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Journal articles on the topic 'Victorian Public Hospitals'

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Published: 10 December 2022

Last updated: 19 February 2023

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1

Sundararajan, Vijaya, Kaye Brown, Toni Henderson, and Don Hindle. "Effects of increased private health insurance on hospital utilisation in Victoria." Australian Health Review 28, no. 3 (2004): 320. http://dx.doi.org/10.1071/ah040320.

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The proportion of Victorians and Australians generally with private health insurance (PHI) increased from 31% in 1998 to 45% in 2001. We analysed a dataset containing all hospital separations throughout Victoria to determine whether changes in the level of private health insurance have had any impact on patterns of public and private hospital utilisation in Victoria. Total utilisation of private hospitals grew by 31% from 1998?99 to 2002?03, whereas utilisation of public hospitals increased by 18%. Total bed-days have increased in both private hospitals and public hospitals by 12%. The proportion of all separations at private hospitals has remained relatively stable between these 2 years, with 33% of all separations being private patients in private hospitals in 1998? 99, increasing slightly to 35% by 2002?03. Analysis of a number of specific DRGs shows that patients with more severe disease are more likely to be seen at public hospitals; notably this trend has strengthened between 1998?99 and 2002?03. The number of patients treated in Victorian public hospitals has continued to grow, despite a rapid increase in the utilisation of private hospitals. Given the limited extent of the shift in caseload share between the two sectors, the effectiveness of the Commonwealth?s subsidy of private health insurance as a mechanism to reduce pressure on the public sector needs to be carefully examined.

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2

Braithwaite, Jeffrey. "Victorian public hospitals: taking a sledgehammer … ?" Medical Journal of Australia 160, no. 3 (February 1994): 136–39. http://dx.doi.org/10.5694/j.1326-5377.1994.tb126560.x.

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3

Stanton, Pauline. "Employment relationships in Victorian public hospitals: the Kennett years." Australian Health Review 23, no. 3 (2000): 193. http://dx.doi.org/10.1071/ah000193a.

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From 1992 to 1999, the Kennett government in Victoria moved to competitive market models of service delivery andthe measurement of service provision through casemix funding. Public hospital managers were given greateraccountability for the costs and provision of service delivery and a new range of service providers, many from theprivate sector, entered the public health market. The decentralisation of the industrial relations system led to newdevelopments in bargaining that brought both opportunities and problems. In the Victorian public health system therewas an increasing emphasis on decentralisation in both service provision and employment relations. In this paper Isuggest that there were contradictions in these developments for government, and new challenges and difficulties foremployers, employees and trade unions.

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4

Sharwood, Penny, and Bernadette O'Connell. "Assessing the relationship between inpatient and outpatient activity:a clinical specialty analysis." Australian Health Review 23, no. 3 (2000): 137. http://dx.doi.org/10.1071/ah000137a.

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General and specialist services in public acute hospital outpatient departments play a key role in the health care systemand represent a vital interface between inpatient and community care. Typically outpatient services involve millionsof patient visits within a very short time frame and in Victoria alone between 8-10 million outpatient occasions ofservice are provided each year. Drawing on the first full year of data from the Victorian Ambulatory ClassificationSystem (VACS) this paper examines the patterns underlying the distribution of inpatient separations and outpatientencounters at 16 major Victorian public hospitals and assesses the relationship between inpatient and outpatientactivity at the clinical specialty level.

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5

Rezaei-Darzi, Ehsan, Janneke Berecki-Gisolf, and Dasamal Tharanga Fernando. "How representative is the Victorian Emergency Minimum Dataset (VEMD) for population-based injury surveillance in Victoria? A retrospective observational study of administrative healthcare data." BMJ Open 12, no. 12 (December 2022): e063115. http://dx.doi.org/10.1136/bmjopen-2022-063115.

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ObjectiveThe Victorian Emergency Minimum Dataset (VEMD) is a key data resource for injury surveillance. The VEMD collects emergency department data from 39 public hospitals across Victoria; however, rural emergency care services are not well captured. The aim of this study is to determine the representativeness of the VEMD for injury surveillance.DesignA retrospective observational study of administrative healthcare data.Setting and participantsInjury admissions in 2014/2015–2018/2019 were extracted from the Victorian Admitted Episodes Dataset (VAED) which captures all Victorian hospital admissions; only cases that arrived through a hospital’s emergency department (ED) were included. Each admission was categorised as taking place in a VEMD-contributing versus a non-VEMD hospital.ResultsThere were 535 477 incident injury admissions in the study period, of which 517 207 (96.6%) were admitted to a VEMD contributing hospital. Male gender (OR 1.13 (95% CI 1.10 to 1.17)) and young age (age 0–14 vs 45–54 years, OR 4.68 (95% CI 3.52 to 6.21)) were associated with VEMD participating (vs non-VEMD-participating) hospitals. Residing in regional/rural areas was negatively associated with VEMD participating (vs non-VEMD participating) hospitals (OR=0.11 (95% CI 0.10 to 0.11)). Intentional injury (assault and self-harm) was also associated with VEMD participation.ConclusionsVEMD representativeness is largely consistent across the whole of Victoria, but varies vastly by region, with substantial under-representation of some areas of Victoria. By comparison, for injury surveillance, regional rates are more reliable when based on the VAED. For local ED-presentation rates, the bias analysis results can be used to create weights, as a temporary solution until rural emergency services injury data is systematically collected and included in state-wide injury surveillance databases.

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6

Dooley, Michael. "Recommendations for warfarin in Victorian public hospitals." Australian Prescriber 26, no. 2 (April 1, 2003): 27–29. http://dx.doi.org/10.18773/austprescr.2003.023.

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7

Hanning, Brian W. T. "Impact on public hospitals if private health insurance rates in Victoria declined." Australian Health Review 28, no. 3 (2004): 330. http://dx.doi.org/10.1071/ah040330.

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The additional cost of treating acute care type Victorian private patients as public patients in Victorian public hospitals based on the current public sector payment model and rates was calculated, as was the loss of health fund income to public hospitals. If all private cases became public the net recurrent cost would be $1.05 billion assuming all patients were still treated. If private health insurance (PHI) uptake had declined to 23.3% as was projected without Lifetime Health Cover and the 30% rebate, the additional operating cost and income loss would be $385 million. This compares to the Victorian cost of the 30% rebate for acute hospital cases of $383 million. This takes no account of capital costs and possible public sector access problems. The analysis suggests that 31 extra operating theatres would be needed in the public sector (had the transfer of surgical patients from the public sector to the private sector not occurred). This analysis suggests that without the PHI rebate the current stresses on Victorian public hospitals would be increased, not decreased.

