Journal articles on the topic 'Medical audit Australia'
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Lynch, Elizabeth, Kate Laver, Tamina Levy, and Timothy Schultz. "‘The way that we are collecting and using data has evolved’ evaluating the Australian National Stroke Audit programme to inform strategic direction." BMJ Open Quality 12, no. 1 (January 2023): e002136. http://dx.doi.org/10.1136/bmjoq-2022-002136.
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BackgroundThe National Stroke Audit has been used to audit and provide feedback to health professionals and stroke care services in Australia since 2007. The Australian Stroke Clinical Registry was piloted in 2009 and numbers of hospitals participating in the registry are increasing. Considering the changing data landscape in Australia, we designed this study to evaluate the stroke audit and to inform strategic direction.MethodsWe conducted a rapid review of published literature to map features of successful data programmes, followed by a mixed-methods study, comprising national surveys and interviews with clinicians and administrators about the stroke audit. We analysed quantitative data descriptively and analysed open-ended survey responses and interview data using qualitative content analysis. We integrated data from the two sources.ResultsWe identified 47 Australian data programs, successful programs were usually funded by government sources or professional associations and typically provided twice yearly or yearly reports.106 survey participants, 14 clinician and 5 health administrator interview participants were included in the evaluation. The Stroke Audit was consistently perceived as useful for benchmarking, but there were mixed views about its value for local quality improvement. Time to enter data was the most frequently reported barrier to participation (88% of survey participants), due to the large number of datapoints and features of the audit software.Opportunities to improve the Stroke Audit included refining Audit questions, developing ways to automatically export data from electronic medical records and capturing accurate data for patients who transferred between hospitals.ConclusionWhile the Stroke Audit was not perceived by all users to be beneficial for traditional quality improvement purposes, the ability to benchmark national stroke services and use these data in advocacy activities was a consistently reported benefit. Modifications were suggested to improve usability and usefulness for participating sites.
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James, Rodney, Caroline Chen, Kirsty Buising, Karin Thursky, and Courtney Ierano. "From Little Things Big Things Grow: The Development of an Auditing Program to Assess the Quality of Antimicrobial Prescribing." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s237. http://dx.doi.org/10.1017/ice.2020.792.
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Background: An important aspect of antimicrobial stewardship is the qualitative assessment of antimicrobial prescribing. Owing to lack of standardized tools and resources required to design, conduct and analyze qualitative audits, these assessments are rarely performed. Objective: We designed an audit tool that was appropriate for all Australian hospital types, suited to local user requirements and including an assessment of the appropriateness of antimicrobial prescribing. Methods: In 2011, a pilot survey was conducted in 32 Australian hospitals to assess the usability and generalizability of a qualitative audit tool. The tool was revised to reflect the respondents’ feedback. A second study was performed in 2012 in 85 hospitals. In 2013, following further feedback and refinement, an online auditing tool, the Hospital National Antimicrobial Prescribing Survey (NAPS), was developed. Early audits demonstrated that surgical prophylaxis had the highest rates of inappropriate prescribing. In 2016, the Surgical NAPS was developed to further investigate reasons for this, and the NAPS program was further expanded to audit antimicrobial prescribing practices in Australian aged-care homes (ie, the Aged Care NAPS). Results: Between January 1, 2013, and November 12, 2019, 523 Australian public and private hospitals (53.8%) utilized the Hospital NAPS; 215 (22.1%) have utilized the Surgical NAPS; and 774 of Australian aged-care homes (29.0%) have utilized the Aged Care NAPS. National reporting has identified key target areas for quality improvement initiatives at both local and national levels. The following initiatives have been outlined in 14 public reports: improved documentation; prolonged antimicrobial prophylaxis; compliance with prescribing guidelines; appropriateness of prescribing; access to evidence-based guidelines; and improved microbiology sampling. Conclusions: By utilizing the Plan-Do-Study-Act cycle for healthcare improvement and by involving end users in the design and evaluation, we have created a practical and relevant auditing program to assess both quantitative and qualitative aspects of antimicrobial prescribing in a wide range of settings. This voluntary program is now endorsed by the National Strategy for Antimicrobial Resistance Surveillance, partners with the Antimicrobial Use and Resistance in Australian Surveillance System, and is utilized by facilities to meet mandatory national accreditation standard requirements. With the success of the NAPS program in Australia, it has now been implemented in New Zealand, Canada, Malaysia, Fiji, and Bhutan, with plans for other countries to implement the program soon. Current research is being conducted to expand the program to include audits for family physicians, veterinarians, and remote indigenous communities, and for antifungal use.Disclosures: NoneFunding: None
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Sagar, Vidya, Deepak Patel, Piyush Patel, Anil Kumar, Avni Rana, Bhavin Trivedi, and Vipul Bavisa. "Audit requirements and expectations, The good and better about MDSAP Regulations." International Journal of Drug Regulatory Affairs 10, no. 1 (March 16, 2022): 23–27. http://dx.doi.org/10.22270/ijdra.v10i1.506.
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The most sure-fire way to pass MDSAP audit with flying colours is to have an effective Quality Management System (QMS). Having a good QMS will make sure work is correctly documented, kept up to date, and easy to present to an auditor. For regulators too, it means a reduced burden. There is pooling of regulatory resources. The audits are conducted by Auditing Organizations designated by the regulatory bodies. The MDSAP program is expected to improve audit predictability because a standardized audit model has been introduced. Every audit follows the same set of steps. For the first time, a grading system is introduced for noncompliance. This approach helps reduce subjectivity. MDSAP has a very rigid auditing process to ensure the proper market authorizations have been obtained and facility registrations have occurred but not represent Marketing Authorization. Recently proposed greater alignment of FDA Quality System Regulation (QSR) with ISO 13485, would bring US QMS requirements for medical device manufacturers closer in line with quality system requirements in markets such as the European Union, Japan and Australia, potentially streamlining medical device registration and compliance processes across the US and other markets.
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Seidler, Zac E., Simon M. Rice, Haryana M. Dhillon, and Helen Herrman. "Why it’s time to focus on masculinity in mental health training and clinical practice." Australasian Psychiatry 27, no. 2 (October 8, 2018): 157–59. http://dx.doi.org/10.1177/1039856218804340.
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Objective: Men present with complex, diverse and often contradictory expressions of masculinity that are relevant to their health status. This article argues for the inclusion of masculinity into mental health curricula in Australia. Masculinity mediates health outcomes by influencing help seeking and engagement with treatment. Conclusion: An online curricula audit of publicly available information from Australian medical programs and their professional bodies reveals increasing awareness of the needs, but limited practical inclusion of masculinity models in training and practice. Described are the elements essential to training and subsequent clinical practice to curb the poor mental health outcomes of Australian men.
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Grimshaw, Alice, Pamela Palasanthiran, Julie Huynh, Ben Marais, Sharon Chen, and Brendan McMullan. "Cryptococcal infections in children: retrospective study and review from Australia." Future Microbiology 14, no. 18 (December 2019): 1531–44. http://dx.doi.org/10.2217/fmb-2019-0215.
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Aim: Cryptococcosis causes significant morbidity and mortality worldwide, but pediatric data are limited. Methods: A retrospective literature review of Australian pediatric cryptococcosis and additional 10-year audit of cases from a large pediatric network. Results: 22 cases of cryptococcosis in children were identified via literature review: median age was 13.5 years (IQR 7.8–16 years), 18/22 (82%) had meningitis or central nervous system infection. Where outcome was reported, 11/18 (61%) died. Of six audit cases identified from 2008 to 2017, 5 (83%) had C. gattii disease and survived. One child with acute lymphoblastic leukemia and C. neoformans infection died. For survivors, persisting respiratory or neurological sequelae were reported in 4/6 cases (67%). Conclusion: Cryptococcosis is uncommon in Australian children, but is associated with substantial morbidity.
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Foster, J’Belle, Diana Mendez, Ben J. Marais, Justin T. Denholm, Dunstan Peniyamina, and Emma S. McBryde. "Critical Consideration of Tuberculosis Management of Papua New Guinea Nationals and Cross-Border Health Issues in the Remote Torres Strait Islands, Australia." Tropical Medicine and Infectious Disease 7, no. 9 (September 19, 2022): 251. http://dx.doi.org/10.3390/tropicalmed7090251.
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The international border between Australia and Papua New Guinea (PNG) serves as a gateway for the delivery of primary and tertiary healthcare for PNG patients presenting to Australian health facilities with presumptive tuberculosis (TB). An audit of all PNG nationals with presumptive TB who presented to clinics in the Torres Strait between 2016 and 2019 was conducted to evaluate outcomes for PNG patients and to consider the consistency and equity of decision-making regarding aeromedical evacuation. We also reviewed the current aeromedical retrieval policy and the outcomes of patients referred back to Daru General Hospital in PNG. During the study period, 213 PNG nationals presented with presumptive TB to primary health centres (PHC) in the Torres Strait. In total, 44 (21%) patients were medically evacuated to Australian hospitals; 26 met the evacuation criteria of whom 3 died, and 18 did not meet the criteria of whom 1 died. A further 22 patients who met the medical evacuation criteria into Australia were referred to Daru General Hospital of whom 2 died and 10 were lost to follow-up. The cross-border movement of people from PNG into Australia is associated with an emergent duty of care. Ongoing monitoring and evaluation of patient outcomes are necessary for transparency and justice.
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Harvey, C. E. "35. OUT OF THE SPOTLIGHT: AN AUDIT OF FIVE YEARS OF IMPLANON® USE IN QUEENSLAND." Sexual Health 4, no. 4 (2007): 298. http://dx.doi.org/10.1071/shv4n4ab35.
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The progestogen contraceptive implant -Implanon� was launched into the Australian marketplace in May 2001, with intense marketing and extensive training programs for doctors. However, negative media focused on removal problems and unexpected pregnancies, followed by increased medical indemnity requirements for providers, resulted in restricted access for Australian women as many GPs ceased providing insertions. To date there is no published data on the use of this contraceptive implant in Australia. To identify trends in usage, continuation rates, side effects and acceptability of this method, a retrospective chart audit of clients attending Family Planning Queensland (FPQ) clinics for implant insertion and/or removal over a 5 year period was conducted. The audit examined1800 implant users from the two busiest FPQ clinics, one in a regional setting. Preliminary results from the audit indicate:- All age groups across the reproductive years are represented in the group. The major reason for removal is unacceptable bleeding patterns Many women have the device removed because they no longer require contraception. There have been no pregnancies identified with implants The last 2 years have seen significant numbers of women presenting for implant replacement, with these women providing valuable information on factors contributing to longer term acceptability of the method. This presentation will provide an analysis of the audit findings, particularly in relation to duration of use and implications for client acceptability of this contraceptive method. The information about Implanon� use in a clinical setting will be used to make recommendations on improvements in the appropriate selection and counselling of women considering this contraceptive method.
