Johanna Westbrook

Are patients with a nasally placed feeding tube at risk of potential drug-drug interactions? A multicentre cross-sectional study

Publisher: Public Library of Science (PLoS)

Date: 31-07-2019

DOI: 10.1371/JOURNAL.PONE.0220248

Medication safety incidents in paediatric oncology after electronic medication management system implementation

Publisher: Hindawi Limited

Date: 11-2019

DOI: 10.1111/ECC.13152

Mobile application to enhance self-management of gout.

Publisher: Elsevier BV

Date: 10-2016

DOI: 10.1016/J.IJMEDINF.2016.06.021

Abstract: Gout is an arthritic condition that is characterised by extremely painful, debilitating acute attacks and eventual joint and organ damage if not controlled. Despite the availability of very effective therapies that, if adhered to, will prevent acute attacks and long-term damage, the disorder is increasingly prevalent. There is an urgent need to improve self-management of gout. Mobile health (mHealth) applications ('apps'), designed to facilitate management of chronic conditions, present novel opportunities for supporting patient self-management of gout. The aim of this review was to assess features of available gout management apps designed to assist consumers in managing their gout and their consistency with guidelines for gout management. English-language, smart-device apps designed to assist self-management of gout were identified using search term "gout" and downloaded from Apple and Google Play app stores. To be included in the review, apps had to allow users to monitor their gout disease (e.g. serum uric acid (sUA) tracking, record acute attacks) and/or educate patients about gout. Investigators derived patient-focused recommendations for gout management from contemporary guidelines. Features of reviewed apps were independently assessed by two reviewers for their facilitation of these recommendations. The search identified 57 apps possibly relevant to gout management, of which six met the inclusion criteria. One app incorporated all recommendations for patient-focused gout management from guidelines including monitoring sUA, recording attacks and lifestyle advice. However, the majority of these elements were not functional within the app, and instead required users to manually complete printouts. Currently, only one app exists that includes all recommendations to facilitate patient self-management of gout, however some features can only be actioned manually. Given the lack of progress in achieving better patient outcomes and the promise of mHealth interventions to deliver significant gains, new or updated gout management apps are required to promote successful self-management of this chronic disease.

The value of sociotechnical theories for implementation of clinical information systems

Publisher: IGI Global

Date: 2011

DOI: 10.4018/978-1-60960-768-5.CH012

Abstract: The following chapter provides an overview of sociotechnical theories that can be used to understand, design, implement, and evaluate clinical information systems in health care settings. The sociotechnical approach is one that seeks to identify the dynamics between technology and the social, professional, and cultural environment in which it is used. Theories and models covered include: the technology and information technology acceptance models a multi-level integration framework approach social cognition theory theories that propose a fit between in iduals, tasks and the technology diffusion of innovation theory, and a contextual implementation model. The frameworks presented in this chapter are not exhaustive but are most relevant to the complexity of information and communication technology use in health care settings.

Variation in electronic test results management and its implications for patient safety

Publisher: Oxford University Press (OUP)

Date: 27-07-2020

DOI: 10.1093/JAMIA/OCAA093

Abstract: The management and follow-up of diagnostic test results is a major patient safety concern. The aim of this qualitative study was to explore how clinicians manage test results on an everyday basis (work-as-done) in a health information technology–enabled emergency department setting. The objectives were to identify (1) variations in work-as-done in test results management and (2) the strategies clinicians use to ensure optimal management of diagnostic test results. Qualitative interviews (n = 26) and field observations were conducted across 3 Australian emergency departments. Interview data coded for results management (ie, tracking, acknowledgment, and follow-up), and artifacts, were reviewed to identify variations in descriptions of work-as-done. Thematic analysis was performed to identify common themes. Despite using the same test result management application, there were variations in how the system was used. We identified 5 themes relating to electronic test results management: (1) tracking test results, (2) use and understanding of system functionality, (3) visibility of result actions and acknowledgment, (4) results inbox use, and (5) challenges associated with the absence of an inbox for results notifications for advanced practice nurses. Our findings highlight that variations in work-as-done can function to overcome perceived impediments to managing test results in a HIT-enabled environment and thus identify potential risks in the process. By illuminating work-as-done, we identified strategies clinicians use to enhance test result management including paper-based manual processes, cognitive reminders, and adaptive use of electronic medical record functionality. Test results tracking and follow-up is a priority area in need of health information technology development and training to improve team-based collaboration/communication of results follow-up and diagnostic safety.

Computerized Clinical Decision Support Systems for the Early Detection of Sepsis Among Pediatric, Neonatal, and Maternal Inpatients: Scoping Review (Preprint)

Publisher: JMIR Publications Inc.

Date: 02-12-2021

DOI: 10.2196/PREPRINTS.35061

Abstract: epsis is a severe condition associated with extensive morbidity and mortality worldwide. Pediatric, neonatal, and maternal patients represent a considerable proportion of the sepsis burden. Identifying sepsis cases as early as possible is a key pillar of sepsis management and has prompted the development of sepsis identification rules and algorithms that are embedded in computerized clinical decision support (CCDS) systems. his scoping review aimed to systematically describe studies reporting on the use and evaluation of CCDS systems for the early detection of pediatric, neonatal, and maternal inpatients at risk of sepsis. EDLINE, Embase, CINAHL, Cochrane, Latin American and Caribbean Health Sciences Literature (LILACS), Scopus, Web of Science, OpenGrey, ClinicalTrials.gov, and ProQuest Dissertations and Theses Global (PQDT) were searched by using a search strategy that incorporated terms for sepsis, clinical decision support, and early detection. Title, abstract, and full-text screening was performed by 2 independent reviewers, who consulted a third reviewer as needed. One reviewer performed data charting with a s le of data. This was checked by a second reviewer and via discussions with the review team, as necessary. total of 33 studies were included in this review—13 (39%) pediatric studies, 18 (55%) neonatal studies, and 2 (6%) maternal studies. All studies were published after 2011, and 27 (82%) were published from 2017 onward. The most common outcome investigated in pediatric studies was the accuracy of sepsis identification (9/13, 69%). Pediatric CCDS systems used different combinations of 18 erse clinical criteria to detect sepsis across the 13 identified studies. In neonatal studies, 78% (14/18) of the studies investigated the Kaiser Permanente early-onset sepsis risk calculator. All studies investigated sepsis treatment and management outcomes, with 83% (15/18) reporting on antibiotics-related outcomes. Usability and cost-related outcomes were each reported in only 2 (6%) of the 31 pediatric or neonatal studies. Both studies on maternal populations were short abstracts. his review found limited research investigating CCDS systems to support the early detection of sepsis among pediatric, neonatal, and maternal patients, despite the high burden of sepsis in these vulnerable populations. We have highlighted the need for a consensus definition for pediatric and neonatal sepsis and the study of usability and cost-related outcomes as critical areas for future research. R2-10.2196/24899

Stepped-wedge cluster randomised controlled trial to assess the effectiveness of an electronic medication management system to reduce medication errors, adverse drug events and average length of stay at two paediatric hospitals: A study protocol

Publisher: BMJ

Date: 10-2016

DOI: 10.1136/BMJOPEN-2016-011811

Patient groups, clinicians and healthcare professionals agree

Publisher: Walter de Gruyter GmbH

Date: 17-10-2018

DOI: 10.1515/DX-2018-0083

Abstract: Diagnostic testing provides integral information for the prevention, diagnosis, treatment and management of disease. Inadequate test result reporting and follow-up is a major risk to patient safety. Factors contributing to failure to follow-up test results include unclear delineation of responsibility about who is meant to act on a test result poor coordination across different levels of care and the absence of integrated health information systems for the efficient information communication. A 2016 Australian Stakeholder Forum brought together over 30 representatives from 14 different consumer, clinical and management stakeholder organisations to discuss safe and effective test result communication, management and follow-up. Thematic analysis was conducted drawing on multimodal data collected in the form of observational fieldnotes and document artefacts produced by participants. The forum identified major challenges which pose immediate risks to patient safety. Participants recommended priorities for addressing issues relating to: (i) the governance of test result management processes (ii) integration of health care processes through the utilisation of effective digital health solutions and (iii) involving patients as key partners in the decision-making and care process. Stakeholder groups erged slightly in their priorities. Consumers highlighted the lack of patient involvement in the test result management process but were less concerned about standardisation of reports and critical result thresholds than pathologists. The forum foregrounded the need for a systems approach, capable of identifying and addressing interconnections and multiple factors that contribute to poor test result follow-up, with a strong emphasis on enhancing the contribution of patients.

Multiple Perspectives on the Impact of Electronic Ordering on Hospital Organisational and Communication Processes

Publisher: SAGE Publications

Date: 12-2005

DOI: 10.1177/183335830503400406

Abstract: Electronic ordering systems provide many potential benefits for improving the efficiency and effectiveness of healthcare delivery. They also have major implications for organisational and communication processes within hospitals. We undertook a qualitative study using focus groups and interviews with doctors, nurses, IT managers, and pathology laboratory managers to investigate the impact of the system on their work processes and relations within a major teaching hospital. This study revealed that the new electronic ordering system involved major alterations to the information management processes within the hospital, which in turn affected communication processes and work relations.

How does an accreditation programme in residential aged care inform the way residents manage their healthcare and lifestyle?

Publisher: Springer International Publishing

Date: 12-10-2018

DOI: 10.1007/978-3-319-62235-4_17

Task errors by emergency physicians are associated with interruptions, multitasking, fatigue and working memory capacity: a prospective, direct observation study

Publisher: BMJ

Date: 09-01-2018

DOI: 10.1136/BMJQS-2017-007333

Abstract: Interruptions and multitasking have been demonstrated in experimental studies to reduce in iduals’ task performance. These behaviours are frequently used by clinicians in high-workload, dynamic clinical environments, yet their effects have rarely been studied. To assess the relative contributions of interruptions and multitasking by emergency physicians to prescribing errors. 36 emergency physicians were shadowed over 120 hours. All tasks, interruptions and instances of multitasking were recorded. Physicians’ working memory capacity (WMC) and preference for multitasking were assessed using the Operation Span Task (OSPAN) and Inventory of Polychronic Values. Following observation, physicians were asked about their sleep in the previous 24 hours. Prescribing errors were used as a measure of task performance. We performed multivariate analysis of prescribing error rates to determine associations with interruptions and multitasking, also considering physician seniority, age, psychometric measures, workload and sleep. Physicians experienced 7.9 interruptions/hour. 28 clinicians were observed prescribing 239 medication orders which contained 208 prescribing errors. While prescribing, clinicians were interrupted 9.4 times/hour. Error rates increased significantly if physicians were interrupted (rate ratio (RR) 2.82 95% CI 1.23 to 6.49) or multitasked (RR 1.86 95% CI 1.35 to 2.56) while prescribing. Having below-average sleep showed a -fold increase in clinical error rate (RR 16.44 95% CI 4.84 to 55.81). WMC was protective against errors for every 10-point increase on the 75-point OSPAN, a 19% decrease in prescribing errors was observed. There was no effect of polychronicity, workload, physician gender or above-average sleep on error rates. Interruptions, multitasking and poor sleep were associated with significantly increased rates of prescribing errors among emergency physicians. WMC mitigated the negative influence of these factors to an extent. These results confirm experimental findings in other fields and raise questions about the acceptability of the high rates of multitasking and interruption in clinical environments.

Use of point‐of‐care online clinical evidence by junior and senior doctors in New South Wales public hospitals

Publisher: Wiley

Date: 16-06-2005

DOI: 10.1111/J.1445-5994.2005.00836.X

Abstract: The Clinical Information Access Program (CIAP), an online evidence retrieval system, provides NSW health professionals in public hospitals with 24 h access to information supporting evidence-based practice. To assess the frequency and type of CIAP usage by senior and junior medical staff and doctors' attitudes to CIAP. A convenience s le of 25% of doctors from 65 randomly selected public hospitals completed a survey. Junior (n = 392) and senior (n = 684) doctors' responses were compared using chi2 analyses and t-tests. Most doctors had heard of CIAP (71.8%) and 60.6% had used it. More junior (72.4%) than senior (53.8%) doctors had used CIAP and junior doctors found it easier to use. Of the users 93.5% believed CIAP had the potential to improve patient care 55.2% had directly experienced this. Most usage (61.5%) occurred at point-of-care 74% of users found all/most of the information they sought and 71.6% found the search time to be 'good/excellent'. Users had increased their usage in the past year and predicted increased future usage. The most popular databases were Medline and MIMS. Age, access to other evidence, and lack of training, time and computer skills were associated with non-usage. Junior and senior users differed in 4 of 15 reasons for using CIAP. CIAP is used and valued by the majority of doctors. Patterns of usage, online experiences and the attitudes toward CIAP of senior doctors who use CIAP are relatively similar to those of junior doctors.

The safety of electronic prescribing: manifestations, mechanisms, and rates of system-related errors associated with two commercial systems in hospitals

Publisher: Oxford University Press (OUP)

Date: 11-2013

DOI: 10.1136/AMIAJNL-2013-001745

Is accreditation linked to hospital infection rates? A 4-year, data linkage study of Staphylococcus aureus rates and accreditation scores in 77 Australian acute hospitals

Publisher: Oxford University Press (OUP)

Date: 29-09-2015

DOI: 10.1093/INTQHC/MZV078

Abstract: To test our hypothesis that hospitals with higher accreditation scores, specifically in infection control, would be associated with lower Staphylococcus aureus bacteraemia (SAB) rates. A retrospective cohort study. Acute public hospitals (n = 77) in New South Wales, Australia, with reported SAB rates, results from two accreditation surveys and results from at least four hand hygiene audits. We linked three separate data sets comprising SAB rates, accreditation scores and hand hygiene rates. SAB rates were regressed against accreditation scores, hand hygiene audit rates and hospital demographics using a generalized linear model to account for the non-linear nature of our outcome variable. Significant (P < 0.05) findings included the following: SAB rates across all hospitals fell from 1.34 per 10 000 bed days in 2009 to 0.77 per 10 000 bed days in 2012 mean SAB rates in small hospitals (0.62/10 000 bed days) over the study period were lower than those for principal referral hospitals (1.52/10 000 bed days) smaller hospitals with higher accreditation scores had lower SAB rates, but larger hospitals with higher overall accreditation scores had higher SAB rates, although the effect size was small (<2%). There is a strong evidence base for using SAB rates to measure the impact of infection control programs that are assessed during accreditation. However, there is less evidence to support whether accreditation scores accurately reflect implementation of the infection control accreditation standards. This impacts identification of indicators to measure patient safety and quality of care, especially in ensuring these are appropriate across a range of hospital size and activities.

Maternity patients' access to their electronic medical records

Publisher: SAGE Publications

Date: 03-2015

DOI: 10.1177/183335831504400101

Abstract: Patients have been able to access clinical information from their paper-based health records for a number of years. With the advent of Electronic Medical Records (EMRs) access to this information can now be achieved online using a secure electronic patient portal. The purpose of this study was to investigate maternity patients' use and perceptions of a patient portal developed at the Mater Mothers' Hospital in Brisbane, Australia. A web-based patient portal, one of the first developed and deployed in Australia, was introduced on 26 June 2012. The portal was designed for maternity patients booked at Mater Mothers' Hospital, as an alternative to the paper-based Pregnancy Health Record. Through the portal, maternity patients are able to complete their hospital registration form online and obtain current health information about their pregnancy (via their EMR), as well as access a variety of support tools to use during their pregnancy such as tailored public health advice. A retrospective cross-sectional study design was employed. Usage statistics were extracted from the system for a one year period (1 July 2012 to 30 June 2013). Patients' perceptions of the portal were obtained using an online survey, accessible by maternity patients for two weeks in February 2013 ( n=80). Descriptive statistics were employed to analyse the data. Between July 2012 and June 2013, 10,892 maternity patients were offered a patient portal account and access to their EMR. Of those 6,518 created one (60% 6,518/10,892) and 3,104 went on to request access to their EMR (48% 3,104/6,518). Of these, 1,751 had their access application granted by 30 June 2013. The majority of maternity patients submitted registration forms online via the patient portal (56.7%). Patients could view their EMR multiple times: there were 671 views of the EMR, 2,781 views of appointment schedules and 135 birth preferences submitted via the EMR. Eighty survey responses were received from EMR account holders, (response rate of 8.1% 80/985). The majority of respondents indicated they would use the portal and access their EMR for future pregnancies (86.2% 69/80). Approximately half looked at their EMR after a visit with their care provider (51.3%) 41/80) and 37.5% (30/80) viewed their EMR before, to prepare for their visit. The majority (65.8%) thought that the EMR improved their ability to understand and recall appointments and almost half (48.1%) thought that with the EMR they were less likely to repeat pregnancy information to caregivers. This study provides the first Australian evidence of a patient portal system, tied to an EMR, working effectively in a maternity care context. It provides new evidence that portals can deliver benefits to maternity patients in terms of providing quick and easy access to current personal and general health information and support patients in their ability to recall and prepare for appointments.

Gaps, disconnections, and discontinuities- The role of information exchange in the delivery of quality long-term care

Publisher: Oxford University Press (OUP)

Date: 26-10-2013

DOI: 10.1093/GERONT/GNS127

Abstract: The smart use of information and communication technologies (ICT) is widely seen as a means of enhancing the quality of aged care services. One of the barriers to ICT diffusion in aged care is the failure to cater for the complex and interdisciplinary requirements of the aged care environment. The aim of this qualitative study was to identify the layers of information exchange and communication and produce a conceptual model that can help to inform decisions related to the design, implementation, and sustainability of ICT. A qualitative study conducted in 2010 within seven Australian residential aged care facilities. It included 11 focus groups involving 47 staff and 54 in idual interviews and observation sessions. The analysis of work processes identified key information exchange components related to the type of information (residential, clinical, and administrative) that is collected, stored, and communicated. This information relies on a erse number of internal and external communication channels that are important for the organization of care. The findings highlight potential areas of communication dysfunction as a consequence of structural holes, fragmentation, or disconnections that can adversely affect the continuity and coordination of care, its safety, and quality.

Interruptions and multi-tasking: moving the research agenda in new directions

Publisher: BMJ

Date: 18-07-2014

DOI: 10.1136/BMJQS-2014-003372

Health outcomes in Australia and the United States - Reply

Publisher: Wiley

Date: 06-1996

DOI: 10.1111/J.1445-5994.1996.TB01934.X

An Evaluation of the Postgraduate Diploma of Applied Science in Health Information Management

Publisher: SAGE Publications

Date: 06-1997

DOI: 10.1177/183335839702700206

Abstract: Thirty-six students have graduated with a Graduate Diploma of Applied Science (Health Information Management) from the University of Sydney since the course was introduced in 1992. A survey of graduates was conducted to examine the extent to which they believed the course had provided them with sufficient knowledge and skills to become effective health information management practitioners. Options for changes to the course were also explored in the questionnaire. The results demonstrated that graduates strongly supported the existing curriculum. Increased opportunities for practical experience were suggested by many respondents. There was not strong support for an option to increase the length of the course. However, the option to commence study in January and undertake some classes in the inter-semester break was viewed positively by 68% of the graduates.

ISQUA17-1976MEDICATION ADMINISTRATION PRACTICES ON THE WEEKEND VERSUS WEEKDAYS?: A DIRECT OBSERVATIONAL STUDY OF 227 PAEDIATRIC NURSES

Publisher: Oxford University Press (OUP)

Date: 09-2017

DOI: 10.1093/INTQHC/MZX125.23

Compliance with pathology testing guidelines in Australian general practice: protocol for a secondary analysis of electronic health record data

Publisher: BMJ

Date: 11-2018

DOI: 10.1136/BMJOPEN-2018-024223

Abstract: In Australia, general practitioners usually are the first point of contact for patients with non-urgent medical conditions. Appropriate and efficient utilisation of pathology tests by general practitioners forms a key part of diagnosis and monitoring. However overutilisationand underutilisation of pathology tests have been reported across several tests and conditions, despite evidence-based guidelines outlining best practice in pathology testing. There are a limited number of studies evaluating the impact of these guidelines on pathology testing in general practice. The aim of our quantitative observational study is to define how pathology tests are used in general practice and investigate how test ordering practices align with evidence-based pathology guidelines. Access to non-identifiable patient data will be obtained through electronic health records from general practices across three primary health networks in Victoria, Australia. Numbers and characteristics of patients, general practices, encounters, pathology tests and problems managed over time will be described. Overall rates of encounters and tests, alongside more detailed investigation between subcategories (encounter year, patient’s age, gender, and location and general practice size), will also be undertaken. To evaluate how general practitioner test ordering coincides with evidence-based guidelines, five key candidate indicators will be investigated: full blood counts for patients on clozapine medication international normalised ratio measurements for patients on warfarin medication glycated haemoglobin testing for monitoring patients with diabetes vitamin D testing and thyroid function testing. Ethics clearance to collect data from general practice facilities has been obtained by the data provider from the RACGP National Research and Evaluation Ethics Committee (NREEC 17–008). Approval for the research group to use these data has been obtained from Macquarie University (5201700872). This study is funded by the Australian Government Department of Health Quality Use of Pathology Program (Agreement ID: 4-2QFVW4M). Findings will be reported to the Department of Health and disseminated in peer-reviewed academic journals and presentations (national and international conferences, industry forums).

Complexity of collaborative work in residential aged care facilities: An analysis of information exchange for medication management

Publisher: IEEE

Date: 2012

DOI: 10.1109/HICSS.2012.170

What are incident reports telling us? A comparative study at two Australian hospitals of medication errors identified at audit, detected by staff and reported to an incident system

Publisher: Oxford University Press (OUP)

Date: 12-01-2015

DOI: 10.1093/INTQHC/MZU098

The prevalence of dose errors among paediatric patients in hospital wards with and without health information technology

Publisher: Springer Science and Business Media LLC

Date: 16-08-2019

DOI: 10.1007/S40264-018-0715-6

Abstract: The risk of dose errors is high in paediatric inpatient settings. Computerized provider order entry (CPOE) systems with clinical decision support (CDS) may assist in reducing the risk of dosing errors. Although a frequent type of medication error, the prevalence of dose errors is not well described. Dosing error rates in hospitals with or without CPOE have not been compared. Our aim was to conduct a systematic review assessing the prevalence and impact of dose errors in paediatric wards with and without CPOE and/or CDS. We systematically searched five databases to identify studies published between January 2000 and December 2017 that assessed dose error rates by medication chart audit or direct observation. We identified 39 studies, nine of which involved paediatric wards using CPOE with or without CDS. Studies of paediatric wards using paper medication charts reported approximately 8-25% of patients experiencing a dose error, and approximately 2-6% of medication orders and approximately 3-8% of dose administrations contained a dose error, with estimates varying by ward type. The nine studies of paediatric wards using CPOE reported approximately 22% of patients experiencing a dose error, and approximately 1-6% of medication orders and approximately 3-8% of dose administrations contained a dose error. Few studies provided data for in idual wards. The severity and prevalence of harm associated with dose errors was rarely assessed and showed inconsistent results. Dose errors occur in approximately 1 in 20 medication orders. Hospitals using CPOE with or without CDS had a lower rate of dose errors compared with those using paper charts. However, few pre ost studies have been conducted and none reported a significant reduction in dose error rates associated with the introduction of CPOE. Future research employing controlled designs is needed to determine the true impact of CPOE on dosing errors among children, and any associated patient harm.

Medication use and hospital‐acquired acute kidney injury: an electronic health record‐based study

Publisher: Wiley

Date: 20-10-2022

DOI: 10.1111/IMJ.15938

Abstract: Medications remain an important contributor to the development of acute kidney injury (AKI). This study aimed to examine associations between (i) administration of medications known to reduce glomerular filtration rate (GFR), that is, GFR modifiers and subsequent hospital‐acquired AKI and (ii) potentially medication‐related AKI and patient adverse outcomes. A retrospective cohort study utilising electronic health record data of patients admitted to a tertiary hospital in Australia in 2015. Timing of medication administration was compared with timing of AKI development. AKI cases were identified using an algorithm based on serum creatinine level changes. Multilevel regression models were applied with adjustment for relevant demographic and clinical factors. Among 11 503 admissions, AKI was identified in 955 patients (8.3%) and 637 (66.7% of 955) were preceded by administration of a GFR modifier. Patients without prior AKI were 17% more likely to develop AKI after administration of these medications (adjusted odds ratio 1.17, 95% confidence interval (CI) 1.003–1.37). Older age and comorbidity with diabetes, acute myocardial infarction, peripheral vascular disease, liver cirrhosis and multiple myeloma were also significant predictors. Patients with potentially medication‐related AKI were 11.69 times more likely to die in hospital (95% CI 7.84–17.43) and stayed 3.49 times longer in hospital (95% CI 3.26–3.73), compared with those without AKI. Administration of medications contributing to the reduction of GFR is associated with an increased risk of hospital‐acquired AKI and worse patient outcomes. Caution is required when prescribing these medications to patients at risk of developing AKI, and monitoring patients for deterioration is needed if administered.

How and where clinicians exercise power: Interprofessional relations in health care

Publisher: Elsevier BV

Date: 09-2010

DOI: 10.1016/J.SOCSCIMED.2010.05.029

Abstract: This study aims to contribute to the limited set of interactional studies of health occupational relations. A "negotiated order" perspective was applied to a multi-site setting to articulate the ways in which clinicians' roles, accountabilities and contributions to patient care are shaped by the care setting and are influenced by the management of patient pathways. The study responds to the polarized debate between a critical perspective that calls for collaboration as the re-distribution of occupational power, and a functionalist view that argues for better coordination of health care teams. The study draws on data from 63 interviews, 68 focus groups and 209 h of observation across acute and non-acute health services within a state/territory in Australia. The paper reveals the exercise of both "competitive power" and "collaborative power" in the negotiated order of health services. Both forms of power are exercised in all settings. Relationships among clinicians in various occupations are mediated by the expectation that doctors assume responsibility for patient management and coordinating roles in health care teams, and the degree of acuity of particular health care settings. The combination of a negotiated order perspective and its unique application across a whole health system shows the continuation of a broad pattern of power by doctors over those in other roles. The paper also reveals novel criteria for evaluating the extent of power-sharing in interprofessional interaction in case conferences, and a unique quantification of such interaction.

Systematic review of 29 self-report instruments for assessing quality of life in older adults receiving aged care services

Publisher: BMJ

Date: 11-2021

DOI: 10.1136/BMJOPEN-2021-050892

Abstract: Quality of life (QoL) outcomes are used to monitor quality of care for older adults accessing aged care services, yet it remains unclear which QoL instruments best meet older adults’, providers’ and policymakers’ needs. This review aimed to (1) identify QoL instruments used in aged care and describe them in terms of QoL domains measured and logistical details (2) summarise in which aged care settings the instruments have been used and (3) discuss factors to consider in deciding on the suitability of QoL instruments for use in aged care services. Systematic review. MEDLINE, EMBASE, PsycINFO, Cochrane Library and CINAHL from inception to 2021. Instruments were included if they were designed for adults ( years), available in English, been applied in a peer-reviewed research study examining QoL outcomes in adults years accessing aged care (including home/social care, residential/long-term care) and had reported psychometrics. Two researchers independently reviewed the measures and extracted the data. Data synthesis was performed via narrative review of eligible instruments. 292 articles reporting on 29 QoL instruments were included. Eight domains of QoL were addressed: physical health, mental health, emotional state, social connection, environment, autonomy and overall QoL. The period between 1990 and 2000 produced the greatest number of newly developed instruments. The EuroQoL-5 Dimensions (EQ-5D) and Short Form-series were used across multiple aged care contexts including home and residential care. More recent instruments (eg, ICEpop CAPability measure for Older people (ICECAP-O) and Adult Social Care Outcomes Toolkit (ASCOT)) tend to capture emotional sentiment towards personal circumstances and higher order care needs, in comparison with more established instruments (eg, EQ-5D) which are largely focused on health status. A comprehensive list of QoL instruments and their characteristics is provided to inform instrument choice for use in research or for care quality assurance in aged care settings, depending on needs and interests of users.