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8

Antioch, Kathryn M., Michael K. Walsh, David Anderson, and Richard Brice. "Forecasting hospital expenditure in Victoria: Lessons from Europe and Canada." Australian Health Review 22, no. 1 (1999): 133. http://dx.doi.org/10.1071/ah990133.

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This paper specifies an econometric model to forecast State government expenditure on recognised public hospitals in Victoria. The OECD's recent cross-country econometric work exploring factors affecting health spending was instructive. The model found that Victorian Gross State Product, population aged under 4 years, the mix of public and private patients in public hospitals, introduction of case mix funding and funding cuts, the proportion of public beds to total beds in Victoria and technology significantly impacted on expenditure. The model may have application internationally for forecasting health costs, particularly in short and medium-term budgetary cycles.

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9

Ackland, Michael J., D. J. Jolley, and M. Z. Ansari. "Postoperative complications of cholecystectomy in Victorian public hospitals." Australian and New Zealand Journal of Public Health 20, no. 6 (December 1996): 583–88. http://dx.doi.org/10.1111/j.1467-842x.1996.tb01070.x.

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10

Ansari, M. Z., A. J. Costello, D. J. Jolley, M. J. Ackland, N. Carson, and I. G. Mc donald. "ADVERSE EVENTS AFTER PROSTATECTOMY IN VICTORIAN PUBLIC HOSPITALS." ANZ Journal of Surgery 68, no. 12 (December 1998): 830–36. http://dx.doi.org/10.1111/j.1445-2197.1998.tb04697.x.

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11

Shih, S., R. Carter, S. Heward, and C. Sinclair. "Costs Related to Skin Cancer Prevention in Victoria and Australia." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 9s. http://dx.doi.org/10.1200/jgo.18.10800.

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Background: The aim of this presentation is to provide an update on the economic evaluation of the Australian SunSmart program as well as outline the cost of skin cancer treatment to the Victorian public hospital system. This follows the publication of two recently released published economic evaluations that discusses the potential effects of skin cancer prevention inventions. Aim: 1. To highlight the cost effectiveness of skin cancer prevention in Australia 2. To highlight the costs of skin cancer treatment in the Victorian public hospital system 3. To provide strong evidence to inform governments of the value of skin cancer prevention to reduce the costs of treatment in future years. Methods: Program cost was compared with cost savings to determine the investment return of the program. In a separate study, a prevalence-based cost approach was undertaken in public hospitals in Victoria. Costs were estimated for inpatient admissions, using state service statistics, and outpatient services based on attendance at three hospitals in 2012-13. Cost-effectiveness for prevention was estimated from 'observed vs expected' analysis, together with program expenditure data. Results: With additional $AUD 0.16 ($USD 0.12) per capita investment into skin cancer prevention across Australia from 2011 to 2030, an upgraded SunSmart Program would prevent 45,000 melanoma and 95,000 NMSC cases. Potential savings in future healthcare costs were estimated at $200 million, while productivity gains were significant. A future upgraded SunSmart Program was predicted to be cost-saving from the funder perspective, with an investment return of $3.20 for every additional dollar the Australian governments/funding bodies invested into the program. In relation to the costs to the Victorian public hospital system, total annual costs were $48 million to $56 million. Skin cancer treatment in public hospitals ($9.20∼$10.39 per head/year) was 30-times current public funding in skin cancer prevention ($0.37 per head/year). Conclusion: The study demonstrates the strong economic credentials of the SunSmart Program, with a strong economic rationale for increased investment. Increased funding for skin cancer prevention must be kept high on the public health agenda. This would also have the dual benefit of enabling hospitals to redirect resources to nonpreventable conditions.

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12

Lee, Peter, Angela L. Brennan, Dion Stub, Diem T. Dinh, Jeffrey Lefkovits, Christopher M. Reid, Ella Zomer, and Danny Liew. "Estimating the economic impacts of percutaneous coronary intervention in Australia: a registry-based cost burden study." BMJ Open 11, no. 12 (December 2021): e053305. http://dx.doi.org/10.1136/bmjopen-2021-053305.

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ObjectivesIn this study, we sought to evaluate the costs of percutaneous coronary intervention (PCI) across a variety of indications in Victoria, Australia, using a direct per-person approach, as well as to identify key cost drivers.DesignA cost-burden study of PCI in Victoria was conducted from the Australian healthcare system perspective.SettingA linked dataset of patients admitted to public hospitals for PCI in Victoria was drawn from the Victorian Cardiac Outcomes Registry (VCOR) and the Victorian Admitted Episodes Dataset. Generalised linear regression modelling was used to evaluate key cost drivers. From 2014 to 2017, 20 345 consecutive PCIs undertaken in Victorian public hospitals were captured in VCOR.Primary outcome measuresDirect healthcare costs attributed to PCI, estimated using a casemix funding method.ResultsKey cost drivers identified in the cost model included procedural complexity, patient length of stay and vascular access site. Although the total procedural cost increased from $A55 569 740 in 2014 to $A72 179 656 in 2017, mean procedural costs remained stable over time ($A12 521 in 2014 to $A12 185 in 2017) after adjustment for confounding factors. Mean procedural costs were also stable across patient indications for PCI ($A9872 for unstable angina to $A15 930 for ST-elevation myocardial infarction) after adjustment for confounding factors.ConclusionsThe overall cost burden attributed to PCIs in Victoria is rising over time. However, despite increasing procedural complexity, mean procedural costs remained stable over time which may be, in part, attributed to changes in clinical practice.

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13

Yan, Bryan P., Andrew E. Ajani, Stephen J. Duffy, Gishel New, Mark Horrigan, Gregory Szto, Antony Walton, et al. "Use of drug‐eluting stents in Victorian public hospitals." Medical Journal of Australia 185, no. 7 (October 2006): 363–67. http://dx.doi.org/10.5694/j.1326-5377.2006.tb00611.x.

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14

Tatchell, P. Michael. "RISING WAGE COSTS IN VICTORIAN HOSPITALS." Community Health Studies 3, no. 3 (February 12, 2010): 152–62. http://dx.doi.org/10.1111/j.1753-6405.1979.tb00249.x.

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15

Duckett, Stephen, and Amanda Kenny. "Hospital outpatient and emergencyservices in rural Victoria." Australian Health Review 23, no. 4 (2000): 115. http://dx.doi.org/10.1071/ah000115.

