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Objective: The medical record is critical for documentation and communication between healthcare professionals. This study compared the completeness of orthopaedic documentation between the electronic medical record (EMR) and paper medical record (PMR). Methods: A review was undertaken of 400 medical records (200 EMR, 200 PMR) of patients with operatively managed traumatic lower limb injury. The operative report, discharge summary and first and second out-patient reviews were evaluated using criteria designed by a senior orthopaedic surgeon and senior physiotherapist. The criteria included information deemed critical to the post-operative care of the patient in the first 6 weeks post-surgery. Results: In all cases, an operative report was completed by a senior surgeon. Notable findings included inferior documentation of patient weight-bearing status on the operative report in the EMR than PMR group (P = 0.018). There was a significant improvement in the completion of discharge summaries in the EMR compared with PMR cohort (100% vs 82.5% respectively; P < 0.001). In the PMR group, 70.0% of discharge summaries were completed and adequately documented, compared with 91.5% of those in the EMR group (P < 0.001). At out-patient review, there was an improvement in documentation of weight-bearing instructions in the EMR compared with PMR group (81.1% vs 76.2% respectively; P = 0.032). Conclusion: The EMR is associated with an improvement in the standard of orthopaedic medical record documentation, but deficiencies remain in key components of the medical record. What is known about the topic?: Medical records are an essential tool in modern medical practice and have significant implications for patient care and management, communication and medicolegal issues. Despite the importance of comprehensive documentation, numerous examples of poor documentation continue to be demonstrated. Recently, significant changes to the medical record in Australia have been implemented with the conversion of some hospitals to an EMR and the implementation of the My Health Record. What does this paper add?: Standards of patient care should be monitored continuously and deficiencies identified in order to implement measures for improvement and to close the quality loop. This study has highlighted that although there has been improvement in medical record keeping with the implementation of an EMR, the standard of orthopaedic medical record keeping continues to be below what is expected, and several key areas of documentation require improvement. What are the implications for practitioners?: The implications of these findings for practitioners are to highlight current deficiencies in documentation and promote change in current practice to improve the quality of medical record documentation among medical staff. Although the EMR has improved documentation, there remain areas for further improvement, and hospital administrators will find these observations useful in implementing ongoing change. [ABSTRACT FROM AUTHOR]

Objectives: Internationally, hip or knee arthroplasty (TJA) with a 1-day hospital length of stay (LOS) is common and demonstrates improved patient and health service outcomes. This study aimed to develop and pilot an enhanced recovery program (ERP) for patients undergoing TJA to achieve a next-day discharge in an Australian public hospital setting. Methods: A project lead and six perioperative clinical craft group leads developed an ERP protocol based on enhanced recovery after surgery (ERAS) principles. Strict patient eligibility criteria were developed. Quality improvement methodology was used to implement the ERP. A patient navigator was put in place as a single contact point for patients. Results: A total of 825 patients were screened for the ERP and 47 patients completed the protocol. The mean ± standard deviation (s.d.) of the LOS was 34.7 (± 7.2) h with 41 patients (87%) achieving next-day discharge, the remaining six (13%) discharged on Day 2. Compliance with ERAS was high (96%) with mobilisation within 12 h occurring on 87% of occasions. There were no adverse events. Patient experience was positive. Conclusion: Next-day discharge was achieved with a selected cohort of patients with no adverse events and positive patient experience, using a multidisciplinary approach and an improvement framework. Broadening inclusion criteria will make ERP available to more patients. What is known about the topic? Next-day discharge following hip or knee arthroplasty in Australian public hospital settings is uncommon and little has been published reflecting enhanced recovery principles in this local context. What does this paper add? This paper describes the development and piloting of an enhanced recovery program using a novel approach to achieve next-day discharge following hip and knee replacement. What are the implications for practitioners? Other health services may leverage this approach to design and implement an enhanced recovery program to reduce hospital length of stay and improve patient and health service outcomes. [ABSTRACT FROM AUTHOR]

Objective: HealthPathways is a web-based platform designed for use during a consultation to offer health professionals locally agreed information to support clinical and referral decision making. This study aimed to investigate whether access to specific HealthPathways pages in the North Coast New South Wales (NSW) region increased during specific critical events. High pageviews is used as a proxy for platform usefulness, and/or trust as a source of up-to-date information. Methods: Data were extracted from Google Analytics from December 2015 to December 2021. Descriptive statistics were generated for the total number of pageviews for all pages by month and year (2015–2021); for the top 15 most viewed pages in 2019, February–March 2020 inclusive (early COVID-19 pandemic period), 10–24 March 2021 (North Coast NSW region local disaster declaration period) and 26 June–11 October 2021 (NSW COVID-19 lockdown period); and for monthly pageviews for the Influenza Immunisation pathway (2016–2021). Results: Access to specific pages in HealthPathways increased alongside the occurrence of critical events affecting the region. Spikes in access to specific pages were seen during COVID-19 lockdown periods, during natural disasters, as well as during the annual influenza season. Conclusions: HealthPathways is viewed as a useful and trusted source of information for health professionals in the North Coast NSW region. HealthPathways provides an opportunity for timely dissemination of information during critical events, including natural disasters and emergencies. What is known about the topic? Evidence from New Zealand suggests that HealthPathways is viewed as a useful and trusted source of information by health professionals during critical and emergency events, and when information needs are subject to frequent change. What does this paper add? This paper provides evidence in the Australian context that health professionals access specific pages in HealthPathways at higher rates during critical and emergency events. What are the implications for practitioners? HealthPathways has the capacity to provide timely and accurate information to health professionals during critical and emergency events, as well as to identify their emerging information needs. [ABSTRACT FROM AUTHOR]

Objective: Clinician's experiences of providing care are identified as a key outcome associated with value-based healthcare (VBHC). In contrast to patient-reported experience measures, measurement tools to capture clinician's experiences in relation to VBHC initiatives have received limited attention to date. Progressing from an initial 18-item clinician experience measure (CEM), we sought to develop and evaluate the reliability of a set of 10 core clinician experience measure items in the CEM-10. Methods: A multi-method project was conducted using a consensus workshop with clinicians from a range of NSW Health local health districts to reduce the 18-item CEM to a short form 10-item core clinician experience measure (CEM-10). The CEM-10 was deployed with clinicians providing diabetes care, care for older adults and virtual care across all districts and care settings of New South Wales, Australia. Psychometric analysis was used to determine the internal consistency of the tool and its suitability for diverse clinical contexts. Results: Consensus building sessions led to a rationalised 10-item tool, retaining the four domains of psychological safety (two items), quality of care (three items), clinician engagement (three items) and interprofessional collaboration (two items). Data from four clinician cohorts (n = 1029) demonstrated that the CEM-10 four-factor model produced a good fit to the data and high levels of reliability, with factor loadings ranging from 0.77 to 0.92, with Cronbach's alpha (range: 0.79–0.90) and composite reliability (range: 0.80–0.92). Conclusions: The CEM-10 provides a core set of common clinician experience measurement items that can be used to compare clinician's experiences of providing care between and within cohorts. The CEM-10 may be supported by additional items relevant to particular initiatives when evaluating VBHC outcomes. What is known about the topic? Clinician experience of providing care is an outcome of interest for health systems and services internationally who are implementing value-based care initiatives. Review evidence indicates that measurement of clinician's experience of providing care should address experiences of being able to deliver quality care, collaborate with colleagues, experience psychological safety and engagement in decision-making in the workplace. What does this paper add? The paper reports the development of the short form clinician experience measure (CEM-10) and its initial validation in four value-based healthcare initiatives of NSW Health. What are the practical implications for practitioners? The CEM-10 can be used as a core set of items embedded within evaluations of value-based care initiatives to benchmark and examine experiences across clinician cohorts. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]

Objectives: The aims of the study were to investigate discrepancies between general practitioners' paper medication orders and pharmacy-prepared electronic medication administration charts, back-up paper charts and dose-administration aids, as well as delays between prescribing, charting and administration, at a 90-bed residential aged care facility that used a hybrid paper-electronic medication management system. Methods: A cross-sectional audit of medication orders, medication charts and dose-administration aids was performed to identify discrepancies. In addition, a retrospective audit was performed of delays between prescribing and availability of an updated electronic medication administration chart. Medication administration records were reviewed retrospectively to determine whether discrepancies and delays led to medication administration errors. Results: Medication records for 88 residents (mean age 86 years) were audited. Residents were prescribed a median of eight regular medicines (interquartile range 5-12). One hundred and twenty-five discrepancies were identified. Fortyseven discrepancies, affecting 21 (24%) residents, led to a medication administration error. The most common discrepancies were medicine omission (44.0%) and extra medicine (19.2%). Delays from when medicines were prescribed to when they appeared on the electronic medication administration chart ranged from 18 min to 98 h. On nine occasions (for 10% of residents) the delay contributed to missed doses, usually antibiotics. Conclusion: Medication discrepancies and delays were common. Improved systems for managing medication orders and charts are needed. [ABSTRACT FROM AUTHOR]

Objectives: Accreditation to standards developed by the Royal Australian College of General Practice provides assurance to the community of the quality and safety of general practices in Australia. The objective of this study was to conduct an empirical evaluation of the 5th edition standards. Minimal empirically driven evaluation of the standards has been conducted since their publication in 2020. Methods: Data encompass consecutive Australian general practice accreditation assessments between December 2020 and July 2022 recorded from a single accrediting agency. Met and not met compliance (binary) scores for 124 indicators evaluated at the site visit were recorded. A subset of indicators derived from a selection of existing and consistently non-conformant indicators within each criterion was generated. Concordance between the indicator subset and the criterion was assessed to determine the predictive ability of the indicator subset in distinguishing practices who are conformant to the entire criterion. Results: A total of 757 general practices were included in the analysis. On average, 113.69 (s.d. = 8.16) of 124 indicators were evaluated as conformant at the site visit. In total, 52 (42%) indicators were required to obtain a true positive conformity rate above 95% for all criterions of the standards. For criterion 1 (General Practice 1) conformity to the entire criterion (nine indicators; >95% true positive rate) could be obtained by including 2/9 indicators (C1-1a and C1-2a). Conclusion: Our results identified that indicator non-conformity was driven by a small proportion of indicators and identifying a subset of these consistently non-conformant indicators predicted a true positive rate above 95% at the criterion level. What is known about the topic? Minimal empirical evaluation of the 5th edition standards for accreditation have occurred since their implementation. What does this paper add? Our findings suggest that more than half of the indicators currently do not adequately distinguish practices at the site assessment. What are the implications for practitioners? These findings may suggest that a review of individual indicators and the standards structure is required. [ABSTRACT FROM AUTHOR]

