Public Hospitals In Australia Research Articles

Clinical Outcomes of High-Complexity Cardiac Electronic Device Implantation in Private and Public Hospitals in Australia: Comparison of GCOR and VCOR

Reported outcomes following implantation of cardiac implantable electrical devices (CIED) are highly variable. We compared CIED outcomes and patient characteristics between two contemporary Australian registries.

Cross-sectional survey of rehabilitation service availability for stroke and hip fracture in Australian public hospitals.

To describe the rehabilitation services available for people with stroke and hip fracture across New South Wales/Australian Capital Territory metropolitan and rural/regional public hospitals in Australia. A cross-sectional study design was used. New South Wales/Australian Capital Territory public hospital providing rehabilitation services for stroke and hip fracture. Delegates from 59 eligible hospitals. Information about the type, number and availability of inpatient and outpatient rehabilitation services at each hospital was collected via survey. Counts, percentages, mean (SD), median (IQR) were used to quantify the number and type of inpatient and outpatient services available. Across inpatient rehabilitation units, reduced availability was noted in the number of clinical disciplines available, availability of neuropsychology and social work in rural units. Across outpatient rehabilitation services, reduced availability was noted in the number of disciplines available, availability of occupational therapy, psychology, rehabilitation physicians, specialist nursing, geriatricians, and podiatry in rural services. Five rural hospitals had no access to outpatient rehabilitation. There was reduced availability of rehabilitation services and health disciplines in rural/regional settings. A follow-up study is underway investigating relationships between reduced outpatient service availability and inpatient length of stay in rural/regional versus metropolitan hospitals.

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.

An integrated multicomponent care model for men affected by prostate cancer: A feasibility study of TrueNTH Australia.

ObjectiveTo evaluate the feasibility of implementing an integrated multicomponent survivorship care model for men affected by prostate cancer.MethodsUsing a single arm prospective cohort study design, men with prostate cancer were recruited from two regional public hospitals in Australia for a 6‐months program that provided information and decision support, exercise and nutrition management, specialised clinical support, and practical support through localised and central care coordination. Carers of the men were also invited to the program. Data were collected from multiple sources to evaluate: (1) recruitment capability and participant characteristics; (2) appropriateness and feasibility of delivering the specific intervention components using an electronic care management tool; and (3) suitability of data collection procedures and proposed outcome measures.ResultsOf the 105 eligible men, 51 (consent rate 49%) participated in the program. Of the 31 carers nominated by the men, 13 consented (consent rate 42%). All carers and 50 (98%) men completed the program. Most (92%) men were newly diagnosed with localised prostate cancer. All men attended initial screening and assessment for supportive care needs; a total of 838 episodes of contact/consultation were made by the intervention team either in person (9%) or remotely (91%). The intervention was implemented as proposed with no adverse events. The proposed outcome measures and evaluation procedures were found to be appropriate.ConclusionsOur results support the feasibility of implementing this integrated multicomponent care model for men affected by prostate cancer.

A cross sectional study of organizational factors and their impact on job satisfaction and emotional burnout in a group of Australian nurses: infection control practitioners

BackgroundInfection control practitioners (ICPs) are a group of specialized nurses fundamental to effective healthcare infection prevention and control initiatives. Relative to other groups of nurses much less is known about their working conditions. Organizational factors may impact ICPs’ levels of job dissatisfaction and emotional job burnout and, subsequently, their quality of practice. We measure a range of organizational factors to document the working conditions of ICPs and show how these are linked to job satisfaction and emotional burnout in a sample of Australian ICPs.MethodsWe conducted a cross sectional study using an online survey. All employed ICPs in 50 of the largest public hospitals in Australia were invited to participate. One hundred and fifty three ICPs completed the survey.ResultsICPs are moderately to highly satisfied with their job but show high levels of emotional burnout, time pressure and cognitive demands. Low job satisfaction was associated with less job control, low perceived organizational support and poor communication. In contrast, emotional burnout was associated with high time pressure and cognitive demands coupled with poor communication.DiscussionThis study provides new evidence about the organizational context of ICPs in Australia, and about the factors that impact on job satisfaction and emotional burnout. These findings may be used to modify national infection prevention and control programs to suit local organizational contexts. Further research is needed to determine the precise nature of these relationships and the downstream impacts on hospital-wide infection control outcomes.ConclusionsOrganizational context and factors are important to consider when evaluating the impact and implementation of infection control programs.

