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Value-based healthcare has been described as the sustainable, equitable and transparent use of healthcare resources to achieve improved experiences and outcomes for people and communities. It is supported by all levels of government in Australia, with recent initiatives championing a shift away from traditional, clinician-centric care delivery to a more contemporary, value-based approach. To date, however, efforts in Queensland have focused on smaller scale siloed models of care and have not extended to the transformational change required to create equitable and sustainable healthcare delivery. The Queensland Health Allied Health Framework for Value-Based Health Care (the Framework) builds on contemporary frameworks with reference to the local context in Queensland and provides a structure and starting point for clinicians and managers to work together with consumers to transform services to focus on preventative health and wellbeing, shifting the focus of care to the community and sustainably improving the quality of care delivered. The Framework outlines key considerations for the design and implementation of new services, including understanding the care pathway, supporting an outcome driven workplace culture, measuring what matters and designing for outcomes. Several key lessons were learnt during the development of the Framework, including the importance of early and sustained consumer partnerships, of establishing a shared definition of value-based healthcare that enables integration across the care pathway and the need for leadership at all levels to actively support the change management process. While developed for Queensland public allied health services, the Framework is intended to be a system-wide tool relevant to all health professionals and services. What is known about the topic? Value-based healthcare provides an approach to restructure healthcare systems to improve health outcomes and the holistic experience of care for people and communities. What does this paper add? This paper details the development of a framework to support health services to transition to a value-based approach. What are the implications for practitioners? By reflecting on the diversity of health practitioners, managers and consumer experiences and the unique opportunities and challenges of individual healthcare services, the framework provides a structure and starting point for services to transition to value-based healthcare. This article belongs to the Special Issue: Value-Based Healthcare. [ABSTRACT FROM AUTHOR]

Objectives: Cardiac rehabilitation (CR) provides evidence-based secondary prevention for people with heart disease (HD) (clients). Despite HD being the leading cause of mortality and morbidity, CR is under-utilised in Australia. This research investigated healthcare systems required to improve access to CR in rural and remote areas of North Queensland (NQ). Methods: A qualitatively dominant case study series to review management systems for CR in rural and remote areas of NQ was undertaken. Data collection was via semi-structured interviews in four tertiary hospitals and four rural or remote communities. An audit of discharge planning and CR referral, plus a review of community-based health services, was completed. An iterative and co-design process including consultation with healthcare staff and community members culminated in a systems-based model for improving access to CR in rural and remote areas. Results: Poorly organised CR systems, poor client/staff understanding of discharge planning and low referral rates for secondary prevention, resulted in the majority of clients not accessing secondary prevention, despite resources being available. Revised health systems and management processes were recommended for the proposed Heart: Road to health model, and given common chronic diseases risk factors it was recommended to be broadened into Chronic disease: Road to health. Conclusion: A Chronic disease: Road to health model could provide effective and efficient secondary prevention for people with chronic diseases in rural and remote areas. It is proposed that this approach could reduce gaps and duplication in current healthcare services and provide flexible, client-centred, holistic, culturally responsive services, and improve client outcomes. What is known about the topic? Cardiac rehabilitation is known to improve health outcomes and reduce hospitalisations, but referrals and attendance are low (30%). What does this paper add? A revised systems-based model for improved access to secondary prevention for people with heart and related chronic diseases in rural and remote areas of North Queensland is proposed: Chronic disease: Road to health. What are the implications for practitioners? A functional system from hospitalisation to local healthcare services has been designed to improve access to secondary prevention. Staff require support and education to improve skills, better manage care and improve job satisfaction. [ABSTRACT FROM AUTHOR]

