ORCID Profile
0000-0001-8489-0693
Current Organisations
University of South Australia
,
Macquarie University
,
University of Adelaide
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Organisational Planning And Management | Health Care Administration | Sociology | Social Change | Industrial and Organisational Psychology | Public Health and Health Services | Health Care Administration | Environmental and Occupational Health and Safety | Health Informatics | Quality Management | Business and Management | Psychology | Human Bioethics | Public Policy | Mental Health | Quality Management |
ANZSRC Socio-Economic Objective (SEO)
Health and Support Services not elsewhere classified | Social structure and health | Public services management | The professions and professionalisation | Changing work patterns | Technological and Organisational Innovation | Mental Health | Health policy evaluation | Productivity | Education policy | Management | Occupational Health
Related Links
Publications
Linking clinical quality indicators to research evidence - a case study in asthma management for children
Publisher: Springer Science and Business Media LLC
Date: 21-07-2017
An animal model of systemic carnitine deficiency produced by haemodialysis of sheep
Publisher: Elsevier BV
Date: 1989
DOI: 10.1016/0305-0491(89)90039-4
Abstract: 1. Sheep, which had previously been surgically prepared with cannulae in various vessels to monitor substrate and metabolite exchanges across all the major organs, were connected to a haemodialysis machine and their blood was dialysed at an average rate of 6.23 ml/min/kg body weight. 2. Dialysis for 4 hr reduced the blood free carnitine concentrations to approx. 50% of the initial values and the concentrations returned to the initial values after 18 hr recovery. 3. Carnitine balance studies showed that approx. twice the amount of carnitine lost from the blood during dialysis passed into the dialysate indicating that carnitine was also lost from the extracellular fluid. 4. The average blood concentration of short-chain acylcarnitines did not vary significantly during dialysis or during the recovery phase. However, an output of short-chain acylcarnitines by the liver at 3 and 18 hr recovery and an uptake by the hind-body at 18 hr recovery was observed. 5. These results suggest that haemodialysis of sheep provides a useful model of systemic carnitine deficiency and suggest that treatment with acetylcarnitine or propionylcarnitine could be an efficient means of supplying carnitine in carnitine replacement therapy.
Mixed methods study on the use of and attitudes towards safety checklists in interventional radiology
Publisher: Wiley
Date: 10-06-2017
Abstract: The use of safety checklists in interventional radiology is an intervention aimed at reducing mortality and morbidity. Currently there is little known about their practical use in Australian radiology departments. The primary aim of this mixed methods study was to evaluate how safety checklists (SC) are used and completed in radiology departments within Australian hospitals, and attitudes towards their use as described by Australian radiologists. A mixed methods approach employing both quantitative and qualitative techniques was used for this study. Direct observations of checklist use during radiological procedures were performed to determine compliance. Medical records were also audited to investigate whether there was any discrepancy between practice (actual care measured by direct observation) and documentation (documented care measured by an audit of records). A focus group with Australian radiologists was conducted to determine attitudes towards the use of checklists. Among the four participating radiology departments, overall observed mean completion of the components of the checklist was 38%. The checklist items most commonly observed to be addressed by the operating theatre staff as noted during observations were correct patient (80%) and procedure (60%). Findings from the direct observations conflicted with the medical record audit, where there was a higher percentage of completion (64% completion) in comparison to the 38% observed. The focus group participants spoke of barriers to the use of checklists, including the culture of radiology departments. This is the first study of safety checklist use in radiology within Australia. Overall completion was low across the sites included in this study. Compliance data collected from observations differed markedly from reported compliance in medical records. There remain significant barriers to the proper use of safety checklists in Australian radiology departments.
A sheep preparation for studying interactions between blood flow and drug disposition. III: Effects of general and spinal anaesthesia on regional blood flow and oxygen tensions.
Publisher: Elsevier BV
Date: 11-1984
Abstract: In awake unrestrained sheep the infusions i.v. of five drugs (cefoxitin, pethidine, chlormethiazole, tocainide and lignocaine) with potentially flow-limited clearance were shown to have no significant haemodynamic effects of their own, nor to have any effects on arterial or venous oxygen tensions. Under general anaesthesia (1.5% end-tidal halothane), haemodynamic changes similar to those previously documented in man occurred. Cardiac output and hepatic blood flow were decreased to 70%, and renal blood flow to 50% of control values heart rate was unchanged and mean arterial pressure decreased by an average of 10%. Hepatic and renal vein oxygen tensions were decreased significantly. Under spinal anaesthesia, apart from a 10% decrease in hepatic blood flow, there were no significant changes in any haemodynamic variables or in the arterial or in any of the venous oxygen tensions. The i.v. infusion of adequate volumes of saline at the time of blockade probably contributed to the maintenance of these indices at their baseline values.
Monitoring in emergency medicine
Publisher: Elsevier BV
Date: 1989
DOI: 10.1016/0300-9572(89)90051-8
Abstract: Clinical observation is the most valuable monitoring technique we have. Complexity and invasiveness of monitoring increases from prehospital care to Emergency Department, to Anaesthesia and Intensive Care. Many methods of monitoring have specific applications. Non-invasive blood pressure monitoring has no advantages over conventional cuff methods, other than freeing the hands of the operator. Non-invasive cardiac output measurement, transcutaneous oxygen and carbon dioxide measurement are unlikely to play a major role in the foreseeable future in the emergency setting. The most exciting development in recent years has been the widespread availability of pulse oximetry, which allows beat by beat analysis of haemoglobin oxygen saturation.
A sheep preparation for studying interactions between blood flow and drug disposition. I: Physiological profile.
Publisher: Elsevier BV
Date: 09-1984
Abstract: A sheep preparation has been developed which allows repeated measurements of regional blood flow, oxygen consumption and drug disposition in awake, unrestrained animals. This allows systematic studies of both acute changes, such as haemodynamic disturbances, and of chronic changes, such as enzyme induction, to be carried out. Good agreement was shown between the values for cardiac output and regional blood flow obtained by the Fick and indicator dilution methods, and those obtained by others using microspheres. Significant day-to-day fluctuations in haemodynamic indices were shown to occur assumptions that hepatic or renal blood flows are constant fractions of cardiac output, or that renal or hepatic flow indicator extraction ratios remain unchanged from day-to-day, will lead to significant errors. Thus, control measurements for each experiment are necessary. It is proposed that physiological models for studying drug disposition based on data from awake, unrestrained animals may provide insight into some mechanisms of changes in drug disposition that cannot be obtained using the traditional compartmental method.
Emergency Physicians’ Views of Direct Notification of Laboratory and Radiology Results to Patients Using the Internet: A Multisite Survey
Publisher: JMIR Publications Inc.
Date: 04-03-2015
DOI: 10.2196/JMIR.3721
A sheep preparation for studying interactions between blood flow and drug disposition. II: Experimental applications.
Publisher: Elsevier BV
Date: 10-1984
Abstract: A sheep preparation has been developed which allows systematic direct studies into the sites and rates of distribution, formation and elimination of both endogenous and exogenous substances and their metabolites. Ex les of some experimental applications are presented which provide information not usually available using traditional methods. Substantial metabolism at sites not usually regarded as important (e.g. limbs, lungs) was shown both for exogenous substances (procainamide and chlormethiazole) and for an endogenous substance (choline). Studies on drug clearance by kidney (cefoxitin), liver (chlormethiazole, pethidine and the optical isomers of mepivacaine) and lung (chlormethiazole) demonstrate that simple first-order elimination should not routinely be assumed to occur, as multiple sites and pathways may be involved, and kinetics may be non-linear as a result of characteristics of both organ flow and organ function. It was also shown that large changes (up to three-fold) in arterial blood drug concentrations may occur because of exogenous (anaesthesia) and endogenous (gastric recycling) perturbations, and that simple compartmental kinetics should not be assumed for either the whole body or in idual organs. This preparation may be used in conjunction with traditional pharmacokinetic methods to resolve complex problems relating to interactions between drugs and the body, to establish a data base for physiological models of drug disposition, and to gain practical insights for drug treatment in patients.
Crisis management during anaesthesia: problems associated with drug administration during anaesthesia
Publisher: BMJ
Date: 06-2005
Crisis management during anaesthesia: awareness and anaesthesia
Publisher: BMJ
Date: 06-2005
Towards safer, better healthcare: harnessing the natural properties of complex sociotechnical systems
Publisher: BMJ
Date: 02-2009
Tracing the foundations of a conceptual framework for a patient safety ontology
Publisher: BMJ
Date: 10-08-2010
Abstract: In work for the World Alliance for Patient Safety on research methods and measures and on defining key concepts for an International Patient Safety Classification (ICPS), it became apparent that there was a need to try to understand how the meaning of patient safety and underlying concepts relate to the existing safety and quality frameworks commonly used in healthcare. To unfold the concept of patient safety and how it relates to safety and quality frameworks commonly used in healthcare and to trace the evolution of the ICPS framework as a basis of the electronic capture of the component elements of patient safety. The ICPS conceptual framework for patient safety has its origins in existing frameworks and an international consultation process. Although its 10 classes and their semantic relationships may be used as a reference model for different disciplines, it must remain dynamic in the ever-changing world of healthcare. By expanding the ICPS by examining data from all available sources, and ensuring rigorous compliance with the latest principles of informatics, a deeper interdisciplinary approach will progressively be developed to address the complex, refractory problem of reducing healthcare-associated harm.
The uptake and elution of lignocaine and procainamide in the hindquarters of the sheep described using mass balance principles.
Publisher: Springer Science and Business Media LLC
Date: 02-1988
DOI: 10.1007/BF01061861
Bradycardia as an early warning sign for cardiac arrest during routine laparoscopic surgery
Publisher: Oxford University Press (OUP)
Date: 29-09-2015
Abstract: The aim of this study was to identify clinical patterns of occurrence, management and outcomes surrounding cardiac arrest during laparoscopic surgery using the Australian Incident Monitoring Study (AIMS) database to guide possible prevention and treatment. The AIMS database includes incident reports from participating clinicians from secondary and tertiary healthcare centres across Australia and New Zealand. The AIMS database holds over 11 000 peri- and intraoperative incidents. The primary outcome was to characterize the pattern of events surrounding cardiac arrest. The secondary outcome was to identify successful management strategies in the possible prevention and treatment of cardiac arrest during laparoscopic surgery. Fourteen cases of cardiac arrest during laparoscopic surgery were identified. The majority of cases occurred in 'fit and healthy' patients during elective gynaecological and general surgical procedures. Twelve cases of cardiac arrest were directly associated with pneumoperitoneum with bradycardia preceding cardiac arrest in 75% of these. Management included deflation of pneumoperitoneum, atropine administration and cardiopulmonary resuscitation with circulatory restoration in all cases. The results imply vagal mechanisms associated with peritoneal distension as the predominant contributor to bradycardia and subsequent cardiac arrest during laparoscopy. Bradycardia during gas insufflation is not necessarily a benign event and appears to be a critical early warning sign for possible impending and unexpected cardiac arrest. Immediate deflation of pneumoperitoneum and atropine administration are effective measures that may alleviate bradycardia and possibly avert progression to cardiac arrest.
The use of mass balance principles to describe regional drug distribution and elimination.