A group program for overweight and obese women with urinary incontinence (ATHENA): an implementation-effectiveness hybrid type 3 study.

Supervised pelvic floor muscle training (PFMT), weight loss and exercise are recommended for overweight/obese women with urinary incontinence (UI). This study aimed to implement and evaluate the feasibility, acceptability and effectiveness of a 12-week group exercise and healthy eating program (ATHENA) for overweight/obese women with UI. This study, using an implementation-effectiveness hybrid type 3 design, was conducted within a Women's Health Physiotherapy outpatient service at an Australian tertiary public hospital. Intervention feasibility and acceptability were assessed through process evaluation of implementation, while clinical effectiveness was assessed via pre-/post-clinical and quality of life surveys. Process data were analyzed using descriptive statistics and effectiveness data were compared pre-/post-intervention using inferential statistics. Of 156 eligible patients, 37 (24%) agreed to participate; 29 (78%) completed the ATHENA program. Median (IQR) age and body mass index were 53 (47-65) years and 30.8 (29.1-34.8) kg/m2 respectively. ATHENA was feasible to implement, with all components delivered as intended and high participant satisfaction. Ninety-seven percent of participants reported improved UI symptoms (global rating of change) and significant improvements in overall pelvic floor dysfunction and quality of life utility scores (p = 0.001). While weight did not change, significant improvements were found in body-food choice congruence (intuitive eating scale-2; p < 0.01). The ATHENA intervention was feasible, acceptable and clinically effective for overweight and obese women with urinary incontinence at a tertiary public hospital in Australia. Further research into longer term outcomes and the cost effectiveness of this group intervention is recommended. N/A. Ethics approval, HREC/2018/QGC/46582, date of registration 14/11/2018.

Development and validation of the ‘Knowledge of Gestational Diabetes (GDM)’ questionnaire among a sample of women with GDM in Australia

ObjectiveAt present, there are few validated tools that measure women’s knowledge of GDM and no tool was located, that measured effective self-management of GDM. To address this gap, this study aimed to assess the validity and reliability of the ‘Knowledge of GDM’ questionnaire, for use by pregnant women. MethodsA total of 116 pregnant women, with recently diagnosed GDM, were recruited from a public hospital in Australia. Content validity, construct validity, internal consistency reliability and test-retest reliability of the questionnaire were undertaken as part of the validation process. ResultsThe questionnaire performed well in terms of content validity and internal consistency. Test-retest reliability indicated that the instrument was effective at measuring knowledge of GDM over time. Conclusionwe concluded that the Knowledge of GDM questionnaire is a reliable and valid measure of GDM knowledge, nutrition values and self-management principles. Practice implicationsThe questionnaire can be used to effectively determine knowledge gaps and the information needs of pregnant women with GDM. This information can then be used to improve health literacy and provide targeted support for women to better self-manage GDM.

South Australian Medicines Evaluation Panel in review: providing evidence-based guidance on the use of high-cost medicines in the South Australian public health system.

Objective The South Australian Medicines Evaluation Panel (SAMEP) was established in 2011 to make evidence-based recommendations on the funding of high-cost medicines in South Australian public hospitals via a high-cost medicines formulary. SAMEP represents one component of South Australia's process for state-based health technology assessment (HTA). The aim of this study was to describe the experience of SAMEP in the context of Australia's complex governance model for hospital-based care. Methods A retrospective review was conducted of the SAMEP process and outcomes of medicine evaluations. Decision summaries and meeting minutes were reviewed and reflected upon by the authors to explore the views of the SAMEP membership regarding the function of the committee and state-based HTA more broadly. Results SAMEP has reviewed 29 applications, with 14 (48%) listed on the high-cost medicines formulary. Three applications have been the subject of outcome review and confirm expectations of patient benefit. Conclusion Retrospective review of the committee experience suggests that state-based HTA as operationalised by SAMEP is feasible, provides greater equity of access to high-cost medicines in the South Australian public hospital system and allows for access with evidence development. What is known about the topic? State-based hospital funders often need to make decisions on the provision of high-cost medicines for which there is no national guidance or subsidy. Little published information exists about state-based approaches to medicines evaluation and reimbursement within public hospitals in Australia. What does this paper add? The South Australian experience demonstrates a method for states and territories to tackle the challenges of providing evidence-based access to high-cost medicines in Australian public hospitals. What are the implications for practitioners? This paper provides information for other jurisdictions considering state-based approaches to medicines evaluation and contributes to the broader literature about state-based HTA in Australia.

