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Objective: Patients who do not wait (DNW) to be seen are a problem for emergency department (ED) care. The aim of this study was to identify the rate and reasons of DNW patients during 1 month of the COVID-19 pandemic. Methods: An observational cohort study of DNW patients presenting to Austin Hospital ED was carried out in August 2021. Patients were identified using hospital coding data and surveyed by telephone. DNW patients' reasons were explored, and their demographics and clinical outcomes compared with those who received care. Results: Of 7641 patients presenting to ED in the study period, 6% (n = 452) were DNW patients. Compared with those who received care, DNW patients were younger (P < 0.001), had lower triage categories (P = 0.001) and were more likely to have self-presented (P = 0.006). A total of 47% of DNW patients (n = 213) participated in the survey. Reasons for leaving included waiting time (61%, n = 129), symptom improvement (13%, n = 28), reassurance from staff (7%, n = 15) and ED crowding (6%, n = 12). A total of 75% of DNW patients (n = 159) sought alternative medical care; 14% (n = 29) reported hospitalisation within 7 days. 64% (n = 137) did not feel that the experience affected their likelihood of seeking future ED care; 32% (n = 69) felt less likely to seek future ED care. Conclusions: During the month studied, the DNW rate was 6%. Reassuringly, most patients sought alternative medical care, although one-third were dissuaded from returning to the ED. Future research should focus on high-risk group delineation and qualitative description of the experiences and reasons of DNW patients. What is known about the topic? Patients commonly leave the emergency department without being seen. What does this paper add? Wait time was the primary reason that patients left without medical review. Outcomes were similar for those who left compared with those who were seen. Most sought alternative medical review and did not feel the experience influenced future emergency attendance. What are the implications for practitioners? The motivation of patients to return to emergency or seek alternative care may reduce potential risks associated with leaving. Strategies improving wait time duration or tolerability remain a priority. [ABSTRACT FROM AUTHOR]

Objectives: Frailty is associated with significant mortality and morbidity in hospitalised patients. We describe physiotherapy and occupational therapy practices in hospitalised frail patients and examine the role of early intervention. Methods: We performed a prospective, observational cohort study in a medical assessment unit in a tertiary care hospital. Patients with COVID-19 infection were excluded. Frailty was measured by the Clinical Frailty Scale (CFS). Early allied health intervention was defined as involvement within 48 h of admission. Demographic data, clinical diagnoses, time spent with physiotherapy and occupational therapy, CFS, hospital length of stay and outcomes were recorded and analysed. Results: A total of 356 patients were categorised into non-frail (CFS score <5) and frail (CFS score ≥5) groups. The prevalence of frailty was 68% (n = 241). Physiotherapy (77.2%) and occupational therapy (75.5%) reviews were more frequent in frail patients than in non-frail patients. Frail patients who had allied health involvement within 48 h of admission had a significant reduction in their hospital length of stay (mean reduction of 7.3 days, 95% CI: 0.53, 14, P = 0.035) and a 2.44% reduction in the relative risk of developing pressure injuries (95% CI: 1.31, 4.53). There was no statistically significant differences in outcomes with allied health intervention for non-frail patients and patients who require residential aged care facility level care. Conclusions: Allied health have a key role in the management of frailty. Early allied health intervention was associated with a reduced hospital length of stay as well as a reduced incidence of pressure injury in frail patients. What is known about the topic? Frailty is associated with significant mortality and morbidity in hospitalised patients. The roles of the physiotherapist and occupational therapist need further study. What does this paper add? This study provides evidence that early intervention by physiotherapists and occupational therapists in frail patients is associated with better outcomes, specifically reduced pressure injury and reduced hospital length of stay. What are the implications for practitioners? Early intervention by physiotherapists and occupational therapists can be beneficial in the management of frailty. More research is required to further define the specific interventions that are effective. [ABSTRACT FROM AUTHOR]

