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

Australia's healthcare system faces major challenges related to sustainability, access and equity. Safe, effective care and growing demands require evidence-based innovation and a future-ready health workforce. Digital health - the use of data and digital technology in health and health care - is yet to fully realise its promise. The Australian Council of Senior Academic Leaders in Digital Health (the 'Council') has been established to promote, foster and support academic collaboration that helps address Australia's key challenges and contribute to national and global health. This perspective provides an action plan in a crowded digital health landscape to improve the highlighted issues of effective innovation and a capable workforce. The Council has two key actions: (1) support research and innovation that advances digital health principles and practices by advocating for digital health research and development funding, strategic partnerships, communication, standard setting and adoption of research-informed digital health; and (2) enable system transformation through evidence-based education and training to produce future-fit healthcare workers by advancing health workforce education that embeds digital health capability standards and ongoing learning. True and transformative progress and continuous improvement in digital health require peer-reviewed evidence, as does any other area of health care. We need to acknowledge that our current workforce capabilities are no longer fit for purpose. Our workforce needs to be progressively 'retooled' to face the future of health care in a technological and data science revolution and in a sector that is slow to adapt to change. Implementing these actions will advance digital health research and education to positively impact Australia's healthcare system.

Ojective Hospital wards, staffed by a multidisciplinary team, are complex environments where teamwork, communication and psychological safety are essential for coordinated care delivery, yet are faced with challenges such as staffing changes and complex care needs. There is little literature on interventions to assist staff to connect as a team. This study aimed to evaluate the effect of the Hospital Harmony program on team communication, psychological safety and overall team functioning in a multidisciplinary hospital ward. Methods The study was conducted at a major metropolitan academic health service involving a multidisciplinary general medicine team including nursing, medicine and allied health. A mixed-methods approach was used, combining quantitative surveys and qualitative focus groups, to evaluate Hospital Harmony, a 6-week brief daily group-based program designed to improve team function and mindfulness within the team. For our quantitative component, we used a questionnaire based on measures of team functioning: meeting effectiveness, psychological safety and individual focus. We used linear mixed models to assess the changes in each domain over time. A focus group was undertaken to obtain qualitative data that were thematically analysed. Results Fifty-one unique participants from the multidisciplinary team completed the survey (mean age of 33.5years (s.d. 11.0) and 72% female). Following commencement of the program, there was a significant increase in the team's perception of the meeting's effectiveness (P =0.004), team morale (P <0.0001), focus (P <0.0001) and psychological safety (P =0.014). The focus group identified four broad themes of relationship building, improved psychological safety, the impact of the program on the team's behaviour and mindful self-reflections. Conclusion We found that the Hospital Harmony program improved the multidisciplinary healthcare team by facilitating better communication, improving relationships and promoting psychological safety.

Objective To shift the narrative from 'deficit dialogues' in health and social care in Australia, we aimed to generate a series of consensus 'ambition' statements representing what peak care stakeholders in Australia want health and social care to look like in the future. Methods A multiphase co-design study with Australian 'care' stakeholders was undertaken. This consisted of a desk-based audit of Australian health and social care organisations (n =9) and a pre-forum survey (n =21 responses) (activity 1), the findings of which informed the national forum activities (activity 2, n =31 organisations), which became the content for the Delphi survey (activity 3, n =28 organisations). Results Through this process we distilled five ambition statements and 39 descriptors. These statements are our True North Statement for Better Care, providing a starting point to guide individual, organisation and system redesign across the life span. The statements require action at individual consumer, workforce and system level. Conclusions Creating the True North Statement for Better Care provides a united direction for heterogeneous groups to work together to improve care for consumers, their workforce and the systems they work in. This is an important initiative to change the way we value, talk about, do, own and research care. Further user testing is required to ensure the statements can be translated into action.

Objective To determine the features that are required to increase uptake of advance care directives (ACDs). Methods We conducted a study involving older patients attending aged care outpatient clinics and/or receiving outreach services between March 2021 and December 2022. Patients were assessed using tools related to frailty, end of life and empowerment. If the person agreed to complete an ACD, they were guided through it, and it was subsequently uploaded on the electronic medical record. Results Of 170 patients referred to complete an ACD, 47% completed it. These patients had lower Rockwood Clinical Frailty Scale and SPICT (Supportive and Palliative Care Indicators Tool) scores. The Frailty and SPICT tools were easier to use, the PAM (Patient Activation Measure) was difficult to use and assess. Patients did, however, show satisfaction in the process. Conclusions Patients completing an ACD tended to be a little less frail and less likely to die in the following 12months. Increased uptake of ACD is more likely if the less frail are targeted, and assisted through the process by a health professional at a time and place that suits the person.

