and 18 (11%) were international transfers. Transfers were by road (58%), fixed wing aircraft (27%) or helicopter (15%). No deaths occurred during transport. The median (interquartile range) duration of ECMO treatment was 8.9 (5.2–15.3) days. One hundred and nineteen patients (74%) were successfully weaned from ECMO and 109 (68%) survived to hospital discharge or transfer. In patients treated with VV ECMO, age, sequential organ failure assessment score, pre-existing immunosuppressive disease, pre-existing diabetes, renal failure requiring dialysis and failed prone positioning prior to ECMO were independently associated with increased mortality. ECMO-facilitated patient transport is feasible, safe, and results in acceptable short-term outcomes. The NSW ECMO Retrieval Service provides specialised support to patients with severe respiratory and cardiovascular illness, who may otherwise be too unstable to undergo inter-hospital transfer to access advanced cardiovascular and critical care services.
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MUSCATELLO, D. J., K. A. O'GRADY, K. NEVILLE, and J. McANULTY. "Acute poststreptococcal glomerulonephritis: public health implications of recent clusters in New South Wales and epidemiology of hospital admissions." Epidemiology and Infection 126, no. 3 (June 2000): 365–72. http://dx.doi.org/10.1017/s0950268801005568.
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Acute poststreptococcal glomerulonephritis (APSGN) is an inflammatory kidney condition that can complicate Group A streptococcal infections. Two clusters of APSGN occurred recently in New South Wales (NSW), Australia; one in a rural town in December 1999 and the other in a Sydney suburb in January 2000. We interviewed carers of the affected children but found no common exposures except three of the Sydney cases were cousins in frequent contact. To assess the probability of these clusters occurring, we analysed hospital admissions for acute glomerulonephritis, as a proxy for APSGN in younger patients. The incidence of acute glomerulonephritis in NSW during 1989/90–1997/8 in residents aged under 20 years was 2·2/100000/year (95% CI 2·0–2·5). Incidence was highest in children aged 5–9 years, boys and Aboriginal children. We found no evidence for other clusters during that period. The recent clusters highlight the continued potential for unexpected future outbreaks of APSGN.
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Forrest, P., J. Y. Cheong, M. P. Vallely, P. J. Torzillo, P. N. Hendel, M. K. Wilson, P. G. Bannon, M. S. Bayfield, R. Herkes, and S. W. Walker. "International Retrieval of Adults on Extracorporeal Membrane Oxygenation Support." Anaesthesia and Intensive Care 39, no. 6 (November 2011): 1082–85. http://dx.doi.org/10.1177/0310057x1103900616.
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A retrieval service was established in New South Wales to provide mobile extracorporeal membrane oxygenation support to patients with severe, acute cardiac or respiratory failure. This service has also retrieved four adult patients from Nouméa, New Caledonia to Sydney on extracorporeal membrane oxygenation support, which are the first international retrievals of this type from Australia. We discuss our experience with these patients, three of whom survived to hospital discharge. However, one patient referred from New Caledonia died before extracorporeal membrane oxygenation could be established.
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Barakate, M., E. Maver, G. Wotherspoon, and T. Havas. "Anaesthesia for microlaryngeal and laser laryngeal surgery: impact of subglottic jet ventilation." Journal of Laryngology & Otology 124, no. 6 (January 6, 2010): 641–45. http://dx.doi.org/10.1017/s0022215109992532.
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AbstractObjective:Over the past 20 years, jet ventilation techniques have been developed to enable safe and controlled microlaryngoscopy and the accurate treatment of laryngeal pathology. This study examined how advances in jet ventilation tube design have facilitated safe endolaryngeal surgery.Study design:The study documented the development and use of the Jockjet subglottic jet ventilation tube system at the Prince of Wales Hospital, Sydney. The new system consisted of two components: a Teflon tube with an outer diameter of 4 mm at the larynx, and a companion ventilator. The facility for end-tidal carbon dioxide and distal airways pressure monitoring was incorporated via dedicated channels. The Venturi jet was produced via a covered tip to prevent trauma to the tracheal mucosa.Setting:The Prince of Wales and Sydney Children's Hospitals, incorporated with The University of New South Wales.Patients:From June 2002 to March 2008 inclusive, 1000 consecutive patients underwent microlaryngeal surgery at this institution. Subglottic jet ventilation, via the Jockjet tube, was employed for 332 patients.Main outcome measures:Anaesthetic safety and intra-operative surgical access.Results:In all the 332 patients observed, surgical access was optimised and no adverse anaesthetic outcomes were encountered.Conclusion:Subglottic jet ventilation facilitates safe airway management during microlaryngeal and laser laryngeal surgery.
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Waldron, Liette S., Belinda C. Ferrari, Cristel Cheung-Kwok-Sang, Paul J. Beggs, Nicola Stephens, and Michelle L. Power. "Molecular Epidemiology and Spatial Distribution of a Waterborne Cryptosporidiosis Outbreak in Australia." Applied and Environmental Microbiology 77, no. 21 (September 9, 2011): 7766–71. http://dx.doi.org/10.1128/aem.00616-11.
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ABSTRACTCryptosporidiosis is one of the most common waterborne diseases reported worldwide. Outbreaks of this gastrointestinal disease, which is caused by theCryptosporidiumparasite, are often attributed to public swimming pools and municipal water supplies. Between the months of January and April in 2009, New South Wales, Australia, experienced the largest waterborne cryptosporidiosis outbreak reported in Australia to date. Through the course of the contamination event, 1,141 individuals became infected withCryptosporidium. Health authorities in New South Wales indicated that public swimming pool use was a contributing factor in the outbreak. To identify theCryptosporidiumspecies responsible for the outbreak, fecal samples from infected patients were collected from hospitals and pathology companies throughout New South Wales for genetic analyses. Genetic characterization ofCryptosporidiumoocysts from the fecal samples identified the anthroponoticCryptosporidium hominisIbA10G2 subtype as the causative parasite. Equal proportions of infections were found in males and females, and an increased susceptibility was observed in the 0- to 4-year age group. Spatiotemporal analysis indicated that the outbreak was primarily confined to the densely populated coastal cities of Sydney and Newcastle.
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Malone, Victoria, James McLennan, and David Hedger. "Smoke-free hospital grounds." Australian Health Review 44, no. 3 (2020): 405. http://dx.doi.org/10.1071/ah19125.
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This study investigated whether the implementation of a multicomponent intervention project could improve compliance with the New South Wales (NSW) Health smoke-free healthcare policy. Environmental interventions were implemented on the hospital grounds for a 12-week period. Compliance was measured by a pre- and postintervention observational count of smokers on the hospital grounds. After implementation, there was a significant 73% reduction in people smoking on the hospital grounds, indicating improved compliance with the NSW smoke-free healthcare policy through the use of a non-punitive multicomponent intervention. What is known about the topic?Lack of compliance with the NSW Health smoke-free healthcare policy was reflected by the large numbers of smokers outside the front of an inner-city hospital in Sydney, Australia. This issue had been raised by staff, patients and visitors as an ongoing problem requiring a solution. What does this paper add?Designing and implementing a non-punitive multicomponent intervention using modelling, operant and associative learning principles can successfully increase compliance with policies designed to stop smoking on hospital grounds. What are the implications for practitioners?Implementing non-punitive multicomponent interventions to improve compliance with the NSW Health smoke-free healthcare policy may increase patients’ acceptance of smoking cessation support when offered. Healthcare staff need to be equipped with the knowledge and confidence to offer this support.
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Beumont, P. J. V., E. M. Kopec-Schrader, and W. Lennerts. "Eating Disorder Patients at a NSW Teaching Hospital: A Comparison with State-Wide Data." Australian & New Zealand Journal of Psychiatry 29, no. 1 (March 1995): 96–103. http://dx.doi.org/10.3109/00048679509075897.
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The aim of the study was to present data which may be useful in deciding the type of services needed for eating disorder (ED) patients in New South Wales (NSW). The demographic and clinical characteristics of 155 patients consecutively admitted to a special ED unit at a major Sydney teaching hospital during the triennium 1989–1991 were documented and compared with relevant data from the State as a whole (709 admissions for ED to public facilities and 938 admissions for ED to private facilities during the same period). The findings are discussed in the light of information from overseas studies. Although a relatively large number of ED patients are admitted to hospitals in NSW, their short duration of stay suggests that many may receive inadequate treatment. The unit in the Department of Psychiatry at the Royal Prince Alfred Hospital (RPA), the largest public ED service in NSW, provides a special service for these patients. It is effective in bringing about nutritional restoration, with a duration of stay similar to those reported from centres overseas. Most referrals are tertiary, and there is a high prevalence of physical morbidity indicating a need for access to general medical facilities. Most serious physical complications occur in patients who can be identified by their chronicity and by the pattern of their behavioural disturbance. These various factors are considered in the formulation of recommendations for rationalising the service.
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Ford, Belinda, Lisa Keay, Blake Angell, Stephanie Hyams, Paul Mitchell, Gerald Liew, and Andrew White. "Quality and targeting of new referrals for ocular complications of diabetes from primary care to a public hospital ophthalmology service in Western Sydney, Australia." Australian Journal of Primary Health 26, no. 4 (2020): 293. http://dx.doi.org/10.1071/py20084.