The population is aging, with frailty emerging as a significant risk factor for poor outcomes for older people who become acutely ill. We describe the development and implementation of the Frail Older Persons' Collaborative Program, which aims to optimise the care of frail older adults across healthcare systems in Queensland. Priority areas were identified at a co-design workshop involving key stakeholders, including consumers, multidisciplinary clinicians, senior Queensland Health staff and representatives from community providers and residential aged care facilities. Locally developed, evidence-based interventions were selected by workshop participants for each priority area: a Residential Aged Care Facility acute care Support Service (RaSS); improved early identification and management of frail older persons presenting to hospital emergency departments (GEDI); optimisation of inpatient care (Eat Walk Engage); and enhancement of advance care planning. These interventions have been implemented across metropolitan and regional areas, and their impact is currently being evaluated through process measures and system-level outcomes. In this narrative paper, we conceptualise the healthcare organisation as a complex adaptive system to explain some of the difficulties in achieving change within a diverse and dynamic healthcare environment. The Frail Older Persons' Collaborative Program demonstrates that translating research into practice and effecting change can occur rapidly and at scale if clinician commitment, high-level leadership, and adequate resources are forthcoming. What is known about the topic? Providing frailty-focused care can improve outcomes, particularly by avoiding unnecessary admissions to hospital and reducing hospital-acquired complications, such as delirium and functional decline. Several evidence-based interventions exist that apply to specific points in the trajectory of older frail patients from hospital presentation to discharge and beyond, but these are not generally well integrated across the entire patient journey. What does this paper add? This paper describes a whole-of-healthcare system approach to improving care and outcomes for frail older people in Queensland. Rather than developing new care initiatives, the approach was taken to invest in pre-existing evidence-based interventions developed and validated in Queensland clinical settings and scale them across the state over 3 years. What are the implications for practitioners? This state-wide scale-up of evidence-based interventions has profiled how the healthcare system can be redesigned to implement models that better support vulnerable older people. [ABSTRACT FROM AUTHOR]

Digital transformation of Australian hospitals is occurring rapidly. Although the clinical community has had limited ability to influence high-level decision making and investments into digital health technologies, as these technologies increasingly transform the way patients are cared for, the clinical community must influence the digital health agenda and be an integral part of the decision-making process. This case study details the process and lessons learnt during the development of the state-wide consensus statement detailing the clinical requirements for digital health initiatives to form the Queensland Digital Health Clinical Charter. To the best of our knowledge, Queensland is the first Australian jurisdiction to create a Digital Clinical Charter to be specifically referenced in the investment in and governance of digital health in hospitals. By developing this clinical charter for digital health, and in articulating the needs of clinicians, a clinical framework will be added to both the decision-making process around the investments in digital health and the definition and realisation of the expected benefits from these sizable investments. What is known about the topic?: Digital transformation of healthcare is occurring rapidly. The clinical community has had limited ability to influence high-level decision making and investments into these digital health technologies. Tension currently exists between the clinical community who must use the new digital technologies and the technical groups that govern the introduction of the new technologies. This tension can be manifest as clinicians refusing to adopt new systems, safety concerns and an inability to reach consensus on direction. There are few peer reviewed publications addressing this tension between the clinical community and technical providers. What does this paper add?: This paper is the first attempt to create a list of clinical requirements for digital transformation that crosses professional streams and is endorsed by the state-wide executive leadership team to inform the acquisition and governance of digital health technologies. What are the implications for practitioners?: Clinicians can feel excluded and marginalised during the decision-making process for new digital technologies, despite the fact that they are often using these technologies to deliver hands-on care to patients. This charter clearly articulates the requirements of clinicians for digital transformation and has been endorsed by the executive leadership team of Queensland Health. The charter adds a clinical framework to be referenced during the decision-making process around the investments in digital health, and the definition and realisation of the expected benefits from these sizable investments. As the digital landscape in public hospitals evolves, clinicians are becoming increasingly reliant upon digital technologies. It is critical that clinicians have a strong effect on technology acquisition and governance to maximise the quality and efficiency of the care they provide. [ABSTRACT FROM AUTHOR]

