Australian health review : a publication of the Australian Hospital Association最新文献

Objective: The aim of this study was to estimate avoidance of hospital bed-days and the resulting cost savings from a wholistic quality improvement program that was implemented to systematically reduce hospital-acquired complications (HACs) in an Australian local health service between 2018 and 2023.

Methods: This was an uncontrolled retrospective observational analysis of prospectively collected data. An association between HAC and length of stay (LOS) was explored through a zero truncated negative binomial regression model for two LOS cohorts, using 21 days as the threshold for long-stay share of bed-days. Bed-day cost avoidance was estimated by applying the adjusted marginal effect of HAC on LOS, multiplied by the estimated number of HAC episodes averted, average weighted average units per bed-day, and the national efficiency price in respective years.

Results: HACs were found to increase hospital bed-days by an average of 5.5 days (95% CI: 5.19-5.86) for episodes with LOS of 1-21 days, and by 7.1 days (95% CI: 6.78-7.48) for episodes with LOS exceeding 21 days. The program resulted in an estimated avoidance of HACs in 2991 episodes of care over a 5-year period, averaging 598 episodes per year. This equated to avoidance of a total of 16,751 hospital bed-days, or 3350 annually. Annual cost voidance from bed-days ranged from A$6.4 to A$11.5 million between 2019 and 2023. The budget for program management was A$514,500 per year, resulting in average net benefits of A$7.1 to A$8.2 million, a 14-16-fold return on investment for the health service.

Conclusion: Findings suggest that financially viable opportunities are available for hospitals to achieve sustained reduction in HACs, which have the potential for wider adoption to tackle the challenges associated with adverse events in hospitals.

The Royal Commission into Aged Care Quality and Safety identified two key building blocks to aged care reform: independence from Government and a secure source of funding. It is telling that both the current and the previous Australian Governments rejected each of these in their response to the Royal Commission. A philosophical shift is required that places the people receiving care at the centre of quality and safety regulation. An independent Aged Care Commission with guaranteed funding though a hypothecated Aged Care Levy would, in my view, create the substrate upon which this change in philosophy can flourish.

What is known about the topic? This article explores the integration of artificial intelligence (AI) in aged care, emphasising that technology cannot substitute for systemic reform. While AI is already deployed to detect pain, predict falls, and reduce administrative burdens, its risks include bias, depersonalisation, and inequity when adopted without ethical guardrails. What does this paper add? The article proposes three guiding questions: who designs the AI and who is missing, what outcomes it optimises for, and whether it reduces or reinforces inequities. What are the implications for practitioners? The article concludes that AI should augment-not replace-care, ensuring dignity, equity, and human rights remain at the centre of aged care systems.

Objective Outpatient attendance at metropolitan neurosurgical clinics imposes significant logistical and psychosocial burdens on patients, particularly those with central nervous system tumours residing in geographically dispersed regions. In Australia, where vast distances separate many regional populations from tertiary care centres, these burdens may also translate into substantial environmental costs. This study sought to quantify the environmental and economic impact associated with patient travel to public neurosurgery outpatient services in South Australia. Methods A retrospective analysis was conducted using administrative data from all in-person public neurosurgery outpatient appointments across South Australia's two public neurosurgical centres between July 2022 and June 2024. Patient postcode data were used to calculate geodesic one-way travel distances to clinic sites. Estimated fuel consumption, carbon dioxide (CO2 ) emissions, and petrol costs were derived using published national averages for vehicle efficiency and emissions. Analyses were stratified by Modified Monash Model (MMM) classification to assess regional variation. Results The cohort comprised 9840 patients, accounting for 19,148 outpatient appointments. The median one-way travel distance was 17.7km (IQR: 9.4-52.1km), with 16.9% of patients travelling over 100km. The cumulative distance travelled was 1.75millionkm over 2years, equating to an estimated petrol consumption of 185,531L and CO2 emissions of 435.6tonnes. The associated direct fuel cost exceeded AUD 357,000. Although individual environmental impact increased with MMM classification, the highest aggregate emissions were attributable to patients in MMM category 5, reflecting both travel distance and patient volume. Conclusions The environmental and financial burdens associated with outpatient neurosurgical care are considerable, particularly for patients in rural and remote areas. These findings underscore the need to explore sustainable models of care, including the expanded use of telehealth and regional outreach services, as strategies to reduce carbon emissions and improve healthcare accessibility.

