Private Hospitals In Australia Research Articles

Procurement in public & private hospitals in Australia and Costa Rica – a comparative case study

This article summarizes exploratory research conducted on supply chain management practices in public hospital systems in the Australian State of Victoria and in Costa Rica. Victoria is the site of a clearly articulated (centralized) supply chain strategy as opposed to Costa Rica, where there is a strong presence of government procurement rules but no such articulated strategy. Importantly, both systems have mixed governance structures (public vs private) and had a willingness to share information pertaining to their purchasing practices. Relatively open-ended interviews, analyzed utilizing MAXQDA 11, allowed us to scrutinize the influence of public policy, supply chain integration, supply chain/clinician collaboration, value analysis teams and group purchasing. We found that centralization of procurement was prevalent in public hospitals in both countries, with more regional centralization in Victoria, Australia due to its size. Also, Private hospital systems are encouraged to take advantage of the centralized procurement policy of the government in both the countries. While standardization was achieved in both countries by better integrating procurement and information technology functions, collaboration between clinicians led to more standardization.

University-Private Hospital clinical education partnerships: opportunities, benefits and barriers for medical student clinical training in private hospitals

Introduction: Private hospitals in Australia have the potential to offer rich clinical training opportunities for medical students. This study aimed to identify benefits and barriers to private hospitals engaging with medical schools to provide clinical learning opportunities, as perceived by staff and visiting clinicians at private hospitals. Methods: Visiting clinicians and staff at four private hospitals in Adelaide (South Australia) were surveyed, using open-ended questions, to determine attitudes to medical student training in private hospitals. Responses were analysed using inductive content analysis to determine dominant themes in relation to perceived benefits, perceived barriers, and factors that might facilitate clinical teaching in private hospitals. Results: A total of 59 participants completed the survey: 38 secondary care specialists; 4 general practitioners; 6 senior administrative staff; 6 hospital volunteers, medical students or registered nurses; and 5 not specified. There were three dominant themes related to perceived benefits of teaching: the breadth and diversity of clinical exposure for students, opportunities for students to understand private and community health systems, and the high quality of learning available. There were three dominant themes related to barriers: time constraints, patient unwillingness and limitations of learning opportunities. Factors that might facilitate medical education in private hospitals included senior staff acceptance and provision of clear support structures, faculty clinical academic support, administration and facilitation. Conclusions: Attention to the issues raised, correction of the misunderstanding regarding patient acceptance of students and minimisation of disruption to clinical service provision should allow further development of training placements in private hospitals.

Inadvertent Hypothermia After Procedural Sedation and Analgesia in a Cardiac Catheterization Laboratory: A Prospective Observational Study.

To identify the prevalence of and risk factors for inadvertent hypothermia after procedures performed with procedural sedation and analgesia in a cardiac catheterization laboratory. A single-center, prospective observational study. A tertiary-care private hospital in Australia. 399 patients undergoing elective procedures with procedural sedation and analgesia were included. Propofol infusions were used when an anesthesiologist was present. Otherwise, bolus doses of either midazolam or fentanyl or a combination of these medications was used. None Hypothermia was defined as a temperature<36.0°C. Multivariate logistic regression was used to identify risk factors. Hypothermia was present after 23.3% (n = 93; 95% confidence interval [CI] 19.2%-27.4%) of 399 procedures. Sedative regimens with the highest prevalence of hypothermia were any regimen that included propofol (n = 35; 40.2%; 95% CI 29.9%-50.5%) and the use of fentanyl combined with midazolam (n = 23; 20.3%; 95% CI 12.9%-27.7%). Difference in mean temperature from pre-procedure to post-procedure was -0.27°C (standard deviation 0.45). Receiving propofol (odds ratio [OR] 4.6 95% CI 2.5-8.6), percutaneous coronary intervention (OR 3.2; 95% CI 1.7-5.9), body mass index<25 (OR 2.5; 95% CI 1.4-4.4) and being hypothermic prior to the procedure (OR 4.9; 95% CI 2.3-10.8) were independent predictors of post-procedural hypothermia. A moderate prevalence of hypothermia was observed. The small absolute change in temperature observed may not be a clinically important amount. More research is needed to increase confidence in the authors' estimates of hypothermia in sedated patients and its impact on clinical outcomes.