Objective: Research capacity in health care involves the ability to conduct, access, evaluate, and apply research evidence and results in elevated quality of care. Despite its significance, mental health organisations face challenges in assessing and enhancing their research capacity. This study aimed to evaluate the research capacity and culture within a large metropolitan health service's Mental Health and Wellbeing Program (MHWP). Methods: A cross-sectional, observational study using the Research Capacity and Culture (RCC) tool was conducted among approximately 1081 MHWP employees. An online survey recorded staff views on research readiness, interest, motivators, and barriers. Results: Of 220 survey entries, 100 were completed. The majority were female (n = 68), under 40 years old (n = 51), and employed full-time (n = 54). The highest RCC domain score was for organisational culture. Half of the respondents thought research was not part of their role, yet 70% wanted more involvement. Motivators included skill development, while barriers included a lack of time and funds. Conclusions: The findings emphasise the need for targeted strategies to enhance research culture at the individual level. However, opportunities also exist at the team and organisational levels. The study provided insights that can guide future interventions and capacity-building initiatives. What is known about the topic? Improving research culture and capacity in health care results in elevated quality of care. Research culture and capacity are not uniform among healthcare professions, and some are 'research emergent'. What does this paper add? Our study unveils challenges and strengths among 100 responding mental health workers of an approximately 1100 strong workforce that emphasises organisational culture's importance. It also underscores staff's desire for research involvement, facing barriers such as time and resource scarcity. What are the implications for practitioners? These findings establish a starting point for tracking progress and inform strategies for enhancing mental healthcare service quality through tailored interventions that increase research capacity. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the number of visitors to an acute hospital, the time of visit, destination, and details of parking over the same period. Methods: A prospective observational pilot study in a large metropolitan public hospital in Australia was performed. The research team observed all visitors over a 14-day period between 17 and 30 October 2022 counting the people visiting relatives or friends of admitted hospital patients as well as those visiting outpatient clinics during the observation period. Other outcome measures included time of the visit, destination, and estimated costs of parking. Results: During the 14 days of observation there were 18,066 visitors, averaging 1290 per day. The majority were visitors to inpatients (62.2%, 11,232, averaging 802 per day). Those attending outpatients were less (37.8%, 6834, averaging 668 per weekday). The estimated average parking cost was A$18.10 per day normally and A$11.85 for concessions. Conclusions: This was the first known study on hospital-wide visiting in Australia or globally. These findings would be important for addressing issues such as hospital planning, and for future research including the impact of visiting on patient outcomes, the patient and community experience, and the expectations and experience of hospital visitors. What is known about the topic? Inpatient visitors are an essential part of patient support worldwide. Little is known about the nature of visiting flows. What does this paper add? This is the first observational study exploring visitor patterns, time, destination, and parking costs in an acute hospital setting. What are the Implications for practitioners? The study raises questions about hospital planning and the possibility for future research defining the needs of visitors, whether those expectations were met, and how the concept of visiting could be realigned in order to meet those demands. [ABSTRACT FROM AUTHOR]

Objective: Patient engagement, as measured by the Patient Activation Measure (PAM®), has been used to assess patients' ability to manage their own care. This study aimed to determine whether the PAM® could predict healthcare use in older adults aged >70 years, living independently in the community with mild frailty, within 30 days after emergency department (ED) discharge. Methods: A prospective single-centre observational cohort study was completed including older adults who presented to an ED. The 13-item PAM® and selected International Consortium for Health Outcomes Measures were completed prior to ED discharge. Results: Two hundred patients were recruited with a mean age of 84.8 years (s.d. 6.9). The mean PAM® score was 58.6 (s.d. 13.3), with 12.5% at Level 1 (n = 25), 40% at Level 2 (n = 80), 34.5% at Level 3 (n = 69) and 13.0% at Level 4 (n = 26). The PAM® level was significantly associated with ED presentations in the past 6 months (P = 0.030). The PAM® level did not predict healthcare use within 30 days of discharge consisting of time until ED representation (P = 0.557), number of ED representations (P = 0.560), number of hospital admissions (P = 0.499), length of stay in hospital (P = 0.254) and number of post-discharge contacts (P = 0.667). Conclusions: Overall, the PAM® did not predict prospective short-term healthcare use. However, the PAM® was significantly associated with 6-month previous ED use. With more than 50% of patients at Level 1 or 2, indicating lower capacity for self-management, tailored interventions are required to assist mildly frail patients to manage discharge care plans and engage in preventative strategies. What is known about the topic? High levels of activation measured using the Patient Activation Measure (PAM®) have been associated with improved health behaviours, reduced emergency department (ED) representations and lower healthcare costs. What does this paper add? The PAM® did not predict short-term healthcare use in older adults with mild frailty. However, low levels of activation were significantly associated with ED use in the previous 6 months, indicating older adults may require greater discharge supports. What are the implications for practitioners? Over 50% of patients were at low levels of activation, highlighting the importance of post-discharge care. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the feasibility of twice daily rehabilitation in older patients admitted to an acute care of the elderly (ACE) hospital ward. Method: This was a prospective single-site, cohort study of twice daily interventions provided by ACE physiotherapists, occupational therapists and/or allied health assistants in an ACE hospital ward. The feasibility of twice daily therapy was evaluated using a range of outcomes including satisfaction, fidelity and limited efficacy. Results: A total of 220 patients were included (median age 86 [IQR 81–91] years, 54% female, with a median length of hospital stay of 7 [IQR 5–10] days). Twice daily therapy was delivered on 71% (n = 757) of patient admitted weekdays (fidelity). Moderate-to-large effect sizes were observed in patient functional and mobility measures during their hospital stay and most patients (74%) were able to be successfully discharged home (limited efficacy). Both staff and patients reported high levels of satisfaction with physiotherapy and occupational therapy while on the ACE ward. Conclusion: Twice daily therapy with acutely hospitalised elderly patients is feasible, facilitated discharge home, and is associated with high patient and staff satisfaction. What is known about the topic? Acute care of the elderly (ACE) wards have been shown to improve outcomes for hospitalised older people through early rehabilitation and early discharge planning. What does this paper add? At least twice daily therapy on an ACE ward was feasible, facilitated discharge home and both staff and patients reported positive perceptions of the intervention. What are the implications for practitioners? Measurement of the scalability and sustainability of this model of care and further economic analysis are needed to determine whether the staffing required negates the cost of avoided subacute admission or bed days saved. [ABSTRACT FROM AUTHOR]

Objective: To explore the association between geographic access to allied health services and potentially preventable hospitalisations. Methods: This is a retrospective observational study. Adults aged 18 years or older with a potentially preventable hospitalisation for a chronic condition(s) to a public hospital in South Western Sydney Local Health District between 1 July 2016 and 30 June 2019 were identified from the Secure Analytic for Population Health and Intelligence portal at NSW Health. Locations of allied health amenities or practices in the same geographic area were identified from the 2019 National Health Service Directory. Geospatial analysis was used to identify geographic hotspots and coldspots of potentially preventable hospitalisations. Association with access to allied health services was investigated using linear models. Results: Hotspots of potentially preventable hospitalisations were significantly more disadvantaged than coldspots. Hotspots also had poorer access to allied health services than coldspots. Conclusion: In South Western Sydney, populations with higher burden of chronic disease, as measured through preventable hospitalisations, have poorer access to allied health services than populations with lesser need. What is known about this topic? Barriers to accessing allied health services in primary care in Australia exist, especially among those in need. What does this paper add? We show that hotspots (areas with greater density) versus coldspots (areas with lower density) of potentially preventable hospitalisations were significantly more disadvantaged. Hotspots also had poorer access to allied health services. What are the implications for practitioners? This provides evidence to practitioners and policy makers for advocating greater access to allied health services in areas of socioeconomic disadvantage. [ABSTRACT FROM AUTHOR]