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Outpatient and emergency services in rural hospitals have rarely been studied. This paper analyses routinely collecteddata, together with data from a survey of hospitals, to provide a picture of these services in Victorian public hospitals.The larger rural hospitals provide the bulk of rural outpatients and emergency services, particularly so for medicaloutpatients. Cost per service varies with the size of the hospital, possibly reflecting differences in complexity. Fundingpolicies for rural hospital outpatient and emergency services should be sufficiently flexible to take into account thedifferences between rural hospitals.

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16

Ansari, M. Z., B. T. Collopy, W. G. Hart, N. J. Carson, and E. J. Chandraraj. "IN-HOSPITAL MORTALITY AND ASSOCIATED COMPLICATIONS AFTER BOWEL SURGERY IN VICTORIAN PUBLIC HOSPITALS." ANZ Journal of Surgery 70, no. 1 (January 2000): 6–10. http://dx.doi.org/10.1046/j.1440-1622.2000.01733.x.

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17

Ansari, M. Z., A. J. Costello, M. J. Ackland, N. Carson, and I. G. Mcdonald. "IN-HOSPITAL MORTALITY AFTER TRANSURETHRAL RESECTION OF THE PROSTATE IN VICTORIAN PUBLIC HOSPITALS." ANZ Journal of Surgery 70, no. 3 (March 11, 2000): 204–8. http://dx.doi.org/10.1046/j.1440-1622.2000.01787.x.

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18

Powers, Neil, Vijaya Sandararajan, Steve Gillett, and Ric Marshall. "The Effect of Increased Private Health Insurance Coverage on Victorian Public Hospitals." Australian Health Review 26, no. 2 (2003): 6. http://dx.doi.org/10.1071/ah030006.

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It was anticipated that the recent reforms to private health insurance arrangements would reduce the demand pressureson Australian public hospitals. However, this has not been demonstrated by trends in elective surgery waiting lists inVictorian public hospitals. Moreover, it appears that the increased caseload assumed by Victorian private hospitals sincethe reforms took effect mainly reflects an increase in low cost same day episodes.

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19

Jangwal, H., H. Parker, B. Barger, K. Smith, G. Toogood, K. Soon, Y. Malaiapan, et al. "Pre-Hospital Notification Trial for Primary PCI: A Collaboration between the Victorian Cardiac Clinical Network (Department of Health), Ambulance Victoria and Participating Victorian Public Hospitals." Heart, Lung and Circulation 21 (January 2012): S168—S169. http://dx.doi.org/10.1016/j.hlc.2012.05.419.

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20

Bull, Ann L., Noleen Bennett, Helen C. Pitcher, Philip L. Russo, and Michael J. Richards. "Influenza vaccine coverage among health care workers in Victorian public hospitals." Medical Journal of Australia 186, no. 4 (February 2007): 185–86. http://dx.doi.org/10.5694/j.1326-5377.2007.tb00858.x.

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21

Ramsay, Rosalind. "Psychiatrists and the public." Psychiatric Bulletin 15, no. 12 (December 1991): 795. http://dx.doi.org/10.1192/pb.15.12.795.

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One hundred and fifty years on, how, Professor Clare asked an invited audience of eminent non-psychiatrists at the Royal Society of Medicine, do we fare? Is there really a more positive attitude to mental illness, now than in the nineteenth century, or even the 1960s? The Victorian public image of madness was characterised by ignorance, intolerance and fear and the mentally ill regarded as less than human, available to be exploited or used to entertain; and also, dangerous and incurable, best put away in large mental hospitals or ‘bins’. The media colluded in maintaining such attitudes: a leader in The Times in 1900, commenting on the 30-fold increase in the mental hospital population, was anxious that soon the mad might outnumber the sane!

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22

Clay, Fiona J., and Joan Ozanne-Smith. "Private hospital insurance status among a state-wide injured population." Australian Health Review 30, no. 2 (2006): 252. http://dx.doi.org/10.1071/ah060252.

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Injury is a leading cause of inpatient hospital episodes. Over a 4-year period (1997?2000) the Australian Government introduced measures to support the private health insurance industry by providing incentives for people to take up private health insurance (PHI) in order to take the pressure off public hospitals. This study examined the levels of PHI for moderately and severely injured people in Victoria as a way of determining the effectiveness of government incentives. The method involved an analysis of all Victorian public and private hospital injury admissions between July 2000 and June 2003. We found that people with injuries, either unintentional or intentional, had lower levels of PHI than state norms. While numbers of injured patients occupying private hospital beds initially increased, levels then dropped below the levels before the introduction of the incentives. The burden of injury is substantial and suggests that incentives need to be targeted towards at-risk groups.

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BEAVES, Mark, Valerie JENKINS, and Euan M. WALLACE. "A survey of intrapartum fetal surveillance education practices in Victorian public hospitals." Australian and New Zealand Journal of Obstetrics and Gynaecology 47, no. 2 (April 2007): 95–100. http://dx.doi.org/10.1111/j.1479-828x.2007.00688.x.

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24

Standen, Pat, and Stuart J. Dilley. "A review of triage nursing practice and experience in Victorian public hospitals." Emergency Medicine 9, no. 4 (August 26, 2009): 301–5. http://dx.doi.org/10.1111/j.1442-2026.1997.tb00459.x.

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25

Walker, Christine. "Funding Melbourne?s hospitals:Some historical moments." Australian Health Review 21, no. 1 (1998): 29. http://dx.doi.org/10.1071/ah980029.

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In 1993 the Victorian Government introduced casemix funding as part of itsrestructure of the public hospital system. Casemix funding provides a new basis forgovernment funding according to outcomes. At the same time, restructure of hospitalsallows for a reconsideration of who is eligible to use them. Historical research intothe growth of the public hospital system in Melbourne shows that attempts to reformthe hospital system are as old as the system itself. This paper argues that the views ofhospitals in funding crises and the solutions that are recommended have more to dowith the politics of the day than the economics of running hospitals.

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Reiger, Kerreen M., and Karen L. Lane. "Working together: collaboration between midwives and doctors in public hospitals." Australian Health Review 33, no. 2 (2009): 315. http://dx.doi.org/10.1071/ah090315.

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While collaborative, multidisciplinary teamwork is widely espoused as the goal of contemporary hospitals, it is hard to achieve. In maternity care especially, professional rivalries and deep-seated philosophical differences over childbirth generate significant tensions. This article draws on qualitative research in several Victorian public maternity units to consider the challenges to inter-professional collaboration. It reports what doctors and midwives looked for in colleagues they liked to work with ? the attributes of a ?good doctor? or a ?good midwife?. Although their ideals did not entirely match, both groups respected skill and hard work and sought mutual trust, respect and accountability. Yet effective working together is limited both by tensions over role boundaries and power and by incivility that is intensified by increasing workloads and a fragmented labour force. The skills and qualities that form the basis of ?professional courtesy? need to be recognised as essential to good collaborative practice.