Objectives: This study explored the familiarity, perceptions and confidence of Australian radiology clinicians involved in reading screening mammograms, regarding artificial intelligence (AI) applications in breast cancer detection. Methods: Sixty-five radiologists, breast physicians and radiology trainees participated in an online survey that consisted of 23 multiple choice questions asking about their experience and familiarity with AI products. Furthermore, the survey asked about their confidence in using AI outputs and their preference for AI modes applied in a breast screening context. Participants' responses to questions were compared using Pearson's χ 2 test. Bonferroni-adjusted significance tests were used for pairwise comparisons. Results: Fifty-five percent of respondents had experience with AI in their workplaces, with automatic density measurement powered by machine learning being the most familiar AI product (69.4%). The top AI outputs with the highest ranks of perceived confidence were 'Displaying suspicious areas on mammograms with the percentage of cancer possibility' (67.8%) and 'Automatic mammogram classification (normal, benign, cancer, uncertain)' (64.6%). Radiology and breast physicians preferred using AI as second-reader mode (75.4% saying 'somewhat happy' to 'extremely happy') over triage (47.7%), pre-screening and first-reader modes (both with 26.2%) (P < 0.001). Conclusion: The majority of screen readers expressed increased confidence in utilising AI for highlighting suspicious areas on mammograms and for automatically classifying mammograms. They considered AI as an optimal second-reader mode being the most ideal use in a screening program. The findings provide valuable insights into the familiarities and expectations of radiologists and breast clinicians for the AI products that can enhance the effectiveness of the breast cancer screening programs, benefitting both healthcare professionals and patients alike. What is known about the topic? Artificial intelligence (AI) holds promise in providing computer-aided detection in health care, however, current research suggests that standalone AI applications in clinical practice fall short of matching the accuracy of a single radiologist. What does this paper add? The study showed a significant preference among clinicians for using AI as a supplementary tool, serving as a second-reader. Such an integrated approach, where AI aids in flagging suspicious areas on mammograms or offers automatic classification, reflects the ideal cooperation between breast screening readers and AI systems. What are the implications for practitioners? These insights shed light on clinicians' familiarity with and expectations of AI tools that can boost the effectiveness of breast screening programs. [ABSTRACT FROM AUTHOR]

Objective: To explore the training needs of the home care workforce in supporting the social and emotional wellbeing (SEWB) of Aboriginal and Torres Strait Islander peoples receiving aged care services through the Home Care Package (HCP) Program. Methods: A mixed-methods design including (1) a focus group and interview with coordinators of HCP Program services for Aboriginal and Torres Strait Islander peoples across metropolitan and rural South Australia in April and June 2022, and (2) a desktop review of training, professional development opportunities and resources for existing and pre-entry workforce addressing the SEWB of Aboriginal and Torres Strait Islander peoples in aged care across the Vocational Education Training and higher education sectors in South Australia, the Australian Indigenous HealthInfoNet, the Department of Health and Aged Care website and aged care email alerts between December 2021 and September 2022. Results: Five themes representing workforce training needs were identified: cultural safety, trauma-informed care, case management, compliance with funding rules and preferred formats for training. The desktop review identified a paucity of formal training, professional development and resources within the context of addressing the SEWB of Aboriginal and Torres Strait Islander peoples in aged care. Conclusions: These findings suggest that ongoing practice-based professional development learning opportunities are needed within organisations to enhance peer-learning and support. These need to be available together with dedicated formal training programs and practical resources on meeting Aboriginal and Torres Strait Islander peoples' SEWB in aged care. What is known about the topic? Supporting social and emotional wellbeing is an important aspect of delivering quality aged care for Aboriginal and Torres Strait Islander peoples. What does this paper add? Insights into workforce training needs which support the social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples in home-based aged care. What are the implications for practitioners? Ongoing practice-based learning opportunities, training and resources are needed to enhance peer-learning and support workforce in supporting Aboriginal and Torres Strait Islander peoples' social and emotional wellbeing in aged care. [ABSTRACT FROM AUTHOR]

Objective: There is a need to undertake more proactive and in-depth analyses of general practice accreditation processes. Two areas that have been highlighted as areas of potential inconsistency are the self-assessment and surveyor assessment of indicators. Methods: The data encompass 757 accreditation visits made between December 2020 and July 2022. A mixed-effect multilevel logistic regression model determined the association between attempt of the self-assessment and indicator conformity from the surveyor assessment. Furthermore, we present a contrast of the rate of indicator conformity between surveyors as an approximation of the inter-assessor consistency from the site visit. Results: Two hundred and seventy-seven (37%) practices did not attempt or accurately report conformity to any indicators at the self-assessment. Association between attempting the self-assessment and the rate of indicator non-conformity at the site visit failed to reach statistical significance (OR = 0.90 [95% CI = 1.14–0.72], P = 0.28). A small number of surveyors (N = 9/34) demonstrated statistically significant differences in the rate of indicator conformity compared to the mean of all surveyors. Conclusions: Attempt of the self-assessment did not predict indicator conformity at the site visit overall. Appropriate levels of consistency of indicator assessment between surveyors at the site visit were identified. What is known about the topic? There is a need to undertake more proactive and in-depth analyses of the general practice accreditation process and outcomes to improve the quality and safety within this healthcare sector. What does this paper add? Attempt of the self-assessment does not predict indicator conformity at the site visit overall, and appropriate levels of consistency of indicator assessment between surveyors at the site visit were identified. What are the implications for practitioners? We present empirical evidence as to the consistency of assessment with general practice accreditation to inform future standards and (re)accreditation assessments. [ABSTRACT FROM AUTHOR]

Objective: The study examined emergency department (ED) presentations, unplanned hospitalisations and potentially preventable hospitalisations in older people receiving long-term care by type of care received (i.e. permanent residential aged care or home care packages in the community), in Australia in 2019. Methods: A retrospective cohort study was conducted using the Registry of Senior Australians National Historical Cohort. Individuals were included if they resided in South Australia, Queensland, Victoria or New South Wales, received a home care package or permanent residential aged care in 2019 and were aged ≥65 years. The cumulative incidence of ED presentations, unplanned hospitalisations and potentially preventable hospitalisations in each of the long-term care service types were estimated during the year. Days in hospital per 1000 individuals were also calculated. Results: The study included 203,278 individuals accessing permanent residential aged care (209,639 episodes) and 118,999 accessing home care packages in the community (127,893 episodes). A higher proportion of people accessing home care packages had an ED presentation (43.1% [95% confidence interval, 42.8–43.3], vs 37.8% [37.6–38.0]), unplanned hospitalisation (39.8% [39.6–40.1] vs 33.4% [33.2–33.6]) and potentially preventable hospitalisation (11.8% [11.6–12.0] vs 8.2% [8.1–8.4]) than people accessing permanent residential aged care. Individuals with home care packages had more days in hospital due to unplanned hospitalisations than those in residential care (7745 vs 3049 days/1000 individuals). Conclusions: While a high proportion of older people in long-term care have ED presentations, unplanned hospitalisations and potentially preventable hospitalisations, people in the community with home care packages experience these events at a higher frequency. What is known about the topic? Unplanned hospitalisations and emergency department presentations are frequent and burdensome for older people receiving long-term aged care. What does this paper add? While unplanned hospitalisations and emergency department presentations were high in all people receiving long-term care, these events were higher in people receiving home care packages than those in residential aged care. What are the implications for practitioners? Further efforts to address the high unplanned hospitalisations and emergency department presentations experienced by the increasing number of older adults accessing home care packages are required to allow this population to remain at home successfully. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to quantify the out-of-pocket (OOP) costs and perceived financial burden among Australian men with localised prostate cancer in the first 6 months after diagnosis, by primary management option. Methods: This cost-analysis quantified OOP costs using administrative claims data and self-reported survey data. Financial burden was assessed using the COmprehensive Score for financial Toxicity–Functional Assessment of Chronic Illness Therapy (COST-FACIT) tool. Participants were recruited into a randomised control trial from public or private treatment centres in Victoria and Queensland. Generalised linear models were used to predict OOP costs and COST-FACIT scores. Results: Median total OOP costs within 6 months of diagnosis for 256 Australian patients with localised prostate cancer was A$1172 (A$343–2548). Up to 50% of the sample reported A$0 costs for most medical services. Compared with those managed with active surveillance, men having active treatment had 6.4 (95% CI: 3.2–12.7) times greater total OOP costs. Management option, higher Gleason score at diagnosis and having multiple comorbidities were significant predictors of higher OOP costs. Overall high scores on the COST-FACIT indicated low levels of financial burden for the entire sample. Conclusion: Largely attributable to being managed with active surveillance, Australian men diagnosed with localised prostate cancer reported relatively low OOP costs and financial burden in the first 6 months post-diagnosis. Together with clinical outcomes, clinicians can use this up to date evidence on costs and perceived financial burdens to assist localised prostate cancer patients and their families make informed decisions about their preferred management option. What is known about the topic? International evidence suggests that men with low-risk prostate cancer managed with active surveillance initially incur lower out-of-pocket costs than those managed with active treatment. What does this paper add? Australian men with low-risk prostate cancer report low out-of-pocket costs and financial burden in the first 6 months post-diagnosis. Compared with those managed with active surveillance, men having active treatment had 6–7 times greater out-of-pocket expenses. What are the implications for practitioners? Being managed by active surveillance as the primary management option for low-risk prostate cancer reduces the financial burdens associated with a cancer diagnosis. [ABSTRACT FROM AUTHOR]

Objective: Consumer-centred care is fundamental to high-quality health care, with allied health professionals playing a pivotal role in hospital settings. Allied health typically operates within standard weekday working-hours. Consumer preferences for receiving allied health services are largely unexplored but could inform whether weekend and/or out-of-hours services are required. This study aims to understand consumer preferences for hospital-based inpatient and outpatient allied health services. Methods: Using a cross-sectional survey and convenience sampling approach, consumers of a public health service in Melbourne, Australia were surveyed about preferences for allied health service delivery. Electronic health record reviews compared the accuracy of self-reported service delivery times. Descriptive statistics, concordance and predictive values were calculated. Responses to free-text survey items were analysed using content analysis. Results: Of 120 participants (79% response rate), most (69%) received allied health services, however, almost half of inpatient responders (44%) were unsure of the specific allied health professional involved. Audit results found moderate–high concordance overall (range, 77–96%) between self-reported and audit-identified allied health services by profession. Most inpatient responders had no strong day of week preference, equally selecting weekdays and weekend days, with most preferring services between 8 am and 4 pm. Outpatient responders (81%) preferred a weekday appointment between 8 am and 12 pm or before 8 am (29%) to complete scheduled activities early in the day. Conclusion: While provision of allied health services during standard working-hours was preferred by most consumers, some inpatient and outpatient consumers are receptive to receiving weekend and out-of-hours services, respectively. Decisions about offering these services should consider operational capacity and research evidence. What is known about the topic? Research on consumer acceptance of out-of-hours or weekend allied health services is lacking, with an assumption of consumer willingness and demand for these service models. What does this paper add? Hospital inpatients are generally indifferent to the day of allied health services, preferring weekday or weekend day equally, typically between 8 am and 4 pm, while outpatients favour weekday mornings. Although consumers reported that their needs were met by allied health services, there was a lack of awareness about the specific services they received. What are the implications for practitioners? Results highlight the importance of not only aligning service delivery with consumer preferences for timing, but also enhancing awareness and understanding of the available allied health services for consumers. [ABSTRACT FROM AUTHOR]