Characteristics of older Australian community aged care clients who fall: Incidents reported by care staff

Publisher: Hindawi Limited

Date: 02-09-2022

DOI: 10.1111/HSC.13145

Abstract: Falls are the leading cause of injury and hospitalisation for older adults (aged 65 years or older) worldwide. Data collected by community aged care providers are an underutilised source of information about precipitating risk factors and consequences of falls for older adults living in the community. The objective of this longitudinal, observational study was to describe and compare the characteristics of older Australians who did and did not have falls reported by community aged care staff. We analysed 19 months of routinely collected care management and incident data for 1,596 older clients from a large Australian community care provider. Differences in sociodemographic characteristics, care needs and community care service use were compared between those who had one or more reported falls and those who had none. Fall-related outcomes (injuries, hospitalisations, relocation to residential aged care) were examined. The average age of clients was 82 years and most were women (66%). Seventy-seven (4.8%) clients had one or more reported falls over the study period (total falls = 92). Clients who had falls reported by care staff were more likely to be older adults, male and use more hours of community care services per week. There were 38 falls-related injuries, 5 falls-related hospitalisations and 20 clients relocated to residential aged care after a reported fall. This study demonstrates the potential for using routinely collected community aged care data to understand risk factors and monitor longitudinal outcomes for a population at high risk of falls.

Duration of Antipsychotic Medication Use by Aged Care Facility Residents With Dementia

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 19-07-2019

DOI: 10.1097/WAD.0000000000000336

Pre-operative medication frequencies matter

Publisher: Macquarie University

Date: 2022

DOI: 10.25949/7YC3-A257

Examining the role of information exchange in residential aged care work practices-a survey of residential aged care facilities

Publisher: Springer Science and Business Media LLC

Date: 02-08-2012

DOI: 10.1186/1471-2318-12-40

The effect of physicians' long-term use of CPOE on their test management work practices

Publisher: Oxford University Press (OUP)

Date: 11-2006

DOI: 10.1197/JAMIA.M2152

Managing competing demands through task-switching and multitasking: a multi-setting observational study of 200 clinicians over 1000 hours

Publisher: BMJ

Date: 17-10-2013

DOI: 10.1136/BMJQS-2013-002097

Abstract: To provide a detailed characterisation of clinicians' work management strategies. 1002.3 h of observational data were derived from three previous studies conducted in a teaching hospital in Sydney, Australia, among emergency department (ED) doctors (n=40), ward doctors (n=57) and ward nurses (n=104). The rates of task-switching (pausing a task to handle an incoming task) and multitasking (adding a task in parallel to an existing task) were compared in each group. Random intercepts logistic regression was used to determine factors significantly associated with clinicians' use of task-switching over multitasking and to quantify variation between in idual clinicians. Task-switching rates were higher among ED doctors (6.0 per hour) than ward staff (2.2 and 1.8 per hour for doctors and nurses, respectively) and vice versa for multitasking rates (9.2 vs 17.3 and 14.1 per hour). Clinicians' strategy use was significantly related to the nature and complexity of work and to the person they were working with. In some settings, time of day, day of the week or previous chosen strategy affected a clinician's strategy. Independent of these factors, there was significant variation between in idual clinicians in their use of strategies in a given situation (ED doctors p=0.04, ward staff p=0.03). Despite differences in factors associated with work management strategy use among ED doctors, ward doctors and ward nurses, clinicians in all settings appeared to prioritise certain types of tasks over others. Documentation was generally given low priority in all groups, while the arrival of direct care tasks tended to be treated with high priority. These findings suggest that considerations of safety may be implicit in task-switching and multitasking decisions. Although these strategies have been cast in a negative light, future research should consider their role in optimising competing quality and efficiency demands.

Vital signs monitoring on general wards

Publisher: Oxford University Press (OUP)

Date: 17-06-2016

DOI: 10.1093/INTQHC/MZW062

Abstract: Early detection of patient deterioration and prevention of adverse events are key challenges to patient safety. This study investigated clinical staff perceptions of current monitoring practices and the planned introduction of continuous monitoring devices on general wards. Multi-method study comprising structured surveys, in-depth interviews and device trial with log book feedback. Two general wards in a large urban teaching hospital in Sydney, Australia. Respiratory and neurosurgery nursing staff and two doctors. Nurses were confident about their abilities to identify patients at risk of deterioration, using a combination of vital signs and visual assessment. There were concerns about the accuracy of current vital signs monitoring equipment and frequency of intermittent observation. Both the nurses and the doctors were enthusiastic about the prospect of continuous monitoring and perceived it would allow earlier identification of patient deterioration provide reassurance to patients and support interdisciplinary communication. There were also reservations about continuous monitoring, including potential decrease in bedside nurse-patient interactions increase in inappropriate escalations of patient care and discomfort to patients. While continuous monitoring devices were seen as a potentially positive tool to support the identification of patient deterioration, drawbacks, such as the potential for reduced patient contact, revealed key areas that will require close surveillance following the implementation of devices. Training and improved interdisciplinary communication were identified as key requisites for successful implementation.

Nurses’ use of online clinical evidence

Publisher: Wiley

Date: 14-06-2004

DOI: 10.1111/J.1365-2648.2004.03079.X

Implementing electronic medication management at an Australian teaching hospital

Publisher: AMPCo

Date: 11-2011

DOI: 10.5694/MJA11.10451

Abstract: We describe the implementation of an electronic medication management system (eMMS) in an Australian teaching hospital, to inform future similar exercises. The success of eMMS implementation depends on: a positive workplace culture (leadership, teamwork and clinician ownership) acceptance of the major impact on work practices by all staff timely system response to user feedback training and support for clinicians a usable system adequate decision support.

Guiding principles for effective collaborative implementation strategies for multisite hospital improvement initiatives

Publisher: BMJ

Date: 06-2023

DOI: 10.1136/BMJOPEN-2022-070799

Abstract: Large-scale, multisite hospital improvement initiatives can advance high-quality care for patients. Implementation support is key to adoption of change in this context. Strategies that foster collaboration within local teams, across sites and between initiative developers and users are important. However not all implementation strategies are successful in all settings, sometimes realising poor or unintended outcomes. Our objective here is to develop guiding principles for effective collaborative implementation strategies for multi-site hospital initiatives. Mixed-method realist evaluation. Realist studies aim to examine the underlying theories that explain differing outcomes, identifying mechanisms and contextual factors that may trigger them. We report on collaborative strategies used in four multi-site initiatives conducted in all public hospitals in New South Wales, Australia (n ). Using an iterative process, information was gathered on collaborative implementation strategies used, then initial programme theories hypothesised to underlie the strategies’ outcomes were surfaced using a realist dialogic approach. A realist interview schedule was developed to elicit evidence for the posited initial programme theories. Fourteen participants from 20 key informants invited participated. Interviews were conducted via Zoom, transcribed and analysed. From these data, guiding principles of fostering collaboration were developed. Six guiding principles were distilled: (1) structure opportunities for collaboration across sites (2) facilitate meetings to foster learning and problem-solving across sites (3) broker useful long-term relationships (4) enable support agencies to assist implementers by giving legitimacy to their efforts in the eyes of senior management (5) consider investment in collaboration as effective well beyond the current projects (6) promote a shared vision and build momentum for change by ensuring inclusive networks where everyone has a voice. Structuring and supporting collaboration in large-scale initiatives is a powerful implementation strategy if contexts described in the guiding principles are present.

Factors associated with consulting medical or non‐medical practitioners for dyspepsia: an Australian population‐based study

Publisher: Wiley

Date: 27-12-2000

DOI: 10.1046/J.1365-2036.2000.00878.X

Abstract: Little is known about how many dyspeptics in the population consult medical and non-medical practitioners, or the factors associated with various consulting patterns. A cross-sectional survey of 748 Australians with dyspepsia investigated their age, sex, dyspepsia symptoms, medical and non-medical consultations, and health status on the SF-12. Overall, 56% had ever consulted a medical practitioner for dyspepsia. Of these, 54% consulted within 6 months of first symptoms. Non-medical practitioners were consulted by 29%. Compared to dyspeptics in all, or most, other consulting groups, subjects who did not consult (37%, group NO) were characterized by fewer symptoms, better physical health, and younger age. Those who only consulted doctors (34%, group M) were older and had better mental, but poorer physical health. Those who only consulted non-medical practitioners (7%, group N) were younger and had better physical, but poorer mental health. Dyspeptics consulting both medical and non-medical practitioners (22%, group M + N), were older, more dissatisfied with medical care, had more symptoms and poorer physical and mental health. Timing of medical consultations was similar in groups M and M + N. Group M + N dyspeptics consulted similar types, but more non-medical practitioners than group N. No sex differences were found in consulting behaviour. Many dyspeptics do not consult they have fewer symptoms than consulters. Consultation with non-medical practitioners is common and is associated with poor mental health. Dyspeptics seeking advice from both medical and non-medical practitioners are less satisfied with their medical management than those who only consult doctors for their dyspepsia.

Making sense of a haemolysis monitoring and reporting system: a nationwide longitudinal multimethod study of 68 Australian laboratory participant organisations

Publisher: Walter de Gruyter GmbH

Date: 15-09-2018

DOI: 10.1515/CCLM-2017-0056

Abstract: The key incident monitoring and management systems (KIMMS) quality assurance program monitors incidents in the pre- and postanalytical phases of testing in medical laboratories. Haemolysed specimens have been found to be the most frequent preanalytical error and have major implications for patient care. The aims of this study were to assess the suitability of KIMMS for quality reporting of haemolysis and to devise a meaningful method for reporting and monitoring haemolysis. A structured survey of 68 Australian KIMMS laboratory participant organisations was undertaken. Quarterly haemolysis reports (2011–2014) were analysed. Among 110 million accessions reported, haemolysis rates varied according to the reporting methods that participants used for assigning accessions (16% of participants reported haemolysis by specimen and 83% reported by episode) and counting haemolysis rejections (61% by specimen, 35% by episode and 3% by test). More than half of the participants (56%) assigned accessions by episode and counted rejections by specimen. For this group, the average haemolysis rate per 100,000 episodes was 177 rejected specimens with the average rate varying from 100 to 233 over time. The majority of participants (91%) determined rejections using the haemolysis index. Two thirds of participants (66%) recorded the haemolysis manually in laboratory information systems. KIMMS maintains the largest longitudinal haemolysis database in the world. However, as a means of advancing improvements in the quality of the preanalytical laboratory process, there is a need to standardise reporting methods to enable robust comparison of haemolysis rejection rates across participant laboratories.

CareTrack Australia: Assessing the appropriateness of adult healthcare: Protocol for a retrospective medical record review

Publisher: BMJ

Date: 2012

DOI: 10.1136/BMJOPEN-2011-000665

The development, design, testing, refinement, simulation and application of an evaluation framework for communities of practice and social-professional networks

Publisher: Springer Science and Business Media LLC

Date: 15-09-2009

DOI: 10.1186/1472-6963-9-162

Medication-related calls received by a national telenursing triage and advice service in Australia: a retrospective cohort study

Publisher: Springer Science and Business Media LLC

Date: 14-03-2017

DOI: 10.1186/S12913-017-2135-1

Speaking up as an extension of socio-cultural dynamics in hospital settings: a study of staff experiences of speaking up across seven hospitals

Publisher: Emerald

Date: 15-11-2022

DOI: 10.1108/JHOM-04-2022-0129

Abstract: The study aimed to understand the significance of how employee personhood and the act of speaking up is shaped by factors such as employees' professional status, length of employment within their hospital sites, age, gender and their ongoing exposure to unprofessional behaviours. Responses to a survey by 4,851 staff across seven sites within a hospital network in Australia were analysed to interrogate whether speaking up by hospital employees is influenced by employees' symbolic capital and situated subjecthood (SS). The authors utilised a Bourdieusian lens to interrogate the relationship between the symbolic capital afforded to employees as a function of their professional, personal and psycho-social resources and their self-reported capacity to speak up. The findings indicate that employee speaking up behaviours appear to be influenced profoundly by whether they feel empowered or disempowered by ongoing and pre-existing personal and interpersonal factors such as their functional roles, work-based peer and supervisory support and ongoing exposure to discriminatory behaviours. The findings from this interdisciplinary study provide empirical insights around why culture change interventions within healthcare organisations may be successful in certain contexts for certain staff groups and fail within others.

Cue utilization predicts the impact of interruptions during a rail simulation task

Publisher: SAGE Publications

Date: 11-2019

DOI: 10.1177/1071181319631081

Abstract: This study was designed to examine the role of cue utilization in the management of interruptions during a high workload, rail control simulation incorporating an implicit pattern of rail movement. The experiment required participants to manage frequent interruptive tasks while erting and logging the arrival of trains. Measures of response latency and accuracy in erting and logging the arrival of trains were recorded. Participants with lower cue utilization demonstrated a greater loss of performance following interruptions. These results provide support for the assertion that a relatively greater capacity for cue utilization is associated with superior performance in the management of interruptions during high workload tasks.

Social participation as an indicator of successful aging: an overview of concepts and their associations with health

Publisher: CSIRO Publishing

Date: 2017

DOI: 10.1071/AH16038

Abstract: Objectives Social participation has generated a wealth of research in gerontology, but the concept suffers from a lack of conceptual clarity that renders it difficult to define and measure. This means that research on social participation is difficult to compare directly. The aim of the present study was to draw the literature on social participation in older adults together to inform health services researchers seeking to investigate social participation as an indicator of successful aging. Methods A narrative review of studies investigating the association between social participation and health in adults aged 65 years and older was conducted. Results Three concepts of social participation (i.e. social connections, informal social participation and volunteering) were defined, their measurement instruments described and evidence of their associations with health explored. All three concepts have demonstrated associations with an array of health indicators. Prospective studies reveal that social participation at baseline is positively associated with mental and physical health. Conclusion A model of social participation on health is presented, showing the evidence that all three concepts contribute to the association between social participation and health through their shared mechanisms of social support and social cohesion with the wider community. Using an instrument that can be separated into these three distinct concepts will assist health services researchers to determine the relative effect of each form of participation on the health of older adults. What is known about the topic? Social participation has generated a wealth of research in gerontology. The scope of the literature on social participation is broad and the concepts erse. For this reason, most previous systematic reviews have been unable to comprehensively assess the effect of all concepts of social participation on health. This means the research on social participation is difficult to compare directly, and indicators of social participation in older adults are difficult for policy makers to select. What does this paper add? This paper overviews the three concepts of social participation, their methods of measurement and their associations with health in older adults. We present a model of social participation that incorporates all three concepts of social participation and their effects on health. We argue that the use of a measure that can be segmented into each of the three forms of social participation will predict more of the variance in health outcomes than any measure on its own. What are the implications for practitioners? Enhancing the social participation of older adults is a key factor in successful aging that many older adults value. However, many service provision organisations tend to focus on meeting the specific physical needs of clients, rather than targeting services that connect older adults with their community. Targeting social participation may present one of the greatest opportunities to improve older adults’ general health, and will also generate societal benefits by increasing community contributions from this group. Selecting an indicator of social participation that measures each of the three concepts overviewed in this paper will enable policy makers to identify the areas in which social interventions for older adults will have the most effect.

The impact of clinical leadership on health information technology adoption: Systematic review

Publisher: Elsevier BV

Date: 06-2014

DOI: 10.1016/J.IJMEDINF.2014.02.005

Abstract: To conduct a systematic review to examine evidence of associations between clinical leadership and successful information technology (IT) adoption in healthcare organisations. We searched Medline, Embase, Cinahl, and Business Source Premier for articles published between January 2000 to May 2013 with keywords and subject terms related to: (1) the setting--healthcare provider organisations (2) the technology--health information technology (3) the process--adoption and (4) the intervention--leadership. We identified 3121 unique citations, of which 32 met our criteria and were included in the review. Data extracted from the included studies were assessed in light of two frameworks: Bassellier et al.'s IT competence framework and Avgar et al.'s health IT adoption framework. The results demonstrate important associations between the attributes of clinical leaders and IT adoption. Clinical leaders who have technical informatics skills and prior experience with IT project management are likely to develop a vision that comprises a long-term commitment to the use of IT. Leaders who possess such a vision believe in the value of IT, are motivated to adopt it, and can maintain confidence and stability through the adversities that IT adoptions often entail. This leads to proactive leadership behaviours and partnerships with IT professionals that are associated with successful organisational and clinical outcomes. This review provides evidence that clinical leaders can positively contribute to successful IT adoption in healthcare organisations. Clinical leaders who aim for improvements in the processes and quality of care should cultivate the necessary IT competencies, establish mutual partnerships with IT professionals, and execute proactive IT behaviours to achieve successful IT adoption.

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

DOI: 10.1371/JOURNAL.PMED.1001164

Strengthening organizational performance through accreditation research-a framework for twelve interrelated studies: the ACCREDIT project study protocol

Publisher: Springer Science and Business Media LLC

Date: 09-10-2011

DOI: 10.1186/1756-0500-4-390

IORapp: An R tool for Inter-Observer Reliability Assessment of Time and Motion data

Publisher: ACM

Date: 23-04-2021

DOI: 10.1145/3452853.3452890

A four-year, systems-wide intervention promoting interprofessional collaboration

Publisher: Springer Science and Business Media LLC

Date: 20-04-2012

DOI: 10.1186/1472-6963-12-99

Narrative synthesis of health service accreditation literature

Publisher: BMJ

Date: 04-10-2012

DOI: 10.1136/BMJQS-2012-000852

Abstract: To systematically identify and synthesise health service accreditation literature. A systematic identification and narrative synthesis of health service accreditation literature published prior to 2012 were conducted. The search identified 122 empirical studies that examined either the processes or impacts of accreditation programmes. Study components were recorded, including: dates of publication research settings levels of study evidence and quality using established rating frameworks and key results. A content analysis was conducted to determine the frequency of key themes and subthemes examined in the literature and identify knowledge-gaps requiring research attention. The majority of studies (n=67) were published since 2006, occurred in the USA (n=60) and focused on acute care (n=79). Two thematic categories, that is, 'organisational impacts' and 'relationship to quality measures', were addressed 60 or more times in the literature. 'Financial impacts', 'consumer or patient satisfaction' and 'survey and surveyor issues' were each examined fewer than 15 times. The literature is limited in terms of the level of evidence and quality of studies, but highlights potential relationships among accreditation programmes, high quality organisational processes and safe clinical care. Due to the limitations of the literature, it is not prudent to make strong claims about the effectiveness of health service accreditation. Nonetheless, several critical issues and knowledge-gaps were identified that may help stimulate and inform discussion among healthcare stakeholders. Ongoing effort is required to build upon the accreditation evidence-base by using high quality experimental study designs to examine the processes, effectiveness and financial value of accreditation programmes and their critical components in different healthcare domains.

Understanding Clinical Workflow Through Direct Continuous Observation: Addressing the Unique Statistical Challenges

Publisher: Springer International Publishing

Date: 2019

DOI: 10.1007/978-3-030-16916-9_12

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.

An assessment of organisational culture in Australian hospitals using employee online reviews

Publisher: Public Library of Science (PLoS)

Date: 14-09-2022

DOI: 10.1371/JOURNAL.PONE.0274074

Abstract: The aim of this study was to analyse the content of online reviews posted by hospital employees on job websites for themes of organisational culture. 103 anonymous online reviews across three job websites, posted by hospital employees of four hospitals within an Australian health network were extracted. Reviews had been posted across a period of six years, from 2014 to early 2020. Sentiment rating based on user-allotted ratings on the selected websites was calculated. The sentiment score was validated against the textual content of the review to confirm employee recommendation and sentiment. Sentiment was coded as neutral, positive, or negative. Significant keywords, associations, and usage within the context of identified sentiment were deductively coded and clustered manually against eight pre-determined safety culture themes. These themes were derived from the most used assessment tools for self-reported measures of occupational health and safety, and safety culture in healthcare. Workers across clinical roles (n = 49) and non-clinical roles (n = 50) were evenly represented in the dataset. 35.9% of commenters (n = 37) reported their length of employment in the hospitals that they reviewed. Most online employee reviews addressed broad themes related to perceptions of management (n = 98), safety climate (n = 97), teamwork climate (n = 91) and working conditions (n = 98). A significant set of reviews addressed themes related to job satisfaction (n = 49) and learning, training, and development (n = 41). 72.8% of online reviews (n = 75) expressed positive sentiment towards their employer. Reviews expressing negative sentiment were largely posted by former employees and indicated areas of discontent that reflected organisational and systemic factors. Online employee reviews posted by hospital workers on job sites provide valuable insights into healthcare organisational culture. Therefore, employee online reviews could be used as a supplementary source of data to inform organisational employee engagement initiatives.

Caution: editing within a dose calculator can result in large dose errors

Publisher: Macquarie University

Date: 2022

DOI: 10.25949/MWNH-P929

Does Computerized Provider Order Entry Reduce Prescribing Errors for Hospital Inpatients? A Systematic Review

Publisher: Oxford University Press (OUP)

Date: 09-2009

DOI: 10.1197/JAMIA.M3050

Development and application of an indicator assessment tool for measuring health services accreditation programs

Publisher: Springer Science and Business Media LLC

Date: 20-08-2015

DOI: 10.1186/S13104-015-1330-6

Shedding light on junior doctors' work practices after hours

Publisher: Wiley

Date: 12-2013

DOI: 10.1111/IMJ.12223

Abstract: It is imperative to understand the current work practices of hospital personnel to inform efforts and secure resources towards the improvement of hospital systems. Research examining doctors' work during night-shifts is limited. To describe and quantify the night-shift work practices of junior doctors. An observational time and motion study was conducted. Eight resident doctors in four general wards were observed for 96 h during night shifts (Monday-Friday, 2200-0800). Doctors spent the highest proportion (28% 95% CI 21-35) of their time performing social ersonal tasks (e.g. sleeping, eating) and indirect care (24% 95% CI 22-25) (e.g. reviewing notes, ordering tests). Work-related discussion comprised 15% (95% CI 13-17), and most took place at the beginning of the night. Medication-related tasks consumed a small proportion of time (4% 95% CI 3-4) but attracted a higher level of multitasking and interruptions than most other tasks. On average, 2 h of every shift were spent at a computer and 1.3 h with patient notes. Doctors spent 72% of the night-shift alone, multitasked 6.4% of the time and were interrupted, on average, once every 46 min. This study provides new data about junior doctors' work at night. Relative to doctors during the day, greater proportions of time were devoted to social ersonal tasks (including sleep) and indirect care, but a similar proportion to direct care. Multitasking and interruptions were minimal. Computer activities were an integral part of work. Handovers were observed at the beginning but not the completion of the night shift, which may have implications for patient safety.

HEALTH SCIENCE STUDENTS' IMAGES OF DISABLED PEOPLE

Publisher: Wiley

Date: 12-02-2010

DOI: 10.1111/J.1753-6405.1988.TB00591.X

Abstract: The sepsis syndrome represents an improper immune response to infection and is associated with unacceptably high rates of mortality and morbidity. The interactions between T cells and the innate immune system while combating sepsis are poorly understood. In this report, we observed that treatment with the potent, antiapoptotic cytokine interleukin-7 (IL-7) accelerated neutrophil recruitment and improved bacterial clearance. We first determined that T cells were necessary for the previously observed IL-7-mediated enhanced survival. Next, IL-7 increased Bcl-2 expression in T cells isolated from septic mice as early as 3 h following treatment. This treatment resulted in increased gamma interferon (IFN-γ) and IP-10 production within the septic peritoneum together with local and systemic increases of IL-17 in IL-7-treated mice. We further demonstrate that the increase in IL-17 was largely due to increased recruitment and production by γδ T cells, which express CXCR3. Consistent with increased IL-17 production, IL-7 treatment increased CXCL1/KC production, neutrophil recruitment, and bacterial clearance. Significantly, end-organ tissue injury was not significantly different between vehicle- and IL-7-treated mice. Collectively, these data illustrate that IL-7 can mediate the cross talk between Th1 and Th17 lymphocytes during sepsis such that neutrophil recruitment and bacterial clearance is improved while early tissue injury is not increased. All together, these observations may underlay novel potential therapeutic targets to improve the host immune response to sepsis.

Health professional networks as a vector for improving healthcare quality and safety: a systematic review

Publisher: BMJ

Date: 30-11-2012

DOI: 10.1136/BMJQS-2011-000187

Alert override as a habitual behavior - A new perspective on a persistent problem

Publisher: Oxford University Press (OUP)

Date: 06-06-2017

DOI: 10.1093/JAMIA/OCW072

Abstract: Quantifying alert override has been the focus of much research in health informatics, with override rate traditionally viewed as a surrogate inverse indicator for alert effectiveness. However, relying on alert override to assess computerized alerts assumes that alerts are being read and determined to be irrelevant by users. Our research suggests that this is unlikely to be the case when users are experiencing alert overload. We propose that over time, alert override becomes habitual. The override response is activated by environmental cues and repeated automatically, with limited conscious intention. In this paper we outline this new perspective on understanding alert override. We present evidence consistent with the notion of alert override as a habitual behavior and discuss implications of this novel perspective for future research on alert override, a common and persistent problem accompanying decision support system implementation.

Do user preferences align with human factors assessment scores of drug–drug interaction alerts?

Publisher: SAGE Publications

Date: 11-04-2020

DOI: 10.1177/1460458219840210

Abstract: This study aimed to assess drug–drug interaction alert interfaces and to examine the relationship between compliance with human factors principles and user-preferences of alerts. Three reviewers independently evaluated drug–drug interaction alert interfaces in seven electronic systems using the Instrument-for-Evaluating-Human-Factors-Principles-in-Medication-Related-Decision-Support-Alerts (I-MeDeSA). Fifty-three doctors and pharmacists completed a survey to rate the alert interfaces from best to worst and reported on liked and disliked features. Human factors compliance and user-preferences of alerts were compared. Statistical analysis revealed no significant association between I-MeDeSA scores and user-preferences. However, the strengths and weaknesses of drug–drug interaction alerts from users’ perspectives were in-line with the human factors constructs evaluated by the I-MeDeSA. I-MeDeSA in its current form, is unable to identify alerts that are preferred by the users. The design principles assessed by I-MeDeSA appear to be sound, but its arbitrary allocation of points to each human factors construct may not reflect the relative importance that the end-users place on different aspects of alert design.

Studying interruptions and multitasking in situ: The untapped potential of quantitative observational studies

Publisher: Elsevier BV

Date: 07-2015

DOI: 10.1016/J.IJHCS.2015.01.008

Computerized Clinical Decision Support Systems for the Early Detection of Sepsis Among Adult Inpatients: Scoping Review

Publisher: JMIR Publications Inc.

