Box Hill Hospital Research Articles

Eastern Health, Box Hill Hospital and Maroondah Hospital. Melbourne, Australia.

Box Hill Hospital has approximately 750 stroke presentations per annum and in 2023, 99 patients received thrombolysis and 40 were transferred out for thrombectomy. Thrombolysis rates, for patients with ischaemic stroke that present within 4.5 hours of symptom onset, was at 37%, with a median door-to-needle (DNT) of 41 minutes, 86% of cases being treated under 60 minutes of arrival and our fastest DNT being 16 minutes. Meidan DIDO was 47 minutes with the fastest recorded 17 minutes. Reperfusion time metrics have improved significantly over the years with the biggest impact being from a direct to CT protocol, organisational coordination and the presence of an Acute Stroke Nurse (ASN) for patients receiving thrombolysis.

COBRA: COde Blue Retrospective Audit in a metropolitan hospital.

Inhospital cardiac arrest (IHCA) is an uncommon but challenging problem. To investigate the management and outcomes of IHCA, and to investigate the effect of introducing a medical emergency team (MET) on IHCA prevalence. Retrospective medical record review of 176 adult IHCA episodes at Box Hill Hospital, a university-affiliated public hospital in metropolitan Melbourne, from July 2012 to June 2017. Inpatients receiving cardiopulmonary resuscitation for IHCA, in inpatient wards, intensive care unit, cardiac catheterisation laboratory and operating theatres were included. Data collected included demographics, resuscitation management and outcomes. Average treatment effect (ATE) was derived from margins estimates and linear regression fitted to hospital outcome, adjusted for IHCA factors. An exponentially weighed moving average control chart was used to explore IHCA prevalence over time. There were 65.3% of IHCA patients who died in hospital. IHCA prevalence was unchanged after the introduction of a dedicated MET service. Factors associated with higher likelihood of survival to discharge were initial cardiac of rhythm ventricular tachycardia (VT) (ATE 0.10 (95% CI = -0.03 to 0.25)) or ventricular fibrillation (VF) (ATE 0.28 (95% CI=0.11-0.46)), cardiac monitoring at the time of arrest (ATE 0.06 (95%CI = -0.04 to 0.16)) and time to return of spontaneous circulation (ATE 0.023 (95% CI=0.015-0.031)). IHCA is uncommon and is associated with high mortality. IHCA prevalence was unchanged after the introduction of a dedicated MET service. Factors associated with improved survival to hospital discharge were initial rhythm VT or VF, cardiac monitoring and shorter resuscitation times.

Impact of SARS-CoV-2 transmission-based precautions on inpatient management of general medical patients.

This audit reviewed the impact on access to routine medical care and adverse outcomes in patients with suspected SARS‐CoV‐2 infection managed on a ‘COVID‐19’ (CV) ward compared with a general medicine ward at Box Hill Hospital, Victoria. Data were collected at two time points to capture changes associated with onsite testing. We found no healthcare delays from admission to CV wards and observed faster exits from CV wards with improved testing efficiency. This critical finding is relevant as Victoria manages a third wave of infections.

Epidemic thunderstorm asthma

Epidemic thunderstorm asthma

Is there a difference in adenoma detection rates between gastroenterologists and surgeons?

AIMTo compare the adenoma detection rate (ADR) between gastroenterologists and colorectal surgeons at Box Hill Hospital, Melbourne, Australia.METHODSA total of 300 colonoscopies performed by gastroenterologists and colorectal surgeons at Box Hill Hospital were retrospectively reviewed from May 2016 to June 2017. Exclusion criteria were: Patients ≤ 50 years old, colonoscopies with failure of caecal intubation, patients who previously had colon cancer and/or a colonic resection, history of polyposis syndromes or inflammatory bowel disease, or a colonoscopy within the last 10 years. Patient demographics, indications, symptoms and procedural-related outcomes were measured.RESULTSThe ADR was not significantly different between gastroenterologists and colorectal surgeons (34% vs 34.67%; P = 0.90). The adjusted odds ratio correcting for gender, age, 1st degree relative with colorectal cancer, previous colonoscopy, trainee involvement and caecal or terminal ileum intubation rate was 1.19 (0.69-2.05).CONCLUSIONBoth specialties at our institution exceed benchmark standards suggested by published Australian and American guidelines. An association between endoscopist specialty and ADR was not observed.