Objective: To describe change in costs to different funders over time for women giving birth in Queensland between 2012 and 2018. Methods: A whole-of-population linked administrative dataset was used that contained all health service use in Queensland for women who gave birth between 1 July 2012 and 30 June 2018 and their babies. Aggregated costs for mother and baby from pregnancy to 12 months postpartum were used to compare the change in costs to funders over time. Results: There was an increase in mean total cost to all funders per birth in the public system and private system from 2012 to 2018. North West Hospital and Health Service (HHS) had the highest mean total cost (in Australian dollars) in 2018 (A$42 353), while home births had the lowest (A$6105). For the majority of HHSs the proportion of births with a positive birth outcome (as defined by a composite outcome measure) has remained largely static or declined during this time period. Cairns and Hinterland HHS and Townsville HHS had the largest declines of 15% and 16% respectively, while mean total cost to all funders rose 36.39% and 46.41%, respectively. Conclusions: There has been an increase over time across Queensland in the cost of childbirth in public hospitals and in the private system, while the cost of home birth has remained static. For most HHSs this increase in cost is also associated with little change or a decline in the percentage of births with a positive outcome. Increases in cost are therefore not being translated into better outcomes for women and their babies. Routine performance monitoring of cost, quality and safety should be adopted to ensure the provision of high value maternity care in Australia. What is known about the topic? Public maternity care costs vary in Australia dependent upon place of birth, even after adjusting for clinical and demographic factors. What does this paper add? This paper compares the change in costs for mother and baby from birth through to 12 months for births across Queensland over time. Costs for maternity care have increased over time and higher-cost treatment does not necessarily result in better health outcomes. What are the implications for practitioners? Reporting of cost alongside clinical outcomes should be included in performance monitoring of public hospital maternity care. [ABSTRACT FROM AUTHOR]

Objective: Falls in hospital are a significant public health issue and patients with communication disability have unique risk factors that have the potential to contribute to falls. The aim of this study is to determine how the content of hospital falls policies relate to patients with communication disability and to identify gaps in policy that need to be addressed. Methods: A scoping review and content analysis of (a) policies and related documents, from a target health service in Victoria, Australia, and all relevant Australian state and territory health departments, and (b) national guidelines was performed. Data were analysed for content relating to inclusion of patients with communication disability. Results: Communication disability is not captured as a risk factor for a fall in assessment tools. When included, aspects of communication disability were often conflated with cognitive impairments. There was little guidance for staff on adapting falls prevention education to suit the needs of patients with communication disability and limited identified role for speech pathologists. Conclusion: This study suggests that a patient's communication disability is not visible in hospital falls policies and guidelines. What is known about the topic? Falls prevention is an important part of the national health policy agenda and there is extensive literature informing hospital policy and guidelines. What does the paper add? This study provides insights into how hospital falls policies and guidelines relate to the assessment of risk, and prevention of falls in people with communication disability. What are the implications for practitioners? The results suggest that a patient's communication disability is not considered in falls risk assessment, or prevention plans. Communication disability should not be a barrier to engaging patients in this process. [ABSTRACT FROM AUTHOR]

Objective: The coronavirus disease 2019 (COVID-19) vaccination response in primary health care provides important learnings for strengthening health systems and preparing for surge response. The aim of this study was to examine the contributions of service providers to the COVID-19 vaccination program in Victoria, Australia, to gain insight into the role of primary health care during surge response and determine if this differs with rurality. Methods: A descriptive quantitative study design using existing COVID-19 vaccination data extracted from the Australian Immunisation Record via the Department of Health and Aged Care, Health Data Portal, de-identified for primary health networks, was used. Vaccination administrations were categorised by provider type for the first year of the Australian COVID-19 vaccination program in Victoria, Australia from February 2021 to December 2021. Descriptive analyses describe the total and proportional vaccinations administered by provider type and patient rurality. Results: Overall, primary care providers delivered half (50.58%) of total vaccinations for the population, and the number and proportion of vaccinations increased with patient rurality. The largest difference was observed in remote communities where 70.15% of COVID-19 vaccinations were administered by primary care providers. Primary care providers administered fewer COVID-19 vaccines in regional centres at 42.70%, compared to 46.45% administered by state government (and 10.85% administered by other). Conclusion: The contribution of primary health care to the COVID-19 vaccine program highlights the importance of rural primary care providers and settings, primarily general practice, to the delivery of population health interventions in rural communities especially during times of crisis. What is known about the topic? Research on pandemic response provides important insights for future surge planning and preparedness. What does this paper add? The contribution of primary care to the COVID-19 vaccine program highlights the importance of rural general practice to the delivery of population health interventions during times of crisis. What are the implications for practitioners? Policymakers must tailor reforms towards strengthening rural primary health care in preparation for future surge response. [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]

Objectives: The importance of engaging junior doctors in quality improvement (QI) initiatives is well recognised. Junior doctors bring fresh perspectives and engage closely with patients, consumers, families and the healthcare team. They are well positioned to recognise inefficiencies in the system that may compromise safe, timely and effective care. To promote QI participation by our junior doctors our organisation created a specific role; the Improvement House Medical Officer (IHMO). The objective of this study is to describe and evaluate the IHMO rotation at the Royal Melbourne Hospital, a large tertiary hospital in Australia. Methods: A mixed-methods study was performed that involved a survey of previous IHMOs since 2011, including a review of the major QI projects undertaken by IHMOs. Results: Twenty-seven out of 40 IHMOs completed the survey. Doctors were attracted to the rotation to make an impact on the working conditions of junior doctors (selected by 20 respondents, 74%) and improve the quality of health care experienced by patients (18, 67%). Most respondents strongly agreed or agreed (22, 82%) that they used the skills gained in the rotation in their ongoing work. More than 40 QI projects have been led or co-led by IHMOs since 2011. Challenges of the role included the short timeframe of the rotation and the perceived slow pace of institutional change. Respondents found engaging other junior doctors with QI and understanding the hospital's organisational structure to be barriers. Conclusions: The full engagement of junior doctors in QI upholds a healthcare culture that celebrates innovation and promotes patient safety. The IHMO rotation offers an immersive, experiential and impactful way to do so. What is known about the topic? The importance of engaging junior doctors in quality improvement initiatives is well recognised. What does this paper add? Introduces and evaluates the Improvement House Medical Officer position at a large tertiary hospital. What are the implications for practitioners? Other health services may be inspired to implement quality improvement programs for the benefit of their health service, patients and junior doctors. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to conduct a learning and development needs analysis of quality improvement partnership capabilities of staff and consumers on partnership committees at an Australian metropolitan hospital and health service. Objectives were to compare consumer and staff self-rated capability importance, performance, and learning needs; to investigate if years of partnership experience influenced ratings; and to ascertain staff and consumer preferred learning strategies. Methods: An online cross-sectional survey was adapted from the Hennessy–Hicks Training Needs Analysis questionnaire. Participants self-rated the importance of, and their performance on, 10 capabilities, across four domains, of an internationally validated co-produced capability development framework. They also rated preferences regarding learning approaches and media. Results: A total of 199 members from 41 committees (174 staff; 25 consumers; response rate 35.38%) participated. There was a statistically significant learning and development need across all capabilities (P < 0.01). The highest learning need was for influencing organisational systems and policy (mean = −0.96; s.d. = 1.23), followed by equalising power and leadership (mean = −0.91; s.d. = 1.22), and then implementing partnership best practices (mean = −0.89; s.d. = 1.22). There were no statistically significant differences between consumers and staff on ratings, or correlations between years of partnership experience and ratings (P < 0.01). A combination of learning approaches was preferred, followed by learning through experience. Self-reflection was least preferred, which is concerning given it may promote equalising power and leadership. Face-to-face then videoconferencing were the preferred learning media. Conclusions: Continuous co-learning for staff and consumers about QI partnerships is essential. Committee members needed more feedback regarding their influence and to be engaged in innovative co-design practices. What is known about the topic? Staff and consumer capabilities are essential for effective collaboration on quality improvement (QI) committees, however, research is lacking. What does this paper add? This learning and development needs analysis provides direction for effective design of education and support programs. What are the implications for practitioners? Staff and consumers should continuously develop QI partnership capabilities together, and through multiple learning approaches. Increased exposure to innovative co-design strategies is needed to enhance capabilities and influence on organisational systems and policies. Sharing power and leadership was also a high learning need with self-reflection being vital. [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: This study aimed to investigate COVID-19 vaccine hesitancy, acceptance, and unmet informational needs in a cancer population during the first phase of the coronavirus disease 2019 (COVID-19) vaccination rollout in Australia. Methods: A cross-sectional survey was conducted in a large tertiary hospital in Queensland, Australia, between 10 May and 31 July 2021. The survey assessed health beliefs, experiences of the COVID-19 pandemic, COVID-19 vaccine hesitancy and informational needs. Results: COVID-19 was perceived to be a significant threat to both physical and mental health. While 57.9% (n = 110) of respondents believed the COVID-19 vaccines were safe and 64.2% (n = 122) believed they were effective, more than half (52.6%; n = 100) agreed that they worried about vaccine side effects. Most respondents (84.2%; n = 160) planned to receive the COVID-19 vaccine; however, feelings of hesitancy remained. There was a statistically significant association between those aged under 60 years (P = 0.003), those with previous vaccine hesitancy (P = 0.000), those who felt they had not received adequate information (P = 0.000) and vaccine hesitancy. Requested information pertained to interactions with cancer treatments, those with a history of blood clotting and information for those undergoing bone marrow transplantation. Conclusions: There is a need for tailored COVID-19 vaccine communication that is responsive to the concerns of people with cancer. This will be beneficial during current and future vaccination rollouts. What is known about topic? People with cancer are a COVID-19 vaccine priority group, as they are at increased risk of morbidity and mortality from this disease. There is currently a dearth of information regarding COVID-19 vaccine hesitancy, acceptance, or informational needs for this population. What does this paper add? This paper has shown that although vaccine refusal rates were low in this population, feelings of hesitancy remained. Women, those in younger age categories, those with previous vaccine hesitancy and those who felt they had not received adequate information had stronger vaccine hesitancy and higher refusal rates. What are the implications for practitioners? There is a need for tailored information and open communication regarding COVID-19 vaccines and people with cancer. There is an opportunity to build upon established relationships of trust between cancer patients and their clinicians. [ABSTRACT FROM AUTHOR]