Date: 23-02-2022

DOI: 10.2196/31083

Abstract: Sepsis is a significant cause of morbidity and mortality worldwide. Early detection of sepsis followed promptly by treatment initiation improves patient outcomes and saves lives. Hospitals are increasingly using computerized clinical decision support (CCDS) systems for the rapid identification of adult patients with sepsis. This scoping review aims to systematically describe studies reporting on the use and evaluation of CCDS systems for the early detection of adult inpatients with sepsis. The protocol for this scoping review was previously published. A total of 10 electronic databases (MEDLINE, Embase, CINAHL, the Cochrane database, LILACS [Latin American and Caribbean Health Sciences Literature], Scopus, Web of Science, OpenGrey, ClinicalTrials.gov, and PQDT [ProQuest Dissertations and Theses]) were comprehensively searched using terms for sepsis, CCDS, and detection to identify relevant studies. Title, abstract, and full-text screening were performed by 2 independent reviewers using predefined eligibility criteria. Data charting was performed by 1 reviewer with a second reviewer checking a random s le of studies. Any disagreements were discussed with input from a third reviewer. In this review, we present the results for adult inpatients, including studies that do not specify patient age. A search of the electronic databases retrieved 12,139 studies following duplicate removal. We identified 124 studies for inclusion after title, abstract, full-text screening, and hand searching were complete. Nearly all studies (121/124, 97.6%) were published after 2009. Half of the studies were journal articles (65/124, 52.4%), and the remainder were conference abstracts (54/124, 43.5%) and theses (5/124, 4%). Most studies used a single cohort (54/124, 43.5%) or before-after (42/124, 33.9%) approach. Across all 124 included studies, patient outcomes were the most frequently reported outcomes (107/124, 86.3%), followed by sepsis treatment and management (75/124, 60.5%), CCDS usability (14/124, 11.3%), and cost outcomes (9/124, 7.3%). For sepsis identification, the systemic inflammatory response syndrome criteria were the most commonly used, alone (50/124, 40.3%), combined with organ dysfunction (28/124, 22.6%), or combined with other criteria (23/124, 18.5%). Over half of the CCDS systems (68/124, 54.8%) were implemented alongside other sepsis-related interventions. The current body of literature investigating the implementation of CCDS systems for the early detection of adult inpatients with sepsis is extremely erse. There is substantial variability in study design, CCDS criteria and characteristics, and outcomes measured across the identified literature. Future research on CCDS system usability, cost, and impact on sepsis morbidity is needed. RR2-10.2196/24899

An evaluation of variation in pathology investigations and associated factors for adult patients presenting to emergency departments with chest pain: An observational study

Publisher: Hindawi Limited

Date: 27-12-2018

DOI: 10.1111/IJCP.13305

Abstract: To determine variation in pathology test ordering practices and identify associated factors for adult patients presenting to emergency departments (ED) with chest pain and subsequently admitted with ischaemic heart disease. A retrospective study across six hospital EDs in New South Wales, Australia. A total of 6769 patient presentations between January 2014 and December 2017 met the inclusion criteria. Ordered pathology tests were grouped into three categories based on Australasian College for Emergency Medicine and the Royal College of Pathologists of Australasia recommendations: category I (no restriction in ordering), category II (can be ordered after consulting a supervisor) and category III (not for routine ordering in ED). The primary outcome was the proportion of category III test ordering across study EDs. Factors associated with category III test ordering were identified using a logistic regression. A total of 34 936 pathology tests were ordered: 65.6% (n = 22 932) were category I/II tests and 34.4% (n = 12 004) were category III tests. Five tests (Calcium Magnesium Phosphate, Coagulation Studies, Lipase, C-reactive Protein and Blood Gas tests) accounted for 84.7% of all category III tests. The proportion of category III tests ordered varied by hospitals from 29.8% to 45.9%. The proportion of patients with at least one category III test was 76.3% (range across hospitals: 68.3%-95.6%). Increasing age, presentation to an ED at night, and those in an imminently life-threatening triage category were significantly associated with increased likelihood of category III test ordering. The proportion of category III tests decreased over time. EDs in medium and/or regional hospitals were more likely to order a category III test. Pathology investigations for patients presenting with chest pain varied significantly across EDs suggesting opportunities to improve standardisation of test ordering practices.

Impact of an electronic medication management system on hospital doctors' and nurses' work: a controlled pre–post, time and motion study

Publisher: Oxford University Press (OUP)

Date: 11-2013

DOI: 10.1136/AMIAJNL-2012-001414

An action research protocol to strengthen system-wide inter-professional learning and practice [LP0775514]

Publisher: Springer Science and Business Media LLC

Date: 13-09-2007

DOI: 10.1186/1472-6963-7-144

Abstract: Inter-professional learning (IPL) and inter-professional practice (IPP) are thought to be critical determinants of effective care, improved quality and safety and enhanced provider morale, yet few empirical studies have demonstrated this. Whole-of-system research is even less prevalent. We aim to provide a four year, multi-method, multi-collaborator action research program of IPL and IPP in defined, bounded health and education systems located in the Australian Capital Territory (ACT). The project is funded by the Australian Research Council under its industry Linkage Program. The program of research will examine in four inter-related, prospective studies, progress with IPL and IPP across tertiary education providers, professional education, regulatory and registration bodies, the ACT health system's streams of care activities and teams, units and wards of the provider facilities of the ACT health system. One key focus will be on push-pull mechanisms, ie, how the education sector creates student-enabled IPP and the health sector demands IPL-oriented practitioners. The studies will examine four research aims and meet 20 research project objectives in a comprehensive evaluation of ongoing progress with IPL and IPP. IPP and IPL are said to be cornerstones of health system reforms. We will measure progress across an entire health system and the clinical and professional education systems that feed into it. The value of multi-methods, partnership research and a bi-directional push-pull model of IPL and IPP will be tested. Widespread dissemination of results to practitioners, policymakers, managers and researchers will be a key project goal.

Key factors influencing the incidence of hemolysis: a critical appraisal of current evidence.

Publisher: Informa UK Limited

Date: 26-12-2016

DOI: 10.1080/10408363.2016.1250247

Abstract: Hemolysis is a leading cause of pre-analytical laboratory errors. The identification of contributing factors is an important step towards the development of effective practices to reduce and prevent hemolysis. We performed a review of PUBMED, Embase, Medline and CINAHL to identify articles published between January 2000 and August 2016 that identified factors influencing in vitro hemolysis rates. The 40 studies included in this review provide excellent evidence that hemolysis rates are higher in Emergency Departments (EDs), for non-antecubital draws, for specimens drawn using an intravenous catheter compared to venipuncture and for s les transported by pneumatic tube compared to by hand. There is also good evidence that hemolysis rates are higher when specimens are not collected by professional phlebotomists, larger volume specimen tubes are used, specimen tubes are filled less than halfway and tourniquet time is greater than one minute. The results of this review suggest that hospitals and clinical laboratories should consider deploying phlebotomists in EDs, drawing all blood through a venipuncture, using the antecubital region as the optimum blood collection site and transporting specimens by laboratory assistant/other personnel, or if this in not practical, ensuring that pneumatic transport systems are validated, maintained and monitored. Studies also recommend making hemolysis a hospital-wide issue and ensuring high-quality staff training and adherence to standard operating procedures to reduce hemolysis rates. Awareness of the factors that influence hemolysis rates, and adoption of strategies to mitigate these risk factors, is an important step towards creating quality practices to reduce hemolysis rates and improve the quality of patient care.

The complexities, coordination, culture and capacities that characterise the delivery of oncology services in the common areas of ambulatory settings.

Publisher: Springer Science and Business Media LLC

Date: 12-02-2022

DOI: 10.1186/S12913-022-07593-3

Abstract: Relatively little is understood about real-world provision of oncology care in ambulatory outpatient clinics (OPCs). This study aimed to: 1) develop an understanding of behaviours and practices inherent in the delivery of cancer services in OPC common areas by characterising the organisation and implementation of this care and 2) identify barriers to, and facilitators of, the delivery of this care in OPC common areas. A purpose-designed ethnographic study was employed in four public hospital OPCs. Informal field scoping activities were followed by in-situ observations, key informant interviews and document review. A view of OPCs as complex adaptive systems was used as a scaffold for the data collection and interpretation, with the intent of understanding ‘work as done’. Data were analysed using an adapted “Qualitative Rapid Appraisal, Rigorous Analysis” approach. Field observations were conducted over 135 h, interviews over 6.5 h and documents were reviewed. Analysis found six themes. Staff working in OPCs see themselves as part of small local teams and as part of a broader multidisciplinary care team. Professional role boundaries could be unclear in practice, as duties expanded to meet demand or to stop patients “falling through the cracks.” Formal care processes in OPCs were supported by relationships, social capital and informal, but invaluable, institutional expertise. Features of the clinic layout, such as the proximity of departments, affected professional interactions. Staff were aware of inter- and intra-service communication difficulties and employed strategies to minimise negative impacts on patients. We found that complexity, coordination, culture and capacity underpin the themes that characterise this care provision. The study advances understanding of how multidisciplinary care is delivered in ambulatory settings and the factors which promote or inhibit effective care practice. Time pressures, communication challenges and competing priorities can pose barriers to care delivery. OPC care is facilitated by: self-organisation of participants professional acumen institutional knowledge social ties and relationships between and within professional groups and commitment to patient-centred care. An understanding of the realities of ‘work-as-done’ may help OPCs to sustain high-quality care in the face of escalating service demand.

Authors' response

Publisher: BMJ

Date: 21-07-2011

DOI: 10.1136/BMJQS-2011-000196

Does an integrated Emergency Department Information System change the sequence of clinical work? A mixed-method cross-site study

Publisher: Elsevier BV

Date: 12-2014

DOI: 10.1016/J.IJMEDINF.2014.08.010

Abstract: (1) to describe Emergency Department (ED) physicians' and nurses' perceptions about the sequence of work related to patient management with use of an integrated Emergency Department Information System (EDIS), and (2) to measure changes in the sequence of clinician access to patient information. A mixed method study was conducted in four metropolitan EDs. Each used the same EDIS which is a module of the hospitals' enterprise-wide clinical information system composed of many components of an electronic medical record. This enabled access to clinical and management information relating to patients attending all hospitals in the region. Phase one - data were collected from ED physicians and nurses (n=97) by 69 in-depth interviews, five focus groups (28 participants), and 26 h of observations. Phase two - physicians (n=34) in one ED were observed over 2 weeks. Data included whether and what type of information was accessed from the EDIS prior to first examination of the patient. Clinicians reported, and phase 2 observations confirmed, that the integrated EDIS led to changes to the order of information access, which held implications for when tests were ordered and results accessed. Most physicians accessed patient information using EDIS prior to taking the patients' first medical history (77/116 66.4%, 95% CI: 57.8-75.0%). Previous discharge summaries (74%) and past test results (61%) were most frequently accessed and junior doctors were more likely to access electronic past history information than their senior colleagues (χ(2)=20.717, d.f.=1, p<0.001). The integrated EDIS created new ways of working for ED clinicians. Such changes could hold positive implications for: time taken to reach a diagnosis and deliver treatments length of stay patient outcomes and experiences.

Integrating social engagement instruments into Australian community aged care assessments to enhance service provision

Publisher: Hindawi Limited

Date: 03-08-2018

DOI: 10.1111/HSC.12591

Abstract: Rich social relationships contribute to improved well-being and health outcomes, yet aged care client assessments tend to focus almost exclusively on physical issues. We aim to explore the experiences of aged care staff following their use of social engagement and well-being instruments as part of routine assessments for home-care clients. The social engagement (Australian Community Participation Questionnaire, ACPQ) and well-being (ICEpop CAPability Measure for Older Adults, ICECAP-O) instruments were embedded into the centralised information system of an Australian aged care provider. Staff administered these instruments during routine client assessments across a 9-month period involving 289 assessments. Semistructured interviews with 12 staff members were conducted and themes explored using qualitative content analysis. Key factors related to the acceptability of instrument adoption were found. Staff reported the instruments were convenient to use and were valuable in eliciting information for care plan development. Staff found that the instruments complemented their standard assessment procedures and did not disrupt their routine workload. They emphasised that the information gained greatly assisted their discussions with clients, identified social needs, and enhanced client involvement in decisions about desired services. There were also some challenging elements, including staff concerns regarding their ability to deal with emotional responses from clients evoked by the survey questions. ACPQ and ICECAP-O are useful tools for identifying psychosocial client needs, are feasible for use by large-scale aged care organisations and provide valuable information to guide decision-making about services. Future research should identify the long-term effects on improving social participation and client outcomes.

The Reactions of Adolescents, Parents and Clinicians to Participating in Qualitative Research Interviews Regarding Adolescents Bereaved by Suicide and Other Traumatic Death

Publisher: MDPI AG

Date: 2022

DOI: 10.3390/IJERPH19010452

Abstract: There are concerns that involving adolescents bereaved by suicide and other traumatic death in research may cause distress and harm. However, no study has investigated such bereaved adolescents’ research experiences. In addition, no study has looked at the experiences of parents and clinicians as participants in adolescent suicide and traumatic death bereavement research. This study aimed to explore the short-term impact of research participation experienced by adolescents, parents, and clinicians. A total of 61 participants (adolescents, n = 17 parents, n = 12 clinicians, n = 32) filled out a short survey within two weeks of having taken part in a qualitative interview study. Data were analyzed descriptively. Most participants had experienced no distress while participating and no negative effects of participating rather, participation was experienced as helpful for them and they would highly recommend participating in a study like this to others. A few adolescents and parents reported some distress, related to anxiety about participation and the unpleasantness of grief memories. The study clearly indicates that bereaved adolescents, parents and clinicians can safely participate in research interviews regarding their experiences of grief and help after suicide, generally valuing the opportunity to share their experience. To prevent and mitigate potential distress, training of research staff and implementation of appropriate participant distress protocols are imperative. Future studies could include longitudinal follow-up of participants to assess any longer-term consequences.

Creating a culture of safety and respect through professional accountability

Publisher: CSIRO Publishing

Date: 12-05-2022

DOI: 10.1071/AH21308

Abstract: Behaviour that is disrespectful towards others occurs frequently in hospitals, negatively impacts staff, and may undermine patient care. Professional accountability programs may address unprofessional behaviour by staff. This article examines a whole-of-hospital program, Ethos, developed by St Vincent’s Health Australia to address unprofessional behaviour, encourage speaking up, and improve organisational culture. Ethos consists of a bundle of tools, training, and resources, including an online system where staff can make submissions regarding their co-workers’ exemplary or unprofessional behaviour. Informal feedback is provided to the subject of the submission to recognise or encourage reflection on their behaviour. Following implementation in eight St Vincent’s Health Australia hospitals, the Ethos Messaging System has had 2497 submissions, 54% about positive behaviours. Peer messengers who deliver ‘Feedback for Reflection’ have faced practical challenges in providing feedback. Guidelines for the team who ‘triage’ Ethos messages have been revised to ensure only feedback that will promote reflection is passed on. Early evidence suggests Ethos has positively impacted staff, although evaluation is ongoing. The COVID-19 pandemic has required some adaptations to the program.

Temporal and regional trends of antibiotic use in long-term aged care facilities across 39 countries, 1985-2019

Publisher: Public Library of Science (PLoS)

Date: 23-08-2021

DOI: 10.1371/JOURNAL.PONE.0256501

Abstract: Antibiotic misuse is a key contributor to antimicrobial resistance and a concern in long-term aged care facilities (LTCFs). Our objectives were to: i) summarise key indicators of systemic antibiotic use and appropriateness of use, and ii) examine temporal and regional variations in antibiotic use, in LTCFs (PROSPERO registration CRD42018107125). Medline and EMBASE were searched for studies published between 1990–2021 reporting antibiotic use rates in LTCFs. Random effects meta-analysis provided pooled estimates of antibiotic use rates (percentage of residents on an antibiotic on a single day [point prevalence] and over 12 months [period prevalence] percentage of appropriate prescriptions). Meta-regression examined associations between antibiotic use, year of measurement and region. A total of 90 articles representing 78 studies from 39 countries with data between 1985–2019 were included. Pooled estimates of point prevalence and 12-month period prevalence were 5.2% (95% CI: 3.3–7.9 n = 523,171) and 62.0% (95% CI: 54.0–69.3 n = 946,127), respectively. Point prevalence varied significantly between regions (Q = 224.1, df = 7, p .001), and ranged from 2.4% (95% CI: 1.9–2.7) in Eastern Europe to 9.0% in the British Isles (95% CI: 7.6–10.5) and Northern Europe (95% CI: 7.7–10.5). Twelve-month period prevalence varied significantly between regions (Q = 15.1, df = 3, p = 0.002) and ranged from 53.9% (95% CI: 48.3–59.4) in the British Isles to 68.3% (95% CI: 63.6–72.7) in Australia. Meta-regression found no association between year of measurement and antibiotic use prevalence. The pooled estimate of the percentage of appropriate antibiotic prescriptions was 28.5% (95% CI: 10.3–58.0 n = 17,245) as assessed by the McGeer criteria. Year of measurement was associated with decreasing appropriateness of antibiotic use over time (OR:0.78, 95% CI: 0.67–0.91). The most frequently used antibiotic classes were penicillins (n = 44 studies), cephalosporins (n = 36), sulphonamides/trimethoprim (n = 31), and quinolones (n = 28). Coordinated efforts focusing on LTCFs are required to address antibiotic misuse in LTCFs. Our analysis provides overall baseline and regional estimates for future monitoring of antibiotic use in LTCFs.

Understanding stakeholders' perspectives and experiences of general practice accreditation

Publisher: Elsevier BV

Date: 07-2017

DOI: 10.1016/J.HEALTHPOL.2017.05.006

Abstract: To examine general practice accreditation stakeholders' perspectives and experiences to identify program strengths and areas for improvements. In idual (n=2) and group (n=9) interviews were conducted between September 2011-March 2012 with 52 stakeholders involved in accreditation in Australian general practices. Interviews were recorded, transcribed and thematically analysed. Member checking activities in April 2016 assessed the credibility and currency of the findings in light of current reforms. Overall, participants endorsed the accreditation program but identified several areas of concern. Noted strengths of the program included: program ownership, peer review and collaborative learning access to Practice Incentives Program payments and, improvements in safety and quality. Noted limitations in these and other aspects of the program offer potential for improvement: evidence for the impact of accreditation resource demands clearer outcome measures and, specific experiences of accreditation. The effectiveness of accreditation as a strategy to improve safety and quality was shaped by the attitudes and experience of stakeholders. Strengths and weaknesses in the accreditation program influence, and are influenced by, stakeholder engagement and disengagement. After several accreditation cycles, the sector has the opportunity to reflect on, review and improve the process. This will be important if the continued or extended engagement of practices is to be realised to assure the continuation and effectiveness of the accreditation program.

Endemic unprofessional behaviour in health care: the mandate for a change in approach

Publisher: AMPCo

Date: 11-2018

DOI: 10.5694/MJA17.01261

Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience

Publisher: BMJ

Date: 20-06-2011

DOI: 10.1136/BMJQS-2011-000089

Electronic ordering and the management of treatment interdependencies: a qualitative study of paediatric chemotherapy

Publisher: Springer Science and Business Media LLC

Date: 14-08-2020

DOI: 10.1186/S12911-020-01212-Z

Abstract: There are serious safety risks associated with chemotherapy, often associated with interdependencies in regimens administered over months or years. Various strategies are used to manage these risks. Computerized provider order entry (CPOE) systems are also implemented to improve medication safety. Little is known regarding the effect of CPOE on how clinicians manage chemotherapy interdependencies and their associated safety strategies. We conducted a multi-method qualitative study in a paediatric hospital. We analysed 827 oncology incidents reported following CPOE implementation and carried out semi-structured interviews with doctors ( n = 10), nurses ( n = 6), a pharmacist, and oncology CPOE team members ( n = 2). Results were interpreted according to safety models (ultra-safe, high-reliability organisations [HROs], or ultra-adaptive). Incident reports highlighted two interrelated types of interdependencies: those within organisation of clinical activities and those inherent in chemotherapy regimens. Clinicians reported strategies to address chemotherapy risks and interdependencies. These included rigid rules and ‘no go’ contexts for treatment to proceed, typical of the ultra-safe model use of time (e.g. planning only so far ahead) and sensitivity to operations, typical of HROs. We identified three different time horizons in CPOE use in relation to patients’ treatments: life-long, the whole regimen, and the ‘here and now’. CPOE supported ultra-safe strategies through automation and access to rules/standardisation, but also created difficulties and contributed to incidents. It supported the ‘here and now’ better than a life-long or whole regimen view of a patient treatment. Sensitivity to operations was essential to anticipate and resolve uncertainties, hazards, CPOE limitations, and mismatches between CPOE processes and workflow in practice. Within oncology, CPOE appears to move the ‘mix’ of risk strategies towards ultra-safe models of safety and protocol-mandated care. However, in order to operate ultra-safe strategies embedded in CPOE and stay on protocol it is essential for clinicians to be thoughtful and show sensitivity to operations in CPOE use. CPOE design can be advanced by better consideration of mechanisms to support interdependencies.

Why is measuring the effects of information technology on medication errors so difficult?

Publisher: Elsevier BV

Date: 12-2019

DOI: 10.1016/S2589-7500(19)30157-8

Exploring information technology (IT) sophistication in New South Wales residential aged care facilities

Publisher: CSIRO Publishing

Date: 2020

DOI: 10.1071/AH18260

Abstract: Objective The aim of this study was to determine baseline information technology (IT) sophistication in New South Wales (NSW), Australia, residential aged care facilities. Method IT sophistication measures IT capabilities, extent of IT use and IT integration in two domains, resident care and clinical support. A survey was administered to all NSW residential aged care facilities (n = 876) between February and May 2017. A 15% response rate was achieved (130/876). Facilities were organised by organisational type, total residential places and remoteness. Using post-stratification weights, estimates of IT sophistication scores for NSW were determined. Regression was used to examine whether there was a linear relationship between IT sophistication and the ratio of residents receiving high care. Results Participating facilities were similar to other NSW facilities in residential places and remoteness, but different in organisational type. IT sophistication was highest in IT capabilities and integration in resident care. IT sophistication was lowest in clinical support. Respondents had a mean of 1.2 years of IT experience. IT sophistication varied among aged care facilities. There was a linear relationship (P & 0.05) with the proportion of high-care residents and total IT sophistication Conclusion Routine reports of IT sophistication in aged care are not available. If data were available, determining the influence of IT sophistication on the quality care for residential aged care would be possible. What is known about the topic? Aged care settings that deliver care to the older population need to be contemporary in their approach to delivering high-quality and safe care. Health IT holds great potential for improving the quality and safety of care of older residents in aged care facilities. What does this paper add? This report provides a baseline assessment of IT capabilities, extent of IT use and IT integration, called IT sophistication, among aged care facilities with variable characteristics. What are implications for practitioners? Increasing IT sophistication has the potential to improve the quality of care delivered by aged care staff.

How well do general practitioners manage laboratory test results for patients with diabetes mellitus and cardiovascular disease?: A systematic review.

Publisher: Oxford University Press (OUP)

Date: 28-08-2017

DOI: 10.1093/INTQHC/MZX105

Abstract: To evaluate how well general practitioners (GPs) manage and respond to laboratory results for patients with diabetes mellitus (DM) and cardiovascular disease (CVD). MEDLINE, CINAHL, Embase, EBM reviews, ProQuest and Scopus. Peer-reviewed journal articles published between 2000 and 2015 that assessed GPs' management of laboratory results for patients with DM or CVD. Study design and demographics, laboratory tests and key findings relating to GP management of laboratory results were extracted from studies. Thirteen articles were included, comprising seven studies which utilized surveys, four observational studies, one cohort study and one randomized controlled trial. Findings indicate that GPs often overestimate the risk of complications associated with DM and CVD based on laboratory results and have unrealistically high expectations regarding the precision of laboratory tests. Considerable variation existed in the use of repeat testing for diagnostic confirmation and in GPs' identification of the difference between two consecutive results required to indicate a change in patient condition. GPs also often failed to initiate appropriate treatment for patients with DM and CVD based on laboratory results. Feedback to GPs about their test ordering patterns and educational messages on laboratory results improved clinical outcomes. Evidence about how well GPs manage results and its impact on patient outcomes remains weak and inconclusive. This review identified a number of areas where interventions could support GPs to improve the interpretation and management of laboratory test results, including feedback to GPs and educational messages on test result reports.

An experimental investigation of the impact of alert frequency and relevance on alert dwell time

Publisher: Elsevier BV

Date: 2020

DOI: 10.1016/J.IJMEDINF.2019.104027

Abstract: This study aimed to determine the impact of alert frequency and relevance on alert dwell time. A 2 × 3 design was used where 127 university students completed 60 prescribing tasks and were presented with a variable frequency of computerized alerts (low, medium and high) with variable relevance (low and high). Participants were instructed to override an alert if it was not relevant to their prescription, and to cancel the order if the alert signalled an error in their order. Participants presented with a small number of alerts spent more time attending to alert content than participants presented with a medium or high number of alerts (respectively median 15.6 s vs 10.8 vs 10.2 s). Alert relevance had no impact on alert dwell time. Alerts requiring an override response were 4.5 times more likely to be correctly actioned than alerts requiring the order to be cancelled. Dwell time was influenced by alert frequency, with greater exposure to alerts associated with shorter dwell times. We hypothesize that this was because participants came to learn that spending time on alert information was unnecessary. We propose that when users experience no consequences or feedback from overriding alerts they quickly learn that this action is more efficient and so more rewarding than taking any other action.

Visualising differences in professionals' perspectives on quality and safety

Publisher: BMJ

Date: 27-08-2012

DOI: 10.1136/BMJQS-2011-051755

Abstract: The safety-and-quality movement is now two decades old. Errors persist despite best efforts, indicating that there are entrenched overt and perhaps less explicit barriers limiting the success of improvement efforts. OBJECTIVES AND HYPOTHESES: To examine the perspectives of five groups of healthcare workers (administrative staff, nurses, medical practitioners, allied health and managers) and to compare and contrast their descriptions of quality-and-safety activities within their organisation. Differences in perspectives can be an indicator of ergence in the conceptualisation of, and impetus for, quality-improvement strategies which are intended to engage healthcare professions and staff. Study data were collected in a defined geographical healthcare jurisdiction in Australia, via in idual and group interviews held across four service streams (aged care and rehabilitation mental health community health and cancer services). Data were collected in 2008 and analysed, using data-mining software, in 2009. Clear differences in the perspectives of professional groups were evident, suggesting variations in the perceptions of, and priorities for, quality and safety. The visual representation of quality and safety perspectives provides insights into the conceptual maps currently utilised by healthcare workers. Understanding the similarity and differences in these maps may enable more effective targeting of interprofessional improvement strategies.

The Quality of Burns Coding: Compliance with Standards and the Effects on Clinical Data

Publisher: SAGE Publications

Date: 12-1998

DOI: 10.1177/183335839902800409

Abstract: Coded burns cases in two NSW public acute care facilities were reviewed to determine 1. the degree of compliance with Australian Coding Standards (ACS) relating to burns separations 2. the relationship between coding errors and poor quality documentation and 3. the impact of coding errors on ANDRG allocation. Despite high compliance with specific aspects of the ACS, coding errors occurred in 89% of cases. The ANDRG changed in 9% of total cases as a result of recoding. While some cases changed to a higher weighted ANDRG, overall the hospitals would have lost $98,445 after recoding. Significant associations were found between coding errors and poor quality documentation. The results indicate that while the ACS are adhered to, a high degree of coding variation still exists. This is largely due to inadequacies in medical record documentation. Clinicians and coders need to work together to ensure that coding variation is kept to a minimum.