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Botvinik, Lev, Chee Ng, and Isaac Schweitzer. "Audit of Antipsychotic Prescribing in a Private Psychiatric Hospital." Australasian Psychiatry 12, no. 3 (September 2004): 227–33. http://dx.doi.org/10.1080/j.1039-8562.2004.02099.x.
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Objectives: There exists a substantial and growing body of evidence suggesting that antipsychotic medications are efficacious in the treatment of many non-psychotic psychiatric disorders. Although indications for the use of antipsychotics (particularly the atypicals) remain relatively narrow in Australia, psychiatrists seem to be using them for an expanding range of disorders in a variety of clinical settings. This has raised issues of costeffectiveness and methods of funding of these medications. The present study aimed to quantify and describe the patterns of prescribing of antipsychotic medications in a large private psychiatric hospital. Another aim was to compare the findings with other published evidence, and consider the implications of antipsychotic use for current clinical practice in Australia. Methods: A retrospective review of the medical records of 100 consecutive patients admitted to a private psychiatric hospital was conducted. The data collected included demographic details, major psychiatric diagnoses, all medications prescribed during the admission and their doses and, in the case of antipsychotics, the target symptoms/conditions for which they were prescribed. Results: Fifty-nine per cent of inpatients received at least one dose of an antipsychotic during their admission. While all patients with psychotic illnesses were treated with antipsychotics, 57% of patients with primary mood disorders and 40% of patients with a primary anxiety disorder also received an antipsychotic. The most common indications for use of antipsychotics included the treatment of psychotic symptoms, augmentation of antidepressants, relief of anxiety symptoms and lessening of agitation, and control of difficult behaviours (including self-harm and aggression) associated with personality disorders. The most frequently used antipsychotic was olanzapine (22%), followed by chlorpromazine (20%), and quetiapine (14%). Eleven per cent of patients received a combination of two antipsychotics. Conclusions: Antipsychotic medications were widely used in a private psychiatric inpatient setting for the treatment of non-psychotic disorders. This finding parallels those from other Australian studies of psychotropic prescribing patterns. The issues of clinical utility, cost-effectiveness and benefits of funding of these medications for such wider indications require further study and evaluation.
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Nadew, Gelaye Tadesse. "Clinical Audit: Paediatric Medical Team Attendance at Deliveries in an Outer Metropolitan Hospital in Western Australia." International Journal of Medical Students 4, no. 3 (December 26, 2016): 104–7. http://dx.doi.org/10.5195/ijms.2016.161.
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Background: The attendance of paediatric medical teams at deliveries has become accepted as an integral part of birth management under current multidisciplinary team arrangements. Under current guidelines, specific clinical indicators have been developed to determine whether paediatric teams need to attend deliveries. High rates of attendance indicate that paediatric medical team resources are being extended beyond the criteria at the expense of essential services being provided elsewhere. Methods: A retrospective clinical audit was used to evaluate the frequency of paediatric team attendance and related clinical indicators. Deliveries were recorded and audited for a randomly selected calendar month. Paediatric team attendance was evaluated against foetal distresses, types of delivery, gestational age and birth weight. Results: A total of 112 deliveries were recorded for the selected calendar month and paediatric medical teams attended 74.1% (n=80) of the deliveries. Participants were comprised of 50.9% (n=57) male and 49.1% (n=55) female babies. Of these deliveries, 66.7% (n=72) were term, 30.6% (n=33) post-term and 2.8% (n=3) pre-term. A total of 69.4% (n=75) of deliveries were spontaneous vaginal deliveries (SVD), while 22.2% (n=24) were caesarean sections and 8.3% (n=9) were instrumental deliveries. Foetal distress was experienced by 16.2% (n=17) of babies. Conclusion: Paediatric medical team attendance at deliveries was higher than the combined rate of caesarean sections, pre-term babies, instrumental deliveries and reported cases of foetal distress.
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Lyons, Oscar, Karina McHardy, Warwick Bagg, and Tim Wilkinson. "Leadership development in New Zealand and Australian medical schools: needs analysis." BMJ Leader 3, no. 4 (November 25, 2019): 123–28. http://dx.doi.org/10.1136/leader-2019-000147.
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BackgroundLeadership is a core competency of doctors. However, specific learning outcomes for leadership are often not well defined in medical school curricula. This article uses New Zealand (NZ) and Australian medical school curricula as a case example for conducting a needs analysis of leadership learning outcomes.AimsTo identify which elements of medical leadership development are already met by Australian Medical Council (AMC) Outcomes for Graduates, which elements are missing, and which missing elements might reasonably be included in prequalification curricula in NZ and Australia.MethodsThe Medical Leadership Competency Framework (MLCF) was selected as the reference framework for a general needs analysis of leadership development in the AMC curriculum.To identify curriculum gaps, we first assessed the achievability of MLCF Domains at an undergraduate level. We then considered whether the AMC Outcomes for Graduates would satisfy each MLCF Domain. Where MLCF Domains were judged unachievable at the undergraduate level, we considered whether foundations were sufficiently laid for future development.ResultsFive of eight (63%) undergraduate MLCF Domains and 7 of 12 (58%) postgraduate domains were found to be already satisfied by the AMC Outcomes for Graduates.Some key elements of leadership as described in the MLCF are not yet encapsulated in the AMC Outcomes for Graduates. Two particularly notable absences are audit and quality improvement.ConclusionsLeadership is multidimensional. Some dimensions may be more appropriately learnt after medical school. There are, however, significant gaps in current curricula in Australia and NZ as defined by the AMC. These could be met more effectively using the MLCF.
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Lukin, Bill, Jaimi Greenslade, Alison Mary Kearney, Carol Douglas, Tegwen Howell, Michael Barras, and Phillip Good. "Conversion of other opioids to methadone: a retrospective comparison of two methods." BMJ Supportive & Palliative Care 10, no. 2 (February 16, 2019): 201–4. http://dx.doi.org/10.1136/bmjspcare-2018-001645.
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ContextA rapid method of methadone conversion known as the Perth Protocol is commonly used in Australian palliative care units. There has been no follow-up or validation of this method and no comparison between different methods of conversion.ObjectivesThe primary objective of this study was to test the hypothesis that the achieved doses of methadone are independent of the conversion method (rapid vs slower). The secondary objectives included examining the relationship between calculated target doses, actual achieved doses and duration of conversions.MethodsThis is a retrospective chart audit conducted at two hospital sites in the Brisbane metropolitan area of Australia which used different methadone conversion methods.ResultsMethadone conversion ratios depended on previous opioid exposure and on the method of conversion used. The method most commonly used in Australia for calculating target doses for methadone when converting from strong opioids is a poor predictor of actual dose achieved. More appropriate conversion ratios are suggested.ConclusionFurther research is needed to refine the ratios used in practice when converting patients from strong opioids to methadone. Caution and clinical expertise are required. A palliative methadone registry may provide useful insights.
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Hains, Toni, Catherine Turner, and Haakan Strand. "Practice audit of the role of the Non-medical surgical assistant in Australia, an online survey." International Journal of Nursing Practice 22, no. 6 (August 4, 2016): 546–55. http://dx.doi.org/10.1111/ijn.12462.
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Biezen, Ruby, Kirsty Buising, Tim Monaghan, Rachael Ball, Karin Thursky, Ron Cheah, Malcolm Clark, and Jo-Anne Manski-Nankervis. "Evaluating the Implementation of a Pilot Quality Improvement Program to Support Appropriate Antimicrobial Prescribing in General Practice." Antibiotics 10, no. 7 (July 16, 2021): 867. http://dx.doi.org/10.3390/antibiotics10070867.
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Inappropriate antimicrobial prescribing contributes to increasing antimicrobial resistance. An antimicrobial stewardship (AMS) program in the form of quality improvement activities that included audit and feedback, clinical decision support and education was developed to help optimise prescribing in general practice. The aim of this study was to evaluate the implementation of this program (Guidance GP) in three general practices in Melbourne, Australia, between November 2019 and August 2020. Thirty-one general practitioners (GPs) participated in the program, with 11 GPs and three practice managers participating in follow-up focus groups and interviews to explore the acceptability and feasibility of the program. Our findings showed that the quality improvement activities were acceptable to GPs, if they accurately fit GPs’ decision-making process and workflow. It was also important that they provided clinically meaningful information in the form of audit and feedback to GPs. The time needed to coordinate the program, and costs to implement the program were some of the potential barriers identified. Facilitators of success were a “whole of practice” approach with enthusiastic GPs and practice staff, and an identified practice champion. The findings of this research will inform implementation strategies for both the Guidance GP program and AMS programs more broadly in Australian general practice, which will be critical for general practice participation and engagement.
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Allen-Graham, Judith, Lauren Mitchell, Natalie Heriot, Roksana Armani, David Langton, Michele Levinson, Alan Young, Julian A. Smith, Tom Kotsimbos, and John W. Wilson. "Electronic health records and online medical records: an asset or a liability under current conditions?" Australian Health Review 42, no. 1 (2018): 59. http://dx.doi.org/10.1071/ah16095.