Publisher: Springer Science and Business Media LLC
Date: 02-1988
DOI: 10.1007/BF01061860
Crisis management during anaesthesia: cardiac arrest
Publisher: BMJ
Date: 06-2005
Towards safer drug use in general practice
Publisher: Wiley
Date: 03-1999
DOI: 10.1046/J.1440-1762.1999.00302.X
Abstract: A voluntary, anonymous incident-monitoring study was set up to identify and characterize events or circumstances which could have or did harm a patient in general practice. The study included 673 practitioners who made 2582 reports, of which half (n = 1294) involved medication problems. Amongst these reports, 1556 adverse drug events (ADE) were identified. More common in general practice than in hospitals were problems with therapeutic use (26% vs. 8%), and prescribing of contraindicated medications (15% vs. 5%). In the latter group, 64 reports (4%) involved the prescription of a medication to which the patient was known to be allergic, 66 (4%) involved medication for which there was a recognized potential for a drug interaction, and 68 (4%) involved contraindicated medications due to pathophysiological factors. It was estimated that computer-based prescribing with decision support could eliminate at least a third of these problems in general practice. Further studies are needed to develop this and other preventive strategies.
Making existing technology safer in healthcare
Publisher: BMJ
Date: 08-2010
Abstract: Technology, equipment and medical devices are vital for effective healthcare throughout the world but are associated with risks. These risks include device failure, inappropriate use, insufficient user-training and inadequate inspection and maintenance. Further risks within the developing world include challenging conditions of temperature and humidity, poor infrastructure, poorly trained service providers, limited resources and supervision, and inappropriately complex equipment being supplied without backup training for its use or maintenance. This document is the product of an expert working group established by WHO Patient Safety to define the measures being taken to reduce these risks. It considers how the provision of safer technology services worldwide is being enhanced in three ways: through non-punitive and open reporting systems of technology-related adverse events and near-misses, with classification and investigation through healthcare quality assessment, accreditation and certification and by the investigation of how appropriate design and an understanding of the conditions of use and associated human factors can improve patient safety. Many aspects of these steps remain aspirational for developing countries, where highly disparate needs and a vast range of technology-related problems exist. Here, much greater emphasis must be placed on failsafe, durable and user-friendly design--ex les of which are described.
Identifying and classifying incidents related to health information technology in medical imaging as a basis for improvements in practice
Publisher: IEEE
Date: 12-2019
Identifying and characterizing the 18 steps of medical imaging process workflow as a basis for targeting improvements in clinical practice
Publisher: IEEE
Date: 12-2019
Clinical safety of England's national programme for IT: A retrospective analysis of all reported safety events 2005 to 2011
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.IJMEDINF.2014.12.003
Abstract: To analyse patient safety events associated with England's national programme for IT (NPfIT). Retrospective analysis of all safety events managed by a dedicated IT safety team between September 2005 and November 2011 was undertaken. Events were reviewed against an existing classification for problems associated with IT. The proportion of reported events per problem type, consequences, source of report, resolution within 24h, time of day and day of week were examined. Sub-group analyses were undertaken for events involving patient harm and those that occurred on a large scale. Of the 850 events analysed, 68% (n=574) described potentially hazardous circumstances, 24% (n=205) had an observable impact on care delivery, 4% (n=36) were a near miss, and 3% (n=22) were associated with patient harm, including three deaths (0·35%). Eleven events did not have a noticeable consequence (1%) and two were complaints (<1%). Amongst the events 1606 separate contributing problems were identified. Of these 92% were predominately associated with technical rather than human factors. Problems involving human factors were four times as likely to result in patient harm than technical problems (25% versus 8% OR 3·98, 95%CI 1·90-8.34). Large-scale events affecting 10 or more in iduals or multiple IT systems accounted for 23% (n=191) of the s le and were significantly more likely to result in a near miss (6% versus 4%) or impact the delivery of care (39% versus 20% p<0·001). Events associated with NPfIT reinforce that the use of IT does create hazardous circumstances and can lead to patient harm or death. Large-scale patient safety events have the potential to affect many patients and clinicians, and this suggests that addressing them should be a priority for all major IT implementations.
Health service accreditation as a predictor of clinical and organisational performance: a blinded, random, stratified study
Publisher: BMJ
Date: 02-2010
Abstract: Despite the widespread use of accreditation in many countries, and prevailing beliefs that accreditation is associated with variables contributing to clinical care and organisational outcomes, little systematic research has been conducted to examine its validity as a predictor of healthcare performance. To determine whether accreditation performance is associated with self-reported clinical performance and independent ratings of four aspects of organisational performance. Independent blinded assessment of these variables in a random, stratified s le of health service organisations. Acute care: large, medium and small health-service organisations in Australia. Study participants Nineteen health service organisations employing 16 448 staff treating 321 289 inpatients and 1 971 087 non-inpatient services annually, representing approximately 5% of the Australian acute care health system. Correlations of accreditation performance with organisational culture, organisational climate, consumer involvement, leadership and clinical performance. Results Accreditation performance was significantly positively correlated with organisational culture (rho=0.618, p=0.005) and leadership (rho=0.616, p=0.005). There was a trend between accreditation and clinical performance (rho=0.450, p=0.080). Accreditation was unrelated to organisational climate (rho=0.378, p=0.110) and consumer involvement (rho=0.215, p=0.377). Accreditation results predict leadership behaviours and cultural characteristics of healthcare organisations but not organisational climate or consumer participation, and a positive trend between accreditation and clinical performance is noted.
What is the impact of an electronic test result acknowledgement system on Emergency Department physicians’ work processes? A mixed-method pre-post observational study
Publisher: Elsevier BV
Date: 03-2001
DOI: 10.1016/J.IJMEDINF.2016.12.006
Abstract: To examine the impact of an electronic Results Acknowledgement (eRA) system on emergency physicians' test result management work processes and the time taken to acknowledge microbiology and radiology test results for patients discharged from an Emergency Department (ED). The impact of the eRA system was assessed in an Australian ED using: a) semi-structured interviews with senior emergency physicians and b) a time and motion direct observational study of senior emergency physicians completing test acknowledgment pre and post the implementation of the eRA system. The eRA system led to changes in the way results and actions were collated, stored, documented and communicated. Although there was a non-significant increase in the average time taken to acknowledge results in the post period, most types of acknowledgements (other than simple acknowledgements) took less time to complete. The number of acknowledgements where physicians sought additional information from the Electronic Medical Record (EMR) rose from 12% pre to 20% post implementation of eRA. Given that the type of results are unlikely to have changed significantly across the pre and post implementation periods, the increase in the time physicians spent accessing additional clinical information in the post period likely reflects the greater access to clinical information provided by the integrated electronic system. Easier access to clinical information may improve clinical decision making and enhance the quality of patient care. For instance, in situations where a senior clinician, not initially involved in the care process, is required to deal with the follow-up of non-normal results.
Continuing differences between health professions' attitudes: the saga of accomplishing systems-wide interprofessionalism
Publisher: Oxford University Press (OUP)
Date: 29-11-2012
Abstract: To compare four health professions' attitudes towards interprofessional collaboration (IPC) and their evaluations of a programme aimed at enhancing IPC across a health system. Questionnaire survey. Australian Capital Territory health services. S le of medical (38), nursing (198), allied health (152) and administrative (30) staff. s) A 4-year action research project to improve IPC. Questionnaire evaluating the project and responses to the 'Attitudes toward Health Care Teams' and 'Readiness for Interprofessional Learning' scales. Significant professional differences occurred in 90% of the evaluation items. Doctors were the least and administrative staff most likely to agree project aims had been met. Nurses made more favourable assessments than did allied health staff. Doctors made the most negative assessments and allied health staff the most neutral ratings. Improved interprofessional sharing of knowledge, teamwork and patient care were among the goals held to have been most achieved. Reduction in interprofessional rivalry and improved trust and communication were least achieved. Average assessment of in idual goals being met was agree (31.9%), neutral (56.9%) and disagree (11.2%). On the two attitude scales, allied health professionals were most supportive of IPC, followed by nurses, administrators and doctors. Although overall attitudes towards IPC were favourable, only a third of participants reported that project goals had been achieved indicating the difficulties of implementing systems change. The response profiles of the professions differed. As in the previous research, doctors were least likely to hold favourable attitudes towards or endorse benefits from social or structural interventions in health care.
A prospective, multi-method, multi-disciplinary, multi-level, collaborative, social-organisational design for researching health sector accreditation [LP0560737]
Publisher: Springer Science and Business Media LLC
Date: 12-2006
Abstract: Accreditation has become ubiquitous across the international health care landscape. Award of full accreditation status in health care is viewed, as it is in other sectors, as a valid indicator of high quality organisational performance. However, few studies have empirically demonstrated this assertion. The value of accreditation, therefore, remains uncertain, and this persists as a central legitimacy problem for accreditation providers, policymakers and researchers. The question arises as to how best to research the validity, impact and value of accreditation processes in health care. Most health care organisations participate in some sort of accreditation process and thus it is not possible to study its merits using a randomised controlled strategy. Further, tools and processes for accreditation and organisational performance are multifaceted. To understand the relationship between them a multi-method research approach is required which incorporates both quantitative and qualitative data. The generic nature of accreditation standard development and inspection within different sectors enhances the extent to which the findings of in-depth study of accreditation process in one industry can be generalised to other industries. This paper presents a research design which comprises a prospective, multi-method, multi-level, multi-disciplinary approach to assess the validity, impact and value of accreditation. The accreditation program which assesses over 1,000 health services in Australia is used as an exemplar for testing this design. The paper proposes this design as a framework suitable for application to future international research into accreditation. Our aim is to stimulate debate on the role of accreditation and how to research it.
An analysis of Australian adverse drug events
Publisher: Wiley
Date: 03-1999
DOI: 10.1046/J.1440-1762.1999.00289.X
Abstract: Previous research has shown that there is a high error rate associated with medication use, resulting in significant patient morbidity and mortality, as well as increasing health care costs. Analysis of available Australian data on adverse drug events shows that incident monitoring and retrospective medical record review provide different, but complementary 'windows' into the errors that occur. While retrospective medical record review provides information on the frequency of specific adverse drug events, incident monitoring gives an insight into the contributing factors. From this information, priorities can be set and preventative strategies can be developed.
Evaluation of an intervention aimed at improving voluntary incident reporting in hospitals
Publisher: BMJ
Date: 06-2007
Crisis management during anaesthesia: the development of an anaesthetic crisis management manual
Publisher: BMJ
Date: 06-2005
Australian GP management of osteoarthritis following the release of the RACGP guideline for the non-surgical management of hip and knee osteoarthritis
Publisher: Springer Science and Business Media LLC
Date: 05-10-2015
Experimental Analysis of Catheter-Manometer Systems In Vitro and In Vivo
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-1989
DOI: 10.1097/00000542-198912000-00013
Abstract: The static and dynamic responses of two combinations of transducer lifiers, pressure transducers, resonance elimination devices, extension tubing, and transcutaneous cannulae were tested in vitro using a sine-wave pressure generator, and in vivo by square-wave pressures generated by a "fast-flush" device. In addition, carotid arterial blood pressure waveforms recorded by these systems in sheep, at two different heart rates, were compared with those simultaneously recorded with a catheter-tip pressure transducer. A new term, "Working Heart Rate" is defined and allows for the prediction of the maximum heart rate up to which a system of given frequency response and d ing coefficient should be accurate. When tested in vitro, all the monitoring systems were underd ed and resonated. The performance of all systems was improved by inclusion of an adjustable resonance elimination device but impaired by a nonadjustable resonance eliminator or by recording with an electronically filtered lifier. When tested in vivo, the accuracy of mean and diastolic blood pressure measurement was not affected by any combination of heart rate, lifier, length of extension tubing, or use of resonance eliminators. Both resonance elimination devices improved the performance of all systems. In contrast to predictions based on frequency response and d ing, the smallest errors in systolic blood pressure were recorded using the electronic filter or the nonadjustable resonance eliminator. There were considerable and misleading differences between the frequency responses and d ing coefficients calculated in vitro and those, for the same systems, derived from the in vivo fast-flush tests. It is concluded that the most accurate and consistent readings of systolic blood pressure will be achieved with the use of either an electronic filter or a nonadjustable resonance eliminator.