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McBryde, Emma S., Judy Brett, Philip L. Russo, Leon J. Worth, Ann L. Bull, and Michael J. Richards. "Validation of Statewide Surveillance System Data on Central Line–Associated Bloodstream Infection in Intensive Care Units in Australia." Infection Control & Hospital Epidemiology 30, no. 11 (November 2009): 1045–49. http://dx.doi.org/10.1086/606168.

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Objective.To measure the interobserver agreement, sensitivity, specificity, positive predictive value, and negative predictive value of data submitted to a statewide surveillance system for identifying central line-associated bloodstream infection (BSI).Design.Retrospective review of hospital medical records comparing reported data with gold standard according to definitions of central line–associated BSI.Setting.Six Victorian public hospitals with more than 100 beds.Methods.Reporting of surveillance outcomes was undertaken by infection control practitioners at the hospital sites. Retrospective evaluation of the surveillance process was carried out by independent infection control practitioners from the Victorian Hospital Acquired Infection Surveillance System (VICNISS). A sample of records of patients reported to have a central line-associated BSI were assessed to determine whether they met the definition of central line–associated BSI. A sample of records of patients with bacteremia in the intensive care unit during the assessment period who were not reported as having central line–associated BSI were also assessed to see whether they met the definition of central line-associated BSI.Results.Records of 108 patients were reviewed; the agreement between surveillance reports and the VICNISS assessment was 67.6% (κ = 0.31). Of the 46 reported central line–associated BSIs, 27 were confirmed to be central line–associated BSIs, for a positive predictive value of 59% (95% confidence interval [CI], 43%–73%). Of the 62 cases of bacteremia reviewed that were not reported as central line–associated BSIs, 45 were not associated with a central line, for a negative predictive value of 73% (95% CI, 60%–83%). Estimated sensitivity was 35%, and specificity was 87%. The positive likelihood ratio was 3.0, and the negative likelihood ratio was 0.72.Discussion.The agreement between the reporting of central line–associated BSI and the gold standard application of definitions was unacceptably low. False-negative results were problematic; more than half of central line–associated BSIs may be missed in Victorian public hospitals.

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Moje, Christine, Terri J. Jackson, and Peter McNair. "Adverse events in Victorian admissions for elective surgery." Australian Health Review 30, no. 3 (2006): 333. http://dx.doi.org/10.1071/ah060333.

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Objectives: To investigate a method to identify and understand patterns of adverse events by utilising secondary data analysis; to identify the types of complications associated with elective surgery; to identify any specific ?adverse eventprone? elective procedures; and to consider the implications of these patterns for hospital patient safety programs. Setting: Public hospitals in Victoria. Design: Secondary analysis of data on acute hospital admissions for elective surgery in the period 1 July 2000 to 30 June 2001, for nonobstetric patients older than 15 years (n = 177 533). Main outcome measures: Estimated rates of adverse events for the most commonly performed elective surgery procedures; frequency of the most commonly recorded adverse event types. Results: Of all admissions, 15.5% had at least one complication of care. The most frequent firstrecorded single complication code, in 9.6% of cases with a complication, was ?Haemorrhage and haematoma complicating a procedure?. The most common adverse event categories were cardiac and circulatory complications (23%), symptomatic complications (18%), and surgical and drug-related complications (17%). The procedure blocks most frequently associated with an adverse event were coronary artery bypass surgery (67%), colectomy (52%), hip and knee arthroplasty (42% and 36%, respectively), and hysterectomy (20%). The types of complications associated with the four most adverse eventprone procedures were cardiac arrhythmias, surgical adverse events (haemorrhage or laceration), intestinal obstruction, anaemia, and symptomatic complications. Conclusion: Routinely collected data are valuable in obtaining information on complication types associated with elective surgery. International Classification of Diseases codes and surgical procedure ?blocks? allow very sophisticated investigation of types of complications and differences in complication rates for different surgical approaches. The usefulness of such data relies on good documentation in the medical record, thorough coding and periodic data audit. The limitations of the method described here include the lack of follow-up after discharge, variable coding standards between institutions and over time (potentially distorting information on rates), lack of information on the causative factors for some adverse events, and a limited capacity to support investigation of particular cases. Hospitals should consider monitoring complication rates for individual elective procedures or blocks of similar procedures, and comparing adverse event rates over time and with peer hospitals as an integral part of their patient safety programs.

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Russo, Philip L., Ann Bull, Noleen Bennett, Claire Boardman, Simon Burrell, Jane Motley, N. Deborah Friedman, and Michael Richards. "Infections after coronary artery bypass graft surgery in Victorian hospitals - VICNISS Hospital Acquired Infection Surveillance." Australian and New Zealand Journal of Public Health 29, no. 3 (June 2005): 244–48. http://dx.doi.org/10.1111/j.1467-842x.2005.tb00762.x.

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30

Dwyer, Alison J. "Roles, attributes and career paths of medical administrators in public hospitals: survey of Victorian metropolitan Directors of Medical Services." Australian Health Review 34, no. 4 (2010): 506. http://dx.doi.org/10.1071/ah09750.

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Aim. To document the roles, the perceived skills and attributes and experience required of Medical Administrators in contemporary public hospitals. Method. Interviews with Directors of Medical Services (DMS) from Victorian metropolitan public hospitals between March 2005 and May 2005. Results. A total of 14 of the 21 DMS in Victoria were interviewed. Key roles: Managing Medical Staff; Clinical Governance and Quality Improvement; Strategy and Service development; and Medical advisor to CEO. Key attributes and skills aligned with roles. Most respondents hold Fellowship of Royal Australasian College of Medical Administrators (FRACMA) with over half employed for less than 2 years. Discussion. Core roles identified mirrored in key international literature. Recommendations for further study includes systematic review of literature; the influence of the medically-trained Chief Executive on roles; and further analysis of high turnover. Conclusion. This study clarifies the roles undertaken and skills required by Medical Administrators in contemporary public hospitals, providing: (1) role benchmarking for Chief Executives; (2) reduced ambiguity among the broader medical staff of the roles, to assist those who may need Medical Administrator assistance with providing patient care; (3) assisting the Medical Administration profession and RACMA to provide tailored education and training; and (4) to inform aspiring future Medical Administrators of the broad nature of such roles. What is known about the topic? There is little current Australian literature surrounding the roles and skills and experience required of Medical Administrators in Director of Medical Service positions within contemporary healthcare organisations. The roles are often poorly understood by the greater medical profession and other health professionals. This study provides clarity around the current roles and skills and experience required. What does this paper add? This study illustrates the key roles for Medical Administrators in contemporary public hospitals as (1) Managing Medical Staff (2) Clinical Governance and Quality Improvement (3) Strategy and organisational service development (4) Clinical and Medical advisor to CEO. This study also highlights the key attributes and skills that reflect the needs of the roles, with most respondents holding a Fellowship of the Royal Australasian College of Medical Administrators (RACMA). In addition, there is a high turnover with more than 50% having been in the roles less than 2 years. What are the implications for practitioners? This study clarifies the roles undertaken and skills required by Medical Administrators in contemporary public hospitals. This study (1) assists Chief Executives to benchmark appropriate roles for Medical Administrators in their hospital (2) reduces ambiguity and increases awareness amongst the broader medical staff within a hospital of the roles of a Medical Administrator. The medical staff often need to access the skills of a Medical Administrator to assist them with providing patient care (3) assists the Medical Administration profession and RACMA to tailor education and training for such roles and (4) provides aspiring future Medical Administrators with an understanding of the broad nature of such roles in hospitals.

