Journal articles on the topic 'Patient satisfaction Victoria Melbourne'
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Chia, A. C. L., M. G. Irwin, P. W. H. Lee, T. H. W. Lee, and S. F. Man. "Comparison of Stress in Anaesthetic Trainees between Hong Kong and Victoria, Australia." Anaesthesia and Intensive Care 36, no. 6 (November 2008): 855–62. http://dx.doi.org/10.1177/0310057x0803600617.
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A postal survey was sent to anaesthetic trainees in Hong Kong and Victoria, Australia to compare work-related stress levels. Demographic data were collected. Anaesthetist-specific stressors, Maslach Burnout Inventory and Global Job Satisfaction scores were used for psychological testing. The response rates from Hong Kong and Melbourne were 64 of 133 (48.1%) and 108 of 196 (55.1%), respectively. Victorian respondents were older with greater family commitments, but more advanced in fulfilling training requirements. Hong Kong respondents, being faced with both the challenge of dual College requirements, exhibited consistently higher indices of stress (P <0.001) and less job satisfaction (P <0.001). Common occupational stressors related to dealing with critically ill patients and medicolegal concerns. Higher stress scores observed in Hong Kong trainees related to service provision and a perceived lack of resources. Despite the complex nature of stress, its antecedents and manifestations, an inverse relationship between emotional exhaustion and job satisfaction was evident in correlation analysis (P <0.001). This survey suggests that stress was present in some trainees in both areas. Hong Kong trainees may benefit from local development to address mental wellbeing as being important to fulfil this highly competitive training program.
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Mitchell, Paul, Jennifer Soon, Joanne Kenny, and Katherine Simons. "What do doctors value about attending multi-disciplinary cancer case discussions?" Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e18324-e18324. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18324.
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e18324 Background: Discussion of cancer cases at multi-disciplinary meetings (MDMs) for treatment planning is expected standard care in Australia. There has been rapid uptake of MDMs in the last 10 - 15 years and in the state of Victoria approximately 70% of cancer cases are discussed. MDMs have strong support from medical staff and we investigated their motivation in attending MDMs. Methods: Over 12 months, Austin Health in Melbourne, Victoria, hosted 452 cancer MDMs discussing 5943 patients. MDMs covered 15 tumour areas: 11 solid tumour, one lymphoma and three haematological. Over a 4-week period, medical staff attending MDMs were surveyed and asked to rank what they valued most about cancer MDMs, over and above the benefits for patients. Results: Responses were received from 84% of the 285 medical staff surveyed, which included consultants as well as trainees (registrars and fellows). For 75% of respondents the highest ranking was given to multi-disciplinary communication, 9% gave the highest ranking to quality assurance and governance, 5% ongoing learning for consultants, 5% collegiate relationships, 2% learning and teaching for non-consultant staff, 2% peer support 1% job satisfaction and 1% clinical trials engagement. Similar results were obtained for consultant staff and for registrars / fellows. For consultant medical staff, if multidisciplinary communication was excluded, 44% of respondents gave the highest ranking to quality assurance and governance, 23% to collegiate relationships, 20% ongoing learning for consultants, 10% peer support and 3% clinical trials engagement. Conclusions: When we asked doctors what they valued most about attending cancer MDMs, besides the benefits for patients, communication between disciplines was clearly the most valued aspect. The benefits for quality and governance was the next most valued, then collegiate relationships and peer support, and ongoing learning.
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Doerr, Christine R., Stephen E. Graves, Graham E. Mercer, and Richard H. Osborne. "Implementation of a quality care management system for patients with arthritis of the hip and knee." Australian Health Review 37, no. 1 (2013): 88. http://dx.doi.org/10.1071/ah11107.
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The Orthopaedic Unit of the Repatriation General Hospital (RGH) in Adelaide, South Australia has implemented a quality care management system for patients with arthritis of the hip and knee. The system not only optimises conservative management but ensures that joint replacement surgery is undertaken in an appropriate and timely manner. This new service model addresses identified barriers to service access and provides a comprehensive, coordinated strategy for patient management. Over 4 years the model has reduced waiting times for initial outpatient assessment from 8 to 3 months and surgery from 18 to 8 months, while decreasing length of stay from 6.3 to 5.3 days for hips and 5.8 to 5.3 days for knees. The service reforms have been accompanied by positive feedback from patients and referring general practitioners in relation to the improved coordination of care and enhanced efficiency in service delivery. What is known about the topic? Several important initiatives both overseas and within Australia have contributed significantly to the development of this model of care. These include the UK National Health Service ‘18 weeks’ Project, the Western Canada Waiting List Project, the New Zealand priority criteria project, the Queensland Health Orthopaedic Physiotherapy Screening Clinic, and most importantly the Melbourne Health–University of Melbourne Orthopaedic Waiting List Project where a wide range of models were explored across Victorian hospitals from 2005 and the Multi-Attribute Prioritisation Tool (MAPT) was developed, validated and tested. This project became the Osteoarthritis Hip and Knee Service (OAHKS) and was operationalised in the Victorian healthcare system from 2012. These initiatives examined and addressed various aspects of management systems for patients with arthritis of the hip and knee in their particular setting. What does this paper add? The development of this system is an extension of what is already known and is the first to encompass a comprehensive and coordinated strategy across all stages of the care management pathway for this patient group. Their management extends from the initial referral to development and implementation of a management plan, including surgery if assessed as necessary and organisation of long-term post operative follow up as required. By detailing the elements, key processes and measurable outcomes of the service redesign this paper provides a model for other institutions to implement a similar initiative. What are the implications for practitioners? An important aspect of the design process was practitioner acceptance and engagement and the ability to improve their capacity to deliver services within an efficient and effective model. Intrinsic to the model’s development was assessment of practitioner satisfaction. Data obtained including practitioner surveys indicated an increased level of both satisfaction with the redesigned management service, and confidence in it to deliver its intended improvements.
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Kinsella, Rita, Tom Collins, Bridget Shaw, James Sayer, Belinda Cary, Andrew Walby, and Sallie Cowan. "Management of patients brought in by ambulance to the emergency department: role of the Advanced Musculoskeletal Physiotherapist." Australian Health Review 42, no. 3 (2018): 309. http://dx.doi.org/10.1071/ah16094.
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Objective The aim of the present study was to evaluate the role of the Advanced Musculoskeletal Physiotherapist (AMP) in managing patients brought in by ambulance to the emergency department (ED). Methods This study was a dual-centre observational study. Patients brought in by ambulance to two Melbourne hospitals over a 12-month period and seen by an AMP were compared with a matched group seen by other ED staff. Primary outcome measures were wait time and length of stay (LOS) in the ED. Results Data from 1441 patients within the Australasian Triage Scale (ATS) Categories 3–5 with musculoskeletal complaints were included in the analysis. Subgroup analysis of 825 patients aged ≤65 years demonstrated that for Category 4 (semi-urgent) patients, the median wait time to see the AMP was 9.5 min (interquartile range (IQR) 3.25–18.00 min) compared with 25 min (IQR 10.00–56.00 min) to see other ED staff (P ≤ 0.05). LOS analysis was undertaken on patients discharged home and demonstrated that there was a 1.20 greater probability (95% confidence interval 1.07–1.35) that ATS Category 4 patients managed by the AMP were discharged within the 4-hour public hospital target compared with patients managed by other ED staff: 87.04% (94/108) of patients managed by the AMPs met this standard compared with 72.35% (123/170) of patients managed by other ED staff (P = 0.002). Conclusions Patients aged ≤65 years with musculoskeletal complaints brought in by ambulance to the ED and triaged to ATS Category 4 are likely to wait less time to be seen and are discharged home more quickly when managed by an AMP. This study has added to the evidence that AMPs improve patient flow in the ED, freeing up time for other ED staff to see higher-acuity, more complex patients. What is known about the topic? There is a growing body of evidence establishing that AMPs improve the flow of patients presenting with musculoskeletal conditions to the ED through reduced wait times and LOS and, at the same time, providing good-quality care and enhanced patient satisfaction. What does this paper add? Within their primary contact capacity, AMPs also manage patients who are brought in by ambulance presenting with musculoskeletal conditions. To the authors’ knowledge, there is currently no available literature documenting the performance of AMPs in the management of this cohort of patients. What are the implications for practitioners? This study has added to the body of evidence that AMPs improve patient flow in the ED and illustrates that AMPs, by seeing patients brought in by ambulance, are able to have a positive impact on the pressures increasingly facing the Victorian Ambulance Service and emergency hospital care.
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McCluskey, Trish, John Weldon, and Andrew Smallridge. "Re-building the first year experience, one block at a time." Student Success 10, no. 1 (March 7, 2019): 1–15. http://dx.doi.org/10.5204/ssj.v10i1.1148.
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For many years, universities around the world have been developing and enhancing the First Year Experience (FYE), with a view to improving retention, performance and student satisfaction. This feature practice report outlines a strategic initiative, launched in 2018 at Victoria University in Melbourne, Australia that aims to transform the experience of Victoria University’s first-year students on an unprecedented scale. This unique model reconceptualises the design, structure and delivery of first year units of study in order to deliver a program that deliberately focuses on students’ pedagogical, transition and work/life balance needs. This initiative required the disruption and redevelopment of all university systems to ensure students experience a supportive and seamless transition into, and journey through, their first year of study at university.
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Erasmus, Jaco, Harjit Bagga, and Fintan Harte. "Assessing patient satisfaction with a multidisciplinary gender dysphoria clinic in Melbourne." Australasian Psychiatry 23, no. 2 (January 23, 2015): 158–62. http://dx.doi.org/10.1177/1039856214566829.
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Cox, Shelley, Rohan Martin, Piyali Somaia, and Karen Smith. "The development of a data-matching algorithm to define the ‘case patient’." Australian Health Review 37, no. 1 (2013): 54. http://dx.doi.org/10.1071/ah11161.
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Objectives. To describe a model that matches electronic patient care records within a given case to one or more patients within that case. Method. This retrospective study included data from all metropolitan Ambulance Victoria electronic patient care records (n = 445 576) for the time period 1 January 2009–31 May 2010. Data were captured via VACIS (Ambulance Victoria, Melbourne, Vic., Australia), an in-field electronic data capture system linked to an integrated data warehouse database. The case patient algorithm included ‘Jaro–Winkler’, ‘Soundex’ and ‘weight matching’ conditions. Results. The case patient matching algorithm has a sensitivity of 99.98%, a specificity of 99.91% and an overall accuracy of 99.98%. Conclusions. The case patient algorithm provides Ambulance Victoria with a sophisticated, efficient and highly accurate method of matching patient records within a given case. This method has applicability to other emergency services where unique identifiers are case based rather than patient based. What is known about the topic? Accurate pre-hospital data that can be linked to patient outcomes is widely accepted as critical to support pre-hospital patient care and system performance. What does this paper add? There is a paucity of literature describing electronic matching of patient care records at the patient level rather than the case level. Ambulance Victoria has developed a complex yet efficient and highly accurate method for electronically matching patient records, in the absence of a patient-specific unique identifier. Linkage of patient information from multiple patient care records to determine if the records are for the same individual defines the ‘case patient’. What are the implications for practitioners? This paper describes a model of record linkage where patients are matched within a given case at the patient level as opposed to the case level. This methodology is applicable to other emergency services where unique identifiers are case based.
