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

{"title":"Models of care for voluntary assisted dying: a qualitative study of Queensland's approach in its first year of operation.","authors":"Ben P White, Amanda Ward, Rachel Feeney, Laura Ley Greaves, Lindy Willmott","doi":"10.1071/AH24199","DOIUrl":"10.1071/AH24199","url":null,"abstract":"<p><p>Objective Voluntary assisted dying (VAD) began in Queensland in January 2023 but little is known about its practical operation. This research examined models of care for providing VAD in Queensland. Methods Semi-structured interviews were conducted with 24 participants involved with VAD delivery across Queensland's 16 Health and Hospital Services (HHSs). Participants included HHS VAD Coordinators, nurse practitioners and nurses who acted as administering practitioners, and Queensland VAD Support and Pharmacy Service (QVAD SPS) staff. Results Five themes about Queensland VAD models of care were developed: VAD is accessed almost exclusively through the public sector via HHSs, influenced by a Health Service Directive; local models of care vary; nurses play significant roles facilitating access to and providing VAD; QVAD SPS has been instrumental supporting HHSs and ensuring statewide access as back-up VAD provider; and VAD services need more resourcing. Conclusions The Queensland approach to providing VAD has been largely successful in ensuring patient access across the state. However, it differs from previous Australian VAD models with access predominantly through the public sector, greater roles played by nurse practitioners/nurses, and VAD being provided by QVAD SPS. Under-resourcing and consistency in provision of VAD services remain challenges.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":"693-699"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382732","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":"Voluntary assisted dying: impacts on health professionals.","authors":"Geetanjali Tanji Lamba, Camille LaBrooy, Sophie Lewis, Ian Olver, Alexander Holmes, Cameron Stewart, Paul Komesaroff","doi":"10.1071/AH24142","DOIUrl":"10.1071/AH24142","url":null,"abstract":"<p><p>Objective The introduction and implementation of voluntary assisted dying (VAD) legislation represents a major shift in Australian health policy. Given potential repercussions for health professionals, understanding how they are being affected by this legislation is important to guide future policy and legislative changes. This study aims to explore the perspectives and experiences of Australian health professionals on VAD and compare impacts on those working under different state legislation in Victoria and WA. Methods Data were collected using a cross-sectional survey design, targeting health professionals nationally, primarily doctors and nurses. The survey had closed and open-ended response options, was informed by previous publications and was piloted prior to further roll-out. Recruitment was via professional networks and social media. Quantitative data were descriptively analysed and qualitative data were coded using NVivo and thematically analysed. Results There was a final sample size of 223. Impacts on clinicians identified include inadequate remuneration, a need for ongoing support and the recognition of barriers to mandatory training. Conclusions Impacts on health practitioners, if not addressed, have future implications for workforce sustainability. Increasing numbers of trained VAD practitioners may enable distribution of clinical load and prevent burnout. VAD practitioners are not being appropriately remunerated, which could be addressed by introducing dedicated Medicare Benefits Schedule items for VAD. Attention should also be given to incentivising training, including continuing professional development accreditation and appropriate funding. Strategies to support staff could include debriefing, mentoring, peer support and psychological consultations.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":"720-728"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482841","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":"Predicting hospital bed utilisation for post-surgical care by means of the Monte Carlo method with historical data.","authors":"Andy Wong, Rob Eley, Paul Corry, Brendan Hoad, Prasad Yarlagadda","doi":"10.1071/AH24160","DOIUrl":"10.1071/AH24160","url":null,"abstract":"<p><p>Objective This study aim was to develop a predictive model of bed utilisation to support the decision process of elective surgery planning and bed management to improve post-surgical care. Methods This study undertook a retrospective analysis of de-identified data from a tertiary metropolitan hospital in Southeast Queensland, Australia. With a reference sample from 2years of historical data, a model based on the Monte Carlo method has been developed to predict hospital bed utilisation for post-surgical care of patients who have undergone surgical procedures. A separate test sample from comparable data of 8weeks of actual utilisation was employed to assess the performance of the prediction model. Results Applying the developed prediction model to an 8-week period test sample, the mean percentage error of the prediction was 1.5% and the mean absolute percentage error 5.4%. Conclusions The predictive model developed in this study may assist in bed management and the planning process of elective surgeries, and in so doing also reduce the likelihood of Emergency Department access block.