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Patients with diabetes require regular examination for eye disease, usually in primary care settings. Guidelines recommend patients with at least moderate non-proliferative diabetic retinopathy (NPDR) be referred to an ophthalmologist for treatment; however, poorly targeted referrals lead to access blocks. The quality of new referrals associated with diabetes to a public ophthalmology service in Sydney, New South Wales, Australia, were assessed for referral completeness and targeting. A cross-sectional audit of medical records for new patients referred to Westmead Hospital Eye Clinic in 2016 was completed. Completeness of medical and ophthalmic information in referrals and subsequent patient diagnosis and management in 2016–17 was recorded. Sub-analyses were conducted by primary care referrer type (GP or optometrist). In total, 151 new retinopathy referrals were received; 12% were sent directly to a treatment clinic. Information was incomplete for diabetes status (>60%), medical (>50%) and ophthalmic indicators (>70%), including visual acuity (>60%). GP referrals better recorded medical, and optometrists (37%) ophthalmic information, but information was still largely incomplete. Imaging was rarely included (retinal photos <1%; optical coherence tomography <3%). Median appointment wait-time was 124 days; 21% of patients received treatment (laser or anti-vascular endothelial growth factor) at this or the following encounter. Targeting referrals for ocular complication of diabetes to public hospitals needs improvement. Education, feedback and collaborative care mechanisms should be considered to improve screening and referral in primary care.
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Chopra, Shiv, Rhys Gordon Van der Rijt, Quan Ngo, Frederick K. Clarke, James Peter Southwell-Keely, Kristy Robledo, and Elias Moisidis. "A comparison of maxillofacial trauma before and after implementation of lockout laws in Sydney." Australasian Journal of Plastic Surgery 1, no. 1 (January 20, 2018): 64–70. http://dx.doi.org/10.34239/ajops.v1i1.26.
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Background: Lockout reforms were introduced in February 2014 by the New South Wales government in an attempt to curb alcohol-related violence in Sydney, following a number of fatalities. Changes include 1.30 a.m. venue lockouts and the 3 a.m. cessation of alcohol service. This study aims to assess the results of these reforms through analysis of departmental treatment data. All maxillofacial fractures that required operative management at St Vincent’s Hospital, Sydney, over a two-year period pre and post reforms were analysed.Methods: Medical information, from multiple sources, of patients that required operative management for maxillofacial fractures over a 2-year period (2012-2014) were compared to those between (2014-2016). Data collected included age, gender, demographics, mechanism of injury, pattern of injury, treatment required, association with alcohol, time and place of injury, and long-term complications.Results: 145 maxillofacial fractures were operatively treated prior to the reforms compared to only 58 (p<0.001) post. Reported incidents occurring in the city significantly fell from 54 to 15 (p<0.001), with no change in peripheral locations. The operated cases associated with alcohol dropped post reforms (102/145 (70%) vs 33/58 (57%). The number of assaults related to ‘king hits’ significantly reduced from 30 (33%) to just 5 (19.2%).Conclusion: This study demonstrates a clear correlation with the reduction in maxillofacial trauma, alcohol and violence in a localised region of Sydney since the arrival of the lockout reforms. As such, it can provide guidance to other regions in Australia into the effects of such laws and its repercussions on patient care and service.
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Power, Melissa, Kevin Dong, Jennifer Walsh, David A. Lewis, and Daniel Richardson. "Barriers to HIV testing in hospital settings within a culturally diverse urban district of Sydney, Australia." Sexual Health 18, no. 4 (2021): 340. http://dx.doi.org/10.1071/sh20189.
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Background Eleven percent of people living with HIV in Australia remain unaware of their diagnosis, and there are missed opportunities for HIV testing in priority settings in New South Wales. HIV testing remains low outside of sexual health clinics with the exception of antenatal settings where HIV testing is routine. To understand why HIV testing rates are low, we sought to identify health worker-related barriers to HIV testing. Methods: We conducted an anonymous online survey to health workers in Western Sydney Local Health District (WSLHD) in September 2019. Tick-box, Likert scale responses were analysed using Chi-square and Kruskal–Wallis statistical tests, and free text responses were analysed with thematic analysis. Results: Three percent (n = 420) of WSLHD’s estimated 14 000 health workers responded. These included 317 clinicians (171 nurses, 65 doctors, 56 allied health professionals (AHPs), 25 midwives, and 103 health workers in non-clinical roles). Health workers were from a variety of in-patient/out-patient settings. Many health workers (291/420, 69%; 95%CI = 64.9–73.7%) were unaware that HIV testing is offered in their areas; doctors (82%) and midwives (80%) were more aware than nurses (23%) and AHPs (11%) (P < 0.0001). Doctors (Likert score = 3.62; 3.45/5) and midwives (2.84; 2.76) were significantly more comfortable discussing and confidently offering HIV testing than nurses (2.42; 1.81) or AHPs (1.83; 0.91) (P < 0.0001 for both). The top five barriers to HIV testing were (1) procedural knowledge, (2) identification of at-risk patients, (3) HIV knowledge, (4) positive result management, and (5) privacy concerns. Free text responses highlighted perceived stigma, testing/result responsibilities and resource challenges as barriers to HIV testing. Conclusions: Clinicians working in priority settings and with priority populations require more education and support to increase targeted HIV testing.
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Bhaskar, Sonu, Peter Thomas, Qi Cheng, Nik Clement, Alan McDougall, Suzanne Hodgkinson, and Dennis Cordato. "Trends in acute stroke presentations to an emergency department: implications for specific communities in accessing acute stroke care services." Postgraduate Medical Journal 95, no. 1123 (May 2019): 258–64. http://dx.doi.org/10.1136/postgradmedj-2019-136413.
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Background and purposeSouth Western Sydney comprises of a culturally and linguistically diverse (CALD) and lower socioeconomic status population group within the state of New South Wales. Geographic location and sociodemographic factors play important roles in access to healthcare and may be crucial in the success of time-critical acute stroke intervention. The aim of this study was to examine the trends in the delayed presentation to emergency department (ED) and identify factors associated with prehospital delay for an acute stroke/transient ischaemic attack (TIA) at a comprehensive stroke centre.MethodsPatient health-related data were extracted for stroke/TIA discharges for the period 2009–2017. Electronic medical record data were used to determine sociodemographic characteristics and prehospital factors, and their associations with delayed presentation≥4.5 hours from stroke onset were studied.ResultsDuring the 9-year period, population-adjusted stroke/TIA discharge rates increased from 540 to 676 per 100 000. A significant reduction in the proportion of patients presenting to ED<4.5 hours (56% in 2009 versus 46% in 2017, p<0.001) was observed. Younger patients aged 55–64 and 65–74 years, those belonging to Polynesia, South Asia and Mainland Southeast Asia, and those not using state ambulance as the mode of arrival to the hospital were at increased risk of prehospital delay.ConclusionsComprehensive reappraisal of educational programmes for early stroke recognition is required in our region due to delayed ED presentations of younger and specific CALD communities of stroke/TIA patients.
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Rosen, Alan. "Return from the vanishing point: a clinician's perspective on art and mental illness, and particularly schizophrenia." Epidemiologia e Psichiatria Sociale 16, no. 2 (June 2007): 126–32. http://dx.doi.org/10.1017/s1121189x00004747.
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SUMMARYAims - To examine earlier uses and abuses of artworks by individuals living with severe mental illnesses, and particularly schizophrenia by both the psychiatric and arts communities and prevailing stereotypes associated with such practices. Further, to explore alternative constructions of the artworks and roles of the artist with schizophrenia and other severe mental illnesses, which may be more consistent with amore contemporary recovery orientation, encompassing their potentials for empowerment, social inclusion as citizens and legitimacy of their cultural role in the community. Results - Earlier practices with regardto the artworks of captive patients of psychiatrists, psychotherapists, art therapists, occupational and diversional therapists, often emphasised diagnostic or interpretive purposes, or were used to gauge progress or exemplify particular syndromes. As artists and art historians began to take an interest in such artworks, they emphasised their expressive, communicative and aesthetic aspects, sometimes in relation to primitive art. These efforts to ascribe value to these works, while well-meaning, were sometimes patronising and vulnerable to perversion by totalitarian regimes, which portrayed them as degenerate art, often alongside the works of mainstream modernist artists. This has culminated in revelations that the most prominent European collection of psychiatric art still contains, and appears to have only started to acknowledge since these revelations, unattributed works by hospital patients who were exterminated in the so-called “euthanasia” program in the Nazi era. Conclusions - Terms like Psychiatric Art, Art Therapy, Art Brut and Outsider Art may be vulnerable to abuse and are a poor fit with the aspirations of artists living with severe mental illnesses, who are increasingly exercising their rights to live and work freely, without being captive, or having others controlling their lives, or mediating and interpreting their works. They sometimes do not mind living voluntarily marginal lives as artists, but they prefer to live as citizens, without being involuntarily marginalised by stigma. They also prefer to live with culturally valued roles which are recognised as legitimate in the community, where they are also more likely to heal and recover.Declaration of Interest: This paper was completed during a Visiting Fellowship, Department of Social Medicine, School of Public Health, & Department of Medical Anthropology, Faculty of Arts & Sciences, Harvard University, Cambridge, Mass, USA. A condensed version of this paper is published in “For Matthew & Others: Journeys with Schizophrenia”, Dysart, D, Fenner, F, Loxley, A, eds. Sydney, University of New South Wales Press in conjunction with Campbelltown Arts Centre & Joan Sutherland Performing Arts Centre, Penrith, 2006, to accompany with a large exhibition of the same name, with symposia & performances, atseveral public art galleries in Sydney & Melbourne, Australia. The author is also a printmaker, partly trained at Ruskin School, Oxford, Central St. Martin's School, London, and College of Fine Arts, University of New South Wales, Sydney.
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Crabtree, Nathan, Shirley Mo, Leon Ong, Thuvarahan Jegathees, Daniel Wei, David Fahey, and Jia (Jenny) Liu. "Retrospective Analysis of Patient Presentations at the Sydney (Australia) Royal Easter Show from 2012 to 2014." Prehospital and Disaster Medicine 32, no. 2 (January 31, 2017): 187–94. http://dx.doi.org/10.1017/s1049023x16001540.