Immunohistochemical (IHC) biomarkers associated with response and survival following lenalidomide and prednisolone maintenance post-ASCT in patients with MM: an exploratory, hypothesis generating sub-study of the LEOPARD trial

BP-015 Immunohistochemical (IHC) biomarkers associated with response and survival following lenalidomide and prednisolone maintenance postASCT in patients with MM: an exploratory, hypothesis generating sub-study of the LEOPARD trial A. Kalff, N. Kennedy, P. Walker, T. Khong, A. Schwarer, A.W. Roberts, P. Campbell, R. Filshie, J. Reynolds, A. Thakurta, M. Wang, S. Cuoto, Y. Ren, A. Spencer Alfred Hospital, Monash University, Melbourne, Vic, Australia; Box Hill Hospital, Box Hill, Vic, Australia; Royal Melbourne Hospital, Vic, Australia; Geelong Hospital, Vic, Australia; St Vincents Hospital, Melbourne, Vic, Australia; Celgene Corporation

Synovial White Cell Count in the Diagnosis of Septic Arthritis: Are Current Diagnostic Practices Appropriate?

Introduction & aims: Septic arthritis is an emergency, potentially causing irreversible joint destruction and disability. Synovial WCC and polymorphonuclear cell percentage are the best predictors of septic arthritis likelihood. Yet, synovial white cell and differential count are not routinely assessed. We aim to investigate the incidence of failure to perform these tests, and to develop correct synovial fluid analysis practices. Method: This is a retrospective analysis of native joints having undergone arthrocentesis for suspicion of septic arthritis at Box Hill Hospital (BHH) during September 2011 and September 2013 inclusive. Recruitment was from the Eastern Health Decision Support Service (DSS), a database compiled from all systems within Eastern Health, of which BHH is a member. The study was limited to large joints, including hip, knee and shoulder. All prosthetic joints were excluded from the patient population. All patient histories were examined for suspicion of septic arthritis and subsequent arthrocentesis. Pathology records were accessed to determine incidence of cell count and differential. Results: One hundred and thirty-six cases of joint aspirations were identified within the time frame, of which sixty-seven fitted our criteria for evaluation. All but two cases were delivered using the DSS, which was limited to data compiled only until June 2013. The two remaining cases were identified with a manual search of the radiology and pathology databases from June to September 2013. 22 of the 67 joint aspirates studied did not have a cell count carried out. Four of these 22 cases had a diagnosis of septic arthritis. In five aspirates, there was a failure to confirm a definite diagnosis and they were thus conservatively treated as a septic joint. The remaining acute joints in which no cell count was done were gout (7 cases), pseudogout (5 cases) and rheumatoid arthritis (1 case). Cell counts were not routinely detected for a variety of reasons. Eleven aspirates were deemed too viscous, and in eight cases the sample had clotted prior to pathologist assessment. Two cases had insufficient volume, and one sample was too bloodstained to calculate a cell count and differential; likely due to traumatic aspiration. Conclusions: 33% of acute monoarthritis’ evaluated over the study period failed to have a synovial fluid WCC and differential. This may be due to inadequate samples, or lack of appropriate collection tube. Better education is required for appropriate collection and test requesting wherein a diagnosis of septic arthritis is in question.

