Metropolitan Public Hospital Research Articles

An audit of perioperative speech pathology intervention on improving enhanced recovery after surgery in oesophagectomy patients

Purpose To evaluate the impact of a speech-language pathology (SLP) pathway on recovery following oesophagectomy. Method An audit was conducted at a single metropolitan public hospital in Sydney, Australia. Patients between 2014–2021 undergoing a three-stage oesophagectomy (n = 41) were included in the study. The sample was divided into two groups, those who received usual care (2014–2019) and those who received perioperative SLP assessment and intervention (2020–2021), with data collected across swallowing and health outcomes. Patient demographics and outcomes between the two groups were compared. Result Patients who received perioperative SLP intervention commenced oral intake faster postoperatively (SLP intervention group Mdn = 6.50 days, IQR = 6.00–7.00; usual care group Mdn = 9.00 days, IQR = 7.00–13.25; p = 0.001). There was no statistically significant difference between groups in rates of aspiration on the postoperative leak test (p = 0.32). No statistically significant differences were found between the two groups in length of hospital stay or number of swallowing-related medical images completed during their admission. Conclusion Perioperative SLP intervention has a positive impact on commencing oral intake following a three-stage oesophagectomy, however, it does not have a significant impact on rates of aspiration postoperatively. This pathway may contribute to enhanced recovery after oesophagectomy.

Carbapenemase-producing enterobacterales colonisation status does not lead to more frequent admissions: a linked patient study

BackgroundHospitals in any given region can be considered as part of a network, where facilities are connected to one another – and hospital pathogens potentially spread – through the movement of patients between them. We sought to describe the hospital admission patterns of patients known to be colonised with carbapenemase-producing Enterobacterales (CPE), and compare them with CPE-negative patient cohorts, matched on comorbidity information.MethodsWe performed a linkage study in Victoria, Australia, including datasets with notifiable diseases (CPE notifications) and hospital admissions (admission dates and diagnostic codes) for the period 2011 to 2020. Where the CPE notification date occurred during a hospital admission for the same patient, we identified this as the ‘index admission’. We determined the number of distinct health services each patient was admitted to, and time to first admission to a different health service. We compared CPE-positive patients with four cohorts of CPE-negative patients, sampled based on different matching criteria.ResultsOf 528 unique patients who had CPE detected during a hospital admission, 222 (42%) were subsequently admitted to a different health service during the study period. Among these patients, CPE diagnosis tended to occur during admission to a metropolitan public hospital (86%, 190/222), whereas there was a greater number of metropolitan private (23%, 52/222) and rural public (18%, 39/222) hospitals for the subsequent admission. Median time to next admission was 4 days (IQR, 0–75 days). Admission patterns for CPE-positive patients was similar to the cohort of CPE-negative patients matched on index admission, time period, and age-adjusted Charlson comorbidity index.ConclusionsMovement of CPE-positive patients between health services is not a rare event. While the most common movement is from one public metropolitan health service to another, there is also a trend for movement from metropolitan public hospitals into private and rural hospitals. After accounting for clinical comorbidities, CPE colonisation status does not appear to impact on hospital admission frequency or timing. These findings support the potential utility of a centralised notification and outbreak management system for CPE positive patients.

Early Access to First-Seizure Clinics, Subsequent Outcomes, and Factors Associated With Attendance