Attitudes towards antimicrobial stewardship: results from a large private hospital in Australia

Abstract Introduction An effective hospital-wide antimicrobial stewardship (AMS) program requires engagement with all healthcare professionals involved in antimicrobial use. It is therefore useful to consider attitudes and perceptions among clinical stakeholders in Australian private hospitals before introducingAMS in these facilities. The aim of this study was to describe perceptions and attitudes towards antimicrobial resistance, antimicrobial use, AMS interventions, and willingness to participate. Methods A 26-item attitudinal survey was distributed to visiting specialists, nurses and pharmacists at a large (500 bed) private hospital in Australia. Survey questions utilised ‘Yes/No' responses and a 7-point Likert scale ranging from ‘strongly agree' to ‘strongly disagree'. Descriptive analyses were performed and Chi-squared tests conducted. Results There were a total of 331 respondents (80 physicians, 58 surgeons, 78 anaesthetists, 105 nurses and 10 pharmacists). The response rate was 42% among clinicians, 100% among pharmacists and 13% among nurses. Only half of the respondents were willing to participate in proposed AMS interventions. A larger proportion of respondents believed that antimicrobial resistance was more of a serious problem in other Australian hospitals compared with the surveyed hospital (62% v. 45%, P Conclusions This study highlights the challenge of making antimicrobial resistance a relevant local issue in private hospitals and engaging key health professionals before implementing change.

Using periodic point‐prevalence surveys to assess appropriateness of antimicrobial prescribing in Australian private hospitals

Appropriateness of antimicrobial use is a measure of key importance in evaluating safety and quality of prescribing but has been difficult to define and assess on a wide scale. Published work is limited and has generally focused on tertiary public hospitals, whereas the private sector provides a significant proportion of care in many countries. Information on prescribing in the private hospital context is needed to identify where intervention might be required. An antimicrobial prescribing survey tool was utilised to assess the appropriateness of antimicrobial prescribing among large private hospitals in Australia. 'Appropriateness' of antimicrobial therapy was evaluated by a team consisting of an infectious diseases physician and specialist infectious diseases pharmacist based on clear criteria. Thirteen hospital-wide point-prevalence surveys were conducted. Three thousand, four hundred and seventy-two inpatient medication charts were reviewed to identify 1125 (32.4%) inpatients on 1444 antimicrobials. An indication was documented in 911 (63.1%) of surveyed prescriptions, and overall, 757 (52.4%) of antimicrobials were assessed as appropriate. Antimicrobials prescribed for treatment had a higher proportion of appropriateness when compared with antimicrobials prescribed for surgical prophylaxis (80.4% vs 40.6%). The main reason for a treatment prescription to be considered inappropriate was incorrect selection, while prolonged duration (>24 h) was the main reason for inappropriate surgical prophylaxis prescriptions. This study provides important data on antimicrobial prescribing patterns in Australian private hospitals. Results can be used to target areas for improvement, with documentation of indication and surgical antibiotic prophylaxis requiring initial attention.

Multicenter Randomized Trial of Centralized Nurse-Led Telephone-Based Care Coordination to Improve Outcomes After Surgical Resection for Colorectal Cancer: The CONNECT Intervention