Comparative outcome of patients undergoing percutaneous coronary intervention (PCI) following fibrinolysis or primary PCI for ST-elevation myocardial infarction

K. Rankin1,∗, A. Brennan2, N. Andrianopoulos 2, M. Sebastian1, M. Freeman3, T. Yip1, A. Ajani 4, D. Clark5, C. Reid2, J. O’Brien6, E. Oqueli 7, S. Duffy 6 1University Hospital, Geelong, VIC, Australia 2 Monash University CCRET Centre of Cardiovascular Research & Education in Therapeutics, VIC, Australia 3 Box Hill Hospital, VIC, Australia 4 Royal Melbourne Hospital, VIC, Australia 5 Austin Hospital, VIC, Australia 6 Alfred Hospital, VIC, Australia 7 Ballarat Base Hospital, VIC, Australia

Comparative Outcomes Following Percutaneous Coronary Intervention (PCI): The Victorian Cardiac Outcomes Registry (VCOR)

K. Rankin1,∗, A. Brennan2, N. Andrianopoulos 2, M. Sebastian1, M. Freeman3, T. Yip1, A. Ajani 4, D. Clark5, C. Reid2, J. O’Brien6, E. Oqueli 7, S. Duffy 6 1University Hospital, Geelong, VIC, Australia 2 Monash University CCRET Centre of Cardiovascular Research & Education in Therapeutics, VIC, Australia 3 Box Hill Hospital, VIC, Australia 4 Royal Melbourne Hospital, VIC, Australia 5 Austin Hospital, VIC, Australia 6 Alfred Hospital, VIC, Australia 7 Ballarat Base Hospital, VIC, Australia

Abstract W P177: Direct to CT: Overcoming Barriers to Reduce Door to Needle times in Acute Stroke Patients

Background: Taking acute stroke patients direct from triage to the CT scanner can reduce thrombolysis treatment times, which can improve patient outcomes. In May 2013, Box Hill Hospital introduced a Direct to CT policy for acute stroke patients who are called through as a Code Stroke by the ambulance service within business hours (8am-4.30pm) Monday to Friday. Method: We performed a prospective study comparing door-to-CT times (DTCT) and door-to-needle (DTN) times pre- and post-implementation of Direct to CT, and examined patient characteristics, Emergency Department (ED) presentation time, adverse effects, protocol violations and patient outcomes. Delays in treatment, enablers and barriers to treatment were also examined. Results: There was no statistical difference in demographics or clinical factors in patients who presented pre- (January-April, n=21) or post- Direct to CT (May-July, n=29). However, a reduction in median DTCT times (27 mins vs. 16 mins, p=0.01) and DTN times (97 mins vs. 52 mins, p<0.001) was seen. There was no increase in thrombolysed mimics (4.8% vs. 3.4%, p=0.82), protocol violations (9.5% vs. 0%, p=0.17) or adverse outcomes (33% vs. 35%, p=0.93) in patients taken Direct to CT. There was no difference in patient outcomes, however the current study size is small. Numerous barriers to Direct to CT were identified within four categories: pre-hospital, ED, CT and the stroke team, and issues included: lack of paramedic intravenous cannulation, ED resources, and stroke team indecisions; some of which are ongoing and are taking considerable time and efforts to overcome. Conclusions: Taking patients Direct to CT has significantly reduced time to treatment and further improvements may be achieved through resolution of identified barriers.

Commentary on the KDIGO Clinical Practice Guideline for the management of blood pressure in chronic kidney disease

NephrologyVolume 19, Issue 1 p. 53-55 Original Article Commentary on the KDIGO Clinical Practice Guideline for the management of blood pressure in chronic kidney disease Matthew A Roberts, Corresponding Author Matthew A Roberts Department of Renal Medicine, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia Correspondence: Dr Matthew Roberts, Dept of Nephrology, Box Hill Hospital, Eastern Health, Level 2, 5 Arnold St, Box Hill, Vic. 3128, Australia. Email: matthew.roberts@easternhealth.org.auSearch for more papers by this author Matthew A Roberts, Corresponding Author Matthew A Roberts Department of Renal Medicine, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia Correspondence: Dr Matthew Roberts, Dept of Nephrology, Box Hill Hospital, Eastern Health, Level 2, 5 Arnold St, Box Hill, Vic. 3128, Australia. Email: matthew.roberts@easternhealth.org.auSearch for more papers by this author First published: 15 October 2013 https://doi.org/10.1111/nep.12168Citations: 13Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume19, Issue1January 2014Pages 53-55 RelatedInformation

