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Journal of the Australian Healthcare & Hospitals Association
Australian Health Review

Australian Health Review

Volume 47 Number 3 2023

AH22287An organisational approach to improving diagnostic safety

Ian A. Scott and Carmel Crock
pp. 261-267

What is known about the topic? Diagnostic error affects around 1 in 10 diagnostic decisions, with some causing serious patient harm. Most feature individual clinician cognitive error and predisposing organisational factors. What does this paper add? Healthcare organisations need frameworks for improving diagnostic safety. Modelled on the US Safer Dx framework, we propose an Australianised framework focused on hospitals, including practical strategies actionable within individual departments. What are the implications for practitioners? The proposed framework may act as a starting point for healthcare organisations to develop diagnostic safety programs in collaboration with health service standard and accreditation authorities.


What is known about the topic? Providing timely analgesia to patients presenting to Australian emergency departments (EDs) continues to challenge the resource-constrained ED environment. What does this paper add? Despite legislative and regulatory restrictions in Tasmania (and in most other Australian states), advanced practice physiotherapists provide more timely care than traditional medical or nursing models for patients presenting with musculoskeletal conditions to the ED. What are the implications for practitioners? Further development of the scope of advanced practice physiotherapists, through local (i.e. training) and legislative pathways, has the potential to improve time to analgesia and reduce workloads of nursing and medical staff in ED.


What is known about the topic? Non-traumatic musculoskeletal pain accounts for 3% of all emergency department (ED) presentations. Although often high in acuity, the vast majority of these cases (>99%) are not considered life threatening by EDs and are triaged as non-urgent. What does this paper add? Findings offer seven major themes relating to why patients chose to present to an ED over non-ED services and the interaction of these themes. What are the implications for practitioners? Education to address these reasons and misconceptions may encourage better utilisation of health services and decrease non-urgent ED presentations in the first instance.

AH22271Risk of hospital admission or emergency department presentation due to diabetes complications: a retrospective cohort study in Tasmania, Australia

Ngan T. T. Dinh 0000-0003-2339-2628, Barbara de Graaff, Julie A. Campbell, Matthew D. Jose, John Burgess, Timothy Saunder, Alex Kitsos, Petr Otahal and Andrew J. Palmer
pp. 282-290

What is known about the topic? Timely information regarding the risk of admission due to diabetes complications is required for policy planning, as diabetes complications are responsible for the large burden of disease experienced by people living with diabetes in Australia. What does this paper add? Our results demonstrated the high demand on hospital services due to diabetes complications (especially macrovascular complications) and highlighted the importance of preventing and properly managing microvascular complications. What are the implications for practitioners? Our findings will assist planning for improved management of diabetes complications by determining the high demand on hospital services related to diabetes complications and identifying complications requiring higher health service utilisation.


What is known about the topic? Survivorship care requires increased focus in Australia. Some states and territories have included objectives within cancer plans. What does this paper add? We conducted an audit of state and territory cancer plans. While plans frequently include objectives focusing on different aspects of survivorship care, there is considerable variation. There is also lack of consensus regarding appropriate outcome measures. Tools to assess survivor's patient reported outcomes and experiences appears to be a priority. What are the implications for practitioners? Harmonisation of state and territory survivorship efforts could benefit the care of cancer survivors in Australia.

AH22293Higher fees and out-of-pocket costs in radiotherapy point to a need for funding reform

Kees van Gool 0000-0002-1424-9304, Jane Hall, Philip Haywood 0000-0001-5031-8648, Dan Liu, Serena Yu, Samuel B. G. Webster, Bahare Moradi and Sanchia Aranda 0000-0003-4170-9799
pp. 301-306

What is known about the topic? Out-of-pocket costs have been rising for patients using radiotherapy services funded through the Medicare Benefits Schedule. What does this paper add? At an aggregate level, this paper identifies potential reasons for rising patient and government cost trends. The increasing proportion of benefits paid through the Extended Medicare Safety Net helps explain these trends. What are the implications for practitioners? Despite increasing Medicare funding, some patients face increasing financial barriers. It is important for policymakers to revisit previous reviews of radiation oncology services to ensure that services are easily accessible for all those needing treatment.