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SUMMERS, M., and B. HAPPELL. "Patient satisfaction with psychiatric services provided by a Melbourne tertiary hospital emergency department." Journal of Psychiatric and Mental Health Nursing 10, no. 3 (June 2003): 351–57. http://dx.doi.org/10.1046/j.1365-2850.2003.00600.x.
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Jackson, Terri, and Petia Sevil. "Problems in counting and paying for multidisciplinary outpatient clinics." Australian Health Review 20, no. 3 (1997): 38. http://dx.doi.org/10.1071/ah970038.
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Policy-makers have always found it problematic to formulate fair and consistentcounting rules for public hospital outpatient activities. In the context of output-based funding, such rules have consequences which can affect patient care. This paper reviews the rationale for organising multidisciplinary clinics and reports on a series of focus groups convened in four Melbourne teaching hospitals to consider funding policy for such clinics. It discusses issues of targeting outpatient services, along with implications for payment policy. It evaluates counting rules in terms of intended andunintended consequences in the context of Victoria?s introduction of output-basedfunding for outpatient services.
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Crock, Elizabeth, and Judy-Ann Butwilowsky. "The HIV Resource Nurse Role at the Royal District Nursing Service (Melbourne): Making A Difference for People Living with HIV/AIDS in the Community." Australian Journal of Primary Health 12, no. 2 (2006): 83. http://dx.doi.org/10.1071/py06026.
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The care of people living with HIV/AIDS in the home and community can be complex and challenging, requiring high levels of knowledge, skill, preparedness and, importantly, the ability to engage with people belonging to marginalised groups. In 2003, the Royal District Nursing Service (RDNS) HIV/AIDS Team in Victoria, Australia, developed the new role of HIV Resource Nurse at two RDNS centres in Melbourne serving high numbers of people living with HIV/AIDS. Drawing from two case studies and interviews with two HIV Resource Nurses from one of the centres, this paper describes this practice innovation. Benefits (including a positive impact on client engagement with services, client care, relationships with other health care workers and job satisfaction) are outlined, along with challenges in the implementation and evolution of the role. Strategies to sustain and develop the HIV Resource Nurse role are proposed.
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Rahman, Asheq, Catherine Martin, Andis Graudins, and Rose Chapman. "Deliberate Self-Poisoning Presenting to an Emergency Medicine Network in South-East Melbourne: A Descriptive Study." Emergency Medicine International 2014 (2014): 1–7. http://dx.doi.org/10.1155/2014/461841.
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Background. Deliberate self-poisoning (DSP) comprises a small but significant proportion of presentations to the emergency department (ED). However, the prevalence and patient characteristics of self-poisoning attendances to EDs in Victoria have not been recently characterised.Aim. To identify and compare the characteristics of adult patients presenting to the three EDs of Monash Health following DSP.Methods. Retrospective clinical audit of adult DSP attendances between 1st July 2009 and 30th June 2012.Results. A total of 3558 cases over three years were identified fulfilling the search criteria. The mean age of patients was 36.3 years with the largest numbers aged between 18 and 30 (38%). About 30% of patients were born overseas. Forty-eight percent were discharged home, 15% were admitted to ED short stay units, and 5% required ICU admission. The median ED length of stay was 359 minutes (IQR 231–607). The most frequently reported substances in DSP were benzodiazepines (36.6%), paracetamol (22.2%), and antipsychotics (12.1%). Exposure to more than one substance for the episode of DSP was common (47%).Conclusion. This information may help identify the trends in poisoning substances used for DSP in Victoria, which in turn may provide clinicians with information to provide more focused and targeted interventions.
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NOWOWEISKI, Sarah, Martin HEALEY, and Tiki OSIANLIS. "Patient Experience During COVID-19: How the Introduction of Telehealth has Influenced Patient Practices." Fertility & Reproduction 04, no. 03n04 (September 2022): 155. http://dx.doi.org/10.1142/s266131822274067x.
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Background: Melbourne underwent one of the strictest lockdowns in the world in 2020, with the swing to telehealth-based appointments, bringing into focus the effectiveness of communication between staff and patients. Due to the ongoing provision of a hybrid model of in-person and telehealth appointments, it is important to learn how this shift in delivery of service has impacted patient experiences. Aim: To examine patient experiences with telehealth appointments, and to assess any associations between self-reported personality traits and preferred communication method. Method: Data was collected from a patient satisfaction survey administered in May 2021 (N=127). The patient satisfaction survey consisted of 5-point Likert scale responses regarding specific aspects of IVF care, self-reported personality trait descriptions and qualitative responses. Frequencies and ordinal logistic regression analyses was used to examine associations between personality traits and satisfaction responses. Results: Overall 80% (N=101) of patients liked the flexibility of telehealth appointments. However 68% (N=87), while understanding the need for telehealth during COVID-19, preferred face to face communication. Exploring self-reported personality traits, patients who described themselves as assertive were more likely to prefer succinct written information, whereas patients who described themselves as anxious and/or shy preferred both verbal and written communication. Patients who described themselves as optimistic, were more likely to rate themselves as pleased with their overall experiences at Newlife IVF and felt emotionally supported during treatment. Conclusion: Despite shifting to a majority telehealth service provision, most patients reported high levels of satisfaction with communication, and have continued to actively use telehealth since the lifting of lockdown, indicating that it doesn’t introduce significant barriers to patient and clinic communication. Inadvertently, necessary change due to COVID-19 has spontaneously broadened the scope of patient centered care providing further insight into patient preferences. Further exploration into using heuristics to identify links between personality types and mode of communication is warranted.
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Phillips, Nicole, Lorraine Dennerstein, and Stephen Farish. "Progress and Evaluation of a Consultation-Liaison Psychiatry Service to an Obstetric-Gynaecology Hospital." Australian & New Zealand Journal of Psychiatry 30, no. 1 (February 1996): 82–89. http://dx.doi.org/10.3109/00048679609076075.
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Objective: Recently we described the establishment and first 6 months of a psychiatric consultation-liaison service to a Melbourne obstetric-gynaecology teaching hospital. The follow-up report evaluates the service in two ways: first, it compares referral data for the 12 months of 1992 with that of the first 6 months of operation in 1990; and second, it reports on results of a survey of referrer and patient satisfaction with the service. Method: Referral data were collected for the data comparison from the consultation-liaison referral book and patients' files. Referrer and patient satisfaction was evaluated by questionnaires sent to 45 medical staff, 7 charge nurses, and 100 consecutive patients. Result: A fairly constant referral rate for inpatients has emerged at 0.8%, this very low referral rate being some cause for concern. An internal shift in the type of referrals over time has developed, with an increase in obstetric and a decrease in gynaecology referrals. High referrer satisfaction, with 86% of the doctors finding the consultation(s) “very” or “quite” helpful, and high patient satisfaction, with 83% of respondents having found the consul tat ion(s) “very” or “quite” helpful, was found. Conclusions: Despite high referrer and consumer satisfaction, and objective evidence of need, this pioneering consultation-liaison service in obstetric-gynaecology continues to be grossly under-utilised. Increasing the referral rate will be one of the greatest challenges in the future of this service.
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Zhao, Henry, Lauren Pesavento, Edrich Rodrigues, Patrick Salvaris, Karen Smith, Stephen Bernard, Michael Stephenson, et al. "009 The ambulance clinical triage-for acute stroke treatment (ACT-FAST) algorithmic pre-hospital triage tool for endovascular thrombectomy: ongoing paramedic validation." Journal of Neurology, Neurosurgery & Psychiatry 89, no. 6 (May 24, 2018): A5.1—A5. http://dx.doi.org/10.1136/jnnp-2018-anzan.9.
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IntroductionThe ambulance clinical triage-for acute stroke treatment (ACT-FAST) algorithm is a severity based 3-step paramedic triage tool for pre-hospital recognition of large vessel occlusion (LVO), designed to improve specificity and paramedic assessment reliability compared to existing triage scales. ACT-FAST sequentially assesses 1. Unilateral arm fall to stretcher <10 s; 2a. Severe language disturbance (right arm weak), or 2b. Severe gaze deviation/hemi-neglect assessed by shoulder tap (left arm weak); 3. Clinical eligibility questions. We present the results of the ongoing Ambulance Victoria paramedic validation study.MethodsAmbulance Victoria paramedics assessed ACT-FAST in all suspected stroke patients pre-hospital in metropolitan Melbourne, Australia, and in the Royal Melbourne Hospital Emergency Department since July 2017. Algorithm results were validated against a comparator of ICA/M1 occlusion on CT-angiography with NIHSS ≥6 (Class 1 indications for endovascular thrombectomy).ResultsData were available from n=119 assessments (ED n=68, pre-hospital n=51). Patient diagnoses were LVO n=20 (15.6%), non-LVO infarcts n=45 (38.5%), ICH n=10 (8.3%) and no stroke on imaging n=44 (37.6%). ACT-FAST showed 85% sensitivity, 88.9% specificity, 60.7% (72% excluding ICH) positive predictive value and 96.7% negative predictive value for LVO. Of 10 false-positives, 4 received thrombectomy for non-Class 1 indications (basilar/M2 occlusions/cervical dissection), 3 were ICH, and 1 was tumour. Three false-negatives were LVO with milder syndromes.DiscussionThe ongoing ACT-FAST algorithm validation study shows high accuracy for clinical recognition of LVO. The streamlined algorithmic approach with just two examination items provides a more practical option for implementation in large emergency service networks. Accurate pre-hospital recognition of LVO will allow bypass to endovascular centres and early activation of neuro-intervention services to expedite endovascular thrombectomy.
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Eastwood, Kathryn, Dhanya Nambiar, Rosamond Dwyer, Judy A. Lowthian, Peter Cameron, and Karen Smith. "Ambulance dispatch of older patients following primary and secondary telephone triage in metropolitan Melbourne, Australia: a retrospective cohort study." BMJ Open 10, no. 11 (November 2020): e042351. http://dx.doi.org/10.1136/bmjopen-2020-042351.
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BackgroundMost calls to ambulance result in emergency ambulance dispatch (direct dispatch) following primary telephone triage. Ambulance Victoria uses clinician-led secondary telephone triage for patients identified as low-acuity during primary triage to refer them to alternative care pathways; however, some are returned for ambulance dispatch (secondary dispatch). Older adult patients are frequent users of ambulance services; however, little is known about the appropriateness of subsequent secondary dispatches.ObjectivesTo examine the appropriateness of secondary dispatch through a comparison of the characteristics and ambulance outcomes of older patients dispatched an emergency ambulance via direct or secondary dispatch.DesignA retrospective cohort study of ambulance patient data between September 2009 and June 2012 was conducted.SettingThe secondary telephone triage service operated in metropolitan Melbourne, Victoria, Australia during the study period.ParticipantsThere were 90 086 patients included aged 65 years and over who had an emergency ambulance dispatch via direct or secondary dispatch with one of the five most common secondary dispatch paramedic diagnoses.Main outcome measuresDescriptive analyses compared characteristics, treatment and transportation rates between direct and secondary dispatch patients.ResultsThe dispatch groups were similar in demographics, vital signs and hospital transportation rates. However, secondary dispatch patients were half as likely to be treated by paramedics (OR 0.51; CI 0.48 to 0.55; p<0.001). Increasing age was associated with decreasing treatment (p<0.005) and increasing transportation rates (p<0.005).ConclusionSecondary triage could identify patients who would ultimately be transported to an emergency department. However, the lower paramedic treatment rates suggest many secondary dispatch patients may have been suitable for referral to alternative low-acuity transport or referral options.
