Care In Australian Hospitals Research Articles

A Scoping Review of the Barriers and Facilitators to Clinician Engagement in Hospital-Based Palliative Care in Australian Hospitals.

Background: Current research has shown that inpatient palliative care (PC) services are under-utilized, poorly integrated, and frequently introduced too late during inpatient hospital stays. The aim of this study was to identify a comprehensive list of multi-disciplinary facilitators and barriers to inpatient PC in Australian hospitals through a scoping literature review. Methods: This review identified articles published since 2000 from 3 electronic databases (CINAHL Plus, MEDLINE and Embase), which included discussion of collaboration among non-palliative care clinicians and palliative care professionals in Australian hospitals. We used an inductive approach to identifying key domains of barriers and facilitators. Results: Thirty-four articles met inclusion criteria following full text review. Barriers and facilitators were categorized in 7 domains: (1) Patient concerns, (2) Family concerns, (3) Clinician knowledge, education, and experience in palliative care, (4) Recognition and acceptance of prognosis when a patient was dying or needing end of life treatment, (5) Reconciliation of individual and professional values around PC, (6) Clinician access to resources for PC in the hospital, and (7) Communication between the PC team and ward clinicians. Each domain included potentially substantial barriers to PC delivery and practice. However, given the small sample sizes and specialized settings of many included studies, it was difficult to draw conclusions on the relative significance of different barriers across hospitals. Conclusion: This review identified a number of barriers and facilitators across studies. Subsequent research needs to more comprehensively compare factors impacting PC use in order to improve implementation of PC across hospital settings.

Evaluation of consultation liaison psychiatry in Australian public hospitals (AU-CLS-1).

This study aimed to determine whether consultation liaison psychiatric service (CLS) staffing within Australian public hospitals meet national and international minimum staffing standards. Semi structured interviews were conducted with CLS Directors across Australia from August to December 2021. Data were collected on demographics, staffing, funding, hospital size and admissions. The majority of services did not meet minimum standards for CLS staffing. Non-medical staff outnumbered medical staff with increasing rurality. Psych-oncology CLS had the greatest resources, skill mix and service breadth. Although CLS are heterogeneous, most services are inadequately resourced to provide baseline specialist mental health care in Australian hospitals. Establishing national minimum standards for CLS staffing will facilitate uniform service development and quality care provision.

Understanding end-of-life care in Australian hospitals.

Objective To explore end-of-life care in the ward and intensive care unit (ICU) environment in nine Australian hospitals in a retrospective observational study. Methods In total, 1693 in-hospital deaths, 356 in ICU, were reviewed, including patient demographics, advance care plans, life-sustaining treatments, recognition of dying by clinicians and evidence of the palliative approach to patient care. Results Most patients (n =1430, 84%) were aged ≥60 years, with a low percentage (n =208, 12%) having an end-of-life care plan on admission. Following admission, 82% (n =1391) of patients were recognised as dying, but the time between recognition of dying to death was short (ICU (staying 4-48h) median 0.34 days (first quartile (Q1), third quartile (Q3): 0.16, 0.72); Ward (staying more than 48h) median 2.1 days (Q1, Q3: 0.96, 4.3)). Although 41% (n =621) patients were referred for specialist palliative care, most referrals were within the last few days of life (2.3 days (0.88, 5.9)) and 62% of patients (n =1047) experienced active intervention in their final 48h. Conclusions Late recognition of dying can expose patients to active interventions and minimises timely palliative care. To attain alignment to the National Consensus Statement to improve experiences of end-of-life care, a nationally coordinated approach is needed. What is known about the topic? The majority of Australian patient deaths occur in hospitals whose care needs to align to the Australian Commission on Safety and Quality in Health Care's National Consensus Statement, essential elements of safe and high -quality end -of -life care. What does this paper add? The largest Australian study of hospital deaths reveals only 12% of patients have existing advance care plans, recognition of death is predominantly within the last 48h of life, with 60% receiving investigations and interventions during this time with late symptom relief. What are the implications for practitioners? Given the poor alignment with the National Consensus Statement, a nationally coordinated approach would improve the patient experience of end-of-life care.

Estimating misclassification error in a binary performance indicator: case study of low value care in Australian hospitals

ObjectiveIndicators based on hospital administrative data have potential for misclassification error, especially if they rely on clinical detail that may not be well recorded in the data. We applied an...

“On time ‐ every time” A new strategy for dosing levodopa in hospital

AbstractMost Parkinson’s Disease (PD) patients are hospitalised for reasons other than their PD. Their PD symptoms are usually under control before admission, however, too many seem to experience medication‐related problems in hospital. Hospitalised PD patients should receive their levodopa within 30 min of the scheduled time (“on time”) and not miss doses (“every time”). Hospital staff should avoid prescribing and administering contraindicated dopamine antagonists to PD patients in their care. Multiple studies have shown the failure to deliver levodopa “on time” to PD patients, with less than 50% of doses being “on time” and an average 0.7 of doses missed each day. The evidence points to hospital medication administration systems (HMAS) as the likely cause of late and missed levodopa doses. PD medication administration guidelines were reviewed to find strategies that reduced late and missed doses. An integrated “on time – every time” medication administration approach is proposed. PD patients should be encouraged to self‐administer their medication in hospital. More PD nurse navigators will be needed to facilitate PD patient care in Australian hospitals.