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AbstractIntroductionComprehensive studies on the relationship between patient demographics and subsequent treatment and disposition at a single mass-gathering event are lacking. The Sydney Royal Easter Show (SRES; Sydney Olympic Park, New South Wales, Australia) is an annual, 14-day, agricultural mass-gathering event occurring around the Easter weekend, attracting more than 800,000 patrons per year. In this study, patient records from the SRES were analyzed to examine relationships between weather, crowd size, day of week, and demographics on treatment and disposition. This information would help to predict factors affecting patient treatment and disposition to guide ongoing training of first responders and to evaluate the appropriateness of staffing skills mix at future events.HypothesisPatient demographics, environmental factors, and attendance would influence the nature and severity of presentations at the SRES, which would influence staffing requirements.MethodsA retrospective analysis of 4,141 patient record forms was performed for patients who presented to St John Ambulance (Australian Capital Territory, Australia) at the SRES between 2012 and 2014 inclusive. Presentation type was classified using a previously published minimum data set. Data on weather and crowd size were obtained from the Australian Bureau of Meteorology (Melbourne, Victoria, Australia) and the SRES, respectively. Statistical analyses were performed using SPSS v22 (IBM; Armonk, New York USA).ResultsBetween 2012 to 2014, over 2.5 million people attended the SRES with 4,141 patients treated onsite. As expected, the majority of presentations were injuries (49%) and illnesses (46%). Although patient demographics and presentation types did not change over time, the duration of treatment increased. A higher proportion of patients were discharged to hospital or home compared to the proportion of patients discharged back to the event. Patients from rural/regional locations (accounting for 15% of all patients) were more likely to require advanced treatment, health professional review, and were more likely to be discharged to hospital or home rather than discharged back to the event. Extremes of temperature were associated with a lower crowd size and higher patient presentation rate (PPR), but had no impact on transfer or referral rates to hospital.ConclusionThis study demonstrated that analyses of patient presentations at an agricultural show provide unique insights on weather, attendance, and demographic features that correlated with treatment and disposition. These data can help guide organizers with information on how to better staff and train health care providers at future mass-gathering events of this type.CrabtreeN,MoS,OngL,JegatheesT,WeiD,FaheyD,LiuJ.Retrospective analysis of patient presentations at the Sydney (Australia) Royal Easter Show from 2012 to 2014.Prehosp Disaster Med.2017;32(2)187–194.
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Cashman, Helen, Eleni Mayson, David Kliman, Sue Vachalec, Jennifer Bell, Sam Milliken, John Moore, Orly Lavee, Barbara Withers, and Nada Hamad. "A Shared Electronic Health Record in a Rural Setting Maintains Hematological Cancer Services Remotely during the COVID-19 Pandemic." Blood 136, Supplement 1 (November 5, 2020): 5. http://dx.doi.org/10.1182/blood-2020-142209.
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Introduction The COVID-19 pandemic has had drastic effects on healthcare provision across Australia and the world. Rural hematology patients who may rely on visiting medical officers from larger cities or long distance travel for reviews are particularly vulnerable to having their treatment affected by the recent changes to healthcare delivery given severe travel restrictions. The Griffith Hematology/Oncology Unit is based in Griffith Base Hospital, a regional hospital in New South Wales, Australia. It is serviced by consultant hematologists from St Vincent's Hospital at the capital city of Sydney, Australia, who visit fortnightly to run hematology outreach clinics and supervise chemotherapy delivery. Griffith is located 575km from Sydney and has an estimated population of over 26,000(1). The COVID-19 pandemic imposed significant travel restrictions, such that visiting haematologists have been unable to travel to continue in-person clinics since April 2020. This has led to the exclusive reliance on telemedicine (telehealth and telephone reviews) and remote chemotherapy delivery supervision. Having an electronic health record (EHR) containing all relevant patient information which is remotely accessible to treating physicians has been integral to the continuity of comprehensive specialist cancer care in this rural setting via telemedicine. Methods The previously reported shared EHR between Griffith and St Vincent's Hospital, Sydney was used to review the impact of COVID-19 on service delivery in Griffith(2). All rural patient information was accessible from the metropolitan location including comprehensive documentation of a patient's clinical findings, routine observations, diagnostic pathology and radiology results, and details of treatment at the Griffith site. Remote chemotherapy prescribing and telemedicine notes were documented through the EHR. Results The number of new referrals, follow ups and total patients over the four months prior to the COVID-19 related changes (December 2019 to March 2020) and the four months following (April to July 2020) were compared. From April 2020 onwards, the Griffith clinic patients underwent reviews via telemedicine or telephone with no in-person reviews able to be conducted in Griffith due to the travel restrictions. The number of new referrals, follows up visits and the total number of patients seen following the change to telemedicine had all increased with no reduction in service delivery seen (Table 1). The total number of patient reviews was 167 visits over the four months prior to the change, which increased to 186 reviews after the travel restrictions were applied. Despite the travel restrictions, the hematology outreach services to Griffith were maintained through telemedicine reviews in a similar manner to the metropolitan service. Griffith rural hematology patients continue to undergo regular telemedicine reviews with monitoring of laboratory and imaging results through the EHR, receiving the same level of care as metropolitan patients. Chemotherapy is still able to be prescribed, adjusted and reviewed from the Sydney location for all patients. The total number of chemotherapy treatment cycles delivered in Griffith only slightly decreased despite the changes to service provision, which was attributed to normal variation in patients requiring treatment over 2020 (Table 2). 32 chemotherapy treatment cycles were delivered prior to the change compared to 26 cycles following, for the primary indications of lymphoma and myeloma. Conclusion In recent months, the centralised EHR has proven critical in minimising clinical service disruptions caused by the COVID-19 pandemic by facilitating telemedicine links and remote patient management. We demonstrate how the shared EHR has been integral to the continuation of complex rural patient management during the COVID-19 pandemic due to the availability of remotely accessible patient information and chemotherapy prescribing. No significant change in clinical service activity was seen following the drastic travel restrictions due to the pandemic. Given these travel restrictions are expected to continue, it is encouraging that the shared EHR will allow rural Griffith patients continued access to appropriate specialist hematology care over the coming months. This work demonstrates how an EHR is fundamental to the sustainability of vital cancer services for rural communities. Disclosures Hamad: Abbvie: Honoraria; Novartis: Honoraria.
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Griffiths, Rosalyn A., Pierre J. V. Beumont, Janice Russell, Stephen W. Touyz, and Gemma Moore. "The Use of Guardianship Legislation for Anorexia Nervosa: A Report of 15 Cases." Australian & New Zealand Journal of Psychiatry 31, no. 4 (August 1997): 525–31. http://dx.doi.org/10.3109/00048679709065074.
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Objective: This paper investigates compulsory treatment under guardianship legislation for 15 anorexia nervosa patients admitted to four eating disorders units in New South Wales (NSW), Australia, between 1991 and 1994. Method: A retrospective follow-up was conducted. This involved an analysis of sociodemographic, clinical, eating and weight history, and Guardianship Order details obtained from medical records. This small sample was compared to a larger sample of anorexia nervosa patients admitted voluntarily to a specialised eating disorder unit in NSW. Further follow-up included a structured interview using the Morgan-Russell Assessment Outcome Schedule at least 1 year after admission for compulsory treatment. Results: For those treated involuntarily, a larger number came from metropolitan Sydney and a larger percentage were unemployed, were purgers and required specialist medical consultations. A significantly higher proportion came from higher socioeconomic groups, and the duration of stay in hospital while patients were under guardianship was significantly greater. A high degree of comorbidity was noted. There were similarities between those treated involuntarily and those treated voluntarily for the source of referral, marital status and Body Mass Index on admission and discharge. Only three patients accepted a follow-up interview using the Morgan-Russell Outcome Schedule. Two of them had made a good recovery. Conclusions: It was noted that the guardianship sample comprised a more severely ill group than anorexic patients treated voluntarily. The nature of guardianship legislation compared to mental health law was discussed and advice offered to clinicians contemplating and implementing compulsory treatment.
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Cashman, Helen, Nada Hamad, John Moore, Sam Milliken, Orly Lavee, Barbara Withers, Eleni Mayson, et al. "An Electronic Health Record Facilitates a Safer and More Efficient Rural Outreach Haematology/Oncology Service." Blood 134, Supplement_1 (November 13, 2019): 4709. http://dx.doi.org/10.1182/blood-2019-127796.
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Background: Rural Australian oncology patients are known to have inferior mortality rates compared to metropolitan patients, possibly related to access to appropriate healthcare services and treatments. Replacement of paper-based chemotherapy charting with electronic systems improves the safety of chemotherapy administration through reduced prescribing and administrative errors. Aims: To integrate the electronic healthcare delivery systems at a metropolitan hospital and a rural outreach haematology clinic to facilitate streamlined and safe rural outpatient care. Method: The MOSAIQ v2.64 [Elekta] system utilized at St Vincent's Hospital, Sydney, was introduced at a linked rural outreach haematology clinic in Griffith, a city in the Riverina region of New South Wales. MOSAIQ is a comprehensive practice management system incorporating all relevant patient results and notes along with administrative capabilities. The two systems were consolidated into one with patient information accessible from both sites. Results: The electronic systems were successfully linked between the two sites in October 2017. As of November 2018 there were 497 patients registered with the service with the breakdown of diagnoses shown in Figure 1, with lymphoma found to be the most common haematological diagnosis. Tracking of service activity over time including clinic appointments and patient numbers is now possible, with increases in both seen since implementation. Nine chemotherapy regimen types encompassing 2174 overall treatments were delivered at the service over the fifteen months since implementation, the most common being R-CHOP [Rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone] followed by azacitidine. The linked system has improved streamlined care during patient transitions between the two hospitals with enhanced continuity of documentation and management. Chemotherapy prescribing has transitioned to electronic at the Griffith site and is guided by inbuilt, pharmacist-reviewed protocols allowing for safer and flexible prescribing remotely which has standardized management of haematology patients across both hospitals. Conclusion: Our study provides a novel example of the successful implementation of a centralised electronic healthcare record and chemotherapy prescribing system in a haematology setting shared between a metropolitan service and a rural outreach hospital clinic. This has positive implications for the safety and efficiency of healthcare delivery at the rural site applicable to all linked rural clinics, as well as allowing data collection to assist future planning of the service. Disclosures No relevant conflicts of interest to declare.