To investigate the effectiveness of a centralized, nurse-delivered telephone-based service to improve care coordination and patient-reported outcomes after surgery for colorectal cancer. Patients with a newly diagnosed colorectal cancer were randomly assigned to the CONNECT intervention or usual care. Intervention-group patients received standardized calls from the centrally based nurse 3 and 10 days and 1, 3, and 6 months after discharge from hospital. Unmet supportive care needs, experience of care coordination, unplanned readmissions, emergency department presentations, distress, and quality of life (QOL) were assessed by questionnaire at 1, 3, and 6 months. Of 775 patients treated at 23 public and private hospitals in Australia, 387 were randomly assigned to the intervention group and 369 to the control group. There were no significant differences between groups in unmet supportive care needs, but these were consistently low in both groups at both follow-up time points. There were no differences between the groups in emergency department presentations (10.8% v 13.8%; P = .2) or unplanned hospital readmissions (8.6% v 10.5%; P = .4) at 1 month. By 6 months, 25.6% of intervention-group patients had reported an unplanned readmission compared with 27.9% of controls (P = .5). There were no significant differences in experience of care coordination, distress, or QOL between groups at any follow-up time point. This trial failed to demonstrate substantial benefit of a centralized system to provide standardized, telephone follow-up for postoperative patients with colorectal cancer. Future interventions could investigate a more tailored approach.

Effect of private insurance incentive policy reforms on trends in coronary revascularisation procedures in the private and public health sectors in Western Australia: a cohort study

BackgroundThe Australian federal government introduced private health insurance incentive policy reforms in 2000 that increased the uptake of private health insurance in Australia. There is currently a lack of evidence on the effect of the policy reforms on access to cardiovascular interventions in public and private hospitals in Australia. The aim was to investigate whether the increased private health insurance uptake influenced trends in emergency and elective coronary artery revascularisation procedures (CARPs) for private and public patients.MethodsWe included 34,423 incident CARPs from Western Australia during 1995-2008 in this study. Rates of emergency and elective CARPs were stratified for publicly and privately funded patients. The average annual percent change (AAPC) in trend was calculated before and after 2000 using joinpoint regression.ResultsThe rate of emergency CARPs, which were predominantly percutaneous coronary interventions (PCIs) with stenting, increased throughout the study period for both public and private patients (AAPC=12.9%, 95% CI=5.0,22.0 and 14.1%, 95% CI=9.8,18.6, respectively) with no significant difference in trends before and after policy implementation. The rate of elective PCIs with stenting from 2000 onwards remained relatively stable for public patients (AAPC=−6.0, 95% C= −16.9,6.4), but increased by 4.1% on average annually (95% CI=1.8,6.3) for private patients (pdifference=0.04 between groups). This rate increase for private patients was only seen in people aged over 65 years and people residing in high socioeconomic areas.ConclusionsThe private health insurance incentive policy reforms are a likely contributing factor in the shift in 2000 from public to privately-funded elective PCIs with stenting. These reforms as well as the increasing number of private hospitals may have been successful in increasing the availability of publicly-funded beds since 2000.

Review of medical discharge summaries and medical documentation in a metropolitan hospital: impact on diagnostic‐related groups and Weighted Inlier Equivalent Separation

Accurate and comprehensive clinical documentation is crucial for effective ongoing patient care, follow up and to optimise case mix-based funding. Each Diagnostic Related Group (DRG) is assigned a 'weight', leading to Weighted Inlier Equivalent Separation (WIES), a system many public and private hospitals in Australia subscribe to. To identify the top DRG in a general medical inpatient service, the completeness of medical discharge documentation, commonly missed comorbidities and system-related issues and subsequent impact on DRG and WIES allocation. One hundred and fifty completed discharge summaries were randomly selected from the top 10 medical DRG in our health service. From a detailed review of the clinical documentation, principal diagnoses, associated comorbidities and complications, where appropriate, the DRG and WIES were modified. Seventy-two (48%) of the 150 reviewed admissions resulted in a revision of DRG and WIES equivalent to an increase of AUD 142,000. Respiratory-based DRG generated the largest revision of DRG and WIES, while 'Cellulitis' DRG had the largest relative change. Twenty-seven per cent of summaries reviewed necessitated a change in coding with no subsequent change in DRG allocation or WIES. Acute renal failure, anaemia and electrolyte disturbances were the most commonly underrepresented entities in clinical discharge documentation. Seven patients had their WIES downgraded. Comprehensive documentation of principal diagnosis/diagnoses, comorbidities and their complications is imperative to optimal DRG and WIES allocation. Regular meetings between clinical and coding staff improve the quality and timeliness of medical documentation, ensure adequate communication with general practitioners and lead to appropriate funding.