First-seizure clinics (FSCs) aim to deliver prompt specialist care to patients with new-onset undifferentiated seizure events. To determine whether FSC attendance and time to FSC are associated with subsequent health care utilization and mortality and to investigate factors associated with FSC nonattendance. This was a record-linkage, retrospective, cohort study of patients who booked appointments at 2 FSCs between 2007 and 2018. Patients' records were linked to state-wide administrative databases between 2000 and 2021. The setting comprised the FSCs of 2 major metropolitan public hospitals in Melbourne, Australia, providing national inpatient and outpatient adult epilepsy services. Of patients who booked appointments at the FSCs, those who were successfully linked for analysis were included in the study. Patients who recorded only canceled appointments were excluded from analysis of outcomes. Study data were analyzed from January 2000 to December 2021. FSC attendance. Subsequent all-cause and seizure-related emergency department (ED) presentations and hospital admissions. Of 10 162 patients with appointments at FSCs, 9392 were linked for analysis, with mean (SD) follow-up time 6.9 (2.8) years after FSC referral. A total of 703 patients were excluded. Among 9392 linked patients, 5398 were male (57.5%; mean [SD] age, 59.7 [11.2] years). FSC attendance was associated with reduced subsequent all-cause emergency presentations (adjusted incidence rate ratio [aIRR], 0.72; 95% CI, 0.66-0.79) and all-cause hospitalization (aIRR, 0.81; 95% CI, 0.75-0.88). Those who attended at the first-scheduled appointment, compared with those who attended only a rescheduled, delayed appointment, had reduced subsequent all-cause emergency presentations (aIRR, 0.83; 95% CI, 0.76-0.91), all-cause hospitalization (aIRR, 0.71; 95% CI, 0.65-0.79), seizure-related presentations (aIRR, 0.40; 95% CI, 0.33-0.49), and mortality (hazard ratio, 0.82; 95% CI, 0.69-0.98). Male sex was associated with nonattendance (adjusted relative risk [aRR], 1.12; 95% CI, 1.03-1.22), as were injury at emergency presentation (aRR, 1.12; 95% CI, 1.01-1.24), psychiatric comorbidity (aRR, 1.68; 95% CI, 1.55-1.81), previous seizure-related presentations (aRR, 1.35; 95% CI, 1.22-1.49), and delays (>14 days) between FSC referral and appointment (aRR, 1.35; 95% CI, 1.18-1.54). Hospitalization at referral was associated with reduced nonattendance (aRR, 0.80; 95% CI, 0.72-0.90), as were non-English language preference (aRR, 0.81; 95% CI, 0.69-0.94), distance greater than 6 mi from home to clinic (aRR, 0.85; 95% CI, 0.76-0.95), and physical comorbidity (aRR, 0.80; 95% CI, 0.72-0.89). Results of this cohort study suggest that FSC attendance, particularly early attendance, was associated with reduced rates of subsequent hospital utilization. This knowledge may support adequately resourcing FSCs to improve equitable, timely access. Future study directions include assessing interventions that may support FSC attendance for at-risk groups.

Adrenal washout CT in patients with no history of cancer: a waste of time?

PurposeTo validate the diagnostic performance of adrenal washout CT in patients without known malignancy in a Western Australian population.MethodsA radiology information system (RIS) search for CT reports containing “adrenal” and “washout” across six networked metropolitan public hospitals between January 2005 and November 2021. Homogenous nodules ≥ 1 cm, ≥ 10 HU without a suspected functional component in patients without a history of malignancy were included. Reported absolute and relative washout percentages were recorded and re-measured from unenhanced, 60-s portal venous and 15-min delayed phase imaging and compared to either histopathological or CT follow up for growth (≥ 12 months) reference standards.Results2653 studies were screened with 191 meeting inclusion criteria. 105 nodules underwent washout CT and then had either histopathological (12 patients) or CT follow up (93 patients) reference standards available.Reported absolute washout (aWO) estimated sensitivity and specificity for malignant/indeterminate nodules was low at 33% (95% CI 25–43%) and 77% (95% CI 68–84%) respectively. Reported relative washout (rWO) sensitivity and specificity were 56% (95% CI 46–65%) and 69% (95% CI 60–77%) respectively. Negative predictive values for both aWO and rWO were reassuring at 92% (95% CI 86–96%) and 94% (95%CI 88–97%).ConclusionOur study validates a recent report suggesting that adrenal washout has poor sensitivity for and consequent limited utility to exclude malignancy in patients with no cancer history. However, patients with incidental adrenal nodules < 4 cm in size with benign washout can be reassured by the high negative predictive value and worked up to exclude functional adenoma and re-imaged in a year to confirm no growth.Graphical

Perspectives on the use of Virtual Reality within a public hospital setting: surveying knowledge, attitudes, and perceived utility among health care professionals