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Davies, Sarah, Cathryn Keenan, and Bernice Redley. "Health Assistant in Nursing: a Victorian health service pilot." Asia Pacific Journal of Health Management 12, no. 2 (July 18, 2017): 17–24. http://dx.doi.org/10.24083/apjhm.v12i2.73.
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Objective: Develop and evaluate pilot of a new role to support nursing care delivery in hospital settings.
Design: A naturalistic, three-stage pre-post, multimethod pilot design used data collected from hospital administrative datasets, and surveys and focus groups with staff participants.
Setting: Three wards at three hospital sites of a large tertiary health service in Victoria, Australia.
Subjects: Staff performing the new role and registered nurses working on participating wards.
Intervention: Pilot of a new Health Assistant in Nursing (HAN) role.
Main outcome measures: Staff outcomes were work satisfaction and workload of registered nurses; quality outcomes included reported patient falls and medication errors; organisational outcomes included service costs and sick leave.
Results: Work satisfaction and workload of registered nurses remained stable after introducing the new role. The frequency of reported patient falls reduced in two of the three wards. Costing outcomes suggested potential for cost benefits attributed to reduced falls in acute wards.
Conclusions: This pilot identified the new HAN role has capacity to contribute to improved patient quality and safety outcomes without compromising nurse job satisfaction and workload. Potential cost benefits of thenew role warrant further consideration in the acute care sector.
Abbreviations: CPO – Constant Patient Observer; CSN – Clinical Support Nurse; HAN – Health Assistant in Nursing. NWSQ – Nursing Workplace Satisfaction
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Hasson, Ruairi, Eoin McDermott, Karena Hanley, Camilla Carroll, and Claire Collins. "Assessing patient satisfaction with a microsuction service in general practice: a comparative study." BJGP Open 3, no. 2 (June 11, 2019): bjgpopen19X101649. http://dx.doi.org/10.3399/bjgpopen19x101649.
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BackgroundIn the UK, about 2.3 million people each year require intervention for wax impaction, while otitis externa accounts for just over 1% of general practice consultations. Aural microsuction of debris from the ear canal is a commonly performed procedure within the ear, nose, and throat (ENT) outpatient clinic. This article examines the patient acceptability of an aural microsuction service delivered in general practice.AimTo determine patient satisfaction following the introduction of a new microsuction service in general practice compared with a hospital-delivered service.Design & settingThis is a prospective comparative study in two rural general practices in Ireland and the emergency department (ED) of the Royal Victoria Eye and Ear Hospital (RVEEH), Dublin.MethodA 3-month period of data collection on usual care of 56 patients in general practice was followed by a 3-month period of GP-intervention data collection on 67 patients. Comparative data were collected on 37 patients who attended the RVEEH for the same intervention procedure. Patients completed a validated patient satisfaction questionnaire (PSQ-18).ResultsBoth general practice groups scored significantly higher in all seven aspects of medical care than the RVEEH cohort. Patients in the GP-intervention group scored significantly higher in terms of satisfaction with procedure technique compared with the usual care GP group.ConclusionThe provision of microsuction as a service in general practice confers as much or more patient satisfaction as the provision of the service in a hospital setting.
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Downer, Sean R., John G. Meara, Annette C. Da Costa, and Kannan Sethuraman. "SMS text messaging improves outpatient attendance." Australian Health Review 30, no. 3 (2006): 389. http://dx.doi.org/10.1071/ah060389.
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Objective: To evaluate the operational and financial efficacy of sending short message service (SMS) text message reminders to the mobile telephones of patients with scheduled outpatient clinic appointments. Design: Cohort study with historical control. Setting: Royal Children's Hospital, Melbourne, Victoria. Patients: Patients who gave a mobile telephone contact number and were scheduled to attend an outpatient clinic at the Royal Children's Hospital, Melbourne in October, November and December 2004 (trial group) or in October, November and December 2003 (historical control group). Main outcome measures: Failure-to-attend (FTA) rate compared between the trial group, whose members were sent a reminder, and the historical control group, whose members were not sent a reminder. Financial benefits versus cost of sending reminders. Results: 22 658 patients with a mobile telephone contact number scheduled to attend an outpatient clinic appointment in October, November and December 2004 were sent an SMS reminder; 20 448 (90.2%) of these patients attended their appointment. The control group included 22 452 patients with a mobile telephone contact number scheduled to attend an appointment, with 18 073 (80.5%) patients attending. The FTA rate was significantly lower in the trial group than in the historical control group (9.8% v 19.5%; P < 0.001). The cost of sending the SMS reminders was small compared with the increase in patient revenue and associated benefits generated as a result of improved attendance. Conclusions: The observed reduction in FTA rate was in line with that found using traditional reminder methods and a prior pilot study using SMS. The FTA reduction coupled with the increase in patient revenue suggests that reminding patients using SMS is a very cost effective approach for improving patient attendance.
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Gao, Crystal, Zheng Jie Lim, Brendan Freestone, Kristy Austin, and Rob McManus. "Use of a Novel Electronic Patient Care Record System at Mass Gathering Events by St. John Ambulance Victoria." Prehospital and Disaster Medicine 34, s1 (May 2019): s88. http://dx.doi.org/10.1017/s1049023x19001845.
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Introduction:The growing number of mass gathering events (MGEs) in Victoria has seen an increase in demand for event health services and the need for real-time reporting of medical incidents at these events.Aim:Since 2016, St. John Ambulance Victoria has introduced an electronic patient care record (ePCR) system with the aim of improving patient care and satisfaction. It appears that this ePCR system is the first of its kind to be trialed at MGEs by a volunteer organization.Methods:A qualitative study was conducted to determine strengths and limitations of the ePCR system by compiling results of surveys and interviews and through anonymous feedback from volunteers and patrons (event organizers, patients). This study is ongoing.Results:It was found that the use of ePCR: 1.Allowed for collection of relevant data to assist in future planning of MGEs2.Aids the overall coordination of first aid delivery at MGEs -faster relaying of patient information to event commanders-reduction of paperwork-improved ability to locate first aid crews using GPS tracking3.Received positive feedback from first aiders, event organizers, and patrons4.Was deemed easy-to-use (4/5), acceptable (4.3/5), and helpful (4.1/5) by our membersDiscussion:These experiences demonstrate that ePCR is well-received, easy to use, and leads to improved patient satisfaction and treatment outcomes at MGEs. Furthermore, the ability to collect and analyze real-time data such as GPS location tracking, incidence heat maps, and patient demographics facilitate future event planning and resource allocation at MGEs. It is acknowledged that this study is preliminary, and the trialed use of an ePCR system has been limited to metropolitan areas and MGEs with <1 million patrons. The intent is to continue this study and explore the use of ePCRs at larger MGEs and events in rural or regional areas.
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Perry, Alison R., and Margaret A. Shaw. "Evaluation of functional outcomes (speech, swallowing and voice) in patients attending speech pathology after head and neck cancer treatment(s): development of a multi-centre database." Journal of Laryngology & Otology 114, no. 8 (August 2000): 605–15. http://dx.doi.org/10.1258/0022215001906516.
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Since April 1997, in Melbourne, Australia, speech pathologists have collaborated to establish a prospective database of functional outcomes of speech, swallowing and voice for patients undergoing head and neck cancer treatments.Staff at eight acute care hospitals, all of which offer speech pathology for head and neck cancer services in Victoria, are contributing data, collated centrally, in an agreed pro forma.Early results are given (after 12 months’ data collection). The implications for clinically-based research, and the future potential for benchmarking outcomes – by expansion of the rehabilitation database beyond the current participating sites – is discussed.This paper outlines the rationale of establishing the database is multicentred, and explores some of the complexities involved, including the challenges inherent in long-term accurate data collection in the head and neck cancer patient population. This work represents the development of an appropriate, usable tool for data collection on functional outcomes.
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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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WARD, Madeleine, Russell DALTON, Glenda WOODS, Katrina DOWLING, and Nyssa POHL. "DuoStim: The Patient Experience of a Follicular and Luteal Phase Stimulation." Fertility & Reproduction 04, no. 03n04 (September 2022): 218. http://dx.doi.org/10.1142/s2661318222741297.
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Background: A dual stimulation, or ‘DuoStim’ protocol results in the recruitment of developing waves of antral follicles to occur one after the other within a menstrual cycle 1 . This proffers benefits for women who have previously demonstrated a poor response to assisted reproductive technologies, providing an opportunity to increase the number of oocytes collected, as well as for women aiming for fertility preservation 1 . Aim: We report on the experience of women who have undergone dual stimulation and oocyte pick up, in both the follicular and luteal phase of the cycle. Result: All women who underwent a DuoStim cycle at a single IVF centre in Victoria, Australia were invited to participate. Information was collected regarding experience and satisfaction across the domains of social, emotional, financial and alignment with fertility goals utilising a 5-point Likert Scale. Conclusion: Whilst dual stimulation protocols offer promising options for specific patient populations there remains a need to report on quality outcomes 2 .
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Curtis, Kate, Margaret Fry, Sarah Kourouche, Belinda Kennedy, Julie Considine, Hatem Alkhouri, Mary Lam, et al. "Implementation evaluation of an evidence-based emergency nursing framework (HIRAID): study protocol for a step-wedge randomised control trial." BMJ Open 13, no. 1 (January 2023): e067022. http://dx.doi.org/10.1136/bmjopen-2022-067022.
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IntroductionPoor patient assessment results in undetected clinical deterioration. Yet, there is no standardised assessment framework for >29 000 Australian emergency nurses. To reduce clinical variation and increase safety and quality of initial emergency nursing care, the evidence-based emergency nursing framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) was developed and piloted. This paper presents the rationale and protocol for a multicentre clinical trial of HIRAID.Methods and analysisUsing an effectiveness-implementation hybrid design, the study incorporates a stepped-wedge cluster randomised controlled trial of HIRAID at 31 emergency departments (EDs) in New South Wales, Victoria and Queensland. The primary outcomes are incidence of inpatient deterioration related to ED care, time to analgesia, patient satisfaction and medical satisfaction with nursing clinical handover (effectiveness). Strategies that optimise HIRAID uptake (implementation) and implementation fidelity will be determined to assess if HIRAID was implemented as intended at all sites.Ethics and disseminationEthics has been approved for NSW sites through Greater Western Human Research Ethics Committee (2020/ETH02164), and for Victoria and Queensland sites through Royal Brisbane & Woman’s Hospital Human Research Ethics Committee (2021/QRBW/80026). The final phase of the study will integrate the findings in a toolkit for national rollout. A dissemination, communications (variety of platforms) and upscaling strategy will be designed and actioned with the organisations that influence state and national level health policy and emergency nurse education, including the Australian Commission for Quality and Safety in Health Care. Scaling up of findings could be achieved by embedding HIRAID into national transition to nursing programmes, ‘business as usual’ ED training schedules and university curricula.Trial registration numberACTRN12621001456842.