An Exercise Training and Healthy Eating Group Program (ATHENA) for Overweight and Obese Women with Urinary Incontinence: An Intervention Description.

Background: Despite strong evidence for supervised pelvic floor muscle training (PFMT) for women with urinary incontinence (UI), and weight loss and exercise for overweight and obese women with UI, implementation literature on these combined interventions is limited. This paper aimed to describe the rigorous and systematic processes involved in the collaborative development, implementation, refinement and evaluation of a novel, holistic 12 week exercise training and healthy eating group program (ATHENA) for overweight and obese women with UI. Methods/Design: This intervention description paper is part of a larger mixed-methods feasibility study of implementing the ATHENA intervention within a physiotherapy service at a public hospital in Australia. The collaborative intervention design had input from clinicians, researchers and a consumer representative. Results: The intervention involved four evidence-based components—(1) supervised PFMT; (2) general exercise training; (3) pelvic health education; and (4) healthy eating education—delivered face to face over a 12 week period. Supporting resources developed included a Facilitator’s Guide and Participant Workbook. Conclusion: ATHENA is an evidence-based, multifaceted, group-based intervention targeting exercise training and healthy eating for management of UI for overweight and obese women. The structured development process and transparency of intervention content and resources aims to enhance practical application and success in future studies.

Glaucoma referrals from primary care and subsequent hospital management in an urban Australian hospital

BackgroundPublic hospital ophthalmology services are in high demand and patients requiring medical or surgical intervention for glaucoma may worsen while awaiting care. In Australia, tertiary hospital care requires a referral from primary care providers. This study investigates the quality of glaucoma referrals received at a tertiary public hospital in Australia, and describes the types of glaucoma cases referred for hospital management.MethodsAn investigation of 200 sequential glaucoma referrals received at a major Australian public hospital from 2013–2016, and the subsequent hospital management. A clinical file audit was made of patient medical records, including referral letters to extract the referral content, and the hospital glaucoma diagnostic outcomes and patient management.ResultsMost referrals came from optometrists (72 per cent) and general practitioners (22 per cent) with the remainder from other specialists. The majority of the referrals contained less than 50 per cent of the key clinical and demographic parameters. Referrals from optometrists provided more ophthalmic information (visual acuity, visual field, intraocular pressure, ocular history). Referrals from general practitioners contained more medical information (systemic co‐morbidities medication and allergies). The median wait‐time from referral to hospital appointment was 400-days. Of patients attending a hospital appointment, 59 per cent required surgical or medical management, and 16 per cent did not have glaucoma. Overall 18 per cent were discharged, with no differences noted by referral content or referring practitioner.ConclusionMost referrals did not include useful diagnostic information on ocular, medical and social risks for glaucoma. There is an opportunity to improve targeting of primary care referrals for glaucoma, since patients who were discharged immediately after their hospital appointment are exacerbating the long hospital wait‐time. Better information transfer may help to identify patients requiring more urgent intervention. A standardised referral template and guidelines would support collaborative care and streamline access to hospital services.

VP29.04: NIPT as frontline screening versus contingency model: outcomes in a public hospital in Australia

VP29.04: NIPT as frontline screening versus contingency model: outcomes in a public hospital in Australia

Modified C1 lateral mass screw insertion using a threaded K-wire. A technical note

Instrumented fixation of the C1-C2 motion segment is a standard surgical technique to stabilise that spinal segment. Instability at C1-C2 can arise from a number of conditions. Fixation of the C1 lateral mass usually involves dissection and exposure of the C2 nerve root and the posterior wall of the C2 lateral mass which can result in significant bleeding from the venous plexus. Whilst image guidance is increasing in accessibility, there are few public hospitals in Australia that have access to this technology. The authors describe their technique for insertion of a C1 lateral mass screw over a threaded K-wire to avoid extensive dissection of the C2 nerve root, reducing the risk of significant haemorrhage from the epidural venous plexus during the procedure. A retrospective analysis was undertaken on 18 consecutive patients who underwent C1-C2 instrumented fixation using this technique. Indications for C1-C2 instrumented fixation included traumatic injury (10 patients), failure of non-operative management of odontoid fractures (5 patients), pathological fractures of C2 (2 patients) and inflammatory conditions (1 patient). All patients underwent successful C1-C2 stabilisation using this technique. Blood loss did not exceed 400mls in any patient. There were no vertebral artery injuries and no patient experienced a neurological deterioration. The authors propose that their technique for insertion of a C1 lateral mass screw over a threaded K-wire is safe and effective with a low risk of neurological or vertebral artery injury. The technique may be considered as a slight modification of the Harm’s procedure to reduce disturbance of the adjacent venous plexus and thereby reduction in intraoperative bleeding and operative time.