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":"642-647"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309352","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":"A digitally enabled health workforce for Australia.","authors":"Anna Janssen, Melissa Baysari, Christina Igasto, Kate Quirke, Petra Milnes, Tim Shaw, Adam Dunn","doi":"10.1071/AH24286","DOIUrl":"10.1071/AH24286","url":null,"abstract":"<p><p>Australia has world-class education for healthcare professionals and is recognised for its strength in digital health research but is yet to fill some important gaps in training healthcare professionals in the safe implementation and use of digital technologies. In this case study, we bring together the perspectives of clinicians, health system leaders, and academics to guide efforts in establishing a digitally enabled workforce in Australia. Building on published evidence, our recommendations include leveraging on recent momentum, building strong partnerships with healthcare organisations, academia, and the digital health industry, and ultimately an expansion of a digitally enabled clinical informatics and digital health workforce.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":"700-704"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649966","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":"Evaluating the outcomes of Australia's first all-age public hospital Sport and Exercise Medicine Outpatient Clinic: a retrospective cross-sectional study.","authors":"Dougal Middleton, Fintan Thompson, Kira James","doi":"10.1071/AH24245","DOIUrl":"10.1071/AH24245","url":null,"abstract":"<p><p>Objectives This study aimed to evaluate the outcomes of Australia's first public hospital all-age Sport and Exercise Medicine Outpatient Clinic (SEMOC). Methods A retrospective cross-sectional study of patients referred to and reviewed in the SEMOC, during a study period from March to October 2023, was performed. Outcomes were the number of appointments, number of patients reviewed, proportion reviewed within Queensland Health recommended timeframes, patient satisfaction, proportion of Aboriginal and Torres Strait Islander patients, and the rurality of the patients based on the Modified Monash Model of remoteness. Results There were 29 clinics, 472 allocated appointments, and 270 new patients referred to the SEMOC (1.7 appointments per patient). Almost a quarter (23.7%) of patients identified as Aboriginal and Torres Strait Islander peoples and a third (31.9%) were from rural or remote regions. Most (88.7%) patients referred during the study period were seen within the Queensland Health recommended timeframes, and almost all patients referred on for orthopaedic review were booked for surgery (93.6%). Over 90% of patients were satisfied with the quality of treatment they received and rated the overall service as good to excellent. Conclusion A SEMOC public hospital model has been shown to be feasible for providing care to patients with musculoskeletal conditions, reaching patients who face barriers to health care, reducing wait times, and improving referral for surgery. The model may assist in meeting Australia's growing demand for orthopaedic and musculoskeletal medicine and expand within Australia's public hospital system to become a nationally accepted practice.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883873","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":"Utility of a digital app to enhance patient-nurse communications and patient involvement in bedside handover: patient and nurse perceptions.","authors":"Penelope Casey, Eva Yuen, Raj Liskaser, Philippa Blencowe, Leanne Boyd, Mohamed Abdelrazek, Zoe Wang, Julie Considine","doi":"10.1071/AH23270","DOIUrl":"10.1071/AH23270","url":null,"abstract":"<p><p>Objective This study aimed to explore patient and nurse perceptions of using a prototype co-designed app to support patient-nurse communication and patient engagement in bedside handover. Methods This qualitative descriptive study evaluated usability of the app with a convenience sample of patient-nurse dyads in a 22-bed medical/oncology ward, during morning shifts. Participants were nurses, and patients proficient in English but without cognitive impairment or physical or mental distress. Patients entered healthcare questions and preferences into the app, nurses acknowledged the information in the app and responded during their usual workflow. Patient comfort level with app use was surveyed. Handovers were observed, and patient