Objective: Detailed quantifications of the environmental footprint of operations that include surgery, anaesthesia, and engineering are rare. We examined all such aspects to find the greenhouse gas emissions of an operation. Methods: We undertook a life cycle assessment of 10 patients undergoing total knee replacements, collecting data for all surgical equipment, energy requirements for cleaning, and operating room energy use. Data for anaesthesia were sourced from our prior study. We used life cycle assessment software to convert inputs of energy and material use into outputs in kg CO2e emissions, using Monte Carlo analyses with 95% confidence intervals. Results: The average carbon footprint was 131.7 kg CO2e, (95% confidence interval: 117.7–148.5 kg CO2e); surgery was foremost (104/131.7 kg CO2e, 80%), with lesser contributions from anaesthesia (15.0/131.7 kg CO2e, 11%), and engineering (11.9/131.7 kg CO2e, 9%). The main surgical sources of greenhouse gas emissions were: energy used to disinfect and steam sterilise reusable equipment (43.4/131.7 kg CO2e, 33%), single-use equipment (34.2/131.7 kg CO2e, 26%), with polypropylene alone 13.7/131.7 kg CO2e (11%), and the knee prosthesis 19.6 kg CO2e (15%). For energy use, the main contributors were: gas heating (6.7 kg CO2e) and heating, cooling, and fans (4 kg CO2e). Conclusions: The carbon footprint of a total knee replacement was equivalent to driving 914 km in a standard 2022 Australian car, with surgery contributing 80%. Such data provide guidance in reducing an operation's carbon footprint through prudent equipment use, more efficient steam sterilisation with renewable electricity, and reduced single-use waste. What is known about the topic? The environmental footprint of health care itself is important. Carbon footprinting of surgical operations are becoming more common, although detailed analyses are rare. What does this paper add? The carbon footprint of a total knee replacement was 132 kg CO2e, i.e. the equivalent of driving >900 km in a typical 2022 Australian car. Orthopaedic surgery itself contributed to 80% of the emissions, with anaesthesia and operating room energy use contributing 10% each to the total carbon footprint. What are the implications for practitioners? By replacing single-use with reusable equipment, and by using 100% renewable energy for decontamination, the greenhouse gas emissions for a total knee replacement can become negligible. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the suitability and acceptability of virtual training post accreditation visits conducted online for medical specialist training in ophthalmology in Australia and New Zealand. Methods: A two-phase study (pilot and implementation) was conducted. In the pilot phase, an open-ended observation proforma was used by the authors to independently record their observations, which were later compared and discussed until consensus was achieved. All participants were asked to complete an online survey. A document analysis of accreditation documents was conducted. Observation data were broken down into themes and triangulated with online survey and document analysis results. In the implementation phase, the inspections were observed by one of the authors (SK) and the observation notes were discussed with other authors to obtain a contextual and consensual view. A document analysis of all accreditation-related documentation was undertaken. The documents included in the document analysis were planning and scheduling records, interview and inspection notes, training post inspection fact and document notices and accreditation reports. Finally, a post-inspection focus group of all inspectors was conducted. Results: The accreditation interviews adequately addressed all relevant issues with high levels of robustness and reliability. Participants found it more difficult to discuss complex issues virtually compared with onsite visits. The virtual accreditation reports were not any different to what would be expected if a face-to-face accreditation visit had been conducted; however, it was not possible using the virtual inspection to determine the appropriateness of facilities and clinic layout to support and facilitate trainee learning and supervision. Conclusions: Virtual accreditation of training posts in medical specialist training is viable in limited circumstances where there are no known complex training post-related issues and the site has not made substantial changes to clinic and theatre layout, equipment and facilities since the previous accreditation. What is known about the topic? All medical specialist colleges in Australia and New Zealand accredit the sites where training is delivered, usually by conducting periodic face‐to‐face visits. What does this paper add? This paper provides evidence that in limited circumstances, it is possible to accredit training posts virtually. What are the implications for practitioners? This paper provides an outline of issues to consider when planning virtual accreditation of training posts in medical specialist education. [ABSTRACT FROM AUTHOR]

Objective: We set out to provide a benchmark assessment of allied health professionals' research capacity and culture in a national private health care organisation, including identifying barriers and facilitators to staff participation in research. Methods: All allied health professionals across 16 sites were invited to participate in an online survey, using the research capacity and culture tool from 9 May to 17 June 2022. Descriptive analysis of each demographic variable was expressed in frequencies and percentages. Differences between organisation, team and individual domains were analysed as ordinal data (scale 1–9), and a mean score and standard deviation were calculated. Results: The survey was completed by 182 allied health professionals across 16 sites, with an estimated response rate of 12%. Overall results identified