Regional pharmacokinetics. II. Experimental methods.
Publisher: Wiley
Date: 12-1990
Abstract: Regional pharmacokinetics is the study of the drug concentrations in specific regions of the body. It allows greater insight into the mechanisms of drug disposition than the study of systemic blood concentrations. Experimental methods in regional pharmacokinetics and their applications and limitations are reviewed. Post-mortem tissue biopsies give the drug concentrations in highly specific regions of the body, but require a large number of animals. Serial tissue biopsies yield the time-course of drug concentrations in in idual animals, but have limited applications. Regional blood s ling in vivo requires catheterization of blood vessels and a measure of regional blood flow, but allows repeated measurements of the time-course of regional drug concentrations in an in idual. In contrast, artificially perfused regions allow greater control of perfusate flow and composition, but are less representative of the in vivo situation. These factors can be retained in some animals by surgically transplanting organs to another location to increase access. Tissues slices and cell cultures can examine drug uptake in the absence of perfusion, and tissue homogenates can be used to study the in vitro rates of drug metabolism and tissue drug binding.
Comparing clinical quality indicators for asthma management in children with outcome measures used in randomised controlled trials: a protocol
Publisher: BMJ
Date: 09-2015
Establishing a global learning community for incident-reporting systems
Publisher: BMJ
Date: 10-2010
Abstract: Incident-reporting systems (IRS) collect snapshots of hazards, mistakes and system failures occurring in healthcare. These data repositories are a cornerstone of patient safety improvement. Compared with systems in other high-risk industries, healthcare IRS are fragmented and isolated, and have not established best practices for implementation and utilisation. Patient safety experts from eight countries convened in 2008 to establish a global community to advance the science of learning from mistakes. This convenience s le of experts all had experience managing large incident-reporting systems. This article offers guidance through a presentation of expert discussions about methods to identify, analyse and prioritise incidents, mitigate hazards and evaluate risk reduction.
Complete retrograde dysmnesia
Publisher: Springer Science and Business Media LLC
Date: 1995
DOI: 10.1007/BF01627411
Australian general practitioner attitudes to clinical practice guidelines and some implications for translating osteoarthritis care into practice
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/PY15079
Abstract: Clinical practice guidelines (CPGs) have been shown to improve processes of care and health outcomes, but there is often a discrepancy between recommendations for care and clinical practice. This study sought to explore general practitioner (GP) attitudes towards CPGs, in general and specifically for osteoarthritis (OA), with the implications for translating OA care into practice. A self-administered questionnaire was conducted in January 2013 with a s le of 228 GPs in New South Wales and South Australia. Seventy-nine GPs returned questionnaires (response rate 35%). Nearly all GPs considered that CPGs support decision-making in practice (94%) and medical education (92%). Very few respondents regarded CPGs as a threat to clinical autonomy, and most recognised that in idual patient circumstances must be taken into account. Shorter CPG formats were preferred over longer and more comprehensive formats, with preferences being evenly ided among respondents for short, 2–3-page summaries, flowcharts or algorithms and single page checklists. GPs considered accessibility to CPGs to be important, and electronic formats were popular. Familiarity and use of The Royal Australian College of General Practitioners OA Guideline was poor, with most respondents either not aware of it (30% 95% confidence interval (CI) 27 – 41%), had never used it (19% 95% CI 12 – 29%) or rarely used it (34% 95% CI 25–45%). If CPGs are to assist with the translation of evidence into practice, they must be easily accessible and in a format that encourages use.
Investigating Errors in Medical Imaging: Lessons for Practice From Medicolegal Closed Claims
Publisher: Elsevier BV
Date: 09-2015
An analysis of computer-related patient safety incidents to inform the development of a classification
Publisher: Oxford University Press (OUP)
Date: 11-2010
Quality of health care for children in Australia, 2012-2013
Publisher: American Medical Association (AMA)
Date: 20-03-2018
Patient safety's missing link: using clinical expertise to recognize, respond to and reduce risks at a population level
Publisher: Oxford University Press (OUP)
Date: 15-11-2015
A sheep preparation for studying interactions between blood flow and drug disposition. V: The effects of general and subarachnoid anaesthesia on blood flow and pethidine disposition.
Publisher: Elsevier BV
Date: 08-1986
DOI: 10.1093/BJA/58.8.888
Abstract: Blood flow through and pethidine extraction ratios across lungs, liver, kidneys and the gastrointestinal tract were measured in awake unrestrained sheep (controls) and with the animals anaesthetized with 1.5% halothane or whilst undergoing high thoracic subarachnoid block with amethocaine. In the control studies, pethidine infused to several times the blood concentrations required for postoperative analgesia in man produced no significant changes in haemodynamics or in the kinetics of iodohippurate (renal and hepatic blood flow) pethidine hepatic extraction ratios were consistently greater than 0.97 renal extraction ratios ranged from negligible to 0.30 and there was negligible extraction across the lungs and the gastrointestinal tract. Under general anaesthesia there were significant reductions in mean cardiac output (46%), mean hepatic blood flow (46%), mean renal blood flow (55%), mean arterial pressure (30%) and mean iodohippurate clearance (17%) but mean arterial blood concentrations of pethidine were doubled, mean hepatic clearance of pethidine was reduced to 60% of control and renal clearance was virtually abolished. With subarachnoid anaesthesia there were no significant changes in haemodynamics or in pethidine or iodohippurate extraction ratios or clearances. Summed measured regional clearances accounted for only one- to two-thirds of the total body clearance of pethidine the rest was by extravisceral clearance or high affinity tissue binding.
Clinical indicators for common paediatric conditions
Publisher: Public Library of Science (PLoS)
Date: 09-01-2019
Crisis management during anaesthesia: recovering from a crisis
Publisher: BMJ
Date: 06-2005
CareTrack Australia: Assessing the appropriateness of adult healthcare: Protocol for a retrospective medical record review
Publisher: BMJ
Date: 2012
Adverse events in health care: Setting priorities based on economic evaluation
Publisher: Wiley
Date: 03-1999
DOI: 10.1046/J.1440-1762.1999.00301.X
Abstract: Adverse events arising from health-care management, rather than a disease process, may place as great a burden on society as all other forms of injury put together. By analysing data from the Quality in Australian Health Care Study (a retrospective review of 14 179 medical records representative of admissions to Australian acute care hospitals in 1992), and applying costing techniques based on Diagnosis Related Group (DRG) cost weights, it is possible to compare the economic impacts of different kinds of adverse events. This can assist in determining priorities for interventions. However, due to limitations inherent in DRG cost weights, there is a need to employ further techniques to refine the costing base of adverse events so that it more closely reflects their resource use. Decisions to invest resources in strategies that reduce the risk of adverse events can then be properly informed by economic data.
Does health information technology improve acknowledgement of radiology results for discharged Emergency Department patients? A before and after study
Publisher: Springer Science and Business Media LLC
Date: 03-06-2020
DOI: 10.1186/S12911-020-01135-9
Abstract: The inadequate follow-up of test results is a key patient safety concern, carrying severe consequences for care outcomes. Patients discharged from the emergency department are at particular risk of having test results pending at discharge due to their short lengths of stay, with many hospitals acknowledging that they do not have reliable systems for managing such results. Health information technology hold the potential to reducing errors in the test result management process. This study aimed to measure changes in the proportion of acknowledged radiology reports pre and post introduction of an electronic result acknowledgement system and to determine the proportion of reports with abnormal results, including clinically significant abnormal results requiring follow-up action. A before and after study was conducted in the emergency department of a 450-bed metropolitan teaching hospital in Australia. All radiology reports for discharged patients for a one-month period before and after implementation of the electronic result acknowledgement system were reviewed to determine i) those that reported abnormal results ii) evidence of test result acknowledgement. All unacknowledged radiology results with an abnormal finding were assessed by an independent panel of two senior emergency physicians for clinical significance. Of 1654 radiology reports in the pre-implementation period 70.6% ( n = 1167) had documented evidence of acknowledgement by a clinician. For reports with abnormal results, 71.6% ( n = 396) were acknowledged. Of 157 unacknowledged abnormal radiology reports reviewed by an independent emergency physician panel, 34.4% ( n = 54) were identified as clinically significant and 50% of these ( n = 27) were deemed to carry a moderate likelihood of patient morbidity if not followed up. Electronic acknowledgement occurred for all radiology reports in the post period ( n = 1423), representing a 30.4% (95% CI: 28.1–32.6%) increase in acknowledgement rate, and an increase of 28.4% (95% CI: 24.6–32.2%) for abnormal radiology results. The findings of this study demonstrate the potential of health information technology to improve the safety and effectiveness of the diagnostic process by increasing the rate of follow up of results pending at hospital discharge.
I.V. BOLUS ADMINISTRATION OF SUBCONVULSIVE DOSES OF LIGNOCAINE TO CONSCIOUS SHEEP: MYOCARDIAL PHARMACOKINETICS
Publisher: Elsevier BV
Date: 03-1993
DOI: 10.1093/BJA/70.3.326
Abstract: Mass balance principles were used to study the myocardial pharmacokinetics of lignocaine in conscious sheep. After i.v. bolus doses of lignocaine 50, 75 or 100 mg, arterial lignocaine concentrations reached a peak in approximately 16 s and these increased linearly with dose. Coronary sinus concentrations reached a peak between 83 and 129 s and the values showed poor relationships with dose. Net myocardial lignocaine uptake lasted for approximately 60 s--this was much shorter than the reported initial distribution half-life of lignocaine. The maximum rate of uptake was proportional to both the dose and the peak arterial lignocaine concentrations. At 15 min, the myocardial lignocaine concentrations were 46 (SD 22)% of their peak values. Pseudo-equilibrium between blood and myocardial lignocaine concentrations was not observed. It is concluded that, despite the myocardium being very well perfused, lignocaine myocardial concentrations were not well represented by blood lignocaine concentrations for at least 15 min. A greater understanding of the determinants of myocardial drug concentrations is required.
CareTrack Kids--part 1. Assessing the appropriateness of healthcare delivered to Australian children: study protocol for clinical indicator development
Publisher: BMJ
Date: 08-04-2015
A classification for adverse drug events
Publisher: Wiley
Date: 03-1999
DOI: 10.1046/J.1440-1762.1999.00286.X
Abstract: There is considerable evidence that a large number of patients suffer adverse events arising from their health-care management. A significant proportion of these iatrogenic injuries occur as a result of medication errors. Before prevention strategies can be developed, it is necessary to understand the types of errors that are occurring. In order to set priorities, it is necessary to identify the frequency and impact of the various types of medication errors. To fully investigate medication incidents, it is necessary to classify the information in a way that allows the frequencies, causes and contributing factors to be analysed. The development of a sub-branch of the 'Generic Occurrence Classification', specific to medication incidents, allows this analysis to occur.
CareTrack Kids--part 2. Assessing the appropriateness of the healthcare delivered to Australian children: study protocol for a retrospective medical record review
Publisher: BMJ
Date: 08-04-2015
I.V. BOLUS ADMINISTRATION OF SUBCONVULSIVE DOSES OF LIGNOCAINE TO CONSCIOUS SHEEP: RELATIONSHIPS BETWEEN MYOCARDIAL PHARMACOKINETICS AND PHARMACODYNAMICS
Publisher: Elsevier BV
Date: 05-1993
DOI: 10.1093/BJA/70.5.556
Abstract: We have studied relationships between the time-courses of lignocaine concentrations in arterial and coronary sinus blood and myocardial tissue, and negative inotropic effects on the myocardium, after i.v. bolus administration of 50-, 75- or 100-mg doses of lignocaine to conscious, chronically instrumented sheep. Peak arterial and coronary sinus blood lignocaine concentrations occurred 26-38 s before and 29-78 s after the maximum decreases in myocardial contractility, respectively. Peak myocardial concentrations occurred simultaneously with the maximum decreases in myocardial contractility, except for the 100-mg doses. Anti-clockwise hysteresis occurred only between arterial blood lignocaine concentrations and the negative inotropic effect. It was concluded that, after short-term i.v. administration, only the myocardial concentrations of lignocaine were in pseudoequilibrium with the negative inotropic effects of the lignocaine on the myocardium.