What is known about the topic? The Child Dental Benefits Schedule (CDBS) was introduced in 2014 and aimed to support access to dental care for eligible children in Australia. What does this paper add? The analysis without ‘abnormal’ year data (2019–20, COVID-19 pandemic year) supported no statistically significant decrease in hospitalisation rate after the commencement of the CDBS in 2014 until 2019. What are the implications for practitioners? Although CDBS is improving access to dental care for eligible children, any possible effects the CDBS might have on child hospitalisation rates are not yet evident.


What is known about the topic? No research exists in Australia regarding physicians’ legal duties for cost-motivated prescribing when patients are faced with financial barriers to care. What does this paper add? Using personal importation of medicines as an example, this article presents the first legal analysis of physicians’ legal duty to disclose options for more affordable care. What are the implications for practitioners? As patients face ever increasing cost-barriers to care physicians need to seriously consider their responsibilities for helping patients access affordable treatment.

AH22226Health-related outcomes of a facility-based transition care program for older adults: a prospective cohort study

Jo-Aine Hang 0000-0002-7621-8263, Jacqueline Francis-Coad 0000-0002-9892-103X, Angela Jacques, Nicholas Waldron, Kate Purslowe and Anne-Marie Hill 0000-0003-1411-6752
pp. 322-330

What is known about the topic? There is limited evidence comprehensively describing the functional abilities of older adults undertaking transition care programs. Clinicians in this setting need to identify whether older adults have adequate functional ability for successful community living. What does this paper add? Older adults discharged home after completing a transition care program scored below normative community values for gait speed and mobility tasks and had significant decline in performance of instrumental activities of daily living. What are the implications for practitioners? Rehabilitation in transition care needs to be tailored and sufficiently intensive, particularly for lower functioning older adults, to improve the broader aspects of function that are needed for successful independent community living.

AH22296In Australian hospitals and residential aged care facilities, how do we train nursing and direct care staff to assist patients and residents to move? A national survey

Natasha Brusco 0000-0002-8825-5109, Terry Haines, Nicholas F. Taylor, Helen Rawson, Leanne Boyd, Christina Ekegren 0000-0002-7656-6209, Helen Kugler, Helen Dawes, Camilla Radia-George, Christine Graven and Keith Hill
pp. 331-338

What is known about the topic? Little is known about the staff manual handling training programs that aim to prevent nursing staff injuries during patient/resident-assisted movement. What does this paper add? While most Australian hospitals and residential aged care services provide staff training, variability exists from one training program to the next, and few provide upskilling in dynamic risk assessment to improve staff and patient/resident safety. What are the implications for practitioners? Evidenced-based models of staff manual handling training are urgently needed to guide future program development. Common barriers and potential improvements have been identified for consideration in the future.

AH22256Client and staff perspectives regarding effective work injury rehabilitation

Diana Dorstyn 0000-0002-7799-8177, Melissa Oxlad, Sharni Whitburn, Boris Fedoric, Rachel Roberts and Anna Chur-Hansen
pp. 339-343

What is known about the topic? Person-centred approaches are considered best-practice for injury rehabilitation, yet lived experiences are rarely evaluated. What does this paper add? Interviews with clients and rehabilitation staff highlighted the value of allied health treatment delivered alongside return-to-work services. However, systemic barriers limited the quality of this integrated care. What are the implications for practitioners? Effective communication between clients, case managers, employers and health providers should include early discussion about return-to-work expectations. Where possible, jurisdictions may need to reform their return-to-work processes to strengthen this collaboration.