Variation in the use of online clinical evidence: A qualitative analysis

Publisher: Elsevier BV

Date: 2003

DOI: 10.1016/S1386-5056(02)00046-1

Abstract: To investigate factors influencing variations in clinicians' use of an online evidence retrieval system. Public hospitals in New South Wales, Australia. Web log analysis demonstrated considerable variation in rates of evidence use by clinicians at different hospitals. Focus groups and interviews were held with 61 staff from three hospitals, two with high rates of use and one with a low rate of use, to explore variation in evidence use. Differences between hospitals' and professional groups' (doctors, nurses and allied health) use of online evidence could be explained by organizational, professional and cultural factors. These included the presence of ch ions, organizational cultures which supported evidence-based practice (EBP), and database searching skills of in idual clinicians. Staff shortages, ease of access and time taken to use the online evidence system were cited as barriers to use at the low use site, but no objective differences in these measures were found between the high and low use sites. Social and cultural factors were found to be better discriminators of high and low evidence use than technical factors.

Effectiveness of non-interruptive nudge interventions in electronic health records to improve the delivery of care in hospitals

Publisher: Oxford University Press (OUP)

Date: 15-05-2023

DOI: 10.1093/JAMIA/OCAD083

Abstract: To describe the application of nudges within electronic health records (EHRs) and their effects on inpatient care delivery, and identify design features that support effective decision-making without the use of interruptive alerts. We searched Medline, Embase, and PsychInfo (in January 2022) for randomized controlled trials, interrupted time-series and before–after studies reporting effects of nudge interventions embedded in hospital EHRs to improve care. Nudge interventions were identified at full-text review, using a pre-existing classification. Interventions using interruptive alerts were excluded. Risk of bias was assessed using the ROBINS-I tool (Risk of Bias in Non-randomized Studies of Interventions) for non-randomized studies or the Cochrane Effective Practice and Organization of Care Group methodology for randomized trials. Study results were summarized narratively. We included 18 studies evaluating 24 EHR nudges. An improvement in care delivery was reported for 79.2% (n = 19 95% CI, 59.5–90.8) of nudges. Nudges applied were from 5 of 9 possible nudge categories: change choice defaults (n = 9), make information visible (n = 6), change range or composition of options (n = 5), provide reminders (n = 2), and change option-related effort (n = 2). Only one study had a low risk of bias. Nudges targeted ordering of medications, laboratory tests, imaging, and appropriateness of care. Few studies evaluated long-term effects. Nudges in EHRs can improve care delivery. Future work could explore a wider range of nudges and evaluate long-term effects. Nudges can be implemented in EHRs to improve care delivery within current system capabilities however, as with all digital interventions, careful consideration of the sociotechnical system is crucial to enhance their effectiveness.

The impact of vulnerability and exposure to pervasive interprofessional incivility among medical staff on wellbeing

Publisher: Frontiers Media SA

Date: 14-07-2023

DOI: 10.3389/FPUBH.2023.1168978

Abstract: Traditional methods for modelling human interactions within organisational contexts are often hindered by the complexity inherent within these systems. Building on new approaches to information modelling in the social sciences and drawing on the work of scholars in transdisciplinary fields, we proposed that a reliable model of human interaction as well as its emergent properties can be demonstrated using theories related to emergent information. We demonstrated these dynamics through a test case related to data from a prevalence survey of incivility among medical staff. For each survey respondent we defined their vulnerability profile based upon a combination of their biographical characteristics, such as age, gender, and length of employment within a hospital and the hospital type (private or public). We modelled the interactions between the composite vulnerability profile of staff against their reports of their exposure to incivility and the consequent negative impact on their wellbeing. We found that vulnerability profile appeared to be proportionally related to the extent to which they were exposed to rudeness in the workplace and to a negative impact on subjective wellbeing. This model can potentially be used to tailor resources to improve the wellbeing of hospital medical staff at increased risk of facing incivility, bullying and harassment at their workplaces.

Measuring the prevalence of 60 health conditions in older Australians in residential aged care with electronic health records

Publisher: Springer Science and Business Media LLC

Date: 08-10-2020

DOI: 10.1186/S12963-020-00234-Z

Abstract: The number of older Australians using aged care services is increasing, yet there is an absence of reliable data on their health. Multimorbidity in this population has not been well described. A clear picture of the health status of people using aged care is essential for informing health practice and policy to support evidence-based, equitable, high-quality care. Our objective was to describe the health status of older Australians living in residential aged care facilities (RACFs) and develop a model for monitoring health conditions using data from electronic health record systems. Using a dynamic retrospective cohort of 9436 RACF residents living in 68 RACFs in New South Wales and the Australian Capital Territory from 2014 to 2017, we developed an algorithm to identify residents’ conditions using aged care funding assessments, medications administered, and clinical notes from their facility electronic health record (EHR). We generated age- and sex-specific prevalence estimates for 60 health conditions. Agreement between conditions recorded in aged care funding assessments and those documented in residents’ EHRs was evaluated using Cohen’s kappa. Cluster analysis was used to describe combinations of health conditions (multimorbidity) occurring among residents. Using all data sources, 93% of residents had some form of circulatory disease, with hypertension the most common (62%). Most residents (93%) had a mental or behavioural disorder, including dementia (58%) or depression (54%). For most conditions, EHR data identified approximately twice the number of people with the condition compared to aged care funding assessments. Agreement between data sources was highest for multiple sclerosis, Huntington’s disease, and dementia. The cluster analysis identified seven groups with distinct combinations of health conditions and demographic characteristics and found that the most complex cluster represented a group of residents that had on average the longest lengths of stay in residential care. The prevalence of many health conditions among RACF residents in Australia is underestimated in previous reports. Aged care EHR data have the potential to be used to better understand the complex health needs of this vulnerable population and can help fill the information gaps needed for population health surveillance and quality monitoring.

The impact of COVID‐19 on the quality of life of older adults receiving community‐based aged care

Publisher: Wiley

Date: 03-2021

DOI: 10.1111/AJAG.12924

Why do acute healthcare staff engage in unprofessional behaviours towards each other and how can these behaviours be reduced? A realist review protocol

Publisher: BMJ

Date: 07-2022

DOI: 10.1136/BMJOPEN-2022-061771

Abstract: Unprofessional behaviours encompass many behaviours including bullying, harassment and microaggressions. These behaviours between healthcare staff are problematic they affect people’s ability to work, to feel psychologically safe at work and speak up and to deliver safe care to patients. Almost a fifth of UK National Health Service staff experience unprofessional behaviours in the workplace, with higher incidence in acute care settings and for staff from minority backgrounds. Existing analyses have investigated the effectiveness of strategies to reduce these behaviours. We seek to go beyond these, to understand the range and causes of such behaviours, their negative effects and how mitigation strategies may work, in which contexts and for whom. This study uses a realist review methodology with stakeholder input comprising a number of iterative steps: (1) formulating initial programme theories drawing on informal literature searches and literature already known to the study team, (2) performing systematic and purposive searches for grey and peer-reviewed literature on Embase, CINAHL and MEDLINE databases as well as Google and Google Scholar, (3) selecting appropriate documents while considering rigour and relevance, (4) extracting data, (5) and synthesising and (6) refining the programme theories by testing the theories against the newly identified literature. Ethical review is not required as this study is a secondary research. An impact strategy has been developed which includes working closely with key stakeholders throughout the project. Step 7 of our project will develop pragmatic resources for managers and professionals, tailoring contextually-sensitive strategies to reduce unprofessional behaviours, identifying what works for which groups. We will be guided by the ‘Evidence Integration Triangle’ to implement the best strategies to reduce unprofessional behaviours in given contexts. Dissemination will occur through presentation at conferences, innovative methods (cartoons, videos, animations and/or interactive performances) and peer-reviewed journals. CRD42021255490.

A time and motion study of junior doctor work patterns on the weekend: a potential contributor to the weekend effect?

Publisher: Wiley

Date: 07-2016

DOI: 10.1111/IMJ.13120

Abstract: Patients admitted to hospital on weekends have a greater risk of mortality compared to patients admitted on weekdays. Junior medical officers (JMO) make up the majority of medical staff on weekends. No previous study has quantified JMO work patterns on weekends. To describe and quantify JMO work patterns on weekends and compare them with patterns previously observed during the week. Observational time and motion study of JMO working weekends using the Work Observation Method by Activity Timing (WOMBAT Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia) software. Descriptive statistics were used to determine the proportion of total observed time spent in tasks. Weekend JMO predominately spent time in indirect care (32.0%), direct care (23.0%) and professional communication (22.1%). JMO spent 20.9% of time multitasking and were interrupted, on average, every 9 min. Weekend JMO spent significantly more time in direct care compared with weekdays (13.0% P < 0.001) and nights (14.3% P < 0.001). Weekend JMO spent significantly less time on breaks (8.5%), with less than 1 h in an 11-h shift, compared with JMO during weekdays (16.4% P = 0.004) and nights (27.6% P = <0.001). Weekend JMO were interrupted at a higher rate (6.6/h) than on weekdays (rate ratio (RR) 2.9, 95% confidence intervals (CI) 2.6, 3.3) or nights (RR 5.1, 95% CI 4.2, 6.1). Multitasking on weekends (20.9%) was comparable to weekdays (18.9% P = 0.19) but significantly higher than nights (6.4% P = <0.001). On weekends, JMO had few breaks, were interrupted frequently and engaged in high levels of multitasking. This pattern of JMO work could be a potential contributing factor to the weekend effect in terms of JMO abilities to respond safely and adequately to care demands.

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

Allocation of physician time in ambulatory practice

Publisher: American College of Physicians

Date: 06-09-2016

DOI: 10.7326/M16-0961

Prevalence of medication errors among paediatric inpatients

Publisher: Springer Science and Business Media LLC

Date: 09-07-2019

DOI: 10.1007/S40264-019-00850-1

Abstract: The risk of medication errors is high in paediatric inpatient settings. However, estimates of the prevalence of medication errors have not accounted for heterogeneity across studies in error identification methods and definitions, nor contextual differences across wards and the use of electronic or paper medication charts. Our aim was to conduct a systematic review and meta-analysis to provide separate estimates of the prevalence of medication errors among paediatric inpatients, depending on hospital ward and the use of electronic or paper medication charts, that address differences in error identification methods and definitions. We systematically searched five databases to identify studies published between January 2000 and December 2018 that assessed medication error rates by medication chart audit, direct observation or a combination of methods. We identified 71 studies, 19 involved paediatric wards using electronic charts. Most studies assessed prescribing errors with few studies assessing administration errors. Estimates varied by ward type. Studies of paediatric wards using electronic charts generally reported a reduced error prevalence compared to those using paper, although there were some inconsistencies. Error detection methods impacted the rate of administration errors in studies of multiple wards, however, no other difference was found. Definition of medication error did not have a consistent impact on reported error rates. Medication errors are a frequent occurrence in paediatric inpatient settings, particularly in intensive care wards and emergency departments. Hospitals using electronic charts tended to have a lower rate of medication errors compared to those using paper charts. Future research employing controlled designs is needed to determine the true impact of electronic charts and other interventions on medication errors and associated harm among hospitalized children.

Appropriate management of acute gastroenteritis in Australian children

Publisher: Public Library of Science (PLoS)

Date: 07-11-2019

DOI: 10.1371/JOURNAL.PONE.0224681

Effectiveness of a ‘Do not interrupt’ bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility study

Publisher: BMJ

Date: 23-02-2017

DOI: 10.1136/BMJQS-2016-006123

The public disclosure of accreditation information in Australia: Stakeholder perceptions of opportunities and challenges

Publisher: Elsevier BV

Date: 11-2013

DOI: 10.1016/J.HEALTHPOL.2013.09.002

Abstract: Public disclosure is increasingly a requirement of accrediting agencies and governments. There are few published empirical evaluations of disclosure interventions that inform evidence-based implementation or policy. This study investigated the practices associated with the public disclosure of healthcare accreditation information, in addition to multi-stakeholder perceptions of key challenges and opportunities for improvement. We conducted a mixed methods study comprising analysis of disclosure practices by accreditation agencies, and 47 semi-structured in idual or group interviews involving 258 people. Participants were erse stakeholders associated with Australian primary, acute and residential aged care accreditation programmes. Four interrelated issues were identified. First, there was broad agreement that accreditation information should be publicly disclosed, although the three accreditation agencies differed in the information they made public. Second, two implementation issues emerged: the need to educate the community about accreditation information, and the practical question of the detail to be provided. Third, the impact, both positive and negative, of disclosing accreditation information was raised. Fourth, the lack of knowledge about the impact on consumers was discussed. Public disclosure of accreditation information is an idea that has widespread support. However, translating the idea into practice, so as to produce appropriate, meaningful information, is a challenge.

Gender differences in the symptoms and physical and mental well-being of dyspeptics

Publisher: Springer Science and Business Media LLC

Date: 2002

DOI: 10.1023/A:1015239020403

Abstract: To compare women and men with dyspepsia in terms of symptoms, physical and mental well-being and the relationships between in idual symptoms and well-being. A cross-sectional random telephone survey of 2300 Australians identified 748 people with dyspepsia who were interviewed regarding the number, types and severity of symptoms and physical (PCS) and mental well-being (MCS) measured by the SF-12. There were no significant gender differences in number or average severity of symptoms. Bloating, nausea, and early satiety were significantly more frequent among women food regurgitation and heartburn in men. Dyspeptics (PCS = 47.1, MCS = 46.0) had poorer physical (p < 0.001) and mental well-being (p < 0.001) than did non-dyspeptics (PCS = 53.5, MCS = 55.3). Among dyspeptics, women (PCS = 46.4, MCS = 44.7) had poorer physical (p < 0.05) and mental well-being (p < 0.001) than males (PCS = 47.9, MCS = 47.5). Some symptoms were associated with low well-being for both sexes e.g. nausea. For women retching was related to poor physical well-being, and food regurgitation, dysphagia. bloating and epigastric pain to poor mental well-being. Among men epigastric pain and heartburn were associated with poor physical well-being, acid regurgitation with poor mental well-being, and vomiting with both. Dyspeptics report poorer physical and mental well-being than do non-dyspeptics. The difference between groups is greater for mental well-being, especially among women. Both physical and social factors may contribute to gender differences.

Audit and feedback of antibiotic use

Publisher: Georg Thieme Verlag KG

Date: 2013

DOI: 10.4338/ACI-2013-08-RA-0063

Abstract: Background: There is now little doubt that improving antimicrobial use is necessary for the containment of resistance. Objective: To determine whether providing in idualised feedback to doctors about their recent compliance with the hospital’s antibiotic policy improves compliance with the policy. Methods: This study was conducted at a teaching hospital in Sydney, Australia. Computerised alerts integrated into the electronic prescribing system (ePS) inform prescribers of the local antibiotic policy. We utilised prescribing data extracted from the ePS for ‘audit and feedback’. Thirty-six prescribers were sent feedback letters via email. We also interviewed doctors who had received letters to explore their views of the feedback and the policy in general. Results: There was no significant change in compliance with the policy following implementation of the feedback intervention (0% compliant vs 11.9% p = 0.07). Several problems with the policy and the approval process were identified by researchers during auditing and by prescribers during interviews. Some problems identified made it difficult to accurately assess compliance and for doctors to comply with the policy. Conclusions: Our intervention did not result in improved compliance with the antibiotic policy but revealed practical problems with the policy and approval process that had not been identified prior to the trial. Greater support for the policy by senior doctors and the assignment of more clearly defined roles and responsibilities associated with antibiotic use and approval may result in improved compliance. Harnessing the full potential of technology would streamline the antimicrobial approval process and allow more efficient and reliable monitoring of antibiotic use and compliance. Many of the problems we identified are generic issues of importance to all organisations seeking to integrate antimicrobial stewardship into ePS. Citation: Baysari MT, Oliver K, Egan B, Li L, Richardson K, Sandaradura I, Westbrook J I, Day RO. Audit and feedback of antibiotic use: Utilising electronic prescription data. Appl Clin Inf 2013 4: 583–595 0.4338/ACI-2013-08-RA-0063

The effectiveness of information technology to improve antimicrobial prescribing in hospitals: A systematic review and meta-analysis

Publisher: Elsevier BV

Date: 08-2016

DOI: 10.1016/J.IJMEDINF.2016.04.008

Abstract: To review evidence of the effectiveness of information technology (IT) interventions to improve antimicrobial prescribing in hospitals. MEDLINE (1950-March 2015), EMBASE (1947-March 2015) and PubMED (1966-March 2015) were searched for studies where an IT intervention involving any device (e.g. computer, mobile phone) was evaluated in practice. All papers were assessed for quality using a 10-point rating scale. We identified 45 articles that evaluated an IT intervention to improve antimicrobial prescribing in hospitals. IT interventions took four main forms: (1) stand-alone computerized decision support systems (CDSSs), (2) decision support embedded within a hospital's electronic medical record (EMR) or computerized provider order entry (CPOE) system, (3) computerized antimicrobial approval systems (cAAS), and (4) surveillance systems (SSs). Results reported allowed us to perform meta-analyses for three outcome measures: appropriate use of antimicrobials, patient mortality and hospital length of stay (LOS). IT interventions increased appropriate use of antimicrobials (pooled RR: 1.49, 95%CI: 1.07-2.08) however no evidence of an effect was found when analysis included only studies with a quality score of five or above on the 10-point quality scale (pooled RR: 1.53, 95%CI: 0.96-2.44). There was little evidence of an effect of IT interventions on patient mortality or LOS. The range of study designs and outcome measures prevented meaningful comparisons between different IT intervention types to be made. IT interventions can improve the appropriateness of antimicrobial prescribing. However, high quality, systematic multi-site comparative studies are critically needed to assist organizations in making informed decisions about the most effective IT interventions.

Antidementia medication use by aged care facility residents with dementia

Publisher: Wiley

Date: 25-04-2019

DOI: 10.1002/GPS.5105

Abstract: Little is known about the use of antidementia medications in Australia. Other countries have reported sociodemographic disparities in use. Our objective was to estimate prevalence, duration, and time to initiation of antidementia medication (cholinesterase inhibitors or memantine) among Australians with dementia in residential aged care facilities and to evaluate resident and facility factors associated with use. Dynamic retrospective cohort study of people with dementia in 68 residential aged care facilities during 2014 to 2017 using electronic health record and medication administration data. Regression evaluated relationships between medication use (prevalence, duration, and time to initiation) and resident and facility characteristics. Five thousand three hundred fifty-four residents with dementia were included in the analyses. Annual prevalence of antidementia medication use was less than 10% each year and decreased during the study period by 2-percentage points by 2017 (relative to 2014). Antidementia medication use varied by sociodemographic characteristics (3-points lower for single, 4-points lower for orced relative to married residents, and 3-points higher for Australian-born). Each point in ADL score was associated with 0.1-point lower medication use. Antidementia medication use was lower in outer regional facilities. Most comorbidities were associated with lower antidementia medication use (myocardial infarction, cerebrovascular disease and heart failure 3-points lower, respiratory disease, and diabetes 2-points lower). Age had a complex relationship with antidementia medication use that varied by sex and if medication was started before or after admission. After admission, males initiated antidementia medication earlier than females. Antidementia medication use in Australian facilities was lower than in other countries and varied by clinical and sociodemographic factors.

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.

Diagnostic investigation rates and use of prescription and non‐prescription medications amongst dyspeptics: a population‐based study of 2300 Australians

Publisher: Wiley

Date: 05-2003

DOI: 10.1046/J.1365-2036.2003.01555.X

Abstract: : There is limited knowledge of the diagnostic investigation rates and use of prescription and non-prescription drugs amongst dyspeptics. : To assess the investigation rates and use of prescription and non-prescription anti-ulcer medications amongst dyspeptics in the population. : A cross-sectional survey was performed of 2300 Australians. : Of 748 dyspeptics, 422 (56%) had consulted a doctor regarding dyspepsia at some time in their life. Of the consulters, 64% had undergone investigations at some time: 37% an endoscopy, 54% a barium meal and 27% both. A diagnosis of peptic ulcer was reported by 31% of those investigated. The symptom profile of gastroscopy patients differed significantly from that of uninvestigated dyspeptics. Of the consulters, 36% had taken anti-ulcer prescription drugs in the last 3 months: Histamine-2 receptor antagonists (73% of prescriptions), proton pump inhibitors (17%), cytoprotectants (5%) and prokinetic drugs (5%). Antacids were taken by 30% of non-consulting dyspeptics, 44% of consulters not on prescription drugs and 58% of dyspeptics taking prescription drugs. Advancing age, but not gender, was associated with diagnostic investigation and prescription and non-prescription drug usage. : There are high rates of diagnostic investigation amongst dyspeptics who consult doctors. Many in iduals with dyspepsia decide to self-medicate with antacids regardless of consulting or prescriptions, suggesting that current management is suboptimal.

Continuing differences between health professions' attitudes: the saga of accomplishing systems-wide interprofessionalism

Publisher: Oxford University Press (OUP)

Date: 29-11-2012

DOI: 10.1093/INTQHC/MZS071

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

DOI: 10.1186/1472-6963-6-113

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.

Cost-effectiveness analysis of a hospital electronic medication management system

Publisher: Oxford University Press (OUP)

Date: 10-02-2015

DOI: 10.1093/JAMIA/OCU014

Abstract: Objective To conduct a cost–effectiveness analysis of a hospital electronic medication management system (eMMS). Methods We compared costs and benefits of paper-based prescribing with a commercial eMMS (CSC MedChart) on one cardiology ward in a major 326-bed teaching hospital, assuming a 15-year time horizon and a health system perspective. The eMMS implementation and operating costs were obtained from the study site. We used data on eMMS effectiveness in reducing potential adverse drug events (ADEs), and potential ADEs intercepted, based on review of 1 202 patient charts before (n = 801) and after (n = 401) eMMS. These were combined with published estimates of actual ADEs and their costs. Results The rate of potential ADEs following eMMS fell from 0.17 per admission to 0.05 a reduction of 71%. The annualized eMMS implementation, maintenance, and operating costs for the cardiology ward were A$61 741 (US$55 296). The estimated reduction in ADEs post eMMS was approximately 80 actual ADEs per year. The reduced costs associated with these ADEs were more than sufficient to offset the costs of the eMMS. Estimated savings resulting from eMMS implementation were A$63–66 (US$56–59) per admission (A$97 740–$102 000 per annum for this ward). Sensitivity analyses demonstrated results were robust when both eMMS effectiveness and costs of actual ADEs were varied substantially. Conclusion The eMMS within this setting was more effective and less expensive than paper-based prescribing. Comparison with the few previous full economic evaluations available suggests a marked improvement in the cost–effectiveness of eMMS, largely driven by increased effectiveness of contemporary eMMs in reducing medication errors.

Evaluation of current Australian health service accreditation processes (ACCREDIT-CAP): Protocol for a mixed-method research project

Publisher: BMJ

Date: 2012

DOI: 10.1136/BMJOPEN-2012-001726

General practitioners' use of online evidence during consultations

Publisher: Elsevier BV

Date: 2005

DOI: 10.1016/J.IJMEDINF.2004.10.003

Abstract: Clinicians have many unanswered questions during clinical encounters which may impact on the quality and outcomes of decisions made. Provision of online evidence at the point of care is one strategy that provides clinicians with easy access to up-to-date evidence in clinical settings to support evidence-based decision-making. To determine if and when general practitioners use an online evidence system in routine clinical practice, the type of questions for which clinicians seek evidence and the extent to which the system provides clinically useful answers. A prospective cohort study which involved a 4-week clinical trial of Quick Clinical, an online evidence system specifically designed around the needs of general practitioners. Two hundred and twenty-seven clinicians who had a computer with Internet access in their consulting rooms. Computer logs and survey analysis. One hundred and ninety-three general practitioners used the online evidence system to conduct on average 8.7 searches/month. The majority of these (81%) were conducted from consulting rooms and carried out between 9a.m. and 7p.m. (83%). The most frequent searches conducted related to diagnosis (40%) and treatment (35%). 83% of clinicians believed that Quick Clinical (QC) had the potential to improve patient care, and one in four users reported direct experience of improvements in care. In 73% of queries with clinician feedback participants reported that they were able to find clinically useful information during their routine work. General practitioners will use an online evidence retrieval system in routine practice, and report that its use improves the quality of patient care.

What will be the outcome of the outcomes movement?

Publisher: Wiley

Date: 12-1995

DOI: 10.1111/J.1445-5994.1995.TB02862.X

The use of predictive fall models for older adults receiving aged care, using routinely collected electronic health record data: a systematic review

Publisher: Springer Science and Business Media LLC

Date: 16-03-2022

DOI: 10.1186/S12877-022-02901-2

Abstract: Falls in older adults remain a pressing health concern. With advancements in data analytics and increasing uptake of electronic health records, developing comprehensive predictive models for fall risk is now possible. We aimed to systematically identify studies involving the development and implementation of predictive falls models which used routinely collected electronic health record data in home-based, community and residential aged care settings. A systematic search of entries in Cochrane Library, CINAHL, MEDLINE, Scopus, and Web of Science was conducted in July 2020 using search terms relevant to aged care, prediction, and falls. Selection criteria included English-language studies, published in peer-reviewed journals, had an outcome of falls, and involved fall risk modelling using routinely collected electronic health record data. Screening, data extraction and quality appraisal using the Critical Appraisal Skills Program for Clinical Prediction Rule Studies were conducted. Study content was synthesised and reported narratively. From 7,329 unique entries, four relevant studies were identified. All predictive models were built using different statistical techniques. Predictors across seven categories were used: demographics, assessments of care, fall history, medication use, health conditions, physical abilities, and environmental factors. Only one of the four studies had been validated externally. Three studies reported on the performance of the models. Adopting predictive modelling in aged care services for adverse events, such as falls, is in its infancy. The increased availability of electronic health record data and the potential of predictive modelling to document fall risk and inform appropriate interventions is making use of such models achievable. Having a dynamic prediction model that reflects the changing status of an aged care client is key to this moving forward for fall prevention interventions.

Selection and use of decision support alerts in electronic medication management systems in Australian hospitals: a survey of implementers

Publisher: Wiley

Date: 04-2019

DOI: 10.1002/JPPR.1479

Laboratory Test Utilization and Repeat Testing for Inpatients of Age 80 and Over in Australia: A Retrospective Observational Study

Publisher: Oxford University Press (OUP)

Date: 09-2019

DOI: 10.1373/JALM.2019.029025

Abstract: Repeat laboratory testing is often necessary in hospitals. However, frequent blood draws can be harmful to older patients. The objective of this study was to identify the most frequently ordered laboratory tests and repeat testing rates for these tests among older inpatients. A retrospective observational study of inpatients of age 80 years and over in 4 public hospitals in New South Wales, Australia, was conducted between 2008 and 2013. Proportions of laboratory tests and proportions of repeated tests among the most frequently used tests were reported. There were 42739 patients with 108003 admissions (56.2% women 43.2% of ages 80–84). Of these admissions, 95.9% had a laboratory test, with 3012577 tests recorded. Five tests accounted for 62% of all tests and were present in 98.5% of admissions: electrolytes urea and creatinine (EUC 18% of all tests ordered), complete blood count (CBC 16.7%), calcium magnesium phosphate (CaMgPhos 10.2%), liver function test (LFT 9.0%), and C-reactive protein (CRP 8.0%). Proportions of repeat tests for this group performed outside recommended minimum repeat intervals were 10.3% EUC, 8.9% CBC, 41.5% CRP, 68.2% CaMgPhos, and 65.2% LFT tests. An exponential increase in repeat testing for all 5 tests was observed around 24 h after a previous test. Compliance with guidelines on repeat testing intervals among older patients is variable. A better understanding of the underlying reasons for repeat testing would allow targeting of interventions, including decision support, to improve laboratory use for older inpatients.