CareTrack Aged: the appropriateness of care delivered to Australians living in residential aged care facilities: a study protocol
Publisher: BMJ
Date: 06-2019
DOI: 10.1136/BMJOPEN-2019-030988
Abstract: The aged population is increasing rapidly across the world and this is expected to continue. People living in residential aged care facilities (RACFs) represent amongst the sickest and frailest cohort of the aged population, with a high prevalence of chronic conditions and complex comorbidities. Given the vulnerability of RACF residents and the demands on the system, there is a need to determine the extent that care is delivered in line with best practice (‘appropriate care’) in RACFs. There is also a recognition that systems should provide care that optimises quality of life (QoL), which includes support for physical and psychological well-being, independence, social relationships, personal beliefs and a caring external environment. The aims of CareTrack Aged are to develop sets of indicators for appropriate care and processes of care for commonly managed conditions, and then assess the appropriateness of care delivered and QoL of residents in RACFs in Australia. We will extract recommendations from clinical practice guidelines and, using expert review, convert these into sets of indicators for 15 common conditions and processes of care for people living in RACFs. We will recruit RACFs in three Australian states, and residents within these RACFs, using a stratified multistage s ling method. Experienced nurses, trained in the CareTrack Aged methods (‘surveyors’), will review care records of recruited residents within a 1-month period in 2019 and 2020, and assess the care documented against the indicators of appropriate care. Surveyors will concurrently assess residents’ QoL using validated questionnaires. The study has been reviewed and approved by the Human Research Ethics Committee of Macquarie University (5201800386). The research findings will be published in international and national journals and disseminated through conferences and presentations to interested stakeholder groups, including consumers, national agencies, healthcare professionals, policymakers and researchers.
Failures in Transition: Learning from Incidents Relating to Clinical Handover in Acute Care
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2013
DOI: 10.1111/J.1945-1474.2011.00189.X
Abstract: The appropriate handover of patients, whereby responsibility and accountability of care is transferred between healthcare providers, is a critical component of quality healthcare delivery. This paper examines data from recent incidents relating to clinical handover in acute care settings, in order to provide a basis for the design and implementation of preventive and corrective strategies. A s le of incidents (n = 459) relating to clinical handover was extracted from an Australian health service's incident reporting system using a manual search function. Incident narratives were subjected to classification according to the system safety and quality concepts of failure type, error type, and failure detection mechanism. The most prevalent failure types associated with clinical handover were those relating to the transfer of patients without adequate handover 28.8% (n = 132), omissions of critical information about the patient's condition 19.2% (n = 88), and omissions of critical information about the patient's care plan during the handover process 14.2% (n = 65). The most prevalent failure detection mechanisms were those of expectation mismatch 35.7% (n = 174), clinical mismatch 26.9% (n = 127), and mismatch with other documentation 24.0% (n = 117). The findings suggest the need for a structured approach to handover with a recording of standardized sets of information to ensure that critical components are not omitted. Limitations of existing reporting processes are also highlighted.
International standards for safety in the intensive care unit
Publisher: Springer Science and Business Media LLC
Date: 03-1993
DOI: 10.1007/BF01720538
Where Failures Occur in the Imaging Care Cycle: Lessons From the Radiology Events Register
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1016/J.JACR.2010.03.013
Abstract: Adverse events contribute to significant patient morbidity and mortality on a global scale, and this has been documented in a number of international studies. Despite this, there is limited understanding of medical imaging's involvement in such events. Incident reporting is a key feature of high-reliability organizations because, understandably, it is essential to know where things go wrong and why as the very first step in formulating preventative and corrective strategies. Although anesthesiology has led the way, health care in general has been slow to adopt this technique, and this includes medical imaging. Knowledge as to where medical imaging incidents are initiated and detected, and why, is not well documented or appreciated, although this is critical information in relation to quality improvement. Using an online radiology reporting system, the authors therefore sought to gain further insight and also ascertain where failures are located in the imaging cycle, and whether different incidents sources provide different information. Last, the authors sought to examine the resilience of the imaging system using these incident data.
Establishing National Medical Imaging Incident Reporting Systems: Issues and Challenges
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1016/J.JACR.2010.03.014
Abstract: Radiology incident reporting systems provide one source of invaluable patient safety data that, when combined with appropriate analysis and action, can result in significantly safer health care, which is now an urgent priority for governments worldwide. Such systems require integration into a wider safety, quality, and risk management framework because many issues have global implications, and they also require an international classification scheme, which is now being developed. These systems can be used to inform global research activities as identified by the World Health Organization, many of which intersect with the activities of and issues seen in medical imaging departments. How to ensure that radiologists (and doctors in general) report incidents, and are engaged in the process, is a challenge. However, as demonstrated with the ex le of the Australian Radiology Events Register, this can be achieved when the reporting system is integrated with their professional organization and its other related activities (such as training and education) and administered by a patient safety organization.
The effects of general anaesthesia on tocainide clearance in the sheep.
Publisher: Informa UK Limited
Date: 1987
DOI: 10.3109/00498258709043989
Abstract: The haemodynamic effects and regional clearances of tocainide were investigated in sheep with chronic intravascular cannulae to measure blood flow through, and drug extraction by, lungs, kidneys, liver and gut. 2. Tocainide, at arterial blood concentrations in the therapeutic range, caused no haemodynamic effects and was significantly extracted only by the liver. 3. In the presence of general anaesthesia with halothane, the mean hepatic blood flow and tocainide extraction ratio were each reduced by approximately 25% so that the mean hepatic clearance and intrinsic clearance of tocainide each were reduced by approximately 50%. Thus arterial blood tocainide concentrations were increased by 50%. 4. While the clinical implications of this interaction are unclear because of insufficient information about the margin of safety of tocainide, the pharmacological implications are plain. Because general anaesthesia may alter the relationship between dose and blood drug concentrations, pharmacokinetic and pharmacodynamic data should not be interchanged between awake and anaesthetized subjects.
Description of a mechanistic approach to pain management in advanced cancer. Preliminary report
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-1992
DOI: 10.1016/0304-3959(92)90256-B
Abstract: 1. Multi-unit and single-unit recordings were made of muscle spindle afferent activity from the pretibial muscles of human subjects who were initially relaxed. The muscles were subjected to a stretching perturbation of 1 s duration, occurring irregularly, on average once every 5 s. In test sequences, an auditory or visual warning was provided 1 . 06 s before some of the perturbations. Subjects were required to oppose every perturbation by contracting the receptor-bearing muscle as rapidly as possible. 2. Following the warning all subjects sometimes tensed the receptor-bearing muscle unintentionally in preparation for the perturbation. In these contractions, the discharge of a spindle ending accelerated only if the contraction strength exceeded the ending's threshold for activation, established in control voluntary contractions performed under isometric conditions. 3. When the receptor-bearing muscle did not contract in the interval between warning and perturbation, there was no detectable change in the multi-unit recordings of spindle activity or in recordings from twelve of thirteen single spindle afferents. The thirteenth spindle afferent discharged prior to the perturbation in the absence of detectable e.m.g. in response to (only) three of twenty-three warning stimuli. However, this ending had been so responsive during isometric voluntary contractions that a contraction level at which it did not respond could not be established, and it is suggested that the findings with this ending resulted from its low threshold rather than from selective activation of the fusimotor system. 4. When subjects were warned of the perturbations, the dynamic response of spindle endings to the perturbations was not increased in size or altered in latency. 5. The motor response to perturbations without warning generally contained only long-latency (volitional) e.m.g. activity occurring 107--200 ms after the onset of the perturbation. When a warning was given, short-latency (reflex) e.m.g. activity was also recorded, beginning 46--76 ms after the onset of the perturbation. 6. It is concluded that anticipation of the need to contract a muscle does not result in selective activation of fusimotor neurones in preparation for the contraction. The change in stretch reflex gain that occurs as a result of 'anticipation' occurs through a central process which does not involve the fusimotor system.
Using FDA reports to inform a classification for health information technology safety problems
Publisher: Oxford University Press (OUP)
Date: 2012
The development of a crisis management manual for anesthetists and anesthesiologists
Publisher: Elsevier BV
Date: 09-2007
Towards the delivery of appropriate health care in Australia
Publisher: AMPCo
Date: 07-2012
DOI: 10.5694/MJA12.10799
6 Incident monitoring
Publisher: Elsevier BV
Date: 07-1996
Effects of Two Commercial Electronic Prescribing Systems on Prescribing Error Rates in Hospital In-Patients: A Before and After Study
Publisher: Public Library of Science (PLoS)
Date: 31-01-2012
A four-year, systems-wide intervention promoting interprofessional collaboration
Publisher: Springer Science and Business Media LLC
Date: 20-04-2012
A sheep preparation for studying interactions between blood flow and drug disposition. IV: The effects of general and spinal anaesthesia on blood flow and cefoxitin disposition.
Publisher: Elsevier BV
Date: 12-1985
Abstract: Control measurements of blood flow through and cefoxitin extraction ratios across heart and lungs, liver, kidneys and gut were made under steady-state conditions in awake unrestrained sheep. The studies then were repeated with the same animals anaesthetized with 1.5% halothane or whilst undergoing high thoracic (to approximately T4) subarachnoid blockade with amethocaine. In the control-drug studies, it was shown that cefoxitin was cleared by the kidneys and that the cefoxitin infusion produced no significant changes in haemodynamics or in the kinetics of iodohippurate (the marker substance used for determining renal blood flow). Under general anaesthesia, there were significant reductions in renal blood flow (to 61% of the mean control value), in iodohippurate renal extraction ratio and clearance (to, respectively, 64 and 38% of the mean control values) and in cefoxitin renal extraction ratio and clearance (to, respectively, 48 and 23% of the mean control values). Under spinal anaesthesia there were no significant changes in haemodynamics or in cefoxitin or iodohippurate extraction ratios or clearances.
CareTrack Kids--part 3. Adverse events in children's healthcare in Australia: study protocol for a retrospective medical record review
Publisher: BMJ
Date: 08-04-2015
Nation-scale adoption of new medicines by doctors: an application of the Bass diffusion model
Publisher: Springer Science and Business Media LLC
Date: 10-08-2012
Safety Concerns regarding article: Reliability and Validity of a Self-paced Cardiopulmonary Exercise Test in Post-MI Patients. L. A. Jenkins, A. Mauger, J. Fisher, J. Hopker. Int J Sports Med 2017; 38
Publisher: Georg Thieme Verlag KG
Date: 07-2017
Evidence-based risk factors for postoperative deep vein thrombosis
Publisher: Wiley
Date: 12-2004
DOI: 10.1111/J.1445-1433.2004.03258.X
Abstract: Deep vein thrombosis (DVT) is a common postoperative complication that is associated with significant morbidity and mortality. Thromboprophylaxis has been shown to be underused. In the absence of prophylaxis, rates as high as 50% have been reported following orthopaedic surgery, and 25% following general surgery. Many risk factors have been suggested but there is often little evidence to support these claims. A systematic review was performed to determine the evidence base behind each suggested risk factor, and, where sufficient data were available, a random-effects meta-analysis was performed. There is evidence to support a significant association between increased age, obesity, a past history of thromboembolism, varicose veins, the oral contraceptive pill, malignancy, Factor V Leiden gene mutation, general anaesthesia and orthopaedic surgery, with higher rates of postoperative DVT, although there remain some variables within the study designs that may lead to overestimation of effect. There is no evidence to support the suggested risk factors of hormone replacement therapy, gender, ethnicity or race, chemotherapy, other thrombophilias, cardiovascular factors, smoking and blood type. An accurate knowledge of evidence-based risk factors is important in predicting and preventing postoperative DVT, and can be incorporated into a decision support system for appropriate thromboprophylaxis use.