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Objective The aim of the present study was to audit the current use of medical records to determine completeness and concordance with other sources of medical information. Methods Medical records for 40 patients from each of five Melbourne major metropolitan hospitals were randomly selected (n=200). A quantitative audit was performed for detailed patient information and medical record keeping, as well as data collection, storage and utilisation. Using each hospital’s current online clinical database, scanned files and paperwork available for each patient audited, the reviewers sourced as much relevant information as possible within a 30-min time allocation from both the record and the discharge summary. Results Of all medical records audited, 82% contained medical and surgical history, allergy information and patient demographics. All audited discharge summaries lacked at least one of the following: demographics, medication allergies, medical and surgical history, medications and adverse drug event information. Only 49% of records audited showed evidence the discharge summary was sent outside the institution. Conclusions The quality of medical data captured and information management is variable across hospitals. It is recommended that medical history documentation guidelines and standardised discharge summaries be implemented in Australian healthcare services. What is known about this topic? Australia has a complex health system, the government has approved funding to develop a universal online electronic medical record system and is currently trialling this in an opt-out style in the Napean Blue Mountains (NSW) and in Northern Queensland. The system was originally named the personally controlled electronic health record but has since been changed to MyHealth Record (2016). In Victoria, there exists a wide range of electronic health records used to varying degrees, with some hospitals still relying on paper-based records and many using scanned medical records. This causes inefficiencies in the recall of patient information and can potentially lead to incidences of adverse drug events. What does this paper add? This paper supports the concept of a shared medical record system using 200 audited patient records across five Victorian metropolitan hospitals, comparing the current information systems in place for healthcare practitioners to retrieve data. This research identifies the degree of concordance between these sources of information and in doing so, areas for improvement. What are the implications for practitioners? Implications of this research are the improvements in the quality, storage and accessibility of medical data in Australian healthcare systems. This is a relevant issue in the current Australian environment where no guidelines exist across the board in medical history documentation or in the distribution of discharge summaries to other healthcare providers (general practitioners, etc).
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Joshi, Rohit, Christopher Hocking, Siobhan O’Neill, Nimit Singhal, Michelle Kee, and Dorothy M. Keefe. "A Prospective Audit of Inpatient Medical Oncology Consultation Patterns in a Tertiary Teaching Hospital in South Australia." Global Journal of Epidemiology and Public Health 1, no. 2 (December 31, 2014): 42–47. http://dx.doi.org/10.12974/2313-0946.2014.01.02.2.
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Harrison, Kristie H., KS Kylie Lee, Timothy Dobbins, Scott Wilson, Noel Hayman, Rowena Ivers, Paul S. Haber, et al. "Supporting Aboriginal Community Controlled Health Services to deliver alcohol care: protocol for a cluster randomised controlled trial." BMJ Open 9, no. 11 (November 2019): e030909. http://dx.doi.org/10.1136/bmjopen-2019-030909.
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IntroductionIndigenous peoples who have experienced colonisation or oppression can have a higher prevalence of alcohol-related harms. In Australia, Aboriginal Community Controlled Health Services (ACCHSs) offer culturally accessible care to Aboriginal and Torres Strait Islander (Indigenous) peoples. However there are many competing health, socioeconomic and cultural client needs.Methods and analysisA randomised cluster wait-control trial will test the effectiveness of a model of tailored and collaborative support for ACCHSs in increasing use of alcohol screening (with Alcohol Use Disorders Identification Test-Consumption (AUDIT-C)) and of treatment provision (brief intervention, counselling or relapse prevention medicines).SettingTwenty-two ACCHSs across Australia.RandomisationServices will be stratified by remoteness, then randomised into two groups. Half receive support soon after the trial starts (intervention or ‘early support’); half receive support 2 years later (wait-control or ‘late support’).The supportCore support elements will be tailored to local needs and include: support to nominate two staff as champions for increasing alcohol care; a national training workshop and bimonthly teleconferences for service champions to share knowledge; onsite training, and bimonthly feedback on routinely collected data on screening and treatment provision.Outcomes and analysisPrimary outcome is use of screening using AUDIT-C as routinely recorded on practice software. Secondary outcomes are recording of brief intervention, counselling, relapse prevention medicines; and blood pressure, gamma glutamyltransferase and HbA1c. Multi-level logistic regression will be used to test the effectiveness of support.Ethics and disseminationEthical approval has been obtained from eight ethics committees: the Aboriginal Health and Medical Research Council of New South Wales (1217/16); Central Australian Human Research Ethics Committee (CA-17-2842); Northern Territory Department of Health and Menzies School of Health Research (2017-2737); Central Queensland Hospital and Health Service (17/QCQ/9); Far North Queensland (17/QCH/45-1143); Aboriginal Health Research Ethics Committee, South Australia (04-16-694); St Vincent’s Hospital (Melbourne) Human Research Ethics Committee (LRR 036/17); and Western Australian Aboriginal Health Ethics Committee (779).Trial registration numberACTRN12618001892202; Pre-results.
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Taylor, Andrew, and Hanish Bagga. "Measures of Rheumatoid Arthritis Disease Activity in Australian Clinical Practice." ISRN Rheumatology 2011 (May 4, 2011): 1–7. http://dx.doi.org/10.5402/2011/437281.
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Objectives. To investigate which rheumatoid arthritis (RA) disease activity measures are being collected in patients receiving glucocorticoids, non-biologic or biologic disease-modifying antirheumatic drugs (DMARDs) in Australian rheumatology practice. Methods. A retrospective audit of medical records was conducted from eight rheumatology practices around Australia. Each rheumatologist recruited 30 consecutive eligible patients into the review, 10 of whom must have been receiving a biological agent for rheumatoid arthritis. Disease activity measures and radiographic assessments were collected from each patient's last consultation. For biologic patients, disease activity measures were also collected from when the patient was first initiated on the biological agent. Results. At last consultation, the disease measures that were recorded most often were ESR (89.2%), haemoglobin (87.5%), and CRP (84.2%). DAS28 was infrequently recorded (16.3%). The rate of recording disease activity measures for patients receiving biologic DMARDs decreased over time (mean 27 months). Conclusion. This review has shown inconsistency of RA activity measures being recorded in Australian rheumatology clinical practice. An accurate assessment of the disease process is necessary to effectively target rheumatoid arthritis patients to treat in order to achieve optimal outcomes.
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Iyer, Reena, David Smith, and Sharon Lawn. "An audit of the management of nicotine withdrawal in an Australian inpatient unit: are we there yet?" Australasian Psychiatry 26, no. 1 (October 2, 2017): 13–19. http://dx.doi.org/10.1177/1039856217732481.
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Objectives: This paper reports outcomes of a clinical audit of smoke-free policy implementation within an Australian inpatient psychiatric setting. It aimed to evaluate assessment of smoking status and subsequent management of nicotine withdrawal, and investigate any patient factors influencing these processes. Methods: A total of 67 medical case notes were retrospectively analysed for inpatients admitted to psychiatric units of a general hospital in South Australia, from July to September 2015. Patient demographic variables and information from the hospital’s Smoking Assessment and Management Form (SAMF) were recorded. Data analysis involved descriptive statistics and Chi-square tests of association between dependent variables (how the SAMF was completed) and independent variables (sex, voluntary status, diagnosis). Results: The SAMF was implemented for most patients (76.1%), with 64.71% completed within 24 hours of admission; though, many were incomplete. Nicotine dependence was not properly assessed for 42.3% of smokers; 69.23% were prescribed nicotine replacement therapy (NRT), despite most scoring moderate to high nicotine dependence. No statistically significant relationships were found between patient factors and form completion. Conclusions: SAMF completion was timely for most patients; however, sections important for determining support actions remained largely incomplete, suggesting patients’ nicotine withdrawal is not being adequately addressed. More work is needed to improve inpatient staff’s assessment to ensure optimal care.
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Luccisano, Sharon P., Heinrich C. Weber, Giuliana O. Murfet, Iain K. Robertson, Sarah J. Prior, and Andrew P. Hills. "An Audit of Pre-Pregnancy Maternal Obesity and Diabetes Screening in Rural Regional Tasmania and Its Impact on Pregnancy and Neonatal Outcomes." International Journal of Environmental Research and Public Health 18, no. 22 (November 16, 2021): 12006. http://dx.doi.org/10.3390/ijerph182212006.
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Maternal obesity in pregnancy, a growing health problem in Australia, adversely affects both mothers and their offspring. Gestational diabetes mellitus (GDM) is similarly associated with adverse pregnancy and neonatal complications. A low-risk digital medical record audit of antenatal and postnatal data of 2132 pregnant mothers who gave birth between 2016–2018 residing in rural-regional Tasmania was undertaken. An expert advisory group guided the research and informed data collection. Fifty five percent of pregnant mothers were overweight or obese, 43.6% gained above the recommended standards for gestational weight gain and 35.8% did not have an oral glucose tolerance test. The audit identified a high prevalence of obesity among pregnant women and low screening rates for gestational diabetes mellitus associated with adverse maternal and neonatal pregnancy outcomes. We conclude that there is a high prevalence of overweight and obesity among pregnant women in rural regional Tasmania. Further GDM screening rates are low, which require addressing.
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Marsden, Dianne Lesley, Kerry Boyle, Louise-Anne Jordan, Judith Anne Dunne, Jodi Shipp, Fiona Minett, Amanda Styles, et al. "Improving Assessment, Diagnosis, and Management of Urinary Incontinence and Lower Urinary Tract Symptoms on Acute and Rehabilitation Wards That Admit Adult Patients: Protocol for a Before-and-After Implementation Study." JMIR Research Protocols 10, no. 2 (February 4, 2021): e22902. http://dx.doi.org/10.2196/22902.
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Background Urinary incontinence (UI) and lower urinary tract symptoms (LUTS) are commonly experienced by adult patients in hospitals (inpatients). Although peak bodies recommend that health services have systems for optimal UI and LUTS care, they are often not delivered. For example, results from the 2017 Australian National Stroke Audit Acute Services indicated that of the one-third of acute stroke inpatients with UI, only 18% received a management plan. In the 2018 Australian National Stroke Audit Rehabilitation Services, half of the 41% of patients with UI received a management plan. There is little reporting of effective inpatient interventions to systematically deliver optimal UI/LUTS care. Objective This study aims to determine whether our UI/LUTS practice-change package is feasible and effective for delivering optimal UI/LUTS care in an inpatient setting. The package includes our intervention that has been synthesized from the best-available evidence on UI/LUTS care and a theoretically informed implementation strategy targeting identified barriers and enablers. The package is targeted at clinicians working in the participating wards. Methods This is a pragmatic, real-world, before- and after-implementation study conducted at 12 hospitals (15 wards: 7/15, 47% metropolitan, 8/15, 53% regional) in Australia. Data will be collected at 3 time points: before implementation (T0), immediately after the 6-month implementation period (T1), and again after a 6-month maintenance period (T2). We will undertake medical record audits to determine any change in the proportion of inpatients receiving optimal UI/LUTS care, including assessment, diagnosis, and management plans. Potential economic implications (cost and consequences) for hospitals implementing our intervention will be determined. Results This study was approved by the Hunter New England Human Research Ethics Committee (HNEHREC Reference No. 18/10/17/4.02). Preimplementation data collection (T0) was completed in March 2020. As of November 2020, 87% (13/15) wards have completed implementation and are undertaking postimplementation data collection (T1). Conclusions Our practice-change package is designed to reduce the current inpatient UI/LUTS evidence-based practice gap, such as those identified through national stroke audits. This study has been designed to provide clinicians, managers, and policy makers with the evidence needed to assess the potential benefit of further wide-scale implementation of our practice-change package. International Registered Report Identifier (IRRID) DERR1-10.2196/22902
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Chong, Krystle Y., Yee K. Mak, Beverley Vollenhoven, and Ben W. Mol. "An Audit of Management of Ectopic Pregnancy in a Major Tertiary Healthcare Service." Fertility & Reproduction 03, no. 01 (March 2021): 14–18. http://dx.doi.org/10.1142/s266131822150002x.