Establishing an evidence-based framework to monitor and evaluate quality and safety of care for older people is critical. Despite progress in health system performance monitoring in Australia, slower progress has occurred for the older population accessing aged care services. With an aging population and increasing demands on aged care and healthcare systems, there is growing recognition of the need for more coordinated and integrated care across settings. It is not uncommon for older people accessing aged care to require a range of services administered by different organisations simultaneously (e.g. primary care, home care) and sequentially (e.g. hospitals, residential care). Aged care also represents an increasingly regulated sector, with significant investment in and growing recognition of the value of quality measurement. Accountability for care quality and safety is often shared among providers, with consequent challenges in attributing responsibility. Therefore, the development of a pragmatic national framework to support high-quality, person-centred care for the older population accessing aged care services across care settings is one opportunity for shared responsibility, care monitoring, and quality improvement activities that could lead to better outcomes for this population. The strategy for framework development proposed in this perspective has implications for aged care and healthcare providers, consumers, policy makers, regulators, and academics. Once implemented, this framework has the potential to drive consistent high-quality care to improve health outcomes and wellbeing among older people accessing aged care services.

Objective The Australian Medicare Benefits Schedule (MBS) telehealth items were expanded in March 2020 and consolidated in January 2022. We aim to describe the trend of the ratio of MBS psychiatric video items for once-off assessments to follow-up sessions and examine the effect of telehealth consolidation. Methods Psychiatric once-off item to follow-up item ratios in face-to-face (F2F) and video modes were computed from state and territory-level monthly Medicare data (January 2016-December 2023). We performed a multilevel interrupted times series analysis (ITSA) of once-off video consultations with telehealth consolidation as the intervention, followed by subgroup analyses by age groups. Finally, in the young adult group (25-44years), we performed a multiple-group ITSA comparing video once-off to follow-up ratios between genders. Results The once-off to follow-up ratio for video items after telehealth consolidation greatly increased compared with F2F items, with rapid growth in once-off assessments. Sustained high video once-off assessment usage occurred in the youth (15-24years) and young adult (25-44years) groups, while other age groups showed declines following the initial rise. The male group showed a greater initial increase in the video once-off to follow-up ratio among young adults but the ratio continued to rise only in the female group. Conclusions The evolving trends of reimbursed telepsychiatry consultations require further examination given their potential implications concerning service quality, health equity, health attitudes and behaviours, and healthcare costs.

Background Inaccurate or incomplete documentation of severe medication allergies, such as anaphylaxis and severe cutaneous adverse drug reactions (SCAR), may lead to harm from inadvertent re-exposure to implicated medications. My Health Record (MHR) is a national patient-controlled electronic health record in Australia linking hospital, general practitioner and community pharmacy records. The medication allergy/adverse reaction section should contain accurate information to aid prescribing. Objective To investigate the accuracy of documentation in MHR of confirmed medication-related anaphylaxis and SCAR and to determine barriers and facilitators to documentation. Methods A retrospective cohort study of patients with medication-related anaphylaxis and SCAR, validated between January 2019 and June 2023. Medication allergy documentation in MHR was reviewed after patient consent to determine accuracy with medication and reaction type, against the assessment made by the hospital Adverse Drug Reaction Review Committee and/or allergy clinic consultation. Results Forty-eight patients with anaphylaxis and 40 patients with SCAR (total 88) were included, involving 134 medications. Fourteen (15.9%) patients had their reactions documented accurately in MHR. When analysed per medication, 21 medications (15.7%) were documented accurately. Anaphylaxis, allergy clinic follow-up and life-threatening severity were factors significantly associated with a higher frequency of accurate allergy documentation in the MHR. Conclusion The accuracy of medication allergy documentation for severe allergies in the MHR is low, representing a risk of harm from inadvertent re-exposure. This study identifies several system level issues and makes recommendations to improve patient safety.