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Weinberg, L., S. Tay, V. Aykanat, R. Segal, C. O. Tan, P. Peyton, L. Mcnicol, and D. A. Story. "Changing Patterns in Volatile Anaesthetic Agent Consumption over Seven Years in Victorian Public Hospitals." Anaesthesia and Intensive Care 42, no. 5 (September 2014): 579–83. http://dx.doi.org/10.1177/0310057x1404200506.

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32

Ribonson, Priscilla, and Mark F. Gilheany. "Is there a role for podiatric surgeons in public hospitals? An audit of surgery to the great toe joint in Victoria, 1999–2003." Australian Health Review 33, no. 4 (2009): 690. http://dx.doi.org/10.1071/ah090690.

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This project aimed to describe and compare the frequencies of procedures performed by podiatric surgeons and orthopaedic surgeons for elective surgery to the great toe joint, an area of identified clinical need. The objective was to determine whether podiatric surgeons in the Australian context possess a surgical skill set which can be utilised in the public health sector. The Medicare Benefits Schedule (Medicare Australia) was reviewed to identify all codes relating to great toe joint surgery and frequency data were obtained for the period July 1999 to June 2003. A separate audit of the activity of Victorian podiatric surgeons was conducted. During the 4 years in Victoria, the number of procedures performed on this joint by 152 orthopaedic surgeons was 5882. Two podiatric surgeons in Victoria performed 1260 operations on this joint over this period (17.6% of great toe joint surgery on average each year in the private sector). Utilising orthopaedic workforce figures and on a per-surgeon basis, during this period the podiatric surgeons performed this type of surgery between 2 and 16 times more often than the orthopaedic surgeons, and consideration should be given to using these skills in the public sector to address the growing demand.

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Renzaho, André. "Ischaemic Heart Disease and Australian Immigrants: The Influence of Birthplace and Language Skills on Treatment and Use of Health Services." Health Information Management Journal 36, no. 2 (July 2007): 26–36. http://dx.doi.org/10.1177/183335830703600206.

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Admission rates for ischaemic heart disease (IHD), and the use of invasive cardiovascular procedures, separation mode and length of stay (LOS) were compared between Australians from non-English speaking background (NESB; n=8627) and English speaking background (ESB; n=13162) aged 20 years and over admitted to Victorian urban public hospitals. The study covered the period from 1993 to 1998. It was found that, compared with their ESB counterparts, the incidence of admission for acute myocardial infarction was significantly higher for NESB men and women before and after controlling for confounding factors. The age-adjusted ratios for NESB women compared with their ESB counterparts ranged from 1.23 to 1.89 for cardiac catheterisation, from 0.23 to 0.27 for percutaneous transluminal coronary angioplasty (PTCA), and from 1.04 to 1.80 for coronary artery bypass grafting (CABG). Procedure rates were comparable in men for cardiac catheterisation and CABG but higher for PTA rates in NESB men (OR: 1.29, 95%CI: 1.11–1.50) than their ESB counterparts. Both NESB men (β=0.04, 95%CI:0.01–0.07) and women (β=0.03, 95%CI: 0.02–0.08) experienced significantly longer hospital stays than their ESB counterparts. These findings indicate there may be systematic differences in patients' treatment and service utilisation in Victorian public hospitals. The extent to which physicians' bias and patients' choice could explain these differences requires further investigation.

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Fennessy, Paul, and Richard King. "VP40 Robotic Surgery: From Health Technology Assessment To State Health Policy." International Journal of Technology Assessment in Health Care 34, S1 (2018): 169. http://dx.doi.org/10.1017/s0266462318003525.

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Introduction:The aging population means more men are diagnosed with prostate cancer, resulting in greater demand for treatment. Robot-assisted radical prostatectomy (RARP) claims to offer additional benefits to patients and providers. The independent Victorian Health Technology Program Advisory Committee assessed safety, clinical effectiveness and cost effectiveness evidence and financial impact to inform policy, access and reimbursement decision-making by state government policy makers and public hospital providers.Methods:Public and private hospital activity and costs for 2008–09 to 2012–13 from the Victorian Admitted Episodes Database (VAED) and the Victorian Cost Data Collection (VCDC) were identified. Data were extracted and reviewed based on (i) DRGs M01A and B, (ii) primary diagnostic code C61 (ICD-10-AM), and (iii) Australian Classification of Health Interventions procedure codes for open (ORP), laparoscopic (LRP) and RARP, supplemented by Victorian Prostate Cancer Clinical Registry data. English language Health Technology Assessments (HTAs)/systematic reviews published January 2009 to January 2015 were identified and analysed with comparative clinical outcomes data for RARP vs. ORP and RARP vs. LRP analysed. Not all reported the same data and most outcomes data presented were odds ratios and risk ratios.Results:RARP offers patients a shorter length of stay (LOS) compared with ORP or LRP, but the procedure takes longer to perform. While RARP has similar safety and clinical effectiveness profiles compared with ORP and LRP, published data do not unequivocally demonstrate that RARP is superior to ORP or LRP in terms of clinical outcomes. RARP is more expensive than ORP and LRP. The cost differential increases when capital costs are taken into account. Cost offsets from a reduced LOS are insufficient to justify the higher cost.Conclusions:Since RARP produces similar clinical outcomes to ORP and LRP but at a higher cost, the Victorian Health Technology Program Advisory Committee considered the case for public sector support of RARP is weak and provided two recommendations: (i) State Government resources are not used to procure RARP capital equipment; (ii) public hospitals can refer patients to a RARP provider, provided costs are negotiated prior to patient transfer and fully covered by the referring hospital.