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Background: Ectopic pregnancy remains the most common cause of early pregnancy mortality, with management options differing according to clinical presentation and investigations. This audit aims to investigate the indications for medical and surgical management of ectopic pregnancy at a tertiary hospital network, in order to assess variances in practice and adherence to local hospital protocols. Methods: A retrospective audit of the management of women with a diagnosis of ectopic pregnancy was performed over 12 months from July 2018 to June 2019, at three hospitals in the largest healthcare network in Victoria, Australia. Information collected included patient demographics, risk factors for ectopic pregnancy, pathology and radiology results, documented indication for surgery, and any complications of treatment. A subgroup analysis of data was done to investigate changes and deficiency in management of ectopic pregnancy compared to local hospital protocol. Results: Over a 12-month period, 138 women were diagnosed with an ectopic pregnancy, of which 99 (72%) received surgical management and 39 (28%) received medical management. Four women within the medical group were excluded from analysis, one due to loss of follow-up and three patients who were diagnosed with nontubal ectopic pregnancies. About 94% (33/35) of women who received methotrexate were within hospital guidelines for medical management and 91% (32/35) were successfully managed without surgery. All women who received surgical management underwent a salpingectomy and 97% (96/99) had clear indications documented for surgery within local protocol. Conclusion: Overall, the majority of women with ectopic pregnancy were treated according to local guidelines. Expectant management and the option of salpingostomy as a surgical alternative could be considered in the local guidelines. The dissemination of this clinical audit data is aimed at continuing clinical governance and improvements in outcomes.
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Ferrer, Pedro E., Mark Bloch, Norman Roth, Robert Finlayson, David Baker, Ken Koh, David Orth, Rimgaile Urbaityte, Dannae Brown, and Fraser Drummond. "A retrospective clinical audit of general practices in Australia to determine the motivation for switch to dolutegravir/abacavir/lamivudine and clinical outcomes." International Journal of STD & AIDS 29, no. 3 (September 13, 2017): 300–305. http://dx.doi.org/10.1177/0956462417730474.
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The most common reasons for switching HIV-1 therapy in patients with virologic suppression are treatment regimen simplification and resolving tolerability issues. Single-pill regimens that include an integrase inhibitor are recommended options. A retrospective clinical audit was performed to determine the motivations for switching to dolutegravir (DTG)/abacavir (ABC)/lamivudine (3TC) at high HIV-caseload general practice clinics in Australia. The most common reasons for switching from a prior suppressive therapy to DTG/ABC/3TC were simplification of regimen, resolving toxicity/intolerance and patient preference (73%, 13% and 12%, respectively). Kaplan–Meier analysis showed that the probability of patients remaining on DTG/ABC/3TC therapy at 12 months was 95.1%. Switching to DTG/ABC/3TC from a range of other regimens was associated with a discontinuation rate of 3.2%, with 2.5% of patients discontinuing due to adverse events and no patients discontinuing due to virologic failure. Switching to DTG/ABC/3TC was a viable treatment strategy in this cohort of Australian patients.
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Carlin, Emma, Zaccariah Cox, Kristen Orazi, Kate L. Derry, and Pat Dudgeon. "Exploring Mental Health Presentations in Remote Aboriginal Community Controlled Health Services in the Kimberley Region of Western Australia Using an Audit and File Reviews." International Journal of Environmental Research and Public Health 19, no. 3 (February 3, 2022): 1743. http://dx.doi.org/10.3390/ijerph19031743.
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The study aims to explore the role of mental health care in remote Aboriginal health services in the Kimberley region of Western Australia and provide a more nuanced understanding of the patients presenting for care, their needs, and the clinical response. Little is currently known about primary health care presentations for mental health, suicide, and self-harm for remote dwelling Aboriginal residents of the Kimberley region, despite high rates of psychological distress, self-harm, and suicide across the area. This study was progressed through a retrospective, cross-sectional audit of the electronic medical records system used by three remote clinics to explore the interactions recorded by the clinics about a patient’s mental health. In addition, an in-depth file review was conducted on a stratified purposive sample of 30 patients identified through the audit. Mental ill-health and psychological distress were found to be prominent within clinical presentations. Psychosocial factors were frequently identified in relation to a patient’s mental health presentation. Optimizing patients’ recovery and wellness through service improvements, including an enhanced mental health model of care, is an important next step.
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Marr, I., and S. Sabesan. "Video linked medical oncology clinics: A novel way to improve patients’ access to medical oncology services in rural Australia." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e17573-e17573. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e17573.
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e17573 Background: To improve the access of Mt Isa patients to medical oncologists, Townsville Cancer Centre runs weekly medical oncology clinics via videolink. Aim of this study was to assess patient satisfaction, safety of chemotherapy delivery, and cost effectiveness of such technology. Methods: Between 2006 and 2008, 42 patients were seen. A questionnaire based survey was conducted by telephone to assess patient's level of satisfaction and quality of communication. Safety of chemotherapy delivery was evaluated by retrospective chart audit. Results: 25 patients completed the questionnaire. Six were new patients and the rest were for review leading to more than 90 encounters. Satisfaction: 100% of those interviewed were satisfied with the care given by the Townsville Cancer Centre. Of these 88% felt they developed a friendly relationship with the specialist. 90% felt medication could be taken without any concerns after videolink. 27% of patients interviewed felt examination was needed by the specialist, but 92% of the patients would rather see the specialist via videolink than travel to Townsville. Overall 96% felt it saved time, money and was convenient. Responses, apart from the question about the need for physical examination by the specialist, were more than 80% in agreement. Safety: 32 patients received active therapy. 60% were treated with palliative intent and the rest adjuvant. The median number of cycles was 5 (1–8). A total of 4 patients were admitted for complications- 2 for febrile neutropenia and 2 for emesis.There were no treatment related deaths. Cost effectiveness: Factors for consideration were cost of patient and specialist travel and accommodation,cost of interruption of routine clinics at specialists’ home, cost of video link apparatus and maintenance and cost of disturbance of quality of life for patients and doctors resulting from travel. Conclusions: Satisfaction with video linked clinics is high. It saves travel time for the patients and specialists and seems to be cost effective. It is safe to supervise chemotherapy administration using this technology. Therefore, this method of service delivery could be adopted by medical oncology departments to improve services to the rural and remote areas. No significant financial relationships to disclose.
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Carr, Peter J., James Rippey, Tim Moore, Hanh Ngo, Marie L. Cooke, Niall S. Higgins, and Claire M. Rickard. "Reasons for Removal of Emergency Department–Inserted Peripheral Intravenous Cannulae in Admitted Patients: A Retrospective Medical Chart Audit in Australia." Infection Control & Hospital Epidemiology 37, no. 7 (April 1, 2016): 874–76. http://dx.doi.org/10.1017/ice.2016.70.
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Busingye, Doreen, Monique F. Kilkenny, Tara Purvis, Joosup Kim, Sandy Middleton, Bruce C. V. Campbell, and Dominique A. Cadilhac. "Is length of time in a stroke unit associated with better outcomes for patients with stroke in Australia? An observational study." BMJ Open 8, no. 11 (November 2018): e022536. http://dx.doi.org/10.1136/bmjopen-2018-022536.
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ObjectiveSpending at least 90% of hospital admission in a stroke unit (SU) is a recommended indicator of receiving high-quality stroke care. However, whether this makes a difference to patient outcomes is unknown. We aimed to investigate outcomes and factors associated with patients with acute stroke spending at least 90% of their admission in an SU, compared with those having less time in the SU.DesignObservational study using cross-sectional data.SettingData from hospitals which participated in the 2015 Stroke Foundation National Audit: Acute Services (Australia) and had an SU. This audit includes an organisational survey and retrospective medical record audit of approximately 40 admissions from each hospital.ParticipantsPatients admitted to an SU during their acute admission were included.Outcome measuresHospital-based patient outcomes included length of stay, independence on discharge, severe complications and discharge destination. Patient, organisational and process indicators were included in multilevel logistic modelling to determine factors associated with spending at least 90% of their admission in an SU.ResultsEighty-eight hospitals with an SU audited 2655 cases (median age 76 years, 55% male). Patients who spent at least 90% of their admission in an SU experienced: a length of stay that was 2 days shorter (coefficient −2.77, 95% CI −3.45 to –2.10), fewer severe complications (adjusted OR (aOR) 0.60, 95% CI 0.43 to 0.84) and were less often discharged to residential aged care (aOR 0.59, 95% CI 0.38 to 0.94) than those who had less time in the SU. Patients admitted to an SU within 3 hours of hospital arrival were three times more likely to spend at least 90% of their admission in an SU.ConclusionSpending at least 90% of time in an SU is a valid measure of stroke care quality as it results in improved patient outcomes. Direct admission to SUs is warranted.
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Gillespie, Brigid M., Wendy Chaboyer, Rhonda J. Boorman, Ishtar Sladdin, Teresa Withers, and Carl de Wet. "Characterising the nature of clinical incidents reported across a tertiary health service: a retrospective audit." Australian Health Review 45, no. 4 (2021): 447. http://dx.doi.org/10.1071/ah20271.