Measuring the relationship between interruptions, multitasking and prescribing errors in an emergency department: a study protocol: Table 1

Publisher: BMJ

Date: 10-2015

DOI: 10.1136/BMJOPEN-2015-009076

Are General Practitioners Getting the Information They Need from Hospitals to Manage Their Lung Cancer Patients? A Qualitative Exploration

Publisher: SAGE Publications

Date: 06-2012

DOI: 10.1177/183335831204100201

Abstract: The delivery of cancer services is primarily hospital-based however, General Practitioners (GPs) have a key role to play within the context of a multidisciplinary model of care. In order to fulfill their role in cancer care GPs must receive complete and timely information from appropriate members of the hospital team. The aim of this study was to investigate perceptions of the quality, format and timeliness of the patient information GPs receive from a multidisciplinary hospital-based lung cancer team, and elicit how communication between the team and the GP could be improved. Data were collected using semi-structured interviews with a representative s le ( n=22) of members of the hospital team and a s le of GPs ( n=8). A grounded theory approach was used to categorise the data. Most communications with GPs were from medical officers however, GPs desired information from all health professional groups in the hospital-based lung cancer team. Most GPs were dissatisfied with the timing of communication. A multidisciplinary discharge summary was suggested as a means of providing both clinical and social information from the team to the GP. Further developments in electronic health records could improve access to patient information by GPs. Results from this study illustrate the need for GPs to receive information from all members of the multidisciplinary hospital team so that they may fulfill their erse role in supporting patients through all phases of the cancer journey.

Short- and long-term effects of an electronic medication management system on paediatric prescribing errors

Publisher: Springer Science and Business Media LLC

Date: 13-12-2022

DOI: 10.1038/S41746-022-00739-X

Abstract: Electronic medication management (eMM) systems are designed to improve safety, but there is little evidence of their effectiveness in paediatrics. This study assesses the short-term (first 70 days of eMM use) and long-term (one-year) effectiveness of an eMM system to reduce prescribing errors, and their potential and actual harm. We use a stepped-wedge cluster randomised controlled trial (SWCRCT) at a paediatric referral hospital, with eight clusters randomised for eMM implementation. We assess long-term effects from an additional random s le of medication orders one-year post-eMM. In the SWCRCT, errors that are potential adverse drug events (ADEs) are assessed for actual harm. The study comprises 35,260 medication orders for 4821 patients. Results show no significant change in overall prescribing error rates in the first 70 days of eMM use (incident rate ratio [IRR] 1.05 [95%CI 0.92–1.21], but a 62% increase (IRR 1.62 [95%CI 1.28–2.04]) in potential ADEs suggesting immediate risks to safety. One-year post-eMM, errors decline by 36% (IRR 0.64 [95%CI 0.56–0.72]) and high-risk medication errors decrease by 33% (IRR 0.67 [95%CI 0.51–0.88]) compared to pre-eMM. In all periods, dose error rates are more than double that of other error types. Few errors are associated with actual harm, but 71% [95%CI 50–86%] of patients with harm experienced a dose error. In the short-term, eMM implementation shows no improvement in error rates, and an increase in some errors. A year after eMM error rates significantly decline suggesting long-term benefits. eMM optimisation should focus on reducing dose errors due to their high frequency and capacity to cause harm.

Medication errors in residential aged care facilities: A distributed cognition analysis of the information exchange process

Publisher: Elsevier BV

Date: 05-2013

DOI: 10.1016/J.IJMEDINF.2012.08.006

Abstract: Medication safety is a pressing concern for residential aged care facilities (RACFs). Retrospective studies in RACF settings identify inadequate communication between RACFs, doctors, hospitals and community pharmacies as the major cause of medication errors. Existing literature offers limited insight about the gaps in the existing information exchange process that may lead to medication errors. The aim of this research was to explicate the cognitive distribution that underlies RACF medication ordering and delivery to identify gaps in medication-related information exchange which lead to medication errors in RACFs. The study was undertaken in three RACFs in Sydney, Australia. Data were generated through ethnographic field work over a period of five months (May-September 2011). Triangulated analysis of data primarily focused on examining the transformation and exchange of information between different media across the process. The findings of this study highlight the extensive scope and intense nature of information exchange in RACF medication ordering and delivery. Rather than attributing error to in idual care providers, the explication of distributed cognition processes enabled the identification of gaps in three information exchange dimensions which potentially contribute to the occurrence of medication errors namely: (1) design of medication charts which complicates order processing and record keeping (2) lack of coordination mechanisms between participants which results in misalignment of local practices (3) reliance on restricted communication bandwidth channels mainly telephone and fax which complicates the information processing requirements. The study demonstrates how the identification of these gaps enhances understanding of medication errors in RACFs. Application of the theoretical lens of distributed cognition can assist in enhancing our understanding of medication errors in RACFs through identification of gaps in information exchange. Understanding the dynamics of the cognitive process can inform the design of interventions to manage errors and improve residents' safety.

Observational cohort study investigating cognitive outcomes, social networks and well-being in older adults

Publisher: BMJ

Date: 06-2019

DOI: 10.1136/BMJOPEN-2019-029495

Abstract: Social networks play a role in slowing the development of dementia. However, there is a need for further investigation of the effects of improving social networks on health-related quality of life and cognitive performance. Targeted community aged care services are a central strategy for supporting older adults to initiate and maintain their social engagement with other in iduals at all stages of later life. This protocol describes a prospective observational cohort study aimed at (1) characterising interpersonal relationships in older adults receiving community care services, (2) assessing the relationship social networks and health-related quality of life and cognition and (3) identifying the association between community care use, social networks and cognition. The findings will contribute to our understanding of how specific social network structures and social support services can maintain cognitive function in community-dwelling older adults. This is a prospective, observational cohort study of 201 older Australians residing in the community and receiving care services from one of three aged care organisations. Clients with a history of neurological injury will be excluded. Participants will undergo baseline measures of social networks, health-related quality of life and cognitive function, and a follow-up at 6 months. Service use and sociodemographic variables will also be collected. The primary outcome is cognitive function, and secondary outcomes include social networks and health-related quality of life. Multivariable linear regression will test the hypothesis that increased social networks are associated with an increase in cognitive function. Approval of the study by Macquarie University Research Ethics Committee (reference number 5201831394062) has been obtained. This work will be disseminated by publication of peer-reviewed manuscripts, presentations in abstract form at scientific meetings and results will be made available to home and community-based care older adults and care staff of the involved organisations. ACTRN12618001723279 Pre-results.

Electronic Medication Management Systems' Influence on Hospital Pharmacists' Work Patterns

Publisher: Wiley

Date: 06-2010

DOI: 10.1002/J.2055-2335.2010.TB00516.X

Abstract: Implementation of electronic medication management systems (eMMS) are advocated to reduce medication errors, improve patient safety and impact on hospital pharmacists' work patterns. To quantify hospital pharmacists' distribution of their time and to identify differences in work patterns on wards with and without eMMS. An observational time and motion study was conducted at a major Sydney teaching hospital. 8 pharmacists (3 on wards with eMMS, 5 on wards without eMMS) were observed on their wards for 37 hours. Distribution of tasks across work categories, mean task times, tasks performed with others and tasks using information tools, were calculated and compared between wards with and without eMMS. Medication chart review was the most frequently performed task on both ward types. Pharmacists on eMMS wards had lower rates of interruptions (1/19.2 min vs 1/13.7 min) and multi‐tasking (2.4% vs 8.7%) than non‐eMMS wards. On eMMS wards, review activities were more frequent and faster, fewer ‘in‐transit’ tasks occurred and more work was completed alone compared to non‐eMMS wards. Patient care tasks took longer but occurred less often on eMMS wards. Pharmacists on eMMS wards spent more time clarifying medication orders but did it less often than pharmacists on non‐eMMS wards. Pharmacists' work patterns in terms of task frequency, duration and location was different on the two ward types. Differences may be attributable to eMMS allowing easy and speedy access to information for reviews shift away from the bedside to a computer terminal reducing tasks in‐transit, interruptions and contact with patients and others and improved clarity of medication orders reducing queries.

Mobile Applications for Patient-centered Care Coordination: A Review of Human Factors Methods Applied to their Design, Development, and Evaluation

Publisher: Georg Thieme Verlag KG

Date: 08-2015

DOI: 10.15265/IY-2015-011

Abstract: Objectives: To examine if human factors methods were applied in the design, development, and evaluation of mobile applications developed to facilitate aspects of patient-centered care coordination. Methods: We searched MEDLINE and EMBASE (2013-2014) for studies describing the design or the evaluation of a mobile health application that aimed to support patients’ active involvement in the coordination of their care. Results: 34 papers met the inclusion criteria. Applications ranged from tools that supported self-management of specific conditions (e.g. asthma) to tools that provided coaching or education. Twelve of the 15 papers describing the design or development of an app reported the use of a human factors approach. The most frequently used methods were interviews and surveys, which often included an exploration of participants’ current use of information technology. Sixteen papers described the evaluation of a patient application in practice. All of them adopted a human factors approach, typically an examination of the use of app features and/or surveys or interviews which enquired about patients’ views of the effects of using the app on their behaviors (e.g. medication adherence), knowledge, and relationships with healthcare providers. No study in our review assessed the impact of mobile applications on health outcomes. Conclusion: The potential of mobile health applications to assist patients to more actively engage in the management of their care has resulted in a large number of applications being developed. Our review showed that human factors approaches are nearly always adopted to some extent in the design, development, and evaluation of mobile applications.

Who Do Hospital Physicians and Nurses Go to for Advice About Medications? A Social Network Analysis and Examination of Prescribing Error Rates

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 09-2015

DOI: 10.1097/PTS.0000000000000061

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.

Allied health service delivery in residential aged care and the impact of the coronavirus (COVID-19) pandemic: a survey of the allied health workforce

Publisher: CSIRO Publishing

Date: 2023

DOI: 10.1071/AH23093

Increased rates of ENT surgery among young children: Have clinical guidelines made a difference?

Publisher: Wiley

Date: 05-10-2004

DOI: 10.1111/J.1440-1754.2004.00488.X

Abstract: To examine the association between introduction of paediatric ear, nose and throat (ENT) surgery guidelines and population procedure rates. To determine changes in children's risk of undergoing ENT surgery. Trend analysis of incidence of myringotomy, tonsillectomy and adenoidectomy among New South Wales (NSW) children aged 0-14 between 1981 and mid 1999. Poisson regression models were used to estimate annual rates of change pre and postguidelines introduction and age/gender specific rates, and lifetable methods to determine risk of undergoing an ENT procedure by age 15. ENT surgery rates increased by 21% over the study period. Children's risk of surgery increased from 17.9% in 1981 to 20.2% in 1998/99. Guideline introduction was associated with moderate short-term decreases in rates. For tonsillectomy, rates decreased between 1981 and 1983, but then rose continually until the introduction of myringotomy guidelines in 1993, when they fell, only to recommence rising until the end of the study period. For myringotomy, rates rose annually from 1981 to 1992/93 and fell in the 3 years following guideline introduction, after which they rose again. Increases were almost exclusively restricted to children aged 0-4 and correspond with increased use of formal childcare. The prevalence of myringotomy by the age of 5 years rose from 5.6% of children born in 1988/89 to 6.4% of those born in 1994/95, and the prevalence of tonsillectomy from 2.4% to 2.7%. The risk of young Australian children undergoing ENT surgery increased significantly over the last two decades despite the introduction of guidelines and no evidence of an increase in otitis media, one condition prompting surgery. Surgery increased most among the very young. We hypothesize this is related to increasing use of childcare.

A comparative study of the utilisation of an electronic test–result management system in emergency and intensive care settings

Publisher: SAGE Publications

Date: 03-12-2020

DOI: 10.1177/1460458219889223

Abstract: The purpose of this qualitative study was to identify differences in the utilisation of an electronic medical record test–result management system between two acute care departments. Field observations (130 min) and semi-structured interviews (n = 24) were conducted in the Intensive Care Unit and Emergency Department of an Australian hospital. Work processes identified from audio transcripts were modelled using business process modelling. Comparison of the Emergency Department and Intensive Care Unit identified the following: (1) test ordering variations according to clinical roles, (2) differences in the use of electronic medical record functionality according to specific demands of the clinical environment and (3) the non-linear components of the test–result management process. Variations were identified in the number of process decisions, external collaborations and temporal process workflows. Modelling the business processes, collaboration and communication needs of in idual clinical environments can aid in enhancing the quality and appositeness of health information technology interventions and thus contribute to improving patient safety. Future health information technology interventions/evaluations aimed at improving the safety of test–result management processes need to address both the nuances of the clinical environment and accommodate the in idual work practices of clinicians within that environment.

Net benefits: assessing the effectiveness of clinical networks in Australia through qualitative methods

Publisher: Springer Science and Business Media LLC

Date: 02-11-2012

DOI: 10.1186/1748-5908-7-108

A national survey on COVID-19 second-wave lockdowns on older adults’ mental wellbeing, health-seeking behaviours and social outcomes across Australia

Publisher: Springer Science and Business Media LLC

Date: 30-06-2021

DOI: 10.1186/S12877-021-02352-1

Abstract: The impact of severe second lockdown measures on older adults’ wellbeing is unknown. We aimed to (i) identify the impact of the second lockdown that resulted from the second wave of COVID-19 cases on older Australians’ quality of life (ii) compare the impact of second wave lockdowns in Victoria, Australia’s second most populous State, to those in other States and Territories not in lockdown. A national cross-sectional study of community-dwelling older adults completed online questionnaires for quality of life, social networks, healthcare access, and perceived impact of COVID-19 between July to September 2020. Tobit regression was used to measure the relationships of healthcare service access and social networks with quality of life of older adults in Victoria compared to those in the rest of Australia. A total of 2,990 respondents (mean [SD] age, 67.3 [7.0] 66.8 % female) participated. At time of data collection, Victoria’s second COVID-19 lockdown had been in force for an average 51.7 days. Median quality of life scores were significantly higher in Victoria compared to the rest of Australia (t 2,827 =2.25 p = 0.025). Being female (95 % CI, -0.051–0.020), having lower educational attainment (95 % CI, -0.089–-0.018), receiving government benefits (95 % CI, -0.054–-0.024), having small social networks (95 % CI, 0.006–0.009) and self-reported physical chronic health conditions were all independent predictors of lower quality of life. Longer-term studies are required to provide more robust evidence of the impact as restrictions lift and normal social conventions return.

A systematic review of the effectiveness of interruptive medication prescribing alerts in hospital CPOE systems to change prescriber behavior and improve patient safety

Publisher: Elsevier BV

Date: 09-2017

DOI: 10.1016/J.IJMEDINF.2017.05.011

Abstract: To assess the evidence of the effectiveness of different categories of interruptive medication prescribing alerts to change prescriber behavior and/or improve patient outcomes in hospital computerized provider order entry (CPOE) systems. PubMed, Embase, CINAHL and the Cochrane Library were searched for relevant articles published between January 2000 and February 2016. Studies were included if they compared the outcomes of automatic, interruptive medication prescribing alert/s to a control/comparison group to determine alert effectiveness. Twenty-three studies describing 32 alerts classified into 11 alert categories were identified. The most common alert categories studied were drug-condition interaction (n=6), drug-drug interaction alerts (n=6) and corollary order alerts (n=6). All 23 papers investigated the effect of the intervention alert on at least one outcome measure of prescriber behavior. Just over half of the studies (53%, n=17) reported a statistically significant beneficial effect from the intervention alert 34% (n=11) reported no statistically significant effect, and 6% (n=2) reported a significant detrimental effect. Two studies also evaluated the effect of alerts on patient outcome measures neither finding that patient outcomes significantly improved following alert implementation (6%, n=2). The greatest volume of evidence relates to three alert categories: drug-condition, drug-drug and corollary order alerts. Of these, drug-condition alerts had the greatest number of studies reporting positive effects (five out of six studies). Only two of six studies of drug-drug interaction and one of six of corollary alerts reported positive benefits. The current evidence-base does not show a clear indication that particular categories of alerts are more effective than others. While the majority of alert categories were shown to improve outcomes in some studies, there were also many cases where outcomes did not improve. This lack of evidence hinders decisions about the amount and type of decision support that should be integrated into CPOE systems to increase safety while reducing the risk of alert fatigue. Virtually no studies have sought to investigate the impact on changes to prescriber behavior and outcomes overall when alerts from multiple categories are incorporated within the same system.

The work of front line community aged care staff and the impact of a changing policy landscape and consumer-directed care

Publisher: Oxford University Press (OUP)

Date: 22-09-2017

DOI: 10.1093/BJSW/BCW112

Lessons learned from the introduction of an electronic safety net to enhance test result management in an australian mothers' hospital

Publisher: Oxford University Press (OUP)

Date: 11-2014

DOI: 10.1136/AMIAJNL-2013-002466

Control room operators’ cue utilization predicts cognitive resource consumption during regular operational tasks

Publisher: Frontiers Media SA

Date: 27-08-2019

DOI: 10.3389/FPSYG.2019.01967

Timing of respiratory virus molecular testing in emergency departments and its association with patient care outcomes

Publisher: BMJ

Date: 08-2019

DOI: 10.1136/BMJOPEN-2019-030104

Abstract: A rapid molecular diagnostic test (RMDT) offers a fast and accurate detection of respiratory viruses, but its impact on the timeliness of care in the emergency department (ED) may depend on the timing of the test. The aim of the study was to determine if the timing of respiratory virus testing using a RMDT in the ED had an association with patient care outcomes. Retrospective observational study. Linked ED and laboratory data from six EDs in New South Wales, Australia. Adult patients presenting to EDs during the 2017 influenza season and tested for respiratory viruses using a RMDT. The timing of respiratory virus testing was defined as the time from a patient’s ED arrival to time of s le receipt at the hospital laboratory. ED length of stay (LOS), hour ED LOS and having a pending RMDT result at ED disposition. A total of 2168 patients were included. The median timing of respiratory virus testing was 224 min (IQR, 133–349). Every 30 min increase in the timing of respiratory virus testing was associated with a 24.0 min increase in the median ED LOS (95% CI, 21.8–26.1 p .001), a 51% increase in the likelihood of staying hours in ED (OR, 1.51 95% CI, 1.41 to 1.63 p .001) and a 4% increase in the likelihood of having a pending RMDT result at ED disposition (OR, 1.04 95% CI, 1.02 to 1.05 p .001) after adjustment for confounders. The timing of respiratory virus molecular testing in EDs was significantly associated with a range of outcome indicators. Results suggest the potential to maximise the benefits of RMDT by introducing an early diagnostic protocol such as triage-initiated testing.

What do physicians tell laboratories when requesting tests? A multi-method examination of information supplied to the Microbiology laboratory before and after the introduction of electronic ordering

Publisher: Elsevier BV

Date: 09-2011

DOI: 10.1016/J.IJMEDINF.2011.06.003

Abstract: The provision of relevant clinical information on pathology requests is an important part of facilitating appropriate laboratory utilization and accurate results interpretation and reporting. (1) To determine the quantity and importance of handwritten clinical information provided by physicians to the Microbiology Department of a hospital pathology service and (2) to examine the impact of a Computerized Provider Order Entry (CPOE) system on the nature of clinical information communication to the laboratory. A multi-method and multi-stage investigation which included: (a) a retrospective audit of all handwritten Microbiology requests received over a 1-month period in the Microbiology Department of a large metropolitan teaching hospital (b) the administration of a survey to laboratory professionals to investigate the impact of different clinical information on the processing and/or interpretation of tests (c) an expert panel consisting of medical staff and senior scientists to assess the survey findings and their impact on pathology practice and patient care and (d) a comparison of the provision and value of clinical information before CPOE, and across 3 years after its implementation. The audit of handwritten requests found that 43% (n=4215) contained patient-related clinical information. The laboratory survey showed that 97% (84/86) of the different types of clinical information provided for wound specimens and 86% (43/50) for stool specimens were shown to have an effect on the processing or interpretation of the specimens by one or more laboratory professionals. The evaluation of the impact of CPOE revealed a significant improvement in the provision of useful clinical information from 2005 to 2008, rising from 90.1% (n=749) to 99.8% (n=915) (p<.0001) for wound specimens and 34% (n=129) to 86% (n=422) (p<.0001) for stool specimens. This study showed that the CPOE system provided an integrated platform to access and exchange valuable patient-related information between physicians and the laboratory. These findings have important implications for helping to inform decisions about the design and structure of CPOE screens and what data entry fields should be designated or made voluntary.

How does accreditation influence staff perceptions of quality in residential aged care?

Publisher: Emerald

Date: 12-06-2017

DOI: 10.1108/QAOA-07-2016-0028

Abstract: Quality of care in the residential aged sector has changed over the past decade. The purpose of this paper is to examine these changes from the perspectives of staff to identify factors influencing quality of residential aged care, and the role and influence of an aged care accreditation programme. Focus groups were held with 66 aged care staff from 11 Australian aged care facilities. Data from semi-structured interviews were analysed to capture categories representing participant views. Participants reported two factors stimulating change: developments in the aged care regulatory and policy framework, and rising consumer expectations. Four corresponding effects on service quality were identified: increasing complexity of resident care, renewed built environments of aged care facilities, growing focus on resident-centred care and the influence of accreditation on resident quality of life. The accreditation programme was viewed as maintaining minimum standards of quality throughout regulatory and social change, yet was considered to lack capacity of itself to explicitly promote or improve resident quality of life. For an increasingly complex aged care population, regulatory and societal change has led to a shift in service provision from institutional care models to one that is becoming more responsive to consumer expectations. The capacity of long-established and relatively static accreditation standards to better accommodate changing consumer needs comes into question. This is the first study to examine the relationship between accreditation and residential aged care service quality from the perspectives of staff, and offers a nuanced view of “quality” in this setting.

Maladministrations in nuclear medicine: Revelations from the Australian Radiation Incident Register

Publisher: AMPCo

Date: 2014

DOI: 10.5694/MJA13.10145

Abstract: To describe the incidence, type, causes and consequences of nuclear medicine maladministrations. Review of prospectively acquired maladministration reports within the Australian Radiation Incident Register (ARIR), a mandatory incident register managed by the Australian Radiation Protection and Nuclear Safety Agency. In idual reports from 2007 to 2011 were evaluated for dose of radiation exposure and type, cause and consequence of maladministrations. Incidence was estimated using data from Medicare Australia. There were 149 maladministrations and the estimated incidence was 5.8 per 100,000 nuclear medicine procedures (95% CI, 5.0-6.9). About half of all maladministrations (48%) arose from an incorrect radiopharmaceutical being prepared and/or dispensed. Other causes included mistakenly injecting the wrong radiopharmaceutical because of inattention (n = 27 18.1%) extravasations, failures in equipment or procedure leading to a non-diagnostic study (n = 25 16.8%) misinterpreting a request form and performing an incorrect procedure (n = 13 8.7%) or injecting an incorrect patient (n = 13 8.7%). ARIR reports focused on active rather than latent causes. Most (n = 147) maladministrations occurred following diagnostic procedures, and the mean effective radiation dose was 7.9 mSv (range, 0.015-45 mSv). Two therapeutic maladministrations likely caused unintended organ injury. The ARIR provides unique insight into the type, causes and complications of maladministrations in Australia. Nearly all maladministrations occur in a diagnostic context, and the risk of patient harm appears low. Among active causes, radiopharmaceutical preparation and dispensation, and medical supervision before injection merit attention. The ARIR could be refined by attending to latent errors, addressing possible underreporting and securing more complete Medicare data.

Use and Evaluation of Computerized Clinical Decision Support Systems for Early Detection of Sepsis in Hospitals: Protocol for a Scoping Review

Publisher: JMIR Publications Inc.

Date: 20-11-2020

DOI: 10.2196/24899

Abstract: Sepsis is a leading cause of death in hospitals, with high associated costs for both patients and health care systems worldwide. Early detection followed by timely intervention is critical for successful sepsis management and, hence, can save lives. Health care institutions are increasingly leveraging clinical data captured in electronic health records for the development of computerized clinical decision support (CCDS) systems aimed at enhancing the early detection of sepsis. However, a comprehensive evidence base regarding sepsis CCDS systems to inform clinical practice, research, and policy is currently lacking. This scoping review aims to systematically describe studies reporting on the use and evaluation of CCDS systems for early detection of sepsis in hospitals. The methodology for conducting scoping reviews presented by the Joanna Briggs Institute Reviewer’s Manual and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) will be used and adapted as guides. A comprehensive literature search of 10 electronic databases will be conducted to identify all empirical quantitative and qualitative studies that investigate the use of CCDS systems for early detection of sepsis in hospitals. Detailed inclusion and exclusion criteria have been developed. Two reviewers will independently screen all articles based on these criteria. Any discrepancies will be resolved through discussion and further review by a third researcher if required. Electronic database searches have retrieved 12,139 references after removing 10,051 duplicates. As of the submission date of this protocol, we have completed the title and abstract screening. A total of 372 references will be included for full-text screening. Only 15.9% (59/372) of these studies were focused on children: 11.0% (41/372) for pediatric and 4.8% (18/372) for neonatal patients. The scoping review and the manuscript will be completed by December 2020. Results of this review will guide researchers in determining gaps and shortcomings in the current evidence base for CCDS system use and evaluation in the early detection of sepsis. The findings will be shared with key stakeholders in clinical care, research, policy, and patient advocacy. PRR1-10.2196/24899

What Information Do General Practitioners Need to Care for Patients with Lung Cancer? A Survey of General Practitioners Perceptions

Publisher: SAGE Publications

Date: 03-2010

DOI: 10.1177/183335831003900103

Abstract: General practitioners (GPs) are an integral part of the multidisciplinary team that care for patients with lung cancer. It is essential that patient information including results of tests, management plans, treatment, and follow-up arrangements are communicated between hospital-based carers and the community-based GR. The aim of this study was to explore GPs' views about the information they need from hospital-based health professionals in the management of their patients with lung cancer. This exploration is undertaken within the context of a multidisciplinary model of care, a relatively new concept in service delivery for cancer patients. Data were collected using a questionnaire that was distributed to the population of 433 GPs from one Australian regional Division of General Practice. Questions related to from whom, what, when and how GPs would like to receive information from the multidisciplinary hospital-based lung cancer team. GPs reported that they wanted information from all members of the multidisciplinary hospital-based lung cancer team, not just physicians. The key triggers for communication included: any change in the patient's condition following initial outpatient visit at admission and discharge and following treatment milestones. Both medical and social information were seen as important to GPs and there was strong support to receive information electronically. This study illustrates the desire by GPs to receive information from all members of the hospital-based lung cancer team if it is relevant to the ongoing care of their patient. Technology-enabled solutions, such as an electronic multidisciplinary discharge summary, the electronic health record and the person-controlled electronic health record, offer strategies to improve both timeliness and access to information.

