Torres Strait Islander Patients Research Articles

Sepsis associated acute kidney injury is common among Aboriginal and Torres Strait Islanders with septic shock and has poor outcomes: A nested cohort study.

Exploration of the incidence and outcomes of Acute Kidney Injury (AKI) broadly, and sepsis associated AKI specifically, in Aboriginal and Torres Strait Islander (First Nations) people has been limited. We compared a nested cohort of First Nations people drawn from a multinational randomised controlled trial of hydrocortisone in septic shock, to a cohort matched for age, sex and severity of illness. Acute Kidney Injury was defined using the Kidney Disease Improving Global Outcomes (KDIGO) criteria, as well as incident use of kidney replacement therapy (KRT). Major Adverse Kidney Events (MAKE) were described as the composite of death, new dialysis requirement or persisting kidney dysfunction at hospital discharge. A cohort of 57 Aboriginal and/or Torres Strait Islander patients with septic shock was identified. 91.2% (52) of the First Nations cohort met KDIGO criteria for Stage 1 AKI or greater and 63% (36) met Stage 3 criteria. 59.6% (34) of the First Nations required dialysis as compared to 45.6% (26) in the matched cohort. 60.7% (34) of First Nations participants met criteria for MAKE at hospital discharge. The proportions requiring dialysis at 6, 12 and 24 months were 8.3%, 9.1% and 6.9% respectively. The incidences of AKI and MAKE reported in this First Nations cohort are substantially higher than in previously published cohorts of patients with sepsis, even those that use sensitive definitions of AKI. Measures to promote better management of infectious diseases in First Nations communities are required.

Improving access to quaternary and tertiary health services for Aboriginal and Torres Strait Islander patients by addressing their social, emotional and spiritual wellbeing

Improving access to quaternary and tertiary health services for Aboriginal and Torres Strait Islander patients by addressing their social, emotional and spiritual wellbeing

A Retrospective Analysis of Characteristics Favouring In-Hospital Resuscitation Plan Completion, Their Timing, and Associated Outcomes.

Background: Comprehensive resuscitation plans document treatment recommendations, such as 'Not for cardiopulmonary resuscitation'. When created early in admission as a shared decision-making process, these plans support patient autonomy and guide future treatment. The characteristics of patients who have resuscitation plans documented, their timing, and associations with clinical outcomes remain unclear. Objectives: To characterise factors associated with resuscitation plan completion, early completion, and differences in mortality rates and Intensive Care Unit (ICU) admissions based on resuscitation plan status. Methods: This retrospective study analysed non-elective admissions to an Australian tertiary centre from January to June 2021, examining plan completion timing (early < 48 h, late > 48 h) and associations with mortality and ICU admission. Results: Of 13,718 admissions, 5745 (42%) had a resuscitation plan recorded. Most plans (89%) were completed early. Furthermore, 9% of patients died during admission, and 8.2% were admitted to the ICU. For those without resuscitation plans, 0.5% died (p < 0.001), and 9.7% were admitted to the ICU (p = 0.002). Factors associated with plan completion included a medical unit, in-hours admission, older age, female gender, limited English proficiency, and non-Indigenous status. Plans completed late (>48 h) correlated with a higher mortality (14% vs. 9%; p < 0.001) and more ICU admissions (25% vs. 6%; p < 0.001). Aboriginal and/or Torres Strait Islander patients were often overlooked for resuscitation documentation before death. No resuscitation plans were documented for 62% of ICU admissions. Conclusions: Important disparities exist in resuscitation plan completion rates across highly relevant inpatient and demographic groups.

Fungal Keratitis, Epidemiology and Outcomes in a Tropical Australian Setting.