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ObjectiveReducing the number of adverse patient safety incidents (PSIs) requires careful monitoring and active management processes. However, there is limited information about the association between hospital settings and the type of PSI. The aims of this study were to describe the severity, nature and characteristics of PSIs from an analysis of their incidence and to assess the relationships between the type of PSI and its setting. MethodsA retrospective audit of a clinical incident management system database was conducted for a tertiary health service in Australia with 620000 residents. Records of PSIs reported for patients between 1 July 2017 and 30 June 2018 with Safety Assessment Codes (SAC) of PSIs were extracted from the clinical incident management system and analysed using descriptive and inferential statistics. PSIs involving paediatrics, mental health and primary care were excluded. ResultsIn all, 4385 eligible PSIs were analysed: 24 SAC1, 107 SAC2 and 4254 SAC3 incidents. Across reported PSIs, the most common incidents related to skin injury (28.6%), medication (23.2%), falls (19.9%) and clinical process (8.5%). Falls were reported significantly more often in the medical division (χ2=43.85, P<0.001), whereas skin injury incidents were reported significantly more often in the surgical division (χ2=22.56, P<0.001). ConclusionsA better understanding of the nature of PSIs and where they occur may lead to more targeted quality improvement strategies. What is known about this topic?Improving patient safety requires effective safety learning systems, which include incident reporting and management processes. Although incident reporting systems typically underestimate the incidence of iatrogenic harm, they do provide valuable opportunities to improve the future safety of health care. What does this paper add?This study reports the extent and severity of different types of PSIs that typically occur in a large tertiary hospital in Australia. The most common types of incidents are skin injury, falls, medication errors and clinical process. There are empirical associations between the type of PSI and clinical division (medical, surgical). What are the implications for practitioners?A greater understanding of the types of PSI and the settings in which they occur may inform the development of more targeted quality improvement strategies that potentially reduce their incidence.
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Kitsos, Alex, Gregory M. Peterson, Matthew D. Jose, Masuma Akter Khanam, Ronald L. Castelino, and Jan C. Radford. "Variation in Documenting Diagnosable Chronic Kidney Disease in General Medical Practice: Implications for Quality Improvement and Research." Journal of Primary Care & Community Health 10 (January 2019): 215013271983329. http://dx.doi.org/10.1177/2150132719833298.
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Background: National health surveys indicate that chronic kidney disease (CKD) is an increasingly prevalent condition in Australia, placing a significant burden on the health budget and on the affected individuals themselves. Yet, there are relatively limited data on the prevalence of CKD within Australian general practice patients. In part, this could be due to variation in the terminology used by general practitioners (GPs) to identify and document a diagnosis of CKD. This project sought to investigate the variation in terms used when recording a diagnosis of CKD in general practice. Methods: A search of routinely collected de-identified Australian general practice patient data (NPS MedicineWise MedicineInsight from January 1, 2013, to June 1, 2016; collected from 329 general practices) was conducted to determine the terms used. Manual searches were conducted on coded and on “free-text” or narrative information in the medical history, reason for encounter, and reason for prescription data fields. Results: From this data set, 61 102 patients were potentially diagnosable with CKD on the basis of pathology results, but only 14 172 (23.2%) of these had a term representing CKD in their electronic record. Younger patients with pathology evidence of CKD were more likely to have documented CKD compared with older patients. There were a total of 2090 unique recorded documentation terms used by the GPs for CKD. The most commonly used terms tended to be those included as “pick-list” options within the various general practice software packages’ standard “classifications,” accounting for 84% of use. Conclusions: A diagnosis of CKD was often not documented and, when recorded, it was in a variety of ways. While recording CKD with various terms and in free-text fields may allow GPs to flexibly document disease qualifiers and enter patient specific information, it might inadvertently decrease the quality of data collected from general practice records for clinical audit or research purposes.
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Fortington, Lauren V., Sheree Bekker, and Caroline F. Finch. "Integrating and maintaining automated external defibrillators and emergency planning in community sport settings: a qualitative case study." Emergency Medicine Journal 37, no. 10 (June 16, 2020): 617–22. http://dx.doi.org/10.1136/emermed-2019-208781.
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IntroductionA voluntary State Government-led programme in Victoria, Australia ‘Defibrillators for Sporting Clubs and Facilities Program’ ran from 2015 to 2019, broadly aimed at increasing access to automated external defibrillators (AEDs), together with a greater number of community members trained for management of medical emergencies. This study aimed to understand whether participating sport clubs/facilities had successfully integrated an AED and medical planning with other club/facility safety practices, 12 months after delivery of the programme.MethodsThis was a qualitative case study of 14 sport clubs/facilities in Victoria, Australia in 2017, underpinned by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. We conducted observational audits of facilities (to locate AED placement, signage and other relevant location-specific factors) and semi-structured, face-to-face interviews with representatives of the clubs/facilities. Interview questions were designed to determine if and how the related, mandated emergency management programme was adapted for the long term (embedding), whether this aligned to ongoing organisational mission (active engagement), and whether or not it was still ongoing 6 months postinitial implementation (sustainability). Data were evaluated using qualitative descriptive methodology. For reporting, descriptive summaries of the audit were combined with interview data to contextualise and visualise the sport club/facility setting and key results.ResultsKey issues identified were accessibility and visibility of the AED, with inadequate signage and challenges identifying an efficient location for access and storage. Most interviewees reported the AED and training were received with no further actions taken towards safety planning or integration with club/facility practice. Several challenges regarding remaining up to date with training and ensuring required routine checks of the AED take place were also raised.ConclusionsThis study identified several challenges for community sport clubs/facilities in the implementation of an AED and medical planning programme, including where to store the AED, how to make its presence known to the community and how to integrate changes alongside other club/facility practices.
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Hustig, A., C. Bell, and R. Waddell. "An audit of pharyngeal gonorrhoea treatment in a public sexual health clinic in Adelaide, South Australia." International Journal of STD & AIDS 24, no. 5 (May 2013): 399–400. http://dx.doi.org/10.1177/0956462412472792.
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Nguyen, Van T., Mary G. Etty-Leal, and Jean T. Hua. "Colecalciferol Initiation Post Minimal Trauma Fracture." Hospital Pharmacy 54, no. 2 (April 30, 2018): 105–11. http://dx.doi.org/10.1177/0018578718769564.
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Purpose: The purpose of this study was to determine the proportion of patients admitted to a major tertiary teaching hospital in Australia aged 50 years and older with a confirmed neck of femur or vertebral minimal trauma fracture, who are commenced on colecalciferol supplementation by discharge, and to describe the doses prescribed. Methods: A subanalysis of a retrospective audit of electronic medical files for patients admitted with a minimal trauma fracture of the hip or vertebra between January 1, 2016, and June 30, 2016, was conducted. Results: A total of 406 patients were screened and 64 patients were included in the audit. In this subanalysis of these 64 patients eligible for inclusion, 38 were not on any vitamin or mineral supplementation at admission. Of these, 26 patients (68.4%) had their serum colecalciferol levels measured, and 21 patients (55.2%) overall were initiated on colecalciferol. Conclusion: Over half of patients with a minimal trauma fracture were commenced on colecalciferol therapy, but a noteworthy proportion of patients remain untreated. Patients with colecalciferol levels are more likely to be initiated on therapy compared with those of whom levels were not taken during admission. This is a missed opportunity for intervention that may place patients at a higher risk of subsequent fracture; therefore, effective strategies should be implemented to address this treatment gap in the future.
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Laing, Joshua, Georgia Grant, Cecilia Harb, Elise White, Terence O’Brien, and Patrick Kwan. "130 Continuous EEG monitoring in australia: s first year audit of practice 2018–2019 of a combined hospital epilepsy program in melbourne." Journal of Neurology, Neurosurgery & Psychiatry 90, e7 (July 2019): A42.2—A42. http://dx.doi.org/10.1136/jnnp-2019-anzan.115.
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IntroductionContinuous EEG (cEEG) monitoring is essential for the optimal diagnosis and management of non-convulsive seizures. We audited the use of cEEG across two major metropolitan hospitals in Melbourne, Australia as part of a new combined epilepsy program. There are no reported case series of cEEG in Australia.MethodsData was collected retrospectively from consecutive patients who underwent cEEG monitoring as part of their acute inpatient care between Jan 2018 to Dec 2018 at the Alfred and Royal Melbourne Hospitals. All inpatient EEG studies over 1 hr were included. Elective cases from the epilepsy monitoring unit were excluded. Demographic and clinical information regarding their admission was collected. Descriptive statistics, and comparative analysis was performed.ResultsThere were 94 patients identified that underwent cEEG. 50% were male and 50% female, with an average age of 51.3 yrs. 45% were performed in the ICU, and 55% on the acute medical ward. The average duration of recording per patient was 86.2 hrs or 3.6 days. Of 89 of 94 available cEEG reports, seizures were seen in 55%, the majority being non-convulsive. Interictal discharges were seen in 60%. 19% (13/67 of available records) were dead at the time of the audit.ConclusionNon-convulsive seizures and non-convulsive status epilepticus is common and widely underrecognized without cEEG. We present 94 cases as part of our newly expanding cEEG program across two major Australian hospitals over a one year period, 55% with seizures which were predominantly non-convulsive. A prospective database will be designed for further quality improvement and future research.
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Palmer, G. M., S. P. Chen, K. R. Smith, and W. Hardikar. "Introduction and Audit of Intravenous Paracetamol at a Tertiary Paediatric Teaching Hospital." Anaesthesia and Intensive Care 35, no. 5 (October 2007): 702–6. http://dx.doi.org/10.1177/0310057x0703500507.
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Although intravenous (IV) paracetamol is an attractive analgesic, there is little information on its paediatric use. During an introduction phase with limited prescribing rights, an audit was performed to assess its use and cost impact at a tertiary paediatric centre. Patients receiving IV paracetamol prescribed by two pain specialists for restricted indications had their medical records retrospectively reviewed for age, weight, diagnosis, indications/dose for IV (and other route) paracetamol/other analgesics/antiemetics, vomiting/oral intake and liver function tests if performed. One-hundred-and-twenty-one children and five neonates received 1216 (median 8 each) doses of paracetamol IV. Audited expenditure for IV paracetamol was 3.9 times the rectal alternative ($3435 vs. $875). Indications were appropriate, with 97% of patients nil oral, 41% vomiting, 17% having rectal route replaced and 3% avoiding parenteral morphine. Only five patients received incorrect dosing: three through prescription errors and two as guideline deviations; none were considered dangerous. No liver function test derangements could be directly attributed to paracetamol. This data facilitated our application to extend prescribing rights for IV paracetamol within our institution. As there is limited information or local experience with the use of IVparacetamol in paediatric settings in Australia, our data may be of use to other centres considering the introduction of the IV form of this agent.