low levels of research support or skills at organisational and team levels and moderate levels of skills at an individual level. Respondents were motivated to participate in research 'to develop skills', for 'improved job satisfaction' and 'career advancement'. Major barriers to participation in research were 'lack of time', 'lack of resources' and 'other work roles taking priority'. Conclusion: The current study fills a knowledge gap by reporting the research capacity and culture among allied health professionals in a national private healthcare organisation in Australia. This study suggests that allied health professionals in private healthcare organisations perceive less than adequate levels of support at the team and organisational levels compared to their public counterparts. However, the barriers and motivators to participate in research activities were consistent with public hospitals. What is known about the topic? Current knowledge on research capacity and culture in allied health professionals is primarily based on studies conducted in public hospitals. What does this paper add? This is the first study to explore the allied health research capacity and culture within a private healthcare sector, and highlights the training needs of private allied health workforce and their barriers to research provision. What are the implications for practitioners? The results suggest the development of organisational structure and more resource support at team level would have a positive flow-down effect on research culture in a private healthcare sector. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to identify factors associated with an emergency department (ED) length of stay ≥4 hours (h) and hospital admission for people with a mental health problem brought in by police. Methods: We undertook a retrospective, observational cohort study of state-wide adult ED mental health presentations brought in by police from 1 January 2012 to 31 December 2017. We used multivariable logistic regression to determine factors associated with an ED length of stay ≥4 h and hospital admission. Results: In total, 9325 ED presentations with a mental health problem brought in by police to Queensland EDs were included. Factors most strongly associated with an ED length of stay ≥4 h included an Australasian Triage Score (ATS) of 1, an age of 85 years or older, night shift arrival and subsequent hospital admission. For hospital admission, an ATS of 1, an age of 85 years or older and an ED length of stay ≥4 h were the strongest factors. Conclusion: Findings indicate opportunities for targeted mental health models of care to better support people brought in by police to an ED. Such models should involve ED, pre-hospital providers (police and ambulance) and mental health services to support early intervention and potentially reduce the likelihood of a long ED length of stay and subsequent hospital admission. What is known about the topic? Some people with mental health problems are brought in by police to an emergency department (ED). People brought in by police are recognised as having poorer health profiles compared to other arrival modes. What does this paper add? Several patient and clinical factors influence ED length of stay and hospital admission for people with a mental health problem brought in by police, indicating a need for targeted health care that addresses these factors. What are the implications for practitioners? This study justifies the need to develop specialised pre-hospital models of care and embed early assessment processes in an ED for people with mental health problems brought in by police. [ABSTRACT FROM AUTHOR]

Objective: To explore clinicians' use and perceptions of interdisciplinary communication pathways for escalating care within the pre-medical emergency team (pre-MET) tier of rapid response systems. Method: A sequential mixed-methods study was conducted using observations and interviews. Participants were clinicians (nurses, allied health, doctors) caring for orthopaedic and general medicine patients at one hospital. Descriptive and thematic analyses were conducted. Results: Escalation practices were observed for 13 of 27 pre-MET events. Leading communication methods for escalating pre-MET events were alphanumeric pagers (61.5%) and in-person discussions (30.8%). Seven escalated pre-MET events led to bedside pre-MET reviews by doctors. Clinician interviews (n = 29) culminated in two themes: challenges in escalation of care, and navigating information gaps. Clinicians reported deficiencies in communication methods for escalating care that hindered interdisciplinary communication and clinical decision-making pertaining to pre-MET deterioration. Conclusion: Policy-defined escalation pathways were inconsistently utilised for pre-MET deterioration. Available communication methods for escalating pre-MET events inadequately fulfilled clinicians' needs. Variable perceptions of escalation pathways illuminated a lack of of a shared mental model about clinicians' roles and responsibilities. To optimise timely and appropriate management of patient deterioration, communication infrastructure and interdisciplinary collaboration must be enhanced. What is known about the