BackgroundVirtual reality (VR) is a burgeoning technology within healthcare, though routine implementation of VR within hospital settings remains limited. Health professionals are key stakeholders in knowledge translation, though limited research has explored their knowledge and attitudes towards using VR for different purposes within healthcare. This study aimed to scope health professionals’ knowledge of, and attitudes towards, the use of VR applications in a public hospital setting.MethodsA cross-sectional survey of multidisciplinary health professionals (medical, nursing, allied health professionals) was conducted in a major metropolitan public hospital in Australia. The custom survey was comprised of 28 mixed categorical and free-text fields designed to scope levels of knowledge, prior experience, and interest in VR; the perceived utility of VR within a hospital context; and perceived barriers and enablers of VR use within the hospital setting. Data were analyzed via descriptive and non-parametric statistics.ResultsOne hundred and thirty-seven health professionals participated (38% allied health, 37% nursing, 24% medical). The majority had no prior exposure to VR in clinical (95%) or recreational (67%) settings; and only 16% were aware of any clinical research evidence for VR. Despite limited awareness, participants expressed support for VR use in hospitals. 99% reported VR had potential utility in healthcare, most commonly for clinical simulations (81%), clinical education (80%) and as a physical therapy tool (68%). Participants identified multiple barriers to VR implementation most commonly relating to perceived cost, lack of required infrastructure, time, knowledge and technical skill. Prominent enablers related to increasing capability at provider and system levels. Participants’ familiarity with VR was associated with stronger support for its’ use (Rho = 0.4, p < 0.001).ConclusionsHealth professionals in the hospital workforce reported limited knowledge and familiarity with VR; yet they perceived VR had broad utility and expressed overall support for different VR applications within hospitals. Health professionals appear interested in VR though face multiple barriers to its use in a hospital context. Increasing capability among multidisciplinary health providers and the wider hospital system appear to be important considerations for the success of future VR implementation in public hospitals.

Evaluation of opioid prescribing for surgical patients discharged from three metropolitan hospitals between 2012 and 2020.

This multicentre, retrospective medical record audit evaluated opioid analgesia prescribing within a Victorian metropolitan public hospital network. The study included all surgical patients discharged between January 2012 and December 2020 with one or more discharge prescriptions from three metropolitan hospitals (n = 117,989). The main outcome measures were mean oral morphine equivalent daily dose (OMEDD), mean number of opioid types and proportion of patients prescribed one or more slow-release opioids on discharge.Total opioid prescribing (mean OMEDD) peaked in 2013. Between 2017 and 2020 there was a trend towards prescribing fewer opioids on discharge. Over the study period, there was decreasing prescription of codeine and increasing prescription of oxycodone and tapentadol. The proportion of patients prescribed slow-release opioids increased in the earlier years of the study, reaching a peak of 20.6% in 2017. Since 2017 there has been a rapid reduction in the prescription of slow-release opioids.Subanalysis was undertaken to evaluate key changes in the opioid prescribing landscape in the health network. The removal of default opioid pack sizes in the electronic medication management system (December 2014) and the release of the Faculty of Pain Medicine-Australian and New Zealand College of Anaesthetists' statement regarding the use of opioid analgesics in patients with chronic non-cancer pain (March 2018) were associated with significant reductions in mean OMEDD prescribed on discharge (136 mg vs 122 mg and 120 mg vs 85.4 mg, respectively, P < 0.001).In conclusion, the quantity of opioids prescribed on discharge in this patient group peaked in 2013 and has been decreasing since.

Implementing good life with osteoArthritis from Denmark (GLA:D®) in australian public hospitals. Part 1: Feasibility