Objectives: To examine: the impact of the coronavirus disease 2019 (COVID-19) pandemic on access to health services by middle-aged and older Australians; and the use of telehealth services during the COVID-19 pandemic and its ongoing usefulness. Methods: A cross-sectional survey was conducted among participants who completed the COVID-19 supplement in the 45 and Up Study 2020 Survey. Multivariable logistic regression analysis was used to examine the association between socio-demographic characteristics and health conditions with missed/delayed access to health services, changes in health outcomes resulting from missed/delayed access, and use of telehealth services. Results: Data for 45 071 participants were analysed (56% female, 72% aged ≥65 years). Almost half (42.2%) reported they had missed/delayed access to health care due to COVID-19; mainly for dental services (26.1%), visits to a general practitioner (GP) (16.3%) and specialists (12.6%). Missed/delayed visits to GPs and specialists were more likely among females, participants from non-English-speaking backgrounds, with disability/illness, living in outer regional/remote areas or with chronic health conditions. People with a disability or high/very high psychological distress were twice as likely to report worse health as a result of missed/delayed care. Half (48.0%) the study participants used telehealth during the COVID-19 pandemic and 81.9% indicated telehealth would be useful post-pandemic. Conclusions: The COVID-19 pandemic impacted access to healthcare services, particularly for people with a disability, and chronic or mental health issues who also reported worse health. This may account for their higher use of telehealth services as an alternate way of accessing health care. Ongoing evaluation of telehealth services for vulnerable groups post-pandemic is required. What is known about the topic ? The COVID-19 pandemic has had a significant impact on healthcare usage and access. What does this paper add? This paper identifies the impact of access to health care during the COVID-19 pandemic on vulnerable subgroups within middle-aged and older Australians, including those with chronic and mental health issues. Telehealth is an acceptable way to facilitate access to services for these groups. What are the implications for practitioners? Practitioners are strategically positioned to provide alternatives to face-to-face visits during times of limited access and identify those who are in most need of additional care by way of telehealth intervention. [ABSTRACT FROM AUTHOR]

Objective: To examine implicit bias in employees at a cancer centre using an Australian race (Aboriginal–white) Implicit Association Test (IAT), in an attempt to understand a potential factor for inequitable outcomes of First Nations Australians cancer patients. Methods: All employees at an Australian cancer centre were invited to take part in a web-based, cross-sectional study using an Australian race IAT. The results were analysed using Welch t-tests, linear regression and ANOVA. Results: Overall, 538/2871 participants (19%) completed the IAT between January and June 2020. The mean IAT was 0.147 (s.d. 0.43, P < 0.001, 95% CI 0.11–0.18), and 60% had a preference for white over First Nations Australians. There was no significant mean difference in IAT scores between sub-groups of gender, age or clinical/non-clinical employees. 21% of employees (95% CI 17.65–24.53) had moderate to strong preference for white over First Nations Australians, compared to 7.1% with moderate to strong preference for First Nations over white Australians (95% CI 5.01–9.09). Conclusions: Inequitable cancer survival for First Nations patients has been well established and cancer is now the leading cause of mortality. This paper documents the presence of racial bias in employees at one cancer centre. We argue that this cannot be understood outside the history of colonialism and its effects on First Nations Australians, healthcare workers and our society. Further research is required to evaluate measures of racism, its effect on health care, and how to eliminate it. What is known about this topic? Australian cancer care providers deliver inequitable access and outcomes for First Nations Australians. Systemic and personal racism experienced by First Nations patients are thought to contribute to these inequities. What does this paper add? This paper documents the presence of cancer centre employee racial bias and reiterates the need for further research to document the effect of racism on cancer care outcomes for First Nations patients. What are the implications for practitioners? Healthcare practitioners, similar to other Australians, have implicit bias against First Nations Australians. Previous studies suggest that the presence of bias affects treatment options and outcomes for people of colour. In order to eliminate racism and associated inequities in cancer care services, multi-faceted anti-racism approaches are required. [ABSTRACT FROM AUTHOR]

Objective: Optimal utilisation of theatre time increases efficiency and reduces the cost of health care. The accuracy of surgical time estimation between different members of the theatre team has not been well documented, and may aid in more efficient utilisation of available theatre time. This study aims to identify the cohort of theatre staff with greatest accuracy in estimating orthopaedic surgical time. Methods: This study was conducted in a prospective fashion using consecutive orthopaedic trauma and elective operative lists over a period of 3 months. Prior to each operating list, a senior member of each of the anaesthetic, orthopaedic and scrub/scout nursing teams predicted the surgical duration for orthopaedic procedures after being provided with information regarding the individual cases. The absolute difference between estimated and actual surgical times was calculated. Results: When expressed as a percentage difference from true surgical time, the orthopaedic team provided the most accurate estimates, with a mean difference of 33.0%. This was followed by nursing staff (40.5%) and anaesthetics (50.9%). Similarly, a higher proportion of estimates by the orthopaedic team were within the limits of 20% underestimation and 10% overestimation (deemed clinically significant). Conclusions: Surgical times for orthopaedic trauma and elective cases are most accurately estimated by the operating team. These estimates should be implemented when planning theatre utilisation, and may benefit computer algorithms for theatre scheduling. What is known about the topic? The ability of surgeons, nurses and anaesthetists to accurately predict surgical times is often debated, with heated discussions if additional cases can fit onto a scheduled list. What does the paper add? Our paper demonstrated that despite all groups being inaccurate with timing predictions, orthopaedic surgeons were the most accurate. What are the implications for practitioners? With ever-growing pressure on health systems, it is paramount that available theatre resources are utilised with maximal efficiency. [ABSTRACT FROM AUTHOR]

Objective: Adverse incident research within residential aged care facilities (RACFs) is increasing and there is growing awareness of safety and quality issues. However, large-scale evidence identifying specific areas of need and at-risk residents is lacking. This study used routinely collected incident management system data to quantify the types and rates of adverse incidents experienced by residents of RACFs. Methods: A concurrent mixed-methods design was used to examine 3 years of incident management report data from 72 RACFs in New South Wales and the Australian Capital Territory. Qualitative thematic analysis of free-text incident descriptions was undertaken to group adverse incidents into categories. The rates and types of adverse incidents based on these categories were calculated and then compared using incidence rate ratios (IRRs). Results: Deidentified records of 11 987 permanent residents (aged ≥65 years; mean (±s.d.) age 84 ± 8 years) from the facilities were included. Of the 60 268 adverse incidents, falls were the most common event (36%), followed by behaviour-related events (33%), other impacts and injuries (22%) and medication errors (9%). The number of adverse incidents per resident ranged from 0 (42%) to 171, with a median of 2. Women (IRR 0.804; P < 0.001) and residents with low care needs (IRR 0.652; P < 0.001) were significantly less likely to adverse incidents compared with men and residents with high care needs respectively. Conclusion: This study demonstrates that data already collected within electronic management systems can provide crucial baseline information about the risk levels that adverse incidents pose to older Australians living in RACFs. What is known about the topic?: To date, research into aged care adverse incidents has typically focused on single incident types in small studies involving mitigation strategies. Little has been published quantifying the multiple adverse incidents experienced by residents of aged care facilities or reporting organisation-wide rates of adverse incidents. What does this paper add?: This paper adds to the growing breadth of Australian aged care research by providing baseline information on the rates and types of adverse incidents in RACFs across a large and representative provider. What are the implications for practitioners?: This research demonstrates that the wealth of data captured by aged care facilities' incident management information systems can be used to provide insight into areas of commonly occurring adverse incidents. Better use of this information could greatly enhance strategic planning of quality improvement activities and the care provided to residents. [ABSTRACT FROM AUTHOR]

Objective: To quantify patterns of overtime among doctors-in-training in New South Wales and to explore the reasons doctors-in-training cite for not claiming overtime worked. Methods: A confidential online self-reporting survey was conducted of post-graduate doctors-in-training, working in hospitals in NSW, from post-graduate year 1 through to completion of specialist training. Questions sought to determine the average amount of overtime worked, overtime claiming patterns, and reasons why overtime was not claimed. Comparisons were made by level of training and specialty training pathway. Results: A total of 1351 valid responses were received. Unrostered overtime was extremely common, as was underpayment for work completed. Though 73.5% of respondents reported working at least 5 h of unrostered overtime per fortnight, only 15.6% of respondents reported claiming all their unrostered overtime, and among those who did claim overtime, only 45.5% reported being paid the amount in full. Common reasons for not claiming overtime included workplace cultural expectations (37.0%), and overtime not falling under approved reasons (32.6%). There were statistically significant differences (P < 0.001) in all response categories between critical care, physician and surgical training pathways. Conclusions: The survey data demonstrated a significant disconnect between expectations and reality of working hours among doctors-in-training. This is indicative of concerns regarding loss of income, impaired ability to plan workforce allocation due to hidden workload, and possibly impaired wellbeing. What is known about the topic? Among Australian doctors-in-training, there appears to be a significant discrepancy between contracted working hours, actual expectations for working hours, and remuneration for hours worked. What does this paper add? This paper outlines and analyses patterns of overtime claiming among Australian doctors‐in‐training. Notably, doctors‐in‐training worked significant quantities of unrostered overtime, demonstrating a discrepancy between formal expectations set out by rosters, and the reality of workplace demands. What are the implications for practitioners? These findings have significant implications for healthcare economics, workforce planning and improving junior doctor wellbeing. [ABSTRACT FROM AUTHOR]

