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

Background Benefits of effective team-based working in healthcare settings are well established, with the ultimate form being transdisciplinary teams. Achieving transdisciplinary teams at the large organisation or system level has not been extensively studied. Purpose To examine and describe exemplar organisations where transdisciplinary working was enabled and that can be reproduced in other organisations. Methods An expert panel reached consensus on three healthcare organisations in the USA that exemplified transdisciplinary working. Available public information about each organisation was reviewed and site visits with direct observation and interviews were conducted with two of the three exemplar sites (the third completed remotely due to the onset of COVID-19). The process of immersion-crystallisation was used to review the collated material and to identify key themes that were then repeatedly checked with the expert panel. Results Consistent themes were identified across all three organisations, although they each arrived at these commonalities via distinctly different routes. All had a clear and shared creation story as to how they came about as an entity, which was supported by consistent longitudinal leadership. This enabled an environment whereby each organisation created its own language that reflected their culture as an organisation, thus continually reinforcing the uniqueness of their organisation. Conclusions Large healthcare organisations can achieve the concepts of transdisciplinary practice. While no single achievement pathway was identified, common themes noted were a clear creation story, consistent leadership, and building a language that reflected the organisation.

Objective Community-acquired pneumonia (CAP) is a leading cause of emergency hospitalisations globally and is associated with high readmission rates. Specific score systems developed for all medical conditions such as the HOSPITAL score and the LACE index can also usefully predict CAP readmissions. However, there is limited evidence regarding their performance in the Australian healthcare settings. Methods This multicentre retrospective study analysed adult CAP discharges from two metropolitan hospitals in South Australia between 1 January 2018 and 31 December 2023. Data for determining the HOSPITAL score and the LACE index were derived from electronic medical records. Demographic characteristics of patients readmitted within 30 days were compared with those who were not readmitted. The scores were evaluated for overall performance, discriminatory power and calibration, with discriminatory power assessed using the concordance statistic (C-statistic). Results Over 6years, 7245 CAP discharges were recorded, with 1329 (18.3%) readmissions within 30days. The mean (s.d.) age of the cohort was 74.4 (17.8) years. Readmitted patients were more likely to have multiple morbidities and frailty than those not readmitted (P <0.05). They also had a higher mean number of emergency department presentations and hospital admissions in the previous year and a longer initial hospital stay (P <0.05). Overall, the mean (s.d.) HOSPITAL score and LACE index were 3.4 (2.1) and 9.3 (3.6), respectively. Among readmissions, 28.4% occurred in patients with a HOSPITAL score >4 (intermediate and high-risk group), while 25.8% occurred in patients in the high-risk LACE category (LACE index>10). The C-statistic for the HOSPITAL score and LACE index was 0.62 (95% CI 0.61-0.64) and 0.63 (95% CI 0.61-0.65), respectively, with no significant difference in the area under the receiver operating characteristic curves (P >0.05). Conclusions The predictive abilities of the HOSPITAL score and the LACE index for CAP readmissions are modest and comparable in an Australian setting.

Objective This study aimed to evaluate the feasibility of a workplace-delivered outpatient multidisciplinary service (ReCOV) for staff experiencing post COVID-19 condition ('Long COVID'). Methods A mixed-methods study of staff at a large, tertiary hospital with Long COVID who attended the service was conducted. Participants completed questionnaires to determine baseline symptoms and were offered allied health appointments for up to 12weeks each based on clinical indication. Acceptability, implementation, practicality and limited efficacy were evaluated via one-on-one semi-structured interviews and analysed using inductive thematic analysis. Limited efficacy was evaluated via pre- and post-questionnaires and demand via multidisciplinary utilisation. Results Twenty-three (median age 37 [interquartile range 30-45] years, 52% female) participants were included. Participants had appointments with a median of 4 [3-5] different professions; most commonly exercise physiology (n =19, 83%), occupational therapy (n =17, 74%) and neuropsychology (n =15, 65%). Median time spent on the ReCOV service was 15 [9-19] weeks. Thirteen semi-structured interviews were completed and analysed. Participants valued ReCOV for being a COVID-19 specific, convenient, flexible and multidisciplinary service at their workplace. Participants preferred the service to have been available for longer than 12weeks to achieve further benefits as many participants perceived little change in physical health. Conclusions Attending a multidisciplinary service located at their workplace was feasible for staff to manage post COVID-19 symptoms. Further research is required to confirm the efficacy on patient outcomes.