Fungal keratitis is an ophthalmic emergency that can cause visual impairment and blindness. We reviewed the epidemiology and clinical features of fungal keratitis in a tropical Australian setting. To document the clinical and microbiological characteristics of fungal keratitis in an Australian tropical setting. A retrospective cohort study of patients with fungal keratitis from October 2014 to December 2022 was conducted at Royal Darwin Hospital, Northern Territory, Australia. We reviewed all patients with culture-proven fungal keratitis and their outcomes. There were 31 patients identified. Aboriginal and Torres Strait Islander (ATSI) patients were of a significantly younger median age (28 years) compared to non-ATSI patients (42 years), and they also presented later to health care. Contact lens use and ocular trauma were the most common predisposing factors. Most patients presented with a corneal infiltrate and corneal epithelial defect, and the central visual axis was affected in 54% of patients. Curvularia spp. and Fusarium spp. were the commonest causative fungi (39% and 30% respectively). Our series is different and reveals a wider range of fungal species identified over the 7 years of the study, in particular, a range of Curvularia spp. were detected. Access to eye health services in rural and remote settings is important, particularly for ATSI patients, as morbidity remains high.

Exploring what GP registrars consider distinctive to consultations with Aboriginal and Torres Strait Islander patients: a mixed-methods study

Background and objectiveUnderstanding what general practice (GP) registrars consider as distinctive in their consultations with Aboriginal and Torres Strait Islander patients may help bridge the gap between patient-determined cultural safety...

Exploring how Australian general practice registrars define cultural safety with Aboriginal and Torres Strait Islander patients: a mixed method study

BackgroundUnderstanding how the general practice medical workforce defines cultural safety may help tailor education and training to better enable community-determined culturally safe practice. This project seeks to explore how Australian general practice registrars define cultural safety with Aboriginal and Torres Strait Islander patients and alignment with an Australian community derived definition of cultural safety.MethodsThis mixed method study involved a survey considering demographic details of general practice registrars, questionnaire, and semi-structured interviews to explore how general practice registrars defined cultural safety and a culturally safe consultation.ResultsTwenty-six registrars completed the survey. Sixteen registrars completed both the survey and the interview.ConclusionThis study shows amongst this small sample that there is limited alignment of general practice registrars’ definitions of cultural safety with a community derived definition of cultural safety. The most frequently cited aspects of cultural safety included accessible healthcare, appropriate attitude, and awareness of differences.

Healthcare social network research and the ECHO model™: Exploring a community of practice to support cultural brokers and transfer cultural knowledge

BackgroundProject ECHO® networks at Children’s Health Queensland Hospital and Health Service (CHQHHS) are communities of practice designed to mitigate services and systems fragmentation by building collaborative partnerships addressing priority child and youth health needs. Aboriginal and Torres Strait Islander people experience the negative impacts of fragmentation in addition to historical challenges of absent or culturally inappropriate health services. Access to culturally safe and responsive services can be improved by engaging Aboriginal and Torres Strait Islander Health Workers and similar roles in an online community of practice, supporting the integration of cultural and clinical knowledge and self-determination of Aboriginal and Torres Strait Islander consumers in decisions affecting their health.Analysing professional support networks and knowledge sharing patterns helps identify enablers and barriers to partnerships. Using social network research, the multilevel network inclusive of ECHO network members and their colleagues was studied to identify interdisciplinary and cross-sector advice exchange patterns, explore the position of cultural brokers and identify common relational tendencies.MethodsSocial network theories and methods informed the collection of network data and analysis of advice-seeking relationships among ECHO network members and their nominees. Registered members from two ECHO networks were invited to complete the Qualtrics survey. Networks analysed comprised 398 professionals from mainstream health, Aboriginal and Torres Strait Islander Community Controlled Health Organisation, education, disability and child safety service settings.ResultsBrokers were well represented, both those who hold knowledge brokerage positions as well as cultural brokers who incorporate clinical and cultural knowledge enabling holistic care for Aboriginal and Torres Strait Islander patients (38 individuals, 17% of network). Professionals who occupy brokerage positions outside the ECHO network tend to be more connected with co-members within the network.ConclusionsThis study is the first application of contemporary social network theories and methods to investigate an ECHO network. The findings highlight the connectivity afforded by brokers, enabling the coordination and collaboration necessary for effective care integration. Inclusion of cultural brokers in an ECHO network provides sustained peer group support while also cultivating relationships that facilitate the integration of cultural and clinical knowledge.

