Hospitals In Queensland Research Articles

Measuring success: program fidelity of Queensland's child health home visiting services. A document analysis.

The Family CA.R.E. (Community-based Assistance Resourcing and Education) program was introduced in Queensland two decades ago. It aimed to redress health inequalities for infants from families experiencing specific social stressors. The program has been locally adapted over time and has not been evaluated against the original program. This study assessed the extent to which selected hospital and health services in Queensland, Australia have modified the original Family C.A.R.E. Altheide's model was used to facilitate a critical document analysis of policies and guidelines for adapted Family C.A.R.E. home visiting programs in use by hospital and health services (target n=7). Five of seven eligible services provided service model documentation. There was low alignment with the original Family C.A.R.E. program across four of the five participating services. While the program delivered within Service 4 was highly aligned to the structure and intent of the original model, variation to the program was still evident. Importantly, four of the five participating programs were not collecting evaluation measures. Health services have adapted the original Family C.A.R.E program format to 'fit' the local service environment but have largely failed to collect data to facilitate evaluation. Inability to evaluate the program leads to uncertainty about program success and benefits as well as any unintended consequences for families engaging in unevaluated home visiting programs. This study highlights the importance of monitoring program fidelity and evaluating success given the potential ramifications for this vulnerable cohort and for health service delivery.

Understanding compensable and non-compensable patient profiles, pathways and physical outcomes for transport and work-related injuries in Queensland, Australia through data linkage

IntroductionIn many jurisdictions, people experiencing an injury often pursue compensation to support their treatment and recovery expenses. Healthcare costs form a significant portion of payments made by compensation schemes. Compensation...

General surgical unit experience of traumatic vascular injuries in an Australian regional hospital

Background: Vascular trauma is a significant burden to the regional community due to the associated high morbidity and mortality from the complications of the injuries. This may be due to the complexity of the injuries and the issues with initial management at the regional hospitals. Vascular injury management training should improve the outcome of initial surgical management by the general surgical team in regional centres. The study aims to describe the epidemiology and management of vascular injury in regional hospitals in Queensland, Australia.Methods: A retrospective descriptive analysis was performed using the data of patients with traumatic vascular injuries between January 2017 and July 2021 presented to Hervey Bay hospital in Queensland, Australia.Results: Fifty-nine patients with vascular injuries were reviewed. The reported number of penetrating and blunt trauma cases were 43 (72.9%) and 16 (27.1%) respectively, and 42 (71.2%) were males. Most mechanisms of injury were cuts (n=32, 54.2%), followed by falls (n=16, 27.1%) and stabs (n=11, 18.7%). Fifty-one (86.4%) were initially surgically managed regionally, with 21 (35.6%) requiring transfer to a tertiary trauma centre. Outcomes of the incidents resulted in one (1.7%) patient requiring amputation, three (5.1%) needing a fasciotomy and the mortality of two (3.4%) patients.Conclusions: Vascular trauma causes a significant burden to Australian regional hospitals. Identifying injury patterns and common causes for vascular injury will help in early identification and prompt management. Vascular trauma management training should improve the quality of care from the general surgeons in the regional centres.

Outpatient Letters in Real Time for Better Patient Outcomes

The Sunshine Coast Hospital and Health Service commenced a six-month proof-of-concept to trial speech recognition and self-type software in 2020. This action was taken in response to an ageing medical transcription workforce; an increase in outpatient letters due to population growth and the novel coronavirus pandemic; and more timely transfer of care communication to GPs. The proof-of-concept presented the health service with a unique opportunity as no other public hospital in Queensland had leveraged speech recognition or self-type software for the production and distribution of outpatient letters. The proof-of-concept trial provided 18 clinicians with the choice to type or dictate outpatient letters, electronically sign, and distribute to referring general practitioners (GPs) in one transaction. The results of the proof-of-concept demonstrated a 39% uptake of speech recognition and self-type software, demonstrating an opportunity to supplement the medical transcription workforce to address the rising outpatient activity. The proof-of-concept also demonstrated an average reduction in transaction time of 25% from the baseline measure over the six-month trial period. This finding supports the timely transfer of communication to GPs. However, it will need to be carefully analysed against the participant frustrations of voice to text accuracy to minimise the risk of poor adoption.