Objective: This study determined caregivers' evaluations of telehealth consultations for their child, preference over in-person consultations and potential cost savings by child condition, family socioeconomic status and location. Methods: A survey was conducted of 2436 caregivers attending a telehealth consultation with their child for a broad group of conditions between 3 June and 25 August 2020 at a tertiary paediatric hospital in Melbourne, Australia. Results: Most caregivers found telehealth consultations convenient, acceptable, safe and private, and capable of answering their questions and concerns. However, caregivers who spoke a language other than English and patients attending for behavioural and mental health, developmental or other (e.g. allied health) concerns were more likely to prefer in-person consultations over telehealth. Mean (±s.d.) reported cost savings on caregiver time were A$144.98 ± 99.04 per family per consultation, whereas mean (±s.d.) transport cost savings were A$84.90 ± 100.74 per family per consultation. Cost savings were greatest for families living in low and middle socioeconomic areas and regional or rural areas. Conclusions: Paediatric telehealth video consultations were largely viewed favourably by caregivers, except for those attending for behavioural and mental health or developmental concerns. What is known about the topic?: Adult consumers of telehealth consultations view them as useful, convenient and cost saving, but less is known about caregivers' evaluations of telehealth consultations and potential cost savings for paediatric patients, and whether these differ by family location, socioeconomic status or child condition. What does this paper add?: This is the first Australian paper to report on caregivers' evaluations across a range of paediatric conditions and locations. Most caregivers found telehealth consultations convenient, safe, acceptable, able to answer their questions and concerns about their child's health and cost saving. What are the implications for practitioners?: Caregivers of children with behavioural, mental health or developmental problems were less likely to prefer telehealth over in-person consultations, so practitioners should consider providing such consultations in person. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to investigate how healthcare practitioners use real-time prescription monitoring tools in clinical practice. Methods: An online survey was distributed to Australian prescribers and pharmacists who use a real-time prescription monitoring tool. Data were analysed and descriptive statistics summarised participant characteristics and responses. A Chi-squared test was conducted to test the difference between prescribers and pharmacists. Results: The majority of participants agreed that real-time prescription monitoring (RTPM) information is useful (92.2%) and the tool is valuable for informing clinical decisions (90.2%); however, just over half reported that they had changed their prescribing or dispensing practices as a result of RTPM information (51.0%), and they employed evidence-based clinical interventions to varying degrees. No statistically significant differences were detected between pharmacists and prescribers and perceptions on tool use. Conclusions: This is the first known study to investigate practitioner use of RTPM tools in Australia, and is a starting point for further research. What constitutes 'success' in the clinical application of RTPM tools is yet to be realised. What is known about the topic? Real-time prescription monitoring tools have been implemented in most states and territories across Australia to reduce the harms of prescription medication misuse. What does this paper add? This is the first study to explore pharmacists' and prescribers' perspectives on tool use in clinical practice, and the impact of these tools on clinical decision-making and clinical interventions. What are the implications for practitioners? Practitioners can optimise tool use in clinical practice to provide patients with best quality health care. [ABSTRACT FROM AUTHOR]

Objective: To determine the proportion of staff employed in smaller Victorian public acute healthcare facilities with evidence of immunity to hepatitis B. Methods: For optimal long-term immunity, a completed hepatitis B vaccination course and post vaccination hepatitis B surface antibody (anti-HBs) level ≥10 mIU/mL is desirable for all high-risk staff employed in healthcare facilities. For the financial years 2016/17–2019/20, a standardised surveillance module developed by the Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre was completed by the smaller Victorian public acute healthcare facilities (individual hospitals with <100 acute care beds or their multi-site health service). Staff were assessed as having evidence or no evidence of optimal immunity to hepatitis B. Those without optimal evidence were sub-classified as 'incomplete vaccination course', 'no serology', 'contraindicated', 'non-responder', 'declined' or 'unknown'. Data were analysed to determine trends over time for healthcare facilities that participated more than once. Results: A total of 88 healthcare facilities reported hepatitis B immunity status of high-risk (Category A) staff (n = 29 920) at least once over 5 years; 55 healthcare facilities reported more than once. The aggregate proportion with evidence of optimal immunity was 66.3%. Healthcare facilities with 100–199 Category A staff employed reported the lowest evidence of optimal immunity (59.6%). Of all Category A staff with no evidence of optimal immunity, the majority had 'unknown' status (19.8%), with only 0.6% overall who declined vaccination. Conclusions: Our study found evidence of optimal staff hepatitis B immunity in only two-thirds of Category A staff working in surveyed healthcare facilities. What is known about the topic? Non-immune healthcare staff are at risk of acquiring hepatitis B in the event of an occupational exposure to blood-borne pathogens. What does this paper add? An update about the proportion of staff employed in healthcare facilities with evidence of optimal long-term immunity to hepatitis B. What are the implications for practitioners? To mitigate risk, enhanced immunisation policies and programs are needed to actively support healthcare staff hepatitis B vaccination and serological testing; this includes documented follow up of those staff whose immune status is currently reported as unknown. [ABSTRACT FROM AUTHOR]

Objective: To retrospectively analyse the key factors associated with listing decisions by the Pharmaceutical Benefits Advisory Committee (PBAC) for medicines for diabetes and its complications on the Pharmaceutical Benefits Scheme. Methods: The clinical and economic evidence were retrieved from public summary documents (PSD) of all major submissions between July 2005 and March 2020. A multivariate binary logit regression analysis was conducted to assess the relationship between the categorical explanatory variables and PBAC recommendations. Results: We identified a total of 211 PSD of which 118 (56%) were recommended for listing. Clinical and economic uncertainty were significantly and inversely associated with the PBAC recommendation. Submissions with high clinical and economic uncertainty were less likely to be recommended. Conclusion: Our findings will enhance the understanding of medical professionals, pharmaceutical companies, and other stakeholders about the rationale of PBAC reimbursement decisions for these medicines and assist prospective applicant sponsor companies in preparing their submissions. What is known about the topic? Most studies on Pharmaceutical Benefits Advisory Committee (PBAC) decisions focused mainly on the cost-effectiveness, while some assessed only the financial impact of medicines. A few PBAC studies analysed the reimbursement decisions for medicines targeting specific disease groups, e.g. oncology, orphan disease, and multiple sclerosis. What does this paper add? This study presents an in-depth retrospective analysis of the PBAC decisions for listing medicines related to diabetes and its complications on the Pharmaceutical Benefits Scheme and contributes to the existing evidence-based knowledge of health technology assessment. What are the implications for practitioners? Our findings will enhance the understanding of medical professionals, pharmaceutical companies, and other stakeholders about the rationale of PBAC reimbursement decisions for these medicines and assist prospective applicant sponsor companies in preparing their submissions. [ABSTRACT FROM AUTHOR]

Objective: Little is known about the epidemiology of medical emergencies occurring in the intensive care unit (ICU). The aim of this study is to draw attention to the importance of auditing emergency events in the ICU. We hypothesised that emergency events occurring in the ICU would be clustered during periods of decreased medical and nursing attention and would occur in patients who had a higher illness severity and a greater risk of death. Methods: A retrospective observational cohort study was carried out in a 36-bed tertiary intensive care unit. The data capture all intensive care patients admitted to the ICU from 1 January to 1 December 2020. The number of emergency events occurring during each clock hour was correlated with ICU shift staffing patterns. In-hospital mortality and illness severity scores for patients experiencing emergency events were compared with those for all other ICU patients. Results: Serious medical emergencies were most frequent during the day, specifically during the morning ICU round (30% of all such events occurred between 08:00 and 12:00 hours), and there were peaks of incidence in the hour following each nursing and medical shift handover (following shift change times at 08:00, 15:00 and 21:00 hours). Agitation-related emergency events were least frequent during the periods of nursing day shift and afternoon shift overlap (07:00–08:00 hours and 13:00–15:00 hours). Patients who experienced serious medical emergency events in the ICU had a higher in-hospital mortality rate (28.3%) compared with the overall ICU mortality of 10.5% (OR = 4.89, 95% CI: 3.04–7.86). Conclusions: Patients who deteriorate suddenly in the ICU have greater illness severity and a significantly increased risk of death. The incidence of serious emergency events correlates with patterns of ICU staffing and work routines. This has implications for rostering, clinical workflow and education program design. What is known about the topic? Some common quality assurance indicators may underrepresent the true incidence of critical events or their impact on ICU team workload, given that often only adverse outcomes are captured Our study is significant because it captures all such workload. What does this paper add? By identifying periods of peak internal emergency activity, our study demonstrates the utility of collecting internal ICU emergency data for purposes of roster coordination. What are the implications for practitioners? We propose consistent senior medical presence and minimised non-essential interruptions during the hours of peak activity. Our method is easily reproducible and our findings, although from a single centre, are broadly generalisable, given that we discuss their similarity with other published works. [ABSTRACT FROM AUTHOR]

Objective: To describe self-reported general and psychological health for allied health practitioners at an Australian acute public health service over three time points within the coronavirus disease 2019 (COVID-19) pandemic. Methods: This study collected data from cross-sectional online surveys at three time points: May–June 2020 (T 1), October–November 2020 (T 2) and November–December 2021 (T 3). The self-report questionnaire consisted of demographic questions, a general health question and the 21-item version of the Depression Anxiety Stress Scales (DASS-21). Results: A total of 308 responses were received (T 1 n = 135, T 2 n = 78, T 3 n = 95) from representatives of eight allied health professions. The proportion of allied health practitioners reporting poor general health significantly increased over time, as did mean scores on all DASS-21 sub-scales. General health status was also significantly associated with DASS-21 subscale scores. Anxiety scores increased significantly between T 1 and T 2, while depression scores increased significantly between T 2 and T 3. Significant increases in stress scores were recorded across all time intervals. Between T 1 and T 3, the proportion of allied health practitioners reporting moderate, severe, or extremely severe symptoms increased for depression (10.3–30.9%), anxiety (5.2–18.2%) and stress (13.3–36.3%). Conclusion: The general and psychological health of allied health practitioners appears to be worsening as the COVID-19 pandemic continues. Organisational strategies to support the health of the allied health workforce in acute care settings must address the cumulative effects of prolonged pressure on their general and psychosocial health. Support strategies need to be responsive to changes in psychological wellbeing at different phases of the pandemic. What is known about the topic? Many cross-sectional studies report poor psychosocial wellbeing during the COVID-19 pandemic. What does this paper add? Here we provide evidence about the long-term and declining general and psychological health status of Australian allied health practitioners during the COVID-19 pandemic. What are the implications for practitioners? The psychological wellbeing of allied health practitioners has declined as the COVID-19 pandemic continues. There is an urgent need for initiatives targeting allied health practitioners that support their wellbeing and ongoing ability to provide high quality patient care. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to describe the patterns in emergency department (ED) presentations and hospital admissions in children with Ambulatory Care Sensitive Conditions (ACSCs) before and during the coronavirus disease 2019 (COVID-19) pandemic restrictions in Victoria, Australia, to assess if changes in out-of-hospital care resulted in an increase in delayed/severe presentations. Methods: This study involved secondary analysis of Victorian Emergency Minimum Dataset and Victorian Admitted Episode Dataset data. Patients (<18 years) attending EDs with a diagnosis of an ACSC were included. We compared the number and severity of ASCS presentations pre-COVID-19 (1January 2018–27 March 2020) and during COVID-19 (28 March–31 October 2020). A linear regression prediction model was built to compare the observed versus predicted presentation number in the 2020 period. Results: In total, there were 108 104 paediatric ACSC ED presentations in Victoria during the study period. Females accounted for 51 462/108 104 (47.6%) of all presentations, with a median age of 3 years. A significant decrease in ED presentations was seen in 2020 (41 319 in 2018; 44 978 in 2019; and 21 807 until October 2020), predominantly due to reductions in conditions that are typically mediated by viruses in childhood (i.e. asthma, convulsions/epilepsy and ear, nose and throat conditions). The proportion of high-urgency presentations and those requiring admission was stable in 2020. Conclusions: An overall reduction in the number of ED presentations and admissions with paediatric ACSCs was seen in Victoria in 2020, indicating that rates of delayed or more severe presentations did not occur as a result of changes in out-of-hospital care. What is known about the topic? Ambulatory Care Sensitive Conditions (ACSCs) relate to conditions or diagnoses that in the paediatric context are frequently mediated by common viral illness. What does this paper add? A reduction in the numbers of presentations and admissions with paediatric ACSCs was seen during the public health measures implemented to reduce the transmission of COVID-19 in Victoria, Australia. What are the implications for practitioners? These data can assist development of healthcare policy to allow healthcare resources to be prioritised for patients in whom viral transmission is not relevant. [ABSTRACT FROM AUTHOR]