Objective: Long specialist out-patient waitlists are common in public health facilities, but not all patients require consultation with a medical specialist. Studies of single allied health primary contact services have shown they provide timely, appropriate care and reduce demand on medical specialist out-patient waitlists. This study evaluated the collective benefits across multiple allied health primary contact services and models to determine their clinical effectiveness, safety, timeliness of care and impact on medical specialist out-patient waitlists. Method: Using a prospective observational study design, data were collected and analysed for patients attending 47 allied health primary contact services in Queensland public hospitals over a 2-year period. Outcomes reported are global status, adverse events, wait times and impact on medical specialist out-patient waitlists. Results: In all, 10 634 patients were managed in and discharged from the allied health services. Most adult patients (80%) who attended at least two consultations reported an improvement in health status. No adverse events were attributed to the model of care. Approximately 68%, 44% and 90% of urgent, semi-urgent and non-urgent out-patients respectively were seen within clinically recommended time frames. Between 35% and 89% of patients were removed from out-patient waitlists without medical specialist consultation across the service models. Conclusions: Allied health primary contact services provide safe, effective and timely care. The impact on medical specialist out-patient waitlists varied depending on service model and pathway characteristics. What is known about this topic?: Most studies of allied health primary contact services have focused on the management of patients on orthopaedic specialist out-patient waitlists by a physiotherapist. These studies of either individual services or groups of services with the same model cite benefits, including reduced waiting times, high levels of patient and referrer satisfaction, improved conversion to surgery, cost-effectiveness and more effective utilisation of medical specialists. What does this paper add?: This paper highlights that, collectively, allied health primary contact services are safe, effective and provide timely care. The proportion of patients independently managed and removed from various medical specialist out-patient waitlists and the services involved are reported, demonstrating the variety of service models. This study reports outcomes for primary contact services for which there is a dearth of published literature, including dietician services for patients on gastroenterology waitlists, speech pathology and audiology services for patients on ear, nose and throat waitlists, occupational therapy hand services for patients on orthopaedic waitlists and physiotherapy led pelvic-health services for patients on gynaecology waitlists. Possibilities for efficiency gains are identified and discussed. What are the implications for practitioners?: Health service managers should consider allied health primary contact services as a viable option to increase specialist out-patient capacity. Service model characteristics that maximise impact on medical specialist out-patient waitlist management are highlighted to inform resource allocation. [ABSTRACT FROM AUTHOR]

Objective: This study sought to compare costs for women giving birth in different public hospital services across Queensland and their babies. Methods: A whole-of-population linked administrative dataset was used containing all health service use in a public hospital in Queensland for women who gave birth between 1 July 2012 and 30 June 2015 and their babies. Generalised linear models were used to compare costs over the first 1000 days between hospital and health services. Results: The mean unadjusted cost for each woman and her baby (n = 134 910) was A$17406 in the first 1000 days. After adjusting for clinical and demographic factors and birth type, women and their babies who birthed in the Cairns Hospital and Health Service (HHS) had costs 19% lower than those who birthed in Gold Coast HHS (95% confidence interval (CI) –32%, –4%); women and their babies who birthed at the Mater public hospitals had costs 28% higher than those who birthed at Gold Coast HHS (95% CI 8, 51). Conclusions: There was considerable variation in costs between hospital and health services in Queensland for the costs of delivering maternity care. Cost needs to be considered as an important additional element of monitoring programs. What is known about the topic?: The Australian maternal care system delivers high-quality, safe care to Australian mothers. However, this comes at a considerable financial cost to the Australian public health system. It is known that there are variations in the cost of care depending upon the model of care a woman receives, and the type of delivery she has, with higher-cost treatment not necessarily being safer or producing better outcomes. What does this paper add?: This paper compares the cost of delivering a full cycle of maternity care to a woman at different HHSs across Queensland. It demonstrates that there is considerable variation in cost across HHSs, even after adjusting for clinical and demographic factors. What are the implications for practitioners?: Reporting of cost should be an ongoing part of performance monitoring in public hospital maternity care alongside clinical outcomes to ensure the sustainability of the high-quality maternal health care Australian public hospitals deliver. [ABSTRACT FROM AUTHOR]