BackgroundLiterature reporting positive outcomes from the Good Life with osteoArthritis in Denmark (GLA:D®) program in Australia mainly involves patients attending private physiotherapy services. ObjectiveEvaluate the feasibility of implementing GLA:D® in Australian public hospitals. DesignImplementation study in three metropolitan tertiary public hospitals over six months. MethodPatients aged ≥18 years with knee or hip joint-related problems deemed appropriate for non-surgical care were invited to participate in GLA:D®. Feasibility was evaluated using RE-AIM framework components (Implementation, Effectiveness, Maintenance) using service-level metrics, patient-level data, and program fidelity assessment. Findings of qualitative interviews with service providers are presented in Part 2. ResultsImplementation: 70 patients (69 with knee osteoarthritis) participated (13 cohorts). 55 (79%) patients attended both education sessions, and 49 patients (70%) attended 10–12 exercises sessions. Fidelity was met based on environmental, therapist, participant- and program-related criteria. Effectiveness: At 3 months, patients reported lower average pain (visual analogue scale [0–100 mm]: effect size −0.56, 95% CI -0.88 to −0.23) and disability (HOOS/KOOS-12 [100-0]: 0.67, 0.28 to 1.05), and improved quality of life (EQ-5D overall score: 0.46, 0.11 to 0.80). No adverse events were reported. All patients who completed 3-month assessment (n = 52) would recommend GLA:D®. Maintenance: All participating services elected to continue delivering GLA:D® beyond the study. ConclusionsImplementing GLA:D® in Australian public hospitals is feasible, safe, and acceptable to patients with knee osteoarthritis. Public hospital patients with knee osteoarthritis reported improvements in pain, disability, and quality of life similar to previous GLA:D® cohorts.

Development and clinical empirical validation of the chronic critical illness prognosis prediction model.

The evolution of critical care medicine and nursing has aided and enabled the rescue of a large number of patients from numerous life-threatening diseases. However, in many cases, patient health may not be quickly restored, and the long-term prognosis may not be optimistic. In this study, we aimed to develop and validate a prediction model for accurate, precise, and objective identification of the severity of chronic critical illness (CCI) in patients. We used a retrospective case-control and prospective cohort study with no interventions. Patients diagnosed with CCI admitted to the ICU of a large metropolitan public hospital were selected. In the case-control study, 344 patients (case: 172; control:172) were enrolled to develop the prognosis prediction model of chronic critical illness (PPCCI Model); 88 patients (case:44; control: 44) in a prospective cohort study, served as the validation cohort. The discrimination of the model was measured using the area under the curve (AUC) of the receiver operating characteristic curve (ROC). Age, prolonged mechanical ventilation (PMV), sepsis or other severe infections, Glasgow Coma Scale (GCS), mean artery pressure (MAP), heart rate (HR), respiratory rate (RR), oxygenation index (OI), and active bleeding were the nine predictors included in the model. In both cohorts, the PPCCI model outperformed the Acute Physiology And Chronic Health Evaluation II (APACHE II), Modified Early Warning Score (MEWS), and Sequential Organ Failure Assessment (SOFA) in identifying deceased patients with CCI (development cohort: AUC, 0.934; 95%CI, 0.908-0.960; validation cohort: AUC, 0.965; 95% CI, 0.931-0.999). The PPCCI model can provide ICU medical staff with a standardized measurement tool for assessing the condition of patients with CCI, enabling them to allocate ward monitoring resources rationally and communicate with family members.

Impact of a general medicine consultant-led ward round in the emergency department.

Patients requiring admission to the general medicine wards in a public hospital are usually assessed by a medical registrar. This study is based at a metropolitan public hospital in Melbourne where the majority of general medicine patients in the emergency department (ED) are not seen by a consultant physician until they are transferred to the ward. To assess the impact of general medicine consultant-led ward rounds (CWRs) in the ED on patient length of stay (LOS). One-month audit was conducted of all patients admitted to general medicine and awaiting transfer to ward from ED at a metropolitan public hospital in Melbourne. A general medicine CWR was then implemented in the ED, followed by another 1-month audit, with the primary outcome being LOS and the secondary outcome being 30-day readmission rate. Additionally, admitting medical registrars were invited to complete a survey before and after the implementation of CWRs to assess satisfaction rate. Data from electronic medical records were analysed for 162 patients (90 preimplementation group and 72 postimplementation group). The median LOS was 6 days in the preimplementation group and 4 days in the postimplementation group (P = 0.014). There was no significant difference in 30-day readmission rates. Surveys showed admitting medical registrars reported a reduced level of stress and fewer barriers to seeking consultant input following implementation. A CWR in the ED has led to decreased LOS for general medicine patients and improved satisfaction among junior medical staff.

Achieving equity: patient demographics and outcomes after surgical and non-surgical procedures in South Australia, 2022.

