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

Objective Globally, the social and economic costs of alcohol-related disorders are considerable. The aim of this study was to determine the characteristics, clinical care requirements and outcomes of alcohol-related presentations (ARPs) to emergency departments (EDs). Methods A multi-site observational study was undertaken in Queensland, Australia. We selected a random sample of 2720 presentations to four public hospital EDs between April 2016 and August 2017, in which the treating clinician perceived that alcohol contributed to the presentation. Routinely collected demographic, clinical, outcomes and costings data were analysed. Additional data about clinical care delivery in the ED (bedside tests, radiology, pathology and referrals) were extracted by manual medical record review. Results The ARPs predominantly involved young men: 62% arrived by ambulance and 61% arrived between 6pm and 6am. Most (>83%) ARPs had at least one vital observation (i.e. heart rate, blood pressure, respiratory rate) recorded, 46% had pathology, and 41% had radiology. Some form of medication (e.g. paracetamol, diazepam, thiamine) was ordered in 65% of ARPs and 20% involved intravenous fluid treatment. Referrals to a specialist team (e.g. mental health, alcohol and other drug services) were documented for 42% of patients. The median ED length of stay was 194min (IQR: 122-292 min); the admission rate was 38%; and the median cost of ED episodes of care (in Australian dollars) was A$651 (IQR: A$422-961). Conclusions The ED resource utilisation and costs due to the use of alcohol are considerable. Public health measures that reduce alcohol-related harm have the potential to reduce ED occupancy, workloads and costs.

National regulation of health practitioners in Australia is 15years old. Raising the bar on public safety, national mobility and responding to future workforce needs were drivers of transformational reform. As the national regulatory scheme has progressively matured, its benefits and progress have been substantial, although at times debated. These benefits include a substantial growth in the registered health workforce, national mobility underpinned by national standards and an on-line register which provides greater transparency about the registration status of health practitioners. Regulation can never stand still as the health system in which it works is ever changing. The rapid increase in entrepreneurial models of health care, as well as the acceleration of telehealth, social media and augmented intelligence technologies, create new challenges for accountability, transparency, equity and patient safety. While there are undoubtedly opportunities for further reform, the national, multi-professional set of regulatory arrangements provide a strong foundation from which to build and address new challenges and workforce needs.

Objective Acute migraine episodes affect >18% of Australians. Triptans are most effective when taken early in migraine attacks, making timely access critical. Before February 2021, triptans were prescription-only, but a downscheduling policy change enabled over-the-counter (OTC) purchase with pharmacist advice. This study examined the effect on subsidised Pharmaceutical Benefits Scheme (PBS) dispensing rates and illustrative patient costs. Methods Aggregated PBS dispensing data were used to estimate monthly triptan dispensing rates per 1000 people using population data from the Australian Bureau of Statistics. As PBS data excludes OTC supply, we projected dispensings, and illustrate potential costs based on pre-downscheduling trends to estimate the potential shift to OTC. PBS beneficiaries include concessional (social security recipients/low-income earners) and general (those ineligible for concessions). Prescription costs were based on a four-tablet PBS pack of sumatriptan 50mg (A$7.70 concessional; up to A$24.60 general). OTC costs were estimated using a two-tablet pack (A$10.00 standard pharmacy, A$7.00 discount pharmacy). Results Before downscheduling, triptan dispensings grew 1.4% monthly, slowing to 0.6% post-downscheduling. By illustration, we estimate that shift to OTC access would have led to a cost saving of up to A$2million for general patients, but an increased cost of A$2.3-5.8million for concessional patients, depending on pharmacy pricing models. Conclusion Downscheduling slowed PBS dispensing growth. If reduced PBS dispensing was offset by OTC access, the policy may have improved timely migraine treatment, although PBS use remains high. Cost benefits depend on patient concession status and potential offsets, such as reduced doctor visits, which should be considered in further policy evaluations.

Healthcare organisations (HCOs) must prepare for large-scale implementation of artificial intelligence (AI)-enabled tools that can demonstrably achieve one or more aims of better care, improved efficiency, enhanced professional and patient experience, and greater equity. Failure to do so may disadvantage patients, staff, and the organisation itself. We outline key strategies Australian HCOs should enact in maximising successful AI implementations: (1) establish transparent and accountable governance structures tasked to ensure responsible use of AI, including shifting organisational culture towards AI; (2) invest in delivering the human talent, technical infrastructure, and organisational change management that underpin a sustainable AI ecosystem; (3) gain staff and patient trust in using AI tools by virtue of their value to real world care and minimal threats to patient safety and privacy, existence of reliable governance, provision of appropriate training and opportunity for user co-design, transparency in AI tool use and consent, and retention of user agency in responding to AI generated advice; (4) establish risk assessment and mitigation processes that delineate unacceptable, high, medium, and low risk AI tools, based on task criticality and rigour of performance evaluations, and monitor and respond to any adverse impacts on patient outcomes; and (5) determine when and how liability for patient harm associated with a specific AI tool rests with, or is shared between, staff, developers, and the deploying HCO itself. In realising the benefits of AI, HCOs must build the necessary AI infrastructure, literacy, and cultural adaptation with foresighted planning and procurement of resources.