Requesting air ambulance transport of patients with suspected appendicitis: The decision-making process through the eyes of the rural clinician.

The primary aim is to explore rural clinicians' self-reported knowledge, skills and attitudes in the decision-making process for requesting aeromedical retrieval of patients with suspected appendicitis. A secondary aim is to understand the supports and barriers of rural clinicians experience in this clinical scenario. Clinician interviews conducted face-to-face in three rural hospitals in Central Queensland. Rural doctors and nurses. A five-part qualitative content analysis. The majority of 44 participants identified the strong and effective teamwork. The decision to request aeromedical retrieval was a shared, joint process and identified a supportive collegial culture which supported the asking of questions and not expecting to have all the answers. Perceived barriers were lack of receiving clinicians understanding of transfer agreements, and data connectivity. Clinician pessimism was identified for perceived patient outcomes. Effective teamwork can nurture trust and collaboration across multiple health service roles. High job satisfaction may counter the physical isolation in some rural environments. Fragmentation of care is the unintended consequence of interhospital transfer and may impact rural clinicians' perception of patients' outcomes and hinder receiving clinicians' understanding of rural service limitations. Future work in the area of linked electronic medical records could remove a barrier for rural clinicians and improve their reflective practice by challenging their perception of definitive patient outcomes. Increased awareness by receiving clinicians of the limitation of rural services, may minimize communication barriers and thereby, improve timely patient care transfers.

Evaluation of a closed loop-blood sampling system in intensive care: A pilot randomised controlled trial. The ENCLOSE trial

To test the feasibility of conducting a randomised controlled trial to evaluate the impact of a closed-loop blood sampling system and blood conservation bundle. Single site, parallel group, pilot randomised control trial comparing open system sampling to closed system sampling and conservation bundle aligned with national guidelines. Randomisation sequence was generated by an independent statistician and allocation concealment maintained via sealed opaque envelopes. The study setting was the general intensive care unit of a major metropolitan public hospital in Queensland, Australia. Participants were≥18years who had an arterial catheter inserted in intensive care. Main outcome measures included trial feasibility, blood sample loss, haematocrit (HCT) change, and packed red blood cell transfusion use. Eighty patients were randomised (n=39 open group, n=41 closed group). Characteristics in each group were equal at baseline with overall median age 60years (IQR 48.6-70.4), 58% male, and median APACHE II score 16 (IQR 11-22). The proportion of patients eligible was 29% and missed eligible was 65%. Otherwise, feasibility criteria were met with proportion of eligible patients agreeing to enrolment 99%, 100% of patients receiving allocated treatment; only 1% of data missing. Analysis demonstrated a significant reduction in mean daily blood sample losses (open 32.7 (SD 1.58) mL vs closed 15.5 (SD 5.79) mL, t =-8.454, df=78, p<0.001). A large, multi-site trial is feasible with enhanced eligibility criteria, increased recruitment support. The intervention reduced daily blood sample volumes and transfusion use. Further trials are required to provide both effectiveness and implementation outcomes.

Show me the money: how do we justify spending health care dollars on digital health?

Show me the money: how do we justify spending health care dollars on digital health?

Communication and access to healthcare: Experiences of Aboriginal and Torres Strait Islander people managing pain in Queensland, Australia.