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Heinz, Sean J., and Sam Milliken. "Length of stay variations between rural and urban patients with acute myeloid leukemia: a case-matched study." Australian Health Review 37, no. 3 (2013): 397. http://dx.doi.org/10.1071/ah13021.
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Background. Keeping patients in hospital longer than medically necessary is costly and occupies resources that could be better utilised. If patients from regional areas remain in hospital longer because of logistical issues such as transport and accommodation, then there is an argument for establishing or expanding appropriate medical services for rural areas. However, if the length of stay (LOS) for rural and urban patients is similar, it could be surmised that current logistic services appropriately meet demand. Methods. This study reviews the cases of 40 patients with acute myeloid leukemia. This disease was selected as patients are generally required to travel to a metropolitan hospital for treatment, regardless of location. Twenty patients resided within the Sydney metropolitan area and 20 lived in rural New South Wales. Each of the 20 metropolitan patients were case-matched (1 : 1) with 20 rural patients with reference to sex, specific acute myeloid leukemia subtype (by World Health Organisation ICD-10 classification), and age. Results. Following statistical non-parametric (t-test) analysis, rural and urban medians were found to be very similar with a high t-value and small mean (urban median = 29, rural median = 29.5, t-value = 0.722, m = –0.95, s.d. = 15.236, two-tailed P = 0.789, 95% CI = –7.89, 5.99). This demonstrates that there was no statistically significant difference between mean LOS for rural or urban patients after case-matching, a conclusion supported by qualitative analysis of the data. Conclusion. Logistical issues are therefore unlikely to keep rural patients with AML in hospital beyond their immediate medical treatment. What is known about this topic? A United States-based study found that LOS in hospital for rural patients with human immunodeficiency virus was one-third longer than for urban patients across each of the 6 years analysed (from 1998 to 2003). However it was noted that after adjusting for covariates such as age and sex, differences between LOS for rural and urban residents were not of statistical significance. What does this paper add? This paper provides evidence that current services are utilised appropriately by demonstrating that rural and urban patients spend on average the same amount of time in hospital. Factors such as lack of transport or accommodation are therefore unlikely to keep rural patients in hospital beyond their immediate medical requirements. This paper adds to the limited research base within the Australian context. What are the implications for practitioners? It appears that support organisations adequately fulfil the needs of rural patients in the discharge process. LOS does not appear to correlate with the distance of residence from hospital. Practitioners should continue to support and encourage such support networks.
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Spies, M., J. Gutjahr-Holland, J. V. Bertouch, and A. Sammel. "THU0284 PREVALENCE OF NEUROPSYCHIATRIC LUPUS IN PSYCHOSIS PATIENTS WITH A POSITIVE ANTINUCLEAR ANTIBODY." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 369.1–369. http://dx.doi.org/10.1136/annrheumdis-2020-eular.1585.
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Background:Psychosis is a rare manifestation of Neuropsychiatric Systemic Lupus Erythematosus (NPSLE). Patients with SLE may have Psychosis as part of their initial presentation of disease1. Current guidelines do not make a recommendation regarding the use of Antinuclear Antibody (ANA) in the assessment of patients with psychosis2. There is limited evidence assessing the utility of ANA testing in this setting.Objectives:Primary objective: Determine the prevalence of NPSLE in patients admitted to a mental health service with a diagnosis of a psychosis, who have had a positive antinuclear antibody test.Secondary objectives: Determine the frequency and proportion of positive ANA testing in this patient group. Determine the pattern and titres of positive ANAs. Determine the subsequent investigation, referral and diagnosis of patients with positive ANAs.Methods:Retrospective chart review of patients admitted to a mental health service of two metropolitan tertiary referral centres, Prince of Wales Hospital (POWH) and Royal Prince Alfred Hospital (RPAH), with a diagnosis of psychosis who had been tested for ANA. Patients were identified using their electronically entered diagnosis based on the International Classification of Disease3codes. Assessment of patient data for SLE used the 2019 ACR/EULAR classification criteria4. Decisions regarding attribution of psychosis related events to SLE follows the criteria used by Bortoluzzi et al5.Results:Between 1stof January 2010 and 31stof March 2018 there were 5585 (POWH) and 4620 (RPAH) mental health admission with an ICD diagnosis of psychosis representing 2451 and 2315 individual patients. 449/2451 (18%) and 462/2315 (20%) patients were tested for ANA. 78/449 (17%) and 57/462 (12%) were positive. Discharge data was available for all patients and long-term follow up data was completed for 53/78 (81% - POWH) patients and 50/57 (88% - RPAH). The mean follow-up time 43 ± 23 months and 51 ± 29 months respectively.At discharge there were four patients who met 2019 ACR/EULAR for SLE. Of these, two patients met criteria for NPSLE. One was diagnosed clinically and treated specifically for NPSLE with intravenous methylprednisolone and rituximab.There were no additional diagnoses of SLE or NPSLE clinically or by criteria found in the available follow up data. Hence the overall prevalence of NPSLE in patients admitted with psychosis was 1.3%, 95%CI [0,6.9%] and 1.8%, 95%CI [0,9.4%] respectively.Conclusion:The prevalence of neuropsychiatric lupus in patients with psychosis and a positive ANA was 1/78 and 1/57 a two tertiary referral centres. This study expands significantly on the limited evidence available as to the expected outcomes of a positive ANA test in a patient with psychosis.References:[1]Pego-Reigosa JM, Isenberg DA. Psychosis due to systemic lupus erythematosus: characteristics and long-term outcome of this rare manifestation of the disease. Rheumatology (Oxford). 2008; 47:1498–502.[2]National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management. London: NICE; 2014. Clinical guideline CG178.[3]World Health Organization. (2004). ICD-10: international statistical classification of diseases and related health problems: tenth revision, 2nd ed.[4]Aringer M, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2019; 71(9): 1400–1412.[5]Bortoluzzi A, et al. Development and validation of a new algorithm for attribution of neuropsychiatric events in systemic lupus erythematosus. Rheumatology. 2015; 54: 891-898.Acknowledgments:Gordana Popovic, Statistical Consultant, Stats Central, Mark Wainwright Analytical Centre, University of New South Wales, Sydney, Australia.Disclosure of Interests:None declared
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Vedi, Aditi, Richard Mitchell, Cecelia Oswald, Glenn M. Marshall, Toby Trahair, and David S. Ziegler. "Increased Use of Allogeneic Transplant in CR2 Improves the Outcome for Children with Acute Myeloid Leukaemia." Blood 126, no. 23 (December 3, 2015): 2521. http://dx.doi.org/10.1182/blood.v126.23.2521.2521.
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Abstract Improvements in Outcome for Paediatric de novo Acute Myeloid Leukaemia Aditi Vedi1,2, Richard Mitchell1, Cecelia Oswald1, Glenn Marshall1,2, Toby Trahair1, David S Ziegler1,2 1Kids Cancer Centre, Sydney ChildrenÕs Hospital, Randwick, NSW, Australia, 2 School of Women and Children's Health, University of New South Wales, Randwick, NSW, Australia ABSTRACT The treatment for paediatric acute myeloid leukaemia (AML) has not changed significantly over the past 3 decades, yet outcomes have improved with cure rates increasing from 30% to over 50% of all newly diagnosed children over this period. This improvement in survival has been attributed to both treatment intensification and improved supportive care over the decades, although the precise impact of each remains unknown. Our group has retrospectively analysed a unique cohort of patients with de novo AML diagnosed in childhood (n=276), all treated with the same chemotherapy protocol over a 25-year period from 1986-2012. The contemporary cohort (2000-12), compared to historical cohorts (1986-99) had significantly improved overall survival (OS, 75% vs. 50%, p = 0.01), lower disease related mortality (38% vs. 19%, p = 0.02) and were significantly more likely to receive allogeneic transplant after relapse (SCT, 73% vs. 12%, p <0.0001). Allogeneic transplant post relapse was associated with a significantly improved survival across the entire cohort (OS 50% for allogeneic SCT vs. 12% for autologous or none, p<0.0001). There was no significant difference between the contemporary and historical cohorts in treatment related mortality (13% vs. 7%, p = 0.42) or relapse rates after induction (50% in older cohort vs. 40% in recent era, p=0.25), suggesting consistency of induction treatment efficacy and toxicity across the two periods. This data suggests improved survival in paediatric AML in the modern era has predominantly resulted from increased use of allogeneic SCT after relapse rather than from improved supportive care and is independent of chemotherapy intensification. Disclosures No relevant conflicts of interest to declare.
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Patti, Charles H. "St. James Hospital: A Case in Crisis Management." Journal of Management & Organization 9, no. 2 (January 2003): 75–78. http://dx.doi.org/10.1017/s183336720000482x.