Objective: The delivery of public out-patient services is an essential part of complex healthcare systems, but the contribution of public out-patient services is often ill defined and poorly evaluated. The aim of this study was to identify and better understand those factors that may affect the performance of out-patient services to provide health service managers, clinicians and executives with a conceptual framework for future decision-making processes. Methods: The present qualitative research involved five exploratory case studies. These case studies were conducted across two specialties at hospitals in the Metro North Hospital and Health Service in Queensland. Data were obtained from 38 interviews and 15 focus groups, and were analysed to identify common themes. Further analysis helped identify the most significant factors and build a conceptual framework for understanding the relationships between those factors and their effect on performance. Results: Across both specialties there were 10 factors (scheduling, performance, service framework, categorisation or prioritisation of patients, internal and external stakeholders, resources, service demand, culture, system challenges and medical stakeholders) identified that may affect the performance of out-patient services. These factors were condensed into five core domains: culture, stakeholders, resources, demand and system reform. Conclusion: Strategies to address the five core domains identified may provide a framework for sustainable improvement in the delivery of out-patient services. What is known about the topic?: The provision of specialist out-patient services is an essential element of health service delivery. Access to specialist services in the public sector is challenging because of the escalating demand associated with an increasing and aging demographic. The factors that may affect the delivery of out-patient services need to be addressed for long-term sustainable improvement. What does this paper add?: This paper provides a conceptual framework grounded in rigorous qualitative data analysis for understanding the internal and external factors that affect waiting times for specialist out-patient services. The results of this qualitative research indicate that there are five core domains that may influence waiting times in the public out-patient setting. When these domains are addressed at the strategic, tactical and operational levels, they have the potential to provide significant improvement in the delivery of out-patient services. What are the implications for practitioners?: This paper guides the attention of relevant stakeholders towards the five core domains identified (culture, stakeholders, resources, demand and system reform) that influence the performance of waiting times at the operational, tactical and strategic levels within the public hospital setting. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to determine the clinical activity profile of preregistration physiotherapy students during clinical placements and their clinical activity contribution to health service delivery. Methods: Clinical activity data for 2014 were obtained from five Queensland public sector hospitals providing preregistration physiotherapy students clinical education in three key clinical areas (cardiorespiratory, musculoskeletal and neurological) over four 5-week placement blocks. Data regarding the number of student occasions of service (OOS) and the length of the OOS (LOOS) were collected to determine the average OOS and LOOS per student in each clinical area. Results: Twenty weeks of student data were collected from each hospital in each clinical area, representing 29.1% of cardiorespiratory, musculoskeletal and neurorehabilitation student placements. Students completed 19 051 OOS. The average OOS per student per block for cardiorespiratory, musculoskeletal and neurorehabilitation placements was 98.3, 74.0 and 72.4 respectively. Two-way ANOVA revealed a main effect of weeks (F = 402.1, P < 0.001) and clinical area (F =1331.5, P < 0.001) for LOOS.In addition, an interaction was found between clinical placement week and clinical area for LOOS (F = 8.4, P < 0.001). Conclusions: Student clinical activity data are useful for understanding the student contribution to health services. Student contribution appears to increase throughout the clinical placement and consideration should be given to the clinical educator : student ratio to enhance overall student contribution. What is known about the topic?: Quantitative data describing physiotherapy student clinical care activity during placements are limited. What does this paper add?: This paper profiles physiotherapy student clinical care activity and the changes occurring over 5-week placements. What are the implications for practitioners?: Physiotherapy students provide clinical activity for health services that changes over their 5-week placement. Student clinical activity should be considered when responding to placement demand and planning service delivery. [ABSTRACT FROM AUTHOR]

Student-led interprofessional health clinics offer valuable opportunities for student learning and meeting the health care needs of the community. This case study describes the operation of a new interprofessional student-led community health service over its initial 13-month period of operation. This case study also presents an overview of the service provision, student placement opportunities and focuses on the challenges associated with the service and the impact on future planning. What is known about the topic?: Interprofessional student-led clinics offer an opportunity to meet clinical placement demands and interprofessional training needs while also providing a community service. What does this paper add?: This case study adds to the limited literature around knowledge of service delivery and challenges in the operation of community-based student-led interprofessional health services; future planning to streamline processes is also addressed. What are the implications?: There may be relevance to other university–industry partnerships that intend to explore student-led interprofessional service operations designed to address placement shortages, student training and community needs. [ABSTRACT FROM AUTHOR]