Effects of a culturally informed model of care for Aboriginal and Torres Strait Islander patients with acute coronary syndrome in a tertiary hospital in Australia: a pre-post, quasi-experimental, interventional study

Effects of a culturally informed model of care for Aboriginal and Torres Strait Islander patients with acute coronary syndrome in a tertiary hospital in Australia: a pre-post, quasi-experimental, interventional study

Incidence of hospital-acquired pressure injuries and predictors of severity in a paediatric hospital.

Hospital-acquired pressure injuries (HAPIs) pose significant challenges in healthcare and cause increased patient suffering, longer hospital stays, and higher healthcare costs. Paediatric patients face unique risks, but evidence remains scarce. This study aimed to identify and describe HAPI admission incidence and severity predictors in a large Australian children's hospital. This retrospective cohort study investigated all paediatric patients between January 2020 and December 2021 using a census approach. Demographic and clinical data including HAPI-related data were accessed from the incident monitoring and hospital administration databases. The incidence rate (per 1000 patient admissions) was calculated based on all admissions. Predictors of HAPI severity were identified using multivariable multinomial logistic regression. The study adhered to the STROBE guidelines for retrospective cohort studies. The HAPI incidence rate was 6.96 per 1000 patient admissions. Of the age groups, neonates had the highest HAPI incidence (15.5 per 1000 admissions). Critically ill children had the highest rate for admission location (12.8 per 1000 patient admissions). Most reported cases were stage I (64.2%). Age was associated with injury severity, with older paediatric patients more likely to develop higher-stage HAPIs. Additionally, Aboriginal and/or Torres Strait Islander patients had a higher HAPI severity risk. HAPI injuries in paediatric patients are unacceptably high. Prevention should be prioritized, and the quality of care improved in Australia and beyond. Further research is needed to develop targeted prevention strategies for these vulnerable populations. This research emphasizes the need for standardized reporting, culturally sensitive care and tailored prevention strategies. The research has the potential to influence healthcare policies and practices, ultimately enhancing the quality of patient care. STROBE guidelines. There was no patient or public contribution to the conduct of this study.

Prior hospital attendances in deceased Australian patients with alcohol-related liver disease: a multicentre project.

To establish the hospital visit history of patients who die with alcohol-related liver disease (ArLD). To determine if patients with ArLD present to hospital early or in the terminal phase of their disease. Retrospective cohort study of patients with a history of ArLD who died as an inpatient at three tertiary Western Australian hospitals from February 2015 to February 2017. Hospital records were reviewed to identify the number and cause of emergency department (ED), inpatient and outpatient attendances in all Western Australian public hospitals in the 10 years prior to death. One hundred fifty-nine patients (23% female) had a total of 753 ED, 3535 outpatient appointments, 1602 hospital admissions and 10 755 admission days. Twelve months prior to death, 82% of patients had a public hospital contact and 74% an admission. Patients who had their first hospital contact within 12 months prior to death were significantly more likely to have a liver-related cause of death (P < 0.01). Aboriginal and Torres Strait Islander patients (15% of cohort) died at a significantly younger age (M = 49.2, SD = 10.5 years) than non-Aboriginal and Torres Strait Islander patients (M = 59.9, SD = 10.2 years, P < 0.01). Despite having more ED attendances and hospital admissions, Aboriginal and Torres Strait Islander patients had significantly less (P = 0.04) outpatient appointments (Mdn = 5.5, interquartile range [IQR] = 1-18 vs Mdn = 11, IQR = 3-33). Most patients with ArLD have multiple early attendances, which present an opportunity for early interventions. There are missed opportunities for Aboriginal and Torres Strait Islander patients for outpatient hospital engagement.