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This definitely was not the type of day that St. James Hospital CEO, Paul Ryan, was expecting. As the groundbreaking ceremonies for the Hospital's new addition were about to begin, Paul found himself facing an unsympathetic press and an angry group of protesters. Clearly, he had a crisis on his hands.St. James Hospital in Parramatta (Western Sydney area of New South Wales, Australia) is a 400-bed multi-specialty community hospital providing ambulatory care, acute care, and psychiatric care services to residents living within the five suburbs of Auburn, Holroyd, Parramatta, Blacktown, and Baulkhaum Hills in the area of Western Sydney. The population of this area is multi-cultural with nearly one-third of the population born overseas and thirty percent speaking a language other than English. The area's population also differs from the population of New South Wales in other demographic characteristics. Table 1 shows some of these differences, although the data do not always allow direct comparisons. These differences have presented the management and staff of St. James Hospital with special socio-cultural, financial, and communication challenges.
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Patti, Charles H. "St. James Hospital: A Case in Crisis Management." Journal of the Australian and New Zealand Academy of Management 9, no. 2 (January 2003): 75–78. http://dx.doi.org/10.5172/jmo.2003.9.2.75.
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This definitely was not the type of day that St. James Hospital CEO, Paul Ryan, was expecting. As the groundbreaking ceremonies for the Hospital's new addition were about to begin, Paul found himself facing an unsympathetic press and an angry group of protesters. Clearly, he had a crisis on his hands.St. James Hospital in Parramatta (Western Sydney area of New South Wales, Australia) is a 400-bed multi-specialty community hospital providing ambulatory care, acute care, and psychiatric care services to residents living within the five suburbs of Auburn, Holroyd, Parramatta, Blacktown, and Baulkhaum Hills in the area of Western Sydney. The population of this area is multi-cultural with nearly one-third of the population born overseas and thirty percent speaking a language other than English. The area's population also differs from the population of New South Wales in other demographic characteristics. Table 1 shows some of these differences, although the data do not always allow direct comparisons. These differences have presented the management and staff of St. James Hospital with special socio-cultural, financial, and communication challenges.
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David T. Roth. "Chemical Restraint at Callan Park Hospital for the Insane in Sydney, New South Wales, 1877 to 1920." Health and History 20, no. 1 (2018): 1. http://dx.doi.org/10.5401/healthhist.20.1.0001.
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Parker, Gordon. "The Prince Henry Hospital Mood Disorders Unit." Psychological Medicine 23, no. 4 (November 1993): 1033–41. http://dx.doi.org/10.1017/s0033291700026490.
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In 1985 a Mood Disorders Unit (MDU) was established at Prince Henry Hospital in Sydney as a clinical research module, linked with the psychiatric department of the University of New South Wales. There were three general objectives: first, to provide a specialized state-wide clinical service for the assessment and management of those with affective disorders, particularly treatment-resistant depression; secondly, to make a research contribution; and thirdly, to serve as an academic centre for teaching and training of undergraduate and postgraduate students from a variety of disciplines.
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Collyer, Fran, and Catherine Heal. "Patient Satisfaction with Sex Re-assignment Surgery in New South Wales, Australia." Australian Journal of Primary Health 8, no. 3 (2002): 9. http://dx.doi.org/10.1071/py02039.
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An evaluation of the effect of sex re-assignment surgery on a group of patients attending a private clinic in Sydney, Australia. Fifty-seven patients who underwent full male-to-female sex re-assignment surgery between 1987 and 2000 completed a satisfaction survey. Several factors that might influence the extent of satisfaction with surgical outcome were explored, including age, work status, social life, and the appearance and function of the new genitalia. Patients reported significantly improved social and personal satisfaction following surgery, compared with five years previously. The study challenges outcomes from previously reported studies with regard to the age of patients at the time of surgery, and the finding that from the patient's perspective, there is no fundamental association between a successful surgical outcome and a satisfactory post-operative life experience.
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Bendall, Jason C., Paul M. Simpson, and Paul M. Middleton. "Prehospital Analgesia in New South Wales, Australia." Prehospital and Disaster Medicine 26, no. 6 (December 2011): 422–26. http://dx.doi.org/10.1017/s1049023x12000180.
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AbstractIntroduction: With at least 20% of ambulance patients reporting pain of moderate to severe intensity, pain management has become a primary function of modern ambulance services. The objective of this study was to describe the use of intravenous morphine, inhaled methoxyflurane, and intranasal fentanyl when administered in the out-of-hospital setting by paramedics within a large Australian ambulance service.Methods: A retrospective analysis was conducted using data from ambulance patient health care records (PHCR) for all cases from 01 July 2007 through 30 June 2008 in which an analgesic agent was administered (alone or in combination).Results: During the study period, there were 97,705 patients ≤100 years of age who received intravenous (IV) morphine, intranasal (IN) fentanyl, or inhaled methoxyflurane, either alone or in combination. Single-agent analgesia was administered in 87% of cases. Methoxyflurane was the most common agent, being administered in almost 60% of cases. Females were less likely to receive an opiate compared to males (RR = 0.83, 95% CI, 0.82–0.84, p <0.0001). Pediatric patients were less likely to receive opiate analgesia compared to adults (RR = 0.65, 95% CI, 0.63–0.67, p <0.0001). The odds of opiate analgesia (compared to pediatric patients 0–15 years) were 1.47; 2.10; 2.56 for 16–39 years, 40–59 years, and ≥60 years, respectively. Pediatric patients were more likely to receive fentanyl than morphine (RR = 1.69, 95% CI, 1.64–1.74, p < 0.0001).Conclusion: In this ambulance service, analgesia most often is provided through the use of a single agent. The majority of patients receive non-opioid analgesia with methoxyflurane, most likely because all levels of paramedics are authorized to administer that analgesic. Females and children are less likely to receive opiate-based analgesia than their male and adult counterparts, respectively. Paramedics appear to favor intranasal opiate delivery over intravenous delivery in children with acute pain.
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Hume, Frank, and Kay Wilhelm. "Career Choice and Experience of Distress Amongst Interns: A Survey of New South Wales Internship 1987–1990." Australian & New Zealand Journal of Psychiatry 28, no. 2 (June 1994): 319–27. http://dx.doi.org/10.1080/00048679409075646.
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Successive cohorts of interns assigned to a Sydney teaching hospital since 1987 were interviewed at the beginning and end of their intern year to document factors influencing career choice and psychological morbidity, with comparisons between the graduates of the three NSW medical faculties. Intellectual challenge and altruism were the two most reported motivating factors in choosing Medicine. Many interns expressed regret at their career choice. Apart from anger, self-reported psychological morbidity during internship was low. Interns' evaluation of the relevance of their undergraduate training declined during internship, except for Newcastle graduates. Increased “hands on” clinical experience during undergraduate years, career guidance, assertive-ness training, and time management skills should be included in the undergraduate curriculum. More registrar teaching, frequent performance feedback, regular grievance sessions and decreased clerical activities contribute to more enriching intern experiences.
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Mohsin, Mohammed, Lis Young, Sue Ieraci, and Adrian E. Bauman. "Factors associated with walkout of patients from New South Wales hospital emergency departments, Australia." Emergency Medicine Australasia 17, no. 5-6 (October 2005): 434–42. http://dx.doi.org/10.1111/j.1742-6723.2005.00774.x.
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Draper, Brian, Rosemary Karmel, Diane Gibson, Ann Peut, and Phil Anderson. "Alcohol-Related Cognitive Impairment in New South Wales Hospital Patients Aged 50 Years and Over." Australian & New Zealand Journal of Psychiatry 45, no. 11 (November 2011): 985–92. http://dx.doi.org/10.3109/00048674.2011.610297.
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Objectives: The aim of this study was to describe the principal reasons for admission, medical comorbidities, interventions and outcomes of patients admitted to New South Wales hospitals with alcohol-related cognitive impairment. Methods: We extracted data from the NSW Admitted Patient Care Database for nearly 410 000 multi-day hospital admissions from 222 public hospitals ending between July 2006 and June 2007 for people aged 50 and over. Data linkage using a unique patient identifier, derived by the Centre for Health Record Linkage identified hospital transfers and readmissions for individual patients. Using ICD10-AM codes, we identified patients with alcohol-related dementia, amnesic syndrome due to alcohol, and Wernicke's encephalopathy, their principal reasons for admission and medical comorbidities, and procedures undertaken. Outcomes were length of stay, mortality, discharge destination, and readmission. Results: A total of 462 patients diagnosed with alcohol-related dementia (n = 300; 82% male, mean age 63.9 years), Wernicke's encephalopathy (n = 77) or amnesic syndrome due to alcohol (n = 126) were identified with overlap between diagnoses. Alcohol-related dementia occurred in 1.4% of dementia patients, and was more likely to occur in younger age groups and men than other types of dementia. Alcohol-related mental disorder was recorded in 70% of alcohol-related dementia multi-day admissions: dependence (52%), ‘harmful use’ (11%) and withdrawal (12%). Principal reasons for admission for multi-day stays included alcohol-related mental disorder (18%), liver disease (11%) and injuries/poisonings (10%). Medical comorbidity was common. Like other dementia patients, alcohol-related dementia patients had longer length of stay (mean of 15 days) than non-dementia patients and more transfers to residential care (7%). However, mortality was similar to non-dementia patients (5%). Discharge at own risk was high (3.7%). Conclusions: Alcohol-related dementia is a preventable and potentially reversible condition. Investigation of intervention strategies initiated during hospitalization are warranted.
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Assareh, Hassan, Helen M. Achat, Jean-Frederic Levesque, and Stephen R. Leeder. "Exploring interhospital transfers and partnerships in the hospital sector in New South Wales, Australia." Australian Health Review 41, no. 6 (2017): 672. http://dx.doi.org/10.1071/ah16117.