Objective: The acuity and number of presentations being made to emergency departments (EDs) is increasing. In an effort to safely and efficiently manage this increase and optimise patient outcomes, innovative models of care (MOC) have been implemented. What is not clear is how these MOC reflect the needs of patients or relate to each other or to ED performance. The aim of this study was to describe ED MOC in Queensland, Australia. Methods: Situated within a larger mixed-methods study, the present study was a cross-sectional study. In early 2015, leaders (medical directors and nurse managers) from public hospital EDs in Queensland were invited to complete a survey detailing ED activity, staffing profiles, treatment space, MOC and National Emergency Access Target (NEAT) performance. Routinely collected ED information system data was also used. Results: Twenty of the 27 EDs invited participated in the study (response rate 74%). An extensive array of MOC were identified that were categorised into those that facilitate input, throughput and output from the ED. There was no consistent evidence as to the relative effectiveness of these MOC in achieving ED performance benchmarks, such as NEAT performance. Conclusion: There is considerable variability in the MOC used throughout EDs in Queensland. A more complete analysis of the relative effectiveness of different MOC either in isolation or as part of a comprehensive approach would help inform more consistent MOC in Queensland EDs. What is known about the topic?: MOC in any given ED are implemented in response to factors such as the geographical location of the hospital, hospital-specific characteristics and service profile, staffing profile and patient demographic profile. In the era of time-based targets, they may also serve to address a particular aspect of flow in the face of rising ED demand. Although many of the MOC attempt to deal with flow in a linear fashion, target specific phases of the ED journey or address particular patient cohorts, what is clear is that not all EDs are shaped and formed the same. What does this paper add?: The study provides a comprehensive description of the varied models of care operating within Queensland public hospital EDs and how they relate to ED performance. A basic taxonomy of contemporary ED MOC is necessary to allow comparison between departments and inform decisions regarding safety, efficiency and cost-effectiveness. What are the implications to practitioners?: A contemporary understanding of the presence and profile of ED MOC that currently exist within a network of hospitals and health services is important for managers, clinicians and patients to inform decision-making regarding the safety, clinical effectiveness and cost-effectiveness of these models. This understanding can also inform where and how further improvements in care delivery can progress. [ABSTRACT FROM AUTHOR]

The aim of the present case study is to illustrate the outcomes of a dedicated allied health (AH) research position within a large Queensland regional and rural health service. The secondary aim of the case study is to describe the enabling and hindering mechanisms to the success of the role. Semistructured interviews were conducted with the Executive Director of Allied Health and the current AH research fellow incumbent within the health service. A focus group was also undertaken with six stakeholders (e.g. clinicians, team leaders) who had engaged with the research position. Outcomes of the AH research fellow included clinical and service improvements, enhanced research culture and staff up-skilling, development of research infrastructure and the formation of strategic research collaborations. Despite being a sole position in a geographically expansive health service with constrained resources, key enabling mechanisms to the success of the role were identified, including strong advocacy and regular communication with the Executive. In conclusion, the case study highlights the potential value of an AH research position in building research capacity within a large non-metropolitan health service. Factors to facilitate ongoing success could include additional research and administrative funding, as well as increased use of technology and team-based research. What is known about the topic?: Dedicated research positions embedded within health care settings are a well cited strategy to increase research capacity building of allied health professionals (AHPs). However the majority of these positions are within metropolitan health settings and unique challenges exist for these roles in regional and rural areas. Few studies have described the impact of dedicated AH research positions within regional health centres or the factors which facilitate or hinder their role. What does this paper add?: Dedicated research positions within a non-metropolitan Australian health service may have a positive impact on AH clinical services, research culture, staff upskilling, research infrastructure and research collaborations. Key enabling mechanisms to support the role may include advocacy from higher level management, strong networks and communication channels. Additional research and administrative funding, the use of technology and team based research may enhance sustainability of such roles. What are the implications for practitioners?: AH research positions have potential value in building research capacity within a large non-metropolitan health service. Health managers and researchers should be aware of the unique challenges to these roles and consider mechanisms that may best enhance and sustain outcomes of the positions including: the development of infrastructure (i.e. technology, website of resources), networks, and communication strategies (i.e. regular meetings with leadership and promotion internally). [ABSTRACT FROM AUTHOR]

This brief paper describes a recent exercise undertaken within a hospital and health service in south-east Queensland to attempt to link patient records between general practice and hospital services. It describes the technical and governance processes undertaken to achieve this link and the challenges experienced to date in linking the two data sources. [ABSTRACT FROM AUTHOR]

The utilisation of telehealth among culturally and linguistically diverse communities in Australia remains unexplored. We aimed to describe telehealth (telephone and videoconference) utilisation within a major health service and identify sociodemographic factors that may contribute to limited telehealth access. Methods. A cross-sectional study was performed using service activity data from four metropolitan hospitals in Queensland, Australia. Outpatient department data (January to December 2021) were examined. These data included patients (N = 153 427) of all ages who had an outpatient appointment within 10 speciality services (i.e. Hepatology, Gastroenterology, Immunology and Psychology) that were the most frequent videoconference users. This study measured telehealth utilisation across the four tertiary hospitals and its association with sociodemographic factors. Descriptive statistics and regression analysis were used. Multivariate regression models were adjusted by sex, socioeconomic level and language use. Results. Overall, 39% of appointments were delivered through telehealth, with 65% of all reported telehealth services involving a telephone consultation. People who required interpreter services were 66% less likely to use telehealth services (OR adjusted 0.33, 95% CI 0.31–0.36, P < 0.05) than English-speaking people. Among those using telehealth, people requiring interpreter services were 13% less likely to use videoconference than phone (OR adjusted 0.87, 95% CI 0.77–0.98, P < 0.005). Conclusion. There is a gap in Australian telehealth service use for people with culturally diverse backgrounds and limited English proficiency. This study highlights a critical need to determine how people from culturally diverse backgrounds would like to engage with digital care options such as telehealth and the necessary support to enable this. [ABSTRACT FROM AUTHOR]