Second opinions in medical oncology

BackgroundThe current study aimed to further our understanding of second opinions among medical oncology patients by examining the proportion of patients who sought a second opinion about their cancer treatment, and why.MethodsThe study was conducted between 2013 and 2015 in three medical oncology clinics located in public hospitals in Australia: in metropolitan New South Wales, metropolitan Queensland, and in Tasmania.Those patients who provide written informed consent were asked to complete a brief paper and pencil survey in the clinic containing questions on sociodemographic, disease and treatment characteristics. Approximately 1 month later, participants were mailed a second paper and pencil survey which contained questions about whether they had sought a second opinion and their motivation for doing so. Non-responders were followed up by letter at 3 and 6 weeks.ResultsOf 823 patients screened for eligibility, 698 eligible patients, 612 provided consent.Of those who consented, 355 completed both the initial survey and the second survey and were included in the analyses. Of the 57 patients who sought a second opinion, the most frequent reasons given for doing so were the need for reassurance (49.1%) and the need to consider the range of treatment options (41.8%).Of the 297 (83.6%) participants who did not seek a second opinion, the main reason was confidence in the first doctor (88.7%). Only 3.1% patients did not know that they could ask for a second opinion. Occasionally the doctor will initiate the referral for a second opinion.ConclusionsOur study suggests that a minority of cancer patients seek a second opinion at some phase during their care. Most did so for reassurance or to ensure that they had covered all of the treatment options and not because of discomfort or distrust of their treating doctor.Few patients reported a lack of awareness of second opinions. This suggests that second opinions form part of a patient-centred approach to information provision about care options. Whether the second opinion improves the quality of care or indeed outcomes has been difficult to demonstrate.

Preoperative physiotherapy is cost-effective for preventing pulmonary complications after major abdominal surgery: a health economic analysis of a multicentre randomised trial.

Is preoperative physiotherapy cost-effective in reducing postoperative pulmonary complications (PPC) and improving quality-adjusted life years (QALYs) after major abdominal surgery? Cost-effectiveness analysis from the hospitals' perspective within a multicentre randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis. Four hundred and forty-one adults awaiting elective upper abdominal surgery attending pre-anaesthetic clinics at three public hospitals in Australia and New Zealand. The experimental group received an information booklet and a 30-minute face-to-face session, involving respiratory education and breathing exercise training, with a physiotherapist. The control group received the information booklet only. The probability of cost-effectiveness and incremental net benefits was estimated using bootstrapped incremental PPC and QALY cost-effectiveness ratios plotted on cost-effectiveness planes and associated probability curves through a range of willingness-to-pay amounts. Cost-effectiveness modelling utilised 21-day postoperative hospital cost audit data and QALYs estimated from Short Form-Six Domain health utilities and mortality to 12 months. Preoperative physiotherapy had 95% probability of being cost-effective with an incremental net benefit to participating hospitals of A$4,958 (95% CI 10 to 9,197) for each PPC prevented, given that the hospitals were willing to pay $45,000 to provide the service. Cost-utility for QALY gains was less certain. Sensitivity analyses strengthened cost-effectiveness findings. Improved cost-effectiveness and QALY gains were detected when experienced physiotherapists delivered the intervention. Preoperative physiotherapy aimed at preventing PPCs was highly likely to be cost-effective from the hospitals' perspective. For each PPC prevented, preoperative physiotherapy is likely to cost the hospitals less than the costs estimated to treat a PPC after surgery. Potential QALY gains require confirmation. ACTRN12613000664741.

A Multidisciplinary Exploratory Approach for Investigating the Experience of Older Adults Attending Hospital Services.

