Australian health review : a publication of the Australian Hospital Association最新文献

{"title":"Transforming evidence into support: investing in a carer wellbeing research agenda.","authors":"Bróna Nic Giolla Easpaig, Bronwyn Newman, Lukas Hofstaetter, Lucy Jones, Rhiannon Edge, Reema Harrison","doi":"10.1071/AH26073","DOIUrl":"https://doi.org/10.1071/AH26073","url":null,"abstract":"<p><p>As Australia's first National Carer Strategy gets underway, this perspective article explicates the role research can play in addressing critical gaps in carer support. The contribution of Australia's more than three million unpaid carers is vital for those they support and health system sustainability. Progress towards carer support is constrained by limited knowledge of the support that works, how it works, and how it can be implemented in practice in the busy lives of those who provide unpaid care. A reframing of how we think about the role of carers is warranted, in tandem with investment to bolster capacity for developing, trialling, and translating accessible, evidence-based support that is tailored to carer preferences. A carer wellbeing research agenda is called for that is equity-oriented, is undertaken in partnership with carers, builds on existing knowledge gains, and incorporates co-design and implementation science principles to promote practice-ready initiatives.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":"50 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient flow implications of delayed access to inpatient rehabilitation in Australian acute hospitals.","authors":"Jane Wu, Yuriko Watanabe, Christine T Shiner, Abraham Arulanandam, Swee-Ling Toh, Louise Sellars","doi":"10.1071/AH26106","DOIUrl":"10.1071/AH26106","url":null,"abstract":"<p><strong>Objective: </strong>Delays in transferring patients from acute care to inpatient rehabilitation contribute to hospital exit-block; however, the magnitude of rehabilitation-related delays is poorly quantified in contemporary health systems. This study aimed to quantify the time spent waiting for inpatient rehabilitation in Australian acute hospitals.</p><p><strong>Methods: </strong>Secondary analysis of a prospective observational cohort study of consecutive adult patients accepted for inpatient rehabilitation across two metropolitan tertiary hospitals in Sydney, Australia, over a 4-month period was performed. The main outcome measures were the time from rehabilitation readiness to transfer, and the proportion of acute bed-days spent waiting for rehabilitation.</p><p><strong>Results: </strong>Among the 373 patients accepted for inpatient rehabilitation, a total of 1499 acute bed-days were spent waiting for transfer. The overall acute length of stay for the cohort was 7953 days, indicating that 18.8% of all acute bed-days were occupied by patients waiting for rehabilitation transfer. The median wait time was 2 days (IQR 1-6). Although 40% of patients were transferred within 1 day of being deemed ready for rehabilitation, 42% waited ≥4 days, and 15.7% experienced delays exceeding 1 week.</p><p><strong>Conclusions: </strong>Delayed access to inpatient rehabilitation makes a substantial contribution to acute bed occupancy. Nearly one-fifth of acute bed-days among patients requiring inpatient rehabilitation were spent waiting for transfer. Strategies such as earlier identification of rehabilitation needs, in-reach rehabilitation in acute care, and expansion of subacute capacity may help reduce delays and improve hospital throughput.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":"50 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the protocol: navigating ethics and governance in the multicentre implementation trials - the QASC Australasia and T3 Trials.","authors":"Simeon Dale, Sawsan Saheb, Oyebola Fasugba, Kelly Coughlan, Elizabeth McInnes, Dominique A Cadilhac, Ngai W Cheung, Kelvin Hill, Kirsty Page, Estela Sanjuan Menendez, Emily Neal, Vivien Pollnow, Eileen Gilder, Nicola Straiton, Tessa Holman, Julia Slark, Annemarei Ranta, Christopher Levi, Sandy Middleton","doi":"10.1071/AH26079","DOIUrl":"10.1071/AH26079","url":null,"abstract":"<p><strong>Objective: </strong>To describe and compare ethics and governance approval timelines for the Quality in Acute Stroke Care (QASC) Australasia Trial (2021-present) and Triage, Treatment, and Transfer of Patients with Stroke in Emergency Departments (T3) Trial (2012-2014), benchmarking against national and international targets.</p><p><strong>Methods: </strong>Retrospective, descriptive analysis of approval timelines for ethics, Site-Specific Assessment (SSA), Clinical Trials Research Agreements (CTRA), and Public Health Act (PHA) application (Queensland hospitals).</p><p><strong>Results: </strong>The QASC Australasia Trial involved 52 Australian and 8 New Zealand hospitals. In Australia, lead ethics approval took 30 days. SSA approvals took a median of 91 days (interquartile range (IQR) 52-144). CTRA execution required a median of 56 days (IQR 38-105). PHA approval was required at 10 sites, with a median of 34 days (IQR 29-52). In New Zealand, ethics approval took 53 days. SSA approvals and CTRA execution took medians of 121 days (IQR 73-152) and 133 days (IQR 84-146), respectively. The T3 Trial involved 26 Australian hospitals. Lead ethics approval took 76 days. SSA approvals (n = 22) took a median of 132 days (IQR 106-175). Since the T3 Trial, Australian lead ethics approval times decreased by 61% and SSA approvals decreased by 31%. Only 33% of Australian QASC Australasia Trial and 5% of T3 Trial SSA approvals met the 60-day national benchmark.</p><p><strong>Conclusions: </strong>Multicentre trial governance processes remain lengthy, particularly for New Zealand. CTRA and jurisdiction requirements delayed SSA approval. Streamlined processes are needed to optimise resources and accelerate evidence translation.