Objectives: To compare outpatient attendance rates for Aboriginal and Torres Strait Islander ('Aboriginal') and non-Aboriginal patients at a large metropolitan health service in Melbourne, Australia, and to describe the barriers and enablers experienced by urban-dwelling Aboriginal patients in attending hospital outpatient appointments. Methods: This study used a mixed-method approach. Proportions of referred patients who booked and attended outpatient appointments were extracted from a health service database. Aboriginal versus non-Aboriginal cohorts were compared using chi-squared tests. Eleven patients, one parent of a patient and two community nurses were interviewed by telephone to investigate perceived barriers and enablers to attending outpatient appointments among Aboriginal patients. Results: Outpatient referrals were greater among Aboriginal than non-Aboriginal people; however, referrals were significantly less likely to result in an outpatient clinic booking and attendance for Aboriginal compared to non-Aboriginal people. Interview participants reported several barriers to attending appointments, related to logistical, quality of care and cultural factors. Suggested facilitators to make appointment attendance easier included: provision of transport support, improving clinic scheduling, utilising a variety of appointment reminder formats, providing food in waiting rooms, flexible appointment timing options, outreach services, access to Aboriginal support workers, improving communication and relationships with Aboriginal people, cultural awareness training for staff and the provision of culturally appropriate spaces. Conclusion: Some barriers faced by Aboriginal patients in attending hospital outpatient appointments in urban areas can be addressed through implementation of enablers suggested by participants. Data have informed the development of a tailored, inclusive, culturally and consumer-focused appropriate hospital outpatient service model of care. What is known about the topic? Health outcomes are poorer and burden of disease greater among Aboriginal and Torres Strait Islander people than non-Aboriginal and Torres Strait Islander people. What does this paper add? Compared to non-Aboriginal and Torres Strait Islander people, among Aboriginal and Torres Strait Islander people in urban settings, more outpatient referrals are made, but these referrals are significantly less likely to result in an outpatient clinic booking and attendance. Barriers and enablers to urban-dwelling Aboriginal and Torres Strait Islander people attending outpatient hospital appointments relate to logistical, quality of care and cultural factors. What are the implications for practitioners? Identifying and understanding the barriers and enablers to healthcare access for urban-dwelling Aboriginal and Torres Strait Islander people provides a foundation on which practitioners and organisations can facilitate urban hospital outpatient service development, with the aim to better support healthcare engagement and appointment attendance. [ABSTRACT FROM AUTHOR]

Objective: To identify baseline factors associated with outcomes from an inpatient multidisciplinary pain management program (PMP) located in a bicultural area of Aotearoa New Zealand. Methods: A prospective cohort study was undertaken involving 164 people with chronic pain who attended the PMP. Demographic, clinical, and psychosocial measures were obtained at baseline, whereas clinical and psychosocial outcome measures were also obtained at program discharge and 3-month follow up (N = 100). Multivariate analyses were used to determine baseline demographic variables that were associated with outcomes at discharge and follow up. Results: Being male and working full-time were associated with poorer outcomes in select measures at discharge. At the 3-month follow up, Māori ethnicity, working full-time, being retired or unemployed, or having chronic widespread pain were associated with poorer outcomes for some measures, whereas those with rheumatoid arthritis had greater self-efficacy. Conclusions: Sex, ethnicity, employment status, and patient condition impact clinical outcomes from the program and in the time from discharge to follow up. Program content and/or delivery should be altered to promote more equitable outcomes for all patients in the long term. What is known about the topic? Multidisciplinary pain management programs (PMPs) are the best treatment for chronic pain, but not everyone benefits from such programs to the same extent. What does this paper add? Ethnicity, employment status, and pain condition are associated with PMP outcomes, but mainly in the long term. What are the implications for practitioners? Program content, delivery, and follow up should be adapted to facilitate equity in long-term outcomes. [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: To explore out-of-pocket (OOP) costs within specialties and individual specialists, and use of Medicare Benefits Schedule (MBS) data for potential price transparency initiatives. Methods: We conducted a cross-sectional descriptive study of claims for a 10% random sample of Medicare enrolees for out-of-hospital MBS-billed subsequent and initial consultations between 1 January 2014 and 31 December 2014, specific to cardiologist, oncologist and ophthalmologists (with at least 10 patient visits in 2014). Our main outcomes were the number of locations per provider, number of unique OOP consultation costs per provider and provider-location, and the proportion of bulk-billed visits for these visits. Results: We studied 970 cardiologists, 913 ophthalmologists and 376 oncologists. At least 67% of specialists across each specialty had at least two practice locations: cardiologists had a median of three (interquartile range [IQR]: 2–4) and ophthalmologists and oncologists both had a median of two (IQR: 1–3). For subsequent consultations, cardiologists had a median of three unique costs per location (IQR: 2–3), whereas ophthalmologists had a median of four unique costs per location (IQR: 3–5). In contrast, oncologists had a median of one unique cost per location (IQR: 1–2) (57.6% of oncologists' provider-locations charged only the bulk-billing amount). Conclusions: Specialists have distinct fee lists that can vary based on location. Summary statistics on price transparency websites based on a single amount (like a median or mean OOP charge) might mask substantial variation in costs and lead to bill shock for individual patients. What is known about the topic? Australia has high out-of-pocket (OOP) medical costs. Statistics on price transparency websites could mask specialist variability. What does this paper add? Most specialists have a discrete tiered 'fee list' they charge, which can vary across locations. Specialists with high OOP costs may still bulk-bill many patients. What are the implications for practitioners? Publishing a specialist's fee list would be most transparent, allowing users to see a range of potential OOP costs. Additionally, individual specialists would avoid being labelled the highest charging provider, which might hide their lowest fees to prospective patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate demographics, clinical patterns and outcomes of rapid response reviews in hospital, reviewing indications for and outcomes of rapid response reviews initiated for clinical concern and to understand the role of clinical concern in identifying the deteriorating patient and at-risk patient populations. Method: This was a retrospective analysis of General Medical inpatients at Alfred Hospital from 1 January 2018 to 31 July 2020. Data extraction from electronic medical records identified patients who had a rapid response review during admission. Demographic and clinical data, investigations and clinical outcomes from rapid response reviews were investigated. Comparisons were performed using χ 2 or Fisher's exact test where appropriate. Odds ratios and 95% confidence intervals were calculated for factors associated with rapid response reviews for clinical concern and clinical outcomes. Results: There were 10 797 admissions of 7409 individual patients. There were 2359 rapid response reviews during the study period, occurring in 13% of admissions. Patients were majority female (50.4%), and the median age was 79 ± 17.6 years. Rapid response reviews were for cardiovascular (46.8%), respiratory (25.3%) and neurological (14.3%) indications. A total of 11% of rapid response reviews (n = 258) were for clinical concern. Inpatient falls accounted for a significant proportion of rapid response reviews for clinical concern. Reviews were more common in older patients, those admitted after-hours, and patients with disabilities. The latter group were more likely to have rapid response reviews for clinical concern. Rapid response reviews initiated for clinical concern were more likely than those initiated for standard criteria to change patients' clinical status, particularly the withdrawal of active management. Conclusions: Rapid response reviews for clinical concern are important triggers to identify clinical deterioration in vulnerable patients. Reviews were initiated for clinical concern were more likely than those initiated for standard criteria to result in a change in patients' resuscitation status and care trajectory. Clinician concern, even when prompting review for parameters outside of standard clinical review criteria, remains an important factor in recognising the deteriorating patient. What is known about the topic? Rapid response reviews, including those initiated for clinician gestalt for clinical concern, are important tools to identify deteriorating patients in the inpatient setting. What does this paper add? Rapid response reviews for clinical concern are of particular relevance in vulnerable populations and may be important in identifying deteriorating patients and reassessing care trajectory. What are the implications for practitioners? Clinical concern may be just as clinically relevant as rapid response reviews prompted by standard criteria, especially in vulnerable populations. This might prompt investigation of better identifiers and tools for escalation of concerns for vulnerable patients, which may improve outcomes in this patient group. [ABSTRACT FROM AUTHOR]

Objective: The aims of this study were to explore and compare the perceptions of research capacity and culture (RCC) in metropolitan and non-metropolitan New South Wales (NSW) Local Health Districts (LHDs). Methods: The Research Capacity and Culture Tool was delivered online to clinicians and health managers. A 10-point Likert scale of success or skill at organisational, team and individual level of research capacity was used. An independent t -test assessed differences in domain means between non-metropolitan and metropolitan LHDs. Results: A total of 1243 participants responded. Responses to the survey indicated the perception of individual's research skills were greater than the perception of RCC at both the team and organisational levels. Participants from metropolitan locations had significantly higher mean scores across all three domains compared with non-metropolitan locations (P < 0.001). Conclusion: Results indicated the perception of individual's research skills were greater than the team and organisational levels. Participants from metropolitan locations had significantly higher perceptions of RCC across all three domains compared with non-metropolitan locations. This was the largest study to date in Australia investigating RCC in NSW LHDs, and the first study to explore multiple professions across multiple organisations while comparing metropolitan and non-metropolitan settings. This research may inform targeted strategies for building research capacity in NSW LHDs. What is known about the topic? Challenges exist in the current healthcare system to provide the infrastructure and resources to build capacity and embed a culture of research. What does this paper add? This study was significant in its reach across NSW and its perspective of capturing multiple professions. What are the implications for practitioners? Factors found to be consistent across the state may be suggestive of prioritisation for further investigation and implementation at the state and/or national level. [ABSTRACT FROM AUTHOR]

