ORCID Profile
0000-0003-0166-2287
Current Organisations
St George Hospital
,
University of Tasmania
,
University of New South Wales
,
University of London
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Publications
Carbon emissions and hospital pathology stewardship: a retrospective cohort analysis
Publisher: Wiley
Date: 20-08-2022
DOI: 10.1111/IMJ.15622
Abstract: As healthcare is responsible for 7% of Australia's carbon emissions, it was recognised that a policy implemented at St George Hospital, Sydney, to reduce non‐urgent pathology testing to 2 days per week and, on other days only if essential, would also result in a reduction in carbon emissions. The aim of the study was to measure the impact of this intervention on pathology collections and associated carbon emissions and pathology costs. To measure the impact of an intervention to reduce unnecessary testing on pathology collections and associated carbon emissions and pathology costs. The difference in the number of pathology collections, carbon dioxide equivalents (CO 2 e) for five common blood tests and pathology cost per admission were compared between a 6‐month reference period and 6‐month intervention period. CO 2 e were estimated from published pathology CO 2 e impacts. Cost was derived from pathology billing records. Outcomes were modelled using multivariable negative binomial, generalised linear and logistic regression. In total, 24 585 pathology collections in 5695 patients were identified. In adjusted analysis, the rate of collections was lower during the intervention period (rate ratio 0.90 95% confidence interval (CI), 0.86–0.95 P 0.001). This resulted in a reduction of 53 g CO 2 e (95% CI, 24–83 g P 0.001) and $22 (95% CI, $9–$34 P = 0.001) in pathology fees per admission. The intervention was estimated to have saved 132 kg CO 2 e (95% CI, 59–205 kg) and $53 573 (95% CI, 22 076–85 096). Reduction in unnecessary hospital pathology collections was associated with both carbon emission and cost savings. Pathology stewardship warrants further study as a potentially scalable, cost‐effective and incentivising pathway to lowering healthcare associated greenhouse gas emissions.
Lifting the curtains of silence: Patient perceptions towards needs and responsibilities in contributing to the prevention of healthcare-associated infections and antimicrobial resistance
Publisher: Elsevier BV
Date: 08-2023
DOI: 10.1016/J.AJIC.2022.11.013
Abstract: Beyond the use of policy and system-focused approaches, it has been established globally that patients can play a role in enhancing the healthcare landscape. However, efforts to meaningfully translate patient engagement strategies that promote participation by hospitalized patients in relevant infection prevention and antimicrobial stewardship activities have not yet been realized. This study mapped the key factors acting as barriers and facilitators of patient engagement using a theoretical framework to identify potential new approaches to promote engagement. Semi-structured interviews were conducted with 36 patients from three major hospitals in Sydney, Australia, in 2019. Transcripts were inductively analyzed, with the resulting themes categorized into the components of the Capability-Opportunity-Motivation-Behavior (COM-B) model. The themes regarding barriers to patient engagement with relevant infection prevention and antimicrobial stewardship activities were: (1) Capability: misunderstanding and knowledge gaps about antimicrobial resistance (2) Opportunity: strong family atient support networks and good relationships with nursing staff provide an opportunity to support engagement (3) Motivation: those who have some level of understanding or experience see the benefit and are most likely to engage actively. Assuming patients are inclined to participate in efforts, a logical starting point would be to build awareness amongst patients and providers however, education will not suffice. There needs to be a system and policy shift to ensure that patient engagement is recognized as a worthy endeavor.
Institutional governance and responsiveness to antimicrobial resistance: A qualitative study of Australian hospital executives
Publisher: BMJ
Date: 12-2021
DOI: 10.1136/BMJOPEN-2021-055215
Abstract: Despite escalating antimicrobial resistance (AMR), implementing effective antimicrobial optimisation within healthcare settings has been h ered by institutional impediments. This study sought to examine, from a hospital management and governance perspective, why healthcare providers may find it challenging to enact changes needed to address rising AMR. Semistructured qualitative interviews around their experiences of antimicrobial stewardship (AMS) and responsiveness to the requirement for optimisation. Data were analysed using the framework approach. Two metropolitan tertiary-referral hospitals in Australia. Twenty hospital managers and executives from the organisational level of department head and above, spanning a range of professional backgrounds and in both clinical and non-clinical roles, and different professional streams were represented. Thematic analysis demonstrated three key domains which managers and executives describe, and which might function to delimit institutional responsiveness to present and future AMR solutions. First, the primacy of ‘political’ priorities. AMR was perceived as a secondary priority, overshadowed by political priorities determined beyond the hospital by state health departments/ministries and election cycles. Second, the limits of accreditation as a mechanism for change. Hospital accreditation processes and regulatory structures were not sufficient to induce efficacious AMS. Third, a culture of acute problem ‘solving’ rather than future proofing. A culture of reactivity was described across government and healthcare institutions, precluding longer term objectives, like addressing the AMR crisis. There are dynamics between political and health service institutions, as well as enduring governance norms, that may significantly shape capacity to enact AMS and respond to AMR. Until these issues are addressed, and the field moves beyond in idual behaviour modification models, antimicrobial misuse will likely continue, and stewardship is likely to have a limited impact.
Related Organisations
University Of London
Location: United Kingdom of Great Britain and Northern Ireland
Related Funding Activities
No related grants have been discovered for Pam Konecny.