involvement rated. After handover, semi-structured interviews and feedback surveys on app usability were conducted. Interviews were recorded, transcribed, and then analysed thematically. Survey data were analysed using descriptive statistics. Results Patient-nurse dyads (n =18) used the app between March and May 2023. Patients were mostly older (median 69.5years; IQR 52.3, 75), female, and frequent users of smartphones. Nurses were mostly younger (median 23years; IQR 21, 40) and female. Five themes were identified, which indicated that using the app empowered patients to engage in healthcare communications, facilitated opportunities for patient-centred information sharing, and refocused nurses' attention onto patient-centred care. Views differed on the app's influence on patient involvement in handover. Surveys (n =36, 100%) indicated that the interface was easy to navigate, features were useful, and only minor amendments were suggested. Conclusion This prototype app shows potential to facilitate patient-centred communication and patient engagement with health care, including bedside handover. With further refinement and testing, this app could enhance experiences of care and reduce harm from miscommunication.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":"673-681"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303280","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":"Medication incidents at supported disability accommodation (group homes) in Victoria, Australia: a retrospective audit of calls to a poisons information centre.","authors":"Rita Hormiz, Beata Stanley, Rohan A Elliott","doi":"10.1071/AH24221","DOIUrl":"10.1071/AH24221","url":null,"abstract":"<p><p>Background Many residents of shared supported disability homes (sometimes referred to as group homes) require assistance from staff to manage their medicines. Disability support workers in Australia often call a 24-h emergency poisons information service for advice following a medication incident. Objective To describe the number, type and timing of medication incident calls to the Victorian Poisons Information Centre from supported disability homes in Victoria, Australia. Methods This was a retrospective audit of poisons centre calls from supported disability homes over a 3-month period (October to December 2021). Incidents not related to therapeutic medication use, including deliberate self-poisoning, were excluded. Calls were categorised by incident-type, time-of-call and risk of an adverse event (low/moderate/high) based on the type of medicine involved. Results A total of 391 medication incident calls were included (mean 4.3 per day). The most common incidents were missed doses (n =145/391, 37%) and accidental overdoses (e.g. double-dose) (n =80/391, 20%). Most calls to the poisons centre (n =284/391, 73%) were received outside business hours (before 9am or after 5pm). For incidents where the medicine(s) were known (n =326), a moderate-risk medicine (most commonly an anticonvulsant or antipsychotic) or high-risk medicine (most commonly an anticoagulant or opioid) was involved in two-thirds of cases (n =217, 66.6%). Conclusions Calls to an emergency poisons information service about medication incidents were common, and were mostly outside business hours. Nearly half of the calls were about incidents unrelated to poisoning or toxicology, including missed doses. The study highlights a gap in medication management support for residents and disability support workers, especially after-hours, that needs to be addressed.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831078","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":"Can I record this? A scoping review of Australian hospital policies governing consultation recording.","authors":"Megan Prictor, Nikka Milani, Amelia Hyatt","doi":"10.1071/AH24306","DOIUrl":"10.1071/AH24306","url":null,"abstract":"<p><p>Objective Recording consultations can benefit patients and healthcare providers, but advantageous recording practices are dogged by legal concerns. In Australia, relevant laws are poorly understood. We postulate that local policies are more important than law in guiding consultation recording. This study aimed to describe the availability and content of consultation recording policy in Australian hospitals. Methods We conducted a scoping review utilising JBI methods and our previously published protocol. We collected policies from Australian hospitals (April-October 2023) about the audio/video recording of patients, providers or others within the hospital. We reported findings descriptively and analysed policies' alignment with the law. Results Of the 43 hospitals examined, 17/43 (40%) had relevant policies, 17/43 (40%) had a partial policy and 9/43 (21%) had no policy. Policies were usually difficult to find and were stricter than relevant law. Conclusions When patients want to record their appointments, it can be hard to identify relevant hospital policy. Policies generally weigh against consultation recording and are more restrictive than Australian law allows. These results indicate that healthcare services should develop clear, readily available policies on recording, balancing patients' and providers' interests.