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Objective The aim of the present study was to explore characteristics of interhospital transfers (IHT) and sharing of care among hospitals in New South Wales (NSW), Australia. Methods Data were extracted from patient-level linked hospital administrative datasets for separations from all NSW acute care hospitals from 1 July 2013 to 30 June 2015. Patient discharge and arrival information was used to identify IHTs. Characteristics of patients and related hospitals were then analysed. Results Transfer-in patients accounted for 3.9% of all NSW admitted patients and, overall, 7.3% of NSW admissions were associated with transfers (IHT rate). Patients with injuries and circulatory system diseases had the highest IHT rate, accounting for one-third of all IHTs. Patients were more often transferred to larger than smaller hospitals (61% vs 29%). Compared with private hospitals, public hospitals had a higher IHT rate (8.4% vs 5.1%) and a greater proportion of transfer-out IHTs (52% vs 28%). Larger public hospitals had lower IHT rates (3–8%) compared with smaller public hospitals (13–26%). Larger public hospitals received and retransferred higher proportions of IHT patients (52–58% and 11% respectively) than their smaller counterparts (26–30% and 2–3% respectively). Less than one-quarter of IHTs were between the public and private sectors or between government health regions. The number of interacting hospitals and their interactions varied across hospital peer groups. Conclusion NSW IHTs were often to hospitals with greater speciality services. The patterns of interhospital interactions could be affected by organisational and regional preferences. What is known about the topic? IHTs aim to provide efficient and effective care. Nonetheless, information on transfers and the sharing of care among hospitals in an Australian setting is lacking. Studies of transfers and hospital partnership patterns will inform efforts to improve patient-centred transfers and hospital accountability in terms of end outcomes for patients. What does this paper add? Transfer-in patients accounted for 3.9% of all NSW admissions; they were often (61%) transferred to hospitals with greater speciality services. The number of IHTs and sharing of care among hospitals varied across hospital peer groups, and could have been affected by organisational and regional preferences. What are the implications for practitioners? The findings of the present study suggest that different patterns of IHTs may not only have resulted from clinical priorities, but that organisational and regional preferences are also likely to be influential factors. Patient-centred IHTs and the development of guidelines need to be pursued to enhance the care and functionality of healthcare. Patient sharing should be acknowledged in hospital and regional performance profiling.
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Pryor, Julie. "A snapshot of rehabilitation referrals in rural New South Wales." Australian Health Review 34, no. 2 (2010): 204. http://dx.doi.org/10.1071/ah08713.
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The aim of this paper is to describe patterns of referral to inpatient rehabilitation in rural NSW. Archival records of referrals to one rural speciality medical rehabilitation service during 2004 and 2005 were analysed using descriptive statistics displayed using tables and graphs. Seventy-six referrers referred 922 patients for inpatient rehabilitation. Almost two-thirds (63.6%) came from the local acute hospital. Most referrals (80.4%) were considered appropriate for inpatient rehabilitation. Almost three-quarters (72.5%) of the patients referred were admitted. The demand for inpatient rehabilitation is high in rural NSW, suggesting that many healthcare providers view rehabilitation as a valuable service. Furthermore, this study suggests the important contribution that inpatient rehabilitation makes to the utilisation of acute care beds, but does not confirm it. What is known about the topic?Internationally and nationally there is a growing appreciation of the contribution that clinical rehabilitation services make to quality of life for people with a range of conditions, but little is known about referrals patterns to inpatient rehabilitation in rural NSW. What does the paper add?This paper provides the first focussed study of referrals to inpatient rehabilitation in rural NSW. It reports the number of patients referred, the number of referrers, the appropriateness of those referrals and their outcomes. What are the implications for practitioners?Rehabilitation services are important, widely and largely appropriately used; and that further work is needed to assess whether additional services are required to meet this demand.
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Jeremy, June. "Images of Child Care in Kenya." Aboriginal Child at School 21, no. 1 (March 1993): 50–51. http://dx.doi.org/10.1017/s0310582200005587.
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It was nearly two years ago that I heard about Alois Letipila, an early childhood Masai teacher-trainer who had suffered severe spinal injuries in a car crash in February 1989. As Co-ordinator of the New South Wales “Contact” project for isolated families (funded by DCS & H) I am also responsible for the Contact Children's Mobile sponsored by the Bernard Van Leer Foundation, which also funds Letipila's early childhood education program. Our suggestion to bring Letipila to the spinal unit of the Royal North Shore Hospital in Sydney was generously taken up and financed by the Foundation.
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Chalmers, John, James Angus, Robert Graham, John Carmody, Roger Dampney, Garry Jennings, and Nicholas Korner. "Paul Ivan Korner 1925–2012." Historical Records of Australian Science 24, no. 2 (2013): 251. http://dx.doi.org/10.1071/hr13008.
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Paul Korner's life's work centered on unraveling the sympatho-adrenal control of the circulation and applying this knowledge to understanding the pathogenesis of hypertension and to improving the management of cardiovascular diseases. He made major contributions as Foundation Professor of Physiology at the University of New South Wales (1960–8), as the first Scandrett Professor of Cardiology at the University of Sydney and the Royal Prince Alfred Hospital (1968–74), and as Director of the Baker Institute for Medical Research (1975–90). After retirement in 1990, he undertook his last major work, writing an influential single-author text, Essential Hypertension and it Causes.
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Brieger, David B., Austin C. C. Ng, Vincent Chow, Mario D'Souza, Karice Hyun, Paul G. Bannon, and Leonard Kritharides. "Falling hospital and postdischarge mortality following CABG in New South Wales from 2000 to 2013." Open Heart 6, no. 1 (March 2019): e000959. http://dx.doi.org/10.1136/openhrt-2018-000959.
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ObjectivesTo describe changes in mortality among patients undergoing coronary artery bypass grafting (CABG) in New South Wales (NSW) Australia from 2000 to 2013.MethodsPatients undergoing CABG were identified from the NSW Admission Patient Data Collection (APDC) registry, linked to the NSW state-wide death registry database. Changes in all-cause mortality over time were observed following stratification of the study cohort into two year groups.ResultsWe identified 54 767 patients undergoing CABG during the study period. The risk profile of patients increased over time with significant increases in age, comorbidities and concomitant valve surgery (all p < 0.0001). During a median follow-up period of 6 years, a total 12 161 (22.2%) of patients had died. Survival curves and adjusted analyses showed a steady fall in mortality rate: those operated on during 2012–2013 had 40 % lower mortality than those operated on during 2000–2001 (HR 0.61; 95% CI 0.53 to 0.69). This was contributed to both by a fall in mortality both in hospital (HR 0.48, 95% CI 0.37 to 0.62) and postdischarge (HR 0.73; 95% CI 0.61 to 0.86).ConclusionsWe report a consistent reduction in medium-term mortality among a large unselected cohort of NSW patients undergoing CABG between 2000 and 2013. This fall is attributable both to an improvement in outcomes in hospital and in the postdischarge period.
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Buhrich, Neil, Anne Butchart, Susan Johnston, and Roberta Lauchlan. "Delivery of Medication to Psychiatric Patients in Community Health Services in New South Wales." Australian & New Zealand Journal of Psychiatry 30, no. 4 (August 1996): 523–30. http://dx.doi.org/10.3109/00048679609065027.
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Objective: We investigated the supply and monitoring of medication to patients who attend community mental health services in NSW. Method: The staff at four metropolitan and one rural community centre health service were interviewed. Information sought included policies and procedures concerning medication, the delivery of medication to patients, and staff reports concerning their knowledge and practice related to the legal requirements of the New South Wales Poisons Act 1966. Results: Sixty-five (62%) of 104 coordinators, medical officers and staff who were responsible for case managing patients were interviewed. The centres all differed in their existing policies and practices and the extent to which they were supported by their local hospital and retail pharmacies. Only one centre had a designated pharmacist and this was a part-time position. Conclusions: The delivery of medication at most centres is a fairly ad hoc arrangement with staff organising medication as best as they can. At times the supply of medication to patients fails to comply with legal and New South Wales Department of Health requirements.
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O’Connor, Nick, Katherine Zantos, and Viviana Sepulveda-Flores. "Use of personal electronic devices by psychiatric inpatients: benefits, risks and attitudes of patients and staff." Australasian Psychiatry 26, no. 3 (February 20, 2018): 263–66. http://dx.doi.org/10.1177/1039856218758564.
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Objectives: The study aimed to evaluate the attitudes of patients and staff in relation to the potential benefits and risks of allowing psychiatric inpatients controlled access to personal electronic devices (PEDs), and to document a snapshot audit of practice within the mental health inpatient units of New South Wales, Australia. Methods: Psychiatric inpatients and staff at Royal North Shore Hospital’s Mental Health inpatient units were surveyed, and an audit of the policies of the psychiatric inpatients of New South Wales was undertaken. Results: Access to PEDs is denied in 85% of New South Wales psychiatric inpatient units. While patients and staff appear to concur on the risks of access to PEDs and the need for risk assessment and rules, compared to patients, staff appear to underestimate the importance of PEDs to maintaining social connection and recovery. Conclusions: This study may assist in the formulation of local policy and procedure to allow a more recovery-oriented approach to the question of whether patients should have access to their PEDs while in hospital.
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Hazell, Philip, Titia Sprague, and Joanne Sharpe. "Psychiatric hospital treatment of children and adolescents in New South Wales, Australia: 12-year trends." BJPsych Open 2, no. 1 (January 2016): 1–5. http://dx.doi.org/10.1192/bjpo.bp.115.000794.