Medication incident reporting in residential aged care facilities: Limitations and risks to residents' safety

Publisher: Springer Science and Business Media LLC

Date: 02-11-2012

DOI: 10.1186/1471-2318-12-67

Challenges associated with electronic ordering in the emergency department: A study of doctors' experiences

Publisher: Wiley

Date: 10-2009

DOI: 10.1111/J.1742-6723.2009.01214.X

Abstract: The objective of the present study was to identify and report on the key challenges confronted by emergency doctors following the introduction of Computerised Provider Order Entry system in a major metropolitan hospital in Sydney. A qualitative study was undertaken during the period May 2006 to December 2006. The study included a series of eight interviews with three senior doctors and one focus group involving six registrars. Participants were chosen on the basis of their experience of planning for, or working with the new electronic ordering system. The study also incorporated five observation sessions and document analysis. Data were analysed iteratively, which led to the identification and elaboration of issues relevant to the research question. Three major issues emerged from the findings: (i) the implementation of the new system was accompanied by major shifts in ED work responsibilities and tasks (ii) the appearance of dysfunctional consequences of the new system related to the excess time it took to electronically order and the usability of some features of the new system and (iii) doctors' concerns that their views and opinions about the design and implementation of the new system had not been adequately addressed. The implementation of electronic ordering has important implications for ED functioning and the delivery of patient care. The complexity of the ED makes it vulnerable to disruption caused by inadequate system design and ineffective channels of communication across the hospital.

Usability and acceptability of clinical dashboards in aged care

Publisher: JMIR Publications Inc.

Date: 19-06-2023

DOI: 10.2196/42274

Abstract: The use of clinical dashboards in aged care systems to support performance review and improve outcomes for older adults receiving care is increasing. Our aim was to explore evidence from studies of the acceptability and usability of clinical dashboards including their visual features and functionalities in aged care settings. A systematic review was conducted using 5 databases (MEDLINE, Embase, PsycINFO, Cochrane Library, and CINAHL) from inception to April 2022. Studies were included in the review if they were conducted in aged care environments (home-based community care, retirement villages, and long-term care) and reported a usability or acceptability evaluation of a clinical dashboard for use in aged care environments, including specific dashboard visual features (eg, a qualitative summary of in idual user experience or metrics from a usability scale). Two researchers independently reviewed the articles and extracted the data. Data synthesis was performed via narrative review, and the risk of bias was measured using the Mixed Methods Appraisal Tool. In total, 14 articles reporting on 12 dashboards were included. The quality of the articles varied. There was considerable heterogeneity in implementation setting (home care 8/14, 57%), dashboard user groups (health professionals 9/14, 64%), and s le size (range 3-292). Dashboard features included a visual representation of information (eg, medical condition prevalence), analytic capability (eg, predictive), and others (eg, stakeholder communication). Dashboard usability was mixed (4 dashboards rated as high), and dashboard acceptability was high for 9 dashboards. Most users considered dashboards to be informative, relevant, and functional, highlighting the use and intention of using this resource in the future. Dashboards that had the presence of one or more of these features (bar charts, radio buttons, checkboxes or other symbols, interactive displays, and reporting capabilities) were found to be highly acceptable. A comprehensive summary of clinical dashboards used in aged care is provided to inform future dashboard development, testing, and implementation. Further research is required to optimize visualization features, usability, and acceptability of dashboards in aged care.

Information technology in health care

Publisher: Elsevier BV

Date: 06-2010

DOI: 10.1016/J.IJMEDINF.2010.03.006

The role of computerized decision support in reducing errors in selecting medicines for prescription: Narrative review

Publisher: Springer Science and Business Media LLC

Date: 04-2011

DOI: 10.2165/11588200-000000000-00000

Abstract: This narrative review includes a summary of research examining prescribing errors, prescription decision making and the role computerized decision support plays in this decision-making process. A reduction in medication prescribing errors, specifically a reduction in the selection of inappropriate medications, is expected to result from the implementation of an effective computerized decision support system. Previous research has investigated the impact of the implementation of electronic systems on medication errors more broadly. This review examines the specific characteristics of decision support systems that may contribute to fewer knowledge-based mistakes in prescribing, and critically appraises the large volume of information available on the decision-making process of selecting medicines for prescription. The results highlight a need for work investigating what decision strategies are used by doctors with different levels of expertise in the prescribing of medications. The nature of the relationship between decision support and decision performance is not well understood and future research is needed to determine the mechanisms by which computerized decision support influences medication selection.

Design challenges for electronic medication administration record systems in residential aged care facilities: A formative evaluation

Publisher: Georg Thieme Verlag KG

Date: 2014

DOI: 10.4338/ACI-2014-08-RA-0062

Abstract: Introduction: Electronic medication administration record (eMAR) systems are promoted as a potential intervention to enhance medication safety in residential aged care facilities (RACFs). The purpose of this study was to conduct an in-practice evaluation of an eMAR being piloted in one Australian RACF before its roll out, and to provide recommendations for system improvements. Methods: A multidisciplinary team conducted direct observations of workflow (n=34 hours) in the RACF site and the community pharmacy. Semi-structured interviews (n=5) with RACF staff and the community pharmacist were conducted to investigate their views of the eMAR system. Data were analysed using a grounded theory approach to identify challenges associated with the design of the eMAR system. Results: The current eMAR system does not offer an end-to-end solution for medication management. Many steps, including prescribing by doctors and communication with the community pharmacist, are still performed manually using paper charts and fax machines. Five major challenges associated with the design of eMAR system were identified: limited interactivity inadequate flexibility problems related to information layout and semantics the lack of relevant decision support and system maintenance issues.We suggest recommendations to improve the design of the eMAR system and to optimize existing workflows. Discussion: Immediate value can be achieved by improving the system interactivity, reducing inconsistencies in data entry design and offering dedicated organisational support to minimise connectivity issues. Longer-term benefits can be achieved by adding decision support features and establishing system interoperability requirements with stakeholder groups (e.g. community pharmacies) prior to system roll out. In-practice evaluations of technologies like eMAR system have great value in identifying design weaknesses which inhibit optimal system use. Citation: Tariq A, Lehnbom E, Oliver K, Georgiou A, Rowe C, Osmond T, Westbrook J. Design challenges for electronic medication administration record systems in residential aged care facilities: a formative evaluation. Appl Clin Inf 2014 5: 971–987 0.4338/ACI-2014-08-RA-0062

Clinical team functioning and IT innovation

Publisher: Oxford University Press (OUP)

Date: 28-01-2003

DOI: 10.1197/JAMIA.M1285

Nursing students’ experiences of unprofessional behaviours and associations with guideline compliance: A multicenter survey

Publisher: Elsevier BV

Date: 08-2023

DOI: 10.1016/J.NEPR.2023.103739

NSAID use among residents in 68 residential aged care facilities 2014 to 2017: An analysis of duration, concomitant medication use, and high‐risk conditions

Publisher: Wiley

Date: 06-08-2019

DOI: 10.1002/PDS.4866

Abstract: People in residential aged care are at increased risk of adverse events from nonsteroidal anti-inflammatory drugs (NSAIDs) due to their age and health status, but little is known about use of NSAIDs in this setting. We aimed to estimate the prevalence of NSAID use by route, differences by high-risk conditions, prevalence of concurrent proton pump inhibitor (PPI) use, and prevalence of the "triple whammy" combination (oral NSAID, diuretic, and angiotensin-converting-enzyme inhibitor or angiotensin receptor antagonist). We conducted a dynamic cohort study using medication administration data from 68 residential aged care facilities (RACFs) during 2014 to 2017. Descriptive statistics and regression were used to estimate the proportion of residents who used NSAIDs, NSAIDs long term, NSAIDs with PPIs, and the triple whammy combination. Ten thousand three hundred sixty-seven residents were included. Two thousand four hundred fourteen (23.3%) used at least one NSAID: 756 (7.3%) used only oral, 1326 (12.8%) used only topical, and 332 (3.2%) used both topical and oral NSAIDs. One thousand five hundred forty two (14.8%) used an NSAID long term, a majority of which only used topical NSAIDs 933/1542 (60.5%). Age, sex, and health status were associated with greater variation in long-term topical use relative to oral NSAID use. A majority of oral NSAID users concomitantly used a PPI, which varied according to age, sex, and health status. Among residents with any oral NSAID use, 182/1088 (16.7%) had triple whammy medication use. Targeted interventions to reduce NSAID use among RACF residents, to reduce triple whammy medication use, and increase PPI use for long-term oral NSAID users are warranted.

Are interventions to reduce interruptions and errors during medication administration effective?: a systematic review

Publisher: BMJ

Date: 26-08-2013

DOI: 10.1136/BMJQS-2013-002118

An empirically-derived approach for investigating Health Information Technology: The Elementally Entangled Organisational Communication (EEOC) framework

Publisher: Springer Science and Business Media LLC

Date: 12-07-2012

DOI: 10.1186/1472-6947-12-68

An empirical test of short notice surveys in two accreditation programmes.

Publisher: Oxford University Press (OUP)

Date: 02-12-2012

DOI: 10.1093/INTQHC/MZR074

Abstract: To evaluate short notice surveys in accreditation programmes. Two trials using short notice surveys were conducted independently: a study of 20 healthcare organizations with the Australian Council on Healthcare Standards (ACHS) and a study of 7 general practices with the Australian General Practice Accreditation Limited (AGPAL). Participating organizations volunteered. ACHS and AGPAL selected 17 and 13 surveyors, respectively, and provided training for them on short notice surveys. Each agency's short notice surveys were an abbreviated version of their current advanced notification surveys. Short notice surveys assessed accreditation programme criteria or indicators that corresponded to the Australian Commission on Safety and Quality in Health Care's priority issues. Fifteen (out of 45) ACHS criteria and 48 (out of 174) AGPAL indicators that aligned to the Commission's criteria were evaluated. Participating organizations were given 2 days notice prior to the short notice surveys. Ratings from the short notice surveys were compared with those from the most recent advanced notification surveys, and statistical tests were performed to detect differences and potential confounding factors. Surveyors and organizational staff completed a post-survey feedback questionnaire which was analysed thematically and by inferential statistics. The short notice survey approach overall produced ratings congruent with the advanced notification survey for both accreditation programmes. However, for both programmes short notice surveys assessed that more organizations would not reach the accreditation threshold as compared with the previous survey. Organizations in both programmes were judged to have achieved less successful performance against clinical standards by the short notice survey than the advanced notification survey. There was support from surveyors and organizational staff for short notice survey to be adopted. However, there were mixed views about the impact of short notice surveys and whether they validated trial participants' continuous improvement efforts. The study demonstrated that short notice surveys are more critical in their assessment of clinical than administrative or corporate items. Short notice surveys, while broadly comparable with existing advanced notification survey practice, produced different accreditation outcomes for a significant proportion of the study organizations. The overall value and worth of short notice surveys remains to be proved.

How and why are communities of practice established in the healthcare sector? A systematic review of the literature

Publisher: Springer Science and Business Media LLC

Date: 14-10-2011

DOI: 10.1186/1472-6963-11-273

The prevalence and impact of unprofessional behaviour among hospital workers

Publisher: AMPCo

Date: 10-11-2021

DOI: 10.5694/MJA2.50849

Quality of life measurement in community-based aged care

Publisher: Springer Science and Business Media LLC

Date: 28-06-2021

DOI: 10.1186/S12877-021-02254-2

Abstract: Measuring person-centred outcomes and using this information to improve service delivery is a challenge for many care providers. We aimed to identify predictors of QoL among older adults receiving community-based aged care services and examine variation across different community care service outlets. A retrospective s le of 1141 Australians aged ≥60 years receiving community-based care services from a large service provider within 19 service outlets. Clients’ QoL was captured using the ICEpop CAPability Index. QoL scores and predictors of QoL (i.e. sociodemographic, social participation and service use) were extracted from clients’ electronic records and examined using multivariable regression. Funnel plots were used to examine variation in risk-adjusted QoL scores across service outlets. Mean age was 81.5 years (SD = 8) and 75.5% were women. Clients had a mean QoL score of 0.81 (range 0–1, SD = 0.15). After accounting for other factors, being older ( p 0.01), having lower-level care needs ( p 0.01), receiving services which met needs for assistance with activities of daily living ( p 0.01), and having higher levels of social participation ( p 0.001) were associated with higher QoL scores. Of the 19 service outlets, 21% ( n = 4) had lower mean risk-adjusted QoL scores than expected ( 95% control limits) and 16% ( n = 3) had higher mean scores than expected. Using QoL as an indicator to compare care quality may be feasible, with appropriate risk adjustment. Implementing QoL tools allows providers to measure and monitor their performance and service outcomes, as well as identify clients with poor quality of life who may need extra support. Australian and New Zealand clinical trial registry number: ACTRN12617001212347 . Registered 18/08/2017.

Changes in the profile of Australians in 77 residential aged care facilities across New South Wales and the Australian Capital Territory

Publisher: CSIRO Publishing

Date: 2017

DOI: 10.1071/AH16125

Abstract: Objective Government expenditure on and the number of aged care facilities in Australia have increased consistently since 1995. As a result, a range of aged care policy changes have been implemented. Data on demographics and utilisation are important in determining the effects of policy on residential aged care services. Yet, there are surprisingly few statistical summaries in the peer-reviewed literature on the profile of Australian aged care residents or trends in service utilisation. Therefore, the aim of the present study was to characterise the demographic profile and utilisation of a large cohort of residential aged care residents, including trends over a 3-year period. Methods We collected 3 years of data (2011–14) from 77 residential aged care facilities and assessed trends and differences across five demographic and three service utilisation variables. Results The median age at admission over the 3-year period remained constant at 86 years. There were statistically significant decreases in separations to home (z = 2.62, P = 0.009) and a 1.35% increase in low care admissions. Widowed females made up the majority (44.75%) of permanent residents, were the oldest and had the longest lengths of stay. One-third of permanent residents had resided in aged care for 3 years or longer. Approximately 30% of residents were not born in Australia. Aboriginal residents made up less than 1% of the studied population, were younger and had shorter stays than non-Aboriginal residents. Conclusion The analyses revealed a clear demographic profile and consistent pattern of utilisation of aged care facilities. There have been several changes in aged care policy over the decades. The analyses outlined herein illustrate how community, health services and public health data can be used to inform policy, monitor progress and assess whether intended policy has had the desired effects on aged care services. What is known about the topic? Characterisation of permanent residents and their utilisation of residential aged care facilities is poorly described in the peer-reviewed literature. Further, publicly available government reports are incomplete or characterised using incomplete methods. What does this paper add? The analyses in the present study revealed a clear demographic profile and consistent pattern of utilisation of aged care facilities. The most significant finding of the study is that one-third of permanent residents had resided in an aged care facility for ≥3 years. These findings add to the overall picture of residential aged care utilisation in Australia. What are the implications for practitioners? The analyses outlined herein illustrate how community, health services and public health data can be utilised to inform policy, monitor progress and assess whether or not intended policy has had the desired effects on aged care services.

Agreement between Medical Record Data and Patients' Accounts of Their Medical History and Treatment for Dyspepsia

Publisher: Elsevier BV

Date: 02-1998

DOI: 10.1016/S0895-4356(97)00281-3

Abstract: We examined agreement between data abstracted from medical records and interview data for patients with dyspepsia admitted to hospital for endoscopy, to determine the extent to which health records could be used to validate self-reports of dyspepsia and the management of this condition. Results from the s le of 220 patients showed that there was poor agreement between data sources for information about duration of dyspepsia (k=0.34) and previous barium meal examination (k=0.34). Patients reported significantly longer dyspepsia histories (Wilcoxon sign test Z=4.13, p<0.0001) and significantly more barium meals (sign test Z=8.43, p<0.0001) than were documented in their records. There was also disagreement between data sources regarding the number of drugs taken before and after endoscopy (k=0.28 and k=0.31, respectively). Where there was disagreement for number of drugs there was no significant difference in the direction of the disagreement. There was moderate agreement regarding the name of pre-endoscopy medication (k=0.55) and substantial agreement for the name of medication used post-endoscopy (k=0.62). There was very poor agreement regarding diagnosis. The medical record was the gold standard for this information. Choice of data source, medical records or self-reports, will in many instances provide significantly different results and it is likely that this may also be true for other variables of interest to researchers. Thus in the case where no gold standards are available researchers need to consider carefully the implication of choice of data source on their results.

Data quality associated with handwritten laboratory test requests

Publisher: SAGE Publications

Date: 10-2015

DOI: 10.1177/183335831504400302

Abstract: Manual data-entry of handwritten laboratory test requests into electronic information systems has implications for data accuracy. This study sought to identify the types and number of errors occurring for handwritten serology test requests received from outpatient clinics. A 15-day audit at a serology laboratory in Sydney, Australia, compared the content of all transcribed serology outpatient test requests in the laboratory information system with the handwritten request form. One or more errors were detected in 67/627 (10.7%) audited requests ( N=68 errors). Fifty-one of the errors (75.0%) were transcription errors: the wrong test was transcribed in 40/68 cases (58.8%) – ten of these occurred when the abbreviations ‘HBsAb’ and ‘HBsAg’ were confounded for one another – and transcribed requests were missing a test in 11/68 cases (16.2%). The remaining 17 non-transcription errors (25.0%) described request forms not signed by the ordering clinician, mislabelled specimens, and wrong tests due to computer algorithm errors. Manual data-entry of handwritten serology requests is an error-prone process. Electronic ordering has the potential to eliminate illegible handwriting and transcription errors, thus improving data accuracy in hospital information systems.

The quality, safety and governance of telephone triage and advice services – an overview of evidence from systematic reviews

Publisher: Springer Science and Business Media LLC

Date: 30-08-2017

DOI: 10.1186/S12913-017-2564-X

Releasing test results directly to patients: A multisite survey of physician perspectives

Publisher: Elsevier BV

Date: 06-2015

DOI: 10.1016/J.PEC.2015.02.011

Abstract: To determine physician perspectives about direct notification of normal and abnormal test results. We conducted a cross-sectional survey at five clinical sites in the US and Australia. The US-based study was conducted via web-based survey of primary care physicians and specialists between July and October 2012. An identical paper-based survey was self-administered between June and September 2012 with specialists in Australia. Of 1417 physicians invited, 315 (22.2%) completed the survey. Two-thirds (65.3%) believed that patients should be directly notified of normal results, but only 21.3% were comfortable with direct notification of clinically significant abnormal results. Physicians were more likely to endorse direct notification of abnormal results if they believed it would reduce the number of patients lost to follow-up (OR=4.98, 95%CI=2.21-1.21) or if they had personally missed an abnormal test result (OR=2.95, 95%CI=1.44-6.02). Conversely, physicians were less likely to endorse if they believed that direct notification interfered with the practice of medicine (OR=0.39, 95%CI=0.20-0.74). Physicians we surveyed generally favor direct notification of normal results but appear to have substantial concerns about direct notification of abnormal results. Widespread use of direct notification should be accompanied by strategies to help patients manage test result abnormalities they receive.

A profile of health status and demographics of aged care facility residents with gout

Publisher: Wiley

Date: 21-08-2020

DOI: 10.1111/AJAG.12716

Abstract: To estimate gout prevalence and examine associated factors in residential aged care facilities. Electronic data from 11 548 residents aged 65+ during 2014-2017 from 68 residential aged care facilities in Australia were analysed. Gout prevalence was estimated, and regression was used to assess differences in comorbidities, sociodemographic factors and health status between residents with and without gout. Over 10% of residents had gout. Most common comorbidities in these residents were hypertension (71.3%), heart disease (37.9%) and diabetes (33.0%) and they were more likely to have renal disease and historical myocardial infarction. The interaction between comorbid gout had complex interactions between age, sex and comorbidities for diabetes and depression was complex. Gout is common among older people in residential care but may be under-recognised. Holistic management of gout is needed in this population, with careful consideration of chronic comorbidities and treatments.

Computerized Provider Order Entry-What are health professionals concerned about? A qualitative study in an Australian hospital

Publisher: Elsevier BV

Date: 2009

DOI: 10.1016/J.IJMEDINF.2008.09.007

Abstract: To identify the main concerns of a broad range of hospital staff about the implementation of a new Computerized Provider Order Entry (CPOE) system for medication management. The study was conducted in a large Australian teaching hospital using semi-structured interviews (n=20) and focus groups (six focus groups involving a total of 30 participants) from a broad section of health professionals including doctors, nurses, managers, pharmacists and senior health executives. Systematic concurrent analysis of the data was undertaken by a team of researchers. We identified 20 recurrent themes related to nine areas of shared concern including work practices, software/hardware, relationships/communication, education and training, inexperienced staff and de-skilling. A higher level of analysis identified four interrelated constructs that highlight what people are concerned about: (1) Will it help? (2) Will it work? (3) Will we cope? (4) Will it impair existing interaction? The research provides a snapshot overview of perceptions from a range of hospital personnel in the lead up to CPOE implementation. Generalizability is limited by the size of the s le and the contextual circumstances of the hospital being studied. This work contributes valuable evidence about an often-neglected dimension in the evaluation of computer systems in hospitals, namely the pre-implementation concerns of staff. These pre-conceptions can have a significant effect on how technology is implemented and utilised. Acknowledging and addressing people's concerns can contribute to the establishment of durable channels of negotiation and communication. Further research informed by the findings of this study will help advance this process.

Test turnaround times and mortality rates 12 and 24 months after the introduction of a computerised provider order entry system

Publisher: Georg Thieme Verlag KG

Date: 2009

DOI: 10.3414/ME9219

Abstract: Objectives: Few studies have measured the long-term effects of computerised provider order entry systems on pathology test turnaround time. Further, a recent study has raised the possibility that such systems, which require significant work practice change, may be associated with an increase in mortality rates. Our study answered two questions in relation to system introduction in a major Australian teaching hospital: i) are improvements in turnaround times achieved in the first 12 months after system introduction sustained 24 months post-implementation and ii) do mortality rates change following the introduction of an order entry system? Methods: Turnaround time and mortality rates 5 months before and 12 and 24 months after implementation of a computerised order entry system were measured. Turnaround time was defined as the time from receipt of a specimen and order in a laboratory to availability of a result. Results: Improvements in turnaround time achieved in the first 12 months were sustained with a further significant 12.6% reduction at 24 months post-implementation, with no change in average number of tests per patient. The mortality rate significantly increased in the year following system introduction but returned to the pre-system rate in the second year of system use. Review of the excess deaths demonstrated these were most likely attributable to a coincidental influenza outbreak and not to system introduction. Conclusions: The computerised provider order entry system produced sustained and continuing improvements in laboratory efficiency over a two-year period. Associations between increased mortality rates and system introduction should be investigated carefully to ascertain any likely association.

America's health care reforms.

Publisher: SAGE Publications

Date: 03-1994

DOI: 10.1177/183335839402400114

Abstract: President Bill Clinton is currently proposing the most sweeping changes to American social policy since the New Deal by Roosevelt in the 1930s. Major concerns about escalating health care costs, a mushrooming health care bureaucracy and a growing proportion of the American population who can no longer afford adequate health care insurance coverage have motivated Clinton's plan for health care reform. Ideas about telemedicine, the electronic medical record and more comprehensive and advanced information systems are already being canvassed during the course of the debate. Australian clinicians and policy makers are following the American debate closely. So too, should health information managers. America watching should prove interesting, stimulating and professionally rewarding.

The Impact of Mobile Handheld Technology on Hospital Physicians' Work Practices and Patient Care: A Systematic Review

Publisher: Oxford University Press (OUP)

Date: 28-08-2009

DOI: 10.1197/JAMIA.M3215

Consistency or efficiency? A dilemma for designers

Publisher: Oxford University Press (OUP)

Date: 11-2012

DOI: 10.1136/AMIAJNL-2012-001254

An empirical test of accreditation patient journey surveys: randomized trial.

Publisher: Oxford University Press (OUP)

Date: 11-07-2012

DOI: 10.1093/INTQHC/MZS035

Abstract: To evaluate the effectiveness of utilizing the patient journey survey (PJS) method in healthcare accreditation processes. Randomized trial of the PJS method in parallel with the current accreditation survey (CAS) method of the Australian Council on Healthcare Standards (ACHS). Acute healthcare organizations in Australia. Seventeen organizations, 28 organizational staff, nine surveyors and 38 patients. The results of each surveying method were compared. Participants provided feedback, via 18 interviews and 40 questionnaire surveys, about the benefits and disadvantages of a PJS compared to a CAS. The PJS method is not as comprehensive as the CAS method for accreditation assessment. In matched assessments the majority of items were rated lower by the PJS method than by the CAS. PJSs were shown to be appropriate for assessing mandatory clinical criteria, but were less effective for assessing corporate and support criteria. The two methods erged in their final assessments of which organizations met the accreditation threshold. Participants endorsed the use of PJSs within accreditation processes. The PJS methodology complements but is not a substitute for existing accreditation methods. There is significant stakeholder support for the inclusion of the PJS method within the current accreditation programme.

Analysis of Australian newspaper coverage of medication errors.

Publisher: Oxford University Press (OUP)

Date: 24-11-2012

DOI: 10.1093/INTQHC/MZR067

Abstract: To investigate the frequency, style and reliability of newspaper reporting of medication errors. Content analysis of articles discussing medication errors that were published in the 10 most widely read Australian daily newspapers between January 2005 and January 2010. Main outcome measure(s) Newspaper source, article type, article topic, leading news actors, identified causes and solutions of medication errors and cited references. Ninety-two articles included discussion of medication errors, with the one national newspaper, The Australian, the main source of articles (n = 24). News items were the most frequent type of articles (n = 73), with the majority (n = 55) primarily focused on broader hospital problems. Government representatives, advocacy groups, researchers, health service staff and private industry groups were prominent news actors. A shortage of hospital resources was identified as the central cause of medication errors (n = 38), with efficient error reporting systems most frequently identified as a solution (n = 25). Government reports were cited on 39 occasions, with peer-reviewed publications infrequently cited (n = 4). Australian newspaper reporting of medication errors was relatively limited. Given the high prevalence of errors and the potential role consumers can play in identifying and preventing errors, there is a clear argument for increasing public awareness and understanding of issues relating to medication safety. Existing coverage of this issue is unrelated to research evidence. This suggests the need for patient safety researchers and advocacy groups to engage more strongly with the media as a strategy to increase the productive public discourse concerning medication errors and gain support for evidence-based interventions.

Contested innovation: the diffusion of interprofessionalism across a health system

Publisher: Oxford University Press (OUP)

Date: 14-10-2011

DOI: 10.1093/INTQHC/MZR064

Abstract: Interprofessionalism (IP) has emerged as a new movement in healthcare in response to workforce shortages, quality and safety issues and professional power dynamics. Stakeholders can push for IP (e.g. education providers to the health system) or pull (e.g. the health system to the education provider). Based on innovation theory, we hypothesized that there would be unequal forces within and across stakeholder domains which would work to facilitate or resist IP. The strongest pull pressures would be from the health system and services push pressures for IP would come from government and higher education with weaker push forces and levels of resistance, from protectionist professional bodies. /st> Our model was tested in a geographically bounded health jurisdiction. Information was gathered and analysed via in idual (n= 99 participants) and group (n= 372 participants) interviews with stakeholders, and through document analysis. /st> The health system and services exerted the strongest pull in demanding IP. The strongest push factor was in idual ch ions in positions of power. Professional bodies balanced their support of IP competencies with their role as advocates for their in idual professions. A weak push factor came from government support for health workforce reform. /st> Our hypothesis was supported, as were our predictions that the strongest pull would be from the providers and the strongest push from government and higher education. Our original model should be extended to account for contextual factors such as large-scale workplace and professional reform, which worked both for and against, IP.