Outcome of Prolift mesh repair in treatment of pelvic organ prolapse and its effect on lower urinary tract symptoms: 5‐year retrospective case study

To assess the outcome of the Prolift Gynecare (Ethicon, Somerville, NJ, USA) mesh repair in the treatment of pelvic organ prolapse. This includes the anatomical success, complication rate and effect on associated lower urinary tract symptoms. Retrospective case analysis of the above outcomes of 41 Prolift mesh repairs performed on 40 women over a 5-year period by a single surgeon in a private hospital in Australia. Successful anatomical correction and bulge symptom resolution were observed in 100% (2/2), 91.6% (11/12) and 100% (27/27) of anterior, posterior and total Prolift, respectively. Prolapse in a non-treated compartment occurred in one woman. Two patients developed postoperative hematomas requiring surgical evacuation; one of whom developed urinary retention for 2 weeks. Preoperative urinary symptoms were reported in 35/40 (92%) of women, 8 of whom reported only urge symptoms and experienced complete resolution after Prolift. Resolution of stress urinary incontinence in women who had urodynamic stress incontinence with and without urge symptoms was reported in 60% (12/20) and 20% (1/5), respectively. This represented 62.5% (10/16) and 33.3% (3/9) of women who had total Prolift and posterior Prolift respectively. Average follow-up periods were 7 and 39 weeks in 38 and 18 women, respectively. This study shows that Prolift procedure is safe and effective in women with severe pelvic organ prolapse with resolution of most of the bulge and urinary urge symptoms. Total Prolift was effective in the treatment of associated mixed urinary incontinence.

Comprehensive systematic review of age-friendly nursing interventions in the management of older people in Emergency Departments.

Review Objective: To identify the best available evidence on age-friendly nursing interventions used in the management of older people (over 65) during their stay in the Emergency Department Review Questions: 1. What is the effectiveness of age-friendly nursing interventions used in the management of older people (over 65) during their stay in the Emergency Department? 2. What are the recommended policies regarding age-friendly nursing interventions for the management of older people (over 65) during their stay in the Emergency Department? Inclusion criteria: Types of participants: This review will consider men and women over the age of 65 presenting to the Emergency Department. Types of intervention(s)/phenomena of interest: The review will consider any age-friendly nursing interventions in the management of older patients during their stay in the Emergency Department. These may include nursing interventions to enhance comfort, nutrition, hydration, pressure area care, pain management and communication. The opinion part of the review will consider the policies and recommendations related to age-friendly nursing interventions. Types of outcomes: Outcomes of interest for the quantitative part of the review are: pressure area status, hydration status, nutritional status and pain status measured during their stay in the emergency department. The text and opinion part of the review will focus on the recommended policies for age-friendly nursing interventions.

