NSW Public Hospitals Research Articles

Feasibility, acceptability and sustainability of postpartum contraceptive implant provision by midwives in NSW public hospitals

BackgroundRepeat pregnancy in the first year after a birth is common. Many of these conceptions are unintended and may be prevented by providing access to contraception in the immediate postpartum period. Midwives in the hospital setting could potentially play a greater role in improving postnatal contraception information and provision. AimWe sought to implement and examine the success of a program training hospital-based midwives in immediate postpartum implant insertion. MethodsThis mixed methods study in two hospitals in New South Wales sought to explore the feasibility, acceptability and sustainability of a program that provided competency-based implant insertion training for midwives. The study documented training completion, implant insertion numbers and experience, and conducted end of study interviews with midwives and stakeholders. FindingsTwenty-seven midwives undertook training and inserted 265 implants during the study period. Interviews with 13 midwives and 11 stakeholders concluded the program to be feasible and acceptable with midwives reporting high satisfaction from their involvement. All interviewees felt that midwives were well placed to insert implants, and reported that challenges around workload and opportunities for practice were generally manageable. It was recognised that sustainability of the program would require supportive policy and regular insertion opportunities. ConclusionsMidwives successfully upskilled in implant insertions and there was widespread support for the program with expectations it would be sustained. Provision of contraceptive information and implant insertion by midwives in the immediate postpartum period is likely to increase contraceptive choice and access for women and contribute to reducing rapid repeat pregnancies.

1437Rates of low value care in NSW public hospitals: variation between public and private inpatients

Abstract Background Low value care (LVC) services have limited or no benefit to patients, and curtailing LVC can curb unnecessary spending and improve the quality of care. Some public hospitals in Australia have financial incentives to perform procedures for patients with private health insurance, yet little is known if there are differences in LVC between public and private patients. Methods We performed a retrospective analysis of New South Wales public hospital data from January 2013 to June 2018. We measured hospital-specific rates of five LVC services and compared rates within each public hospital by patient funding status (private or public), descriptively and using random-slope multilevel models. Results Overall rates of LVC varied between services, ranging from 0.3 to 30.8 procedures per 1,000 eligible patients for hyperbaric oxygen therapy and vertebroplasty, respectively. There was large variation in rates of the LVC services between hospitals, and a few hospitals had higher rates of LVC among private than public patients. However, we found no consistent association between patient funding status and LVC services: private patients had lower rates of knee arthroscopic debridement than public patients (aOR:0.56) and higher rates of low value vertebroplasty for osteoporotic spinal fractures (aOR:1.08), hyperbaric oxygen therapy (aOR:1.53) and oophorectomy (aOR:1.77); all statistically non-significant. Conclusions Private patient funding may contribute to LVC in some public hospitals, but it was not consistently associated with higher rates of the five LVC services measured. Key messages Reducing LVC services requires investigating the role of health-system factors at both the global- and local-level.

Changes in Aboriginal Patient Experiences of Care in NSW Public Hospitals From 2014 To 2018: The NSW Patient Survey Program

IntroductionNew South Wales is home to more Aboriginal people than any other state or territory in Australia. While much is known about social and health status among these Aboriginal people, less is known about their experience of healthcare.
 Objectives and ApproachBHI produces independent reports and information about the performance of the NSW healthcare system. In collaboration with the NSW Ministry of Health Centre for Aboriginal Health, our report explored trends in Adult Admitted Patient Survey in public hospitals for a range of measures from 2014 to 2018 for Aboriginal and non-Aboriginal patients. Administrative survey data were used to establish a sample frame, send questionnaires to a random sample of patients within three months following discharge and assess representativeness of respondents. We used logistic regression models, adjusted for age, sex, education and language spoken at home, to estimate the change of experience over time for both populations.
 ResultsThere were 122,626 patients who shared their experiences each year from 2014 to 2018, among them, 4% identified themselves as Aboriginal. Aboriginal respondents in the survey were similar in age, sex, country of birth and stay type to the administrative sampling data. In 2018, 70% of Aboriginal patients said they would “speak highly” of their experience compared to 79% of non-Aboriginal patients. Across 51 measures, experience of care improved significantly for 39 measures among non-Aboriginal patients, and four among Aboriginal patients (privacy, experience with nurse, communication with patients).
 Conclusion / ImplicationsAboriginal patients have less positive experience of the hospital care in general and there has been little improvement in their experience in recent years. Identifying areas of less positive experiences where health professionals can play a role individually or in a team could minimise disparities in experience of care.