Exploring equity of care for Aboriginal and Torres Strait Islander peoples within the state-wide Musculoskeletal Physiotherapy Screening Clinic and Multi-disciplinary Service in Queensland Health.

ObjectiveThis study aimed to explore equity of care for Aboriginal and Torres Strait Islander peoples compared to non-Indigenous Australians within a Queensland-wide musculoskeletal service.MethodThe service database was analysed between July 2018 and April 2022 across 18 Queensland Health facilities. Representation of Aboriginal and Torres Strait Islander peoples within the service's patient population was first explored. Second, service and patient-related characteristics and outcomes between Aboriginal and Torres Strait Islander patients and non-Indigenous patients undergoing an episode of care in the service were compared using analysis of variance and chi-squared tests.ResultsA greater proportion of Aboriginal and Torres Strait Islander peoples (4.34%) were represented within the service's patient population than in the general population (3.61%) state-wide. Aboriginal and Torres Strait Islander patients presented with a generally higher severity of clinical presentation across measures at initial consult. Very similar proportions of Aboriginal and Torres Strait Islander (63.2%) and non-Indigenous (64.3%) patients reported clinically meaningful treatment benefits. While a higher proportion of Aboriginal and Torres Strait Islander patients (69.7%) were discharged from the service without requiring specialist review compared to non-Indigenous patients (65.6%), Aboriginal and Torres Strait Islander patients had higher rates of discharge due to non-attendance (20.8%) when compared to non-Indigenous (10.6%) patients (P<0.01).ConclusionsDisparity in care retention for Aboriginal and Torres Strait Islander patients compared to non-Indigenous patients was observed within the musculoskeletal service. Consultation with Aboriginal and Torres Strait Islander communities is needed to address access barriers once in the service to guide service improvement.

Measuring what counts in Aboriginal and Torres Strait Islander care: a review of general practice datasets available for assessing chronic disease care.

Background Large datasets exist in Australia that make de-identified primary healthcare data extracted from clinical information systems available for research use. This study reviews these datasets for their capacity to provide insight into chronic disease care for Aboriginal and Torres Strait Islander peoples, and the extent to which the principles of Indigenous Data Sovereignty are reflected in data collection and governance arrangements. Methods Datasets were included if they collect primary healthcare clinical information system data, collect data nationally, and capture Aboriginal and Torres Strait Islander peoples. We searched PubMed and the public Internet for data providers meeting the inclusion criteria. We developed a framework to assess data providers across domains, including representativeness, usability, data quality, adherence with Indigenous Data Sovereignty and their capacity to provide insights into chronic disease. Datasets were assessed against the framework based on email interviews and publicly available information. Results We identified seven datasets. Only two datasets reported on chronic disease, collected data nationally and captured a substantial number of Aboriginal and Torres Strait Islander patients. No dataset was identified that captured a significant number of both mainstream general practice clinics and Aboriginal Community Controlled Health Organisations. Conclusions It is critical that more accurate, comprehensive and culturally meaningful Aboriginal and Torres Strait Islander healthcare data are collected. These improvements must be guided by the principles of Indigenous Data Sovereignty and Governance. Validated and appropriate chronic disease indicators for Aboriginal and Torres Strait Islander peoples must be developed, including indicators of social and cultural determinants of health.