topic? To promote earlier recognition of, and response to, deteriorating ward patients, Australian rapid response systems include a pre-medical emergency team (pre-MET) tier. Escalation pathways within the pre-MET tier are poorly understood. What does this paper add? Policy-defined escalation pathways were inconsistently utilised. Clinicians identified deficiencies in communication methods (e.g. alphanumeric pagers) for escalating pre-MET deterioration. Perceptions of escalation pathways illuminated a lack of of a shared mental model about clinicians' roles and responsibilities. What are the implications for practitioners? To optimise the management of pre-MET deterioration, ward-based communication infrastructure and interdisciplinary collaboration must be enhanced. [ABSTRACT FROM AUTHOR]

Objective: The harmful use of alcohol is a global issue. This study aimed to describe and compare the profiles, emergency department (ED) clinical characteristics, and outcomes of alcohol-related ED presentations (ARPs) and non-alcohol-related ED presentations (NARPs). Methods: A multi-site observational study of all presentations to four EDs between 4 April 2016 and 31 August 2017, was conducted. Routinely collected ED clinical, administrative and costings data were used. Classification of ARPs were prospectively recorded by clinicians. Analysis was performed at the presentation, rather than person level. Univariate tests were undertaken to compare demographics, ED clinical characteristics and outcomes between ARPs and NARPs. Results: A total of 418 051 ED presentations occurred within the 17-month study period; 5% (n = 19 875) were ARPs. Presentations made by people classified as ARPs were younger, more likely to be male, present on weekends or at night, and arrive by ambulance or police compared to NARPs. Compared with NARPs, ARPs had a longer median ED length of stay of over 20 min (95% CI 18–22, median 196 min vs 177 min, P < 0.001), a 5.5% (95% CI 4.9–5.3) lower admission rate (36% vs 42%, P < 0.001), and a AUD69 (95% CI 64–75) more expensive ED episode-of-care (AUD689 vs AUD622, P < 0.001). Conclusion: Clinically meaningful differences were noted between alcohol-related and non-alcohol-related ED presentations. The higher cost of care for ARPs likely reflects their longer time in the ED. The healthcare and economic implications of incidents of alcohol-related harm extend beyond the ED, with ARPs having higher rates of ambulance and police use than NARPs. What is known about the topic? The harmful use of alcohol is a major health issue globally contributing to morbidity and mortality. What does this paper add? The demographic profile, clinical characteristics, and outcomes of people presenting to emergency departments with alcohol-related harm differ to people arriving for other reasons. What are the implications for practitioners? Indicating alcohol as a cause of an ED presentation, as standard practice, may foster quality assurance/improvement activities. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to estimate the public hospital costs associated with primary liver cancer (PLC) in the first and second years following the cancer diagnosis. Methods: This study linked administrative datasets of patients diagnosed with PLC in Victoria, Australia, from January 2008 to December 2015. The health system perspective was adopted to estimate the direct healthcare costs associated with PLC, based on inpatient and emergency costs. Costs were estimated for the first 12 months and 12–24 months after the PLC diagnosis and expressed in 2017 Australian dollars (A$). The cost estimated was then extrapolated nationally. The linear mixed model with a Box–Cox transformation of the costs was used to explore the relationship between costs and patients' sociodemographic and clinical characteristics. Results: For the first 12 months, the total and annual per-patient cost was A$211.4 million and A$63 664, respectively. Costs for the subsequent year were A$49.7 million and A$46 751, respectively. Regarding the cost extrapolation to Australia, the total cost was A$137 million for the first 12 months after notification and A$42.6 million for the period from 12 to 24 months. Higher costs per episode of care were mostly associated with older age, hepatocellular carcinoma type of PLC, metropolitan hospitals, and Asian birth region. Conclusion: This study showed the public hospital admission and emergency costs associated with PLC and the substantial economic burden this cancer has placed on the Australian health system. What is known about the topic? There are limited data on the economic burden of primary liver cancer in Australia. What does this paper add? This study showed the cost in the second year after cancer diagnosis was substantially lower than that of the first year. Higher costs per episode of care were mostly associated with older age, metropolitan hospitals, and Asian birth region. What are the implications for practitioners? Results from this study can be used as a baseline for comparison with other initiatives to mitigate cancer risk factors or inputs for future economic evaluations of cancer surveillance. [ABSTRACT FROM AUTHOR]