Objective This study aims to evaluate the effectiveness of utilising an artificial intelligence (AI) model to generate emergency department (ED) discharge summaries in an easily accessible format. Methods This single-centre, proof-of-concept trial was conducted at a tertiary metropolitan private hospital. It involved 142 randomly selected patients who attended in 2023 and were able to be discharged home after care by a single ED doctor. A total of 284 documents were randomised, consisting of 142 de-identified ED medical notes and 142 AI-generated discharge summaries created by ChatGPT4 based on the corresponding ED medical notes. Both document types were distributed to six senior ED doctors, each of whom graded them individually and independently using a predetermined tool that assessed 17 items in four domains (expected contents, readability, medical accuracy, and internal consistency). The primary outcome was the graded score for the AI-generated discharge summaries, compared with that of the original ED medical notes. Results Across the 17 items and four domains assessed, AI-generated discharge summaries rated comparably to ED medical notes in 12 items (including key information, reason for the ED visit, past medical history, allergies and medications, social history, history of presenting complaint, investigations, differential diagnoses list, grammar, formatting, appropriateness, and consistency) and three domains (expected contents, readability, and internal consistency). AI-generated discharge summaries demonstrated high mean scores in the remaining five items (examination findings, primary diagnosis, detailed plan, language clarity, and reflectiveness of treatment) and one domain (medical accuracy). Conclusions AI-generated discharge summaries are potentially comparable to ED medical notes in most key performance domains of a discharge summary.

Objectives The ageing population and increasing chronic illness pose significant healthcare challenges, including care late in life. Advance care planning (ACP) is an ongoing process of making decisions regarding future health care for patients. This process can include formal completion of an advance care directive (ACD), which is a legally binding document. ACP can improve patient outcomes and satisfaction, but rates are low across Australia. This study assessed the sociodemographic and clinical predictors of individuals engaging with ACP and ACDs using data from the 45 and Up Study cohort in New South Wales. Methods A cross-sectional cohort study of 28,626 people responded to ACP-related questions in the wave 2 questionnaire of the Sax Institute's 45 and Up Study. ACP completion was recorded if people responded 'yes' to any of the three ACP questions, and ACD was recorded if they responded 'yes' to the ACD question. Poisson regression modelling was used to estimate the prevalence ratio and the 95%CI. Results A total of 28,626 people completed the ACP- and/or ACD-related questions, of whom 17,458 (61%) completed ACP and 3744 (13.1%) completed ACD. The predictors associated with an increased likelihood of ACP and ACD completion included having a will, advancing age, being female, having private health insurance, not currently working, and having one or more self-reported medical conditions. Predictors unique to increased overall ACP completion included having a university degree or higher, being married and having a health care concession card (Health Care Card). Being a carer increased ACD rates, whereas being married or in a de facto relationship decreased ACD completion. Conclusions These findings could inform interventions aimed at improving ACP uptake by identifying groups that engage less in ACP and provide a basis for future research.

Objective Australians often wait a long time for public oral healthcare. This research analyses the numbers of people waiting for care, and numbers and percentage waiting beyond a desirable time for their clinical priority group, from 2015 to 2024, in Queensland. Methods Data are publicly available as part of the Queensland Government Open Data Portal. Data report the numbers of people waiting by time category, clinical priority group and Hospital and Health Service. Data for the end of September for each year from 2015 to 2024 were analysed. Results Across the 10-year period, there were always in excess of 100,000 people on the waiting list. In 2015 there were 116,046 people on the waiting list, peaking at 154,247 in 2020, and 150,485 in 2024. Of these, 80-90% are on the list for general care, desirable within 24months. Generally, across priority clinical groups the percentage waiting beyond the desirable time increased from 2015 to the pandemic period (2020-2021) and has since improved. For example, for Priority 1 (dental treatment desirable within 1month) the percentage waiting too long was 50% in 2015, which reached a peak of 80% in 2021 and decreased to 59% in 2024. Conclusion Reducing waiting list numbers for public oral healthcare is a challenge. In Queensland there are about 150,000 people on this waiting list, however, the majority are within the desirable wait time. This challenge is identified in numerous state and federal government documents, however, clear and feasible strategies appear to be lacking to reduce waiting list numbers and times.