Glucometric benchmarking in an Australian hospital enabled by networked glucose meter technology.

To assess glucometric outcomes and to estimate the incidence of hypo- and hyperglycaemia among non-critical care inpatients in a major Australian hospital. A prospective 10-week observational study (7 March - 22 May 2016) of consecutive inpatients with diabetes or newly detected hyperglycaemia admitted to eight medical and surgical wards at the Royal Melbourne Hospital. Point-of-care blood glucose (BG) data were collected with networked glucose meters. Glycaemic control, as assessed with three glucometric models (by population, by patient, by patient-day); incidence of adverse glycaemic days (AGDs; patient-days with BG levels below 4mmol/L or above 15mmol/L). During the study period, there were 465 consecutive admissions of 441 patients with diabetes or newly detected hyperglycaemia, and 9817 BG measurements over 2953 patient-days. The mean patient-day BG level was 9.5mmol/L (SD, 3.3mmol/L). The incidence of hyperglycaemia was higher than for a United States hospital benchmark (patient-days with mean BG level above 10mmol/L, 37% v 32), and that of hypoglycaemia lower (proportion of patient-days with mean BG level below 3.9mmol/L, 4.1% v 6.1%). There were 260 (95% CI, 245-277) AGDs per 1000 patient-days; the incidence was higher in medical than surgical ward patients (290 [CI, 270-310] v 206 [CI, 181-230] per 1000 patient-days). 604 AGDs (79%) were linked with 116 patients (25%). Episodes of hyperglycaemia (BG above 15mmol/L) were more frequent before lunch, dinner, and bedtime; 94 of 187 episodes of hypoglycaemia (BG below 4mmol/L) occurred between 11pm and 8am. Glucometric analysis supported by networked glucose meter technology provides detailed inpatient data that could enable local benchmarking for promoting safe diabetes care in Australian hospitals.

Towards National Consensus: Spiritual Care in the Australian Healthcare Context

The Enhancing Quality and Safety: Spiritual Care in Health National Consensus Conference brought together key stakeholders from across Australia to agree a national framework to ensure quality and safety in spiritual care services through a nationally consistent approach to the provision of spiritual care in Australian hospitals. A working group planned the conference that was held over two days. Invitations were distributed to a wide range of stakeholders to ensure a diversity of voices contributed to the outcomes. The conference proceedings included presentations, small group work and facilitated discussion to enable progress on the conference objective. A conference report of the key outcomes was produced and widely distributed. The national consensus conference outcomes described five principles for the design and delivery of spiritual care services for the Australian context. Ten policy statements described key deliverables that could be used to benchmark and measure a nationally consistent approach to spiritual care.

Stakeholder views on the role of spiritual care in Australian hospitals: An exploratory study

Research increasingly demonstrates the contribution of spiritual care to patient experience, wellbeing and health outcomes. Responsiveness to spiritual needs is recognised as a legitimate component of quality health care. Yet there is no consistent approach to the models and governance of spiritual care across hospitals in Australia. This is consistent with the situation in other developed countries where there is increased attention to identifying best practice models for spiritual care in health. This study explores the views of stakeholders in Australian hospitals to the role of spiritual care in hospitals. A self-completion questionnaire comprising open and closed questions was distributed using a snowball sampling process. Analysis of 477 complete questionnaires indicated high levels of agreement with ten policy statements and six policy objectives. Perceived barriers to spiritual care related to: terminology and roles, education and training, resources, and models of care. Responses identified the issues to inform a national policy agenda including attention to governance and policy structures and clear delineation of roles and scope of practice with aligned education and training models. The inclusion of spiritual care as a significant pathway for the provision of patient-centred care is noted. Further exploration of the contribution of spiritual care to wellbeing, health outcomes and patient experience is invited.

Cost impact of hospital acquired diagnoses and impacts for funding based on quality signals

Background Internationally, there have been efforts to adjust hospital funding based on the quality of care provided by the hospital. A variety of approaches has been used by different countries and payers. Incorporating quality signals into activity-based funding is also a possibility for Australia. This study set out to explore the cost impact of potentially poor quality care in Australian hospitals, and to understand the implications from a funding perspective.

Should patients in a persistent vegetative state be allowed to die? Guidelines for a new standard of care in Australian hospitals.

In this article we will be arguing in favour of legislating to protect doctors who bring about the deaths of PVS patients, regardless of whether the death is through passive means (e.g. the discontinuation of artificial feeding and respiration) or active means (e.g. through the administration of pharmaceuticals known to hasten death in end-of-life care). We will first discuss the ethical dilemmas doctors and lawmakers faced in the more famous PVS cases arising in the US and UK, before exploring what the law should be regarding such patients, particularly in Australia. We will continue by arguing in favour of allowing euthanasia in the interests of PVS patients, their families, and finally the wider community, before concluding with some suggestions for how these ethical arguments could be transformed into a set of guidelines for medical practice in this area.