Objective: This study assessed the impact of the COVID-19 pandemic on emergency departments (EDs) in South Australia, measured by changes in the number and casemix of patients in the system over time. Methods: Data from the South Australia Emergency Department Dashboard, updated every 30 min, were analysed for the period 4 October–21 December 2020. The Dashboard reports live counts of the number and type of patients in each of the six adult metropolitan public EDs in Adelaide, South Australia. Results: There was a significant difference in the mean daily average occupied ED capacity before and during two distinct increases in COVID-19 cases in South Australia. An increase in COVID-19 cases coincided with a decrease in patients in EDs (Pearson's r = –0.93 and –0.67; P < 0.001 for both). Presentations in Australasian Triage Scale (ATS) Categories 2–5 decreased during these periods, whereas ATS Category 1 stayed constant. Mental health patients continued to present to the ED, despite the overall drop in ED presentations. Conclusions: During the two periods of COVID-19 case growth in South Australia, there was a significant drop in the number of patients presenting to the major public EDs and a change in the casemix of patients over time. What is known about the topic?: EDs in Australia often operate at or over capacity, with frequent reports of ambulance ramping, access block and long waiting times. There have been reports internationally of significant declines in ED presentations throughout the COVID-19 pandemic. What does this paper add?: This paper uses a novel publicly available data source that is available in real time to contribute a new perspective from South Australia, which has experienced two distinct periods of strict restrictions and lockdown. The research showed that the number of mental health presentations remained consistently high, despite a significant overall decline in ED occupancy. What are the implications for practitioners?: This study demonstrates that South Australians are accessing emergency medical treatment differently in response to the COVID-19 pandemic. In the context of an overall decline in presentation numbers, the number of mental health-related presentations has not changed significantly, suggesting that this trend should be closely monitored. The findings corroborate the national concern that unwell people have avoided accessing emergency medical care during the pandemic, leading to worse outcomes and increased need for healthcare resources at a later date. It will be important to monitor and quickly detect further changes in ED usage using real-time data as the pandemic evolves, as well as in any future significant health crises. [ABSTRACT FROM AUTHOR]

Objective: Many cancer care services (CCS) provide pragmatic models of emergent care for their patients as part of 'business as usual' without understanding the scope of this work. We aimed to describe an Australian CCS-led model of emergent care and quantify and profile emergent care provided over a 6-month period to understand scope and demand. Methods: This prospective cohort study was performed at a large tertiary hospital on the eastern coast of Australia in 2016. The study explored emergent care provided during business hour and after-hours, including telephone advice, unplanned care and unplanned admissions. Data were collected via electronic hospital records and clinical nurses regarding who accessed care, why care was accessed, what care was provided and how the episode of care ended. Results: Between March and September 2016, 1412 episodes of unplanned care were provided in the CCS-led model of care, including 307 episodes of telephone advice (237 patients; min max 1–4 episodes per patient; 825 episodes of unplanned care (484 patients; min max 1–9 episodes per patient) and 280 unplanned admissions (233 patients; min max 1–6 episodes per patient). During the same time, an additional 459 unplanned admissions (361 patients) occurred via the emergency department (ED), of which 125 (27.2%) occurred during business hours which could have been managed by the CCS. Most people who received care experienced issues associated with disease or treatment and had received systemic anticancer therapy in the past 30 days. Conclusions: The data demonstrate that a significant volume of emergent care was provided within the CCS over the study period, in addition to planned cancer treatment. Due to the ever-increasing demands on EDs and the significant need for emergent care for people with cancer, there is need for CCS-led models of care to provide specialist emergent care specifically for people who are receiving systemic anticancer therapy. Such models must be adequately resourced to meet the needs of patients, carers and healthcare professionals. What is known about the topic?: There is increasing focus on innovative models of emergent care for people with cancer in the out-patient setting to relieve pressure on EDs and improve patient experiences. Limited literature has focused on such models in the Australian context. What does this paper add?: This paper describes, quantifies and profiles care provided in a pragmatic CCS-led model of emergent care in a large tertiary hospital in Australia over 6 months. The data demonstrate significant demand for emergent care within business hours, as well as out of hours, predominantly for people undergoing systemic anticancer therapy. What are the implications for practitioners?: The findings of this study highlight the need for CCS to develop pragmatic models of emergent care. Appropriate resources, infrastructure, policies and procedures are required to adequate meet the needs of patients and carers. [ABSTRACT FROM AUTHOR]

Objective: In Australian hospitals, a central distribution system is often utilised to supply medication to clinical areas. This study investigated the impact of automated dispensing cabinets (ADCs) and inventory robots in medication distribution within an Australian hospital. Methods: A prospective observational study of pharmacy technician medication supply to clinical areas was conducted over a 2-week period pre- and post-implementation of ADCs and inventory robots. Information was collected on the time taken to perform all tasks required to provide a weekly medication supply service for medication other than drugs of addiction. Results: There was no significant reduction of total duration for medication supply, pre-implementation mean 73.08 min versus post-implementation 68.59 min (P = 0.567). An instance of automation downtime occurred during the post-implementation period for which manual downtime procedures were implemented. Without downtime, a significant reduction in overall time taken was observed, 74.25 min versus 63.18 min (P = 0.019). Pre-restocking medication selection errors were reduced non-significantly after implementation of inventory robots, 11 (0.43%) versus 4 (0.21%) errors (P = 0.090). Conclusions: Implementation of ADCs and robots did not significantly reduce the total time to provide a weekly medication supply service when downtime occurred, although a significant reduction was observed when downtime did not occur. Pharmacy medication selection errors were non-significantly lower. What is known about the topic?: Australian hospitals are increasingly implementing automated technology such as ADCs and inventory robotics in an attempt to improve efficiency and accuracy of medication supply; however, limited literature is available in an Australian setting. What does this paper add?: This paper describes the impact of implementing ADCs in clinical areas (e.g. inpatient wards) and inventory robots in a main store pharmacy on the medication supply process. This paper highlights the benefit of improved efficiency and accuracy in selecting medication in pharmacy for distribution and identifies time to restock the ADCs is significantly increased. What are the implications for practitioners?: Implementing ADCs and inventory robotics in Australian hospitals can provide benefits in efficiency and accuracy; however, robust downtime procedures are essential. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to explore allied health professional (AHP) managers' implementation of the right to request part-time hours on return from maternity leave in Queensland Health (QH) hospitals. Methods: Qualitative data were collected via interviews with AHP managers from a cross-section of professions with variations in workforce size and gender composition. Interviews were audio recorded, transcribed and analysed thematically. Results: Twenty-one of a potential 40 AHP managers agreed to participate in the study (response rate 53%). The main finding was that the implementation of part-time work arrangements was being driven by regulation and work was being managed without complementary changes to established workplace practices or adequate organisational support. Conclusion: The use of regulatory instruments to implement part-time work in organisations without complementary work redesign, change management and organisational support suggests that there are significant barriers to this type of flexible working arrangement (FWA) becoming accepted workplace practice for AHPs in QH. A whole-of-organisation approach is needed to make FWA a reality. What is known about the topic?: Research has underlined the importance of implementation and management rather than simply the adoption of FWA policies. However, there have been few reports about AHP management of part-time hours on return from maternity leave. What does this paper add?: This paper provides information specifically about the management response to part-time work entitlements for AHP in QH. It indicates that managers are implementing part-time work because it is a regulatory requirement, but often without a substantive commitment to FWA complementary redesign of services or sufficient organisational support. What are the implications for practitioners?: Complementary work redesign measures and resources are needed to make workplaces genuinely flexible rather than just superficially consistent with regulatory requirements. [ABSTRACT FROM AUTHOR]

Objective: MindStep™ is an Australian low-intensity cognitive behaviour therapy (LICBT) program for individuals with mild-to-moderate symptoms of anxiety and depression. UK-produced LICBT guided self-help (GSH) materials were originally used in the MindStep™ program. In 2017, Australian LICBT GSH materials were developed to better suit Australian users. This study explored whether the Australian-produced materials continued to achieve the benchmark recovery rates established in the UK and maintained in recent Australian studies. Methods: Binomial logistic regression was conducted using retrospective client data, including the Patient Health Questionnaire-9 and the Generalised Anxiety Disorder 7-item scale, between 2016 and 2019. Results: During time periods in which the Australian-produced materials were used, equivalent rates of reliable recovery and improvement were achieved compared with time periods in which the UK-produced materials were used. Australian-trained LICBT coaches, using Australian-produced LICBT GSH materials, achieve client recovery rates of up to 60%, reliable improvement rates of 58% and reliable recovery rates of 46% (with the probability of recovery increasing with client age). Conclusions: These findings are particularly pertinent with COVID-19 changing the landscape of mental health service delivery, requiring greater flexibility in the use of teleservices to ensure access to effective mental health care for populations that may already experience problems with isolation, access and service engagement. What is known about the topic?: LICBT is an acceptable, feasible and effective treatment approach for people experiencing mild-to-moderate anxiety and depression in Australia. LICBT GSH materials used with clients in Australia originated from the UK. However, according to guidelines, LICBT GSH materials should be contextualised to suit the audience they are being used with. What does this paper add?: This paper demonstrates that LICBT GSH materials tailored to an Australian context can be used in place of UK-produced materials because they yield equivalent and consistent therapeutic outcomes. Although contextualising the LICBT GSH materials for health services users was important, it is likely that the evidence-based cognitive behaviour therapy techniques sitting 'under the hood' of these materials are most important to ensure successful therapeutic outcomes. What are the implications for practitioners?: As we face unprecedented challenges following 2020, the physical, social, psychological and economic impacts of life-changing events must not inhibit access to treatments for common mental health conditions. It is anticipated that more non-traditional, alternative providers of mental health services will be needed to scale-up and respond to increasing demand. This paper shows that the provision of telephone-based LICBT in Australia, by trained coaches using Australian-produced GSH materials, is an evidenced-based support pathway that can reduce the access gap to treatments. [ABSTRACT FROM AUTHOR]

Objective: In recent years, there have been considerable increases in both the utilisation and reported harms of prescription opioids in Australia. This report details the development of adaptable resources, implementation and the evaluation of pilot projects that optimise oxycodone prescribing and introduce concepts of opioid stewardship into hospital settings. Methods: An adaptable suite of resources, based on principles of implementation science, was developed and used to facilitate the projects. Local prescribing practice audits of oxycodone guided the development of context-sensitive educational strategies that were piloted and evaluated in a repeat audit. The primary outcome was the proportion of oxycodone prescriptions indicating tailored prescribing practices. In emergency departments (EDs), a prescription was considered tailored if it was for ≤10 tablets. In surgery, tailored prescriptions were those given to patients who had required opioids in the 24 h before discharge. Results: Cumulative results of the pilot projects in three EDs demonstrated improved rates of tailored oxycodone prescribing on discharge (62% vs 90%; P < 0.0001). In the surgical setting of one hospital, tailored prescribing increased significantly (from 76% to 91%; P = 0.013) and was accompanied by a halving of the proportion of patients receiving oxycodone prescriptions (36% vs 18%; P < 0.001). Conclusions: The implementation of facilitated, adaptable, prescriber-led quality improvement projects significantly improved tailored oxycodone prescribing practices and provides a platform to advance further opioid-related practice improvement in Australia. What is known about the topic?: The increasing trend in opioid prescribing, misuse, harm and death in Australia, and the potential for hospital prescribing to contribute to long-term opioid use, is well known. Recent changes to the Pharmaceutical Benefits Scheme are designed to help better identify patients who need oxycodone on discharge and the quantity to prescribe, rather than default prescribing. However, how to implement tailored prescribing has not been described in detail in the Australian literature. What does this paper add?: This paper adds to the mass of literature describing the 'problem' of opioid prescribing by providing a 'solution' in the form of evidence for the implementation of a facilitated and adaptable quality improvement strategy in emergency and surgical settings. The focus is not on a reduction of opioids, but rather on providing tailored pain management and opioid prescribing. What are the implications for practitioners?: This paper provides a practical, pragmatic and achievable starting point for other Australian practitioners to adapt the described processes and take the first steps towards opioid stewardship in their setting. [ABSTRACT FROM AUTHOR]