Hospital level risk-standardised all-cause readmission and returns to acute care following hospitalisations for eight clinical conditions

IntroductionMeasures that assess how healthcare affects health outcomes make an important contribution to efforts to inform local efforts to improve care for patients in NSW.
 Objectives and ApproachThe Bureau of Health Information (BHI) in New South Wales, Australia produces independent reports and information about the performance of the healthcare system. Our reports on readmission and returns to acute care following hospitalisation from eight clinical conditions investigated variation across more than 70 NSW public hospitals, with information available for 2000 to 2018.
 Readmissions included both returns to acute care from non-acute inpatient settings and readmissions to any public or private hospital within 30-days or 60-days following hospital discharge. Risk standardised readmission ratios (RSRR) were calculated following linkage of admitted patient and mortality data, to also account for competing risk of death. Hospital outliers were identified using funnel plots. A sensitivity analysis explored the effect of residence in an aged care facility.
 ResultsIn the most recent period, the unadjusted rate of readmission ranged from 10% for ischaemic stroke to 22% for congestive heart failure with rates remaining relatively stable over time for most of the condition. The proportion of readmissions that were returns to acute care from a non-acute hospitalisation ranged from 2% for chronic obstructive pulmonary disease (COPD) to 42% for hip fracture surgery. Across all eight conditions majority of hospitals had results lower or no different than expected. Number of hospitals with higher than expected readmissions ranged from none for total knee replacement to six for COPD. Taking into account residence in an aged care facility did not impact the results in a meaningful way.
 Conclusion/ImplicationsThe RSRR method compares a hospital’s readmissions given its case-mix with an average NSW hospital with the same case-mix. In NSW, this method is a screening tool, identifying areas of excellence and of potential improvement.

Complications of cardiac implantable electronic device placement in public and private hospitals.

Few safety data exist comparing clinical outcomes in Australian public and private hospitals. We hypothesised that differences could exist between public and private hospitals due to differences in acuity and patient-level co-morbidities. To report comparative complications of cardiac implantable electronic device (CIED) placement in public and private hospitals. We conducted an observational cohort study of outcomes of patients aged >18 years from 2010 to 2015 undergoing a new permanent pacemaker (PPM), implantable cardioverter defibrillator (ICD) or cardiac resynchronisation therapy pacemaker or defibrillator (CRT-D/P) implant in NSW and Queensland public and private hospitals. The primary endpoint was major CIED-related complications occurring in-hospital or within 90 days of discharge. The independent effect of hospital sector was determined using multiple logistic regression, adjusting for covariates, including age, sex, co-morbidities and procedural acuity. A total of 32 364 new CIED implants (PPM 23 845, ICD 5361 and CRT-D/P 3158) were included (49% in private hospitals). Overall, 8.0% of private hospital procedures and 9.6% public hospital procedures experienced at least one complication. After adjustment, the overall risk of CIED complications was similar in private and public hospitals (OR: 0.92, 95% CI: 0.84-1.00, P = 0.06). In analysis of individual complications, adjusted all-cause in-hospital mortality was higher in private hospitals, (OR: 1.49, 95% CI: 1.03-2.16, P = 0.036) primarily driven by an excess mortality in acute cases. The adjusted risk of in-hospital generator operation (OR: 0.53, 95% CI: 0.30-0.94, P = 0.03) and post-discharge infection (OR: 0.61, 95% CI: 0.46-0.81, P < 0.001) was lower in private hospitals. These data identify important similarities and differences in safety outcomes of CIED implantation between Australian public and private hospitals.