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Rauw, Jennifer Marie, Sunil Parimi, Helen Anderson, Pamela Hinada, Bethina Abrahams, and Katie Hennessy. "Improving management of hypersensitivity reactions: A BC Cancer-Victoria quality improvement initiative." Journal of Clinical Oncology 39, no. 28_suppl (October 1, 2021): 230. http://dx.doi.org/10.1200/jco.2020.39.28_suppl.230.
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230 Background: Hypersensitivity reactions (HSR) are a documented, predictable side effect of multiple chemotherapy agents. Reactions negatively affect the patient experience, increase the amount of chair time, nursing and physician resources, may result in the omission of a potentially effective cancer management tool from a patient’s treatment plan and could potentially result in death. BC Cancer is a Health Care Organization with 6 cancer centres across British Columbia, Canada. Guideline(GL)s have been developed at BC Cancer to support clinicians to manage reactions acutely and reduce the risk of reactions with subsequent cycles. A recent audit identified that the GLs were not always being followed at the Victoria Centre. Our goal was to encourage physician and nursing staff to follow GLs, which we hypothesized would result in decreased rates of HSR. Methods: Our aim was to decrease HSR to < 5% of doses delivered within 1 year at BC Cancer-Victoria. We engaged stakeholders (nursing, physicians, pharmacy, clerical staff and administration). Our change ideas improved adherence to GLs by focusing on: physician attendance and documentation, written orders for rescue medication, and rate of infusion of the chemotherapy drug rechallenge. Our interventions included: two physician-education sessions, one nursing education session, daily huddles, pre-printed order development for management of the reaction (PPOA) and prophylaxis for subsequent cycles (PPOB), and a modified clinic flow. All interventions were introduced and underwent modifications through PDSA cycles. Our family of measures were: Outcome: number of reactions, percent of reactions per dose given. Process: percent of PPO use per reaction, physician attendance and notes dictated per reaction. Balancing: physician and nursing satisfaction. We analyzed the data using quality improvement run charts and control charts. Results: After the start of our initiative, our total number of reactions displayed special cause variation, and a shift in the baseline from a mean of 11.27 HSR per month to 7.526. This change was reflected in the percentage of reactions per doses given which fell from 3.1% to 1.9%. Average percentage of dictated notes per reaction increased from 55% to 64%. Physician attendance per reaction also showed special cause variation with the average increasing from 57% to 90%. PPOA and PPOB use both increased over time. Nursing and Physician satisfaction data will also be presented. Conclusions: Our successful initiative has resulted in HSR management which more closely reflects GLs, including increased physician attendance and notes, and clear consistent written orders detailed on PPO A and B. This has led to decreased HSRs at our site, resulting in decreased resource use and increased patient safety and quality. This has provincial implications as there is the potential to spread this initiative to other BC Cancer sites.
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Rauw, Jennifer Marie, Sunil Parimi, Nikita Ivanov, Jessica Noble, Eugenia Wu, Monita Sundar, Jennifer Goulart, and Celestia S. Higano. "The evolution of the education module for men with metastatic prostate cancer (mPC) in the prostate cancer supportive care (PCSC) program." Journal of Clinical Oncology 39, no. 28_suppl (October 1, 2021): 279. http://dx.doi.org/10.1200/jco.2020.39.28_suppl.279.
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279 Background: The PCSC Program was initiated in 2013 at the Vancouver Prostate Centre to provide a comprehensive program for patients and partners with prostate cancer. This program provides educational sessions (ES) and clinical services, including decision-making for primary therapy, sexual health, pelvic floor physiotherapy, hormone therapy, counseling, exercise, and nutrition for patients in BC, Canada. In 2016, the PCSC Program expanded to BC Cancer Victoria and in 2017 to other BC Cancer sites. In 2018, medical oncologists (MDs) in Victoria (JR, SP) developed an Education Module addressing treatment options for men with metastatic hormone sensitive (mHSPC) and metastatic castration resistant (mCRPC) disease. MDs delivered in-person ES in Victoria in 2018 and, in 2019, added a virtual platform (VP) option. From 3-5/2020, the ESs were on hold due to the COVID pandemic and parental leaves. In 6/2020, the ESs resumed only on VP, and the PCSC Oncology Nurse Practitioner (NP), NI, gave the presentations for the MDs on leave. In 10/2020, due to a changing standard of care for mHSPC, the PCSC team consolidated the two ESs into one. We report on the evolution of this Education Module in response to both the changing standard of care and the COVID pandemic. Methods: We prospectively collected attendance and patient characteristic metrics from all ES for men with mPC. We tracked presenter type (MD vs. NP) and prospectively collected anonymous patient satisfaction questionnaires. Results: From 1/2018 to 1/2021, 100 men registered for 27 ES; 81 men, 41 partners, and 2 family members actually attended. 48/75 (64%) men were white, 39/75 (52%) retired, and 56/75 (74.7%) married. 47 men attended 12 mHSPC ES, 13 men attended ten mCRPC ES, and 17 attended four consolidated ES. MDs presented 15 ES, and the NP presented 12 ES. Responses to questions on 70 satisfaction surveys were similar for MD vs. NP presenters. 9 responders to the recently added VP-specific questions said they agreed (4) or strongly agreed (5) that it was beneficial to watch the ES at home on a computer. The Table below shows attendance per site per year. Conclusions: The ESs for men with mPC were well-received. Although there was a VP option before COVID, attendance increased significantly after the lockdown as patients and providers became more familiar with VPs. Satisfaction surveys confirmed that an NP could deliver the ES rather than MD. Consolidation of the mHSPC and mCRPC ES reflected the changing standard of care and resulted in more efficient use of presenter time. Virtual delivery of the sessions provided greater access to those living in distant or remote areas of the province and those in lockdown during the COVID pandemic. [Table: see text]
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Dixit, Sunil K., and Murali Sambasivan. "A review of the Australian healthcare system: A policy perspective." SAGE Open Medicine 6 (January 1, 2018): 205031211876921. http://dx.doi.org/10.1177/2050312118769211.
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This article seeks to review the Australian healthcare system and compare it to similar systems in other countries to highlight the main issues and problems. A literature search for articles relating to the Australian and other developed countries’ healthcare systems was conducted by using Google and the library of Victoria University, Melbourne. Data from the websites of the Commonwealth of Australia, the Australian Institute of Health and Welfare, the Australian Productivity Commission, the Organisation for Economic Co-operation and Development and the World Bank have also been used. Although care within the Australian healthcare system is among the best in the world, there is a need to change the paradigm currently being used to measure the outcomes and allocate resources. The Australian healthcare system is potentially dealing with two main problems: (a) resource allocation, and (b) performance and patient outcomes improvements. An interdisciplinary research approach in the areas of performance measurement, quality and patient outcomes improvement could be adopted to discover new insights, by using the policy implementation error/efficiency and bureaucratic capacity. Hospital managers, executives and healthcare management practitioners could use an interdisciplinary approach to design new performance measurement models, in which financial performance, quality, healthcare and patient outcomes are blended in, for resource allocation and performance improvement. This article recommends that public policy implementation error and the bureaucratic capacity models be applied to healthcare to optimise the outcomes for the healthcare system in Australia. In addition, it highlights the need for evaluation of the current reimbursement method, freedom of choice to patients and a regular scrutiny of the appropriateness of care.
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LANTSBERG, Daniel, Yossi MIZRACHI, and Darren KATZ. "Micro-TESE Outcomes for Non-Obstructive Azoospermia — The First Australian Series." Fertility & Reproduction 04, no. 03n04 (September 2022): 140. http://dx.doi.org/10.1142/s2661318222740528.
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Background: Micro-dissection testicular sperm extraction (micro-TESE) for non-obstructive azoospermia (NOA) was shown to achieve the best sperm retrieval rate (SRR) compared to other techniques. However, to date there is no large series of published Australian data. Aim: To study the incidence and predicting factors of successful sperm extraction in men with NOA undergoing micro-TESE in Victoria. Method: We retrospectively analyzed the clinical data of all consecutive patients with confirmed NOA who were treated between August 2014 and April 2020 in a single medical centre in Melbourne, Victoria. None were excluded. Patients underwent micro-TESE and upon a successful sperm retrieval, sperm was either frozen for fertility preservation or used fresh for ICSI. Results: During the study period, 85 men with NOA underwent micro-TESE in our centre. The overall sperm retrieval rate (SRR) was 61.2% (52/85). All patients with a history of surgically treated cryptorchidism or childhood diseases had a successful sperm retrieval. Patients with Kleinfelter syndrome had a 75% SRR. Patients with Idiopathic NOA and patients with a history of chemotherapy had a 50% and 40% SRR, respectively. Among the different types of testicular pathology, the highest SRR was found in men with complete hyalinization (100%). Hypospermatogenesis was associated with a high SRR of 93.3%, while Sertoli-cell-only histology was associated with only 46.3% SRR. The SRR has significantly increased from 33.3% in 2015-2016 to 73.6% in 2019-2020 (p=0.003). On Multivariate logistic regression analysis, baseline FSH levels <20 IU and history of childhood disease or Klinefelter syndrome were significantly associated with successful sperm retrieval. The cumulative pregnancy rate was 23.7%. Conclusion: This first report from Australia indicates that micro-TESE is an effective method for the treatment of NOA with high SRR and pregnancy rate. Our results can help patient management and counseling.
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Mcbride, L. J. "Spinal Anaesthesia—Early Australian Experience." Anaesthesia and Intensive Care 33, no. 1_suppl (June 2005): 39–44. http://dx.doi.org/10.1177/0310057x0503301s06.
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Australia in 1902 was a fledgling colony in its second year of Federation with a population of around 3.7 million. European settlement had been largely confined to the coastal margins of this enormous land mass, although some bold adventurers in search of gold and farmland had struggled their way into the interior. Horsham, situated 300 km northwest of Melbourne in the state of Victoria, was founded in June 1849. By 1902 the town, with a population of around 2500, had grown to boast a hospital, two doctors, a pharmacist and a dentist. It was at the Horsham Hospital on January 7, 1902 that Dr Robert Ritchie performed Australia's first recorded spinal anaesthetic. Ritchie performed a lumbar puncture at the L3–4 level, injected 2 ml of 2% cocaine solution and waited for a total of 20 minutes before realising that the sensation the patient was feeling when he pinched him was pressure, not pain. The 78-year-old man with a gangrenous right leg, prostatic obstruction and congestive cardiac failure was laid supine, and had his right leg amputated through the thigh while being administered brandy and water. Strychnine injections were administered four hourly postoperatively. The adoption of the technique of spinal anaesthesia spread quickly in Australia despite communication difficulties at that time.
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Holloway, Edith E., Bonnie A. Sturrock, Ecosse L. Lamoureux, Jill E. Keeffe, and Gwyneth Rees. "Help seeking among vision-impaired adults referred to their GP for depressive symptoms: patient characteristics and outcomes associated with referral uptake." Australian Journal of Primary Health 21, no. 2 (2015): 169. http://dx.doi.org/10.1071/py13085.