Adverse outcomes of labour in public and private hospitals in Australia

Adverse outcomes of labour in public and private hospitals in Australia

Adverse outcomes of labour in public and private hospitals in Australia

Adverse outcomes of labour in public and private hospitals in Australia

Adverse outcomes of labour in public and private hospitals in Australia

TO THE EDITOR: In their national analysis, Robson and colleagues found less favourable outcomes among term singleton babies born in public hospitals than in private hospitals. Most health services research is non-randomised, and it is unrealistic to expect studies such as this to be as internally valid as a randomised controlled trial. As noted by others, in the absence of randomisation, it is difficult to untangle the myriad differences between mothers, babies, and the care provided in private and public hospitals (ie, the results might be subject to confounding). Robson et al statistically accounted for the potential confounding effect of maternal smoking (although these data were only available for about half the mothers), age, Indigenous status, parity, diabetes, hypertension, rurality and method of birth. We replicated their analysis using the Queensland Perinatal Data Collection (July 2005 – December 2007), which included virtually complete data on maternal smoking. Our analysis of 124 300 term singleton babies gave an adjusted odds ratio (AOR) for perinatal mortality of 2.0 (95% CI, 1.4–2.7), which is similar to that reported by Robson et al. Using more detailed data from the Queensland dataset, we statistically adjusted for other potential confounders — including pre-existing and gestational diabetes, pre-existing and pregnancy-induced hypertension, pre-eclampsia, eclampsia, antepartum haemorrhage, anaemia , depression, urinary tract infection, low birthweight (< 2500 g), socioeconomic status (based on area of usual residence), alcohol and drug misuse, and artificial reproductive technology — and obtained an AOR of 2.1 (95% CI, 1.5–2.9). We are not implying that adding more and more variables to a statistical model is an appropriate way to account for confounding. Our aim is simply to show that Robson et al’s result is robust to statistical adjustment using the available data; this is not the same as saying the analysis is robust to confounding. We found that the higher perinatal mortality in public hospitals was greater for neonatal deaths (AOR, 3.1; 95% CI, 1.8– 5.6) than for stillbirths (AOR, 1.6; 95% CI, 1.0–2.4). Excluding lethal congenital anomalies did not materially change the result (AOR, 1.9; 95% CI, 1.3–2.8). We also stratified our analysis by level of hospital — tertiary referral (neonatal intensive care unit), base (special care nursery), and community — and obtained a similar twofold mortality excess in each stratum. Although perinatal mortality is uncommon among term singleton babies (1 in 1000 in private hospitals versus 2 in 1000 in public hospitals), any excess risk should be investigated and the reasons for it understood. The results from Robson et al’s article might be due to confounding, but they should not be dismissed and should be investigated with more detailed clinical data. Even if all the excess risk is due to confounding, explicit confirmation of this would be extremely useful. To this end, the Statewide Maternity and Neonatal Clinical Network in Queensland Health will undertake clinical review and classification of term singleton deaths according to national guidelines and collaborate with the Australian Maternity Outcomes Surveillance System (AMOSS) to enhance prospective monitoring of late gestation perinatal deaths nationally.

Adverse outcomes of labour in public and private hospitals in Australia

Adverse outcomes of labour in public and private hospitals in Australia

Maximum recovery after knee replacement – the MARKER study rationale and protocol

BackgroundThere is little scientific evidence to support the usual practice of providing outpatient rehabilitation to patients undergoing total knee replacement surgery (TKR) immediately after discharge from the orthopaedic ward. It is hypothesised that the lack of clinical benefit is due to the low exercise intensity tolerated at this time, with patients still recovering from the effects of major orthopaedic surgery. The aim of the proposed clinical trial is to investigate the clinical and cost effectiveness of a novel rehabilitation strategy, consisting of an initial home exercise programme followed, approximately six weeks later, by higher intensity outpatient exercise classes.Methods/DesignIn this multicentre randomised controlled trial, 600 patients undergoing primary TKR will be recruited at the orthopaedic pre-admission clinic of 10 large public and private hospitals in Australia. There will be no change to the medical or rehabilitative care usually provided while the participant is admitted to the orthopaedic ward. After TKR, but prior to discharge from the orthopaedic ward, participants will be randomised to either the novel rehabilitation strategy or usual rehabilitative care as provided by the hospital or recommended by the orthopaedic surgeon. Outcomes assessments will be conducted at baseline (pre-admission clinic) and at 6 weeks, 6 months and 12 months following randomisation. The primary outcomes will be self-reported knee pain and physical function. Secondary outcomes include quality of life and objective measures of physical performance. Health economic data (health sector and community service utilisation, loss of productivity) will be recorded prospectively by participants in a patient diary. This patient cohort will also be followed-up annually for five years for knee pain, physical function and the need or actual incidence of further joint replacement surgery.DiscussionThe results of this pragmatic clinical trial can be directly implemented into clinical practice. If beneficial, the novel rehabilitation strategy of utilising outpatient exercise classes during a later rehabilitation phase would provide a feasible and potentially cost-effective intervention to optimise the physical well-being of the large number of people undergoing TKR.Trial RegistrationACTRN12609000054213