Abstract TP251: The Direct and Indirect Impact of the Acute Stroke Nurse Role on Thrombolysis Treatment Times and Rates

Background: The Acute Stroke Nurse (ASN) role at Box Hill Hospital is a business hours (weekday 8am - 4.30pm) first responder role designed to fast track acute stroke patients through thrombolysis screening in the Emergency Department. Since 2004, this role has been filled in either a full-time (FT) or part-time (PT) capacity, except for a 5-month period in 2010 where the role was vacant. We sought to explore the influence of having a full-time ASN, compared to part-time or no ASN, on thrombolysis rates and times. Methods: Data was extracted from the hospital’s stroke thrombolysis database for the period 2004 to 2012. Comparisons were made for those patients seen by the ASN, when FT and PT and those who saw medical staff only. Statistical comparisons were made using Mann-Whitney Rank Sum test. Results: Almost half (43% n=182) of the 428 thrombolysis cases occurred during business hours, the ASN attended 84% of cases when the role was filled FT and 15% when PT. No difference was seen in median door-to-CT times (25 minutes.) Faster median door-to-needle times were achieved during business hours when the patient was seen by the ASN compared to those who were not (66 mins vs. 83 mins, p=<0.001.) Faster times were seen when the ASN role was FT (68 min) or PT (79 min) compared to vacant (89 mins, p=0.006,) with more patients treated within 60 minutes of arrival (35% FT, 27% PT and 8% vacant, NS). While the ASN only works within business hours, faster door-to-needle times were seen after hours when the ASN role was filled FT and PT compared to vacant (87mins and 100 mins vs. 103 mins, p=0.013;) and treatment was only commenced under 60 minutes when the ASN was employed FT. Conclusion: The Acute Stroke Nurse role seems to have a positive impact on thrombolysis treatment times and rates, with the best results being achieved during and outside business hours when the ASN is employed FT.

Trends in PCI Over the Last Decade at Box Hill Hospital (BHH)

Trends in PCI Over the Last Decade at Box Hill Hospital (BHH)

PWE-181 Pancreatic exocrine function after major upper gastrointestinal surgery measured with a carbon 13 mixed triglyceride breath test

IntroductionMajor upper gastrointestinal resectional surgery, including oesophagectomy, gastrectomy and pancreatico-duodenectomy, can result in post-operative nutritional difficulties, which may in part be associated with reduced pancreatic exocrine function, but there is...

A Decade of PCI Experience with Off-site Surgical Back-up at Box Hill Hospital: What Have We Learnt?

A Decade of PCI Experience with Off-site Surgical Back-up at Box Hill Hospital: What Have We Learnt?

Good cop, bad cop: challenging patients to make hard decisions about aggressive treatment

This is a case study that focuses on two acute presentations of diabetic foot ulcerations. Both men had a history of previous ulceration and presented to the Emergency Department at Box Hill Hospital with acutely infected weight-bearing foot ulceration caused by blistering. Both men worked in manual occupations and were subsequently weight-bearing for a large part of the day. In both cases a Total Contact Cast was decided to be the most effective means of treatment. Upon discharge from hospital, one of the men took a week’s sick leave from him occupation and his ulceration improved rapidly, so much so that he didn’t require a second week of total contact casting. The wound quickly healed and he has had no further problems to date and has returned to work as usual. The second man was in a Total Contact Cast for one week. On review, the Podiatrist determined that he would benefit from a second week in a TCC. The patient refused this treatment as it was inconvenient to his workplace and he didn’t like the TCC. He was treated with a padded CAM walker. Unfortunately he presented with an acute infection one week later and subsequently required a transmetatarsal amputation. He also had to take several weeks sick leave from his workplace and had to be slowly rehabilitated into the workplace post-amputation. These cases have highlighted the benefits of aggressive treatment when dealing with weight-bearing diabetic foot ulcerations. Quite often as Podiatrists, we don’t want to cause inconvenience to the patient’s working life, but this may in fact be to the patient’s detriment. Sometimes to provide the best patient centred care, we need to be the ‘bad cop’ and make unpopular decisions that will offer the best results.