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Altaf, Nishath, Thathya Venu Ariyaratne, Adrian Peacock, Irene Deltetto, Jad El-Hoss, Shannon Thomas, Colman Taylor, and Bibombe Patrice Mwipatayi. "A Budget Impact Model for the use of Drug-Eluting Stents in Patients with Symptomatic Lower-Limb Peripheral Arterial Disease: An Australian Perspective." CardioVascular and Interventional Radiology 44, no. 9 (June 21, 2021): 1375–83. http://dx.doi.org/10.1007/s00270-021-02848-8.
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Abstract Purpose Improvement in long-term outcomes through innovative, cost-effective medical technologies is a focus for endovascular procedures aimed at treating symptomatic lower-limb peripheral arterial disease (PAD). The advent of drug-eluting stents (DES) has improved symptomatic PAD treatment via a reduction in high rates of target lesion revascularisation (TLR). The present study aimed to compare the 5-year financial impact of treatment with Eluvia, a new paclitaxel-eluting stent, versus treatment with Zilver PTX, a drug-coated stent, among patients in Australia by developing a budget impact model (BIM). Methods A BIM was developed from an Australian public hospital payer perspective using Australian national cost weights (AUD), published literature, and public hospital audit data. Clinical outcomes, including clinically driven TLRs (CD-TLRs), adverse events, and length of stay, were based on the 2-year results of the IMPERIAL trial, which compared Eluvia DES to Zilver PTX. Results Assuming EVP eligibility rate of 80% and DES uses rate ranging from 10 to 28% (superficial femoral artery lesions only), the 5-year model forecasted a treatment population between 14,428 and 40,399 patients. The model estimated 1499–4198 fewer CD-TLRs and 16,515–46,243 fewer hospital days with Eluvia DES use. This translated to 5-year potential savings of $4.3–$12.1 million to the Australian public hospital payer attributable to reduced CD-TLRs for Eluvia DES and $33.1–$92.6 million to Australian public hospitals owing to reduced adverse events and hospital bed days. Conclusion Eluvia DES use as treatment for symptomatic lower-limb PAD could lead to potential savings for the Australian public healthcare system based on improved patient outcomes.
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Loong, Ly Sia, Pauline Siew Mei Lai, Nurul Adilla Hayat Jamaluddin, Isa Naina-Mohamed, Petrick Periyasamy, Chee Lan Lau, Karin Thursky, Rodney James, Sasheela Ponnampalavanar, and The Malaysian NAPS Working Group. "Comparing the appropriateness of antimicrobial prescribing among medical patients in two tertiary hospitals in Malaysia." Journal of Infection in Developing Countries 16, no. 12 (December 31, 2022): 1877–86. http://dx.doi.org/10.3855/jidc.15925.
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Introduction: Malaysia is an upper-middle-income country with national antimicrobial stewardship programs in place. However, hospitals in this country are faced with a high incidence of multidrug-resistant organisms and high usage of broad-spectrum antibiotics. Therefore, this study aimed to use a standardized audit tool to assess clinical appropriateness, guideline compliance, and prescribing patterns of antimicrobial use among medical patients in two tertiary hospitals in Malaysia to benchmark practice. Methodology: A prospective hospital-wide point prevalence survey was carried out by a multidisciplinary team in April 2019 at the University Malaya Medical Centre (UMMC) and the Hospital Canselor Tuanku Muhriz (HCTM), Kuala Lumpur, Malaysia. Data was collected from the patient’s electronic medical records and recorded using the Hospital National Antimicrobial Prescribing Survey toolkit developed by the National Centre for Antimicrobial Stewardship, Australia. Results: The appropriateness of prescriptions was 60.1% (UMMC) and 67% (HCTM), with no significant difference between the two hospitals. Compliance with guidelines was 60.0% (UMMC) and 61.5% (HCTM). Amoxicillin-clavulanic acid was the most commonly prescribed antimicrobial (UMMC = 16.9%; HCTM = 11.9%). Conclusions: The appropriateness of antimicrobial prescribing in medical wards, compliance with guidelines, and prescribing patterns were similar between the two hospitals in Malaysia. The survey identified several areas of prescribing that would need targeted AMS interventions.
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Downing, Sandra, Heather McNamee, Debbie Penney, Joanne Leamy, Caroline de Costa, and Darren B. Russell. "Three years on: a review of medical terminations of pregnancy performed in a sexual health service." Sexual Health 7, no. 2 (2010): 212. http://dx.doi.org/10.1071/sh09139.
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Access to abortion services is often limited in parts of regional Australia, including north Queensland. Since March 2006, the Cairns Sexual Health Service (CSHS) has provided medical termination of pregnancy (MToP) services for women up to 9 weeks gestation, using a regimen of methotrexate and misoprostol. We conducted a retrospective chart audit of all women undergoing an MToP at the CSHS between 1 March 2006 and 31 March 2009. In total, 147 medical terminations in 136 women were performed during this 3-year period. At the time of first presentation, the mean age was 27 years, 77 (57%) of the 136 women were of less than 7 weeks gestation and 86 (63%) had not had a previous termination. A successful medical termination of pregnancy was achieved in 69 of 85 (81%, 95% confidence interval (CI): 72, 88) women at less than 7 weeks gestation and in 43 of 62 (69%, 95% CI: 57, 80) women with gestation between 7 and 9 weeks. Provision of medical termination of pregnancy through sexual health services is one strategy to address access inequity in regional areas. Demand for this service in Cairns continues to rise; however, since late August 2009 MToP in Queensland is no longer available pending legal reform.
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Keon-Cohen, Zoe M., David A. Story, Juli A. Moran, and Daryl A. Jones. "An audit of perioperative end-of-life care practices and documentation relating to patients who died in a surgical unit in three Victorian hospitals." Anaesthesia and Intensive Care 50, no. 3 (March 18, 2022): 234–42. http://dx.doi.org/10.1177/0310057x211032652.
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The number of older, frail patients undergoing surgery is increasing, prompting consideration of the benefits of intensive treatment. Despite collaborative decision-making processes such as advance care planning being supported by recent Australian legislation, their role in perioperative care is yet to be defined. Furthermore, there has been little evaluation of the quality of end-of-life care in the surgical population. We investigated documentation of the premorbid functional status, severity of illness, intensity of treatment, operative management and quality of end-of-life care in patients who died in a surgical unit, with a retrospective study of surgical mortality which was performed across three hospitals over a 23-month period in Victoria, Australia. Among 99 deceased patients in the study cohort, 68 had a surgical operation. Preoperative functional risk assessment by medical staff was infrequently documented in the medical notes (5%) compared with activities of daily living (69%) documented by nursing staff. Documented preoperative discussions regarding the risk of death were rarely and inconsistently done, but when done were extensive. Documented end-of-life care discussions were identified in 71%, but were frequently brief, inconsistent, and in 60% did not occur until 48 hours from death. In 35.4% of instances, documented discussions involved junior staff (registrars or residents), and 43.4% involved intensive care unit staff. Palliative or terminal care referrals also occurred late (1–2 days prior to death). Not-for-resuscitation orders were frequently changed when approaching the end of life. Overall, 57% of deceased patients had a documented opportunity for farewell with family. We conclude that discussions and documentation of end-of-life care practices could be improved and recommend that all surgical units undertake similar audits to ensure that end-of-life care discussions occur for high-risk and palliative care surgical patients and are documented appropriately.
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Detering, Karen M., Kimberly Buck, Marcus Sellars, Helana Kelly, Craig Sinclair, Ben White, and Linda Nolte. "Prospective multicentre cross-sectional audit among older Australians accessing health and residential aged care services: protocol for a national advance care directive prevalence study." BMJ Open 9, no. 10 (October 2019): e031691. http://dx.doi.org/10.1136/bmjopen-2019-031691.
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IntroductionAdvance care planning (ACP), an ongoing communication and planning process, aims to clarify a person’s values and preferences, so these guide decision-making if the person becomes unable to make his or her own decisions. Ideally, ACP results in completion of advance care directives (ACD), documents completed by competent people outlining their values, treatment preferences and/or appointment of a substitute decision-maker (SDM). ACDs are most effective at the point of care, where they can be used to inform treatment decisions. Australian governments fund initiatives and have developed policy to increase ACD completion rates. However, little is known about the prevalence of ACDs at the point of care in Australian health services, making ACP evaluation efforts difficult. This study aims to determine the prevalence of ACDs in records of older people in Australian hospitals, aged care facilities and general practices.Methods and analysisThis is a national multicentre cross-sectional prevalence study in selected aged care facilities, hospitals and general practices. Following a 2017 feasibility study, a new protocol incorporating key learnings was developed. Sites will be recruited via expression of interest process. Health records of people aged ≥65 years, admitted to or attending services on study day(s) will be audited by trained staff from sites. Site-level data will be collected during the expression of interest. The primary outcome is the presence of at least one ACD in the health record. Secondary outcomes include prevalence of other documented outcomes of ACP (by health practitioner(s)/family/SDM), assessment of ACD quality and content and concordance between the person’s documented preferences and any medical treatment orders. Individuals and sites characteristics where ACDs are present will be explored.Ethics and disseminationProtocol approval by Austin Health Human Research Ethics Committee, Melbourne, Australia (reference: HREC/18/Austin/109). Results will be disseminated via peer-reviewed journals and conferences. Participating sites and jurisdictions will receive individualised reports of findings.
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Mukhtar, S. Aqif, Debbie A. Smith, Maureen A. Phillips, Maire C. Kelly, Renate R. Zilkens, and James B. Semmens. "Capturing sexual assault data: An information system designed by forensic clinicians and healthcare researchers." Health Information Management Journal 47, no. 1 (January 12, 2017): 46–55. http://dx.doi.org/10.1177/1833358316687575.
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Background: The Sexual Assault Resource Center (SARC) in Perth, Western Australia provides free 24-hour medical, forensic, and counseling services to persons aged over 13 years following sexual assault. Objective: The aim of this research was to design a data management system that maintains accurate quality information on all sexual assault cases referred to SARC, facilitating audit and peer-reviewed research. Methods: The work to develop SARC Medical Services Clinical Information System (SARC-MSCIS) took place during 2007–2009 as a collaboration between SARC and Curtin University, Perth, Western Australia. Patient demographics, assault details, including injury documentation, and counseling sessions were identified as core data sections. A user authentication system was set up for data security. Data quality checks were incorporated to ensure high-quality data. Results: An SARC-MSCIS was developed containing three core data sections having 427 data elements to capture patient’s data. Development of the SARC-MSCIS has resulted in comprehensive capacity to support sexual assault research. Four additional projects are underway to explore both the public health and criminal justice considerations in responding to sexual violence. The data showed that 1,933 sexual assault episodes had occurred among 1881 patients between January 1, 2009 and December 31, 2015. Sexual assault patients knew the assailant as a friend, carer, acquaintance, relative, partner, or ex-partner in 70% of cases, with 16% assailants being a stranger to the patient. Conclusion: This project has resulted in the development of a high-quality data management system to maintain information for medical and forensic services offered by SARC. This system has also proven to be a reliable resource enabling research in the area of sexual violence.