Pain management requires a multidisciplinary approach and a collaborative relationship between patient-provider in which communication is crucial. This study examines the communication experiences of Aboriginal and Torres Strait Islander patients and Aboriginal and Torres Strait Islander Hospital Liaison Officers (ATSIHLOs), to improve understanding of how pain is managed in and through patient-health professional communication. This qualitative study involved a purposive sample of patients attending three persistent pain clinics and ATSIHLOs working in two hospitals in Queensland, Australia. Focus groups and in-depth interviews explored the communication experiences of patients managing pain and ATSIHLOs supporting patients with pain. This study adopted a descriptive phenomenological methodology, as described by Colaizzi (1978). Relevant statements (patient and ATSIHLOs quotes) about the phenomenon were extracted from the transcripts to formulate meanings. The formulated meanings were subsequently sorted into thematic clusters and then integrated into themes. The themes were then incorporated into a concise description of the phenomenon of communication within pain management. Findings were validated by participants. A total of 21 Aboriginal and Torres Strait Islander participants were involved in this study. Exploration of the communication experiences of patients and ATSIHLOs revealed overlapping themes of important barriers to and enablers of communication that affected access to care while managing pain. Acknowledging historical and cultural factors were particularly important to build trust between patients and health professionals. Some patients reported feeling stigmatized for identifying as Aboriginal and Torres Strait Islander, while others were reluctant to disclose their background for fear of not having the same opportunity for treatment. Differences in the expression of pain and the difficulty to use standard pain measurement scales were identified. Communication was described as more than the content delivered, it is visual and emotional expressed through body language, voice intonation, language and the speed of the conversation. Communication can significantly affect access to pain management services. Aboriginal and Torres Strait Islander patients highlighted the burden of emotional pain caused by historical factors, negative stereotypes and the fear of discrimination. Pain management services and their health professionals need to acknowledge how these factors impact patients trust and care.

Improving paediatric antimicrobial stewardship in remote and regional Queensland hospitals: development and qualitative evaluation of a tailored intervention for intravenous-to-oral antibiotic switching

ObjectivesTimely intravenous-to-oral antibiotic switching for children is important for paediatric antimicrobial stewardship (AMS). However, low decision-making confidence and fragmentation of patient care can hamper implementation, with difficulties heightened regionally where...

Colonoscopy quality of GP endoscopists in three rural hospitals in Queensland, Australia.

Rural general practitioners (GPs) are responsible for delivering primary and secondary care to rural populations in Australia. There is limited literature investigating the performance of GP endoscopists. Theaim of this study was to investigate the colonoscopy performance of three GP endoscopists in rural Queensland against current Australian quality indicator (QI) standards. A cross sectional study investigated eligible colonoscopies between January 2018 and February 2021by three GP endoscopists in three rural hospitals inQueensland, Australia. A total of 1674 colonoscopies were investigated. The GP endoscopists demonstrated high QI performance, above the recommended benchmarks. Caecal intubation rate, adenoma detection rate, sessile serrated adenoma/polyp detection rate and clinically significant serrated polyp detection rate were 97.9%, 49.5%, 16% and 14.1% respectively. The major colonoscopy-related complications rate was 0.06%. Rural GP endoscopists potentially can deliver safe, high-quality colonoscopy services for rural communities and can have an integral part in facilitating colorectal cancer prevention and treatment in rural communities.

Pre-hospital predictors of long-term survival from out-of-hospital cardiac arrest

ObjectiveTo identify predictors of longer-term outcomes from adult out-of-hospital cardiac arrest of presumed cardiac aetiology. MethodsIn this retrospective cohort study, three large routinely collected databases were linked: 1)QAS Out-of-Hospital Cardiac (OHCA) Registry; 2)Queensland Hospital Admitted Patient Data Collection; and 3)Queensland Registrar General Death Registry. Participants were adult (18years+) residents of Queensland, who suffered an OHCA of presumed cardiac aetiology and had resuscitation attempted by QAS paramedics between 2002 and 2014. Four mutually exclusive outcomes were analysed: 1) No pre-hospital return of spontaneous circulation (ROSC) sustained to the Emergency Department (ED) or ROSC in ED; 2) Survival< 30 days (Pre-hospital ROSC sustained to ED or ROSC in ED but death within 30 days; 3) survival between 30 and 364 days; and 4) survival to 365 + days. Multinomial logistic regression was used to calculate odds ratios and 95 % confidence intervals. ResultsVariables significantly predictive of survival to 365 + days after adjusting for all measured confounders are: an initial shockable rhythm; bystander witnessed events with bystander CPR; paramedic witnessed events; intubation placement; time of day (midday-2.59 pm); and attendance by Critical Care Paramedic (CCP). ConclusionFrom a service provision perspective, attendance of a CCP at an OHCA may be an important factor to achieve preferred long-term outcomes. Enhanced experience, exposure and expertise, together with extended clinical practice, may explain this finding.