Inadequate pre-operative evaluation and preparation: a review of 197 reports from the Australian Incident Monitoring Study
Publisher: Wiley
Date: 12-2000
DOI: 10.1046/J.1365-2044.2000.01725.X
Abstract: The Australian Incident Monitoring Study database was examined for incidents involving inadequate pre-operative patient preparation and/or evaluation. Of 6271 reports, 727 had appropriate keywords, of which 197 (3.1%) were used for subsequent analysis. All surgical categories were represented. In 10% of reports the patient was not reviewed pre-operatively by an anaesthetist, whilst in 23% the anaesthetist involved in the operating theatre had not performed the pre-operative assessment. Death followed in seven cases, major morbidity in 23 cases, admission to a high-dependency unit or intensive care unit in 17 cases, and surgery was cancelled in nine cases. Poor airway assessment, communication problems and inadequate evaluation were the most common contributing factors. Respondents indicated that the incident was preventable in 57% of cases. Proposed corrective strategies include improved communication, quality assurance activities, development of protocols and additional training. A structured assessment of the airway, along with improvements in information exchange, patient assessment, and use of clearly defined patient management plans and pathways would prevent most of the incidents reported.
Is it time for consultants to join trainees in working night shifts? Yes
Publisher: Wiley
Date: 07-09-2014
STANDING Collaboration: a study protocol for developing clinical standards
Publisher: BMJ
Date: 10-2017
DOI: 10.1136/BMJOPEN-2016-014048
Abstract: Despite widespread availability of clinical practice guidelines (CPGs), considerable gaps continue between the care that is recommended (‘appropriate care’) and the care provided. Problems with current CPGs are commonly cited as barriers to providing ’appropriate care'. Our study aims to develop and test an alternative method to keep CPGs accessible and up to date. This method aims to mitigate existing problems by using a single process to develop clinical standards (embodied in clinical indicators) collaboratively with researchers, healthcare professionals, patients and consumers. A transparent and inclusive online curated (purpose-designed, custom-built, wiki-type) system will use an ongoing and iterative documentation process to facilitate synthesis of up-to-date information and make available its provenance. All participants are required to declare conflicts of interest. This protocol describes three phases: engagement of relevant stakeholders design of a process to develop clinical standards (embodied in indicators) for ‘appropriate care’ for common medical conditions and evaluation of our processes, products and feasibility. A modified e-Delphi process will be used to gain consensus on ‘appropriate care’ for a range of common medical conditions. Clinical standards and indicators will be developed through searches of national and international guidelines, and formulated with explicit criteria for inclusion, exclusion, time frame and setting. Healthcare professionals and consumers will review the indicators via the wiki-based modified e-Delphi process. Reviewers will declare conflicts of interest which will be recorded and managed according to an established protocol. The provenance of all indicators and suggestions included or excluded will be logged from indicator inception to finalisation. A mixed-methods formative evaluation of our research methodology will be undertaken. Human Research Ethics Committee approval has been received from the University of South Australia. We will submit the results of the study to relevant journals and offer national and international presentations.
The effect of carbon monoxide on oxygen metabolism in the brains of awake sheep
Publisher: Elsevier BV
Date: 18-12-1996
DOI: 10.1016/S0300-483X(96)03513-5
Abstract: Eight conscious chronically instrumented sheep were exposed to 1% inspired carbon monoxide (CO) for 35 min. In all sheep, carboxyhaemoglobin (COHb) levels at the end of the exposure were approximately 65%. Mean arterial blood pressure was unchanged with the exception of 2 sheep in which administration was stopped at 25 min following the sudden onset of hypotension. Oxygen delivery to the brain was sustained throughout the administration of CO due to a significant increase in cerebral blood flow (CBF). There was no evidence of either a metabolic acidosis or of lactate production by the brain suggesting the brain did not become hypoxic during the time-course of this study. Despite the apparent lack of hypoxia, oxygen consumption by the brain fell progressively and the sheep showed behavioural changes which varied from agitation to sedation and narcosis. The mechanism of these changes was therefore probably unrelated to hypoxia, but may have been due to raised intracranial pressure or a direct effect of CO on brain function. It is proposed that the time-course of progressive CO poisoning includes a phase in which CBF is elevated, blood pressure is unchanged and the brain is normoxic despite high COHb levels, but that this situation can rapidly evolve into a phase of haemodynamic collapse and severe hypoxia.
The in vivo blood, fat and muscle concentrations of lignocaine and bupivacaine in the hindquarters of sheep.
Publisher: Informa UK Limited
Date: 1991
DOI: 10.3109/00498259109039446
Abstract: 1. A method was developed for s ling muscle and fat from the hindquarters of sheep undergoing spinal anaesthesia. The method was used to measure the concentrations of lignocaine and bupivacaine in the blood, muscle and fat of the hindquarters of sheep during and after 180 min constant-rate infusions of the drugs. 2. For both drugs the muscle drug concentrations were a relatively constant ratio of the simultaneous arterial blood drug concentrations during and after the infusion. 3. There was uptake of both lignocaine and bupivacaine into subcutaneous fat during the infusions. At the end of the infusion the ratio of the fat: arterial blood drug concentrations were 1.54 (SD = 0.57, n = 4) and 3.1 (SD = 1.4, n = 4) for lignocaine and bupivacaine, respectively. 4. The drug concentrations in fat declined relatively slowly after the infusion. The ratio of the fat: arterial blood drug concentrations 180 min after the end of the infusion was 21.5 (SD 4.0, n = 3) and for lignocaine, and 120 min after the end of the infusion was 9.54 (SD 5.2, n = 3) for bupivacaine. 5. It was concluded that the concentrations of lignocaine and bupivacaine in muscle were essentially in equilibrium with the arterial concentrations during and after the infusion. However, the concentrations of lignocaine and bupivacaine in fat were not in equilibrium with the arterial concentrations in the post-infusion period.
System for Reporting and Analysing Incidents
Publisher: Springer Netherlands
Date: 26-09-2013
The in vitro uptake and metabolism of lignocaine, procainamide and pethidine by tissues of the hindquarters of sheep.
Publisher: Informa UK Limited
Date: 1991
DOI: 10.3109/00498259109039445
Abstract: 1. In vitro studies using tissue slices or tissue homogenates of liver, skeletal muscle, fat skin and blood were conducted to determine whether the uptake of procainamide, lignocaine and pethidine into the hindquarters of sheep was due to distribution or metabolism. Both homogenates and slice preparations of liver showed significant metabolism or uptake, confirming the viability of the preparations. 2. None of the drugs was metabolized in blood and there was minimal uptake of the drugs into the skin. 3. There was metabolism of pethidine in skeletal muscle and substantial uptake of pethidine into fat, indicating that the rapid rate of uptake and prolonged elution of pethidine in the hindquarters was due to both distribution and metabolism. 4. No metabolism of lignocaine in muscle was found, but there was substantial uptake into fat, indicating that the rapid rate of uptake and prolonged elution of lignocaine in the hindquarters was due to its distribution into fat. 5. There was negligible uptake of procainamide into either muscle or fat, presumably due to its relatively low lipophilicity.
The epistemology of patient safety research
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2008
DOI: 10.1111/J.1744-1609.2008.00117.X
Abstract: Patient safety has only recently been subjected to wide-spread systematic study. Healthcare differs from other high risk industries in being more erse and multi-contextual, and less certain and regulated. Also many patient safety problems are low-frequency events associated with many, varied contributing factors. The subject of this paper is the epistemology of patient safety (the science of the method of finding out about patient safety). Patient safety research is considered here on the background of a risk management framework which requires researchers to: • Understand the context - as a subset of healthcare quality, services and systems research, with technical and human behavioural (cultural) components and a range of external and internal organisational influences, a wide range of research disciplines is necessary • Identify the risks - identify the things that go wrong and the frequency and nature of different types of incidents from sources such as medical record review, observational studies, audit, incident and medico-legal reports • Analyse the risks - deconstruct the things that go wrong, identifying contributing factors and trying to detect trends and patterns in contributing factors, detection, mitigation factors, ameliorating factors and actions taken to reduce risk • Evaluate the risks - decide on priorities, identifying preventive and corrective strategies and judging the risk- and cost-benefit of potential corrective strategies such as standardisation or simplification of a process or device • Manage the risk - evaluate and scope preventive and/or corrective strategies and then implement these, or place the problem on a risk register pending solution, or accept that what is needed is unaffordable • Communicate and consult - use interactive sessions, audit, on-going feedback, reminders and patient mediated prompts • Monitor and review the state of the problem - get baseline trends and patterns so that changes can be tracked and properly attributed to an intervention A hierarchy of levels of evidence has been proposed for clinical research and we argue that insufficient weighting has been given to lower ranked levels of research and to qualitative research, although critical interpretive synthesis is now gaining acceptance in mainstream thinking (e.g. by the Cochrane Collaboration). Fundamental challenges remain including how to grasp the elusive concept of patient safety, how to quantify, characterise and cost the problems, how to judge the extent to which harm can be attributed to errors, violations or system failures, how to identify contributing factors and the extent to which they can be implicated, how to judge whether incidents or their precursors are preventable, how to generate strong evidence to make healthcare safer and how to translate research into practice. Future directions include addressing the mundane as well as rare, dramatic events, and developing further research in non-hospital settings and in developing countries. In summary, a mixture of qualitative and quantitative methods, using information from all available data sources and combining retrospective, real time and prospective study designs, is necessary to address some of the more difficult patient safety problems.
CareTrack: assessing the appropriateness of health care delivery in Australia
Publisher: AMPCo
Date: 11-2012
DOI: 10.5694/MJA12.11210
Evaluation of two methods for quality improvement in intensive care: Facilitated incident monitoring and retrospective medical chart review*
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2003
Identifying and characterizing system issues of health information technology in medical imaging as a basis for recommendations
Publisher: IEEE
Date: 12-2019
Opioid agonists: Modes of application and dosing regimens.
Publisher: Springer Science and Business Media LLC
Date: 06-1988
DOI: 10.1007/BF02528693
Quality in healthcare: process
Publisher: Elsevier BV
Date: 12-2001
Regional pharmacokinetics. III. Modelling methods.
Publisher: Wiley
Date: 1991
Abstract: Regional pharmacokinetics is the study of drug concentrations in specific regions of the body due to drug uptake and elution. Mathematical methods of interpreting regional pharmacokinetic data can vary greatly in their complexity depending on their intended use (i.e. to describe or predict), but must reinforce rather than replace experimental pharmacokinetics. 'Black box' analysis provides and empirical method for the study of complex pharmacokinetic systems using either statistical moment or linear systems analysis. However, these methods are only applicable to linear and time-invariant systems, and ignore the large body of information concerning the physiological and physiochemical basis of regional pharmacokinetics. Clearance concepts are suitable for describing linear drug uptake processes, but mass balance principles have wider applications in describing the rate and extent of both drug uptake and elution. Compartmental models of a region can vary from single compartment descriptions based on the concept of venous equilibrium to complex multi-compartmental models of the intravascular, interstitial, and intracellular spaces, in which drug transport between compartments is a function of drug binding and ionization. Ultimately, as more regional pharmacokinetic information is obtained, more complex three dimensional models may be necessary such as those used to describe the uptake of oxygen from capillaries.