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":"50 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of the health workforce: lessons from the past for the future.","authors":"Melissa McCusker","doi":"10.1071/AH25298","DOIUrl":"https://doi.org/10.1071/AH25298","url":null,"abstract":"","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":"50 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-prescribed substance use among hospital inpatients in a large Australian hospital: a case series.","authors":"Winston Kardell, Lauren A Monds, Martin Weltman, Paul S Haber, Carolyn A Day","doi":"10.1071/AH25187","DOIUrl":"https://doi.org/10.1071/AH25187","url":null,"abstract":"<p><strong>Objective: </strong>Patients who use substances (e.g. alcohol, illicit drugs, or non-prescribed medications) while in hospital present both medical and ethical challenges for healthcare management. However, little is known about the prevalence of this issue in Australia. This study aimed to quantify non-prescribed substance use among inpatients in a large teaching hospital.</p><p><strong>Methods: </strong>A case file review was conducted using incident reports from a tertiary hospital in outer-metropolitan Sydney, Australia, covering the period between 2014 and 2021.</p><p><strong>Results: </strong>Among 3775 reported critical incidents involving patients, substance use was identified in 99 (2.6%) over 7 years. Patient's median age was 36 years, and 61 (62%) were male. Most admissions were for a substance use issue, and all involved withdrawal management. Notably, patients exhibited high levels of mental and physical health comorbidities, including depression (n = 79, 80%) and chronic pain (n = 24, 24%). Only eight patients (8%) were receiving opioid substitution therapy. Illicit substance use detected during hospitalisation involved various drug classes. Most of the substance use episodes (64%, n = 63) occurred outside regular hours, and fewer than half of the patients completed their admission.</p><p><strong>Conclusions: </strong>Substance use in hospitals was detected infrequently and may be under-recognised. Inconsistent decisions regarding discharge contribute to discharged patients lacking ongoing health care, putting patients at risk of adverse outcomes. Clinicians and hospitals require further support to identify and address substance use within hospital settings. Clear policy guidance and improvements at multiple levels (policy, education, and clinical practice) are necessary to tackle this issue effectively.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":"50 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to: Changes in size and co-location of health services for Australian general practice, 2000-2016.","authors":"Preet Kalkat, Shaun Larkin, Jennifer Lacy-Nichols, Adam Elshaug, Christopher Harrison","doi":"10.1071/AH25105_CO","DOIUrl":"10.1071/AH25105_CO","url":null,"abstract":"","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":"50 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147870872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with the retention and attrition of physiotherapists in Australia: insights from the Physiotherapy Attrition and Retention Collaboration project.","authors":"Rechu Divakar, Jade Tan, Lee Barclay, Bronwyn Darmanin, Paula Harding, Sheila Lennon, Gillian McDermott, Jackie Robertson, Lowana Williams, Sunita Bapuji Bayyavarapu, Sarah Anderson, Kim Gibson","doi":"10.1071/AH25095","DOIUrl":"10.1071/AH25095","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify factors influencing retention and attrition of physiotherapists in Australia.</p><p><strong>Methods: </strong>A cross-sectional survey and analysis of 10 years of Australian Health Practitioner Regulation Agency (Ahpra) registration data, involving current or previously registered physiotherapists, was undertaken.</p><p><strong>Results: </strong>Among participants, 6045 (80.2%) intended to stay in the profession, 711 (9.3%) were unsure, and 779 (10.3%) intended to leave. Of those intending to leave, 87% wanted to leave within 1 year. Reasons for leaving included retirement, unsatisfactory remuneration, lack of career advancement, professional dissatisfaction, and mental burnout. Respondents more likely to leave or be unsure included: older physiotherapists (over 50: OR = 1.6, 95% CI = 1.2-2.0), those with fewer than 15 years of experience (OR = 2.0, 95% CI 1.1-2.8), males (OR = 1.2, 95% CI = 1.0-1.4), practitioners with further qualifications (OR = 1.2, 95% CI = 1.1-1.4), those without Australian Physiotherapy Association (APA) membership (OR = 1.7, 95% CI = 1.5-2.0), those with membership but non-practising (OR = 12.2, 95% CI = 9.2-16.1), and unregistered practitioners (OR = 39.5, 95% CI = 28.7-54.4). From 2014 to 2023, physiotherapists per 100,000 population rose by 41.6%, and the replacement rate (~2.5) remained stable overall, with higher replacement rates among males.</p><p><strong>Conclusion: </strong>Most physiotherapists intended to stay, with registration data indicating strong workforce growth and stable replacement rates over the past decade. However, nearly one in five physiotherapists plan to leave or remain uncertain - most citing retirement, remuneration, career progression, dissatisfaction, or burnout as reasons. Strategies targeting these factors may improve retention.