Integrated care pathways between primary, secondary and tertiary health care for Aboriginal and Torres Strait Islander Australians

Empirical evidence and current policy documents strongly indicate a requirement for greater healthcare integration for Aboriginal and Torres Strait Islander people as an extension of the current coordinated care models. System fragmentation and the documented evidence of inadequate care transitions of many Aboriginal and Torres Strait Islander patients test the adequacy and flexibility of health systems to provide access and effective, efficient and appropriate care. Integration across organisations and sectors in the health system is necessary for coordinated patient-centred care that improves patient experiences and health outcomes and adds value to the system by delivering efficiencies. In this project, we aimed to better understand integrated care as a significant quality improvement approach in delivering care between the primary, secondary and tertiary care systems for Aboriginal and Torres Strait Islander people as the first step to real-world design and implementation. Firstly, we used a ‘participatory’ systematic review methodology to identify care processes and effective components needed to support integrated care models between primary, secondary and tertiary care. We focused on the processes involved in its implementation, delivery, and outcomes and impact to develop a conceptual model. Engagement with healthcare providers and community members grounded the theoretical model in real-world contexts. We then tested the model using a jury approach and wargaming, a soft simulation method. The structural reforms needed to ensure effective multistakeholder, multilevel integrated care implementation were identified and priority setting for implementation considered. We will present the developed integrated care model and discuss the inherent opportunities and challenges for implementation.

Connecting the Dots of Care: A pilot study linking Aboriginal and/or Torres Strait Islander peoples with diabetes care in hospital, using hospital pharmacists

BackgroundDiabetes is common among Aboriginal and/or Torres Strait Islander peoples, yet often undetected in hospital. ObjectiveTo identify how urban hospital pharmacists can detect if Aboriginal and/or Torres Strait Islander patients have diabetes or a higher chance of getting diabetes. MethodsA multi-methods study used data from patients, and researcher field notes. Aboriginal and/or Torres Strait Islander peoples admitted to hospital over 12-weeks (July–October 2021) were prospectively identified from admissions lists. A hospital pharmacist-researcher visited eligible patients. Consenting participants had their blood glucose and HbA1c checked. Participants with HbA1c > 6.5% (no known diabetes) or 7% (known diabetes) were referred for endocrinology review during their stay. Test results and resultant diabetes plan were shared with their general practitioner. Two days after discharge, participants were called to gauge views on their hospital-based diabetes care. Barcode technology recorded pharmacist time. Voice-recorded field notes were thematically analysed. Ethics approval was obtained. ResultsSeventy-two patients were eligible for inclusion, 67/72 (93%) consented to take part. Sixty-one (91%) patients returned a HbA1c < 6.5, of which, 4/61 (6.5%) returned a HbA1c, 6–6.4. They were contacted to yarn about diabetes prevention. Six of the 67 (9%) qualified for endocrine review, 5 had known diabetes, one newly diagnosed. None were known to endocrinology. All participants telephoned were satisfied with their hospital-based diabetes care. Pharmacist time for initial introductory yarn, consenting process, organisation of HbA1c and results discussion was 20 min or 40 min if referred for endocrine review. Field notes guided understanding of service implementation. ConclusionThis novel pharmacist-led diabetes screening service for Aboriginal and/or Torres Strait Islander peoples appeared to provide a unique opportunity for screening and referral links in a holistic way. Future research is required to test this model by upscaling to include more pharmacists and other chronic disease screening and referral pathways.

Chest pain epidemiology and care quality for Aboriginal and Torres Strait Islander peoples in Victoria, Australia: a population-based cohort study from 2015 to 2019

This study examined chest pain epidemiology and care quality for Aboriginal and Torres Strait Islander ('Indigenous') patients presenting to hospital via emergency medical services (EMS) with chest pain. State-wide population-based cohort study of consecutive patients attended by ambulance for acute chest pain with individual linkage to emergency, hospital admission and mortality data in the state of Victoria, Australia from January 2015 to June 2019. Multivariable models were used to assess for differences in pre-hospital and hospital adherence to care quality, process measures and clinical outcomes. From 204,969 EMS attendances for chest pain, 3890 attendances (1.9%) identified as Aboriginal or Torres Strait Islander. Age-standardized incidence rates were higher overall for Indigenous people (3128 vs. 1147 per 100,000 person-years, incidence rate ratio 2.73, 95% CI 2.72-2.74), this difference being particularly striking for younger patients, women, and those residing in outer regional areas. In multivariable models, adherence to care quality and process measures was lower for attendances involving Indigenous people. In the pre-hospital setting, Indigenous people were less likely to be provided intravenous access or analgesia. In the hospital setting, Indigenous people were less likely to be seen by emergency clinicians within target time and less likely to transferred following myocardial infarction to a revascularization capable centre. Incidence of acute chest pain presentations is high among Indigenous people in Victoria, Australia. Opportunities to improve the quality of care for Indigenous Australians presenting with acute chest pain are identified. National Health and Medical Research Council, National Heart Foundation.