Impact of a prospective feedback loop on care review activities in older patients at the end of life. A stepped-wedge randomised trial

BackgroundHospitalisation rates for older people are increasing, with end-of-life care becoming a more medicalised experience. Innovative approaches are warranted to support early identification of the end-of-life phase, communicate prognosis, provide care consistent with people’s preferences, and improve the use of healthcare resources. The Intervention for Appropriate Care and Treatment (InterACT) trial aimed to increase appropriate care and treatment decisions for older people at the end of life, through implementation of a prospective feedback loop. This paper reports on the care review outcomes.MethodsA stepped-wedge randomised controlled trial was conducted in three large acute hospitals in Queensland, Australia between May 2020 and June 2021. The trial identified older people nearing the end of life using two validated tools for detecting deterioration and short-term death. Admitting clinical teams were provided with details of patients identified as at-risk with the goal of increasing awareness that end of life was approaching to facilitate appropriate patient centred care and avoid non-beneficial treatment. We examined the time between when the patient was identified as ‘at-risk’ and three outcomes: clinician-led care review discussions, review of care directive measures and palliative care referrals. These were considered useful indicators of appropriate care at the end of life.ResultsIn two hospitals there was a reduction in the review of care directive measures during the intervention compared with usual care at 21 days (reduced probability of − 0.08; 95% CI: − 0.12 to − 0.04 and − 0.14; 95% CI: − 0.21 to − 0.06). In one hospital there was a large reduction in clinician-led care review discussions at 21 days during the intervention (reduced probability of − 0.20; 95% CI: − 0.28 to − 0.13). There was little change in palliative care referrals in any hospital, with average probability differences at 21 days of − 0.01, 0.02 and 0.04.DiscussionThe results are disappointing as an intervention designed to improve care of hospitalised older people appeared to have the opposite effect on care review outcomes. The reasons for this may be a combination of the intervention design and health system challenges due to the pandemic that highlight the complexity of providing more appropriate care at the end of life.Trial registrationAustralia New Zealand Clinical Trial Registry, ACTRN12619000675123 (registered 6 May 2019).

'Burr holes in the bush': Clinician preparedness for undertaking emergency intracranial haematoma evacuation surgery in rural and regional Queensland.

Delayed inter-hospital transfers of deteriorating neurotrauma patients from rural and regional hospitals to tertiary centres have seen the need for non-neurosurgeons to undertake emergency intracranial haematoma evacuation surgery locally. In the present study, the authors contributed to the paucity in the literature regarding the widespread availability of cranial access equipment in non-tertiary centres and patient outcomes in Queensland. We surveyed delegates (senior theatre nurses or surgical service directors) from rural and regional Queensland hospitals if they were located outside the local catchment of a tertiary centre and had a CT scanner. Questions regarded availability, location and storage conditions of mechanical cranial access kits, as well as last usage, and associated patient outcomes. Twenty-six delegates from eligible hospitals responded. Eighteen hospitals offered surgical services. Eleven hospitals housed complete mechanical cranial access kits. Five hospitals housed incomplete kits. Thirteen hospitals housed their equipment sterile in the operating theatre or ED. Eleven hospitals reported using the equipment, with last usage ranging from 4months to over 30 years. Two hospitals reported using the equipment within 12 months while a further five reported using it within 10 years. Two hospitals reported 'good' outcomes, two 'ok' and one 'poor'. The availability of cranial access equipment outside Queensland tertiary centres has been limited. Inter-hospital transfers are likely to persist in Queensland and haematoma evacuation surgery has been a life-saving endeavour, so improving access to cranial access equipment in hospitals where it is currently lacking is highly warranted.

Characteristics and outcomes of hospitalised inpatients with indwelling urinary catheter-a retrospective study from a large regional hospital in Queensland