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BackgroundIt is preferable that children and adolescents requiring in-patient care for mental health problems are managed in age-appropriate facilities. To achieve this, nine specialist Child and Adolescent Mental Health Services (CAMHS) in-patient units have been commissioned in New South Wales (NSW) since 2002.AimsTo examine trends in child and adolescent in-patient admissions since the opening of these CAMHS units.MethodAnalysis of separation data for under 18-year-olds to CAMHS, adult mental health and paediatric units for the period 2002 to 2013 in NSW, comparing districts with and without specialist CAMHS units.ResultsSeparations from CAMHS, adult and paediatric units rose with time, but there was no interaction between time and health district type (with/without CAMHS unit). Five of eight health districts experienced increased separations of under 18-year-olds from adult units in the year of opening a CAMHS unit. Separations from related paediatric units increased in three of seven health districts.ConclusionsOpening CAMHS units may be followed by a temporary increase in separations of young people from adult units, but it does not influence the flow of patients to non-CAMHS facilities in the longer term.
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Sutherland, Kim, Diane Hindmarsh, Katinka Moran, and Jean‐Frederic Levesque. "Disparities in experiences and outcomes of hospital care between Aboriginal and non‐Aboriginal patients in New South Wales." Medical Journal of Australia 207, no. 1 (July 2017): 17–18. http://dx.doi.org/10.5694/mja16.00777.
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Richardson, Daniel, Hubert Chan, Rohan Bopage, David A. Lewis, Shailendra Sawleshwarkar, Charles Chung, and Jen Kok. "HIV-1 subtype variability and transmitted drug resistance in a culturally diverse population in Western Sydney, New South Wales, Australia." Sexual Health 17, no. 4 (2020): 377. http://dx.doi.org/10.1071/sh20013.
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Abstract Background Transmitted human immunodeficiency virus type 1 (HIV-1) drug resistance (TDR) is an important contributor to antiretroviral treatment failure, and is associated with HIV-1 transmission among men who have sex with men (MSM), non-MSM clusters and individuals diagnosed with concurrent sexually transmissible infections (STI). Western Sydney has a culturally diverse population, with a high proportion of non-Australian-born individuals. This study describes the prevalence of TDR and non-B HIV-1 subtypes in a clinic-based population. Methods: A clinic database was examined for all newly diagnosed treatment-naïve HIV-1 patients and information on their HIV-1 resistance and subtype, demographics including country of birth and diagnosis of a bacterial sexually transmissible infection was collected. Results: Data were available from 74/79 individuals (62 cis-male, 16 cis-female and 1 transgender woman). Of the 74 genotypes, the prevalence of non-B subtypes and TDR was 43/74 (58%; 95%CI = 46.9–69.3) and 14/74 (19%; 95%CI = 10.0 to 27.8). It was also found that 30/79 (38%) had a concurrent bacterial STI. TDR was associated with subtype B infection (OR 3.53; 95%CI = 1.41–8.82; P = 0.007) and being born in Australia (OR 12.0; 95%CI = 2.45–58.86; P = 0.002). Conclusion: The relative prevalence of non-B HIV-1 subtypes and TDR is higher in Western Sydney than in the rest of Australia. TDR is associated with subtype B HIV-1 and being Australian born, suggesting ongoing local transmission. This highlights the diversity of the HIV epidemic locally and the need for interventions to prevent ongoing HIV transmission.
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Tran, H., P. Konecny, and C. Carmody. "49. SYPHILIS SCREENING PROFILE AT SEXUAL HEALTH CLINIC, ST GEORGE HOSPITAL & SUTHERLAND HOSPITAL." Sexual Health 4, no. 4 (2007): 303. http://dx.doi.org/10.1071/shv4n4ab49.
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A retrospective analysis was conducted to describe the cases of Syphilis identified and managed at Short Street Centre and The Sutherland Sexual Health Centre, in South Eastern Sydney and Illawarra Area, from January 2000 to June 2007. Syphilis serology is routinely offered as part of an STI screen to new and follow-up patients as appropriate. Information on the diagnoses, demographic and other variables was extracted from the clinical database Sexual Health Information Program (SHIP) and analysed in SPSS v11. Information on age, gender, relationship status, country of birth, presenting symptoms, stage of Syphilis, type of treatment and subsequent RPR levels were confirmed from patient records. An analysis of the relative frequency of the stages of Syphilis from over 130 patients will be presented and their relationship to a number of demographic and behavioural factors.
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Einfeld, Stewart, Margaret Tobin, John Beard, Elizabeth Evans, Richard Buss, and Michael Dudley. "Sustaining evidence-based practice for young people who self-harm: a 4-year follow-up." Australian Health Review 27, no. 2 (2004): 94. http://dx.doi.org/10.1071/ah042720094.
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Stewart Einfeld is at the School of Psychiatry, University of New South Wales; the late Margaret Tobin was the Director of Mental Health, South Australia; John Beard is Head of the Northern Rivers University Department of Rural Health, University of Sydney; Elizabeth Evans is a Research Assistant at the School of Psychiatry, University of New South Wales; Richard Buss is the Area Manager, Northern Rivers Area Mental Health Service; Michael Dudley is a child psychiatrist at Prince of Wales Hospital and the School of Psychiatry, University of New South Wales.This report is dedicated to our late co-author Margaret Tobin, to honour her contribution to advancing the quality of mental health services.Objective: In 1998 and 1999, two NSW Area Health Services conducted the Youth At Risk of Deliberate Self Harm (YARDS) project. The YARDS project was designed to implement evidence-based service enhancements for the clinical management of young people with Deliberate Self Harm. This paper examines the extent to which service enhancements implemented during YARDS were maintained 4 years after the conclusion of the project and compares service quality with another NSW Area Health Service that did not participate in the YARDS project.Method: Staff from mental health services and emergency departments completed the Service Activity Scale, a measure developed for the YARDS project to assess the quality of health service response to individuals who present following a suicide attempt.Results: Results indicated that the service improvements made during the YARDS project were maintained 4years after the project ended. Furthermore, a significant difference was found between scores for services that participated in YARDS and services that did not participate in YARDS.Conclusions: These results suggest that projects such as YARDS which support evidence based service nhancements may be useful in improving the management of young people with deliberate self-harm, and that these improvements may be long-lasting.
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Singer, Rebecca, Karen Zwi, and Robert Menzies. "Predictors of In-Hospital Mortality in Aboriginal Children Admitted to a Tertiary Paediatric Hospital." International Journal of Environmental Research and Public Health 16, no. 11 (May 29, 2019): 1893. http://dx.doi.org/10.3390/ijerph16111893.
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Background: Aboriginal Australian children have higher rates of mortality at younger ages than non-Aboriginal Australian children. We aimed to (i) calculate the case fatality rate (CFR) for Aboriginal and non-Aboriginal children admitted to children’s hospitals in New South Wales (NSW) and (ii) identify predictors of CFR. Methods: We used a retrospective cross-sectional analysis of data from electronic medical records for in-patient admissions to the Sydney Children’s Hospitals Network (SCHN) over five years (2011–2015). Logistic regression analysis was used to identify predictors of mortality and excess deaths in Aboriginal children were calculated. Results: There were 241,823 presentations over the 5-year period. The CFR for Aboriginal children was double that of non-Aboriginal children (0.4% vs. 0.2%, p = 0.002), with Aboriginal children under 2 years and from remote and regional Australia at highest risk of excess mortality. Predictors of death for all children in order of significance were: Circulatory disorders (Odds Ratio (OR) 17.16, p < 0.001), neoplasm/blood/immune disorders (OR 2.77, p < 0.001), emergency admissions (OR 1.94, p < 0.001), aboriginality (OR 1.73, p = 0.005) and longer length of stay (OR 1.012; p < 0.001). Conclusions: Our data show that Aboriginal children are almost twice as likely to die than non-Aboriginal children. In particular, excess deaths in Aboriginal children are most commonly from outer regional and remote areas and children aged under 2 years with perinatal or circulatory conditions.
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Panesar, Narinder, Iveta Valachova, Robert Schmidtman, and Daniel Kam Yin Chan. "Staff awareness of the application of Mental Health and Guardianship Legislation in the care of hospitalised older persons." Australasian Psychiatry 26, no. 5 (February 26, 2018): 469–73. http://dx.doi.org/10.1177/1039856218758545.
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Objective: The study aimed to survey hospital staff knowledge of the application of the Mental Health Act 2007 (NSW) (MHA) and the Guardianship Act 1987 (NSW) (GA) in the care and treatment of older persons in a teaching hospital in Sydney. Method Over a two-month period in 2017, a survey questionnaire was distributed to staff involved in older persons’ care across the hospital. Results: The majority of the hospital staff demonstrated basic theoretical knowledge of both the GA (76%) and of the MHA (84.5%). Fewer (64.5%) appeared to understand the practical application of the MHA in the hypothetical clinical situations. An even lower proportion of staff appeared to understand the application of the GA either to obtain consent for medical treatment or to appoint a guardian through the Guardianship Division of the NSW Civil and Administrative Tribunal (NCAT). Conclusion: Although clinical staff of the hospital displayed fair knowledge and awareness about the application of the MHA and the GA to inpatient care of older adults, further education is necessary, particularly about the application of the GA. The authors suggest similar findings may occur at other New South Wales hospitals, which may raise concern and need for education.
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Falster, Michael O., Alastair H. Leyland, and Louisa R. Jorm. "Do hospitals influence geographic variation in admission for preventable hospitalisation? A data linkage study in New South Wales, Australia." BMJ Open 9, no. 2 (February 2019): e027639. http://dx.doi.org/10.1136/bmjopen-2018-027639.