Better cardiac care – the patient experience – a qualitative study

BackgroundIn 2015, a Brisbane tertiary hospital’s cardiac unit implemented a new model of multidisciplinary care (Better Cardiac Care (BCC)) for Aboriginal and Torres Strait Islander patients. Since then, clinical indicators for Aboriginal and Torres Strait Islander cardiac patients have improved, but the recipients’ voices have not been heard. This research aimed to determine the acceptability and appropriateness, features of value, and opportunities for improvements in this model of care, from the perspective of patients and their family members.MethodsThis descriptive qualitative study employed a narrative methodology. BCC Health Workers contacted prospective participants; with consent, interested individuals were then contacted by the Aboriginal Research Officer (RO) who arranged yarning sessions and consent. Family members were also invited to share their stories of their loved ones’ hospitalisation. Two researchers conducted the interviews, using a yarning approach. Inductive narrative analysis, informed by Aboriginal and Torres Strait Islander ways of Being, Knowing, and Doing, focused on enabling participants’ stories to be heard and understood from their perspectives.ResultsRelationality was at the heart of the BCC model of care, particularly between patients and Aboriginal and Torres Strait Islander staff. The relationality included a responsibility for holistic care, extending beyond hospital discharge, although support and handover for family members required improvement. The Aboriginal and Torres Strait Islander staff understood the contextual and structural challenges faced by participants, including the disempowerment and racism experienced in healthcare. This understanding was shared with the BCC team who, in turn, protected, advocated for, and holistically supported participants through their cardiac health journeys.ConclusionsEmpowering (and employing) Aboriginal and Torres Strait Islander staff, and relating to patients as people, enabled BCC to meet Aboriginal and Torres Strait Islander patient’s needs and improve outcomes. The wider health system and health academia could benefit from exploring and valuing Aboriginal and Torres Strait Islander discourses of relationality.

Patient Information Resources on Cardiovascular Health After Cancer Treatment: An Audit of Australian Resources.

Up to one third of patients with cancer are thought to experience adverse cardiovascular events after their cancer diagnosis and treatment. High-quality information about cancer treatment-related cardiovascular disease can prepare patients and reduce anxiety. The aim of this project was to systematically identify Australian online information resources about cardiovascular health after cancer and assess the readability, understandability, actionability, and cultural relevance for Aboriginal and Torres Strait Islander patients. We conducted systematic Google and website searches to identify potentially relevant resources. Eligibility was assessed using predefined criteria. For each eligible resource, we summarized the content and assessed readability, understandability, actionability, and cultural relevance for Aboriginal and Torres Strait Islander people. Seventeen online resources addressing cardiovascular health after cancer were identified: three focused solely on cardiovascular health and the remaining 14 dedicated between <1% and 48% of the word count to this topic. On average, three of 12 predefined content areas were covered by the resources. Only one resource was considered comprehensive, covering eight of 12 content areas. Overall, 18% of the resources were deemed readable for the average Australian adult, 41% deemed understandable, and only 24% had moderate actionability. None of the resources were considered culturally relevant for Aboriginal and Torres Strait Islander people, with 41% addressing only one of the seven possible criteria and the remainder addressing none of the criteria. This audit confirms a gap in online information resources about cardiovascular health after cancer. New resources, especially for Aboriginal and Torres Strait Islander people, are needed. The development of such resources must be done through involvement and collaboration with Aboriginal and Torres Strait Islander patients, families, and carers, through a codesign process.