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Musson, Jeremy. "Hospital cases." Psychiatric Bulletin 15, no. 12 (December 1991): 765–66. http://dx.doi.org/10.1192/pb.15.12.765.

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It could be said that one of the chief architectural legacies of the late 20th century, when it comes to be considered retrospectively, will be the wanton destruction and dispersal of buildings constructed in the previous century for the public benefit. Churches, schools and hospitals have been systematically sold off, and a good number of them, if not totally demolished, have lapsed into a pathetic state of limbo, particularly in this time of economic recession. Some of the worst cases of this known to the Victorian Society are hospitals of great architectural quality, constructed for the treatment of the mentally ill, then known as lunatic asylums.

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Brett, Judith, Sandra Johnson, Donna Cameron, Courtney Lane, Marion Easton, Annaliese van Diemen, Brett Sutton, Ann Bull, Michael Richards, and Leon Worth. "CPE in Victorian Hospitals - Usefulness and outcome of point prevalence surveys." Infection, Disease & Health 23 (November 2018): S5. http://dx.doi.org/10.1016/j.idh.2018.09.019.

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Fehlberg, Trafford, John Rose, Glenn Douglas Guest, and David Watters. "The surgical burden of disease and perioperative mortality in patients admitted to hospitals in Victoria, Australia: a population-level observational study." BMJ Open 9, no. 5 (May 17, 2019): e028671. http://dx.doi.org/10.1136/bmjopen-2018-028671.

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ObjectivesComprehensive reporting of surgical disease burden and outcomes are vital components of resilient health systems but remain under-reported. The primary objective was to identify the Victorian surgical burden of disease necessitating treatment in a hospital or day centre, including a thorough epidemiology of surgical procedures and their respective perioperative mortality rates (POMR).DesignRetrospective population-level observational study.SettingThe study was conducted in Victoria, Australia. Access to data from the Victorian Admitted Episodes Dataset was obtained using the Dr Foster Quality Investigator tool. The study included public and private facilities, including day-case facilities.ParticipantsFrom January 2014 to December 2016, all admissions with an International Statistical Classification of Diseases-10 code matched to the Global Health Estimates (GHE) disease categories were included.Primary and secondary outcome measuresAdmissions were assigned a primary disease category according to the 23 GHE disease categories. Surgical procedures during hospitalisations were identified using the Australian Refined Diagnosis Related Groups (AR-DRG). POMR were calculated for GHE disease categories and AR-DRG procedures.ResultsA total of 4 865 226 admitted episodes were identified over the 3-year period. 1 715 862 (35.3%) of these required a surgical procedure. The mortality rate for those undergoing a procedure was 0.42%, and 1.47% for those without. The top five procedures performed per GHE category were lens procedures (162 835 cases, POMR 0.001%), caesarean delivery (76 032 cases, POMR 0.01%), abortion with operating room procedure (65 451 cases, POMR 0%), hernia procedures (52 499 cases, POMR 0.05%) and other knee procedures (47 181 cases, POMR 0.004%).ConclusionsConditions requiring surgery were responsible for 35.3% of the hospital admitted disease burden in Victoria, a rate higher than previously published from Sweden, New Zealand and the USA. POMR is comparable to other studies reporting individual procedures and conditions, but has been reported comprehensively across all GHE disease categories for the first time.

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McCaffrey, N., G. Dowling, and S. L. White. "The estimated effect of reducing the maternal smoking rate on neonatal intensive care unit costs in Victorian public hospitals." Australian Health Review 45, no. 4 (2021): 516. http://dx.doi.org/10.1071/ah20277.

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This analysis estimates the expected number of Victorian public hospital neonatal intensive care unit cot-days that could be saved annually by reducing the maternal smoking rate. Approximately 106 cot-days could be saved if the maternal smoking rate was reduced from 8.4% to 6.4% (estimated annual cost saving of A$276 000).

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Sibbritt, David, and Robert Gibberd. "The annual variation in activity and funding for acute public hospitals in NSW,1988?89 to 1992?93." Australian Health Review 19, no. 1 (1996): 52. http://dx.doi.org/10.1071/ah960052.

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Casemix-based funding was introduced into the Victorian health system withoutan assessment of the annual variation in inpatient activity. Before undertaking sucha funding reform, it would be appropriate to determine the level of annual variationin inpatient activity for individual hospitals that could be attributable to chance orrandom variation. If the annual random variation is not accounted for, then casemix-basedfunding may actually lead to inefficiencies. For this study, hospital inpatientactivity and funding data for 120 acute public hospitals from New South Walesfor the years 1988?89 to 1992?93 were used to estimate the standard deviationof the annual random variation in activity and gross operating payment. Throughlinear regression, estimates of the standard deviation of random variation about theunderlying trend were obtained for each hospital. The results showed that, dependingon the size of the hospital, total diagnosis related group cost weights have a standarddeviation in the range of 2 to 16- per cent of total activity, whilst gross operatingpayment has an equivalent standard deviation that ranges from 1 to 10- per centannually. The magnitude of the variation would suggest that funding of hospitalsshould either be based on average activity over several years or based on bands ofactivity in order to reduce the potential random variation in funding levels.

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O’Connor, Siobhán, Peta L. Hitchens, and Lauren V. Fortington. "Hospital-treated injuries from horse riding in Victoria, Australia: time to refocus on injury prevention?" BMJ Open Sport & Exercise Medicine 4, no. 1 (February 2018): e000321. http://dx.doi.org/10.1136/bmjsem-2017-000321.

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BackgroundThe most recent report on hospital-treated horse-riding injuries in Victoria was published 20 years ago. Since then, injury countermeasures and new technology have aimed to make horse riding safer for participants. This study provides an update of horse-riding injuries that required hospital treatment in Victoria and examines changes in injury patterns compared with the earlier study.MethodsHorse-riding injuries that required hospital treatment (hospital admission (HA) or emergency department (ED) presentations) were extracted from routinely collected data from public and private hospitals in Victoria from 2002–2003 to 2015–2016. Injury incidence rates per 100 000 Victorian population per financial year and age-stratified and sex-stratified injury incidence rates are presented. Poisson regression was used to examine trends in injury rates over the study period.ResultsED presentation and HA rates were 31.1 and 6.6 per 100 000 person-years, increasing by 28.8% and 47.6% from 2002 to 2016, respectively. Female riders (47.3 ED and 10.1 HA per 100 000 person-years) and those aged between 10 and 14 years (87.8 ED and 15.7 HA per 100 000 person-years) had the highest incidence rates. Fractures (ED 29.4%; HA 56.5%) and head injuries (ED 15.4%; HA 18.9%) were the most common injuries. HA had a mean stay of 2.6±4.1 days, and the mean cost per HA was $A5096±8345.ConclusionHorse-riding injuries have remained similar in their pattern (eg, types of injuries) since last reported in Victoria. HA and ED incidence rates have increased over the last 14 years. Refocusing on injury prevention countermeasures is recommended along with a clear plan for implementation and evaluation of their effectiveness in reducing injury.