Impact and acceptance of a state-wide policy to remove sugar-sweetened beverages in hospitals in New South Wales, Australia.

Policy and environmental approaches can reduce the accessibility and purchasing of sugar-sweetened beverages (SSBs), potentially reducing overweight and obesity. This study examined the impact of a state-wide policy on removal of SSBs from sale in NSW public hospitals (launched July 2017), and explored consumer awareness and support. A convenience sample of 81 food outlets in 26 hospitals were audited for SSB availability before and after the target date for SSB removal (31 December 2017). An interviewer-administered intercept survey in 10 randomly selected hospitals (March-May 2018), assessed staff and visitors' awareness of and support for SSB removal. Descriptive and χ2 analyses assessed differences in: SSB availability; staff and visitor awareness and support. Open-ended survey responses were thematically analysed. The proportion of outlets that removed SSBs increased from 58.0% to 96.3% (P<.001). The majority (79.5%) of the 2394 surveyed supported SSB removal, with nearly half (48.4%) reporting it would improve people's health. A minority (13.4%) did not support SSB removal, more than half (61.4%) of those said individuals should have free choice. More staff than visitors were aware of the change (61.9% vs 31.2%; P<.0001). Availability of SSBs in NSW hospitals was significantly reduced after implementation of a policy to remove them from sale. There was strong staff and visitor support for the initiative. SO WHAT?: This study provides clear evidence that a policy designed to provide a healthy hospital retail drink environment can be successfully implemented at scale with high levels of support from staff and visitors. A state-wide policy initiative to remove SSBs from sale in NSW hospital food outlets in 2017 was successfully implemented, with a sample of outlets having nearly 100% compliance. The majority of staff and visitors (80%) supported the removal of SSBs, mostly because they believed it would improve individual and population health.

Risk of emergency hospitalisation and survival outcomes following adjuvant chemotherapy for early breast cancer in New South Wales, Australia.

To examine risk of emergency hospital admission and survival following adjuvant chemotherapy for early breast cancer. Linked data from New South Wales population-based and clinical cancer registries (2008-2012), hospital admissions, official death records and pharmaceutical benefit claims. Women aged ≥18years receiving adjuvant chemotherapy for early-stage operable breast cancer in NSW public hospitals were included. Odds ratios (OR) for emergency hospitalisation within 6months following chemotherapy initiation were estimated using logistic regression and survival using Kaplan-Meier and Cox proportional hazards methods. A total of 3,950 women were included and 30.6% were hospitalised. The most common principal diagnosis at admission was neutropenia (30.8%). Women receiving docetaxel/carboplatin/trastuzumab (TCH) and docetaxel/cyclophosphamide (TC) were the most frequently hospitalised. After adjustment for demographic and clinical factors, the increased risk of hospitalisation for TCH and TC remained compared with doxorubicin/cyclophosphamide 3-weekly (OR 1.71, 95% confidence interval [CI] 1.24-2.37 and OR 1.47, 95% CI 1.17-1.85 respectively). Five-year overall survival was similar for women who were (92.2%, 95% CI 90.7-93.8) and were not hospitalised (93.1%, 95% CI 92.1-94.1). Emergency hospitalisations following chemotherapy for early breast cancer were relatively common, especially following docetaxel-containing protocols. Further examination of reasons for admission is needed to inform actions to improve patient safety.