Objective. Telehealth has for many years been identified as a potential contributor to reducing healthcare access inequality. For these benefits to be realised, patients must be accepting and satisfied with the delivery of healthcare in this manner. Measuring patient satisfaction across a large geographical area is important to ensure that investments in telehealth are delivering the benefits that are intended. Methods. A brief survey was automatically issued on completion of a patient's telehealth appointment, requesting patient feedback on their experience and information on the location of where they participated in the appointment. These results were compared to an article review which sought examples of other patient satisfaction measures that compared rural and urban populations. Results. No significant correlations between survey responses and established demographic indices were found. When stratified by the Modified Monash Model band from which the patient participated in their telehealth appointment from, an ANOVA test determined that rurality was not a predictor of survey response. A review of articles found four articles that compared rural and urban satisfaction responses. Conclusion. No evidence of a patient's location influencing their satisfaction with telehealth was observed. This may be attributed to a variety of technical improvements introduced over the past 5-10 years that have made participating in telehealth appointments less technically demanding and more accessible. Telehealth is likely to be contributing to a reduction in healthcare access inequality in Queensland. [ABSTRACT FROM AUTHOR]

Objective. Non-government organisations make a substantial contribution to the provision of mental health services; despite this, there has been little research and evaluation targeted at understanding the role played by these services within the community mental health sector. The aim of the present study was to examine the depth and breadth of services offered by these organisations in south-east Queensland, Australia, across five key aspects of reach and delivery. Methods. Representatives from 52 purposively targeted non-government organisations providing mental health services to individuals with significant mental health challenges were interviewed regarding their approach to mental health service provision. Results. The findings indicated a diverse pattern of service frameworks across the sector. The results also suggested a positive approach to the inclusion of consumer participation within the organisations, with most services reporting, at the very least, some form of consumer advocacy within their processes and as part of their services. Conclusions. This paper offers an important first look at the nature of non-government service provision within the mental health sector and highlights the importance of these organisations within the community sector. [ABSTRACT FROM AUTHOR]

The aim of this case study was to share lessons learned regarding strategies likely to increase healthcare service efficiency. Following quality assurance review of statewide Hospital in the Home (HITH) average length of stay (ALOS) and readmission data, Queensland's Department of Health observed that for some of the highest volume diagnoses seen in Queensland's HITH services in 2017, services that used a public-private partnership (PPP) model of care achieved a shorter ALOS than services using a traditional public model of care without demonstrably poorer patient outcomes. To understand the reasons for the differences in ALOS, ALOS and readmission data from 2017 for 10 highvolume diagnoses were retrospectively compared for five HITH services. Two of the services used a PPP and three used a public HITH model of care. Additional data were collected to determine similarities and points of difference regarding how the services operated in 2017. Hospitals that used a PPP HITH model of care achieved shorter ALOS for eight of the 10 diagnoses, with the difference ranging from 0.94 to 5.98 days. Differences between how the PPP and public HITH services operated in 2017 were identified. The findings suggest that the use of governance strategies, criteria-led discharge and financial incentives is likely to support safe shorter lengths of stay. [ABSTRACT FROM AUTHOR]