Assessing the appropriateness of prevention and management of venous thromboembolism in Australia: A cross-sectional study
Publisher: BMJ
Date: 03-2016
The Emergency Medicine Events Register: An analysis of the first 150 incidents entered into a novel, online incident reporting registry
Publisher: Wiley
Date: 31-07-2016
Abstract: Incident reporting systems are critical to understanding adverse events, in order to create preventative and corrective strategies. There are very few systems dedicated to Emergency Medicine with published results. All EDs in Australia and New Zealand were contacted to encourage the use of an Emergency Medicine - specific online reporting system called the Emergency Medicine Events Register (EMER). We conducted an analysis of the first 150 incidents entered into EMER. EMER captures Emergency-medicine-specific details including triage score, clinical presentation, outcome, contributing factors, mitigating factors, other specialities involved and patient journey stage. These details were analysed by an expert panel. Over the first 26 months, 150 incidents were reported into EMER. The most common categories reported, in order, were diagnostic error, procedural complication and investigation errors. Most incidents contained more than one category of error. The most common stage of the patient's journey in which an incident was detected was after discharge from the ED. A focus on correct diagnosis, procedure performance and investigation interpretation may reduce errors in the ED. The ability to learn from incidents and make system changes to enhance patient safety in healthcare organisations is an inherent part of providing a proactive, quality culture.
Using multiclass classification to automate the identification of patient safety incident reports by type and severity
Publisher: Springer Science and Business Media LLC
Date: 12-06-2017
EFFECTS OF LIGNOCAINE AND BUPIVACAINE ON REGIONAL MYOCARDIAL FUNCTION AND CORONARY BLOOD FLOW IN ANAESTHETIZED DOGS
Publisher: Elsevier BV
Date: 05-1988
DOI: 10.1093/BJA/60.6.671
Abstract: Empirical i.v. doses of lignocaine or bupivacaine of equal local anaesthetic potency were administered to halothane-anaesthetized dogs. Both local anaesthetics caused the expected depression of global haemodynamic function. Regional myocardial systolic shortening was depressed similarly by both agents. Regional myocardial dysfunction, seen as post-systolic shortening, occurred to a similar extent with both lignocaine and bupivacaine. Coronary blood flow and coronary perfusion pressure were significantly correlated during the administration of lignocaine bupivacaine had erratic effects on coronary blood flow and no correlation between coronary blood flow and coronary perfusion pressure was seen. These results suggest that regional myocardial dysfunction occurs with both local anaesthetics and does not account for the apparent increased cardiotoxicity of bupivacaine. Bupivacaine did, however, cause wider in idual variations compared with lignocaine with respect to coronary blood flow.
The application of the Global Trigger Tool
Publisher: Oxford University Press (OUP)
Date: 24-09-2016
Abstract: This study describes the use of, and modifications and additions made to, the Global Trigger Tool (GTT) since its first release in 2003, and summarizes its findings with respect to counting and characterizing adverse events (AEs). Peer-reviewed literature up to 31st December 2014. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Two authors extracted and compiled the demographics, methodologies and results of the selected studies. Of the 48 studies meeting the eligibility criteria, 44 collected data from inpatient medical records and four from general practice records. Studies were undertaken in 16 countries. Over half did not follow the standard GTT protocol regarding the number of reviewers used. 'Acts of omission' were included in one quarter of studies. Incident reporting detected between 2% and 8% of AEs that were detected with the GTT. Rates of AEs varied in general inpatient studies between 7% and 40%. Infections, problems with surgical procedures and medication were the most common incident types. The GTT is a flexible tool used in a range of settings with varied applications. Substantial differences in AE rates were evident across studies, most likely associated with methodological differences and disparate reviewer interpretations. AE rates should not be compared between institutions or studies. Recommendations include adding 'omission' AEs, using preventability scores for priority setting, and re-framing the GTT's purpose to understand and characterize AEs rather than just counting them.
Identification of patient, medical and nursing staff attitudes to postoperative opioid analgesia: stage 1 of a longitudinal study of postoperative analgesia
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-1992
Setting priorities for patient safety
Publisher: BMJ
Date: 09-2002
DOI: 10.1136/QHC.11.3.224
Abstract: Current "flags" for adverse events (AEs) are biased towards those with serious outcomes, potentially leading to failure to address mundane common problems. To provide a basis for setting priorities to improve patient safety by ranking adverse events by resource consumption as well as by outcome. This was done by classifying a set of AEs, according to how they may be prevented, into "Principal Natural Categories" (PNCs). AEs associated with a representative s le of admissions to Australian acute care hospitals. AEs were classified into PNCs which were ranked by overall frequency, an index of resource consumption (a function of mean extended hospital stay and the number of cases in each PNC), and severity of outcome. The 1712 AEs analysed fell into 581 PNCs only 28% had more than two cases. Most resource use (60%) was by AEs which led to minor disabilities, 36% was by those which led to major disabilities, and 4% by those associated with death. Most of the events with serious outcomes fell into fewer than 50 PNCs only seven of these PNCs had more than six cases resulting in serious outcomes. If interventions for AEs are triggered only by serious outcomes by, for ex le, using recommended risk scoring methods, most problems would not be addressed, particularly the large number of mundane problems which consume the majority of resources. Both serious and mundane problems should be addressed. Most types of events occur too infrequently to be characterised at a hospital level and require large scale (preferably national) collections of incidents and events.
Crisis management during anaesthesia: pulmonary oedema
Publisher: BMJ
Date: 06-2005
An integrated framework for safety, quality and risk management: an information and incident management system based on a universal patient safety classification
Publisher: BMJ
Date: 12-2006
Abstract: More needs to be done to improve safety and quality and to manage risks in health care. Existing processes are fragmented and there is no single comprehensive source of information about what goes wrong. An integrated framework for the management of safety, quality and risk is needed, with an information and incident management system based on a universal patient safety classification. The World Alliance for Patient Safety provides a platform for the development of a coherent approach 43 desirable attributes for such an approach are discussed. An ex le of an incident management and information system serving a patient safety classification is presented, with a brief account of how and where it is currently used. Any such system is valueless unless it improves safety and quality. Quadruple-loop learning (personal, local, national and international) is proposed with ex les of how an exemplar system has been successfully used at the various levels. There is currently an opportunity to “get it right” by international cooperation via the World Health Organization to develop an integrated framework incorporating systems that can accommodate information from all sources, manage and monitor things that go wrong, and allow the worldwide sharing of information and the dissemination of tools for the implementation of strategies which have been shown to work.
A mixed-methods systematic review of the effectiveness and experiences of quality improvement interventions in radiology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 18-05-2022
Crisis management during regional anaesthesia
Publisher: BMJ
Date: 06-2005
Lessons learnt from incidents involving the airway and breathing reported from Australasian emergency departments
Publisher: Wiley
Date: 16-08-2017
Abstract: To review incident reports relating to problems encountered during the ED management of patients with 'airway or breathing' problems, with the aim of finding and highlighting common themes within these rare events, and making recommendations to further improve patient safety in the areas in which deficiencies have been identified. Thematic analysis of 36 incidents reported from Australasian EDs, which were related to problems with airway and breathing. In all, 51 problems were identified among the 36 incidents related to airway and/or breathing. Fourteen involved clinical decision-making, 11 equipment, nine communication, seven intubation, five surgical access and five pneumothorax. Eight incidents involved children and there were nine deaths within hours or days. Recommendations for improving preparedness of ED staff and facilities have been made for each of the problem areas identified with respect to clinical practice, equipment, communication and clinical process. Analysis of incidents from the Australasian Emergency Medicine Events Register allows clusters of like-events to be identified and characterised, providing the possibility of getting a better idea of how problems present and progress, with some information about contributing factors, characteristics and context. This will pave the way for earlier and better detection of life-threatening problems and the development and reinforcement of preventive and corrective strategies.
A comparison of iatrogenic injury studies in Australia and the USA II: reviewer behaviour and quality of care
Publisher: Oxford University Press (OUP)
Date: 10-2000
Abstract: To better understand the remaining three-fold disparity between adverse event (AE) rates in the Quality in Australia Health Care Study (QAHCS) and the Utah-Colorado Study (UTCOS) after methodological differences had been accounted for. Iatrogenic injury in hospitalized patients in Australia and America. Using a previously developed classification, all AEs were assigned to 98 exclusive descriptive categories and the relative rates compared between studies they were also compared with respect to severity and death. The distribution of AEs amongst the descriptive and outcome categories. For 38 categories, representing 67% of UTCOS and 28% of QAHCS AEs, there were no statistically significant differences. For 33, representing 31% and 69% respectively, there was seven times more AEs in QAHCS than in UTCOS. Rates for major disability and death were very similar (1.7% and 0.3% of admissions for both studies) but the minor disability rate was six times greater in QAHCS (8.4% versus 1.3%). A similar 2% core of serious AEs was found in both studies, but for the remaining categories six to seven times more AEs were reported in QAHCS than in UTCOS. We hypothesize that this disparity is due to different thresholds for admission and discharge and to a greater degree of under-reporting of certain types of problems as AEs by UTCOS than QAHCS reviewers. The biases identified were consistent with, and appropriate for, the quite different aims of each study. No definitive difference in quality of care was identified by these analyses or a literature review.
Cardiovascular effects of propofol and of thiopentone anaesthesia in the sheep.
Publisher: Elsevier BV
Date: 09-1990
DOI: 10.1093/BJA/65.3.353
Abstract: We have examined the effects on the cardiovascular system and on regional blood flow of propofol and thiopentone when administered with IPPV (FIO2 0.4). A longitudinal study design was used in which 16 studies were performed in eight sheep for 30 min before, during the last 30 min of 70 min anaesthesia, and for 6 h after anaesthesia. During anaesthesia with propofol and thiopentone, mean total body oxygen consumption decreased, respectively, by 47% (P less than 0.001) and 24% (P less than 0.01) of pre-anaesthesia baseline values, mean heart rate increased by approximately 50% (P less than 0.05) with both agents, mean arterial pressures increased by approximately 50% (P less than 0.05) with both agents and the mean cardiac output was unaltered with propofol anaesthesia but was decreased by 20% (P less than 0.05) with thiopentone anaesthesia. The changes in arterial pressure and heart rate were unexpected and may have been a result of a species-specific effect. Mean hepatic blood flow decreased consistently by a mean of 17% (P less than 0.01) during propofol anaesthesia, and inconsistently during thiopentone anaesthesia so that it was not significantly different from baseline values. Mean renal blood flow decreased during propofol anaesthesia by 7% (P less than 0.05) and by 27% (P less than 0.001) during thiopentone anaesthesia. Whereas most variables returned to baseline values within 2 h after propofol anaesthesia, this took 5 h after thiopentone anaesthesia.
I.V. BOLUS ADMINISTRATION OF SUBCONVULSIVE DOSES OF LIGNOCAINE TO CONSCIOUS SHEEP: EFFECTS ON CIRCULATORY FUNCTION
Publisher: Elsevier BV
Date: 10-1992
DOI: 10.1093/BJA/69.4.368
Abstract: We have studied the effects of subconvulsive doses of lignocaine on circulatory function in five conscious, chronically instrumented sheep. In the absence of overt signs of central nervous system toxicity, 50-, 75- or 100-mg i.v. bolus doses of lignocaine induced reductions in myocardial contractility, as assessed by the maximum rate of increase in left ventricular pressure (LV dP/dtmax), of 17 (SD 4)%, 25 (4)% and 33 (4)%, respectively. The durations of these reductions in myocardial contractility were 2-3.5 min. There were no significant changes in cardiac output, coronary artery blood flow, mean arterial pressure, heart rate or left ventricular systolic and diastolic pressures. It is concluded that the initial toxic effects of lignocaine are on the heart rather than the central nervous system, as is generally believed. This negative inotropic effect of lignocaine in vivo may be more deleterious to myocardial function when the heart is compromised by pre-existing disease, or the co-administration of other myocardial depressive drugs.