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ObjectivePreventable hospitalisations are used internationally as a performance indicator for primary care, but the influence of other health system factors remains poorly understood. This study investigated between-hospital variation in rates of preventable hospitalisation.SettingLinked health survey and hospital admissions data for a cohort study of 266 826 people aged over 45 years in the state of New South Wales, Australia.MethodBetween-hospital variation in preventable hospitalisation was quantified using cross-classified multiple-membership multilevel Poisson models, adjusted for personal sociodemographic, health and area-level contextual characteristics. Variation was also explored for two conditions unlikely to be influenced by discretionary admission practice: emergency admissions for acute myocardial infarction (AMI) and hip fracture.ResultsWe found significant between-hospital variation in adjusted rates of preventable hospitalisation, with hospitals varying on average 26% from the state mean. Patients served more by community and multipurpose facilities (smaller facilities primarily in rural areas) had higher rates of preventable hospitalisation. Community hospitals had the greatest between-hospital variation, and included the facilities with the highest rates of preventable hospitalisation. There was comparatively little between-hospital variation in rates of admission for AMI and hip fracture.ConclusionsGeographic variation in preventable hospitalisation is determined in part by hospitals, reflecting different roles played by community and multipurpose facilities, compared with major and principal referral hospitals, within the community. Care should be taken when interpreting the indicator simply as a performance measure for primary care.
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Houghton, Rebecca, Ruthy McIver, Timmy Lockwood, Karl Johnson, and Rosalind Foster. "Characteristics of clients newly diagnosed with HIV in central Sydney in 2016–17: a retrospective audit comparing a community-based testing site and a clinical sexual health service." Sexual Health 17, no. 4 (2020): 390. http://dx.doi.org/10.1071/sh19152.
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Abstract In New South Wales (NSW), Australia, innovative community-based testing models have been implemented to increase HIV testing among populations at risk. The characteristics of patients newly diagnosed with HIV at a community-based testing site and at a traditional clinical service in Sydney, NSW, were compared. Compared with the clinical service, clients diagnosed at the community-based site were more likely to be diagnosed at their first visit and report no prior HIV test. A high proportion of clients at both sites had a preferred language other than English. Innovative HIV testing models are reaching under-tested populations, but could be further improved.
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Schodde, Dick. "Obituary, Lionel Wayne Braithwaite, Ph.D." Pacific Conservation Biology 17, no. 1 (2011): 4. http://dx.doi.org/10.1071/pc110004.
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ON Friday 4th March, 2011, Australia lost in Wayne Braithwaite one of its most pragmatic, lateral-thinking and influential conservation ecologists at the premature age of 69. He died after a long and brave battle with pulmonary fibrosis. Wayne was born and raised on a small property just west of Griffith, New South Wales, the eldest of three siblings. From the earliest age he was engrossed in the natural world, and particularly in birds: he had the largest and most comprehensive collection of birds’ eggs in the district, all properly data-based. During his secondary schooling as a boarder at Canberra Boys Grammar, he added to his egg collection with long series from Red Hill. He then went on to take his B.Sc. at the University of Sydney, graduating in 1962 and landing a job immediately as a biochemical analyst at Royal Prince Alfred Hospital.
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McIver, Ruthy, Amalie Dyda, Vickie Knight, Rebecca Guy, and Anna McNulty. "Hepatitis B screening and vaccination: how does a Sexual Health service measure up?" Sexual Health 12, no. 5 (2015): 458. http://dx.doi.org/10.1071/sh15061.
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Hepatitis B virus (HBV) is a vaccine-preventable disease. Sexual health clinics in New South Wales see a high caseload of populations at risk of HBV, and thus screening and vaccination are part of routine care. Uptake of screening and vaccination at Sydney Sexual Health Centre was assessed and it was found that among 1577 new patients with an elevated risk of HBV infection, 864 (55%) were potentially susceptible. Of those susceptible, the majority were screened (76%) and approximately one-third (35%) were found to be eligible for vaccination. The majority (83%) initiated vaccination. Of concern, however, is that incremental gaps between initiation and completion of the vaccine course resulted in an overall HBV vaccine coverage of 26% among those HBV susceptible.
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Yellowlees, Peter. "Bush Psychiatric Services." Australian & New Zealand Journal of Psychiatry 26, no. 2 (June 1992): 191–96. http://dx.doi.org/10.1177/000486749202600202.
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This is a description of the psychiatric services at present provided to the Far West Region of New South Wales. On account of the isolation of the region, and noting that the area probably has a higher than normal rate of psychiatric and psycho-social morbidity, there are special problems involved in the provision of comprehensive treatment services. I am the only resident psychiatrist within the region, and work as both a Visiting Medical Officer to the Broken Hill Base Hospital, to Wilcannia Hospital, and to the Prison Medical Service, as well as half time in private practice. The Mental Health Services to the area are at present being considerably expanded, and in this paper their structure and function will be described, and the special problems of providing a comprehensive service to an isolated area of the bush will be discussed. The inequity of service allocation to the region will be highlighted. It is noted that the region's total share of the financial mental health cake has dropped by about 40% in the last ten years as a result of the setting up of local community services and dramatically reduced in-patient hospitalisation costs in Sydney and Adelaide.
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Faruquie, Sahrish Sonia, Elizabeth Kumiko Parker, and Peter Talbot. "An evaluation of current home enteral nutrition services at principal referral hospitals in New South Wales, Australia." Australian Health Review 40, no. 1 (2016): 106. http://dx.doi.org/10.1071/ah15029.
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Objective This cross-sectional study investigates the home enteral nutrition (HEN) services of public principal referral hospitals in NSW, Australia, comparing their services to best practice guidelines for HEN. Methods HEN service processes were investigated using an online questionnaire and telephone interview with the dietitian primarily working with HEN at each hospital. Results Participating hospitals reported a total of approximately 3200 HEN patients, 76% required oral nutrition support. Only 69% of hospitals had a dietitian allocated to their HEN service and no hospitals had established multidisciplinary teams to manage HEN patients. Post-discharge follow-up, as recommended for tube fed and oral patients, was achieved by 8% and 15% of hospitals respectively. Forty-six per cent of dietitians were satisfied and 46% of dietitians were dissatisfied with current HEN services provided, and reported the following improvements were required: increased clinical resources allocated to HEN dietitian/coordinator; increased outpatient services (home visits, outpatient clinic, multidisciplinary clinic); and an efficient registration process and database. Conclusions HEN services among participating hospitals are inconsistent, demonstrating gaps in service provision. Baseline assessment scores varied, with an average of 61% of recommendations currently in use. Best practice guidelines are not firmly adhered to due to limited funding and allocated resources for HEN. What is known about the topic? HEN is recognised as a cost-effective and reliable way of treating patients requiring nutrition support post hospital discharge. There are best practice guidelines available to ensure quality care is provided to HEN patients in the community or home setting. As there is no national framework in place for HEN in Australia, currently total patient numbers are unknown and each state and territory provides different levels of service delivery and funding for HEN. It is unknown how guidelines in Australia have been implemented and practiced, as no studies were found that have audited HEN services in Australia. What does this paper add? From the participating hospitals we were able to obtain updated data on HEN patient numbers (~3200). This paper reports on baseline scores in meeting best practice HEN guidelines for tertiary referral hospitals in NSW, Australia and identifies gaps in service provision. It is essential to identify reasons that limit adherence to HEN guidelines, as consequences may include unnecessary re-admissions to emergency departments or hospitals, increasing healthcare costs. Our study found notable differences in service provision ranging from 29% to 86% of recommendations of HEN guidelines achieved, and identified a lack of multidisciplinary teams to manage HEN patients. What are the implications for practitioners? We found HEN services among principal referral hospitals are inconsistent and best practice guidelines are currently not adhered to. National guidelines together with local health policies assist in defining the required standard of care, enhance service delivery and promote clinical excellence. We found the NSW Health Agency for Clinical Innovation HEN Implementation Checklist to be a practical tool for obtaining baseline scores for adherence to best practice guidelines. Regulation of HEN will be positive for HEN users by ensuring a more equitable service is available by introducing consistent funding for HEN nationally. However, it is the responsibility of states and local health districts to implement guidelines, contributing to better health and quality of care provided to patients.
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Saunders, Carla, and David J. Carter. "Right care, right place, right time: improving the timeliness of health care in New South Wales through a public–private hospital partnership." Australian Health Review 41, no. 5 (2017): 511. http://dx.doi.org/10.1071/ah16075.
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Objective The overall aim of the study was to investigate and assess the feasibility of improving the timeliness of public hospital care through a New South Wales (NSW)-wide public–private hospital partnership. Methods The study reviewed the academic and professional grey literature, and undertook exploratory analyses of secondary data acquired from two national health data repositories informing in-patient access and utilisation across NSW public and private hospitals. Results In 2014–15, the NSW public hospital system was unable to deliver care within the medically recommended time frame for over 27 400 people who were awaiting elective surgery. Available information indicates that the annual commissioning of 15% of public in-patient rehabilitation bed days to the private hospital system would potentially free up enough capacity in the NSW public hospital system to enable elective surgery for all public patients within recommended time frames. Conclusions The findings of the study justify a strategic whole-of-health system approach to reducing public patient wait times in NSW and highlight the need for research efforts aimed at securing a better understanding of available hospital capacity across the public and private hospital systems, and identifying and testing workable models that improve the timeliness of public hospital care. What is known about the topic? There are very few studies available to inform public–private hospital service partnerships and the opportunities available to improve timely health care access through such partnerships. What does this paper add? This paper has the potential to open and prompt timely discussion and debate, and generate further fundamental investigation, on public–private hospital service partnerships in Australia where opportunity is available to address elective surgery wait times in a reliable and effective manner. What are the implications for practitioners? The NSW Ministry of Health and its Local Health Districts have the potential to realise a key objective, namely to deliver the ‘right care, in the right place, at the right time’, through the core value of collaboration, using available infrastructure.