Although modern Australian healthcare systems provide patient-centred care, the ability to predict and prevent suboptimal post-procedural outcomes based on patient demographics at admission may improve health equity. This study aimed to identify patient demographic characteristics that might predict disparities in mortality, readmission, and discharge outcomes after either an operative or non-operative procedural hospital admission. This retrospective cohort study included all surgical and non-surgical procedural admissions at three of the four major metropolitan public hospitals in South Australia in 2022. Multivariable logistic regression, with backwards selection, evaluated association between patient demographic characteristics and outcomes up to 90 days post-procedurally. 40 882 admissions were included. Increased likelihood of all-cause, post-procedure mortality in-hospital, at 30 days, and 90 days, were significantly associated with increased age (P < 0.001), increased comorbidity burden (P < 0.001), an emergency admission (P < 0.001), and male sex (P = 0.046, P = 0.03, P < 0.001, respectively). Identification as ATSI (P < 0.001) and being born in Australia (P = 0.03, P = 0.001, respectively) were associated with an increased likelihood of 30-day hospital readmission and decreased likelihood of discharge directly home, as was increased comorbidity burden (P < 0.001) and emergency admission (P < 0.001). Being married (P < 0.001) and male sex (P = 0.003) were predictive of an increased likelihood of discharging directly home; in contrast to increased age (P < 0.001) which was predictive of decreased likelihood of this occurring. This study characterized several associations between patient demographic factors present on admission and outcomes after surgical and non-surgical procedures, that can be integrated within patient flow pathways through the Australian healthcare system to improve healthcare equity.

Exploring body morphology, sacral skin microclimate and pressure injury development and risk among patients admitted to an intensive care unit: A prospective, observational study

ObjectiveTo determine the association between body morphology, sacral skin microclimate and their impact on the development and risk of pressure injuries among patients in an intensive care unit. MethodologyA prospective observational exploratory study was conducted over 30 weeks. Repeat study observations occurred multiple times a week for 28 days or until discharge. Participant inclusion criteria were ≥ 18 years of age, expected intensive care length of stay > 24 h and intact skin over the sacrum region. SettingThe study was conducted in a 36-bed intensive care unit of a major metropolitan public hospital in Queensland, Australia. Outcome measuresPressure injuries were staged and independently verified according to the international pressure injury classification system. Pressure injury risk was determined by the Braden scale score and subepidermal oedema, using a subepidermal moisture scanner at the sacrum. ResultsOf the 93 participants recruited, an inverted triangle body shape (p =.049), a BMI > 25 kg/m2 (p =.008), a standard foam mattress type (p =.017) and increased length of stay (p <.001) were associated with an increased pressure injury risk according to subepidermal oedema. Participants with increased sacral skin temperature (p <.001), mechanical ventilation (p <.001), vasoactive drugs administered (p =.003), increased sequential organ failure assessment score (p =.047), neurovascular diagnosis (p =.031) and increased length of stay (p =.027) were associated with increased pressure injury risk according to the Braden scale score. ConclusionBody morphology and skin microclimate are associated with pressure injury risk during critical illness. Implications for Clinical PracticeSubepidermal oedema was associated with a patient’s shape, body mass index and mattress type, factors that directly influence the pressure loading and the skin, whereas the Braden scale was associated with sacral temperature and clinical measures of critical illness. Consideration of body morphology and skin microclimate in pressure injury risk assessment could lead to more specific prevention strategies targeting high risk patients.

Abstract 17829: Improving Access to Cardiac Rehabilitation for Minorities and Vulnerable Patients With a Multidisciplinary Program in a Large Metropolitan Public Hospital Network

