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Background: Haemodialysis units are now managing an increasing number of patients with varying needs and levels of acuity. To maintain safety, haemodialysis patients must be placed in the most appropriate dialysis unit that has the required human and physical resources to care for them. The first step towards achieving these goals is to develop a tool specific to haemodialysis units to effectively measure patient acuity. Objective: To develop a haemodialysis acuity tool, utilising a focus group approach, in assessing patient's suitability for a specific dialysis location thus ensuring patient safety. Design: This is a cross‐sectional qualitative study via a focus group approach. Participants: Participants were nurse unit managers and team leaders of a District Renal Service. Approach: Participants were interviewed to explore their views on the elements and measures identified in the research aims. Themes for interviews were informed by current literature on acuity tools for haemodialysis patients' admission to the dialysis units. Interviews were recorded and transcribed verbatim and progressively analysed using a thematic analysis approach. Results: Ten nurse unit managers/team leaders (100%) were interviewed and thematic analysis of the transcripts was conducted utilising the deductive approach. Five themes were identified which will form the main categories in the development of the tool, namely: Age/frailty; co‐morbidity; physical; dialysis; and psychosocial. Conclusion: This study is instrumental in the development of the haemodialysis acuity tool which can be used in allocating dialysis location specific to patient's needs and available resources. The tool can also be used in analysing patient care processes and resource requirements based on the patients' and unit's profile. [ABSTRACT FROM AUTHOR]

Background: Telemonitoring (TM) plays an important role in the self-management of chronic diseases. This study aimed to assess the feasibility of TM in early stages of chronic care for self-management and recognition of signs and symptoms of exacerbation, with a view to completing the TM program in an optimal timeframe to encourage independence and self-management. Methods: This study was conducted from 2019 to 2020. Included in the study were patients with chronic conditions at an early stage of their disease residing in the South Western Sydney region. Eligible patients were allocated a TM device for 6 months. Their routine tests data were sent in real time to health care professionals. Following assessment by a TM coordinator, suitable patients were off-boarded (deactivation of monitoring device) after 6 months. Data on hospitalisation/emergency department presentation and surveys were collected to assess the impact of TM on the level of the patient's understanding of their signs and symptoms of exacerbation, self-care, and quality of life. Results: Out of 44 patients approached, seven were off-boarded at the 6-month timeframe. The follow-up data on the hospitalisation/emergency department presentation during monitoring and 12 months post off-boarding showed a reduction in the frequency of hospitalisation/nil admissions. Patients reported an increased understanding of their health condition and confidence in managing their own health with the support of TM. Conclusion: The result demonstrates the feasibility of TM as a tool for health education and self-management in the coordination of care for chronic disease patients; however, the small sample size was a limitation. Self-management is an important aspect of the management of a range of long-term conditions. This study demonstrates the feasibility of telemonitoring as a tool for health education and self-management in patients with early stages of chronic diseases. Future research on a large cohort is required to optimise this model of care. [ABSTRACT FROM AUTHOR]

There are no clear guidelines or validated models for artificial intelligence (AI)-based approaches in the monitoring of coronavirus disease 2019 (COVID-19) patients who were isolated in the community, in order to identify early deterioration of their health symptoms. Developed in partnership with Curious Thing (CT), a Sydney-based AI conversational technology, a new care robot technology was introduced in South Western Sydney (SWS) in September 2021 to manage the large numbers of low-to-medium risk patients with a COVID-19 diagnosis and who were isolating at home. The CT interface made contact with patients via their mobile phone, following a locally produced script to obtain information recording physical condition, wellness and support. The care robot has engaged over 6323 patients between 2 September to 14 December 2021. The AI-assisted phone calls effectively identified the patients requiring further support, saved clinician time by monitoring less ailing patients remotely, and enabled them to spend more time on critically ill patients, thus ensuring that service and supply resources could be directed to those at greatest need. Engagement strategies had ensured stakeholders support of this technology to meet clinical and welfare needs of the identified patient group. Feedback from both the patients and healthcare staff was positive and had informed the ongoing formulation of a more patient-centred model of virtual care. Developed in partnership with a Sydney-based artificial intelligent (AI) conversational technology, a new care robot was successfully introduced to manage 6323 low-to-medium risk clients with a COVID-19 diagnosis and who were isolating at home. This initiative proved that application of AI was efficient and safe, and demonstrated benefits to support healthcare professionals and the community. [ABSTRACT FROM AUTHOR]

Palliative Extended and Care at Home (PEACH) is a rapid response nurse-led package of care mobilized for palliative care patients who have an expressed preference to die at home. This study aimed to identify the demographic and clinical predictors of home death for patients receiving the package. Deidentified data were used from administrative and clinical information systems. Univariate and multivariate analyses were conducted to assess association of sociodemographic factors with mode of separation. Furthermore, 1754 clients received the PEACH package during the study period. Mode of separation was home death (75.7%), hospital/palliative care unit admission (13.5%), and alive/discharged from the PEACH Program (10.8%). Of participants with clear preference to die at home, 79% met their wish. Multivariate analysis demonstrated cancer diagnosis, patients who wished to be admitted when death was imminent, and patients with undecided preference for location of death were associated with an increased likelihood of being admitted to the hospital. Compared with those with spousal caregivers, those cared for by their child/grandchild and other nonspouse caregivers were significantly associated with a decreased likelihood of being admitted to the hospital/palliative care unit. Our results show that opportunities to tailor home care based on referral characteristics to meet patient preference to die at home, at individual, system, and policy levels, exist. [ABSTRACT FROM AUTHOR]

Background: Although primary care is a well suited context for conducting advance care planning (ACP), there are many barriers to initiating discussions regarding future health preference and end-of-life conversations. Methods: This qualitative study conducted 30 detailed individual interviews with senior administrators, medical and nurse practitioners of a local health district, NSW Ambulance, e-Health NSW, general practitioners and practice nurses to find out about barriers to ACP in South Western Sydney. Results: Thematic analysis was conducted on the interviews. Six major themes were identified: Prevalence; Empowerment of roles and responsibilities; Lack of training/knowledge/confidence; Fragmentation of care; Patient/family readiness; and Prognostication. Half of the participants were willing to use a prognostic tool to identify when a patient was likely to be at the end of their life and provide a prompt to initiate ACP. Conclusion: In addition to addressing training and acknowledging resource constraints, these findings suggest that if a prognostic tool was validated and practical in a primary care setting, it may provide valuable assistance to encourage everyone in society to begin discussing this issue and completing ACP. Previous research indicates that ACP can facilitate care consistent with the patient's attitudes, beliefs and priorities, and reduce the chance of people receiving non-beneficial or inappropriate care at the end-of-life. This study conducted detailed individual interviews with senior administrators, medical and nurse practitioners of a local health district, and general practitioners and practice nurses to understand the barriers to conducting advance care planning in primary care. [ABSTRACT FROM AUTHOR]