The public areas of the hospital built environment have hardly been investigated for their age-friendliness. This exploratory, multidisciplinary pilot study investigates the relationship between the physical environment and design of hospital spaces and older people's outpatient experience. Sixteen participants were recruited from a geriatric Outpatient Clinic at a metropolitan public hospital in Australia. Participants were engaged in a concurrent mixed-method approach, comprising a comprehensive geriatric survey, walking observation, semi-structured interview and an independent architectural audit. Several elements arising from the hospital environment were identified as facilitators and barriers for its utilization and intrinsically related to participants' physical capacity. Age-friendly hospital design needs to consider strategies to remove barriers for older adults of different capacities, thus promoting healthy aging.

Employee voice in a semi‐rural hospital: impact of resourcing, decision‐making and culture

The purpose of this paper is to understand current employee voice arrangements within a semi‐rural hospital and the implications for the engagement of healthcare professionals. The Job Demands‐Resources (JDR) model is used to explore how organisational mechanisms (resourcing, decision‐making processes and culture) provide a voice for staff. We adopt a single case study approach using in‐depth interviews with healthcare professionals in a semi‐rural public hospital in Australia. The study found that the semi‐rural context, characterised by high levels of centralised decision‐making and resourcing and low levels of confidentiality and anonymity, has limited employee voice and the ability for staff to participate in decisions affecting their work. This lack of voice has consequently had negative effects on engagement levels. We propose that employee voice be viewed as a distinct job resource, manifest through an organisation’s resourcing, decision‐making processes and culture, to generate a direct and positive effect on employee engagement.

Group education, night splinting and home exercises reduce conversion to surgery for carpal tunnel syndrome: a multicentre randomised trial.

In people with carpal tunnel syndrome who are waitlisted for surgical consultation, does a therapist-led care pathway involving education, splinting and exercises reduce the need for surgery and improve patient outcomes? A multicentre, randomised controlled trial with concealed allocation, blinded assessment and intention-to-treat analysis. One hundred and five people with electrodiagnostically confirmed carpal tunnel syndrome on a waitlist for surgical consultation and recruited from four public hospitals in Australia. The experimental group (n= 52) received a one-off group session of education, splinting, and nerve and tendon gliding exercises. The control group (n= 53) continued on the waitlist without additional care. The primary outcome measures were conversion to surgery by 24 weeks, the global rating of change (GROC) scale and patient satisfaction. Secondary outcomes included symptom severity and functional limitation. At 24 weeks, conversion to surgery was 59% in the experimental group and 80% in the control group (risk difference-0.21, 95% CI-0.38 to-0.03). More participants in the experimental group identified as improved at 6 weeks (20% vs 4%; risk difference 0.15, 95% CI 0.03 to 0.28) but not at 24 weeks (24% vs 10%; risk difference 0.14, 95% CI-0.01 to 0.29). The intervention was also estimated to be beneficial on some measures of satisfaction, symptom severity and functional limitation. The study's estimates of the benefits came with some uncertainty, which makes it unclear whether the wider population of people awaiting carpal tunnel surgery would consider that the benefits make the intervention worthwhile. No serious adverse effects were reported. A therapist-led pathway reduced conversion to carpal tunnel surgery and increased perceived improvement and satisfaction in people who were already on a waitlist for surgical consultation. ACTRN12613001095752.

Using patient self-checklist to improve the documentation of risk of postoperative nausea and vomiting: an implementation project.

Postoperative nausea and vomiting (PONV) is a common surgical complication, affecting 30-50% of patients and 80% in high risk populations. Successful prevention and management of PONV relies on accurately assessing individual risk prior to surgery. A valid and reliable Apfel score is commonly used to assess patients' risk. It is however challenging to translate this evidence into clinical practice. This evidence-based project aimed to identify the current practice of assessing and documenting the risk factors of PONV prior to surgery, and to develop strategies to improve the practice. The project had three phrases, including forming a team and conducting the baseline audit; identifying problems and developing strategies; and conducting a follow-up tool to assess the impact on compliance with best practice. A research team was formed. A baseline audit was conducted at a public hospital in Victoria in June 2016 to examine PONV risk assessment practice through checking medical files of surgical patients. A getting research into practice audit and feedback tool was used to identify barriers, implementation strategies, stakeholders and resources. After implementation, a second audit was conducted between June and October 2017. Audit criteria were based on a reliable and valid Apfel score. At baseline, accurate PONV risk could only be calculated from 8% of patient files with no file formally recording the risk factors. The proportion of patients with three risk factors preoperatively, indicating high PONV risk, was 5.3%. Barriers identified were the perceived lack of necessity to record the risk, time constraint and too much paperwork. A self-checklist for risk assessment was developed to enable patients to check their own level of risk. Its face validity, construct validity and accuracy were examined. The checklist was then implemented for patients to complete prior to surgery. A number of strategies were used to improve the implementation. The second audit of 1308 files showed that at the end of audit period, 74% of patients had risk assessment conducted and documented postimplementation. 16.8% of the patients were identified as having high PONV risk, nearly triple the number identified at baseline. A simple self-checklist of PONV risk was implemented. It greatly improved PONV risk assessment and documentation in a public hospital in Australia and enabled the identification of patients at high risk.