A single-centre experience of immune checkpoint inhibitors in patients with cancer in the Top End of the Northern Territory, Australia from 2016 to 2021.

e18841 Background: Immune checkpoint inhibitors (ICI) have transformed the oncological landscape, but are associated with immune-related adverse events (irAE) of varying frequency and severity. This regional single-centre experiential study evaluates the real-world incidence of irAE in patients in the Top End of the Northern Territory of Australia. The Top End represents a diverse population with high proportions of Aboriginal and Torres Strait Islander (ATSI) patients and patients living in remote and very remote areas. This captured cohort is under-represented in clinical trials. Methods: We identified all patients with solid tumours who were prescribed ICI between January 2016 and December 2021. We manually reviewed electronic and paper hospital records to record patient characteristics, treatments received, irAE, irAE treatment and patient outcomes. Results: 226 patients across 11 solid tumour streams received ICI. Of these, 58% had lung cancer, 27% melanoma, 5% head &amp; neck cancer, 4% renal cell carcinoma, and the remainder other tumour streams. 70% were male and the median age at diagnosis was 63 years [28-84 years]. 16% identified as ATSI(compared to 2.8% ATSI nation-wide and 26.3% ATSI in the Northern Territory). Of the investigational cohort, 13% were treated in the adjuvant and 87% in the palliative setting. 11% received combination versus 89% single-agent ICI. 30% of patients had concurrent chemotherapy. 122 patients (54%) experienced any grade irAE as documented by the treating oncologist in the medical records. 59 patients (26%) had a severe (grade 3, 4, or 5) irAE. The fatality rate was 0.88% (2 patients); both were treated with a PD-L1 inhibitor for non-small cell lung cancer (NSCLC) and diagnosed with immune-related pneumonitis. The most common irAE were rash (18%), colitis (16%), arthralgia/myalgia (13%), pneumonitis (12%), thyroiditis/hypothyroidism (12%), hepatitis (9%), and adrenal insufficiency (7%). 24% of irAE required hospitalisation and 32% led to discontinuation of treatment. The median number of irAE per patient was 1. Among patients with the most common tumour types (melanoma and NSCLC), rates of irAE were, in both cases, 59% any grade irAE and 20% severe irAE. When compared to published literature, real-world rates of any grade adverse event were significantly lower than reported number in trials – likely due to exclusion of common non-immune-related adverse events in our data set. Rates of severe and fatal irAE were in line with published data. Conclusions: Immune-related adverse events are common among patients in the Top End and reflect rates in the published literature. We did not identify any safety concerns in our cohort of patients – including amongst ATSI patients and those living in remote and very remote areas. Further data analysis is needed to assess frequency and severity of irAE by specific tumour type and ICI.