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Adults with vision impairment commonly experience depression; however, depression often remains undetected and therefore untreated in this group. Using a prospective longitudinal design, the aim of this study was to determine the rate of uptake for a referral to a general practitioner (GP), in vision-impaired adults, who were screened for depression in low vision rehabilitation and eye-care settings. Fifty-seven vision-impaired adults (aged ≥18 years) were recruited from low vision rehabilitation centres across Australia and the Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, between June 2010 and May 2012. Participants screened positive for depressive symptoms and were referred to their GP for follow up. Telephone assessments took place at baseline, 3 and 6 months to determine uptake of a GP referral and changes in depressive symptoms over 6 months. Forty-six per cent of participants followed through with the GP referral. A desire for emotional support and stigma towards seeking support from a psychologist were significantly associated with uptake (both P < 0.05). GPs were more likely to recommend anti-depressant medication compared with a psychologist consultation (69% v. 54%) and patients themselves were more likely to take anti-depressant medication (94% v. 14% who saw a psychologist). Depressive symptoms decreased significantly over 6 months for those who followed through with a GP referral (baseline M = 10.04, s.d. = 5.76 v. 6-months M = 6.20, s.d. = 3.38; z = –2.26, P = 0.02) but not for those who did not use the GP referral (z = –1.92, P = 0.55). This method of referral to a GP following depression screening may provide an effective pathway to detect and manage depression in vision-impaired adults.
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Blackburn, Megan S., Cary Nall, Belinda Cary, and Sallie M. Cowan. "Physiotherapy-led triage clinic for low back pain." Australian Health Review 33, no. 4 (2009): 663. http://dx.doi.org/10.1071/ah090663.
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The aims of this study were to evaluate a physiotherapy-led triage clinic (PLTC) and investigate general practitioner satisfaction with the PLTC. A retrospective cohort study was undertaken from January to December 2005 at a Melbourne tertiary teaching hospital. Outcomes assessed included waiting times to first appointment, patient attendance and surgery conversion rates. Outcomes were compared with the hospital 2002 benchmark data. GP satisfaction was evaluated by a survey. One-hundred and five new patients attended the PLTC clinic during the evaluation period. Patients waited 9 weeks for a PLTC appointment compared with 26 weeks for the general orthopaedic clinic and 23 weeks for the spinal orthopaedic clinic. Sixty-seven percent of the patients triaged in the PLTC were discharged from the orthopaedic outpatient department without requiring an orthopaedic surgeon consultation. Referring GPs were at least as satisfied with the management of their patients through the PLTC as with usual management in the general orthopaedic clinic. A PLTC can significantly reduce waiting times for orthopaedic outpatient appointments in a public hospital. Many patients can be managed by these experienced physiotherapists and their GPs, without the need for face-to-face contact with an orthopaedic surgeon. Pilot results indicated that GPs whose patients are managed in this PLTC were satisfied with this model for their patients with low back conditions.
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Hunter, Barbara, Ruby Biezen, Karyn Alexander, Natalie Lumsden, Christine Hallinan, Anna Wood, Rita McMorrow, Julia Jones, Craig Nelson, and Jo-Anne Manski-Nankervis. "Future Health Today: codesign of an electronic chronic disease quality improvement tool for use in general practice using a service design approach." BMJ Open 10, no. 12 (December 2020): e040228. http://dx.doi.org/10.1136/bmjopen-2020-040228.
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ObjectiveTo codesign an electronic chronic disease quality improvement tool for use in general practice.DesignService design employing codesign strategies.SettingGeneral practice.ParticipantsSeventeen staff (general practitioners, nurses and practice managers) from general practice in metropolitan Melbourne and regional Victoria and five patients from metropolitan Melbourne.InterventionsCodesign sessions with general practice staff, using a service design approach, were conducted to explore key design criteria and functionality of the audit and feedback and clinical decision support tools. Think aloud interviews were conducted in which participants articulated their thoughts of the resulting Future Health Today (FHT) prototype as they used it. One codesign session was held with patients. Using inductive and deductive coding, content and thematic analyses explored the development of a new technological platform and factors influencing implementation of the platform.ResultsParticipants identified that the prototype needed to work within their existing workflow to facilitate automated patient recall and track patients with or at-risk of specific conditions. It needed to be simple, provide visual snapshots of information and easy access to relevant guidelines and facilitate quality improvement activities. Successful implementation may be supported by: accuracy of the algorithms in FHT and data held in the practice; the platform supporting planned and spontaneous interactions with patients; the ability to hide tools; links to Medicare Benefits Schedule; and prefilled management plans. Participating patients supported the use of the platform in general practice. They suggested that use of the platform demonstrates a high level of patient care and could increase patient confidence in health practitioners.ConclusionStudy participants worked together to design a platform that is clear, simple, accurate and useful and that sits within any given general practice setting. The resulting FHT platform is currently being piloted in general practices and will continue to be refined based on user feedback.
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Brijnath, Bianca, Nabita Singh, and Danielle Mazza. "Stakeholder perspectives on the new sickness certificate in Victoria: results from a mixed-methods qualitative study." Australian Health Review 40, no. 1 (2016): 27. http://dx.doi.org/10.1071/ah14136.
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Objective The aim of this study was to present the views of four stakeholder groups, namely general practitioners (GP), employers (EMP), injured workers (IW) and compensation agents (CA), about the content and usability of the draft of the new Victorian sickness certificate. Methods A cross-sectional mixed-methods qualitative study was conducted in GP clinics and community settings in Melbourne, Australia. Interviews were conducted with GPs, EMPs and IWs and one focus group discussion was completed with CAs (n = 29). Data were collected between October and December 2013. Thematic analysis was performed. Results All stakeholders viewed the new draft certificate as an improvement on the old one. GPs saw the certificate as a form of communication, whereas EMPs and CAs saw it as a therapeutic device. GPs continued to certify based on incapacity and provided little information about what IWs could do on return to work. All groups said that assessments for mental health needed more clarity and specificity. GPs, EMPs and CAs also said that the new certificates must be electronically available and integrated into existing medical software to streamline uptake. Conclusions To ensure appropriate use of the new certificate, stakeholders must share a common understanding about its purpose and the certificate must be incorporated into existing medical software. Content on mental health assessment, an area of continued difficulty, needs additional refinement. The new certificate replaced the old certificate in March 2015; after it has been established in clinical practice, an impact evaluation should be completed to determine whether GPs are certifying capacity and earlier return to work. What is known about the topic? When it comes to sickness certification, GPs tend to focus on what injured patients cannot do, rather than what they can do. The new sickness certificate aims to change GP behaviour by focusing the certificate more on capacity (i.e. what the injured patient can do). What does this paper add? Four stakeholder groups agreed that the content and usability of the new certificate has improved. However, they agreed that the assessment of mental health capacity needs further specificity. Dissonances also remain between the stakeholders on the purpose of the certificate. What are the implications for practitioners? Appropriate use of the new certificate requires a common understanding about the purpose of the certificate, training on its appropriate use, incorporation into existing medical software and clarity on mental health assessment.
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Voo, Veronica Tsin Fong, Jim Stankovich, Terence J. O’Brien, Helmut Butzkueven, and Mastura Monif. "Vitamin D status in an Australian patient population: a large retrospective case series focusing on factors associated with variations in serum 25(OH)D." BMJ Open 10, no. 3 (March 2020): e032567. http://dx.doi.org/10.1136/bmjopen-2019-032567.
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ObjectivesTo investigate whether sex, age, medical specialty and seasonal variations in serum concentration of 25-hydroxy vitamin D (25(OH)D) are evident among an Australian patient population.DesignRetrospective study analysing the results of serum 25(OH)D lab tests and vitamin D supplementation from Royal Melbourne Hospital (RMH) between 2014 and 2017.SettingTertiary healthcare centre in Victoria, Australia.Participants30 023 patients (inpatient and outpatient) who had their serum 25(OH)D levels measured at RMH between 2014 and 2017.Main outcome measuresSerum 25(OH)D levels stratified according to patients’ sex, age and medical specialty admitted to, as well as the season and year (2014 to 2017) 25(OH)D level was measured.ResultsMean serum 25(OH)D level of study population was 69.9 nmol/L (95% CI 69.5 to 70.2). Only 40.2% patients in this cohort were sufficient in vitamin D (>75 nmol/L). On average, 25(OH)D levels in male patients were 6.1 units (95% CI 5.4 to 6.9) lower than in females. Linear regression analysis found that 25(OH)D levels increased by 0.16 unit (95% CI 0.14 to 0.18) for every year increase in age. One-way analysis of variance showed patients from neurology had the highest average 25(OH)D level, 76.8 nmol/L (95% CI 74.2 to 79.3) compared with other medical specialties. Mean 25(OH)D level during winter, 64.9 nmol/L (95% CI 64.2 to 65.6) was significantly lower compared with other seasons despite supplementation. Average 25(OH)D level measured in 2014, 71.5 nmol/L (95 CI% 70.8 to 72.2) was significantly higher than levels measured in 2016–2017.ConclusionsThere is a sex, age, medical specialty, seasonal and yearly variation in vitamin D status in an Australian patient population. The association between low vitamin D status and winter despite supplementation suggests other interventions are required to boost serum 25(OH)D levels.
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Cullinane, Meabh, Helen L. McLachlan, Michelle S. Newton, Stefanie A. Zugna, and Della A. Forster. "Using the Kirkpatrick Model to evaluate the Maternity and Neonatal Emergencies (MANE) programme: Background and study protocol." BMJ Open 10, no. 1 (January 2020): e032873. http://dx.doi.org/10.1136/bmjopen-2019-032873.
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IntroductionOver 310 000 women gave birth in Australia in 2016, with approximately 80 000 births in the state of Victoria. While most of these births occur in metropolitan Melbourne and other large regional centres, a significant proportion of Victorian women birth in local rural health services. The Victorian state government recently mandated the provision of a maternal and neonatal emergency training programme, called Maternal and Newborn Emergencies (MANE), to rural and regional maternity service providers across the state. MANE aims to educate maternity and newborn care clinicians about recognising and responding to clinical deterioration in an effort to improve clinical outcomes. This paper describes the protocol for an evaluation of the MANE programme.Methods and analysisThis study will evaluate the effectiveness of MANE in relation to: clinician confidence, skills and knowledge; changes in teamwork and collaboration; and consumer experience and satisfaction, and will explore and describe any governance changes within the organisations after MANE implementation. The Kirkpatrick Evaluation Model will provide a framework for the evaluation. The participants of MANE, 27 rural and regional Victorian health services ranging in size from approximately 20 to 1000 births per year, will be invited to participate. Baseline data will be collected from maternity service staff and consumers at each health service before MANE delivery, and at four time-points post-MANE delivery. There will be four components to data collection: a survey of maternity services staff; follow-up interviews with Maternity Managers at health services 4 months after MANE delivery; consumer feedback from all health services collected through the Victorian Healthcare Experience Survey; case studies with five regional or rural health service providers.Ethics and disseminationThis evaluation has been approved by the La Trobe University Science, Health and Engineering College Human Ethics Sub-Committee. Findings will be presented to project stakeholders in a deidentified report, and disseminated through peer-reviewed publications and conference presentations.