Indwelling urinary catheters (IDCs) are a common invasive device in hospitalised patients. Their use is associated with increased risks of developing catheter associated urinary tract infections (CAUTI), and blood stream infections (BSI). To examine the characteristics and outcomes of adult inpatients with an IDC inserted in hospital and identify risk factors for developing CAUTI and BSI. We performed a retrospective observational study of 430 patients with IDC admitted to medical and surgical units of a leading (tertiary) hospital between Nov 2019 till April 2020. Multiple logistic regression analysis was performed to determine independent risk factors for developing urinary tract infection and blood stream infection. The prevalence of CAUTI in our study was 7.4%. Results of multiple logistic regression indicated that with each day of IDC in situ, the likelihood of UTI development increased by 9% (OR 1.09; 95% CI 1.00 to 1.18; p=0.03). Age, gender, and catheter reinsertion were not associated with UTI development. Longer duration of IDC was associated with elevated risk of developing CAUTI. CAUTI rates were higher than some of those previously published. There was no statistical significance in frequency of CAUTI between medical and surgical patients. No statistically significant variables that contributed to the development of BSI were found. Interventions targeted at reducing catheter days should be used to improve CAUTI rates.

PP286 [Medical Workforce &amp; Education » Staff well being /health (Stress, burnout, moral distress, spirituality)]: IMPACT OF A MINDFULNESS-BASED PROGRAM (MBP) ON PAEDATRIC INTENSIVE CARE STAFF WELLBEING

1Children’s Critical Care Unit, Gold Coast University Hospital, Southport, Queensland Australia 2People and Culture, Children’s Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia 3QCIF Facility for Advanced Bioinformatics, The University of Queensland, Australia 4Paediatric Intensive Care, Queensland Children’s Hospital, South Brisbane, Queensland, Australia

Examining the pharmacological and psychological treatment of child and adolescent ADHD in Australia: Protocol for a retrospective cohort study using linked national registry data

IntroductionAttention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder which affects 5% of children globally. In Australia, it is estimated that 4.1% of children and adolescents have ADHD. While research...

Efficient algorithms for real-time syndromic surveillance

ObjectiveOutbreaks of influenza-like diseases often cause spikes in the demand for hospital beds. Early detection of these outbreaks can enable improved management of hospital resources. The objective of this study was to test whether surveillance algorithms designed to be responsive to a wide range of anomalous decreases in the time between emergency department (ED) presentations with influenza-like illnesses provide efficient early detection of these outbreaks. MethodsOur study used data on ED presentations to major public hospitals in Queensland, Australia across 2017–2020. We developed surveillance algorithms for each hospital that flag potential outbreaks when the average time between successive ED presentations with influenza-like illnesses becomes anomalously small. We designed one set of algorithms to be responsive to a wide range of anomalous decreases in the time between presentations. These algorithms concurrently monitor three exponentially weighted moving averages (EWMAs) of the time between presentations and flag an outbreak when at least one EWMA falls below its control limit. We designed another set of algorithms to be highly responsive to narrower ranges of anomalous decreases in the time between presentations. These algorithms monitor one EWMA of the time between presentations and flag an outbreak when the EWMA falls below its control limit. Our algorithms use dynamic control limits to reflect that the average time between presentations depends on the time of year, time of day, and day of the week. ResultsWe compared the performance of the algorithms in detecting the start of two epidemic events at the hospital-level: the 2019 seasonal influenza outbreak and the early-2020 COVID-19 outbreak. The algorithm that concurrently monitors three EWMAs provided significantly earlier detection of these outbreaks than the algorithms that monitor one EWMA. ConclusionSurveillance algorithms designed to be responsive to a wide range of anomalous decreases in the time between ED presentations are highly efficient at detecting outbreaks of influenza-like diseases at the hospital level.

Understanding workforce needs of allied health staff in regional cancer care centres: Informing recruitment and succession planning.

To describe: (1) the type and frequency of interventions undertaken by regional cancer specialist Allied Health Professionals (AHPs); and (2) regional generalist AHPs' exposure and confidence in undertaking these interventions. Multiphase, observational study including a prospective study and a cross-sectional survey. Two regional Queensland Hospitals. Cancer specialist AHPs (n=13 in a prospective study; n=7 in a cross-sectional survey) and generalist AHPs (n=36 in a cross-sectional survey), across six disciplines from two regional hospitals and cancer services. Phase 1: Frequency of cancer care AHP occasions of service and interventions. Phase 2: Current practice in cancer care AHP interventions; confidence; access to training, professional development and mentorship; barriers to working in cancer care, among cancer care and generalist AHPs. Over 10-months, cancer care AHPs collectively delivered 12 393 interventions across 8850 occasions of service. Only four cancer care interventions were exclusively or predominantly carried out by cancer care AHPs-laryngectomy pre-operative counselling, laryngectomy rehabilitation and tracheostomy management (speech pathology) and lymphoedema management (physiotherapy). Generalist AHPs reported slightly lower confidence across all tasks if asked to carry out known interventions in a cancer setting compared with familiar settings. The primary perceived barrier to working in cancer care was lack of skills/experience/training reported by most CC AHPs, generalist Physiotherapists and Speech Pathologists, but not other generalist AHPs. There was a significant overlap in interventions undertaken in the cancer care and generalist setting for AHPs. Appropriate on-boarding to contextualise interventions to cancer care is recommended to overcome reported lower confidence.