Objective To explore the association between geographic access to allied health services and potentially preventable hospitalisations. Methods This is a retrospective observational study. Adults aged 18years or older with a potentially preventable hospitalisation for a chronic condition(s) to a public hospital in South Western Sydney Local Health District between 1 July 2016 and 30 June 2019 were identified from the Secure Analytic for Population Health and Intelligence portal at NSW Health. Locations of allied health amenities or practices in the same geographic area were identified from the 2019 National Health Service Directory. Geospatial analysis was used to identify geographic hotspots and coldspots of potentially preventable hospitalisations. Association with access to allied health services was investigated using linear models. Results Hotspots of potentially preventable hospitalisations were significantly more disadvantaged than coldspots. Hotspots also had poorer access to allied health services than coldspots. Conclusion In South Western Sydney, populations with higher burden of chronic disease, as measured through preventable hospitalisations, have poorer access to allied health services than populations with lesser need.

Introduction Labour costs are a key driver of healthcare costs and a key component of economic evaluations in healthcare. We undertook the current study to collect information about workforce costs related to clinical genomic testing in Australia, identifying key components of pay scales and contracts, and incorporating these into a matrix to enable modelling of disaggregated costs. Methods We undertook a microcosting study of health workforce labour costs in Australia, from a health services perspective. We mapped the genomic testing processes, identifying the relevant workforce. Data was collected on the identified workforce from publicly available pay scales. Estimates were used to model the total cost from a public health services employer perspective, undertaking deterministic and probabilistic sensitivity analyses. Results We identified significant variability in the way in which pay scales and related conditions are both structured and the levels between jurisdictions. The total costs (2023-2024 Australian dollars) ranged from 160,794 (113,848-233,350) for administrative staff to 703,206 (548,011-923,661) for pathology staff (full-time equivalent). Deterministic sensitivity analysis identified that the base salary accounts for the greatest source of uncertainty, from 24.8% (20.0-32.9%) for laboratory technicians to 53.6% (52.8-54.4%) for medical scientists. Conclusion Variations in remuneration levels and conditions between Australian jurisdictions account for considerable variation in the estimated cost of labour and may contribute significantly to the uncertainty of economic assessments of genomic testing and other labour-intensive health technologies. We outline an approach to standardise the collection and estimation of uncertainty for Australian health workforce costs and provide current estimates for labour costs.

Objective Detailed quantifications of the environmental footprint of operations that include surgery, anaesthesia, and engineering are rare. We examined all such aspects to find the greenhouse gas emissions of an operation. Methods We undertook a life cycle assessment of 10 patients undergoing total knee replacements, collecting data for all surgical equipment, energy requirements for cleaning, and operating room energy use. Data for anaesthesia were sourced from our prior study. We used life cycle assessment software to convert inputs of energy and material use into outputs in kg CO2 e emissions, using Monte Carlo analyses with 95% confidence intervals. Results The average carbon footprint was 131.7kg CO2 e, (95% confidence interval: 117.7-148.5kg CO2 e); surgery was foremost (104/131.7kg CO2 e, 80%), with lesser contributions from anaesthesia (15.0/131.7kg CO2 e, 11%), and engineering (11.9/131.7kg CO2 e, 9%). The main surgical sources of greenhouse gas emissions were: energy used to disinfect and steam sterilise reusable equipment (43.4/131.7kg CO2 e, 33%), single-use equipment (34.2/131.7kg CO2 e, 26%), with polypropylene alone 13.7/131.7kg CO2 e (11%), and the knee prosthesis 19.6kg CO2 e (15%). For energy use, the main contributors were: gas heating (6.7kg CO2 e) and heating, cooling, and fans (4kg CO2 e). Conclusions The carbon footprint of a total knee replacement was equivalent to driving 914km in a standard 2022 Australian car, with surgery contributing 80%. Such data provide guidance in reducing an operation's carbon footprint through prudent equipment use, more efficient steam sterilisation with renewable electricity, and reduced single-use waste.

Objective Chronic disease is common in people with cancer. However, the utilisation of Medicare chronic disease management (CDM) items for cancer patients in Australia remains unexplored. This study investigates Medicare CDM item numbers relating to people with cancer, including general practitioner (GP) and allied health CDM item numbers, and any associated sociodemographic factors. Methods Data from 86,571 people with cancer registered in the Queensland Cancer Registry between July 2011 and June 2015 and the CDM items codes from Medical Benefits Scheme records until 2018 were analysed. This includes utilisation of General Practitioner Management Plans (GPMP) and Team Care Arrangements (TCAs), reviews of GPMPs and TCAs, and engagement with allied health services until June 2018 following a cancer diagnosis. Results In total 47,615 (55%) and 43,286 (50%) people with cancer initiated at least one GPMP and TCA, respectively, with 31,165 (36%) receiving at least one review, and 36,359 (42%) utilising at least one allied health service (e.g. physiotherapists (41%), podiatrists (27%), exercise physiologists (19%)) with variations by cancer type. While people with cancer from disadvantaged socioeconomic groups had a higher likelihood of receiving GPMP (odds ratio, OR: 1.16, 95% confidence interval, CI: 1.11-1.21) and TCA (OR: 1.12, 95% CI: 1.07-1.16), they were less likely to utilise allied health services (OR: 0.89, 95% CI: 0.85-0.93). People with cancer living in remote areas were less likely to receive TCA (OR: 0.84, 95% CI: 0.80-0.88) or utilise allied health services (OR: 0.63, 95% CI: 0.60-0.67) than those in metropolitan areas. Conclusion Our findings underscore the need to examine uptake and implementation patterns of CDM items, especially in relation to clinical, social, and service provider-level factors and related potential barriers. Further exploration is warranted to understand whether people with cancer's care needs are being met and ways to optimise the supportive care of these people.