Objective This research presents a benchmarking study of staffing levels and reporting structures in libraries that support evidence-based health care, and deliver education and research support services within the Australian health system. Methods Benchmarking data were collected through a two-phase approach. First, a set of questions was distributed via email to health libraries across Australia, using a national health libraries e-list and professional networks. Second, an international literature review was conducted to examine workforce composition and organisational structures in health libraries over the past 10years. Results This study reveals that Australian health libraries operate with staffing levels approximately 34% below the country's national guidelines. The recommended ratio of 1 health library staff member per 1250 institutional full-time equivalent is proposed to guide workforce planning. Reporting structures vary widely, with libraries most commonly reporting to corporate divisions. However, reporting to clinical, education or research-aligned portfolios was associated with stronger advocacy and strategic alignment. Conclusions Australian health libraries play a critical role in supporting clinical decision-making, research and education. Despite their importance, health libraries are increasingly under-resourced, threatening equitable access to evidence and information services. Strategic investment and targeted funding are needed to address the workforce shortfall. Reporting structures should be aligned with clinical or research functions to enhance visibility and support.

Despite a doubling of the number of medical graduates almost 25years ago, shortages and persistent distribution problems remain. Policies to direct graduates to areas and specialties of greatest population need have been too little too late. Rural regions and areas with high need continue to be underserved, while the gulf between general practitioner and specialist numbers widens. Recommended reforms have been slow and fragmented, with limited success in addressing fundamental distribution challenges across geography, specialties and professional types. Current reforms need to move much more quickly and require significant additional investment to ensure that patients do not have to experience the harms of shortages and surpluses for the next 25years.

This perspective serves as a primer and overview of the underlying causes of the current stress on the healthcare system, indicating no expected relief in the medium term. Demographic trends - such as ageing and growth of the population, declining birth rates, rising healthcare expenditure, and increasing workforce shortages - are presented as the context for the urgent need for greater efficiency and transformative change within the health system. Potential solutions are discussed in response to the impending crisis.

The primary objective of this study was to engage early career allied health professionals (ECAH) in a career development framework targeted specifically to their needs. The secondary objectives were to: identify if the framework increased clinician participants' career achievements and altered manager participants' practices in offering development opportunities to ECAH. This was a 12-month observational (non-experimental) trial of a pragmatic program implementation. Data collected included: initial uptake of staff into the program; retention rate after 12months; number of participants' career achievements; and program evaluation by both participants and managers. At 12months, 35 of the 123 enrolled ECAH remained engaged in the career development program; that is, 28.5% retention, and these participants had an increased number of achievements. The program was effective in broadening managers' practices, 77% offered increased opportunities to ECAH across the development domains of supervision, service planning and quality. This study was partially successful in meeting its objectives. It was unsuccessful in retaining ECAH in a career development program for 12months, although it was successful in increasing the number of achievements for those ECAH that remained engaged. It also broadened managers' practice in the opportunities they offered. The program's success was heavily reliant on the intrinsic motivation of both managers and clinicians. Increasing career development opportunities for AH is important to pursue as a means of increasing satisfaction, retention, and fostering a culture of quality and safety.

Young-onset dementia presents unique care challenges that require comprehensive range of allied health interventions. While Australia's National Disability Insurance Scheme serves as the primary post-diagnostic care pathway for accessing these essential services, recent national survey findings reveal significant systemic barriers preventing people with young-onset dementia from obtaining adequate allied health care under this scheme. This perspective article outlines the critical but underrecognised role of allied health professionals in young-onset dementia care management and identifies key access barriers within the NDIS framework, including gaps in public awareness and provider education on young-onset dementia needs, and systemic issues affecting service coordination. Drawing on recent survey data, we briefly discuss current issues and concerns, and present key reform areas with direct implications for policymakers, National Disability Insurance Scheme planners, allied health professionals, and service providers. Our discussion highlights the urgent need for targeted reforms to enhance access to essential allied health professionals and improve outcomes for this growing, vulnerable population.