AH23030Optimising rostering patterns for Australian junior doctors

Calvin M. Fletcher 0000-0001-7582-9145 and Laila L. Rotstein
pp. 344-345

What is known about the topic? Increased total work hours for junior doctors are known to increase error, fatigue and burnout. However, the optimal distribution of these hours through rostering patterns is unknown. What does this paper add? This paper summarises considerations required for junior doctor rostering, including fatigue management, adequate training opportunities, and availability of cover for unexpected leave. The paper also describes potential rostering patterns and guidelines that may assist in balancing these considerations. What are the implications for practitioners? Institutions should consider work patterns which prevent fatigue-associated errors while providing adequate training time, exposure, and flexibility.


What is known about the topic? Little is known about the experiences of peer messengers who play a key role in professional accountability programs in hospitals by providing feedback to staff about their behaviour. What does this paper add? Our findings demonstrate that staff will volunteer for a peer messenger role and can be appropriately trained and supported in their roles. Additional support to address challenges, including time scarcity and difficulty effectively communicating information, was desired by messengers. What are the implications for practitioners? Continued support for peer messengers is key to ensuring the effectiveness and sustainability of professional accountability programs.

AH22283Nurse job task analysis: a profile of medical and surgical nursing activities

Julie Considine, Olumuyiwa Omonaiye, Jordana Schlieff and Leanne Boyd
pp. 354-361

What is known about the topic? Task analysis is an evidence-based method used to understand the practices or tasks of health professionals within healthcare systems. What does this paper add? Nurses spent 30.6% of their time in the provision of direct patient care, enrolled and registered nurse activities varied by shift, and there were no significant differences in nursing activities of nurses of different levels of appointment. What are the implications for practitioners? This work provides a foundation for disinvestment in tasks currently performed by nurses that others could do, and how best to optimise nurses’ time and expertise in provision of patient care.

AH22291Projecting the future: modelling Australian dialysis prevalence 2021–30

Dominic Keuskamp, Christopher E. Davies, Georgina L. Irish, Shilpanjali Jesudason and Stephen P. McDonald
pp. 362-368

What is known about the topic? Future growth in the prevalence of dialysis to treat kidney failure is anticipated. Dialysis services are costly and limited, posing a critical problem for consumers, clinicians and service planners. What does this paper add? National trends in dialysis incidence were examined to project numbers for 2021–30. Projected dialysis prevalence had increased 22.5–30.4% by 2030, exceeding population growth, with the greatest increase for people aged ≥70 years. What are the implications for practitioners? Demand for dialysis is projected to grow substantially, and especially for older people with more complex needs and higher healthcare costs. These projections are essential to inform effective healthcare planning for the critical shortage in care.

AH22288Identifying opportunities to optimise the electronic medical record for allied health professionals: a concept mapping study

Maria Schwarz 0000-0001-9367-5696, Elizabeth C. Ward 0000-0002-2680-8978, Anne Coccetti, Joshua Simmons, Sara Burrett, Philip Juffs, Kristy Perkins and Jasmine Foley
pp. 369-378

What is known about the topic? The introduction of an electronic medical record (EMR) is proposed to have numerous clinical and operational benefits. However, optimisation and improved utilisation of an EMR is a continuous process and can be complex due to system and contextual barriers. Currently, little is known about the EMR optimisation opportunities and priorities for allied health professionals (AHPs). What does this paper add? This paper identifies key opportunities for EMR optimisation for AHPs using a concept mapping methodology. Three broad categories of optimisation opportunities were identified, including end-user skills and training; software and system capability; and streamlining processes in relation to collaboration and governance for optimisation requests and enhancements. What are the implications for practitioners? Identifying several changeable and important areas of EMR optimisation for AHPs supports clinicians to create meaningful change in EMR utilisation within their workplace.

AH22281Geospatial distribution of tertiary hospitals across Australian cities

Mazen Baazeem, Estie Kruger and Marc Tennant
pp. 379-385

What is known about the topic? Access to health care is important to maintain public health. There are limited studies to investigate the geospatial data of population and age groups in terms of accessibility to hospitals and emergency departments. What does this paper add? This paper reveals the percentages of population and age groups in terms of accessibility to hospitals. What are the implications for practitioners? The results of this study could be used to locate and improve areas of need with a high burden of disease and low accessibility to healthcare services.

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