Unplanned readmission or death after discharge for\xa0Aboriginal and non-Aboriginal people with chronic disease in NSW Australia: a retrospective cohort study

BackgroundAdmitted patients with chronic disease are at high risk of an unplanned hospital readmission, however, little research has examined unplanned readmission among Aboriginal people in Australia. This study aimed to examine whether rates of unplanned 28 day hospital readmission, or death, significantly differ between Aboriginal and non-Aboriginal patients in New South Wales, Australia, over a nine-year period.MethodsA retrospective cohort analysis of a sample of de-identified linked hospital administrative data was conducted. Eligible patients were: 1) aged ≥18 years old, 2) admitted to an acute facility in a NSW public hospital between 30th June 2005 and 1st July 2014, and 3) admitted with either cardiovascular disease, chronic respiratory disease, diabetes or renal disease. The primary composite outcome was unplanned readmission or death within 28 days of discharge. Generalized linear models and a test for trend were used to assess rates of unplanned readmission or death over time in Aboriginal and non-Aboriginal patients with chronic disease, accounting for sociodemographic variables.ResultsThe final study cohort included 122,145 separations corresponding to 48,252 patients (Aboriginal = 57.2%, n = 27,601; non-Aboriginal = 42.8%, n = 20,651). 13.9% (n = 16,999) of all separations experienced an unplanned readmission or death within 28 days of discharge. Death within 28 days of discharge alone accounted for only a small number of separations (1.4%; n = 1767). Over the nine-year period, Aboriginal separations had a significantly higher relative risk of an unplanned readmission or death (Relative risk = 1.34 (1.29, 1.40); p-value < 0.0001) compared with non-Aboriginal separations once adjusted for sociodemographic, disease variables and restricted to < 75 years of age. A test for trend, including an interaction between year and Aboriginal status, showed there was no statistically significant change in proportions over the nine-year period for Aboriginal and non-Aboriginal separations (p-value for trend = 0.176).ConclusionAboriginal people with chronic disease had a significantly higher risk of unplanned readmission or death 28 days post discharge from hospital compared with non-Aboriginal people, and there has been no significant change over the nine year period. It is critical that effective interventions to reduce unplanned readmissions for Aboriginal people are identified.

Presentations to NSW emergency departments with self-harm, suicidal ideation, or intentional poisoning, 2010-2014.

To evaluate population trends in presentations for mental health problems presenting to emergency departments (EDs) in New South Wales during 2010-2014, particularly patients presenting with suicidal ideation, self-harm, or intentional poisoning. This was a retrospective, descriptive analysis of linked Emergency Department Data Collection registry data for presentations to NSW public hospital EDs over five calendar years, 2010-2014. Patients were included if they had presented to an ED and a mental health-related diagnosis was recorded as the principal diagnosis. Rates of mental health-related presentations to EDs by age group and calendar year, both overall and for the subgroups of self-harm, suicidal ideation and behaviour, and intentional poisoning presentations. 331 493 mental health-related presentations to 115 NSW EDs during 2010-2014 were analysed. The presentation rate was highest for 15-19-year-old patients (2014: 2167 per 100 000 population), but had grown most rapidly for 10-14-year-old children (13.8% per year). The combined number of presentations for suicidal ideation, self-harm, or intentional poisoning increased in all age groups, other than those aged 0-9 years; the greatest increase was for the 10-19-year-old age group (27% per year). The rate of mental health presentations to EDs increased significantly in NSW between 2010 and 2014, particularly presentations by adolescents. Urgent action is needed to provide better access to adolescent mental health services in the community and to enhance ED models of mental health care. The underlying drivers of this trend should be investigated to improve mental health care.

Compliance to clinical pathways in the management of suspected pulmonary embolus: are there cost implications?

This study investigated the cost implications of poor compliance to established guidelines for management of suspected pulmonary embolism (PE) in two NSW public hospitals. A retrospective audit showed that the prevalence of PE overall was 9.9% (4.3% in the low-risk groups) in 436 patients. An estimated total of $32 454 (14%) was spent on unnecessary tests.

Time to research Australian physician-researchers.