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Dennett, Amy M., Katherine E. Harding, Casey L. Peiris, Nora Shields, Christian Barton, Lauren Lynch, Phillip Parente, David Lim, and Nicholas F. Taylor. "Efficacy of Group Exercise–Based Cancer Rehabilitation Delivered via Telehealth (TeleCaRe): Protocol for a Randomized Controlled Trial." JMIR Research Protocols 11, no. 7 (July 18, 2022): e38553. http://dx.doi.org/10.2196/38553.
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Background Access to rehabilitation to support cancer survivors to exercise is poor. Group exercise–based rehabilitation may be delivered remotely, but no trials have currently evaluated their efficacy. Objective We aimed to evaluate the efficacy of a group exercise–based cancer rehabilitation program delivered via telehealth compared to usual care for improving the quality of life of cancer survivors. Methods A parallel, assessor-blinded, pragmatic randomized controlled trial with embedded cost and qualitative analysis will be completed. In total, 116 cancer survivors will be recruited from a metropolitan health network in Melbourne, Victoria, Australia. The experimental group will attend an 8-week, twice-weekly, 60-minute exercise group session supervised via videoconferencing supplemented by a web-based home exercise program and information portal. The comparison group will receive usual care including standardized exercise advice and written information. Assessments will be completed at weeks 0 (baseline), 9 (post intervention), and 26 (follow-up). The primary outcome will be health-related quality of life measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire at week 9. Secondary measures include walking capacity (6-minute walk test), physical activity (activPAL accelerometer), self-efficacy (Health Action Process Approach Questionnaire), and adverse events. Health service data including hospital length of stay, hospital readmissions, and emergency department presentations will be recorded. Semistructured interviews will be completed within an interpretive description framework to explore the patient experience. The primary outcome will be analyzed using linear mixed effects models. A cost-effectiveness analysis will also be performed. Results The trial commenced in April 2022. As of June 2022, we enrolled 14 participants. Conclusions This trial will inform the future implementation of cancer rehabilitation by providing important data about efficacy, safety, cost, and patient experience. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12621001417875; https://tinyurl.com/yc5crwtr International Registered Report Identifier (IRRID) PRR1-10.2196/38553
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Fleming, Julia Ann, and Bradley David O’Connor. "Use of Lidocaine Patches for Neuropathic Pain in a Comprehensive Cancer Centre." Pain Research and Management 14, no. 5 (2009): 381–88. http://dx.doi.org/10.1155/2009/723179.
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BACKGROUND: There are few reports of the use of the lidocaine 5% patch (L5%P) for neuropathic pain (NP) in the cancer patient. Within a comprehensive cancer centre, L5%P has been prescribed by the Pain and Palliative Care Service (Peter McCallum Cancer Centre, East Melbourne, Victoria, Australia) for selected patients with NP since 2001.OBJECTIVE: To retrospectively audit the use of L5%P within a comprehensive cancer centre.METHODS: All L5%P prescriptions up to January 2009 were listed and patient medical records were searched to determine neuropathic pain syndromes treated, the presence of allodynia, previous analgesic medications, treatment duration and outcome.RESULTS: L5%P was prescribed for 97 patients, most frequently for persistent postsurgical NP (n=26), postherpetic neuralgia (n=24) and cancer-related NP (n=18). Six patients had no history of cancer and two patients never applied L5%P. Reviewers classed L5%P analgesic efficacy as ‘potent’ in 38% of patients with postherpetic neuralgia, 35% of patients with postsurgical pain, 27% of patients with NP after other treatments for cancer and 12% of patients with NP attributed to cancer alone. Allodynia featured in at least 60% of patients. Where allodynia was present, the efficacy of L5%P was assessed as ‘potent’ in 38% and ‘partial’ in 24%, but ‘ineffective’ in 26%, and ‘causing worse pain’ in 3.4% of patients. Treatment duration extended longer than one month in 52 patients, longer than two months in 29 patients and longer than one year in 13 patients. Therapy was ceased due to skin irritation in seven patients. The outcomes in relation to other reports are discussed.CONCLUSION: The present data support trials of L5%P for cancer patients with NP syndromes associated with allodynia.
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Castle, Meredith, Rowan O’Hagan, Erin Anderberg, Amanda Wangman, Helen Harrington, and Lakshmi Dhakal. "About face: regional allied health professional early adaptation during the COVID-19 pandemic." Australian Journal of Primary Health 28, no. 2 (February 15, 2022): 110–16. http://dx.doi.org/10.1071/py21150.
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The coronavirus pandemic has led to significant change in allied health practice in Australia. Measures to slow virus spread have included replacing face-to-face services with telehealth services, and hands-on practice with socially distanced intervention. In the present mixed-methods, cross-sectional study, 51 allied health professionals across two public health services in regional Victoria, Australia, completed an online questionnaire with open and closed questions. The aim was to explore their experience in adapting to directed practice change during the first wave of the pandemic. The clinicians reported low levels of clinical satisfaction due to a perceived reduction in service quality and accessibility. Directed use of telehealth significantly contributed to dissatisfaction, with challenges including infrastructure, clinician and patient digital literacy and platform suitability for some patient groups and interventions. In contrast, peer support, timely and accurate communication, decision transparency, recognition and strong leadership from management supported adaptation, as did individuals’ flexibility and learning. Our findings highlight the leadership qualities and support strategies conducive to workplace adaptation during a crisis period. They also support calls for further resource development to support skill translation for telehealth platform use and initiatives to increase digital literacy and infrastructure availability in regional Australia.
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de Gruchy, Adam, Catherine Granger, and Alexandra Gorelik. "Physical Therapists as Primary Practitioners in the Emergency Department: Six-Month Prospective Practice Analysis." Physical Therapy 95, no. 9 (September 1, 2015): 1207–16. http://dx.doi.org/10.2522/ptj.20130552.
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Background Increasing pressure on the emergency department (ED) throughout the world has meant the introduction of innovative ways of working. One such innovation is the advanced practice physical therapist (APP) acting as a primary contact practitioner. There has been little research into the role beyond identifying patient satisfaction with management, cost-effectiveness, and time efficiency. In order to give further support and assist in development of an APP service in the ED, an increased exploration of patient caseload demographics, resource utilization, and management outcomes is needed. Objectives The purpose of this study was to provide quantitative data regarding patient demographics, time efficiency, resource utilization, and management outcomes to examine the APP role in the ED. Design This was a prospective observational study of practice. Setting The study was conducted in a single ED in Melbourne, Australia. Method Data collection was conducted over a 6-month period. Patient demographics and diagnoses, assessment times, hospital resource utilization, and discharge destinations were recorded. Results One thousand seventeen patients (45% female; median age=34 years, interquartile range=25–52) were managed by the APPs; 89% had conditions triaged as not serious or life threatening, and 97% had musculoskeletal pathologies, with the most common diagnosis being fracture or dislocation. Four-hour length-of-stay targets were met in 95% of the patients. Forty-six percent of the patients seen were managed independently, without any support from medical colleagues. The most frequent discharge destination was a referral back to the primary care physician or to hospital outpatient clinics. When comparing similar diagnostic groups, the APPs were significantly more time-efficient than ED physicians in their patient management. Conclusions This study described in detail the caseload managed by the APP in the ED and identified the role as a valuable asset to an ED, managing a great deal of their caseload independently, safely, and time efficiently.
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Begley, Ryan, Yogesan Kanagasingam, Chun Chan, Chandrashan Perera, Moya Vandeleur, and Paul Paddle. "Demonstration of Accuracy and Feasibility of Remotely Delivered Oximetry: A Blinded, Controlled, Real-World Study of Regional/Rural Children with Obstructive Sleep Apnoea." Healthcare 11, no. 2 (January 16, 2023): 278. http://dx.doi.org/10.3390/healthcare11020278.
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Objectives: Evaluate diagnostic accuracy and feasibility of a mail-out home oximetry kit. Design: Patients were referred for both the tertiary/quaternary-centre hospital-delivered oximetry (HDO) and for the mail-out remotely-delivered oximetry (RDO). Quantitative and qualitative data were collected. The COVID-19 pandemic began during this study; therefore, necessary methodological adjustments were implemented. Setting: Patients were first evaluated in Swan Hill, Victoria. RDO kits were sent to home addresses. For the HDO, patients travelled to the Melbourne city area, received the kit, stayed overnight, and returned the kit the following morning. Participants: All consecutive paediatric patients (aged 2–18), diagnosed by a specialist in Swan Hill with obstructive sleep apnoea (OSA) on history/examination, and booked for tonsillectomy +/− adenoidectomy, were recruited. Main outcome measures: Diagnostic accuracy (i.e., comparison of RDO to HDO results) and test delivery time (i.e., days from consent signature to oximetry delivery) were recorded. Patient travel distances for HDO collection were calculated using home/delivery address postcodes and Google® Maps data. Qualitative data were collected with two digital follow-up surveys. Results: All 32 patients that had both the HDO and RDO had identical oximetry results. The HDO mean delivery time was 87.7 days, while the RDO mean delivery time was 23.6 days (p value: <0.001). Qualitatively, 3/28 preferred the HDO, while 25/28 preferred the RDO (n = 28). Conclusions: The remote option is as accurate as the hospital option, strongly preferred by patients, more rapidly completed, and also an ideal investigation delivery method during certain emergencies, such as the COVID-19 pandemic.
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Parker, Alexandra, Sarah Dash, Matthew Bourke, Rhiannon Patten, Melinda Craike, Peter Baldwin, Warwick Hosking, et al. "A Brief, Daily, Online Mental Health and Well-being Intervention for University Staff During the COVID-19 Pandemic: Program Description and Outcomes Using a Mixed Methods Design." JMIR Formative Research 6, no. 2 (February 25, 2022): e35776. http://dx.doi.org/10.2196/35776.
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Background The unprecedented changes and isolation measures to contain COVID-19 have had multiple psychological and social impacts, with implications for professional and personal functioning. Evidence-informed interventions that can be rapidly implemented under pandemic conditions to support mental health during such times are urgently needed. Objective The aim of this study was to determine the acceptability and preliminary outcomes of a daily online mental health promotion program for tertiary education staff during the COVID-19 pandemic. Methods The “Victoria University (VU) Elevenses” program was delivered as an uncontrolled intervention at Victoria University (VU) in the western metropolitan region of Melbourne, Australia. In April 2020, an email invitation was sent to all academic and professional staff inviting them to: (1) participate in the program and (2) opt-in to the research component. The “VU Elevenses” program provided 10-15–minute microinterventions comprising lifestyle and well-being strategies to promote mental health via an online meeting platform at 11 AM each weekday. A mixed methods approach was used to evaluate the program, combining structured questionnaires with semistructured interviews to investigate the experiences of staff who participated in the program. Results Between 16 and 90 participants provided weekly program feedback. A total of 106 university staff opted into the longitudinal research component and 10 staff participated in the interviews. Participants reported high levels of satisfaction with sessions and perceived benefits for mental health. Approximately one quarter of participants reported moderate to severe symptoms of depression, anxiety, and stress at baseline, with significant reductions in these symptoms in the first 7 weeks of the program, corresponding with easing in mandatory isolation (“lockdown”) restrictions. Symptoms of depression, anxiety, and stress all increased when lockdown measures were reintroduced, but not to the same levels as found during the initial lockdown period. Overall changes in depression and anxiety from baseline to the end of the program were explained by changes in COVID-19–related distress, whereas changes in self-compassion explained changes in stress. Conclusions We show that it is feasible and acceptable to develop and deliver a program of brief interventions in a timely manner, using a simple and accessible online platform. Although participation in the program was initially associated with reduced symptoms of depression, anxiety, and stress, participants’ mental health worsened with the reintroduction of a “lockdown” period. However, as symptoms of depression, anxiety, and stress did not return to levels observed at the start of the VU Elevenses program, participation in the uncontrolled intervention may have offered a protective benefit against the impact of the second significant lockdown period.
