State-wide Health Service Research Articles

Implementation of more sensitive cardiac troponin T assay in a state-wide health service

AimsExplore the impact of deploying high-sensitivity (hs) cardiac troponin T (cTnT) assay across a state-wide health service. Methods and resultsPresentations to emergency departments of six tertiary hospitals between January 2008 and August 2019 were included; standard cTnT assay was superseded by hs-cTnT in June 2011 without changing the reference range (≥30 ng/L reported as elevated), despite cTnT level of 30 ng/L being equivalent to ∼44 ng/L with hs-cTnT. Clinical outcomes were captured using state-wide linked health records. Interrupted time series analyses were used adjusted for seasonality and multiple co-morbidities using propensity score matching allowing for correlation within hospitals.In total, 614,847 presentations had ≥1 troponin measurement. Clinical ordering of troponin decreased throughout the study with no increase in elevated measurements amongst those tested with hs-cTnT. Small but statistically significant changes in index myocardial infarction (MI) diagnosis (−0.36%/year, 95%CI [confidence interval]:–0.48, −0.24,p < 0.001) and invasive coronary angiography (0.12%/year,95%CI:0, 0.24,p = 0.02) were seen, with no impact on death/MI at 30 days or 3-year survival in episodes of care (EOCs) with elevated cTnT after hs-cTnT implementation. Length of stay (LOS) was shorter among those with an elevated hs-cTnT (−4.44 h/year, 95%CI:–5.27, −3.60, p < 0.001). Non-elevated cTnT EOCs demonstrated shorter total LOS and improved 3-year survival (adjusted hazard ratio:0.90, 95%CI:0.83, 0.97,p = 0.008) although death/MI at 30 days was unchanged using hs-cTnT. ConclusionWidespread implementation of hs-cTnT without altering clinical thresholds reported to clinicians provided significantly shorter LOS without a clinically significant impact on clinical outcomes. A safer cohort with non-elevated cTnT was identified by hs-cTnT compared to the standard cTnT assay.

P2713Impact of routine implementation of high sensitivity troponin in a state-wide health service

P2713Impact of routine implementation of high sensitivity troponin in a state-wide health service

Health Service Pathways Analysis as Evidence Base for Trauma Policy Change: A Retrospective Study of Patients with Traumatic Spinal Cord Injury

Background: Addressing policy change in traumatic injury care demands a strong evidence base from which to inform necessary amendments, and measure the impact of any change. Current recommendations for acute traumatic spinal cord injury include admission to a specialist Spinal Cord Injury Unit within 24 hours from injury. This study aimed to document pathways for patients with traumatic spinal cord injury across a state-wide Health Service in a historical cohort, prior to and in order to inform trauma policy changes. Methods: Retrospective analysis of a large Ambulance service record-linked dataset, containing 2.04 million Ambulance records linked with hospital and death records (2006-09). Incident cases of traumatic spinal cord injury were identified using ICD-10-AM codes. Multivariate analysis aimed to identify factors associated with admission to specialist units within 24 hours. Results: Of 311 patients with confirmed traumatic spinal cord injury, 177 (56.9%) were admitted to a specialist Spinal Cord Injury Unit, with 130 of these (73.4%) being within 24 hours post injury. The remaining 47 (26.6%) had up to several months delayed transfer to SCIU. Patients were significantly more likely to have timely admission to SCIU with a cervical level cord injury (OR 2.05), aeromedical transfer to a specialist unit (OR 2.5), outer regional geographic location of injury (OR 2.05), or a surgical spinal procedure within 24 hours (OR 3.1). Patients were significantly less likely to be admitted to a specialist unit within 24 hours were those who experienced more than one hospital transfer (OR 0.28), and patients >75 years (OR 0.35). Conclusion: Historically across this state-wide Health Service, patients with traumatic spinal cord injury did not experience consistent treatment pathways. Publication of this study importantly provides a baseline from which changes to clinical policies that have occurred since 2009 can be evaluated.

Factors influencing research engagement: research interest, confidence and experience in an Australian speech-language pathology workforce

BackgroundRecent initiatives within an Australia public healthcare service have seen a focus on increasing the research capacity of their workforce. One of the key initiatives involves encouraging clinicians to be research generators rather than solely research consumers. As a result, baseline data of current research capacity are essential to determine whether initiatives encouraging clinicians to undertake research have been effective. Speech pathologists have previously been shown to be interested in conducting research within their clinical role; therefore they are well positioned to benefit from such initiatives. The present study examined the current research interest, confidence and experience of speech language pathologists (SLPs) in a public healthcare workforce, as well as factors that predicted clinician research engagement.MethodsData were collected via an online survey emailed to an estimated 330 SLPs working within Queensland, Australia. The survey consisted of 30 questions relating to current levels of interest, confidence and experience performing specific research tasks, as well as how frequently SLPs had performed these tasks in the last 5 years.ResultsAlthough 158 SLPs responded to the survey, complete data were available for only 137. Respondents were more confident and experienced with basic research tasks (e.g., finding literature) and less confident and experienced with complex research tasks (e.g., analysing and interpreting results, publishing results). For most tasks, SLPs displayed higher levels of interest in the task than confidence and experience. Research engagement was predicted by highest qualification obtained, current job classification level and overall interest in research.ConclusionsRespondents generally reported levels of interest in research higher than their confidence and experience, with many respondents reporting limited experience in most research tasks. Therefore SLPs have potential to benefit from research capacity building activities to increase their research skills in order to meet organisational research engagement objectives. However, these findings must be interpreted with the caveats that a relatively low response rate occurred and participants were recruited from a single state-wide health service, and therefore may not be representative of the wider SLP workforce.