Introduction: Cardiac rehabilitation (CR) improves outcomes after myocardial infarction, cardiac surgery or in chronic heart failure with reduced ejection fraction. However, access to CR is often limited to insured patients or those who can pay out-of-pocket, leaving uninsured or undocumented patients without access to these benefits. Our aim is to describe the implementation and outcomes of a multidisciplinary comprehensive CR program in the largest public health system in the country, as a strategy to mitigate healthcare disparities and improve access to care for minorities. Methods: Our CR program started in March 2021 as a virtual program and opened for in-person care in November 2022. We collected clinical, demographic, socioeconomic, and immigration data as well as data on clinical outcomes such as hospital readmission, mortality, and program completion rates. Results: A total of 202 patients were included (35.6% women, mean age 62), with 83.7% of patients in virtual CR and 16.3 % in in-person CR. The most common ethnic group was Black (41.6%) followed by Hispanic (38.6%). A total of 23.8% were uninsured, 21.3% were undocumented and 52.5% lived below the poverty level reported for New York City. The highest level of education was &lt; 8th grade in 16.8%, high school in 22.8%, at least 2 years of college in 5.5%, &gt; 4 years of college in 7.9% and unknown in 47%. The hospital readmission rate at 6 months was 12.4% and mortality was 1.5%. There were no significant differences in survival or readmission by ethnic group. Of patients completing at least one visit, 72% were active or graduated from virtual CR and 90% were active or graduated for in-person CR (Figure). Conclusions: Our multidisciplinary CR program demonstrates feasibility in providing care to underserved and vulnerable populations, showing excellent results and providing a strategy to decrease healthcare disparities in access to an intervention which improves outcomes across a broad spectrum of cardiac disease.

Interpreter requirements of women from non-English speaking migrant backgrounds in maternity hospitals in Melbourne, Australia

PurposeAccess to professional interpreter services is a critical facilitator of positive health-care experiences when health-care professionals and women accessing maternity care are not proficient in a shared language. Understanding interpreter demand is essential for the provision of professional interpreter services. This study aims to characterise interpreter requirements among women from nonrefugee and refugee non-English-speaking migrant backgrounds in Australian maternity hospitals.Design/methodology/approachThis study analysed administrative data from four public maternity hospitals in Victoria, Australia. The primary outcome was the proportion of women from non-English speaking migrant backgrounds who required an interpreter during their maternity care, both overall and stratified by refugee and nonrefugee background. Adjusted logistic regression was used to estimate the association between migrant background and interpreter requirements.FindingsAmong the 6,771 women from non-English speaking migrant backgrounds included in analyses, 1,344 (19.8%) required an interpreter during their maternity care. The odds of requiring an interpreter were fivefold higher among women from refugee backgrounds compared to migrant women from nonrefugee backgrounds [adjusted odds ratio (aOR): 4.83; 95% confidence interval (CI): 4.13–5.65].Practical implicationsThe study highlights the diversity in cultural backgrounds and migration experiences of women accessing maternity care within metropolitan public hospitals. The high interpreter requirements, particularly among women from refugee backgrounds, underscores the need for comprehensive and woman-centred interpreter services to attenuate disparities in hospital maternity care.Originality/valueTo the best of the authors’ knowledge, this study is the first to quantify the interpreter requirements of women from non-English-speaking migrant backgrounds in maternity hospital settings and make women comparisons between women from refugee and nonrefugee backgrounds.

The HUSH Project: Using codesign to reduce sleep disruptions for patients in hospital.

Poor quality sleep in hospitals may be problematic for patients, negatively impacting their recovery and wellbeing. This project aimed to investigate the effectiveness of codesign in addressing key issues affecting sleep disruption in the healthcare setting. Codesign with patients, staff and consumer representatives was conducted in an acute metropolitan tertiary public hospital in Sydney, Australia. Through a four-stage process, a multimodal intervention to address and reduce the impact of sleep disruptions among hospital inpatients was created. Pre- and post-intervention evaluation was used to determine changes in patient-reported sleep disruption. 'The HUSH Project' (Help Us Support Healing) intervention resulted from the codesign process, which included the provision of HUSH Sleep Packs (with earplugs, eye masks and herbal tea), patient information resources, and ward-based Sleep Champions. Survey data from 210 patients revealed a statistically significant decrease in patient-reported noise disturbances for patients in shared rooms following the 4-week intervention period of the HUSH program. The HUSH Project demonstrated that a novel multimodal intervention may be valuable in reducing sleep disruption in hospitals. These findings also indicate the benefits of using codesign methodology to support improvement projects that seek to enhance patient experiences of care. This project utilised codesign methodology, which involved significant contributions from patients and consumer representatives, from research conceptualisation into intervention design, implementation and project evaluation.