Objective This study aims to develop a comprehensive chief executive officer (CEO) retention model for Australian hospitals, addressing high turnover rates by integrating key retention strategies to promote organisational stability and enhance patient care. Methods The study employed a sequential exploratory design with four stages: a scoping review, qualitative interviews, a quantitative survey, and comprehensive data analysis. The scoping review examined existing literature on CEO turnover and retention. Qualitative interviews with 14 Australian hospital CEOs provided in-depth insights. A quantitative survey with 51 CEOs validated the findings. Data triangulation ensured a robust and contextually relevant model aligned with Transformational Leadership Theory and a systems approach. Results Five key factors influencing CEO retention were identified: mutual respect and clear roles between CEOs and boards, fostering a positive organisational culture, competitive rewards, robust recruitment and retention practices, and ongoing professional development and mentorship. The model emphasises a supportive environment, equitable compensation, effective succession planning, and leadership development. Findings indicate a holistic approach addressing both professional environment and personal growth is essential for improving CEO retention rates. Conclusions The CEO retention model provides practical solutions to reduce turnover and enhance stability in Australian hospitals. By incorporating Transformational Leadership Theory and a systems approach, the model offers a comprehensive framework that addresses the multifaceted nature of CEO retention. Future research should refine these strategies and explore their applicability in different healthcare settings to further enhance effectiveness.

ObjectivesFrailty is associated with significant mortality and morbidity in hospitalised patients. We describe physiotherapy and occupational therapy practices in hospitalised frail patients and examine the role of early intervention.MethodsWe performed a prospective, observational cohort study in a medical assessment unit in a tertiary care hospital. Patients with COVID-19 infection were excluded. Frailty was measured by the Clinical Frailty Scale (CFS). Early allied health intervention was defined as involvement within 48h of admission. Demographic data, clinical diagnoses, time spent with physiotherapy and occupational therapy, CFS, hospital length of stay and outcomes were recorded and analysed.ResultsA total of 356 patients were categorised into non-frail (CFS score <5) and frail (CFS score ≥5) groups. The prevalence of frailty was 68% (n=241). Physiotherapy (77.2%) and occupational therapy (75.5%) reviews were more frequent in frail patients than in non-frail patients. Frail patients who had allied health involvement within 48h of admission had a significant reduction in their hospital length of stay (mean reduction of 7.3days, 95% CI: 0.53, 14, P=0.035) and a 2.44% reduction in the relative risk of developing pressure injuries (95% CI: 1.31, 4.53). There was no statistically significant differences in outcomes with allied health intervention for non-frail patients and patients who require residential aged care facility level care.ConclusionsAllied health have a key role in the management of frailty. Early allied health intervention was associated with a reduced hospital length of stay as well as a reduced incidence of pressure injury in frail patients.

ObjectiveThis study aimed to determine the number of visitors to an acute hospital, the time of visit, destination, and details of parking over the same period.MethodsA prospective observational pilot study in a large metropolitan public hospital in Australia was performed. The research team observed all visitors over a 14-day period between 17 and 30 October 2022 counting the people visiting relatives or friends of admitted hospital patients as well as those visiting outpatient clinics during the observation period. Other outcome measures included time of the visit, destination, and estimated costs of parking.ResultsDuring the 14 days of observation there were 18,066 visitors, averaging 1290 per day. The majority were visitors to inpatients (62.2%, 11,232, averaging 802 per day). Those attending outpatients were less (37.8%, 6834, averaging 668 per weekday). The estimated average parking cost was A$18.10 per day normally and A$11.85 for concessions.ConclusionsThis was the first known study on hospital-wide visiting in Australia or globally. These findings would be important for addressing issues such as hospital planning, and for future research including the impact of visiting on patient outcomes, the patient and community experience, and the expectations and experience of hospital visitors.