In this June issue

In line with several other journals we co-publish the Australian Commission on Safety and Quality in Health Care Low Back Pain Clinical Care Standard. It describes the early clinical management of people who present with a new acute episode of low back pain. The background to how the standard was developed and finalised are described in an introductory editorial. Coronial findings and royal commissions have repeatedly identified deficiencies in the emergency health care provided to prisoners in Australia. These deficiencies are operational, clinical and stigmatic and not limited to a single prison or jurisdiction. Applying a health quality of care framework focused on prevention and chronic health management appropriate assessment and escalation when urgent medical assistance is requested, and a structured audit framework could avoid future preventable deaths in prisons. We publish an editorial on this topic to accompany the paper written by a team from Victoria and Queensland. A group from the neurosurgery department of the Royal Brisbane and Women's Hospital report that the availability of cranial access equipment outside Queensland tertiary centres is limited. Inter-hospital transfers are likely to persist in Queensland and so improving access to cranial access equipment in hospitals where it is currently lacking is highly warranted. They surveyed senior theatre nurse or surgical service directors from rural and regional Queensland hospitals located outside the local catchment of a tertiary centre and had a CT scanner. Questions regarded availability, location and storage conditions of mechanical cranial access kits, as well as last usage, and associated patient outcomes. Life-threatening thoracic trauma requires emergency pleural decompression, and thoracostomy and chest drain insertion are core trauma procedures. Reliably determining a safe site for pleural decompression in children is challenging, even for experienced clinicians. A team from Melbourne report that the Mid-Arm-Point (MAP) technique, a procedural aid for use with injured adults, is also a safe site for pleural decompression in children <4 years and with a very minor modification is safe in children ≥4 years. An excellent study from Queensland describes the demographics, presentation characteristics, clinical features and cardiac outcomes for Aboriginal and Torres Strait Islander patients who present to a regional cardiac referral centre ED with suspected acute coronary syndrome (ACS). The authors conclude this cohort with suspected ACS have a high burden of traditional cardiac risk factors, regardless of whether they are eventually diagnosed with ACS. These patients may benefit from assessment for coronary artery disease regardless of age at presentation. In a nice paper, James Mallows explores the concept of collegiality, something considered to be any extra-role behaviour that is discretionary, not recognised by a formal reward system and that promotes the effective functioning of the organisation. There are few studies examining collegiality in the medical profession and none looking at collegiality among emergency physicians (EPs). He explores the perceptions of different ED health care professionals on the meaning of collegiality among EPs, the benefits of collegiality and behaviours they identify as indicative of collegiality. He identifies distinct themes and behaviours indicative of collegiality among EPs. Promoting these behaviours could improve staff well-being, ED efficiency, patient safety and productivity. Continuing with the previous theme, team culture underpins team performance. Psychological safety is a critical component of team culture for high performing teams. A group from the Gold Coast Hospital decided to explore this further. They conclude that familiarity of team members and leaders is critical to the development of psychological safety within the ED. Fostering familiarity should be a focus for frontline leadership each shift and a priority in broader departmental decisions for those seeking to enhance the psychological safety of their teams. The focus in this issue is on the anaesthetic component of the Fellowship training programme.

Assessing cultural safety in general practice consultations for Indigenous patients: protocol for a mixed methods sequential embedded design study

BackgroundAssessment of cultural safety in general practice consultations for Indigenous patients is a complex notion. Design and development of any assessment tool needs to be cognizant that cultural safety is determined by Indigenous peoples and incorporates defined components of cultural safety and current educational theory. Consideration of how social, historical, and political determinants of health and well-being impact upon the cultural safety of a consultation is also important. Given this complexity, we assume that no single method of assessment will be adequate to determine if general practice (GP) registrars are demonstrating or delivering culturally safe care. As such, we propose that development and assessment of cultural safety can be conceptualised using a model that considers these variables. From this, we aim to develop a tool to assess whether GP registrars are conducting a culturally safe consultation, where cultural safety is determined by Aboriginal and Torres Strait Islander peoples.MethodsThis protocol will be situated in a pragmatic philosophical position to explore cultural safety primarily from the Australian Aboriginal and Torres Strait Islander patients’ perspective with triangulation and validation of findings with the GP and GP registrar perspective, the Aboriginal and Torres Strait Islander community, and the medical education community. The study will integrate both quantitative and qualitative data through three sequential phases. Data collection will be through survey, semi-structured interviews, an adapted nominal group technique, and a Delphi questionnaire. We aim to recruit approximately 40 patient and 20 GP participants for interviews, conduct one to five nominal groups (seven to 35 participants) and recruit fifteen participants for the Delphi process. Data will be analysed through a content analysis approach to identify components of an assessment of cultural safety for GP registrars.DiscussionThis study will be one of the first to explore how cultural safety, as determined by Indigenous peoples, can be assessed in general practice consultations. This protocol is shared to stimulate awareness and discussion around this significant issue and prompt other studies in this area.