Is there a relationship between ‘getting up and dressed’ and functional and physical outcomes in geriatric rehabilitation inpatients? A quasi-experimental study

Objectives To evaluate the physical and functional outcomes of the ‘Ending Pyjama Paralysis’ intervention in an inpatient geriatric rehabilitation unit. Design Quasi-experimental mixed-methods design nested within the ‘REStORing health of acutely unwell adulTs’ (RESORT) prospective, observational, longitudinal cohort of geriatric rehabilitation inpatients study. Setting Geriatric rehabilitation wards in a major metropolitan public hospital between June 2019 and March 2020. Intervention The ‘Ending Pyjama Paralysis’ movement originated in the UK. Its aim was to encourage patients to ‘Get up, Get dressed and Get moving’ to reduce hospital-associated functional decline. However, the physical and functional benefits of this campaign have not yet been evaluated. The ‘Ending Pyjama Paralysis’ was adopted as an integrated intervention on two out of four geriatric rehabilitation wards. The two control wards received usual care. Main Measures Physical measures included the Short Physical Performance Battery, and functional measures included the Katz Index of Independence in Activities of Daily Living and Lawton and Brody’s Instrumental Activities of Daily Living, which were completed on admission and discharge. A linear mixed-effects model was used to analyse the results. Results A total of 833 admissions were included in this study. Of these, 512 patients were in the control group, and 321 were in the intervention group. There were no significant differences in both physical and functional measures between the intervention and control groups. Conclusion The ‘Ending Pyjama Paralysis’ campaign did not result in enhanced functional or physical benefits in geriatric rehabilitation inpatients in this setting when applied in addition to usual care.

Integration of hospital and community care for paediatric ophthalmology: A mixed-methods study.

To explore collaborative care models for paediatric eye care that integrate hospital and community-based care to address access blocks. Sequential referrals to a tertiary paediatric ophthalmology clinic between April and October 2019 and subsequent encounters up until July 2020 at a major metropolitan public children's hospital in Sydney, Australia, were reviewed to identify those cases suitable for community care. Semi-structured phone interviews were conducted with eye health service providers, including ophthalmologists, orthoptists and optometrists, as well as service users to explore their perspectives on potential changes to service delivery. Qualitative data were analysed deductively using the Levesque model for access to healthcare and Consolidated Framework for Implementation Research (CFIR) to inform implementation strategies for future models of care. One-third of the 439 audited referrals (30.5%; 134/439) were identified as suitable for community management. Interviews revealed five themes relating to potential models of care, which would support and promote access: integrated health systems, standardised quality of care, interprofessional trust, multidisciplinary governance and patient-centred care. Key recommendations for future implementation included: (i) identifying and preparing clinical champions, (ii) conducting educational meetings, (iii) conducting local needs assessments and (iv) informing local opinion leaders. This audit highlights access blocks and poor targeting of referrals to tertiary paediatric ophthalmology services in a metropolitan hospital. Integration with community practitioners was identified as an acceptable way to streamline services, and strategies that may support successful implementation in this setting were identified.

Fathers attending the birth of their baby: Views, intentions and needs.

There is limited information about fathers' views, intentions and needs leading up to childbirth. This study explores the factors influencing fathers' intention to attend the birth, and the needs and supports required leading up to childbirth. Cross-sectional survey of 203 prospective fathers attending antenatal appointments at an outer metropolitan public teaching hospital in Brisbane, Australia. A total of 201/203 (99.0%) participants intended to attend the birth. The reported reasons included: responsibility (99.5%), protectiveness (99.0%), love for their partner (99.0%), the right thing to do (98.0%), desire to see the birth (98.0%), the perception that partners should attend (97.4%), duty (96.4%) and partner preference (91.4%). Some felt pressured by their partner (12.8%), society (10.8%), cultural expectations (9.6%) and family (9.1%), and 10.6% perceived adverse consequences for not attending. Most participants (94.6%) felt well supported, experienced good communication (72.4%), had the opportunity to ask questions (69.8%) and received an explanation of events (66.3%). They were less often supported by antenatal visits (46.7%) and by a plan for future visits (32.2%). Ten per cent of all fathers and 13.8% of experienced fathers requested better mental health support, and 9.0% prefer better clinician communication. Most fathers intend to attend childbirth for personal and moral reasons; however, a small proportion feel pressured. Most fathers feel well supported, although potential improvements include planning for future visits, provision of information, mental health support, clinician communication, increased involvement in their partner's care, the opportunity to ask questions and more frequent clinic visits.