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878927","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":"Leading innovation in transdisciplinary care.","authors":"Martin Chadwick, Jennifer R Hemler, Benjamin F Crabtree","doi":"10.1071/AH24089","DOIUrl":"10.1071/AH24089","url":null,"abstract":"<p><p>Background Benefits of effective team-based working in healthcare settings are well established, with the ultimate form being transdisciplinary teams. Achieving transdisciplinary teams at the large organisation or system level has not been extensively studied. Purpose To examine and describe exemplar organisations where transdisciplinary working was enabled and that can be reproduced in other organisations. Methods An expert panel reached consensus on three healthcare organisations in the USA that exemplified transdisciplinary working. Available public information about each organisation was reviewed and site visits with direct observation and interviews were conducted with two of the three exemplar sites (the third completed remotely due to the onset of COVID-19). The process of immersion-crystallisation was used to review the collated material and to identify key themes that were then repeatedly checked with the expert panel. Results Consistent themes were identified across all three organisations, although they each arrived at these commonalities via distinctly different routes. All had a clear and shared creation story as to how they came about as an entity, which was supported by consistent longitudinal leadership. This enabled an environment whereby each organisation created its own language that reflected their culture as an organisation, thus continually reinforcing the uniqueness of their organisation. Conclusions Large healthcare organisations can achieve the concepts of transdisciplinary practice. While no single achievement pathway was identified, common themes noted were a clear creation story, consistent leadership, and building a language that reflected the organisation.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":"682-687"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482835","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":"External validation and comparative analysis of the HOSPITAL score and LACE index for predicting readmissions among patients hospitalised with community-acquired pneumonia in Australia.","authors":"Yogesh Sharma, Arduino A Mangoni, Chris Horwood, Campbell Thompson","doi":"10.1071/AH24204","DOIUrl":"10.1071/AH24204","url":null,"abstract":"<p><p>Objective Community-acquired pneumonia (CAP) is a leading cause of emergency hospitalisations globally and is associated with high readmission rates. Specific score systems developed for all medical conditions such as the HOSPITAL score and the LACE index can also usefully predict CAP readmissions. However, there is limited evidence regarding their performance in the Australian healthcare settings. Methods This multicentre retrospective study analysed adult CAP discharges from two metropolitan hospitals in South Australia between 1 January 2018 and 31 December 2023. Data for determining the HOSPITAL score and the LACE index were derived from electronic medical records. Demographic characteristics of patients readmitted within 30 days were compared with those who were not readmitted. The scores were evaluated for overall performance, discriminatory power and calibration, with discriminatory power assessed using the concordance statistic (C-statistic). Results Over 6years, 7245 CAP discharges were recorded, with 1329 (18.3%) readmissions within 30days. The mean (s.d.) age of the cohort was 74.4 (17.8) years. Readmitted patients were more likely to have multiple morbidities and frailty than those not readmitted (P <0.05). They also had a higher mean number of emergency department presentations and hospital admissions in the previous year and a longer initial hospital stay (P <0.05). Overall, the mean (s.d.) HOSPITAL score and LACE index were 3.4 (2.1) and 9.3 (3.6), respectively. Among readmissions, 28.4% occurred in patients with a HOSPITAL score >4 (intermediate and high-risk group), while 25.8% occurred in patients in the high-risk LACE category (LACE index>10). The C-statistic for the HOSPITAL score and LACE index was 0.62 (95% CI 0.61-0.64) and 0.63 (95% CI 0.61-0.65), respectively, with no significant difference in the area under the receiver operating characteristic curves (P >0.05). Conclusions The predictive abilities of the HOSPITAL score and the LACE index for CAP readmissions are modest and comparable in an Australian setting.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":"656-663"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115892","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}