Objective: To establish independent factors that influence the likelihood of re-admission within 30 days of discharge from a Geriatric Evaluation and Management Unit. Methods: An observational prospective cohort design using clinical data extracted from the medical charts of eligible patients discharged from a tertiary public hospital Geriatric Evaluation and Management Unit between July 2017 and April 2019. Binary logistic regression was undertaken to determine variables that increased the likelihood of hospital re-admission (dependent variable). Results: A total of 367 patients were eligible for inclusion, with 69 patients re-admitted within 30 days of discharge. Univariate analysis demonstrated significant differences between groups (re-admission vs non-re-admission) with respect to Charlson Comorbidity Index (CCI) (7.4 [2.4] vs 6.3 [2.2], P = 0.001), Clinical Frailty Scale (CFS) (5.6 [1.1] vs 5.2 [1.34], P = 0.02), and documented malnourishment (36.2% vs 23.6%, P = 0.04). All three variables remained significant when entered into the regression model (X 2 = 25.095, P < 0.001). A higher score for the CFS (OR 1.3; 95% CI 1.03–1.64; P = 0.03) and CCI (OR 1.2; 95% CI 1.06–1.33; P = 0.004), and documented malnourishment (OR 1.92; 95% CI 1.06–3.47; P = 0.03) were all independent factors that increased the likelihood of patient re-admission within 30 days of discharge. Conclusions: This study supports the formal inclusion of the CCI and CFS into routine practice in Geriatric Evaluation and Management Units. The inclusion of the measures can help inform future discharge planning practices. Clinicians should use malnourishment status, CCI and CFS to identify at risk patients and target discharge planning interventions accordingly. What is known about the topic? Risk factors for re-admission to hospital are well documented for older patients following an acute admission. No studies have investigated re-admission risk for patients post discharge from a Geriatric Evaluation and Management Unit. Risks should be understood so that interventions can be targeted and resources allocated. What does this paper add? Risk factors for re-admission within 30 days are identified. What are the implications for practitioners? The inclusion of the Clinical Frailty Scale and Charlson Comorbidity Index is supported. These measures can inform future discharge planning practices to decrease the likelihood of re-admission within 30 days. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to describe the prevalence of cognitive impairment in hospital inpatients, the associated need for assistance with activities of daily living (ADL) and carer perceptions of hospital care. Methods: A prospective cross-sectional observational study was conducted in a large metropolitan teaching hospital in Brisbane, Australia. Participants were inpatients aged ≥65 years and their carers. Cognitive impairment was measured by clinician auditors using the validated 4 'A's test (4AT), with a score >0 indicating cognitive impairment (1–3, probable dementia; >3, probable delirium). The need for supervision and/or assistance with ADL was recorded from daily nursing documentation. Carers were invited to complete a brief questionnaire. Results: In all, 92 of 216 older inpatients (43%) had cognitive impairment, including 52 (24%) with probable delirium. The need for supervision and/or assistance with ADL increased significantly with 4AT score. Fifty-two carers of patients with cognitive impairment reported feeling welcome and that care was safe. They identified opportunities for better information, greater support and more inclusion of carers. Conclusions: Cognitive impairment is common in older inpatients and is associated with increased care needs. Workforce planning and health professional training need to acknowledge the needs of patients with cognitive impairment. There are opportunities for greater support and more involvement of carers. What is known about the topic?: Cognitive impairment due to delirium and dementia increases with age, and is common in older medical and surgical inpatients. However, cognitive impairment remains under-recognised by healthcare staff. Australian guidelines now recommend routine screening using valid tools, and including carers, when appropriate, when assessing, caring for and communicating with people with cognitive impairment. What does this paper add?: This cross-sectional study using the validated 4AT showed 43% of hospital inpatients aged ≥65 years had cognitive impairment. Participants with cognitive impairment had higher care needs and much longer hospitalisations. Carers of people with cognitive impairment reported unmet information needs in hospital and had limited involvement in assessment and care. What are the implications for practitioners?: Cognitive impairment is common in older inpatients. Hospitals and healthcare professionals must be prepared and equipped to recognise cognitive impairment, and address the accompanying patient and carer needs. [ABSTRACT FROM AUTHOR]