Identifying patients at risk of unplanned re-hospitalisation using statewide electronic health records

Preventing unplanned hospitalisations, including readmissions and re-presentations to the emergency department, is an important strategy for addressing the growing demand for hospital care. Significant successes have been reported from interventions put in place by hospitals to reduce their incidence. However, there is limited use of data-driven algorithms in hospital services to identify patients for enrolment into these intervention programs. Here we present the results of a study aiming to develop algorithms deployable at scale as part of a state government’s initiative to address rehospitalizations and which fills several gaps identified in the state-of-the-art literature. To the best of our knowledge, our study involves the largest-ever sample size for developing risk models. Logistic regression, random forests and gradient boosted techniques were explored as model candidates and validated retrospectively on five years of data from 27 hospitals in Queensland, Australia. The models used a range of predictor variables sourced from state-wide Emergency Department(ED), inpatient, hospital-dispensed medications and hospital-requested pathology databases. The investigation leads to several findings: (i) the advantage of looking at a longer patient data history, (ii) ED and inpatient datasets alone can provide useful information for predicting hospitalisation risk and the addition of medications and pathology test results leads to trivial performance improvements, (iii) predicting readmissions to the hospital was slightly easier than predicting re-presentations to ED after an inpatient stay, which was slightly easier again than predicting re-presentations to ED after an EDstay, (iv) a gradient boosted approach (XGBoost) was systematically the most powerful modelling approach across various tests.

Understanding the Digital Disruption of Health Care: An Ethnographic Study of Real-Time Multidisciplinary Clinical Behavior in a New Digital Hospital.

Understanding electronic medical record (EMR) implementation in digital hospitals has focused on retrospective "work as imagined" experiences of multidisciplinary clinicians, rather than "work as done" behaviors. Our research question was "what is the behavior of multidisciplinary clinicians during the transition to a new digital hospital?" The aim of the study is to: (1) Observe clinical behavior of multidisciplinary clinicians in a new digital hospital using ethnography. (2) Develop a thematic framework of clinical behavior in a new digital hospital. The setting was the go-live of a greenfield 182-bed digital specialist public hospital in Queensland, Australia. Participants were multidisciplinary clinicians (allied health, nursing, medical, and pharmacy). Clinical ethnographic observations were conducted between March and April 2021 (approximately 1 month post-EMR implementation). Observers shadowed clinicians in real-time performing a diverse range of routine clinical activities and recorded any clinical behavior related to interaction with the digital hospital. Data were analyzed in two phases: (1) content analysis using machine learning (Leximancer v4.5); (2) researcher-led interpretation of the text analytics to generate contextual meaning and finalize themes. A total of 55 multidisciplinary clinicians (41.8% allied health, 23.6% nursing, 20% medical, 14.6% pharmacy) were observed across 58 hours and 99 individual patient encounters. Five themes were derived: (1) Workflows for clinical documentation; (2) Navigating a digital hospital; (3) Digital efficiencies; (4) Digital challenges; (5) Patient experience. There was no observed harm attributable to the digital transition. Clinicians primarily used blended digital and paper workflows to achieve clinical goals. The EMR was generally used seamlessly. New digital workflows affected clinical productivity and caused frustration. Digitization enabled multitasking, clinical opportunism, and benefits to patient safety; however, clinicians were hesitant to trust digital information. This study improves our real-time understanding of the digital disruption of health care and can guide clinicians, managers, and health services toward digital transformation strategies based upon "work as done."