Concerns have been expressed 'that the physician-researcher is a dying breed'. As yet there are few Australian data. To compare over time: (i) research progress of Sydney Medical School (SMS) medical practitioner - PhD awardees; (ii) National Health and Medical Research Council (NHMRC) project grant success rates for physician-researchers; and (iii) compare current NHMRC, NSW University and NSW Public Hospital pay scales for physician-researchers. We evaluated 303 medical practitioners awarded a University of Sydney/SMS PhD in 1989-2012 and their publications. We assessed 1990-2014 NHMRC grants to physicians and non-physicians (nationally) and compared physician salaries from NHMRC, the University of Sydney and NSW public hospitals. SMS PhD completions by clinicians increased ≈2.4-fold since 1989, with a recent decline, whilst non-medical PhD awardees rose 10-fold. The median time of PhD award after medical degree completion was stable at 13 years. A lower percentage of the more recent physician-researchers had completed specialty training at PhD award (34% in 2011-2012 vs 71% in 1989-1990, P = 0.017). Publication rates were stable, but low. Although NHMRC funding increased >10-fold since 1990, national project grant success rates declined (35% in 1990, 17% in 2013 and 15% in 2014, P < 0.0001), with physician-led funded grants declining from 29% in 1989 to 21% in 2013, P = 0.002. Current NHMRC and University salaries are less than comparable-stage public hospital salaries. Since 1989, more medical graduates are completing SMS PhDs, although more often prior to completing clinical Fellowships, and many have ongoing, albeit low, research activity. Nationally NHMRC project grant success rates have declined significantly, as has the proportion of funded physician-led projects. Medical practitioner salaries from NHMRC and from Universities are less than in public hospitals. The Australian physician-researcher is at-risk. Knowledge and actions are needed to protect our medical research capacity.

Easy to open? Exploring the ‘openability’ of hospital food and beverage packaging by older adults

Food is increasingly a packaged commodity, both in the community and in institutionalised settings such as hospitals, where many older people are malnourished. Previous research with patients aged over 65 years in NSW public hospitals identified difficulties opening milk, water, juices, cereal and tetra packs. The aim of this paper was to assess the ability of well older people living in the community to open food and beverage items routinely used in NSW hospitals in order to gain further insights into the older person/pack interaction and the role of hand and finger strength in pack opening. A sample of 40 older people in good health aged over 65 years from 3 community settings participated in the study. The attempts at pack opening were observed, the time taken to open the pack was measured and the correlation between grip and pinch strengths with opening times was determined. Tetra packs, water bottles, cereal, fruit cups, desserts, biscuits and cheese portions appeared to be the most difficult food products to open. Ten percent of the sample could not open the water bottles and 39% could not open cheese portions. The results were consistent with the previous research involving hospitalised older adults, adding emphasis to the conclusion that food and beverage packaging can be a potential barrier to adequate nutrition when particular types of packaged products are used in hospitals or the community. The ageing population is rapidly becoming a larger and more important group to consider in the provision of goods and services. Designers, manufacturers and providers of food and beverage products need to consider the needs and abilities of these older consumers to ensure good ‘openability’ and promote adequate nutritional intakes.