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Mak, Vivienne S. L., Alice Clark, Geoff March, and Andrew L. Gilbert. "The Australian pharmacist workforce: employment status, practice profile and job satisfaction." Australian Health Review 37, no. 1 (2013): 127. http://dx.doi.org/10.1071/ah12180.
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Objective. The aims were to determine Australian registered pharmacists’ current employment status, practice profile and professional satisfaction. Method. A questionnaire was mailed to all registered pharmacists (n = 7764) on the Pharmacy Boards of Victoria and South Australia’s registers; 19 were returned undeliverable. Quantitative data were entered and analysed using the Statistical Package for Social Sciences Version 17. Qualitative data were subjected to a thematic analysis. Results. 1627 (21%) pharmacists responded: 259 (16%) were registered as pharmacists but no longer worked in the pharmacy profession. A total of 1366 respondents reported still working as pharmacists. Of the 1366, 912 (67%) indicated that they spend most of their time in a clinical area; 233 (17%) spend most of their time in ‘non-clinical pharmacist work (i.e. dispensing as technical supply)’; 216 (16%) worked in other non-clinical roles and; 1053 (77%) were professionally satisfied. Conclusion. Measuring the pharmacist workforce based on registration data significantly overestimates the available clinical pharmacist workforce: 708 (44%) respondents were no longer working in the profession, were not mainly involved in clinical practice or were working in non-clinical roles. A significant re-professionalisation program is needed if pharmacists’ unique knowledge and skills are to contribute to better healthcare delivery. What is known about the topic? A well trained and sufficient workforce is an essential requirement if the objectives of Australia’s healthcare reform agenda are to be met. For the pharmacy profession, a change in practice profile of pharmacists from a product supply focus to a patient care focus is also required. Recent workforce studies have used pharmacist registration data to model the supply of pharmacists. What does this paper add? This paper reports on a survey of registered pharmacists to more closely examine the available pharmacist workforce. The insights into the current employment status and practice profile of pharmacists provide an understanding of the available clinical pharmacist workforce. What are the implications for practitioners? Previous workforce modelling may seriously overestimate the ‘available’ pharmacist workforce to meet the needs of the community as the health reform agenda rolls out. Strategies are needed to retain pharmacists within the pharmacy profession, and to attract and retain pharmacists in clinical roles.
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Hallinan, Christine M., and Kelsey L. Hegarty. "Advanced training for primary care and general practice nurses: enablers and outcomes of postgraduate education." Australian Journal of Primary Health 22, no. 2 (2016): 113. http://dx.doi.org/10.1071/py14072.
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The aims of the present study were to understand enablers to participation in postgraduate education for primary care nurses (PCNs), and to explore how postgraduate education has advanced their nursing practice. Cross-sectional questionnaires were mailed out in April 2012 to current and past students undertaking postgraduate studies in primary care nursing at The University of Melbourne, Victoria, Australia. Questionnaires were returned by 100 out of 243 nurses (response rate 41%). Ninety-one per cent (91/100) of the respondents were first registered as nurses in Australia. Fifty-seven per cent were hospital trained and 43% were university educated to attain their initial nurse qualification. The respondents reported opportunities to expand scope of practice (99%; 97/98), improve clinical practice (98%; 97/99), increase work satisfaction (93%; 91/98) and increase practice autonomy (92%; 89/97) as factors that most influenced participation in postgraduate education in primary care nursing. Major enablers for postgraduate studies were scholarship access (75%; 71/95) and access to distance education (74%; 72/98). Many respondents reported an increased scope of practice (98%; 95/97) and increased job satisfaction (71%; 70/98) as an education outcome. Only 29% (28/97) cited an increase in pay-rate as an outcome. Of the 73 PCNs currently working in general practice, many anticipated an increase in time spent on the preparation of chronic disease management plans (63%; 45/72), multidisciplinary care plans (56%; 40/72) and adult health checks (56%; 40/72) in the preceding 12 months. Recommendations emerging from findings include: (1) increased access to scholarships for nurses undertaking postgraduate education in primary care nursing is imperative; (2) alternative modes of course delivery need to be embedded in primary care nursing education; (3) the development of Australian primary care policy, including policy on funding models, needs to more accurately reflect the educational level of PCNs, PCN role expansion and the extent of interprofessional collaboration that is evident from research undertaken to date. Nurses with postgraduate education have the potential to increase their scope of practice, take on a greater teaching role and provide more preventive and chronic disease services in primary care. Policies aimed at increasing access to education for nurses working in primary care would strengthen the primary care nursing profession, and enhance the delivery of primary health care services in Australia.
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Ingram, Graham, and Mary Jane Tacchi. "Service innovation in a heated environment: CATS on a hot tin roof." Psychiatric Bulletin 28, no. 11 (November 2004): 398–400. http://dx.doi.org/10.1192/pb.28.11.398.
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Over the past few years, numerous articles have highlighted the strain on (and drain of staff from) our specialty. Many general adult psychiatrists are developing bleak views of themselves, the world and the future. Encouragingly, consultants such as Hampson (2003) are structuring their roles with some success. However, we are going through a major overhaul of the model of delivery of care and need to adapt our roles accordingly. Although tuning a Triumph Spitfire might make it run more smoothly for a while, it is still an inferior beast compared with a modern car and might be better on the scrap heap. A more radical approach is needed, which we outline in this article. One of the authors (G.I.) has experience of working as a consultant psychiatrist in Australia, where the state of Victoria changed the model of delivery of general adult psychiatric services to adopt a superior American model, leading to improved patient and carer satisfaction (Joyet al, 2001). The same model has been adopted by the UK government (Department of Health, 2001) through the creation of crisis assessment and treatment services (CATS), assertive outreach teams, and specialist community and in-patient services. Consultant psychiatrists are challenged to adapt their practice accordingly. The Royal College of Psychiatrists has recently set up a Working Group to address this issue (Royal College of Psychiatrists, 2004).
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Crabtree, Nathan, Shirley Mo, Leon Ong, Thuvarahan Jegathees, Daniel Wei, David Fahey, and Jia (Jenny) Liu. "Retrospective Analysis of Patient Presentations at the Sydney (Australia) Royal Easter Show from 2012 to 2014." Prehospital and Disaster Medicine 32, no. 2 (January 31, 2017): 187–94. http://dx.doi.org/10.1017/s1049023x16001540.
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AbstractIntroductionComprehensive studies on the relationship between patient demographics and subsequent treatment and disposition at a single mass-gathering event are lacking. The Sydney Royal Easter Show (SRES; Sydney Olympic Park, New South Wales, Australia) is an annual, 14-day, agricultural mass-gathering event occurring around the Easter weekend, attracting more than 800,000 patrons per year. In this study, patient records from the SRES were analyzed to examine relationships between weather, crowd size, day of week, and demographics on treatment and disposition. This information would help to predict factors affecting patient treatment and disposition to guide ongoing training of first responders and to evaluate the appropriateness of staffing skills mix at future events.HypothesisPatient demographics, environmental factors, and attendance would influence the nature and severity of presentations at the SRES, which would influence staffing requirements.MethodsA retrospective analysis of 4,141 patient record forms was performed for patients who presented to St John Ambulance (Australian Capital Territory, Australia) at the SRES between 2012 and 2014 inclusive. Presentation type was classified using a previously published minimum data set. Data on weather and crowd size were obtained from the Australian Bureau of Meteorology (Melbourne, Victoria, Australia) and the SRES, respectively. Statistical analyses were performed using SPSS v22 (IBM; Armonk, New York USA).ResultsBetween 2012 to 2014, over 2.5 million people attended the SRES with 4,141 patients treated onsite. As expected, the majority of presentations were injuries (49%) and illnesses (46%). Although patient demographics and presentation types did not change over time, the duration of treatment increased. A higher proportion of patients were discharged to hospital or home compared to the proportion of patients discharged back to the event. Patients from rural/regional locations (accounting for 15% of all patients) were more likely to require advanced treatment, health professional review, and were more likely to be discharged to hospital or home rather than discharged back to the event. Extremes of temperature were associated with a lower crowd size and higher patient presentation rate (PPR), but had no impact on transfer or referral rates to hospital.ConclusionThis study demonstrated that analyses of patient presentations at an agricultural show provide unique insights on weather, attendance, and demographic features that correlated with treatment and disposition. These data can help guide organizers with information on how to better staff and train health care providers at future mass-gathering events of this type.CrabtreeN,MoS,OngL,JegatheesT,WeiD,FaheyD,LiuJ.Retrospective analysis of patient presentations at the Sydney (Australia) Royal Easter Show from 2012 to 2014.Prehosp Disaster Med.2017;32(2)187–194.
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James, Christopher, Carmel Delzoppo, James Tibballs, Siva Namachivayam, and Warwick Butt. "Adverse Events Sustained by Children in The Intensive Care Unit: Guiding local quality improvement." Asia Pacific Journal of Health Management 13, no. 3 (December 16, 2018): i20. http://dx.doi.org/10.24083/apjhm.v13i3.113.
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Objective: To determine the frequency, nature and consequence of adverse events sustained by children admitted to a combined general and cardiac paediatric intensive care unit (PICU).
Design: Retrospective analysis of data collected between January 1st 2008 and December 31st 2017 from PICU.
Setting: The Royal Children’s Hospital, a paediatric tertiary referral centre in Melbourne, Victoria, Australia. The PICU has thirty beds.
Results: During the study period, PICU received 15208 admissions, of which 73% sustained at least one adverse event with a frequency of 67 adverse events per 100 PICU-days and 3 per admission. One adverse event was sustained for every 35 hours of care. The risk of an adverse event was highest in children less than a month of age, or if mechanically ventilated, a high Pediatric Index of Mortality (PIM2) score, longer PICU length of stay, had a pre-existing disability or a high risk adjustment for congenital heart surgery (RACHS) score. Those patients who sustained an adverse event, as compared to those who did not, were mechanically ventilated for longer (80 hrs Vs. 7 hrs, p=<0.001), had a longer PICU length of stay (131 hrs Vs. 35 hrs, p=<0.001), had a longer hospital length of stay (484 hrs Vs. 206 hrs, p=<0.001) and had a higher mortality rate (3% vs. 0.1%, p=<0.001).