Adverse outcomes of labour in public and private hospitals in Australia: a population‐based descriptive study

Almost all women in Australia have free access to public hospitals, where intrapar- tum care is usually provided by a mixture of midwives, junior medical officers, specialty trainees, and specialist obstetricians. In con- trast, women choosing to deliver in private hospitals have their care directly managed by specialist obstetricians. Compared with public hospitals, birth in Australian private hospitals is characterised by a higher rate of obstetric interventions such as induction of labour, episiotomy, instrumental delivery, ABSTRACT Objective: To compare the rate of serious adverse perinatal outcomes of term labour between private and public maternity hospitals in Australia. Design, setting and participants: A population-based study of 789 240 term singleton births in public and private hospitals in 2001-2004, using data from the National Perinatal Data Collection. Main outcome measures: Third- and fourth-degree perineal injury, requirement for high level of neonatal resuscitation, Apgar score < 7 at 5 minutes, admission to neonatal intensive care unit or special care nursery, and perinatal death. Results: 31.4% of the term singleton births occurred in private hospitals. After adjusting for maternal age, Indigenous status, parity, smoking status, diabetes, hypertension, remoteness of usual residence, and method of birth, the rates of all adverse outcomes studied were higher for public hospital births. For women, the adjusted odds ratio (AOR) for third- or fourth-degree perineal injury was 2.28 (95% CI, 2.16-2.40). For babies, the odds of a high level of resuscitation (AOR, 2.37; 95% CI, 2.17-2.59), low Apgar score (AOR, 1.75; 95% CI, 1.65-1.84), intensive care requirement (AOR, 1.48; 95% CI, 1.45-1.51) and perinatal death (AOR, 2.02; 95% CI, 1.78-2.29) were all higher in public hospitals. Conclusion: For women delivering a single baby at term in Australia, the prevalence of

Adverse outcomes of labour in public and private hospitals in Australia

Medical Journal of AustraliaVolume 190, Issue 9 p. 518-519 Letter Adverse outcomes of labour in public and private hospitals in Australia Georgina A Sutherland, Corresponding Author Georgina A Sutherland Senior Research Officer georgina.sutherland@mcri.edu.au Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Melbourne, VIC.Correspondence: georgina.sutherland@mcri.edu.auSearch for more papers by this authorDeirdre Gartland, Deirdre Gartland Research Officer Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Melbourne, VIC.Search for more papers by this authorJane S Yelland, Jane S Yelland Research Fellow Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Melbourne, VIC.Search for more papers by this authorStephanie J Brown, Stephanie J Brown Head of Research Group and Principal Research Fellow Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Melbourne, VIC.Search for more papers by this author Georgina A Sutherland, Corresponding Author Georgina A Sutherland Senior Research Officer georgina.sutherland@mcri.edu.au Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Melbourne, VIC.Correspondence: georgina.sutherland@mcri.edu.auSearch for more papers by this authorDeirdre Gartland, Deirdre Gartland Research Officer Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Melbourne, VIC.Search for more papers by this authorJane S Yelland, Jane S Yelland Research Fellow Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Melbourne, VIC.Search for more papers by this authorStephanie J Brown, Stephanie J Brown Head of Research Group and Principal Research Fellow Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Melbourne, VIC.Search for more papers by this author First published: 04 May 2009 https://doi.org/10.5694/j.1326-5377.2009.tb02541.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume190, Issue9May 2009Pages 518-519 RelatedInformation

Adverse outcomes of labour in public and private hospitals in Australia

Adverse outcomes of labour in public and private hospitals in Australia

Adverse outcomes of labour in public and private hospitals in Australia

Adverse outcomes of labour in public and private hospitals in Australia

Hospitalization Patterns for Psychiatric Disorders Across the Lifespan in Australia From July 1998 to June 2005

Hospitalization Patterns for Psychiatric Disorders Across the Lifespan in Australia From July 1998 to June 2005