From fragmented to integrated healthcare: an imperative for rural populations

Introduction: Providing healthcare to rural populations is often challenging. Long distances, low population densities, difficulties recruiting and retaining staff, limited opportunities to harness economies of scale, and an ageing population with high prevalence rates of chronic disease – all of these factors place fragmentary pressures on healthcare organisations. In the face of such pressures, there is a particular imperative to integrate services for rural people. Objective: To draw on patient survey data to assess the extent of variation in key elements of healthcare integration across hospitals situated in outer regional/remote, inner regional and major city areas of NSW. Methods: Results from a postal/ online survey of adults admitted to NSW public hospitals between January and June 2013 [Sample size 17,746]. Results were weighted to represent the age and stay type of each hospital’s admitted patient population. Questions relating to communication, coordination of care, patient engagement and integration were included in the study. Results: Patients admitted to hospitals situated in rural areas of NSW scored questions relevant to integration of care more positively than those admitted to hospitals in urban areas. This was particularly the case for questions related to communication and patient involvement in care. Results regarding the extent to which patients were definitely involved in decisions regarding their discharge from hospital were the most variable across aggregated rurality categories (72% for outer regional/remote, 69% for inner regional and 61% for major cities). Results for whether patients felt they were definitely involved in decisions about their care and treatment showed greatest variability across hospitals within rurality categories (rural hospital range 55% 79% patients; metropolitan hospital range 46% 80% patients). Discussion: Complementary data drawn from the 2013 Commonwealth Fund International Health Policy Survey echoed these patterns. Data for NSW respondents show more positive results for people living in outer regional/remote and inner regional areas of NSW with regards to World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. International Journal of Integrated Care – Volume 14, 8 December – URN:NBN:NL:UI:10-1-116662– http://www.ijic.org/ communication regarding prescription medications, the extent to which general practitioners engage patients in their own care, and confidence that patients with chronic conditions report in managing their own health problems. It is not clear whether the isolation and distance that characterise rural life encourages patients to become more engaged in their care; or encourages healthcare providers to facilitate greater engagement of their patients; or a combination of the two. Limitations: The analysis has not taken account of potential confounders such as variation in case mix across hospitals and rurality. It can be argued however, that patients should be engaged in their care, regardless of their specific diagnosis or severity. Further, while the study includes a range of elements pertinent to healthcare integration, there may be elements that have not been captured by the survey instrument. Conclusion: Patients hospitalised in rural NSW report better communication and greater involvement in decisions about their care than those hospitalised in urban areas.

Accuracy of automatic syndromic classification of coded emergency department diagnoses in identifying mental health-related presentations for public health surveillance.

BackgroundSyndromic surveillance in emergency departments (EDs) may be used to deliver early warnings of increases in disease activity, to provide situational awareness during events of public health significance, to supplement other information on trends in acute disease and injury, and to support the development and monitoring of prevention or response strategies. Changes in mental health related ED presentations may be relevant to these goals, provided they can be identified accurately and efficiently. This study aimed to measure the accuracy of using diagnostic codes in electronic ED presentation records to identify mental health-related visits.MethodsWe selected a random sample of 500 records from a total of 1,815,588 ED electronic presentation records from 59 NSW public hospitals during 2010. ED diagnoses were recorded using any of ICD-9, ICD-10 or SNOMED CT classifications. Three clinicians, blinded to the automatically generated syndromic grouping and each other’s classification, reviewed the triage notes and classified each of the 500 visits as mental health-related or not. A “mental health problem presentation” for the purposes of this study was defined as any ED presentation where either a mental disorder or a mental health problem was the reason for the ED visit. The combined clinicians’ assessment of the records was used as reference standard to measure the sensitivity, specificity, and positive and negative predictive values of the automatic classification of coded emergency department diagnoses. Agreement between the reference standard and the automated coded classification was estimated using the Kappa statistic.ResultsAgreement between clinician’s classification and automated coded classification was substantial (Kappa = 0.73. 95% CI: 0.58 - 0.87). The automatic syndromic grouping of coded ED diagnoses for mental health-related visits was found to be moderately sensitive (68% 95% CI: 46%-84%) and highly specific at 99% (95% CI: 98%-99.7%) when compared with the reference standard in identifying mental health related ED visits. Positive predictive value was 81% (95% CI: 0.57 – 0.94) and negative predictive value was 98% (95% CI: 0.97-0.99).ConclusionsMental health presentations identified using diagnoses coded with various classifications in electronic ED presentation records offers sufficient accuracy for application in near real-time syndromic surveillance.