Understanding the contribution of general medical services to acute inpatient care in Victorian public hospitals.

General medicine is an integral part of health services, yet there is little data highlighting their contribution to acute hospital care in Australia. To utilise the Victorian Department of Health's administrative dataset for hospital admissions to evaluate the relative contribution and trends over time of general medical services to acute multiday inpatient hospital separations in the Victorian public healthcare system. A retrospective time-series study of general medical activity compared to other major specialties using hospital-level data provided by the Department of Health: (i) extrapolation from diagnosis-related group (DRG) activity data (2011-2021) and, (ii) directly reported discharge unit-based activity (available from 2018). Acute multiday separations of all patients aged ≥18 years from all metropolitan and rural Victorian public hospitals were included. Using the DRG-based data, general medicine ranked as the largest care provider of all specialties studied, accounting for 12.1% of separations. Despite the largest increase at a rate of 2831 separations/year (0.336%/year of total, P< 0.001) compared to others, mean length of stay declined by 0.08 days/year (P< 0.001). These findings were significant for metropolitan and rural hospitals. The use of directly reported discharge unit-based data also ranked general medicine as the largest care provider accounting for 32.9% of total separations, with rural hospital general medical services contributing nearly 50% of all multiday separations. Both DRG-based data and discharge unit-based data indicate that general medicine is the largest provider of acute multiday inpatient care in Victorian hospitals. The estimate of contribution of general medicine differed between the two datasets as DRG data likely over-represents the role of other specialties possibly due to assumptions regarding specialty management of varying groups of diagnoses.

Dads in Distress: symptoms of depression and traumatic stress in fathers following poor fetal, neonatal, and maternal outcomes

BackgroundThis study aims to explore the prevalence of symptoms of depression and traumatic stress in fathers in the setting of poor fetal, neonatal, and maternal outcomes.MethodsA prospective mixed-methods study was conducted at an outer metropolitan public teaching hospital in Brisbane, Australia, with quantitative results presented here. Subjects included 28 fathers whose partners had experienced pregnancy or childbirth complicated by a significant congenital abnormality or aneuploidy, termination of pregnancy, fetal death in-utero, stillbirth, admission to the neonatal intensive care unit or special care nursery or significant maternal morbidity, such as a postpartum haemorrhage or an emergency postpartum hysterectomy. These experiences were classified into two groups: anticipatory (time to prepare) and sudden (no warning). The fathers were screened using the Edinburgh Postnatal Depression Scale (EPDS) and the Impact of Events Scale-Revised (IES-R) to assess subjective distress at 2-3 weeks (timepoint 1) and 3-4 months (timepoint 2) after the event.ResultsData for both the EPDS and IES-R scales was available for 26 fathers (92.9%) at timepoint 1 and for 15 fathers (53.6%) at timepoint 2. High overall EPDS scores (≥10) were noted in 16/27 (59.3%) fathers at timepoint 1 and 6/15 fathers (40.0%) at timepoint 2. High overall IES-R scores ≥33 were noted in 12/26 (46.2%) fathers at timepoint 1 and 4/15 fathers (26.7%) at timepoint 2. A higher percentage of fathers who experienced anticipatory events had EPDS and IES-R score above these cut-offs at timepoint 1 (8/13 or 61.5%) compared to those experiencing sudden events (8/14 or 57.1%), however, percentages were similar between groups at time point 2 (2/7 or 28.6%% and 4/8 or 50.0%, respectively). More fathers who experienced anticipatory events had IES-R scores ≥33 at timepoint 1 (7/13 or 53.8%) compared to those experiencing sudden events (5/14 or 38.0%).ConclusionOur study indicates high rates of distress in fathers exposed to poor fetal, neonatal, and maternal outcomes, which can persist for months after the event. Increased support for fathers in this setting may be required to prevent poor mental health. Further research on the long-term effects of these adverse events is warranted.

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.