Conclusion: Whilst admission to PICU is an essential aspect of care for many patients, the risk of adverse events is high and is associated with significant clinical consequences. Monitoring of adverse events as part of quality improvement enables targeted intervention to improve patient safety.
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Collins, Anna, Sue-Anne McLachlan, and Jennifer Philip. "Initial perceptions of palliative care: An exploratory qualitative study of patients with advanced cancer and their family caregivers." Palliative Medicine 31, no. 9 (April 3, 2017): 825–32. http://dx.doi.org/10.1177/0269216317696420.
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Background: Despite evidence for early integration of palliative care for people with advanced cancer and their families, patterns of late engagement continue. Prior research has focused on health professionals’ attitudes to palliative care with few studies exploring the views of patients and their carers. Aim: To explore initial perceptions of palliative care when this is first raised with patients with advanced cancer and their families in Australian settings. Design: Cross-sectional, prospective, exploratory qualitative design, involving narrative-style interviews and underpinned by an interpretative phenomenological framework. Setting/participants: Purposively sampled, English-speaking, adult patients with advanced cancer ( n = 30) and their nominated family caregivers ( n = 25) recruited from cancer services at a tertiary metropolitan hospital in Melbourne, Victoria, Australia. Results: Three major themes evolved which represent the common initial perceptions of palliative care held by patients with advanced cancer and their carers when this concept is first raised: (1) diminished care, (2) diminished possibility and (3) diminished choice. Palliative care was negatively associated with a system of diminished care which is seen as a ‘lesser’ treatment alternative, diminished possibilities for hope and achievement of ambitions previously centred upon cure and diminished choices for the circumstances of one’s care given all other options have expired. Conclusion: While there is an increasing move towards early integration of palliative care, this study suggests that patient and caregiver understandings have not equally progressed. A targeted public health campaign is warranted to disentangle understandings of palliative care as the ‘institutional death’ and to reframe community rhetoric surrounding palliative care from that of disempowered dying to messages of choice, accomplishment and possibility.
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Ryland, Georgina L., Lucy C. Fox, Ella Thompson, Graham John Lieschke, David Hughes, Francoise Marie Mechinaud, Anthea Louise Greenway, et al. "Providing Diagnoses in Bone Marrow Failure Syndromes through Multimodal Comprehensive Genomic Evaluation and Multidisciplinary Care: The Melbourne Genomics Health Alliance Bone Marrow Failure Flagship." Blood 132, Supplement 1 (November 29, 2018): 3867. http://dx.doi.org/10.1182/blood-2018-99-114410.
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Abstract Background and Aims The detection of sequence variants and copy number changes can improve diagnosis, inform prognosis and guide treatment in patients with bone marrow failure syndromes (BMFS). We aimed to establish and prospectively assess the impact of comprehensive genomic evaluation on diagnostic categorisation and clinical outcomes in patients with genomically uncharacterised BMFS. Methods Eligible patients were recruited from four participating institutions across Victoria, Australia. Inclusion criteria were (i) age >3 months (ii) clinicopathological diagnosis or suspicion of either acquired aplastic anaemia (AA), inherited BMFS, hypoplastic myelodysplastic syndrome (hMDS) or a BMFS with marrow hypoplasia/aplasia not able to be definitively categorised. Patients initially underwent 90-gene targeted sequencing (Peter MacCallum Cancer Centre PanHaem and Myeloid Amplicon next generation sequencing [NGS] panels) for rapid turnaround of accredited results for clinical decision-making. In addition, whole exome sequencing (WES), whole genome copy number analysis, NGS T-cell receptor β (TRB) repertoire assessment and longitudinal monitoring of selected mutations by digital droplet PCR (ddPCR) were performed. All patients received pre-test counselling and assessment. Genomic results were reviewed in centralised multidisciplinary case conferences including the treating clinician, molecular haematopathologists, medical scientists, clinical geneticists and genetic counsellors. Results 100 patients were enrolled. Median age was 25 years (range 3 months - 80 years); 39% were under 18 years. Detection of sequence variants or copy number abnormalities led to or confirmed a diagnosis of either an inherited or acquired BMFS in 36 patients. In 17 patients a diagnosis of an inherited BMFS was positively made by detection of pathogenic sequence variants or copy number changes in FANCA(1 patient [pt]), FANCM(1 pt), FANCI(1 pt), RAD51C(1 pt), HAX1(1 pt), SBDS(1 pt), DNAJC21(1 pt), RPS19(5 pts), RPL35A(1 pt), TERT(1 pt), TINF2(1 pt) and SAMD9L(1 pt). In five patients the clinical BMFS was considered undifferentiated without a clear candidate gene suspected on phenotypic features prior to genomic evaluation. Importantly, an established diagnosis of AA was altered to an inherited BMFS by genomic characterisation in two patients (SAMD9L, FANCA). In 19 patients pathogenic sequence variants or copy number changes were detected either leading to or confirming a diagnosis of an acquired BMFS (paroxysmal nocturnal haemoglobinuria, hMDS or AA). Pathogenic sequence variants were detected in TET2(n=5), RUNX1(n=4), ASXL1(n=3), PIGA(n=3), DNMT3A(n=3),CBL(n=2), and BCOR/IDH2/SF3B1/SRSF2/TP53/U2AF1(n=1 each). Sequencing-detected copy number abnormalities included loss of chromosome 7 (n=6), losses on chromosome 5q (n=2) and copy number loss of ETV6(n=2). Longitudinal monitoring of an acquired truncating RUNX1 mutation by ddPCR resulted in one patient undergoing allogeneic bone marrow transplant for a progressively rising allelic burden. There was a trend towards more restricted TRB diversity in patients with genomically-defined acquired BMFS versus inherited BMFS (normalised Shannon index ≤0.85, 36.4% vs 0%, p=0.09). Conclusion We have established and evaluated a model of comprehensive multimodal genomic characterisation and multidisciplinary care for 100 patients with BMFS. Our results demonstrate a significant contribution to diagnostic categorisation and patient care in this area of clinical need. Disclosures Lieschke: CSL Behring Australia: Consultancy. Tam:Janssen: Honoraria, Research Funding; Gilead: Honoraria; AbbVie: Honoraria, Research Funding; Pharmacyclics: Honoraria, Travel funding; Pharmacyclics: Honoraria; Beigene: Honoraria, Other: Travel funding; Roche: Honoraria; Beigene: Honoraria, Other: Travel funding; Gilead: Honoraria; Roche: Honoraria; AbbVie: Honoraria, Research Funding.
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Goller, Jane L., Jacqueline Coombe, Meredith Temple-Smith, Helen Bittleston, Lena Sanci, Rebecca Guy, Christopher Fairley, et al. "Management of Chlamydia Cases in Australia (MoCCA): protocol for a non-randomised implementation and feasibility trial." BMJ Open 12, no. 12 (December 2022): e067488. http://dx.doi.org/10.1136/bmjopen-2022-067488.
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IntroductionThe sexually transmitted infection chlamydia can cause significant complications, particularly among people with female reproductive organs. Optimal management includes timely and appropriate treatment, notifying and treating sexual partners, timely retesting for reinfection and detecting complications including pelvic inflammatory disease (PID). In Australia, mainstream primary care (general practice) is where most chlamydia infections are diagnosed, making it a key setting for optimising chlamydia management. High reinfection and low retesting rates suggest partner notification and retesting are not uniformly provided. The Management of Chlamydia Cases in Australia (MoCCA) study seeks to address gaps in chlamydia management in Australian general practice through implementing interventions shown to improve chlamydia management in specialist services. MoCCA will focus on improving retesting, partner management (including patient-delivered partner therapy) and PID diagnosis.Methods and analysisMoCCA is a non-randomised implementation and feasibility trial aiming to determine how best to implement interventions to support general practice in delivering best practice chlamydia management. Our method is guided by the Consolidated Framework for Implementation Research and the Normalisation Process Theory. MoCCA interventions include a website, flow charts, fact sheets, mailed specimen kits and autofills to streamline chlamydia consultation documentation. We aim to recruit 20 general practices across three Australian states (Victoria, New South Wales, Queensland) through which we will implement the interventions over 12–18 months. Mixed methods involving qualitative and quantitative data collection and analyses (observation, interviews, surveys) from staff and patients will be undertaken to explore our intervention implementation, acceptability and uptake. Deidentified general practice and laboratory data will be used to measure pre-post chlamydia testing, retesting, reinfection and PID rates, and to estimate MoCCA intervention costs. Our findings will guide scale-up plans for Australian general practice.Ethics and disseminationEthics approval was obtained from The University of Melbourne Human Research Ethics Committee (Ethics ID: 22665). Findings will be disseminated via conference presentations, peer-reviewed publications and study reports.
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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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Hough, Peter, Stephanie Gleeson, Nataliya Shkuratova, Freya Coker, and Cylie Williams. "Introducing a clinically effective allied health rapid discharge team within a complex aged subacute in-patient cohort on a cost recovery basis: the Supported Patient centred Early Discharge (SPeED) initiative." Australian Health Review 44, no. 6 (2020): 931. http://dx.doi.org/10.1071/ah19137.
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This case study reports the outcomes of an early supported discharge program. This model of care was trialled after Victoria introduced subacute weighted inlier equivalent separations funding to subacute in-patients in 2016. An allied health team (Supported Patient centred Early Discharge (SPeED)) managed patients suitable for assessment, intervention and early supported discharge (ESD). The SPeED cohort was compared to a matched historical control. Data included no advantage financially (NAF) days, length of stay (LOS), functional independence measure (FIM) scores and 30-day readmission rates. Staff and patient experiences were collected through surveys and call-back data. Regression analysis compared quantitative data, whereas a broad thematic approach compared qualitative data. There were no differences between the study cohort and historical control in age or sex (P>0.05). The SPeED cohort had lower median NAF days (F=−21.38; 95% confidence interval (CI) −37.70, −15.00; P<0.001), shorter LOS (F)=4.65; 95% CI −0.41, −0.02; P=0.034), fewer readmissions within 30 days (odds ratio 0.14; 95% CI −0.03, 0.68; P=0.014) and greater change in FIM scores during admission (F=4.20; 95% CI 0.16, 10.74; P=0.044). Staff morale was high in recognition of improved patient care. Patient satisfaction remained positive across the SPeED cohort and historical control group. The introduction of a dedicated allied health ESD team within a geriatric evaluation and management population is effective and enhances patient outcomes. What is known about the topic?Changing public subacute in-patient funding models places increased demand on providers to attain shorter patient LOS with finite staffing resources. Current published literature confirms the efficacy of rapid discharge programs in complex older adult cohorts only in the areas of stroke and respiratory conditions. What does this paper add?For clinicians and health service executives, this paper explores the potential to extend rapid discharge programs for complex older adult patients across a broad cohort of conditions through the introduction of a dedicated allied health rapid discharge team. It presents an intervention that seeks to balance patient-centred care with optimal funding and organisational outcomes. What are the implications for practitioners?The study findings highlight a promising opportunity for dedicated allied health rapid discharge teams within complex older adult in-patient populations to both optimise early patient preferred discharge and improve organisational financial performance.