The three numbers you need to know about healthcare: the 60-30-10 Challenge

Publisher: Springer Science and Business Media LLC

Date: 04-05-2020

DOI: 10.1186/S12916-020-01563-4

Abstract: Healthcare represents a paradox. While change is everywhere, performance has flatlined: 60% of care on average is in line with evidence- or consensus-based guidelines, 30% is some form of waste or of low value, and 10% is harm. The 60-30-10 Challenge has persisted for three decades. Current top-down or chain-logic strategies to address this problem, based essentially on linear models of change and relying on policies, hierarchies, and standardisation, have proven insufficient. Instead, we need to marry ideas drawn from complexity science and continuous improvement with proposals for creating a deep learning health system. This dynamic learning model has the potential to assemble relevant information including patients’ histories, and clinical, patient, laboratory, and cost data for improved decision-making in real time, or close to real time. If we get it right, the learning health system will contribute to care being more evidence-based and less wasteful and harmful. It will need a purpose-designed digital backbone and infrastructure, apply artificial intelligence to support diagnosis and treatment options, harness genomic and other new data types, and create informed discussions of options between patients, families, and clinicians. While there will be many variants of the model, learning health systems will need to spread, and be encouraged to do so, principally through diffusion of innovation models and local adaptations. Deep learning systems can enable us to better exploit expanding health datasets including traditional and newer forms of big and smaller-scale data, e.g. genomics and cost information, and incorporate patient preferences into decision-making. As we envisage it, a deep learning system will support healthcare’s desire to continually improve, and make gains on the 60-30-10 dimensions. All modern health systems are awash with data, but it is only recently that we have been able to bring this together, operationalised, and turned into useful information by which to make more intelligent, timely decisions than in the past.

Co-designing a dashboard of predictive analytics and decision support to drive care quality and client outcomes in aged care

Publisher: BMJ

Date: 08-2021

DOI: 10.1136/BMJOPEN-2021-048657

Abstract: There is a clear need for improved care quality and quality monitoring in aged care. Aged care providers collect an abundance of data, yet rarely are these data integrated and transformed in real-time into actionable information to support evidence-based care, nor are they shared with older people and informal caregivers. This protocol describes the co-design and testing of a dashboard in residential aged care facilities (nursing or care homes) and community-based aged care settings (formal care provided at home or in the community). The dashboard will comprise integrated data to provide an ‘at-a-glance’ overview of aged care clients, indicators to identify clients at risk of fall-related hospitalisations and poor quality of life, and evidence-based decision support to minimise these risks. Longer term plans for dashboard implementation and evaluation are also outlined. This mixed-method study will involve (1) co-designing dashboard features with aged care staff, clients, informal caregivers and general practitioners (GPs), (2) integrating aged care data silos and developing risk models, and (3) testing dashboard prototypes with users. The dashboard features will be informed by direct observations of routine work, interviews, focus groups and co-design groups with users, and a community forum. Multivariable discrete time survival models will be used to develop risk indicators, using predictors from linked historical aged care and hospital data. Dashboard prototype testing will comprise interviews, focus groups and walk-through scenarios using a think-aloud approach with staff members, clients and informal caregivers, and a GP workshop. This study has received ethical approval from the New South Wales (NSW) Population & Health Services Research Ethics Committee and Macquarie University’s Human Research Ethics Committee. The research findings will be presented to the aged care provider who will share results with staff members, clients, residents and informal caregivers. Findings will be disseminated as peer-reviewed journal articles, policy briefs and conference presentations.

Transitional Care in a Federated Landscape

Publisher: Springer International Publishing

Date: 2017

DOI: 10.1007/978-3-319-62346-7_10

The importance of medical and nursing sub-cultures in the implementation of clinical information systems

Publisher: Georg Thieme Verlag KG

Date: 2009

DOI: 10.3414/ME9212

Abstract: Objective: To measure doctors’ and nurses’ perceptions of organisational culture and relate this to their attitudes to, and satisfaction with, a hospital-wide mandatory computerised provider order entry (CPOE) system in order to illuminate cultural compositions in CPOE use. Methods: A cross-sectional survey design was employed. Data were collected by administering an organisational culture survey (Organisational Culture Inventory, OCI) along with a user-satisfaction survey to a population of 103 doctors and nurses from two clinical units in an Australian metropolitan teaching hospital. Clinicians from the hospital had used the CPOE system since 1991 to order and view clinical laboratory and radiology tests electronically for all patients. The OCI provides a measure of culture in terms of three general styles which distinguish between: constructive passive/defensive, and aggressive/defensive cultures. The cluster which best describes the overall culture is the one that has the highest percentile score when the percentile scores of the four cultural norms included in the cluster are averaged. The user satisfaction survey asked questions relating to satisfaction with, and attitudes to, the system. Results: We found identifiable sub-cultures based on professional isions where doctors perceived an aggressive-defensive culture (mean percentile score = 43.8) while nurses perceived a constructive culture (mean percentile score = 61.5). There were significant differences between doctors and nurses on three of the attitude variables with nurses expressing more positive views towards CPOE than doctors. Conclusion: The manifestation of sub-cultures within hospitals and the impact this has on attitudes towards clinical information systems should be recognized and addressed when planning for system implementation. Identification and management of the cultural characteristics of different groups of health professionals may facilitate the successful implementation and use of clinical information systems.

Are specialist physicians missing out on the e-Health boat?

Publisher: Wiley

Date: 10-2009

DOI: 10.1111/J.1445-5994.2009.02023.X

Abstract: Nationally health systems are making increasing investments in the use of clinical information systems. Little is known about current computer use by specialist physicians, particularly outside the hospital setting. To identify the extent and reasons physician Fellows of the Royal Australasian College of Physicians (RACP) use computers in their work. A self-administered survey was emailed from the RACP to all practising physicians in 2007 that were living in Australia and New Zealand who had consented to email contact with the College. The survey was sent to a total of 7445 eligible physicians, 2328 physicians responded (31.3% response rate), but only 1266 responses (21.0%) were able to be analysed. Most 97.5% had access to computers at work and 96.5% used home computers for work purposes. Physicians in public hospitals (72.6%) were more likely to use computers for work (65.6%) than those in private hospitals (12.6%) or consulting rooms (27.3%). Overall physicians working in public hospitals used a wider range of applications with 70.5% using their computers for searching the internet, 53.7% for receiving results and 52.7% used their computers to engage in specific educational activities. Physicians working from their consulting rooms (33.6%) were more likely to use electronic prescribing (11%) compared with physicians working in public hospitals (5.7%). Fellows have not incorporated computers into their consulting rooms over which they have control. This is in contrast to general practitioners who have embraced computers after the provision of various incentives. The rate of use of computers by physicians for electronic prescribing in consulting rooms (11%) is very low in comparison with general practitioners (98%). One reason may be that physicians work in multiple locations whereas general practitioners are more likely to work from one location.

Associations between double-checking and medication administration errors

Publisher: BMJ

Date: 07-08-2021

DOI: 10.1136/BMJQS-2020-011473

Abstract: Double-checking the administration of medications has been standard practice in paediatric hospitals around the world for decades. While the practice is widespread, evidence of its effectiveness in reducing errors or harm is scarce. To measure the association between double-checking, and the occurrence and potential severity of medication administration errors (MAEs) check duration and factors associated with double-checking adherence. Direct observational study of 298 nurses, administering 5140 medication doses to 1523 patients, across nine wards, in a paediatric hospital. Independent observers recorded details of administrations and double-checking (independent primed—one nurse shares information which may influence the checking nurse incomplete or none) in real time during weekdays and weekends between 07:00 and 22:00. Observational medication data were compared with patients’ medical records by a reviewer (blinded to checking-status), to identify MAEs. MAEs were rated for potential severity. Observations included administrations where double-checking was mandated, or optional. Multivariable regression examined the association between double-checking, MAEs and potential severity and factors associated with policy adherence. For 3563 administrations double-checking was mandated. Of these, 36 (1·0%) received independent double-checks, 3296 (92·5%) primed and 231 (6·5%) no/incomplete double-checks. For 1577 administrations double-checking was not mandatory, but in 26·3% (n=416) nurses chose to double-check. Where double-checking was mandated there was no significant association between double-checking and MAEs (OR 0·89 (0·65–1·21) p=0·44), or potential MAE severity (OR 0·86 (0·65–1·15) p=0·31). Where double-checking was not mandated, but performed, MAEs were less likely to occur (OR 0·71 (0·54–0·95) p=0·02) and had lower potential severity (OR 0·75 (0·57–0·99) p=0·04). Each double-check took an average of 6·4 min (107 hours/1000 administrations). Compliance with mandated double-checking was very high, but rarely independent. Primed double-checking was highly prevalent but compared with single-checking conferred no benefit in terms of reduced errors or severity. Our findings raise questions about if, when and how double-checking policies deliver safety benefits and warrant the considerable resource investments required in modern clinical settings.

Impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay, and mortality in intensive care units: a systematic re

Publisher: Oxford University Press (OUP)

Date: 07-10-2016

DOI: 10.1093/JAMIA/OCW145

Abstract: Objective: To conduct a systematic review and meta-analysis of the impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay (LOS), and mortality in intensive care units (ICUs). Methods: We searched for English-language literature published between January 2000 and January 2016 using Medline, Embase, and CINAHL. Titles and abstracts of 586 unique citations were screened. Studies were included if they: (1) reported results for an ICU population (2) evaluated the impact of CPOE or the addition of CDSSs to an existing CPOE system (3) reported quantitative data on medication errors, ICU LOS, hospital LOS, ICU mortality, and/or hospital mortality and (4) used a randomized controlled trial or quasi-experimental study design. Results: Twenty studies met our inclusion criteria. The transition from paper-based ordering to commercial CPOE systems in ICUs was associated with an 85% reduction in medication prescribing error rates and a 12% reduction in ICU mortality rates. Overall meta-analyses of LOS and hospital mortality did not demonstrate a significant change. Discussion and Conclusion: Critical care settings, both adult and pediatric, involve unique complexities, making them vulnerable to medication errors and adverse patient outcomes. The currently limited evidence base requires research that has sufficient statistical power to identify the true effect of CPOE implementation. There is also a critical need to understand the nature of errors arising post-CPOE and how the addition of CDSSs can be used to provide greater benefit to delivering safe and effective patient care.

Unmet Needs for Transdermal Patch Management in Electronic Medication Administration Records: An Analysis of Data from 66 Aged Care Facilities

Publisher: Georg Thieme Verlag KG

Date: 10-2020

DOI: 10.1055/S-0040-1721011

Abstract: Background Transdermal medication patches have caused serious adverse events in residential aged care facilities (RACFs). Preliminary research suggests that facilities are using a workaround consisting of manually entered reminders in their electronic medication administration records (eMARs) to prompt staff to check and remove patches, because the eMAR does not support these tasks. However, the prevalence and factors associated with use of this workaround among facilities is unknown. Objectives The objectives of this study were to (1) examine the frequency and consistency with which manual reminders to check and remove transdermal patches were used in facility eMARs, and (2) identify resident and facility factors associated with reminder use, to inform eMAR redesign. Methods This was a retrospective cross-sectional analysis of eMAR data from 66 Australian RACFs including 4,787 permanent residents, aged ≥65 years in January 2017. Prevalence of the use of reminders to check and remove patches, and consistency in their application within facilities were examined. Generalized estimating equations were used to determine factors associated with use of manual reminders. Results One in five (n = 937) residents used a patch, and 83.6% of patches contained opioids, a high-risk medicine. 56.9% of facilities implemented manually entered check patch reminders in the eMAR, and 72.3% implemented remove reminders. The reminders were applied inconsistently, with only half of these facilities having reminders for all residents with patches. Residents in facilities in regional areas were more likely to have a check reminder compared with those in major cities (adjusted odds ratio = 4.72 [95% confidence interval: 1.69–13.20]). Conclusion Transdermal patches containing high-risk medicines are frequently used in RACFs, but their safe administration is not supported by a widely implemented eMAR. The frequent, but inconsistent use of a workaround to manually enter reminders indicates an unmet need for new eMAR functionality to improve safety.

Clinical thresholds for diagnosing iron deficiency: comparison of functional assessment of serum ferritin to population based centiles

Publisher: Springer Science and Business Media LLC

Date: 26-10-2020

DOI: 10.1038/S41598-020-75435-5

Abstract: Low serum ferritin is diagnostic of iron deficiency, yet its published lower cut-off values are highly variable, particularly for pediatric populations. Lower cut-off values are commonly reported as 2.5th percentiles, and is based on the variation of ferritin values in the population. Our objective was to determine whether a functional approach based on iron deficient erythropoiesis could provide a better alternative. Utilizing 64,443 ferritin test results from pediatric electronic health records, we conducted various statistical techniques to derive 2.5th percentiles, and also derived functional reference limits through the association between ferritin and erythrocyte parameters: hemoglobin, mean corpuscular volume, mean cell hemoglobin concentration, and red cell distribution width. We find that lower limits of reference intervals derived as centiles are too low for clinical interpretation. Functional limits indicate iron deficiency anemia starts to occur when ferritin levels reach 10 µg/L, and are largely similar between genders and age groups. In comparison, centiles (2.5%) presented with lower limits overall, with varying levels depending on age and gender. Functionally-derived limits better reflects the underlying physiology of a patient, and may provide a basis for deriving a threshold related to treatment of iron deficiency and any other biomarker with functional outcomes.

Do Clinicians Use Online Evidence to Support Patient Care? A Study of 55,000 Clinicians

Publisher: Oxford University Press (OUP)

Date: 21-11-2004

DOI: 10.1197/JAMIA.M1385

Transforming routinely collected residential aged care provider data into timely information: Current and future directions

Publisher: Wiley

Date: 06-08-2021

DOI: 10.1111/AJAG.12985

Abstract: Electronic information systems are becoming increasingly common in residential aged care in Australia. These systems contain valuable data generated during day‐to‐day care delivery for older adults. These data (termed ‘routinely collected residential aged care provider data’) are currently underutilised, however have potential significant benefits for both care delivery and research purposes. Routinely collected residential aged care provider data are more readily accessible, contain up‐to‐date information and can be linked to existing national or state‐based administrative data sets, while providing more granular details about care delivered at the coalface. The aim of this paper is to provide clinicians, researchers, policymakers and providers with an understanding of the strengths of these types of data, as well as identifying areas that require future development to maximise their potential to drive improvements in resident care and outcomes. These considerations include data quality, data standardisation and models for data governance, consent and consumer involvement.

Cepheid Xpert® Flu/RSV and Seegene Allplex™ RP1 show high diagnostic agreement for the detection of influenza A/B and respiratory syncytial viruses in clinical practice

Publisher: Wiley

Date: 20-08-2021

DOI: 10.1111/IRV.12799

A Descriptive Analysis of Incidents Reported by Community Aged Care Workers

Publisher: SAGE Publications

Date: 18-12-2014

DOI: 10.1177/0193945914562615

Abstract: Little is known about the types of incidents that occur to aged care clients in the community. This limits the development of effective strategies to improve client safety. The objective of the study was to present a profile of incidents reported in Australian community aged care settings. All incident reports made by community care workers employed by one of the largest community aged care provider organizations in Australia during the period November 1, 2012, to August 8, 2013, were analyzed. A total of 356 reports were analyzed, corresponding to a 7.5% incidence rate per client year. Falls and medication incidents were the most prevalent incident types. Clients receiving high-level care and those who attended day therapy centers had the highest rate of incidents with 14% to 20% of these clients having a reported incident. The incident profile indicates that clients on higher levels of care had higher incident rates. Incident data represent an opportunity to improve client safety in community aged care.

Reducing preventable harm to residents in aged care: A systems approach

Publisher: Wiley

Date: 02-10-2021

DOI: 10.1111/AJAG.12861

Design and implementation of dashboards in healthcare

Publisher: Routledge

Date: 12-05-2022

DOI: 10.4324/9781003109945-42

Unsafe care in residential settings for older adults

Publisher: Oxford University Press (OUP)

Date: 05-10-2023

DOI: 10.1093/INTQHC/MZAD085

Innovative approaches to analysing aged care falls incident data: international classification for patient safety and correspondence analysis

Publisher: Oxford University Press (OUP)

Date: 27-09-2023

DOI: 10.1093/INTQHC/MZAD080

The hierarchy of work pursuits of public health managers

Publisher: SAGE Publications

Date: 05-2007

DOI: 10.1258/095148407780744688

Abstract: How public health is managed in various settings is an important but under-examined issue. We examine themes in the management literature, contextualize issues facing public health managers and investigate the relative importance placed on their various work pursuits using a 14-activity management model empirically derived from studies of clinician-managers in hospitals. Ethnographic case studies of 10 managers in nine erse public health settings were conducted. The case study accounts of managers' activities were content analysed, and substantive words encapsulating their work were categorized using the model. Managerial activities of the nine public health managers were ranked according to the number of words describing each activity. Kendall's coefficient of concordance yielded W = 0.710, P 0.000, revealing significant similarity between the activity patterns of the public health managers. A rank order correlation between the activity patterns of the average ranks for the public health s le and for the hospital clinician-managers ( n = 52) was R = 0.420, P = 0.131, indicating no significant relationship between relative activity priorities of the two groups. Public health managers put less emphasis on pursuits associated with structure, hierarchy and education, and more on external relations and decision-making. The model of hospital clinician-managers' managerial activities is applicable to public health managers while identifying differences in the way the two groups manage. The findings suggest that public health management work is more managerialist than previously thought.

Comparison of health service accreditation programs in low- and middle-income countries with those in higher income countries: A cross-sectional study

Publisher: Oxford University Press (OUP)

Date: 30-10-2012

DOI: 10.1093/INTQHC/MZS064

Abstract: The study aim was twofold: to investigate and describe the organizational attributes of accreditation programmes in low- and middle-income countries (LMICs) to determine how or to what extent these differ from those in higher-income countries (HICs) and to identify contextual factors that sustain or are barriers to their survival. Web-based questionnaire survey. National healthcare accreditation providers and those offering international services. In total, 44 accreditation agencies completed the survey. Income distinctions, accreditation programme features, organizational attributes and cross-national ergence. Accreditation programmes of LMICs exhibit similar characteristics to those of HICs. The consistent model of accreditation worldwide, centres on promoting improvements, applying standards and providing feedback. Where they do differ, the ergence is over specialized features rather than the general logic. LMICs were less likely than HICs to include an evaluation component to programmes, more likely to have certification processes for trainee surveyors and more likely to make decisions on the accreditation status based on a formulaic, mathematically oriented approach. Accreditation programme sustainability, irrespective of country characteristics, is influenced by ongoing policy support from government, a sufficient large healthcare market size, stable programme funding, erse incentives to encourage participation in accreditation by Health Care Organizations as well as the continual refinement and improvement in accreditation agency operations and programme delivery. Understanding the similarities, differences and factors that sustain accreditation programmes in LMICs, and HICs, can be applied to benefit programmes around the world. A flourishing accreditation programme is one element of the institutional basis for high-quality health care.

Design, application and testing of the Work Observation Method by Activity Timing (WOMBAT) to measure clinicians’ patterns of work and communication☆

Publisher: Elsevier BV

Date: 04-2009

DOI: 10.1016/J.IJMEDINF.2008.09.003

Abstract: Evidence regarding how health information technologies influence clinicians' patterns of work and support efficient practices is limited. Traditional paper-based data collection methods are unable to capture clinical work complexity and communication patterns. The use of electronic data collection tools for such studies is emerging yet is rarely assessed for reliability or validity. Our aim was to design, apply and test an observational method which incorporated the use of an electronic data collection tool for work measurement studies which would allow efficient, accurate and reliable data collection, and capture greater degrees of work complexity than current approaches. We developed an observational method and software for personal digital assistants (PDAs) which captures multiple dimensions of clinicians' work tasks, namely what task, with whom, and with what tasks conducted in parallel (multi-tasking) interruptions and task duration. During field-testing over 7 months across four hospital wards, fifty-two nurses were observed for 250 h. Inter-rater reliability was tested and validity was measured by (i) assessing whether observational data reflected known differences in clinical role work tasks and (ii) by comparing observational data with participants' estimates of their task time distribution. Observers took 15-20 h of training to master the method and data collection process. Only 1% of tasks observed did not match the classification developed and were classified as 'other'. Inter-rater reliability scores of observers were maintained at over 85%. The results discriminated between the work patterns of enrolled and registered nurses consistent with differences in their roles. Survey data (n=27) revealed consistent ratings of tasks by nurses, and their rankings of most to least time-consuming tasks were significantly correlated with those derived from the observational data. Over 40% of nurses' time was spent in direct care or professional communication, with 11.8% of time spent multi-tasking. Nurses were interrupted approximately every 49 min. One quarter of interruptions occurred while nurses were preparing or administering medications. This method efficiently produces reliable and valid data. The multi-dimensional nature of the data collected provides greater insights into patterns of clinicians' work and communication than has previously been possible using other methods.

A comparison of self-reported and observational work sampling techniques for measuring time in nursing tasks

Publisher: SAGE Publications

Date: 2007

DOI: 10.1258/135581907779497576

Abstract: Objectives: To compare self-reported and observational work s ling techniques when applied to ward-based nurses. Methods: A self-reported work s ling study was undertaken with nine registered nurses in an Australian teaching hospital over 8.5 weeks, followed by an observational work s ling study conducted over 4.5 weeks. Both studies used a random reminder method and a multidimensional work task classification. Field notes were also recorded and analysed. Results: 3910 data points were collected, 667 during the self-report study and 3243 in the observational study. The two techniques yielded significant differences in work patterns of registered nurses. The observational study showed that compared with the self-reported study, patient care (40% versus 33%, P .000) and ward-related activities (7% versus 3% P .001) were recorded significantly more frequently, and documentation less frequently (8% versus 19% P .000). Both the techniques generated similar proportions of time spent in breaks (12%), medication tasks (13%) and clinical discussion (15%). The self-report technique was poorly accepted by nursing staff. The observational technique was well accepted and data collection was more effcient. Conclusions: The self-report work s ling technique is not a reliable method for obtaining an accurate reflection of the work tasks of ward-based nurses. The observational technique was preferred by nurses, and despite concern regarding a potential Hawthorne effect, this was not substantiated.

Using the international classification of primary care to examine the profile of patients utilising hospital accident and emergency services

Publisher: SAGE Publications

Date: 12-1992

DOI: 10.1177/183335839202200404

Abstract: Changes in the management and financing of health care are resulting in increased demands for better information about patients who are treated on an ambulatory basis in hospitals. A pilot study was conducted with the aim of determining the profile of patients who utilise accident and emergency services at St. Vincent's Hospital, Sydney. The International Classification of Primary Care (ICPC) was used to classify both the diagnoses and treatments of patients in the study. 50% of patients fell into two diagnostic categories, 40% of patients resided outside the Eastern Sydney area, no significant difference in the morbidity profiles according to area of residence of patients was found and 25% of patients returned to the hospital within a five month period. The application of the ICPC in an accident and emergency setting is discussed.

Anti-osteoporosis Medication Use in a High Fracture-Risk Population: Contemporary Trends in Australian Residential Aged Care Facilities

Publisher: SAGE Publications

Date: 2019

DOI: 10.1177/1178632919852111

Abstract: Osteoporotic fractures impose substantial morbidity and mortality among older adults. Undertreatment is an ongoing concern treatment rates declined following reports of adverse effects of guideline-recommended bisphosphonates, but new antiresorptives have since become available. Our goal was to identify contemporary trends in osteoporosis treatment guideline adherence in a high fracture-risk population. We conducted a secondary data analysis using electronic health record data of adults aged ⩾65 years from 68 residential aged care facilities in Australia during 2014-2017 (n = 9094). Using medication administration data, we identified antiresorptive (bisphosphonates and denosumab) and vitamin D supplement use among residents with osteoporosis. Regression was used to evaluate temporal trends, and resident and facility characteristics associated with antiresorptive use and vitamin D use. In 2014, 34% of women and 42% of men with osteoporosis used antiresorptives this decreased 8 percentage points by 2017. Antiresorptive use was higher among those with a history of fracture and lower in the last year of life. Denosumab use increased but did not substitute for the continued decline in bisphosphonate use. Vitamin D was consistently used by more than 60% of residents and was higher among those with fracture history. Greater attention to the treatment of osteoporosis treatment rates among this high fracture-risk population is warranted.

Long-term patterns of online evidence retrieval use in general practice: A 12-month study

Publisher: JMIR Publications Inc.

Date: 19-03-2008

DOI: 10.2196/JMIR.974

Evaluating the long-term effects of a data-driven approach to reduce variation in emergency department pathology investigations

Publisher: BMJ

Date: 10-2020

DOI: 10.1136/BMJOPEN-2020-039437

Abstract: Variation in test ordering is a major issue in Australia and globally with significant financial and clinical impacts. There is currently a lack of research identifying and remediating variation in the use of pathology tests in emergency departments (EDs). In 2019, NSW Health Pathology introduced the Pathology Atlas of Variation that uses a data-driven tool (the Atlas Analytical Model) to investigate test order variation across New South Wales (NSW) and engage with local health districts (LHDs) to reduce variation. The objectives of this study are to evaluate whether this data-driven approach is associated with: (1) a reduction in test order variation (2) improvements in patient outcomes and (3) cost benefits, for the five most frequent ED presentations. This is a large multisite study including 45 major public hospitals across 15 LHDs in NSW, Australia. The Atlas Analytical Model is a data analytics and visualisation tool capable of providing analytical insights into variation in pathology investigations across NSW EDs, which will be used as feedback to inform LHDs efforts to reduce variation. Interrupted time series analyses using 2 years pre Atlas (2017–2018) and 2 years post Atlas (2021–2022) data will be conducted. Study data will be obtained by linking hospital and laboratory databases. Funnel plots will be used to identify EDs with outlying pathology test ordering practices. The outcome measures include changes in test ordering practices, ED length of stay, hospital admission and cost benefits (total pathology costs per ED encounter). The study has received ethical approval from the NSW Population and Health Service Research Ethics Committee (reference, 2019/ETH00184). The findings of the study will be published in peer-reviewed journals and disseminated via presentations at conferences. We will also engage directly with key stakeholders to disseminate the findings and to inform policies related to pathology testing in the ED.