Objective. People detained in police custody are a vulnerable population with complex health needs, sometimes requiring emergency care. This study evaluated the effect of a 24/7 nursing presence in a police watch house on police presentations to the emergency department (ED). Methods. This was a retrospective observational study conducted in a regionalEDin Queensland. Equal time periods of 66 days before (T1), during (T2) and after (T3) the pilot service was trialled in 2013 were compared to determine changes in patient and service delivery outcomes. The time to see a doctor in the ED, ED length of stay, hospital admission rate, number of transfers from the watch house to the ED and associated costs were measured. The nature of health care delivered by nurses to detainees in the watch house during the pilot was also examined. Results. Fewer detainees were transferred from the police watch house to the ED during the pilot period (T1, n =40; T2, n = 29; T3, n = 34). Cost reductions associated with reduced police and ambulance attendance, as well as hospitalisations, outweighed the watch house nursing costs, with cost savings estimated at AUD7800 per week (60% benefiting police; 40% benefiting the health service). The most common health problems addressed during the 1313 healthcare delivery episodes provided to 351 detainees in the watch house during the pilot related to substance misuse, chronic disease and mental health problems. Conclusion. Fewer transfers from the police watch house to the ED were noted when there was a 24/7 nursing presence in the watch house. This model appears to be economically efficient, but further research is required. [ABSTRACT FROM AUTHOR]

Objective. Respiratory diseases are a leading cause of morbidity and mortality in Indigenous Australians. However, there are limited approaches to specialist respiratory care in rural and remote communities that are culturally appropriate. A specialist Indigenous Respiratory Outreach Care (IROC) program, developed to address this gap, is described. Methods. The aim of the present study was to implement, pilot and evaluate multidisciplinary specialist respiratory outreach medical teams in rural and remote Indigenous communities in Queensland, Australia. Sites were identified based on a perception of unmet need, burden of respiratory disease and/or capacity to use the clinical service and capacity building for support offered. Results. IROC commenced in March 2011 and, to date, has been implemented in 13 communities servicing a population of approximately 43 000 Indigenous people. Clinical service delivery has been possible through community engagement and capacity building initiatives directed by community protocols. Conclusion. IROC is a culturally sensitive and sustainable model for adult and paediatric specialist outreach respiratory services that may be transferrable to Indigenous communities across Queensland and Australia. [ABSTRACT FROM AUTHOR]

Objective. Allied health professionals (AHPs) in maternity and neonatology services are essential for quality care and outcomes, reflected in the minimum service delivery requirements in the Queensland Health clinical services capability framework (CSCF). However, allied health (AH) capacity across the Southern Queensland Health Service Districts (SQHSD) is not known. The aim of this project was to redress this knowledge gap to inform ongoing service planning and delivery. Methods. Maternity and neonatal AH clinicians in all birthing facilities in SQHSD were surveyed between October and December 2011 to investigate AHP staffing, practices and models of care. The professions surveyed included dietitians, occupational therapists, physiotherapists, psychologists, social workers and speech pathologists. Results were grouped per question, with stratification by CSCF and/or profession. Results. Fifty-five valid surveys from the 16 facilities were received. All professions were represented. Gaps in maternity AH services were identified. Awareness and use of evidence-based practices were more likely to be reported where higher full-time equivalents (FTE) were allocated. Conclusion. Very low staffing levels have been recorded in all Maternity and Neonatology Services AHPs in the SQHSD. Gaps exist between actual and recommended CSCF staffing standards across all levels and professions. The results indicate that profession-specific support networks for AHPs have positive effects in the spreading of information, and continued promotion, support and involvement in these profession-specific networks is suggested for all facilities. [ABSTRACT FROM AUTHOR]

Background. Appropriate and uniform prioritisation ('triaging') of outpatient referrals is critical to good patient outcomes, equity of access to services and efficient use of resources. Objective. To determine whether there is uniformity in the allocation of triage categories for hepatology outpatient referrals at public hospitals in Queensland. Methods. A series of 10 recent hepatology referrals were de-identified for both patient and referring clinician details and sent to nine gastroenterology or hepatology centres throughout Queensland. Consultant gastroenterologists and hepatologists (n = 25) were asked to triage the referrals using the process in place in their centre. Responses were de-identified and analysed. Each case was reviewed and allocated an 'agreed triage category' based upon the majority view of respondents. Results. Nineteen responses were received. There was substantial variation amongst consultants in the allocation of triage categories. Although almost two-thirds of respondents agreed with the majority view in 60--80% of cases, none agreed with the majority for every case and some agreed in as few as 50% cases. Disagreement with the majority view of an appropriate triage category was not associated with geography or specialist experience. Conclusions. Variability in triage categorisation suggests that similar cases may be allocated different priorities by those responsible for determining the urgency of outpatient review. This has implications for equity of access to treatment. The development of triage guidelines and formal training in their implementation, along with periodic audits of triage practices in different centres, may reduce variability. [ABSTRACT FROM AUTHOR]