Objective: The study examined if, when and how select allied health professional standards currently articulate the Health LEADS Australia themes. Methods: Eighteen allied health professional standards were searched to locate references to leadership. Data were extracted and analysed inductively, deductively and thematically as a meta-synthesis. Frequencies were counted, with subanalysis by professional area, classification level, competency type and level of cognition. Results: There were 953 direct and indirect leadership statements. Only two leadership definitions were located, for pharmacists and dentists. The principal theme 'Leadership' only appeared in 18 (2%) statements from the total dataset that made direct references to leadership, which were mostly vague and unclear. The remaining indirect references to leadership are reported as four overarching themes: Self-leadership (n = 289 statements; 30%); Leadership With and of Others (n = 263; 28%); Improvement and Change Leadership (n = 223; 23%); and Health Reform Leadership (n = 139; 15%). Conclusion: Health leadership was not easily recognisable in the allied health practice standards examined. With some refinement and alignment with a contemporary leadership framework, professional standards could play a critical role in preparing allied health graduates to support the ongoing health system reform required to improve health and well-being outcomes in the future. What is known about the topic?: Leadership is essential at all health system levels, and leadership frameworks can usefully guide leadership development. However, little is known about allied health leadership compared with other clinical groups, and their contributions to directional changes in health system reform may be overlooked. What does this paper add?: This paper presents results of an analysis of where and how 18 allied health disciplines align with the Australian Health LEADS framework, and where greater clarity or alignment is needed. What are implications for practitioners?: Reinstatement of a national health leadership framework, such as the Australian Health LEADS framework, to articulate the need for and capabilities of leadership to enable innovation and support reform across all professional groups working in health care, including medical, nursing and allied health is required. A recognised national leadership framework could guide the revisions to allied health practice standards and coupled with a co-design process involving practitioners and professional associations, further development and incorporation of leadership competencies in a consistent manner would be enabled. Furthermore, alignment of allied health education and professional development with a national health leadership framework may strengthen allied health leadership graduate outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether adding clinical information and written discharge documentation variables improves prediction of paediatric 30-day same-hospital unplanned readmission compared with predictions based on administrative information alone. Methods: A retrospective matched case-control study audited the medical records of patients discharged from a tertiary paediatric hospital in Western Australia (WA) between January 2010 and December 2014. A random selection of 470 patients with unplanned readmissions (out of 3330) were matched to 470 patients without readmissions based on age, sex, and principal diagnosis at the index admission. Prediction utility of three groups of variables (administrative, administrative and clinical, and administrative, clinical and written discharge documentation) were assessed using standard logistic regression and machine learning. Results: Inclusion of written discharge documentation variables significantly improved prediction of readmission compared with models that used only administrative and/or clinical variables in standard logistic regression analysis (χ217 = 29.4, P = 0.03). Highest prediction accuracy was obtained using a gradient boosted tree model (C-statistic = 0.654), followed closely by random forest and elastic net modelling approaches. Variables highlighted as important for prediction included patients' social history (legal custody or patient was under the care of the Department for Child Protection), languages spoken other than English, completeness of nursing admission and discharge planning documentation, and timing of issuing discharge summary. Conclusions: The variables of significant social history, low English language proficiency, incomplete discharge documentation, and delay in issuing the discharge summary add value to prediction models. What is known about the topic?: Despite written discharge documentation playing a critical role in the continuity of care for paediatric patients, limited research has examined its association with, and ability to predict, unplanned hospital readmissions. Machine learning approaches have been applied to various health conditions and demonstrated improved predictive accuracy. However, few published studies have used machine learning to predict paediatric readmissions. What does this paper add?: This paper presents the findings of the first known study in Australia to assess and report that written discharge documentation and clinical information improves unplanned rehospitalisation prediction accuracy in a paediatric cohort compared with administrative data alone. It is also the first known published study to use machine learning for the prediction of paediatric same-hospital unplanned readmission in Australia. The results show improved predictive performance of the machine learning approach compared with standard logistic regression. What are the implications for practitioners?: The identified social and written discharge documentation predictors could be translated into clinical practice through improved discharge planning and processes, to prevent paediatric 30-day all-cause same-hospital unplanned readmission. The predictors identified in this study include significant social history, low English language proficiency, incomplete discharge documentation, and delay in issuing the discharge summary. [ABSTRACT FROM AUTHOR]

Objective: To describe the change in telemental health service volume that resulted from the introduction of the Medicare Benefits Schedule (MBS) item numbers in 2020 for services provided by psychologists and psychiatrists in Australia for a 3-year period, from January 2019 to December 2021. Methods: Quarterly MBS activity and cost data for mental health services provided by consultant psychiatrists, clinical psychologists, and psychologists between January 2019 and December 2021 were extracted from the MBS statistics website. Data were grouped by profession and delivery mode (in-person, telephone or videoconference) and reported using activity counts. Descriptive analysis and interrupted time-series regression analysis were conducted. Specific descriptive explorations were also conducted for psychiatrists, including: new client consultations, review or general consultations, and group consultations. Results: The delivery of mental health services by telehealth (telemental health) during the pandemic has increased (P < 0.0001). When the pandemic started in March 2020, telemental health services provided by psychiatrists and psychologists increased from a combined 1–2% per quarter to 29% videoconference and 20% telephone in quarter two 2020. After the onset of the pandemic, videoconference remained the primary form of telehealth for these professions. However, the telephone accounted for approximately a third of the telehealth activity after the new item numbers were introduced. Conclusion: Telemental health services are more likely to be conducted by videoconference than by telephone. The observed increase in telehealth service activity confirms how crucial appropriate funding models are to the sustainability of telehealth services in Australia. The growth in telehealth was used to support people with mental health conditions in Australia. What is known about the topic? Psychologists and psychiatrists were among the earliest adopters and were assigned some of the first telehealth item numbers on the Medicare Benefits Schedule. What does this paper add? The delivery of mental health services by telehealth during the pandemic has increased. Telemental health services are more likely to be done by videoconference in psychiatry and psychology than by other professions. What are the implications for practitioners? The observed increase in telehealth service activity confirms how crucial appropriate funding models are to the sustainability of telehealth services in Australia. [ABSTRACT FROM AUTHOR]

Objective: To examine the impact of telehealth policy changes on general practitioner (GP) consultation activity in Australia, during the coronavirus disease 2019 (COVID-19) pandemic, from January 2019 to December 2021. Methods: An interrupted time-series analysis was conducted to analyse the impact of two major policy changes, introduced through the Medicare Benefits Schedule (MBS), on GP consultation (in-person, videoconference, telephone) activity. The first policy change was the introduction of additional COVID-19 telehealth funding through the MBS on 30 March 2020. The second policy change was the limitation on telephone consultation length to under 20 min on 1 July 2021. The rate of GP telehealth provision and activity was compared between pre-and post-intervention periods, separated by these MBS policy changes. Results: After the first policy change, there was a significant increase in telehealth provision, with a simultaneous decrease in in-person consultations (P < 0.0001). However, telehealth provision decreased in the months following this first policy change (P < 0.0001), while in-person activity increased. After the second policy change, the initial videoconference provision increased (P < 0.0001). However, all telehealth activity decreased afterwards. In the months following the second policy change, the decrease in monthly activity for in-person (P = 0.700), telephone (0.199) and videoconference (P = 0.178) consultations was not significant. Conclusions: The introduction of additional telehealth funding and limitations on telephone consultation length encouraged the initial provision and growth of telehealth services. However, these policy changes did not sustain the long-term upward trajectory of telehealth activity. Telehealth policies should increase opportunities for appropriate and sustainable GP telehealth services. What is known about the topic? The COVID-19 pandemic was a catalyst for increased telehealth provision by general practitioners (GPs). Since COVID-19, the Australian Government have invested in telehealth by increasing reimbursement opportunities through the Medicare Benefits Schedule (MBS) and making multiple telehealth policy changes. What does this paper add? This study examined the impact of MBS telehealth policy changes on GP consultation activity in Australia over 3 years during COVID-19. What are the implications for practitioners? Telehealth funding is necessary for service viability. However, funding alone is unlikely to encourage increased videoconference use and is unlikely to promote long-term telehealth provision. Future telehealth policies should increase opportunities for appropriate and sustainable GP telehealth services. [ABSTRACT FROM AUTHOR]

Objective: To determine the association between coronavirus disease 2019 (COVID-19) restrictions and paediatric mental health emergency department presentations. Methods: Secondary analysis of Victorian Emergency Minimum Dataset data from 38 Victorian public hospital emergency departments. Paediatric patients (birth to <18 years) attending emergency departments with an International Classification of Disease-Australian Modification (ICD-10-AM) diagnosis of a mental health problem between 1 January 2018 and 31 October 2020 were included. We compared pre-COVID-19 (1 January 2018–27 March 2020) to the COVID-19 period (28 March–26 October 2020) to examine the number of mental health presentations by patient age, socioeconomic status, location, and emergency department triage category. A Poisson regression prediction model was built for each diagnosis group to predict the presentation number in the COVID-19 period, assuming the pandemic and associated restrictions had not happened. Results: There were 15 898 presentations (589 presentations/month on average) in the pre-COVID-19 period and 4747 presentations (678 presentations/month on average) in the COVID-19 period. Compared with predicted presentations, there was an increase in observed presentations for eating disorders throughout lockdown (on average, an increase of 36 presentations/month) and for anxiety (11/month) and self-harm (18/month). There were no meaningful changes for mood disorders or developmental and behavioural problems, and presentations for substance abuse mostly fell. Conclusions: Pandemic restrictions were associated with increased emergency department presentations for eating disorders and, to a lesser extent, anxiety and self-harm. Given the ongoing pandemic, clinicians and policy makers must work together to find timely, accessible solutions to better manage these conditions. What is known about the topic? The COVID-19 pandemic has increased the need for mental health services; however, associated restrictions have limited access to community-based care. What does this paper add? In a Poisson regression prediction model, we found an increase in observed versus predicted emergency department presentations for eating disorders throughout lockdown and for self-harm and anxiety towards the end of the lockdown period only. There were minimal or no differences in observed versus predicted presentations for other common paediatric mental health conditions. What are the implications for practitioners? COVID-19 pandemic restrictions have differentially affected mental health presentations to emergency departments. Practitioners caring for children with eating disorders need to provide greater community support to reduce emergency department presentations. [ABSTRACT FROM AUTHOR]