826 Examining Structural Heart Disease Care Management: An Exploratory Study of the Co-ordinator Role

Minimally invasive treatment options for structural heart disease have rapidly expanded over the last decade. Yet despite national and clinical program recognition of the need for structural heart co-ordinators, limited information is available to describe this role in the Australian context. National exploratory survey across Australian public hospitals (n=18 accredited sites) to identify and describe the current SH co-ordination environment, role and responsibilities of personnel. An online survey consisting of 50 questions and was distributed by the Cardiac Society of Australia and New Zealand (CSANZ). 10 of 18 (56%) sites responded, most prevalent title held was Structural Heart (SH) Co-ordinator (40%). Respondents were predominantly registered nurses, with an average 17 years nursing experience and commonly graded as clinical nurse consultants (50%). Average duration in position was 3years, 44% held post graduate certificate and 22% master’s degree. 60% of respondents co-ordinated care for four or more procedures including TAVI, TMVr MitraClip, ASD/PFO and LAA, with 40% overseeing research procedures and 30% managing national clinical registries. Only 20% said they had cover for planned leave. Common responsibilities were co-ordinating patient clinical assessment for treatment consideration and waitlist management, followed by SH meeting preparation and patient follow-up. Respondents identified key barriers as unrealistic workload and time expectations, poorly defined role and lack of professional support. This study provides an overview of the current SH co-ordination landscape across public hospitals in Australia. This data can be used to further inform development and standardisation of a national position description for coordinators.

Validation of the patient measure of safety (PMOS) questionnaire in Australian public hospitals.

Patients can provide a unique perspective on the safety of care in hospitals. Understanding that the extent to which the way hospitals are organized for quality and safety is associated with patient perceptions of care is becoming increasingly valued and necessary for the direction of targeted interventions across healthcare systems. The UK-developed patient measure of safety (PMOS) assesses eight domains of ward safety from the patient point of view and has recently been adapted and piloted in Australia. The aim of this study is to test the psychometric properties of PMOS-Australia (PMOS-A) amongst a large cohort of hospitalized patients. Cross-sectional questionnaire validation assessment. As part of the DUQuA project, the PMOS-A survey was distributed within acute myocardial infarction, hip fracture and stroke departments across 32 large public hospitals in Australia. Patients could complete the PMOS-A independently, or request the assistance of a family member/guardian, or staff on the wards-space was included to record mode of completion. Confirmatory factor analysis (CFA) was undertaken on a calibration sample to generate the model, and a validation sample was used to cross-validate the model. A subset of only those participants who received assistance for PMOS-A completion was also tested using CFA on a calibration and validation sample. Model fit indices (chi-square to degrees of freedom ratio [Chi-square:DF], root mean square error of approximation [RMSEA], comparative fit indices [CFI], standardized root mean squared residual [SRMR]), Cronbach's α, average inter-item correlations, construct reliability and cross-loadings were examined with reference to recommended thresholds to establish the extent of convergent validity and discriminant validity. A marker of criterion validity was assessed through testing associations between the PMOS-A and adherence to clinical guidelines. Across the calibration and validation samples of the full (N=911) and assisted completers only subset (N=490), three (Chi-square:DF, SRMR, RMSEA) of the four indices consistently or almost always met thresholds for acceptable model fit. CFI indices did not meet the recommended limits (0.72-0.78, against a target > 0.9). Positive relationships were found for all tests between PMOS-A and adherence to clinical guidelines, and these were significant when assessed in the calibration datasets for the full and assisted completion samples. A sufficiently reliable and valid measure of patient perceptions of safety has been developed. These findings should provide adequate support to justify the use of this measure to assess patient perceptions of safety in Australian hospitals and can be modified for use elsewhere.