Day‐to‐day activities of clinical dietitians working in the inpatient and outpatient settings in a group of New South Wales public hospitals: The results of a direct observational study

AbstractAimTo describe the daily tasks undertaken by dietitians working within the inpatient and outpatient sectors within the NSW public hospital system.MethodsThis study used an ethnographic methodology that employed a direct, non‐participatory, discontinuous, observational technique to observe hospital dietitians, in both outpatient and inpatient settings, during a typical work shift. Trained volunteer observers collected the data over a three‐year period (2008, 2009 and 2010). The data were combined and then sorted into five categories including: direct patient care, indirect patient care, communication, administration and education of self or others.ResultsA total of 609 hours and 21 minutes were observed across a three‐year time period 2008–2010. On average, the dietitians in both inpatient and outpatient settings spent 18.3–32.2% of their time in direct patient care activities. The majority of time was spent in indirect patient care activities such as: information collection, documentation and discussion with other health‐care professionals. A comparison between the two work settings showed that those dietitians working in the inpatient setting spent less time in direct patient care (18.3% vs 33.1%, P &lt; 0.05), and more time in indirect care activities (41.7% vs 23.3%, P &lt; 0.05) and in communication about patient care (22.7% vs 14.4%, P &lt; 0.05).ConclusionsThe findings show that dietitians spend most of their time doing activities that support patient care, but these activities occur away from the patient.

Characteristics of rural hospital services for people with dementia: Findings from the Hospital Dementia Services Project

To obtain information about aged care services in rural New South Wales public hospitals, and to describe key operational aspects of their service delivery models. A mixed methods design was used to combine data collected from: (i) a survey of public hospitals and (ii) qualitative site visits in a sample of eleven rural sites. Rural public hospitals in NSW, Australia. Qualitative data were collected from multidisciplinary clinicians, managers and community service providers who participated in site visits in 2010 and from surveys of NSW public hospitals in 2009/10 about aged care and dementia services. Survey and site visit findings demonstrated that rural hospitals have fewer secure beds for managing patients with disturbed behaviour due to dementia and delirium and fewer speciality aged care staff than metropolitan hospitals. Site visit participants also described how secure environments can aid care for people with dementia even in the absence of clinical specialists. The care of people with dementia in rural hospitals is constrained by access to specialist aged care staff and the physical environment of the hospital. Clinicians are adept at maximising resources to manage diagnosis and transitions for people with dementia. Further understanding of how key operational aspects of clinical leadership and environmental modifications impact on a range of patient outcomes would be valuable.

NSW public hospitals accessing digital radiology images.

HealthShare NSW is leading innovative solutions for digital imaging by making radiology images available across all NSW public hospitals through the implementation of the first state-wide Enterprise Imaging Repository (EIR).

Reporting of Aboriginal and Torres Strait Islander peoples on the NSW Admitted Patient Data Collection: the 2010 Data Quality Survey

The reporting of Aboriginal and Torres Strait Islander peoples on the NSW Admitted Patient Data Collection was ascertained using a stratified purposive sample of NSW public hospital patients in 2010. Information was collected by interviewing patients and compared with patient information obtained on admission. The study used the methods used in the national survey by the AIHW in 2007 and the study results were compared to the AIHW survey results. The level of correct reporting was 90.7% (95% CI 84.6-94.2). These results, while indicative, should be interpreted with caution as some people may not have identified themselves as Aboriginal or Torres Strait Islander either on hospital admission or in the survey, and non-random sampling can produce non-representative samples.

An Equilibrium Model of Waiting Times for Elective Surgery in NSW Public Hospitals*

This article studies the effects of waiting times on the demand and supply of elective surgery in NSW public hospitals. The demand and supply equations are estimated at the level of postal code areas using data on public hospital elective surgery admissions in 2004-2005, postal code area characteristics and area-level provisions of public and private hospital capacities. Empirical results imply that demand for elective surgery is affected negatively, and supply positively, by waiting time. The estimated elasticity of demand with respect to waiting time is higher in NSW than estimates reported in studies based on data from the UK National Health Service.

The effectiveness of interprofessional education in university based health professional programs: A systematic review

The effectiveness of interprofessional education in university based health professional programs: A systematic review