‘Paging Podiatry!’: an audit of acute inpatient podiatry referrals

Background In 2010, the Box Hill Hospital podiatry department increased staffing levels from 0.6 to 1.6 EFT. Historically a limited High Risk Foot outpatient service, this increase meant there was more time available to build the much needed inpatient service. Promotion of the new service has resulted in a substantial increase in podiatry referrals from the acute wards. The Podiatry Department has also established close links with the Vascular Surgery Department and is a part of their Outpatient Clinic. Once received, the podiatry referrals are routinely triaged into prioritisation categories, according to the severity of the described complaint and any reported comorbidities. Category 1 and 2 referrals essentially revolve around active foot wounds and complications that require an immediate podiatry response. Category 3 and 4 referrals are less medically urgent and not seen as a priority to the service.

All-Oral Antibiotic Treatment for Buruli Ulcer: A Report of Four Patients

1Department of Infectious Diseases, Austin Health, Melbourne, Australia, 2Department of Surgery, Box Hill Hospital, Melbourne, Australia, 3Department of Surgery,Monash University, Melbourne, Australia, 4Department of Anatomy and Developmental Biology, Monash University, Melbourne, Australia, 5WHO Collaborating Centrefor Mycobacterium ulcerans (Western Pacific Region) and Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia, 6Department of AnatomicalPathology, Box Hill Hospital, Melbourne, Australia, 7Department of Infectious Diseases, Royal Children’s Hospital, Melbourne, Australia

Transferring patients for primary angioplasty in eastern Melbourne (the SHIPEM registry): are we meeting the guidelines?

To compare clinical outcomes between patients with ST-elevation myocardial infarction (STEMI) presenting to a hospital with facilities for primary percutaneous coronary intervention (PCI) and patients transferred from a non-PCI-capable unit, and to determine the success rate of meeting clinical guidelines for management of STEMI. Prospective study of patients with STEMI who underwent PCI at Box Hill Hospital (BHH), Melbourne, between 1 July 2002 and 30 June 2008. We compared two patient groups: "BHH patients", who were admitted directly to BHH (a hospital with PCI capability), and "SHIPEM (Shipping Infarcts for Primary Angioplasty in Eastern Melbourne Registry) patients", who were transferred from other hospitals without PCI capability. Clinical outcomes; symptom-to-first-door time (time between symptom onset and arrival at first hospital); first-door-to-balloon time (time between arrival at the first hospital and inflation of the angioplasty balloon); compliance with Cardiac Society of Australia and New Zealand/National Heart Foundation of Australia (CSANZ/NHFA) guidelines for management of patients with STEMI. There were 598 patients in the BHH group and 189 in the SHIPEM group. The median first-door-to-balloon time was 89 minutes (interquartile range [IQR], 69-107 minutes) for BHH patients and 128 minutes (IQR, 104-157 minutes) for SHIPEM patients. These figures did not vary significantly over the 6 years of the registry. In the BHH group, 180 patients (30.1%) had a symptom-to-first-door time of < or = 60 minutes, with 32 (17.8%) receiving PCI in < or = 60 minutes. The corresponding figure for the SHIPEM group was 48 patients (25.4%), with 1 (2.1%) receiving PCI within 60 minutes. In the BHH group, 304 patients (50.8%) had a symptom-to-first-door time of 61-180 minutes, with 166 (54.6%) receiving PCI in < or = 90 minutes. In the SHIPEM group, 50 patients (26.5%) had a symptom-to-first-door time of > 180 minutes, with 21 (42.0%) receiving PCI in < or = 120 minutes. Our study demonstrates that transfer for PCI is feasible and safe in selected patients, with outcomes comparable to those of patients presenting to a PCI-capable unit. However, the CSANZ/NHFA targets, predicated by symptom-to-first-door time, are not being met and have not improved over time, which suggests that strategies to improve symptom-to-first-door, first-door-to-balloon and transfer times need to be addressed.

Thirty-Day and 1 Year Clinical Follow up of PCI Patients at Box Hill Hospital

Thirty-Day and 1 Year Clinical Follow up of PCI Patients at Box Hill Hospital