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Liang, Zhanming, Sandra G. Leggat, Peter F. Howard, and Lee Koh. "What makes a hospital manager competent at the middle and senior levels?" Australian Health Review 37, no. 5 (2013): 566. http://dx.doi.org/10.1071/ah12004.

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Objective. The purpose of this paper is to confirm the core competencies required for middle to senior level managers in Victorian public hospitals in both metropolitan and regional/rural areas. Methods. This exploratory mixed-methods study used a three-step approach which included position description content analysis, focus group discussions and online competency verification and identification survey. Results. The study validated a number of key tasks required for senior and middle level hospital managers (levels II, III and IV) and identified and confirmed the essential competencies for completing these key tasks effectively. As a result, six core competencies have been confirmed as common to the II, III and IV management levels in both the Melbourne metropolitan and regional/rural areas. Conclusions. Six core competencies are required for middle to senior level managers in public hospitals which provide guidance to the further development of the competency-based educational approach for training the current management workforce and preparing future health service managers. With the detailed descriptions of the six core competencies, healthcare organisations and training institutions will be able to assess the competency gaps and managerial training needs of current health service managers and develop training programs accordingly. What is known about the topic? A competent health service management workforce is critical to the effective functioning of the healthcare system. Consequently, a competency-based educational approach has been proposed to prepare current and future health professionals including health service managers. Although the literature has suggested that core competencies exist for different management levels in different healthcare settings, there has been no study which has provided valuable data to indicate what the core competencies are for hospitals managers in Australian public hospitals. What does this paper add? This paper identified and confirmed that six core competencies are common to middle to senior level managers (levels II-IV) in Victorian public hospitals in both Melbourne metropolitan and regional/rural areas. What are the implications for practitioners? The findings of the study is the first step towards supporting the competency-based educational approach for training and preparing current and future health service managers for their roles. The six identified core competencies provide a very useful guide to the identification of competency gaps and managerial training needs, and the further development of the health service management training curriculum.

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Eastwood, Kathryn, Stuart Howell, Ziad Nehme, Judith Finn, Karen Smith, Peter Cameron, Dion Stub, and Janet E. Bray. "Impact of a mass media campaign on presentations and ambulance use for acute coronary syndrome." Open Heart 8, no. 2 (October 2021): e001792. http://dx.doi.org/10.1136/openhrt-2021-001792.

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ObjectiveBetween 2009 and 2013, the National Heart Foundation of Australia ran mass media campaigns to improve Australian’s awareness of acute coronary syndrome (ACS) symptoms and the need to call emergency medical services (EMS). This study examined the impact of this campaign on emergency department (ED) presentations and EMS use in Victoria, Australia.MethodsThe Victorian Department of Health and Human Services provided data for adult Victorian patients presenting to public hospitals with an ED diagnosis of ACS or unspecified chest pain (U-CP). We modelled changes in the incidence of ED presentations, and the association between the campaign period and (1) EMS arrival and (2) referred to ED by a general practitioner (GP). Models were adjusted for increasing population size, ACS subtype and demographics.ResultsBetween 2003 and 2015, there were 124 632 eligible ED presentations with ACS and 536 148 with U-CP. In patients with ACS, the campaign period was associated with an increase in ED presentations (incidence rate ratio: 1.11; 95% CI 1.07 to 1.15), a decrease in presentations via a GP (adjusted OR (AOR): 0.77; 95% CI 0.70 to 0.86) and an increase in EMS use (AOR: 1.10; 95% CI 1.05 to 1.17). Similar, but smaller associations were seen in U-CP.ConclusionsThe Warning Signs Campaign was associated with improvements in treatment seeking in patients with ACS—including increased EMS use. The increase in ACS ED presentations corresponds with a decrease in out-of-hospital cardiac arrest over this time. Future education needs to focus on improving EMS use in ACS patient groups where use remains low.

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Ariyaratne, Thathya, Zanfina Ademi, Bryan Yan, Molla Huq, Baki Billah, Alexander Black, Gishel New, Nick Andrianopoulos, and Christopher Reid. "PW241 The Cost-Effectiveness of Guideline-Driven Use of Drug-Eluting Stents in Victorian Public Hospitals." Global Heart 9, no. 1 (March 2014): e307. http://dx.doi.org/10.1016/j.gheart.2014.03.2336.

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Bennett, Noleen, Brett Sutton, Janet Strachan, Alex Hoskins, Michael J. Malloy, and Leon J. Worth. "Measles immunisation status of healthcare workers in smaller Victorian hospitals: can we do better?" Australian and New Zealand Journal of Public Health 44, no. 5 (July 22, 2020): 346–48. http://dx.doi.org/10.1111/1753-6405.12989.

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Dabkowski, Elissa, Simon Cooper, Jhodie Duncan, and Karen Missen. "Exploring Hospital Inpatients’ Awareness of Their Falls Risk: A Qualitative Exploratory Study." International Journal of Environmental Research and Public Health 20, no. 1 (December 27, 2022): 454. http://dx.doi.org/10.3390/ijerph20010454.

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Patient falls in hospital may lead to physical, psychological, social and financial impacts. Understanding patients’ perceptions of their fall risk will help to direct fall prevention strategies and understand patient behaviours. The aim of this study was to explore the perceptions and experiences that influence a patient’s understanding of their fall risk in regional Australian hospitals. Semi-structured, individual interviews were conducted in wards across three Australian hospitals. Participants were aged 40 years and over, able to communicate in English and were mobile prior to hospital admission. Participants were excluded from the study if they returned a Standardised Mini-Mental State Examination (SMMSE) score of less than 18 when assessed by the researcher. A total of 18 participants with an average age of 69.8 years (SD ± 12.7, range 41 to 84 years) from three regional Victorian hospitals were interviewed for this study. Data were analysed using a reflexive thematic analysis identifying three major themes; (1) Environment (extrinsic) (2) Individual (intrinsic), and (3) Outcomes, as well as eight minor themes. Participants recognised the hazardous nature of a hospital and their personal responsibilities in staying safe. Falls education needs to be consistently delivered, with the focus on empowering the patient to help them adjust to changes in their clinical condition, whether temporary or permanent.