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Hill, Isaac, David Johnson, David Scrimgeour, and Robyn McDermott. "Accuracy of national key performance indicator reporting from two Aboriginal medical services: potential to underestimate the performance of primary health care." Australian Health Review 42, no. 4 (2018): 453. http://dx.doi.org/10.1071/ah16251.
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Objective The aim of the present study was to assess the accuracy of extracting national key performance indicator (nKPI) data for the Online Community Health Reporting Environment for Health Services (OCHREStreams) program using the Pen Computer Systems (Leichhardt, NSW, Australia) Clinical Audit Tool (CAT) from Communicare (Telstra Health Communicare Systems, Perth, WA, Australia), a commonly used patient information management system (PIMS) in Aboriginal primary care. Methods Two Aboriginal Community-Controlled Health Services (ACCHSs) were recruited to the present study. A sample of regular clients aged ≥55 years from each ACCHS was selected and a subset of 13 nKPIs was examined. A manual case note audit of the nKPI subset within Communicare was undertaken by a clinician at each participating ACCHS and acted as a ‘gold standard’ comparator for three query methods: (1) internal Communicare nKPI reports; (2) PenCS CAT nKPI manual filtering (a third-party data-extraction tool); and (3) nKPI data submitted to the Improvement Foundation qiConnect portal. Results No errors were found in nKPI data extraction from Communicare using the CAT and subsequent submission to the qiConnect portal. However, the Communicare internal nKPI report included deceased clients and past patients, and we can be very confident that deceased clients and past patients are also included in the qiConnect portal data. This resulted in inflation of client denominators and an underestimation of health service performance, particularly for nKPIs recording activity in the past 6 months. Several minor errors were also detected in Communicare internal nKPI reports. Conclusions CAT accurately extracts a subset of nKPI data from Communicare. However, given the widespread use of Communicare in ACCHSs, the inclusion of deceased clients and past patients in the OCHREStreams nKPI data program is likely to have resulted in systematic under-reporting of health service performance nationally. What is known about the topic? There has been limited validation of health data exported via data-extraction tools in Australia. More specifically, there are no current published data describing the accuracy of the CAT in mapping health data extracted from Communicare or the accuracy of internal nKPI reports generated by Communicare. Further, no systematic review has been undertaken to assess the accuracy of the nKPI data submission pathway from PIMSs at the health service level to the OCHREStreams qiConnect portal using the CAT. What does this paper add? The CAT accurately extracts a subset of nKPI data from Communicare and accurately submits this to the qiConnect portal. Minor errors exist in some Communicare internal nKPI reports. The inclusion of deceased clients and past patients in the nKPI reporting system for ACCHSs is likely to have resulted in systematic under-reporting of health service performance nationally through this program. What are the implications for practitioners? The inclusion of deceased clients and past patients in the OCHREStreams nKPI program limits the usefulness of these data for local quality improvement activities and national monitoring of health service performance for participating ACCHSs. The use of the CAT by ACCHSs independently from the OCHREStreams program can enable deceased clients and past patients to be excluded from reports that can provide more accurate nKPI data from Communicare for local quality improvement and planning purposes.
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Hall, Lisa, Greg Merlo, Minyon Avent, Trent Yarwood, Bonnie Smith, and Mieke van Driel. "Where To From Here? Identifying and Prioritizing Future Directions for Addressing Drug-Resistant Infection in Australia." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s434. http://dx.doi.org/10.1017/ice.2020.1097.
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Background: The Australian Government released a national strategy for antimicrobial resistance in 2015 that calls for a collaborative effort to change practices that have contributed to the development of drug-resistant infection and for the implementation of new initiatives to reduce antibiotic use. Although many achievements have been made in antimicrobial stewardship (AMS), particularly in the acute-care hospital setting, progress more broadly has been slow, and novel solutions are now required to improve clinical practice and community awareness. A facilitated workshop was undertaken at the 2019 National Australian Antimicrobial Resistance Forum to explore the complexity of AMS implementation in Australia and to prioritize future action. Methods: Participants engaged in rotating rounds of discussion using a world café format. The participants sat face-to-face at tables of 7 or fewer. At each table were 2 facilitators: one was a note taker and the other was the discussion leader. Each of the 6 facilitator pairs had a topic for discussion related to implementing antimicrobial stewardship in different contexts, with a focus on experience with strategies that have worked, major implementation barriers, and prioritizing the next steps. The topics for discussion included (1) engaging with hospital staff; (2) implementation in resource-poor settings; (3) implementation in primary care and aged care; (4) engaging and empowering the public; (5) linking data with implementation strategies; and (6) leadership. The facilitators moved between tables at 15-minute intervals to encourage evolving rounds of conversation. Once all tables had discussed all of the themes, the discussion concluded and notes were summarized. A qualitative analysis using an interpretive description approach was conducted using the discussion summaries. The documents were independently openly coded by 2 researchers to identify elements relating to the implementation of antimicrobial stewardship. An iterative approach was used to identify themes and reach a consensus on overarching emergent themes from the workshop. Results: In total, 39 experts (ie, pharmacists, infectious disease physicians, infection prevention nurses, researchers, journalists and consumers) participated in the facilitated discussions. Strategies were discussed relating to engaging with clinicians, consumers, and politicians; adapting to funding, governance, and accreditation limitations; and models for outreach of antimicrobial services. Other themes included the role of clinical champions and mentors as leaders and improving use of audit and feedback through focusing on monitoring appropriateness rather than usage. Conclusions: Recommendations from the workshop will be used to prioritize novel ideas to improve the implementation of AMS initiatives across Australia.Funding: NoneDisclosures: None
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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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Hulse, Gary K. "Impediments to Screening for Hazardous Alcohol Use and Dependence in General Hospital Psychiatric Inpatients." Australian & New Zealand Journal of Psychiatry 35, no. 5 (October 2001): 606–12. http://dx.doi.org/10.1080/0004867010060508.
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Objective: The Alcohol Use Disorders Identification Test (AUDIT) has been developed to screen for hazardous and harmful alcohol consumption. It has been used among a variety of primary care, general population and general hospital populations. However, with the exception of one study undertaken by the author and colleagues, the use of the AUDIT in general hospital psychiatric patients has not been reported. This paper reports on a substudy of this larger study whose aim was to determine the frequency of hazardous alcohol use and dependence among patients admitted to the psychiatric units of general hospitals in Perth, Western Australia, and discusses major reasons for non-AUDIT screening among this group. Method: In a 12-month period 990 patients aged 18–64 years and residing in the Perth metropolitan area were admitted to the psychiatric unit of the two hospitals. Using the AUDIT alcohol use in patients with four major types of psychiatric disorder, namely mood, adjustment, anxiety and psychotic disorders, was assessed. Results: Of the 834 admissions targeted for AUDIT screening 263 were not screened. This non-screening represented 27–42% of patients in each of the major diagnostic categories. There was no significant difference in the proportion of patients screened versus not screened for mood, adjustment or schizophrenia/psychosis. There were however, significantly fewer patients with anxiety disorder screened compared with mood disorder. Those non-screened patients in major psychiatric groups had significantly shorter hospital stays than their diagnostic counterparts who were screened. The major reason for non-screening in all groups was due to patients leaving the psychiatric facility before they could be accessed. This included discharge before screening, transfer to another psychiatric facility and short admission. To a lesser extent cognitive dysfunction accounted for non-screening among major diagnostic groups. Conclusions: Failure to screen patients was largely due to short hospital stays. Screening was impeded by the brief window period, commonly 1 or 2 days, between the absence of acute psychiatric sequelae and discharge. This situation contrasts dramatically to the medical or surgical admission where major sequelae are largely resolved in 2–3 days and AUDIT screening can take place over the remaining 3–4 days prior to discharge. To be effective in the general hospital psychiatric setting, alcohol screening needs to be incorporated into the routine ward assessment procedures. The brevity of the AUDIT makes this possible. This would maximize the time available to implement an intervention programme to those found to be consuming alcohol at a hazardous or harmful level.
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Ellis, Louise A., Brette Blakely, Philip Hazell, Sue Woolfenden, Harriet Hiscock, Vanessa Sarkozy, Bronwyn Gould, et al. "Guideline adherence in the management of attention deficit hyperactivity disorder in children: An audit of selected medical records in three Australian states." PLOS ONE 16, no. 2 (February 8, 2021): e0245916. http://dx.doi.org/10.1371/journal.pone.0245916.
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Objective To assess General Practitioner (GP) and pediatrician adherence to clinical practice guidelines (CPGs) for diagnosis, treatment and management of attention deficit hyperactivity disorder (ADHD). Method Medical records for 306 children aged ≤15 years from 46 GP clinics and 20 pediatric practices in Australia were reviewed against 34 indicators derived from CPG recommendations. At indicator level, adherence was estimated as the percentage of indicators with ‘Yes’ or ‘No’ responses for adherence, which were scored ‘Yes’. This was done separately for GPs, pediatricians and overall; and weighted to adjust for sampling processes. Results Adherence with guidelines was high at 83.6% (95% CI: 77.7–88.5) with pediatricians (90.1%; 95% CI: 73.0–98.1) higher than GPs (68.3%; 95% CI: 46.0–85.8; p = 0.02). Appropriate assessment for children presenting with signs or symptoms of ADHD was undertaken with 95.2% adherence (95% CI: 76.6–99.9), however ongoing reviews for children with ADHD prescribed stimulant medication was markedly lower for both pediatricians (51.1%; 95% CI: 9.6–91.4) and GPs (18.7%; 95% CI: 4.1–45.5). Conclusion Adherence to CPGs for ADHD by pediatricians was generally high. Adherence by GPs was lower across most domains; timely recognition of medication side effects is a particular area for improvement.
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Mousavi, Seyyede Neda, Monireh Dahri, Mohsen Nemati, Fatemeh Kazemi, Abdolreza Norouzi, and Seyyed Javad Purafzali Firouzabadi. "2011 World Nutrition Day Report in Training, Research and Clinical Ghaem Hospital in Mashhad." Galen Medical Journal 1, no. 2 (January 25, 2013): 84–87. http://dx.doi.org/10.31661/gmj.v1i2.23.