A comparison of iatrogenic injury studies in Australia and the USA I: context, methods, casemix, population, patient and hospital characteristics
Publisher: Oxford University Press (OUP)
Date: 10-2000
Abstract: To better understand the differences between two iatrogenic injury studies of hospitalized patients in 1992 which used ostensibly similar methods and similar s le sizes, but had quite different findings. The Quality in Australian Health Care Study (QAHCS) reported that 16.6% of admissions were associated with adverse events (AE), whereas the Utah, Colorado Study (UTCOS) reported a rate of 2.9%. Hospitalized patients in Australia and the USA. Investigators from both studies compared methods and characteristics and identified differences. QAHCS data were then analysed using UTCOS methods. Differences between the studies and the comparative AE rates when these had been accounted for. Both studies used a two-stage chart review process (screening nurse review followed by confirmatory physician review) to detect AEs five important methodological differences were found: (i) QAHCS nurse reviewers referred records that documented any link to a previous admission, whereas UTCOS imposed age-related time constraints (ii) QAHCS used a lower confidence threshold for defining medical causation (iii) QAHCS used two physician reviewers, whereas UTCOS used one (iv) QAHCS counted all AEs associated with an index admission whereas UTCOS counted only those determining the annual incidence and (v) QAHCS included some types of events not included in UTCOS. When the QAHCS data were analysed using UTCOS methods, the comparative rates became 10.6% and 3.2%, respectively. Five methodological differences accounted for some of the discrepancy between the two studies. Two explanations for the remaining three-fold disparity are that quality of care was worse in Australia and that medical record content and/or reviewer behaviour was different.
Septicemic Shock
Publisher: Georg Thieme Verlag KG
Date: 20-03-2008
Linking quality indicators to clinical trials: an automated approach
Publisher: Oxford University Press (OUP)
Date: 23-06-2017
Identifying clusters and themes from incidents related to health information technology in medical imaging as a basis for improvements in practice
Publisher: IEEE
Date: 12-2019
Use of surgical safety checklists in Australian operating theatres: an observational study
Publisher: Wiley
Date: 25-05-2017
DOI: 10.1111/ANS.13638
Predicting the cumulative risk of death during hospitalization by modeling weekend, weekday and diurnal mortality risks
Publisher: Springer Science and Business Media LLC
Date: 21-05-2014
A Brief History of the Patient Safety Movement in Anaesthesia
Publisher: Springer New York
Date: 2014
Physiological disposition of i.v. morphine in sheep.
Publisher: Elsevier BV
Date: 10-1991
DOI: 10.1093/BJA/67.4.378
Abstract: In a crossover design study we have measured the total body and regional clearances of morphine. Thirteen experiments were performed in four conscious sheep that had been prepared previously with appropriate intravascular cannulae. Morphine (as sulphate pentahydrate) was infused i.v. at 2.5, 5, 10 and 20 mg h-1 to produce constant blood concentrations. Morphine (base) concentrations were measured in blood, urine and tissues with a specific HPLC method. The mean (SEM) total body clearance of morphine was 1.63 (0.21) litre min-1 this comprised 1.01 (0.10) litre min-1 clearance by the liver and 0.55 (0.06) litre min-1 by the kidneys. There was no evidence of dose-dependent clearance or significant extraction of morphine by the lungs, brain, heart, gut or hindquarters at any dose. The kidney clearance of morphine was greater than the 0.21 (0.06) litre min-1 renal clearance determined from the product of the mean total body clearance and the 12.3 (2.4%) of the administered dose recovered as unmetabolized morphine from 48 h urine collection (P less than 0.05). It was concluded that the liver and kidneys account for the majority of morphine clearance, and that the kidneys both excrete and metabolize morphine.
Trauma: development of a sub-algorithm
Publisher: BMJ
Date: 06-2005
Systems, Safety, and Quality: Harm, Error, and Litigation
Publisher: Springer London
Date: 18-09-2013
Crisis management during anaesthesia: difficult intubation
Publisher: BMJ
Date: 06-2005
Australians with osteoarthritis; the use of and beliefs about complementary and alternative medicines.
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.CTCP.2014.08.002
Abstract: To investigate complementary and alternative medicine (CAM) use amongst a cohort of osteoarthritis (OA) sufferers and to explore reasons for use. A self-administered questionnaire was used to assess CAM use and its relationship with self-rated health status, patient knowledge of OA and attitudes towards OA management. Sixty-nine percent of respondents (95% CI, 64%-73%) reported that they had tried CAM, with little difference between age groups and genders. Patients who had a better knowledge of their condition and excellent self-rated health were more likely to use CAM. An aversion to the side effects of conventional medicine, failure to engage in exercise, and a belief in the efficacy of CAM were the principal factors underlying use. As CAM use is a key component of the self-management strategies for a substantial proportion of Australians with OA, users need to be more fully informed about evidence of efficacy.
Crisis management during anaesthesia: desaturation
Publisher: BMJ
Date: 06-2005
A sheep preparation for studying interactions between blood flow and drug disposition. VI: Effects of general or subarachnoid anaesthesia on blood flow and chlormethiazole disposition.
Publisher: Elsevier BV
Date: 11-1986
Abstract: Blood flow through and chlormethiazole extraction ratios across lungs, liver, kidneys and gut were measured in awake unrestrained sheep (controls) and with the same animals anaesthetized with 1.5% halothane or whilst undergoing high thoracic subarachnoid blockade with amethocaine. In the control-drug studies, chlormethiazole infused to sub-sedative blood concentrations produced no significant changes in haemodynamics or in the kinetics of iodohippurate (renal and hepatic blood flows). Chlormethiazole was eliminated predominantly by the liver (mean extraction ratio and clearance, respectively, 0.90 and 1.3 litre min-1) and lungs (0.15 0.6 litre min-1). Renal clearance was absent or negligible (greater than 0.1 litre min-1). Because of pulmonary clearance, mean total body clearance was derived from analysis of pulmonary arterial concentrations. Under general anaesthesia, there were significant reductions in mean cardiac output, hepatic and renal blood flow (to 54%, 63% and 43% of control) chlormethiazole mean hepatic extraction ratios and clearance were reduced, respectively, to 82% and 56% of control, and its pulmonary and renal clearances were abolished. With subarachnoid anaesthesia there were no significant changes in haemodynamics or in chlormethiazole extraction ratios or clearances.
Towards an International Classification for Patient Safety: the conceptual framework
Publisher: Oxford University Press (OUP)
Date: 02-2009
Towards an International Classification for Patient Safety: key concepts and terms
Publisher: Oxford University Press (OUP)
Date: 02-2009
A systems science perspective on the capacity for change in public hospitals
Publisher: Springer Science and Business Media LLC
Date: 24-03-2017
A qualitative content analysis of retained surgical items: learning from root cause analysis investigations
Publisher: Oxford University Press (OUP)
Date: 30-03-2020
Abstract: To describe incidents of retained surgical items, including their characteristics and the circumstances in which they occur. A qualitative content analysis of root cause analysis investigation reports. Public health services in Victoria, Australia, 2010–2015. Incidents of retained surgical items as described by 31 root cause analysis investigation reports. The type of retained surgical item, the length of time between the item being retained and detected and qualitative descriptors of the contributing factors and the circumstances in which the retained surgical items occurred. Surgical packs, drain tubes and vascular devices comprised 68% (21/31) of the retained surgical items. Nearly one-quarter of the retained surgical items were detected either immediately in the post-operative period or on the day of the procedure (7/31). However, about one-sixth (5/31) were only detected after 6 months, with the longest period being 18 months. Contributing factors included complex or multistage surgery the use of packs not specific to the purpose of the surgery and design features of the surgical items. Retained drains occurred in the post-operative phase where surgical counts are not applicable and clinician situational awareness may not be as great. Root cause analysis investigation reports can be a valuable means of characterizing infrequently occurring adverse events such as retained surgical items. They may detect incidents that are not detected by other data collections and can inform the design enhancements and development of technologies to reduce the impact of retained surgical items.
The management of severe hypertension in Australian general practice
Publisher: Springer Science and Business Media LLC
Date: 14-10-2013
Effects of propofol and of thiopentone anaesthesia on the renal clearance of cefoxitin in the sheep.
Publisher: Elsevier BV
Date: 09-1990
DOI: 10.1093/BJA/65.3.360
Abstract: We have examined the renal extraction ratios and clearances of cefoxitin in three groups of adult merino ewes. One group (n = 3) was studied for 12 h without perturbation these were designated control studies. The other two groups (n = 4 each) were studied before (baseline values), during and after the induction and 70-min maintenance of anaesthesia with propofol or thiopentone. In the control studies, mean renal extraction ratio and clearance for cefoxitin were, respectively, 0.67-0.92 and 0.66-0.91 litre min-1 and were consistent throughout the entire study period in in idual animals. Comparable values were obtained as baseline values in the anaesthesia groups. Compared with in idual baseline values, blood concentrations of cefoxitin doubled during anaesthesia with each agent. At the same time, renal extraction ratio and clearance for cefoxitin each decreased significantly to about 50-60% of their control values. Recovery to control values of arterial blood concentrations and renal extraction ratio of cefoxitin took at least 5 h, but recovery of renal clearance was more rapid. The results indicate that renal elimination of an organic anion such as cefoxitin may be affected by changes in renal blood flow and in renal function produced by propofol and thiopentone these effects may last for several hours after recovery of renal blood flow.
Australians with osteoarthritis: Satisfaction with health care providers and the perceived helpfulness of treatments and information sources
Publisher: Informa UK Limited
Date: 08-2016
DOI: 10.2147/JMDH.S110751
Effects of propofol and of thiopentone anaesthesia on the regional kinetics of pethidine in the sheep.
Publisher: Elsevier BV
Date: 09-1990
DOI: 10.1093/BJA/65.3.365
Abstract: We have examined the extraction ratios, net fluxes and clearances of pethidine by the liver, kidneys and hindquarters in sheep before, during and after continuous anaesthesia (70 min) with propofol or thiopentone. Before anaesthesia, the overall mean respective regional pethidine extraction ratios were 0.98 (SD 0.01), 0.20 (0.06) and 0.44 (0.13), the corresponding net fluxes were 47 (7), 5 (2) and 20 (10)% dose min-1 and the clearances 1.44 (0.22), 0.17 (0.07) and 0.80 (0.39) litre min-1. During propofol anaesthesia, arterial blood concentrations of pethidine approximately doubled (P less than 0.05), mean pethidine hepatic extraction ratio was unchanged, flux was increased to 145 (20)% and clearance decreased to 79 (10)% (P less than 0.05) of baseline values mean pethidine renal extraction ratio, flux and clearance were 73 (34), 112 (43) and 69 (31)% of baseline values mean hindquarter pethidine extraction ratio decreased to 65 (25)% (P less than 0.05) of baseline values. During thiopentone anaesthesia, arterial blood concentrations of pethidine approximately doubled (P less than 0.01), mean pethidine hepatic extraction ratio was 97 (2)% of baseline values and flux and clearance were unchanged, mean pethidine renal extraction ratios, flux and clearance decreased to 37 (21), 54 (18) and 27 (19)% (all P less than 0.05) of baseline values and mean pethidine hindquarter extraction ratio was 81 (20)% of baseline values. In spite of only modest changes in hepatic and renal blood flow during anaesthesia, blood concentrations of pethidine doubled and pethidine kinetics were disturbed for several hours after anaesthesia. Overall, however, the changes were of smaller magnitude and shorter duration than those that have been described for anaesthesia with the volatile anaesthetic agents.