Objective. My Therapy is an allied health guided, co-designed rehabilitation self-management program for residents of aged care facilities. This study aimed to determine the feasibility of implementing My Therapy in a residential aged care setting. Methods. This observational study was conducted on a 30-bed wing, within a 90-bed metropolitan residential aged care facility, attached to a public health service, in Victoria, Australia. Staff and resident data were collected prospectively over 6 weeks (staff focus groups, patient surveys, and audits) to evaluate the feasibility domains of acceptability, reach and demand, practicality, integration, limited efficacy testing and adaptations. Results. Twenty-six residents and five allied health staff (physiotherapy and occupational therapy) participated. My Therapy was acceptable to residents (survey) and staff (focus groups). Via initial My Therapy discussions between the resident and the therapists, to determine goals and resident preferences, My Therapy reached 26 residents (n = 26/26, 100% program reach), with 15 residents subsequently receiving a rehabilitation program (n = 15/26, 58% program demand). The remaining 11 residents did not participate due to resident preference or safety issues (n = 11/26, 42%). Collecting physical function outcome measures for limited efficacy testing was practical, and the cost of My Therapy was AUD$6 per resident per day, suggesting financial integration may be possible. Several adaptations were required, due to limited allied health staff, complex resident goal setting and program co-design. Conclusion. My Therapy has the potential to improve the rehabilitation reach of allied health services in residential aged care. While introducing this low-cost intervention is feasible, adaptations were required for successful implementation. [ABSTRACT FROM AUTHOR]

Objective. To assess the timeliness of analgesia provided to patients presenting with musculoskeletal conditions, by advanced practice physiotherapists, medical officers and nurse practitioners in two Tasmanian emergency departments. Methods. A retrospective case-controlled comparative observational study collected patient data over a 6 month period. Index cases were consecutive cases treated by an advanced practice physiotherapist, with a medical and nurse practitioner cohort case-matched based on clinical and demographic factors. Time to analgesia from initial triage and time to analgesia from patient allocation to health professional groups were analysed using Mann–Whitney U-test. Further assessment comparing betweengroup differences in access to analgesia within 30 and 60 min of emergency department triage was included. Results. Two hundred and twenty-four patients who received analgesia while in the primary care of advanced practice physiotherapists were matched against 308 others. Median time to analgesia for the advanced practice physiotherapy group was 40.5 min compared with 59 min in the comparison group (P = 0.001). Allocation to analgesia time for the advanced practice physiotherapy group was 27 min, compared with 30 min in the comparison group (P = 0.465). Access to analgesia within 30 min of presentation to the emergency department is low (36.1% vs 30.8%, P = 0.175). Conclusion. For musculoskeletal presentations in two Tasmanian emergency departments, patients received more timely analgesia when in the care of an advanced practice physiotherapist compared with medical or nurse practitioner care. Further improvements in analgesia access are possible, with time from allocation to analgesia a potential target for intervention. [ABSTRACT FROM AUTHOR]

Background. In South Australian hospitals, 'Do Not Resuscitate' orders have been replaced by '7-Step Pathway Acute Resuscitation Plans', a standardised form and approach that encourages shared decision-making while providing staff with clarity about goals of care. This initiative has led to increased rates of documentation about treatment preferences, including 'Not-For- Cardiopulmonary Resuscitation'. Aim. To quantify any effect of the 7-Step Pathway form versus previous 'Do Not Resuscitate' orders on cardiopulmonary resuscitation, mechanical ventilation, and/or intensive care unit admission during hospitalisation. Methods. We completed a retrospective, observational study in two Australian tertiary hospitals using interrupted time-series analysis. We examined the number of medical inpatients aged 70 years and over who received one or more Intensive Treatments-cardiopulmonary resuscitation, mechanical ventilation, or intensive care unit admission-in the 2 years before and 2 years after the introduction of the form. Results. There were 2759 Intensive Treatments across 66 051 inpatient admissions; 1304/32 489 (4.0%) pre-intervention and 1455/33 562 post-intervention (4.3%). Sub-group analysis of those who died in hospital showed 400/1669 (24%) received Intensive Treatments pre-intervention and 382/1624 post-intervention (24%). Interrupted time-series analysis suggested that the intervention did not significantly alter Intensive Treatments over time at Hospital 1 and was associated with a significant slowing of the already decreasing use of Intensive Treatments at Hospital 2. Among patients who died in hospital, there was minimal change at either site. Conclusions. There was no reduction in Intensive Treatments in older medical inpatients following the introduction of standardised goals of care documentation. [ABSTRACT FROM AUTHOR]