Adverse event rates as measures of hospital performance

ObjectivesAdverse event or complication rates are increasingly advocated as measures of hospital quality and performance. Objective of this study is to analyse patient-complexity adjusted adverse events rates to compare the performance of hospitals in Victoria, Australia. We use a unique hospital dataset that routinely records adverse events which arise during the admission. We identify hospitals with below or above average performance in comparison to their peers, and show for which types of hospitals risk adjusting makes biggest difference. MethodsWe estimate adverse event rates for 87,790 elective and 43,771 emergency episodes in 34 public hospitals over the financial year 2005/06 with a complementary log–log model, using patient level administrative hospital data and controlling for patient complexity with a range of covariates. ResultsTeaching hospitals have average risk-adjusted adverse event rates of 24.3% for elective and 19.7% for emergency surgical patients. Suburban and rural hospitals have lower rates of 17.4% and 17%, and 16.1% and 15.7%, respectively. Selected non-teaching hospitals have relatively high rates, in particular hospitals in rural and socially disadvantaged areas. Risk adjustment makes a significant difference to most hospitals. ConclusionWe find comparably high adverse events rates for surgical patients in Australian hospitals, possibly because our data allow identification of a larger number of adverse events than data used in previous studies. There are marked variations in adverse event rates across hospitals in Victoria, even after risk adjusting. We discuss how policy makers could improve quality of care in Australian hospitals.

The ACHS Care Evaluation Program: a decade of achievement. Australian Council on Healthcare Standards.

In 1989 the Australian Council on Healthcare Standards (ACHS) embarked on a programme to develop acute health care clinical indicators in conjunction with the Australian medical colleges. Through a carefully structured stepwise process this collaboration established a 'World first' in 1993 with the introduction of the first set of indicators into the ACHS Accreditation programme. The programme remains unique in the formal involvement of providers in the development process and in the scope of the clinical areas covered in acute health care. From the year 2000 there will be 18 sets (and over 200 indicators) from which health care organisations (HCOs) can choose to monitor the major services they provide. There remains no compulsion to address a specific number of indicators. The growth of the programme has been considerable with more than half of the nations' acute HCOs reporting their clinical indicator data (twice yearly) and it provides a reflection of the care given for the majority of patient separations in acute care. This reporting process allows HCOs to receive feedback on the aggregate results together with comparative peer group information for each indicator they address. In addition to numerous publications in peer reviewed journals an annual aggregate report, 'the Measurement of Care in Australian Hospitals' is published. It reports both qualitative and quantitative data on all indicator sets for the preceding year. Validity of the indicators is strengthened each year with a review process and reliability and reproducibility of the data can now be demonstrated. The clinical response to the indicators has been overwhelming and there is now documented evidence of numerous actions taken by HCOs to improve both the processes and the outcomes of patient care. The nation wide database can be expected to reflect trends in care over the next few years. The process of indicator refinement, however, will continue and it is likely that a reduction in the total number of indicators will occur with a core group of the more 'robust' indicators remaining. Further directions in indicator development are likely to be in the area of multidisciplinary care and in the assessment of longer-term outcomes. In addition to measures of the quality of care, hopefully, in time, health care providers will also take part in the establishment of measures of the appropriateness of that care.

Feasibility of national benchmarking of patient satisfaction with Australian hospitals.

This paper discusses the feasibility of developing national benchmark questions on patient satisfaction with hospital care in Australian hospitals. The research was undertaken for the Australian government under the National Health Outcomes Programme. The paper draws on a review of research with consumers to identify issues of importance to them about hospital care. The Australian sources were reports by consumer and community organizations, research reports by hospitals, governments and academics, and data from complaints authorities. The emphasis was on consumers' own views. The main debates on patient satisfaction methodology were reviewed. Published material from the USA and Britain highlighting organizational policy issues was reviewed, as well as literature on benchmarking. Material was obtained through journal searches and identification of organizations which undertake consumer-oriented or service development research. The paper argues that national benchmarking of patient satisfaction is not reliable because patient satisfaction is a poorly understood concept and not a unitary concept. Also, the paper argues that benchmarking is about processes, and that the link between survey results and hospital processes is not well researched or understood. While patient satisfaction surveys appear to promote consumer perspectives, they remain caught within a passive approach to consumer participation in shaping service development and improving the quality of hospital care. The task of government is to mandate consumer feedback, resource the development of expertise and technologies, trial and evaluate approaches to obtaining feedback, disseminate research and effective models, and resource consumer organizations to be participants at all stages. This is described as providing the resources for benchmarking at local levels.

A typology for legal risk management in patient care in Australian hospitals.

The author reviewed the literature on legal risk management in patient care, and carried out research in two acute care hospitals. The hospital research involved auditing policies and procedures, interviewing key people in the hospital, reviewing external legal and policy trends, and examining selected complaints files and legal cases. The results were used to develop a 'typology' of legal risk management to provide guidelines and assistance to hospital management in improving their hospital's strategic response to legal vulnerability. The model sets out four levels of legal risk management programs, and identifies specific components classified as promoting loss prevention, or loss minimisation.