Pharmacokinetics and pharmacodynamics in the critically ill
Publisher: Elsevier BV
Date: 09-1990
Measures of patient safety in developing and emerging countries: a review of the literature
Publisher: BMJ
Date: 02-2010
Abstract: The World Alliance for Patient Safety was formed to accelerate worldwide research progress towards measurably improving patient safety. Although rates of adverse events have been studied in industrialised countries, little is known about the rates of adverse events in developing and emerging countries. To review the literature on patient safety issues in developing and emerging countries, to identify patient safety measures presently used in these countries and to propose a method of measurably improving patient safety measurement in these countries. Using the Medline database for 1998 to 2007, we identified and reviewed 23 English-language articles that examined patient safety measurement in developing and emerging countries. Results Our review included 12 studies that prospectively measured patient safety and 11 studies that retrospectively measured safety. Two studies used measures of structure and the remaining used process measures, outcome measures or both. Whereas a few studies used surveys or direct observation, most studies used chart audits to measure patient safety. Most studies addressed safety at a single facility. Investigation of patient safety in developing and emerging countries has been infrequent and limited in scope. Establishing fundamental safe patient practices, integrating those processes into routine health services delivery and developing patients' expectations that such processes be present are necessary prerequisites to measuring and monitoring progress towards safe patient care in emerging and developing countries.
Identifying patient safety problems associated with information technology in general practice: an analysis of incident reports: Table 1
Publisher: BMJ
Date: 05-11-2015
DOI: 10.1136/BMJQS-2015-004323
Abstract: To identify the categories of problems with information technology (IT), which affect patient safety in general practice. General practitioners (GPs) reported incidents online or by telephone between May 2012 and November 2013. Incidents were reviewed against an existing classification for problems associated with IT and the clinical process impacted. 87 GPs across Australia. Types of problems, consequences and clinical processes. GPs reported 90 incidents involving IT which had an observable impact on the delivery of care, including actual patient harm as well as near miss events. Practice systems and medications were the most affected clinical processes. Problems with IT disrupted clinical workflow, wasted time and caused frustration. Issues with user interfaces, routine updates to software packages and drug databases, and the migration of records from one package to another generated clinical errors that were unique to IT some could affect many patients at once. Human factors issues gave rise to some errors that have always existed with paper records but are more likely to occur and cause harm with IT. Such errors were linked to slips in concentration, multitasking, distractions and interruptions. Problems with patient identification and hybrid records generated errors that were in principle no different to paper records. Problems associated with IT include perennial risks with paper records, but additional disruptions in workflow and hazards for patients unique to IT, occasionally affecting multiple patients. Surveillance for such hazards may have general utility, but particularly in the context of migrating historical records to new systems and software updates to existing systems.
CareTrack
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2017
Are root cause analyses recommendations effective and sustainable? An observational study
Publisher: Oxford University Press (OUP)
Date: 16-01-2018
Abstract: To assess the strength of root cause analysis (RCA) recommendations and their perceived levels of effectiveness and sustainability. All RCAs related to sentinel events (SEs) undertaken between the years 2010 and 2015 in the public health system in Victoria, Australia were analysed. The type and strength of each recommendation in the RCA reports were coded by an expert patient safety classifier using the US Department of Veteran Affairs type and strength criteria. Thirty-six public health services. The proportion of RCA recommendations which were classified as 'strong' (more likely to be effective and sustainable), 'medium' (possibly effective and sustainable) or 'weak' (less likely to be effective and sustainable). There were 227 RCAs in the period of study. In these RCAs, 1137 recommendations were made. Of these 8% were 'strong', 44% 'medium' and 48% were 'weak'. In 31 RCAs, or nearly 15%, only weak recommendations were made. In 24 (11%) RCAs five or more weak recommendations were made. In 165 (72%) RCAs no strong recommendations were made. The most frequent recommendation types were reviewing or enhancing a policy/guideline/documentation, and training and education. Only a small proportion of recommendations arising from RCAs in Victoria are 'strong'. This suggests that insights from the majority of RCAs are not likely to inform practice or process improvements. Suggested improvements include more human factors expertise and independence in investigations, more extensive application of existing tools that assist teams to prioritize recommendations that are likely to be effective, and greater use of observational and simulation techniques to understand the underlying systems factors. Time spent in repeatedly investigating similar incidents may be better spent aggregating and thematically analysing existing sources of information about patient safety.
Crisis management during anaesthesia: hypertension
Publisher: BMJ
Date: 06-2005
Lessons from the Australian Patient Safety Foundation: setting up a national patient safety surveillance system--is this the right model?
Publisher: BMJ
Date: 09-2002
DOI: 10.1136/QHC.11.3.246
Abstract: The evolution of the concepts and processes underpinning the Australian Patient Safety Foundation's systems over the last 15 years are traced. An ideal system should have the following attributes: an independent organisation to coordinate patient safety surveillance agreed frameworks for patient safety and surveillance systems common, agreed standards and terminology a single, clinically useful classification for things that go wrong in health care a national repository for information covering all of health care from all available sources mechanisms for setting priorities at local, national and international levels a just system which caters for the rights of patients, society, and healthcare practitioners and facilities separate processes for accountability and "systems learnings" the right to anonymity and legal privilege for reporters systems for rapid feedback and evidence of action mechanisms for involving and informing all stakeholders. There are powerful reasons for establishing national systems, for aligning terminology, tools and classification systems internationally, and for rapid dissemination of successful strategies.
Morphine blood concentrations in elderly postoperative patients following administration via an indwelling subcutaneous cannula.
Publisher: Wiley
Date: 04-1997
DOI: 10.1111/J.1365-2044.1997.83-AZ0081.X
Abstract: The pharmacokinetics of morphine in venous blood after a 5 mg bolus dose via an indwelling subcutaneous cannula were characterised in 22 elderly patients undergoing elective major surgery. In a subgroup of seven patients, the kinetics were also characterised after a second 5 mg dose of morphine administered 180 min after the first dose. Blood morphine concentrations following the single dose were highly variable--the coefficients of variation of Cmax, Tmax and the AUC up to 180 min (AUC180) were 54, 37 and 39%, respectively, with mean values of 86.6 ng.ml-1, 15.9 min and 3954 ng.ml-1, respectively. These mean values for the second dose were not statistically different to those of the first dose but were more variable. It was concluded that the injection of morphine via an indwelling subcutaneous cannula results in blood concentrations that are comparable to, and as variable as, those arising from intramuscular injection.
Propofol: assay and regional mass balance in the sheep.
Publisher: Informa UK Limited
Date: 1989
DOI: 10.3109/00498258909043185
Abstract: 1. Pharmacokinetic data for propofol, a new intravenous anaesthetic agent, indicate that there may be extensive extrahepatic clearance. This was investigated during intravenous infusions of propofol in adult merino ewes with chronic intravascular cannulae using a newly developed simple and rapid assay for propofol in blood and other biological s les. 2. The assay was based on organic solvent extraction of pH 4.5 buffered blood, urine or tissue homogenate, followed by reverse-phase h.p.l.c. with fluorescence detection. 3. A mean total body clearance of propofol of 3.15 l/min, (SD 0.87 l/min n = 8) was found, consistent with a high hepatic extraction ratio (overall mean 0.87, SD 0.19 n = 8) and clearance (overall mean 1.12, SD 0.25 l/min n = 7). The difference between total and hepatic clearances consisted principally of pulmonary clearance, but its extent was variable. 4. Other regional pharmacokinetic data were consistent with propofol distribution into muscle and brain tissues and propofol 'production' by the kidney, probably from a propofol metabolite formed elsewhere. 5. If these data are confirmed in humans then clinical pharmacokinetic data so far derived from peripheral venous blood s ling will require re-evaluation.
Characterising the types of paediatric adverse events detected by the global trigger tool - CareTrack Kids
Publisher: SAGE Publications
Date: 11-2020
Abstract: A common method of learning about adverse events (AEs) is by reviewing medical records using the global trigger tool (GTT). However, these studies generally report rates of harm. The aim of this study is to characterise paediatric AEs detected by the GTT using descriptive and qualitative approaches. Medical records of children aged 0–15 were reviewed for presence of harm using the GTT. Records from 2012–2013 were s led from hospital inpatients, emergency departments, general practice and specialist paediatric practices in three Australian states. Nurses undertook a review of each record and if an AE was suspected a doctor performed a verification review of a summary created by the nurse. A qualitative content analysis was undertaken on the summary of verified AEs. A total of 232 AEs were detected from 6,689 records reviewed. Over four-fifths of the AEs (193/232, 83%) resulted in minor harm to the patient. Nearly half (112/232, 48%) related to medication/intravenous (IV) fluids. Of these, 83% (93/112) were adverse drug reactions. Problems with medical devices/equipment were the next most frequent with nearly two-thirds (32/51, 63%) of these related to intravenous devices. Problems associated with clinical processes rocedures comprise one in six AEs (38/232, 16%), of which diagnostic problems (12/38, 32%) and procedural complications (11/38, 29%) were the most frequent. Adverse drug reactions and issues with IVs are frequently identified AEs reflecting their common use in paediatrics. The qualitative approach taken in this study allowed AE types to be characterised, which is a prerequisite for developing and prioritising improvements in practice.
What is the association between the presence of comorbidities and the appropriateness of care for low back pain?
Publisher: Springer Science and Business Media LLC
Date: 06-11-2018
Acute Systemic Reactions to Intravascular Contrast Media –a planned approach
Publisher: Wiley
Date: 05-1987
DOI: 10.1111/J.1440-1673.1987.TB01807.X
Abstract: Antibiotic prophylaxis with norfloxacin, intravenous ciprofloxacin, or ceftriaxone has been recommended for cirrhotic patients with gastrointestinal hemorrhage but little is known about intravenous cefazolin. This study aimed to compare the outcome of intravenous cefazolin and ceftriaxone as prophylactic antibiotics among cirrhotic patients at different clinical stages, and to identify the associated risk factors. The medical records of 713 patients with acute variceal bleeding who had received endoscopic procedures from were reviewed. Three hundred and eleven patients were entered for age-matched adjustment after strict exclusion criteria. After the adjustment, a total of 102 patients were enrolled and sorted into 2 groups according to the severity of cirrhosis: group A (Child's A patients, n = 51) and group B (Child's B and C patients, n = 51). The outcomes were prevention of infection, time of rebleeding, and death. Our subgroup analysis results failed to show a significant difference in infection prevention between patients who received prophylactic cefazolin and those who received ceftriaxone among Child's A patients (93.1% vs. 90.9%, p = 0.641) however, a trend of significance in favor of ceftriaxone prophylaxis (77.8% vs. 87.5%, p = 0.072) was seen among Child's B and C patients. More rebleeding cases were observed in patients who received cefazolin than in those who received ceftriaxone among Child's B and C patients (66.7% vs. 25.0%, p = 0.011) but not in Child's A patients (32% vs. 40.9%, p = 0.376). The risk factors associated with rebleeding were history of bleeding and use of prophylactic cefazolin among Child's B and C patients. In conclusion, this study suggests that prophylactic intravenous cefazolin may not be inferior to ceftriaxone in preventing infections and reducing rebleeding among Child's A cirrhotic patients after endoscopic interventions for acute variceal bleeding. Prophylactic intravenous ceftriaxone yields better outcome among Child's B and C patients.
CareTrack: Assessing the appropriateness of health care delivery in Australia
Publisher: AMPCo
Date: 07-2012
DOI: 10.5694/MJA12.10510
Crises in clinical care: an approach to management
Publisher: BMJ
Date: 06-2005
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