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145607431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Have we [fully] untapped the potential of allied health in the Australian healthcare system?","authors":"Sarah Dennis, Elise Baker, Leanne Hassett, Steven J Kamper, Bronwyn Morris-Donovan, Gillian Nisbet, Iona Novak, Trudy Rebbeck, Andrew Baillie","doi":"10.1071/AH25248","DOIUrl":"10.1071/AH25248","url":null,"abstract":"<p><p>In 2015, allied health professionals (AHPs) were described as the 'untapped potential' of the Australian health system. A decade later, this perspective paper critically reflects on the progress made and the barriers that continue to prevent AHPs from working to their full potential. Despite being the second largest workforce, AHPs remain underrepresented in policy leadership and funding structures, with medical dominance still shaping health system priorities. While notable advancements have occurred - such as the establishment of a Commonwealth Chief Allied Health Officer, the National Allied Health Workforce Strategy, and expanded roles during the COVID-19 pandemic - systemic challenges endure. Despite a growing evidence base supporting the cost-effectiveness and clinical value of AHP interventions, policy and funding mechanisms have not kept pace. This paper argues that although the visibility of AHPs has improved, their potential remains constrained by structural, cultural and systemic barriers. To truly unlock the value of allied health, Australia must invest in robust workforce planning, equitable funding models, and integrated policy frameworks that recognise AHPs as essential contributors to a sustainable health system. Although the potential of allied health might be more visible, the potential remains constrained.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":"49 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145535086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The implementation of a virtual fracture clinic in Far North Queensland: satisfaction and success without travel.","authors":"John Maunder, William O'Callaghan, Callum Fryer, Dougal Middleton, Tim Dwyer","doi":"10.1071/AH25178","DOIUrl":"10.1071/AH25178","url":null,"abstract":"<p><strong>Objective: </strong>Orthopaedic injuries often require timely management. This is challenging in remote regions, such as Far North Queensland, where patients must travel long distances. A Virtual Fracture Clinic (VFC) model offers a promising alternative, allowing remote management of select cases, and reducing travel burdens and healthcare costs. This prospective cohort study assessed the implementation of a VFC at Cairns Base Hospital.</p><p><strong>Methods: </strong>An orthopaedic registrar triaged patients to the VFC based on predefined criteria over a 5-week period. Primary outcomes included patient satisfaction, travel distance savings and cost savings. Secondary outcomes included the clinical outcomes of the VFC and the traditional clinic.</p><p><strong>Results: </strong>Out of 514 referrals, 36.4% were managed through the VFC. Compared with the traditional clinic, VFC patients had shorter wait times, and 91.4% of those seen in the VFC could be discharged without further review. VFC patients were highly satisfied, with 75.2% indicating a willingness to undergo the same treatment again. The VFC also resulted in significant travel distance and cost savings. No patients in the VFC required surgery during the follow-up period.</p><p><strong>Conclusion: </strong>This study provides the first prospective evidence that registrar-led VFCs in regional Australia can safely deliver orthopaedic care with substantial logistical and economic benefits. With high patient satisfaction and no compromise in safety, this model could redefine how fracture care is delivered across Australia's vast rural landscape, helping close the gap in access for remote and Indigenous populations.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":"49 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145558537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic breathlessness is associated with much longer lengths of hospital stay.","authors":"David Currow, Slavica Kochovska, Rachael Evans, Janelle Yorke, Patricia M Davidson","doi":"10.1071/AH25253","DOIUrl":"10.1071/AH25253","url":null,"abstract":"<p><p>There are wide variations in acute care inpatient lengths of stay. Until now, analysing these variations included patient, clinical and system factors, leaving 40-80% of the variation still unexplained. Chronic breathlessness has been ignored by health systems: the first international consensus definition was only proposed in 2017, and the first International Classification of Disease (ICD) code for it was accepted in 2022. (Until 2022, the health system through ICD only recognised 'acute breathlessness' and 'orthopnoea' (the inability to lie flat without breathlessness).) Studies of the general population (independent of health service contact) have shown that at least 1 in 300 Australians are housebound or have difficulty dressing and undressing because of chronic breathlessness. The symptom affects every part of a person's life and contributes to unplanned use of primary and tertiary healthcare. Rather than focusing only on diseases in understanding variations in length of stay, the addition of chronic symptoms is of value. In recent work, pre-existing breathlessness (captured in general practice) predicts a shorter time to people's next unplanned hospital admission and longer hospital admissions for every increased level of chronic breathlessness severity, having controlled for other factors. ICD v11.0 now has a code 'chronic breathlessness' that we should be using. Research is needed on why people with chronic breathlessness have increased use of emergency departments and longer lengths of stay. Clinicians need to actively identify the presence of chronic breathlessness, and health systems need to research how to minimise its impacts.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":"49 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145590287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}