Objective The aim of this study was to develop a taxonomy of urgent care service models and their relationships within healthcare systems through concept mapping, and by addressing inconsistent terminology and service classifications. Methods This descriptive study used an iterative mapping methodology to analyse and categorise urgent care services. Data collection involved literature describing urgent care models across international healthcare systems, focusing on terminology, operational characteristics, and integration points with primary and emergency care. This was complemented by an Australian urgent care model analysis, that is, a comparative review of publicly declared service characteristics and clinical scopes across Australian urgent care models, coded to ICD-10 (International Classification of Diseases, 10th Revision) and presented in tabular form. Results The concept map presents a taxonomy of healthcare services across three distinct care pathways based on condition acuity: primary care for non-urgent needs, urgent care for non-life-threatening conditions requiring prompt, non-scheduled treatment, and emergency care for acute emergencies. The map establishes standardised nomenclature, including intersectoral areas such as co-located facilities and nurse practitioner walk-in services. Supplementary analysis highlights scope variation between models, particularly differences in procedural capability, diagnostics access and mental health response. These findings inform current Australian policy directions, particularly the Medicare Urgent Care Clinics rollout. Conclusions This concept map provides a framework for examining urgent care services within the broader healthcare landscape. Alongside a comparative analysis of Australian models, it supports systematic investigation, highlights variation in service scope and design, and informs planning, integration and policy development across diverse urgent care settings.

Objective This study aims to evaluate how extracurricular involvement, such as sports, music, volunteering and teaching, are weighted within standardised curriculum vitae (CV) scoring criteria for medical officers applying to medical and surgical specialty training programs in Australia. Methods A cross-sectional observational analysis of point allocations for extracurricular involvement was performed, as detailed by publicly available standardised CV scoring criteria for medical and surgical training programs. The analysis includes all specialty training programs in Australian and New Zealand listed by the Australian Health Practitioner Regulation Agency that publish these criteria for the 2023 intake. Results Of the 47 reviewed specialty training programs, 14 publish publicly available standardised CV scoring criteria, and 8 of these allocate points for extracurricular involvement. The mean weighting for extracurricular involvement was 11.5% (range 4.5-20%), compared with 42.5% for research. The allocation of points varies by training program and subdomain. Conclusion The weighting of extracurricular involvement within standardised CV scoring criteria is limited and varied among specialty training programs, despite alignment with non-cognitive competencies emphasised by training frameworks. Current emphasis on academic achievements may disadvantage applicants with limited access to research opportunities. Greater clarity and consistency in evaluating non-academic attributes may support fairer, more holistic selection processes.

Objective The role of mental health nurses (MHNs) working in inpatient units involves providing care to patients with complex needs and challenging behaviours, with reporting and documenting findings from brief interactions a critical part of their duties. Despite this, there is no agreed-upon instrument to document a patient's mental state or recognise signs of progress or deterioration. The aim of this study was to assess the impact of implementing a standardised instrument known as the SMART card on MHNs documentation, knowledge, and self-efficacy in assessing and reporting a patient's mental state. Methods The SMART card was implemented across eight mental health inpatient units. Completion rates of the SMART card and quality of assessments were measured using a file/chart audit before and 3months post-implementation. A pre/post-implementation survey measured changes in MHNs' perceived knowledge and self-efficacy, with the post survey evaluating attitudes towards training and SMART card acceptability. Results Clinical file audits showed significant improvement in completion rates in documentation of key clinical/symptom domains. Survey results showed a positive attitude towards the SMART card, with training having increased MHNs' understanding of psychiatric terminology and significantly improved confidence and self-efficacy. Conclusions This study demonstrates how the implementation of a standardised instrument significantly improved MHNs' reporting of patient mental health status.

There is increasing recognition of the benefits of robust data infrastructures, capacity building for a data informed society, and strategic policy and financial support to enable data integration (also known as data linkage). However, despite widespread availability of data, and recognition of the value of data linkage and investment in this area, data linkage continues to be complex, timely, and costly, and these elements are often underestimated by researchers. In this article, we introduce data linkage basics for Australian researchers and discuss important considerations for those embarking on healthcare research that utilises data linkage.

Artificial intelligence (AI) medical scribes (AI scribes), which ambiently record and transcribe patient-clinician interactions into structured documentation, aim to ameliorate documentation burdens, but their suitability for allied health remains unclear. AI scribes are often designed for doctors, raising concerns about accuracy, workflow integration, and applicability to allied health's diverse documentation needs. While potential benefits include improved efficiency and patient engagement, evidence is lacking for their effectiveness in allied health settings. Risks such as AI bias, patient safety, and integration barriers may also require consideration. This paper argues that further research is needed before widespread allied health adoption, emphasising the need for discipline-specific evaluations to assess AI scribes' viability in allied health practice.