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McDonald, Paul. "From Streets to Sidewalks: Developments in Primary Care Services for Injecting Drug Users." Australian Journal of Primary Health 8, no. 1 (2002): 65. http://dx.doi.org/10.1071/py02010.

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Primary Health Care for the Injecting Drug User (IDU) has been established in Victoria in recognition of the serious health needs of IDUs, which require a relevant and effective response. Research shows the medical consequences that flow from drug abuse, ranging from the onset of blood borne viruses to cardiovascular conditions, and the propensity of drug users to access health services only through accident and emergency areas of hospitals. In 1999, the Victorian government announced the funding of five Local Drug Strategies in five of Melbourne's 'hotspot' street drug areas to address both the needs of users and communities in relation to substance abuse. This funding was an impetus to establish and trial the concept of primary health services, combining both a fixed site and a mobile outreach service. These services are designed to meet the primary health needs of street-based injecting drug users who are at high risk of experiencing overdose or other forms of drug-related harm.

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Peck, Blake, Daniel Terry, and Kate Kloot. "The Socioeconomic Characteristics of Childhood Injuries in Regional Victoria, Australia: What the Missing Data Tells Us." International Journal of Environmental Research and Public Health 18, no. 13 (June 30, 2021): 7005. http://dx.doi.org/10.3390/ijerph18137005.

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Background: Injury is the leading cause of death among those between 1–16 years of age in Australia. Studies have found that injury rates increase with socioeconomic disadvantage. Rural Urgent Care Centres (UCC) represent a key point of entry into the Victorian healthcare system for people living in smaller rural communities, often categorised as lower socio-economic groups. Emergency presentation data from UCCs is not routinely collated in government datasets. This study seeks to compare socioeconomic characteristics of children aged 0–14 attending a UCC to those who attend a 24-h Emergency Departments with an injury-related emergency presentation. This will inform gaps in our current understanding of the links between socioeconomic status and childhood injury in regional Victoria. Methods: A network of rural hospitals in South West Victoria, Australia provide ongoing detailed de-identified emergency presentation data as part of the Rural Acute Hospital Data Register (RAHDaR). Data from nine of these facilities was extracted and analysed for children (aged 0–14 years) with any principal injury-related diagnosis presenting between 1 February 2017 and 31 January 2020. Results: There were 10,137 injury-related emergency presentations of children aged between 0–14 years to a participating hospital. The relationship between socioeconomic status and injury was confirmed, with overall higher rates of child injury presentations from those residing in areas of Disadvantage. A large proportion (74.3%) of the children attending rural UCCs were also Disadvantaged. Contrary to previous research, the rate of injury amongst children from urban areas was significantly higher than their more rural counterparts. Conclusions: Findings support the notion that injury in Victoria differs according to socioeconomic status and suggest that targeted interventions for the reduction of injury should consider socioeconomic as well as geographical differences in the design of their programs.

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Harrington, Glenys, Philip Russo, Denis Spelman, Sue Borrell, Kerrie Watson, Wendy Barr, Rhea Martin, et al. "Surgical-Site Infection Rates and Risk Factor Analysis in Coronary Artery Bypass Graft Surgery." Infection Control & Hospital Epidemiology 25, no. 6 (June 2004): 472–76. http://dx.doi.org/10.1086/502424.

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AbstractBackground:The Victorian Infection Control Surveillance Project (VICSP) is a multicenter collaborative surveillance project established by infection control practitioners. Five public hospitals contributed data for patients undergoing coronary artery bypass graft (CABG) surgery.Objective:To determine the aggregate and comparative interhospital surgical-site infection (SSI) rates for patients undergoing CABG surgery and the risk factors for SSI in this patient group.Method:Each institution used standardized definitions of SSI, risk adjustment, and reporting methodology according to the National Nosocomial Infections Surveillance System of the Centers for Disease Control and Prevention. Data on potential risk factors were prospectively collected.Results:For 4,474 patients undergoing CABG surgery, the aggregate SSI rate was 7.8 infections per 100 procedures (95% confidence interval [CI95], 7.0-8.5), with individual institutions ranging between 4.5 and 10.7 infections per 100 procedures. Multivariate risk factor analysis demonstrated age (odds ratio [OR], 1.02; CI95, 1.01-1.04; P < .001), obesity (OR, 1.8; CI95, 1.4-2.3; P < .001), and diabetes mellitus (OR, 1.6; CI95, 1.2-2.1; P < .001) as independent predictors of SSI. Three hundred thirty-four organisms were isolated from 296 SSIs. Of the total SSIs, methicillin-resistant Staphylococcus aureus was isolated from 32%, methicillin-sensitive S. aureus from 24%, gram-negative bacilli (eg, Enterobacter and Escherichia colt) from 18%, and miscellaneous organisms from the remainder.Conclusion:We documented aggregate and comparative SSI rates among five Victorian public hospitals performing CABG surgery and defined specific independent risk factors for SSI. VICSP data offer opportunities for targeted interventions to reduce SSI following cardiac surgery.

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Riley, Marie. "City of the Plague: Victorian Liverpool’s Response to Epidemic." Transactions of the Historic Society of Lancashire and Cheshire 171, no. 1 (January 1, 2022): 83–103. http://dx.doi.org/10.3828/transactions.171.8.

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Conscious of its reputation as Britain’s unhealthiest town, the Corporation of Liverpool, in the mid-nineteenth century, developed a long-term strategy to combat the factors that allowed disease to flourish. Typhus, which periodically reached epidemic proportions, had been an underlying factor behind much public health reform, yet by the 1860s, it tended to be viewed with some degree of inevitability. The re-emergence of cholera in 1866 after a gap of twelve years triggered more urgent and immediate interventions. Perceived as a potentially catastrophic ‘alien’ invader, its outbreak in Liverpool was traceable to European emigrants in transit. Just as Irish immigrants had been scapegoated for importing typhus, the ‘Germans’ were identified as a source of dirt, degradation and disease. Despite the alarm generated by cholera, its sporadic incidence was a disincentive to the building of a permanent infrastructure with sufficient capacity to cope. Isolation hospitals, quarantine facilities, and nursing care needed to be constructed, commandeered, or conjured up on an ad hoc basis, bringing into focus the practical role of parochial authorities in the health of the town.

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Yan, B., A. Ajani, N. Andrianopoulos, S. Duffy, D. Clark, A. Brennan, P. Loane, et al. "Recent Trends in Percutaenous Coronary Intervention Practise in Victorian Public Hospitals: Insights from the Melbourne Interventional Group Registry." Heart, Lung and Circulation 19 (January 2010): S35. http://dx.doi.org/10.1016/j.hlc.2010.06.746.

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