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Introduction: Malnutrition in hospitalized patients will worsen the medical condition or disease prognosis. Also, duration of hospitalization and recovery will be delayed. In order to investigate these problems, the team of World Nutrition Day, on behalf of Nutritional Support Organization of Australia (with ESPEN support) decided to perform extensive research as a multi-centered one on the nutritional status of hospitalized patients in the world. This study aimed to compare the nutritional status of patients in the intensive care units (ICUs) of Ghaem Hospital with that in the world. Methods and Materials: This study is part of a cross-sectional multi-center audit which was held by the Nutritional Support Organization in Australia (with ESPEN support) on November 4th, 2010. From Iran, only Ghaem Hospital, with 8 ICUs, participated in this study. First, the consent form, and then questionnaires designed by the team of World Nutrition Day were filled for patients. After the completion of the questionnaires, they were sent online to the Center of Nutritional Support in Australia. Data were analyzed by the Center of Nutritional Support in Australia and were returned after they had been compared with the other centers as tables. Results: Thirty-two patients from the ICUs of Ghaem Hospital were participated in this study. Mean age was 57 years, and 46.9% of the patients were female. Parenteral feeding was not prescribed, and the total calorie intake of the patients was 394±790. Also, no monitoring was performed for the blood glucose of the patients, and the mean duration of hospitalization in the ICU was 19 days. Conclusions: This study shows that the presence of nutrition experts in the various units of hospitals is critical to better assess patients’ needs and to promote Iranian hospitals to reach global standards. [GMJ. 2012;1(2):84-87]
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Stewart, Claire, Emma Power, Annie McCluskey, Suzanne Kuys, and Meryl Lovarini. "Evaluation of a staff behaviour change intervention to increase the use of ward-based practice books and active practice during inpatient stroke rehabilitation: a phase-1 pre–post observational study." Clinical Rehabilitation 34, no. 5 (March 23, 2020): 607–16. http://dx.doi.org/10.1177/0269215520911420.
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Objective: The aim of this study was to evaluate a staff behaviour change intervention to increase the use of ward-based practice books and active practice by stroke inpatients. Design: This is a pre–post observational study. Setting: This study was conducted in a inpatient rehabilitation unit in Australia. Subjects: Stroke inpatients participated in the study. Intervention: A staff behaviour change intervention was designed to support staff to implement practice books. The intervention included staff training on motivation and coaching, and weekly audit and feedback for six months. The environment was restructured to bring staff together weekly at the bedside to review audit data and share skills. Main measures: Medical record audit and behavioural mapping were used to compare the number of stroke participants with/using a practice book pre- and post-intervention. Pre- and post-intervention, the percentage of observations where a stroke participant was actively practising, repetitions of practice recorded and type of supervision were compared. Results: A total of 24 participants were observed ( n = 12 pre, n = 12 post). Post-intervention, the number of participants with practice books increased from one to six (OR = 11, 95% CI = (0.9, 550.7)), but this change was not statistically significant ( P = 0.069). Five participants recorded repetitions in their practice books post-intervention, three were observed using practice books. There was no change in median repetitions recorded ( rpbs = 0.00, 95% CI = (−0.4, 0.4), P = 1.000) or observed active practice ( rpbs = –0.02, 95% CI = (−0.4, 0.4), P = 0.933). Active practice was often fully supervised by a therapist. Conclusion: A staff behaviour change intervention has the potential to increase the number of stroke survivors receiving ward-based practice books but did not increase active practice.
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Jennings, Warren, Geoffrey K. Spurling, and Deborah A. Askew. "Yarning about health checks: barriers and enablers in an urban Aboriginal medical service." Australian Journal of Primary Health 20, no. 2 (2014): 151. http://dx.doi.org/10.1071/py12138.
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The annual health check for Aboriginal and Torres Strait Islander People has been welcomed as a means of conducting a comprehensive assessment to address preventive health care delivery, identify new diagnoses and initiate new treatments. Rates of health check uptake across Australia have been poor with less than 12% of the eligible population receiving one during 2009/10. This qualitative study sought to identify barriers and enablers to undertaking health checks in an urban Aboriginal Medical Service through semistructured interviews with 25 clinical staff (doctors, nurses and Aboriginal and Torres Strait Islander health workers). Clinical systems for conducting health checks were unclear to staff, with barriers relating to time pressures for both patients and clinic staff, and lack of clarity about staff responsibilities for initiating and conducting the health check. Additionally some staff perceived some content as sensitive, invasive, culturally inappropriate and of questionable value. Other barriers included concerns about community health literacy, disengagement with preventative health care, and suspicion about confidentiality and privacy. The development of clear service-wide systems that support the conduct of health checks are required to increase uptake, combined with supportive local clinical leadership and audit and feedback systems. Staff training, consideration of culture and roles, and critical review of health check content may improve staff confidence and community acceptance. Community-based health education and promotion is strongly supported by staff to increase client engagement, knowledge and acceptance of the health check.
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Dwyer, Alison, and John McNeil. "Are Clinical Registries Actually Used? The Level of Medical Staff Participation in Clinical Registries, and Reporting within a Major Tertiary Teaching Hospital." Asia Pacific Journal of Health Management 11, no. 1 (March 16, 2016): 56–64. http://dx.doi.org/10.24083/apjhm.v11i1.245.
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Clinical Registries are established to provide a clinically credible means for monitoring and benchmarking healthcare processes and outcomes, to identify areas for improvement, and drive strategies for improving patient care. Clinical Registries are used to assess changes in clinical practice, appropriateness of care and health outcomes over time. The American Heart Association Policy Statement in April 2011 called for expanding the application for existing and future Clinical Registries, with well-designed Clinical Registry programs. Concurrently, in Australia, and similarly within the United States and United Kingdom, there has been an increased focus on performance measurement for quality and patient safety. Within Victoria, the Victorian Clinical Governance Policy Framework outlines clinical effectiveness as one of the four domains of Clinical Governance
As Clinical Registries evaluate effectiveness and safety of patient care by measuring patient outcomes compared with peers, the use of Clinical Registries data to improve a health service’s quality of care seems intuitive. A mixed methods approach was utilised, involving (1) semi-structured interviews and (2) documentation audit in this study conducted at Austin Health, a major tertiary teaching hospital in North-Eastern metropolitan Melbourne, affiliated with the University of Melbourne and various research institutes within Austin LifeSciences.
Although many studies have highlighted the benefits of data collected via individual Clinical Registries, [5,6] the level of voluntary medical staff participation in Clinical Registries at a health service level is yet to be established. The aim of this study was to document the level of medical staff involvement for Clinical Registries within a major tertiary teaching hospital, and the level of reporting into Quality Committees within the organisation.
This study demonstrates that along with a very high level of medical staff participation in Clinical Registries, there is a lack of systematic reporting of Registries data into quality committees beyond unit level, and utilisation of such data to reflect upon practice and drive quality improvement.
Abbreviations: CREPS – Centre for Excellence in Patient Safety; CSU – Clinical Services Unit; HOU – Heads of Unit; VASM – Victorian Audit of Surgical Mortality.
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Endlich, Yasmin, Linda A. Beckmann, Siu-Wai Choi, and Martin D. Culwick. "A prospective six-month audit of airway incidents during anaesthesia in twelve tertiary level hospitals across Australia and New Zealand." Anaesthesia and Intensive Care 48, no. 5 (September 2020): 389–98. http://dx.doi.org/10.1177/0310057x20945325.
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This audit of airway incidents was conducted over six months in 12 tertiary level hospitals across Australia and New Zealand. During that time, 131,233 patients had airway management and 111 reports were submitted (incidence 0.08%). The airway incidents included a combination of difficult airway management (83), oxygen desaturation (58), aspiration (19), regurgitation (14), laryngospasm (16), airway bleeding (10), bronchospasm (5) and dental injury (4), which gave a total of 209 events in 111 reports. Most incidents occurred during general anaesthesia (GA; 83.8%) and normal working hours (81.1%). Forty-three percent were associated with head and neck surgery and 12.6% with upper abdominal procedures. Of these patients, 52% required further medical treatment or additional procedures and 16.2% required unplanned admission to an intensive care unit or a high dependency unit. A total of 31.5% of patients suffered from temporary harm and 1.8% from permanent harm. There was one death. The factors associated with a high relative risk (RR) of an airway incident included American Society of Anesthesiologists Physical Status (ASA PS) (ASA PS 2 versus 1, RR 1.75; ASA PS 3 versus 1, RR 3.56; ASA PS 4 versus 1, RR 6.1), and emergency surgery (RR 2.16 compared with elective). Sedation and monitored anaesthesia care were associated with lower RRs (RR 0.49 and RR 0.73 versus GA, respectively). Inadequate airway assessment, poor judgement and poor planning appeared to be contributors to these events. Future teaching and research should focus on these areas to further improve airway management and patient safety.
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Kalo, Eric, Nashwa Sheriff, Marina Isaac, Asma Baig, Scott Read, and Golo Ahlenstiel. "A Call for Implementation of an Evidence-Based, Quality Improvement, Decompensated Cirrhosis Discharge Care Bundle in Australia." Livers 2, no. 2 (June 20, 2022): 97–104. http://dx.doi.org/10.3390/livers2020007.
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A growing body of research suggests that evidence-based interventions can tackle high rates of hospital readmissions among patients with decompensated cirrhosis. Care bundles are a prime example of an evidence-based intervention to reduce hospital readmissions through documentation and communication. In this pilot study, a comprehensive baseline audit of electronic medical records of 497 discharges for 175 patients was conducted to assess the current standards of care on discharge from Blacktown Hospital, Australia, and the scope for introducing a care bundle. Our results demonstrated suboptimal discharge communication in a number of areas: Only 54% of decompensated cirrhosis patients had a follow-up appointment pre-scheduled at discharge. Despite alcohol being identified as a key cause of cirrhosis in 60% of patients, a review by alcohol services was conducted on only 24.9% of patients. Moreover, a general lack of focus on patient education and health literacy was identified. In conclusion, our pilot study has highlighted areas for improvement in the standard of care provided to this cohort of patients. Implementation of a standardized care bundle could address the current shortfalls, improve the standard of care and refocus discharge planning to address health literacy and education in patients admitted with a decompensated liver.