Multimethod Evaluation of Information and Communication Technologies in Health in the Context of Wicked Problems and Sociotechnical Theory

Publisher: Oxford University Press (OUP)

Date: 11-2007

DOI: 10.1197/JAMIA.M2462

Under‐detection of acute kidney injury in hospitalised patients: a retrospective, multi‐site, longitudinal study

Publisher: Wiley

Date: 03-2020

DOI: 10.1111/IMJ.14264

Abstract: Acute kidney injury (AKI) is a rapid deterioration of renal function, often caused by a variety of co-existing morbidities complicating its recognition and treatment, leading to short- and long-term adverse clinical outcomes. There are limited data on the incidence of AKI in Australia using the Kidney Disease Improving Global Outcomes creatinine-based consensus definition. To determine the incidence and estimate the extent of under-reporting of AKI in four hospitals in the South-Eastern Sydney/Illawarra regions of New South Wales, Australia. A laboratory algorithm based on the Kidney Disease Improving Global Outcomes creatinine-based definition for AKI was applied retrospectively to laboratory data for adult patients admitted to the study hospitals between 2009 and 2013 to identify those with AKI. The results were compared with the incidence of AKI based on diagnostic codes for AKI reported for the same period. AKI was detected in 12.4% of all hospitalisations (46 101/370 969) and 16.4% of patients (31 448/192 133) across the 5-year study period using the laboratory algorithm. Of these, 72.1% were AKI Stage 1 (33 246/46101). AKI was coded in only 15.9% of hospitalisations with AKI Stage 1 (5294/33 246), 38.5% of hospitalisations with Stage 2 (2381/6185), and 46.8% with Stage 3 (3120/6670). Yearly incidence of laboratory-identified AKI trended downward between 2009 and 2013, while annual incidence determined by coding trended upward. Although coding trends suggested a continuous increase in clinician awareness of AKI across the study period, AKI in hospitalised patients remained significantly under-reported.

Contextual Implementation Model: A framework for assisting clinical information system implementations

Publisher: Oxford University Press (OUP)

Date: 03-2008

DOI: 10.1197/JAMIA.M2468

The impact of national accreditation reform on survey reliability: a 2-year investigation of survey coordinators’ perspectives

Publisher: Wiley

Date: 25-01-2016

DOI: 10.1111/JEP.12512

Abstract: Accrediting health care organizations against standards is a recognized safety and quality intervention. The credibility of an accreditation programme relies on surveying reliability. We investigated accreditation survey coordinators' perceptions of reliability issues and their continued relevancy, during a period of national accreditation reform. In 2013 and 2014, questionnaire surveys were developed using survey coordinators' feedback of their experiences and concerns regarding the accreditation process. Each year, a purpose-designed questionnaire survey was administered during the accrediting agency survey coordinator training days. Participants reported that survey reliability was informed by five categories of issues: the management of the accreditation process, including standards and health care organizational issues surveyor workforce management survey coordinator role survey team and in idual surveyors. A new accreditation system and programme did not alter the factors reported to shape survey reliability. However, across the reform period, there was a noted change within each category of the specific issues that were of concern. Furthermore, consensus between coordinators that existed in 2013 appears to have diminished in 2014. Across all categories, in 2014 there was greater ersity of opinion than in 2013. The known challenges to the reliability of an accreditation programme retained their potency and relevancy during a period of reform. The ersity of opinion identified across the coordinator workforce could potentially place the credibility and reliability of the new scheme at risk. The study highlights that reliability of an accreditation scheme is an ongoing achievement, not a one-off attainment.

What factors are associated with the integration of evidence retrieval technology into routine general practice settings?

Publisher: Elsevier BV

Date: 10-2007

DOI: 10.1016/J.IJMEDINF.2006.06.009

Abstract: Information retrieval systems have the potential to improve patient care but little is known about the variables which influence clinicians' uptake and use of systems in routine work. To determine which factors influenced use of an online evidence retrieval system. Computer logs and pre- and post-system survey analysis of a 4-week clinical trial of the Quick Clinical online evidence system involving 227 general practitioners across Australia. Online evidence use was not linked to general practice training or clinical experience but female clinicians conducted more searches than their male counterparts (mean use=14.38 searches, S.D.=11.68 versus mean use=8.50 searches, S.D.=9.99 t=2.67, d.f.=157, P=0.008). Practice characteristics such as hours worked, type and geographic location of clinic were not associated with search activity. Information seeking was also not related to participants' perceived information needs, computer skills, training nor Internet connection speed. Clinicians who reported direct improvements in patient care as a result of system use had significantly higher rates of system use than other users (mean use=12.55 searches, S.D.=13.18 versus mean use=8.15 searches, S.D.=9.18 t=2.322, d.f.=154 P=0.022). Comparison of participants' views pre- and post- the trial, showed that post-trial clinicians expressed more positive views about searching for information during a consultation (chi(2)=27.40, d.f.=4, P< or =0.001) and a significantly greater number reported seeking information between consultations as a result of having access to an online evidence system in their consulting rooms (chi(2)=9.818, d.f.=2, P=0.010). Clinicians' use of an online evidence system was directly related to their reported experiences of improvements in patient care. Post-trial clinicians positively changed their views about having time to search for information and pursued more questions during clinic hours.

Evaluation of Web-Based Consumer Medication Information: Content and Usability of 4 Australian Websites

Publisher: JMIR Publications Inc.

Date: 21-07-2016

DOI: 10.2196/IJMR.5651

The relationship between fall incidents and place of birth in residential aged care facilities: a retrospective longitudinal cohort study

Publisher: Springer Science and Business Media LLC

Date: 28-04-2023

DOI: 10.1186/S12877-023-03954-7

Abstract: Older populations in residential aged care facilities (RACFs) in many immigrant-receiving countries are now being increasingly culturally and linguistically erse (CALD). CALD populations require tailored social and health services to support their needs and improve health outcomes. Falls among the elderly are common and can have significant health and psychosocial consequences. There is some evidence to suggest that country of birth may influence risk of falls among older people, but such evidence has been scarce. This study aimed to determine the association between place of birth and the incidence of falls in RACFs. Routinely collected incident data relating to 5,628 residents aged ≥ 65 years in 25 RACFs in Sydney, New South Wales, Australia were used. RACF residents were classified into two groups, Australia-born (N = 4,086) and overseas-born (N = 1,542). Overseas-born RACF residents were further categorised into two subgroups: overseas-English-speaking-country (N = 743) and overseas-non-English-speaking-country (N = 799). Outcomes measures were rate of all falls, injurious falls and falls requiring hospitalisation. Multilevel binary negative regression was used to examine the relationship between fall risk and place of birth. Incidence rates of all falls, injurious falls and falls requiring hospitalisation were 8.62, 3.72 and 1.07 incidents per 1,000 resident days, respectively, among the Australia-born RACF residents, but were higher at 11.02, 4.13 and 1.65, respectively, among the overseas-born RACF residents. Within those born overseas, fall rates were higher among the overseas-non-English-speaking-country-born residents (11.32, 4.29 and 2.22, respectively) than those overseas-English-speaking-country-born (10.70, 3.96 and 1.05, respectively). After controlling for confounders, the overseas-born RACF residents overall experienced a higher risk of all three types of falls (incidence rate ratios: [IRR] = 1.278, 95% confidence interval [CI] = 1.131, 1.443 injurious falls: IRR = 1.164 [95% CI = 1.013, 1.338] falls requiring hospitalisation: IRR = 1.460 [95% CI = 1.199, 1.777]) than the Australia-born RACF residents. Among the overseas-born RACF residents, males, respite residents and those overseas-non-English-speaking-country-born experienced higher rates of falls. Fall incidence in RACFs varies significantly by place of birth. With increasingly erse RACF populations, fall intervention and prevention programs should consider cultural and linguistical backgrounds of RACF residents. Greater attention to understand the mechanisms for the differences by place of birth in risk profiles is warranted.

The effect of home care package allocation reforms on service uptake, use and cessation at a large Australian aged care provider

Publisher: Wiley

Date: 09-01-2020

DOI: 10.1111/AJAG.12764

Abstract: To utilise routinely collected data to examine changes in the client profile of a large aged care provider before and after commencement of the 2017 policy reforms, whereby home care packages were allocated to in iduals rather than providers. Interrupted time series analysis was used to measure changes in service uptake and cessation. Chi-square and t tests were used to compare client profiles in the 12 months before and after policy changes. A total of 4132 people used home care services with the provider between March 2016 and March 2018. Fewer people commenced services post-reforms, and they were more likely to be younger and have a partner. There was no change in the number choosing to terminate services post-reforms. Vulnerable older Australians may experience greater difficulty accessing services under the new system, suggesting greater scrutiny of the reforms in achieving policy objectives is required. Analyses of routinely collected data sets can support this evaluation process.

Effectiveness of interventions targeting antibiotic use in long-term aged care facilities: a systematic review and meta-analysis

Publisher: BMJ

Date: 2020

DOI: 10.1136/BMJOPEN-2018-028494

Abstract: There are high levels of inappropriate antibiotic use in long-term care facilities (LTCFs). Our objective was to examine evidence of the effectiveness of interventions designed to reduce antibiotic use and/or inappropriate use in LTCFs. Systematic review and meta-analysis. MEDLINE, Embase and CINAHL from 1997 until November 2018. Controlled and uncontrolled studies in LTCFs measuring intervention effects on rates of overall antibiotic use and/or appropriateness of use were included. Secondary outcomes were intervention implementation barriers from process evaluations. Two reviewers independently applied the Cochrane Effective Practice and Organisation of Care group’s resources to classify interventions and assess risk of bias. Meta-analyses used random effects models to pool results. Of include studies (n=19), 10 had a control group and 17 had a high risk of bias. All interventions had multiple components. Eight studies (with high risk of bias) showed positive impacts on outcomes and included one of the following interventions: audit and feedback, introduction of care pathways or an infectious disease team. Meta-analyses on change in the percentage of residents on antibiotics (pooled relative risk (RR) (three studies, 6862 residents): 0.85, 95% CI: 0.61 to 1.18), appropriateness of decision to treat with antibiotics (pooled RR (three studies, 993 antibiotic orders): 1.10, 95% CI: 0.64 to 1.91) and appropriateness of antibiotic selection for respiratory tract infections (pooled RR (three studies, 292 orders): 1.15, 95% CI: 0.95 to 1.40), showed no significant intervention effects. However, meta-analyses only included results from intervention groups since most studies lacked a control group. Insufficient data prevented meta-analysis on other outcomes. Process evaluations (n=7) noted poor intervention adoption, low physician engagement and high staff turnover as barriers. There is insufficient evidence that interventions employed to date are effective at improving antibiotic use in LTCFs. Future studies should use rigorous study designs and tailor intervention implementation to the setting.

Epidemiology of falls in 25 Australian residential aged care facilities: a retrospective longitudinal cohort study using routinely collected data

Publisher: Oxford University Press (OUP)

Date: 19-05-2022

DOI: 10.1093/INTQHC/MZAC050

Abstract: Falls are frequent among older adults and have significant health and economic consequences. There have been few studies on the epidemiology of falls in residential aged care facilities (RACFs). To determine the incidence of falls in RACFs using longitudinal routinely collected incident data over 5 years (July 2014–December 2019). A retrospective cohort study is conducted using fall incident data from 25 RACFs in Sydney, NSW, Australia. Incidents relating to a population of 6163 aged care residents aged ≥65 years were included. Outcome measures were incidents of all falls, injurious falls and falls requiring hospitalization. The risk-adjusted incidence rate (IR) for each outcome indicator for each of the 25 facilities was calculated. A total of 27 878 falls were reported over 3 906 772 resident days (a crude rate of 7.14 incidents per 1000 resident days 95% confidence interval (CI) 6.81–7.48). Of these, 10 365 (37.2%) were injurious and 2733 (9.8%) required hospitalization. The crude IRs were 2.65 incidents per 1000 resident days (95% CI 2.53–2.78) for injurious falls and 0.70 incidents per 1000 resident days (95% CI 0.66–0.74) for falls requiring hospitalization. The incidence of falls was significantly higher in respite compared to permanent residents for all falls (adjusted IR ratio (aIRR) 1.33 95% CI 1.18–1.51) and injurious falls (aIRR 1.30 95% CI 1.14–1.48) and for men compared to women for all outcomes (all falls aIRR 1.69 95% CI 1.54–1.86 injurious falls aIRR 1.87 95% CI 1.71–2.04 and falls requiring hospitalization aIRR 1.29 95% CI 1.12–1.48). The risk-adjusted IRs per 1000 resident days between facilities varied substantially (all falls 0.57–12.93 falls injurious falls 0.25–4.47 and falls requiring hospitalization 0.10–1.70). Falls are frequent in RACFs, often resulting in injury and hospitalization. The study provides robust and comprehensive information that may help inform future initiatives to minimize the incidence of falls in RACFs.

Student and clinician perceptions of medical student mistreatment

Publisher: BMJ

Date: 09-2022

DOI: 10.1136/BMJOPEN-2022-061253

Abstract: The mistreatment of medical students remains pervasive in medical education. Understanding the extent to which clinicians and students recognise mistreatment can assist in creating targeted interventions that reduce mistreatment. The objective of this study was to use clinical vignettes to assess perceptions of medical student mistreatment among medical students and clinical faculty at an Australian university. This cross-sectional study used a survey of medical students and clinical faculty in a Doctor of Medicine (MD) programme at Macquarie University in Sydney, Australia. Data were collected via an online survey between 13 July and 27 July 2020. Fourteen clinical vignettes were developed based on commonly reported themes of mistreatment. An additional control vignette was also included, and these 15 vignettes were distributed via email to all 169 MD students and 42 teaching faculty at this teaching site. Participants were asked to rate whether the vignettes portrayed mistreatment on a 5-point Likert scale (strongly disagree to strongly agree). Respondents included 83 MD students and 34 clinical faculty. On average, students perceived mistreatment in 9 of 14 vignettes and faculty in 8 of 14 vignettes. Faculty and student perceptions aligned in themes of sexual abuse, physical abuse and in the control vignette depicting a constructive teaching style. Perceptions differed significantly between faculty and students (p .05) for five vignettes across the themes of gender discrimination, requests of students to perform non-educational tasks, humiliation, specialty choice discrimination and requests to perform a task beyond the student’s capacity. Agreement on what constitutes appropriate behaviour is crucial to ensuring that a culture of mistreatment can be replaced with one of kindness, equity and respect. This study demonstrated the successful use of vignettes to compare perceptions of mistreatment, with faculty and student perceptions differing across a variety of themes.

On the Right to Science: Recommendations of Selection Criteria for IMIA Scientific Meetings

Publisher: Georg Thieme Verlag KG

Date: 08-2019

DOI: 10.1055/S-0039-1677924

Abstract: The International Medical Informatics Association (IMIA), a non-governmental, not-for-profit, global organization promoting health and biomedical informatics, is committed to the right of communities opulations and in iduals to science, comprised of three separate constituent rights: 1) the right to participate in science, 2) the right to benefit from science, and 3) the right to benefit from a person’s own contribution to science or inventions. As such, IMIA provides a global platform where scientists, researchers, health information users, vendors, developers, consultants, health care consumers, and suppliers can meet in an environment of cooperation and sharing. In the context of IMIA’s conferences, the IMIA board has discussed and identified the important central factors, which are essential considerations to host a scientific meeting. These factors will be used to help vet future contenders applying for the honor to host an IMIA conference: Reasonable safety and security, commitment by the host member society, freedom of travel, scientific freedom, and freedom from discrimination.

The impact of serious adverse drug reactions: a population-based study of a decade of hospital admissions in New South Wales, Australia

Publisher: Wiley

Date: 29-09-2017

DOI: 10.1111/BCP.13124

The role of ICT in supporting disruptive innovation: A multi-site qualitative study of nurse practitioners in emergency departments

Publisher: Springer Science and Business Media LLC

Date: 02-04-2012

DOI: 10.1186/1472-6947-12-27

The basis of clinical tribalism, hierarchy and stereotyping: a laboratory-controlled teamwork experiment

Publisher: BMJ

Date: 07-2016

DOI: 10.1136/BMJOPEN-2016-012467

Inter-observer agreement and reliability assessment for observational studies of clinical work

Publisher: Elsevier BV

Date: 12-2019

DOI: 10.1016/J.JBI.2019.103317

Abstract: Inter-observer agreement (IOA) is a key aspect of data quality in time-and-motion studies of clinical work. To date, such studies have used simple and ad hoc approaches for IOA assessment, often with minimal reporting of methodological details. The main methodological issues are how to align time-st ed task intervals that rarely have agreeing start and end times, and how to assess IOA for multiple nominal variables. We present a combination of methods that simultaneously addresses both these issues and provides a more appropriate measure by which to assess IOA for time-and-motion studies. The issue of alignment is addressed by converting task-level data into small time windows then aligning data from different observers by time. A method applicable to multivariate nominal data, the iota score, is then applied to the time-aligned data. We illustrate our approach by comparing iota scores to the mean of univariate Cohen's kappa scores through application of these measures to existing data from an observational study of emergency department physicians. While the two scores generated very similar results under certain conditions, iota was more resilient to sparse data issues. Our results suggest that iota applied to time windows considerably improves on previous methods used for IOA assessment in time-and-motion studies, and that Cohen's kappa and other univariate measures should not be considered the gold standard. Rather, there is an urgent need for ongoing explicit discussion of methodological issues and solutions to improve the ways in which data quality is assessed in time-and-motion studies in order to ensure the conclusions drawn from such studies are robust.

Impact of rapid molecular diagnostic testing of respiratory viruses on outcomes of adults hospitalized with respiratory illness

Publisher: American Society for Microbiology

Date: 04-2019

DOI: 10.1128/JCM.01727-18

Abstract: A standard multiplex PCR offers comprehensive testing for respiratory viruses. However, it has traditionally been performed in a referral laboratory with a lengthy turnaround time, which can reduce patient flow through the hospital.

Usability and Acceptability of Clinical Dashboards in Aged Care: Systematic Review (Preprint)

Publisher: JMIR Publications Inc.

Date: 29-08-2022

DOI: 10.2196/PREPRINTS.42274

Abstract: he use of clinical dashboards in aged care systems to support performance review and improve outcomes for older adults receiving care is increasing. ur aim was to explore evidence from studies of the acceptability and usability of clinical dashboards including their visual features and functionalities in aged care settings. systematic review was conducted using 5 databases (MEDLINE, Embase, PsycINFO, Cochrane Library, and CINAHL) from inception to April 2022. Studies were included in the review if they were conducted in aged care environments (home-based community care, retirement villages, and long-term care) and reported a usability or acceptability evaluation of a clinical dashboard for use in aged care environments, including specific dashboard visual features (eg, a qualitative summary of in idual user experience or metrics from a usability scale). Two researchers independently reviewed the articles and extracted the data. Data synthesis was performed via narrative review, and the risk of bias was measured using the Mixed Methods Appraisal Tool. n total, 14 articles reporting on 12 dashboards were included. The quality of the articles varied. There was considerable heterogeneity in implementation setting (home care 8/14, 57%), dashboard user groups (health professionals 9/14, 64%), and s le size (range 3-292). Dashboard features included a visual representation of information (eg, medical condition prevalence), analytic capability (eg, predictive), and others (eg, stakeholder communication). Dashboard usability was mixed (4 dashboards rated as high), and dashboard acceptability was high for 9 dashboards. Most users considered dashboards to be informative, relevant, and functional, highlighting the use and intention of using this resource in the future. Dashboards that had the presence of one or more of these features (bar charts, radio buttons, checkboxes or other symbols, interactive displays, and reporting capabilities) were found to be highly acceptable. comprehensive summary of clinical dashboards used in aged care is provided to inform future dashboard development, testing, and implementation. Further research is required to optimize visualization features, usability, and acceptability of dashboards in aged care.

Avoiding unnecessary hospitalisation for patients with chronic conditions: a systematic review of implementation determinants for hospital avoidance programmes

Publisher: Springer Science and Business Media LLC

Date: 21-10-2020

DOI: 10.1186/S13012-020-01049-0

Abstract: Studies of clinical effectiveness have demonstrated the many benefits of programmes that avoid unnecessary hospitalisations. Therefore, it is imperative to examine the factors influencing implementation of these programmes to ensure these benefits are realised across different healthcare contexts and settings. Numerous factors may act as determinants of implementation success or failure (facilitators and barriers), by either obstructing or enabling changes in healthcare delivery. Understanding the relationships between these determinants is needed to design and tailor strategies that integrate effective programmes into routine practice. Our aims were to describe the implementation determinants for hospital avoidance programmes for people with chronic conditions and the relationships between these determinants. An electronic search of four databases was conducted from inception to October 2019, supplemented by snowballing for additional articles. Data were extracted using a structured data extraction tool and risk of bias assessed using the Hawker Tool. Thematic synthesis was undertaken to identify determinants of implementation success or failure for hospital avoidance programmes for people with chronic conditions, which were categorised according to the Consolidated Framework for Implementation Research (CFIR). The relationships between these determinants were also mapped. The initial search returned 3537 articles after duplicates were removed. After title and abstract screening, 123 articles underwent full-text review. Thirteen articles (14 studies) met the inclusion criteria. Thematic synthesis yielded 23 determinants of implementation across the five CFIR domains. ‘Availability of resources’, ‘compatibility and fit’, and ‘engagement of interprofessional team’ emerged as the most prominent determinants across the included studies. The most interconnected implementation determinants were the ‘compatibility and fit’ of interventions and ‘leadership influence’ factors. Evidence is emerging for how chronic condition hospital avoidance programmes can be successfully implemented and scaled across different settings and contexts. This review provides a summary of key implementation determinants and their relationships. We propose a hypothesised causal loop diagram to represent the relationship between determinants within a complex adaptive system. PROSPERO 162812

The impact of an online evidence system on confidence in decision making in a controlled setting

Publisher: SAGE Publications

Date: 03-2005

DOI: 10.1177/0272989X05275155

Abstract: Objective. To examine the impact of online evidence retrieval on clinicians’ decision-making confidence and to determine if this differs for experienced doctors and nurses. Methods. A s le of 44 doctors and 31 clinical nurse consultants (CNCs) answered 8 clinical scenarios (600 scenario answers) before and after the use of online evidence resources. Clinicians rated their confidence in scenario answers and in the evidence they found using the information system. Results. Prior to using online evidence, 37% of doctors and 18% of CNCs answered the scenarios correctly. These clinicians were more confident (56% very confident or confident) in their answers than those with incorrect (34%) answers. Doctors with incorrect answers prior to searching rated their confidence significantly higher than did nurses who were incorrect. After searching, both groups answered 50% of scenarios correctly. Clinicians with correct answers had greater confidence in the evidence found compared to those with incorrect answers. Doctors were more confident in evidence found confirming an initially correct answer than were nurses. More than 50% of clinicians who persisted with an incorrect answer after searching reported that they were confident or very confident in the evidence found. Clinicians who did not know scenario answers before searching placed equal confidence in evidence that led them to a correct or incorrect answer. Conclusions. The information obtained from an online evidence system influenced clinicians’ confidence in their answers to the clinical scenarios. The relationship between confidence in answers and correctness is complex. Both existing knowledge and professional role were mediating factors. The finding that many clinicians placed confidence in information that led them to incorrect answers warrants further investigation.

Health service accreditation as a predictor of clinical and organisational performance: a blinded, random, stratified study

Publisher: BMJ

Date: 02-2010

DOI: 10.1136/QSHC.2009.033928

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.

The safety implications of missed test results for hospitalised patients: A systematic review

Publisher: BMJ

Date: 02-2011

DOI: 10.1136/BMJQS.2010.044339

When requests become orders-A formative investigation into the impact of a computerized physician order entry system on a pathology laboratory service

Publisher: Elsevier BV

Date: 08-2007

DOI: 10.1016/J.IJMEDINF.2006.04.002

Abstract: The purpose of this study was to identify the key implications of the implementation of a computerized physician order entry (CPOE) system on pathology laboratory services. An in-depth qualitative study using observation, focus groups and interviews with pathology staff, managers, clinicians and information systems staff during implementation of a CPOE system in 2004 at a major Australian teaching hospital. Pathology laboratories experienced a shift in their work roles resulting in altered work practices, responsibilities and procedures. These changes were marked by terminological and procedural changes in the test order process from when clinicians issued a request for a test, to the new system that established clinical orders at the point of care. This change was accompanied by some organizational dysfunctions including the emergence of a new category of "frustrated" orders without specimens problems with the procedure of adding tests to previously existing specimens the appearance of discrepancies in the recorded time of specimen collection. In response to these changes, hospital and pathology staff adopted a variety of means to cope with their changed circumstances. These ranged from efforts to increase clinical awareness to compensatory laboratory workarounds and enforced rule changes. CPOE systems can have a major impact on the nature of the work of pathology laboratories. Understanding how and why these changes occur can be enhanced through considering the organizational and social contexts involved. The effectiveness of CPOE systems will rely on how administrators and staff approach and deal with these challenges.

Comprehensive medical assessments for monitoring and improving the health of residents in aged care facilities: existing comprehensive medical assessments coverage and trial of a new service model.

Publisher: Wiley

Date: 03-2011

DOI: 10.1111/J.1741-6612.2010.00456.X

Interruptions to Clinical Work: How Frequent Is Too Frequent?

Publisher: Journal of Graduate Medical Education

Date: 06-2013

DOI: 10.4300/JGME-D-13-00076.1

Time matters - A theoretical and empirical examination of the temporal landscape of a hospital pathology service and the impact of e-health

Publisher: Elsevier BV

Date: 05-2011

DOI: 10.1016/J.SOCSCIMED.2011.03.020

Abstract: One of the challenges associated with the implementation of e-health systems is the effect they have on the temporal landscape (how time is conceived, structured and monitored) of an organisation particularly as it relates to the way that work is prioritised, allocated, synchronised and coordinated. This study aims to identify the impact of the introduction of a new e-health system on key aspects of the temporal and organisational functioning of a hospital pathology service. The study employed qualitative methods including interviews, focus groups and observation sessions. It was carried out in the period of August 2005 to August 2008 across a hospital pathology service in Sydney, Australia during the introduction of a new laboratory information system and electronic ordering system. The results revealed a number of temporal layers which can be defined as organisational (how the service synchronises its work with other settings) clinical (coordination of work to ensure the appropriate laboratory contribution to effective patient care) procedural (allocating work according to scientific and pathologic processes) and informational and electronic (how and what information is communicated and accessed). The introduction of a new e-health system was shown to have a major impact on the temporal landscape of the pathology service. Specific ex les of this were revealed in changes to the way the pathology service: (1) tracked and monitored specimens within the laboratory and (2) communicated and coordinated its work internally and externally. The use of qualitative methods longitudinally provided key insights into the way that temporal factors operate within pathology laboratories and their interrelationship with the performance, distribution and allocation of work.

A 9 year prospective cohort study of endoscoped patients with upper gastrointestinal symptoms

Publisher: Springer Science and Business Media LLC

Date: 07-2005

DOI: 10.1007/S10654-005-4304-5

Abstract: Despite the high prevalence of upper gastrointestinal symptoms and associated costs of diagnosis and management, evidence regarding long-term outcomes is scant. We studied symptom outcomes 18 months (FU1) and 8/9 years (FU2) post-index endoscopy to identify demographic, diagnostic and treatment factors associated with outcomes. A retrospective review of medical records at two Australian teaching hospitals identified a cohort of 302 patients who had an index endoscopy (performed by 23 endoscopists) 18 months previously. Patients were interviewed at FU1 and FU2. In total 34% (95%CI: 29.0 39.8) of patients were asymptomatic at FUI and 41% (95%CI: 35.6-46.6) at FU2. For 63%, outcomes at FUI predicted long-term outcome, with 19% (95%CI: 14.6-23.4) asymptomatic and 44% (95%CI: 38.4-50.0) symptomatic at both times. Those whose symptom status changed were as likely to deteriorate as improve (p > 0.05). Number and severity of presenting symptoms (F = 3.3, df = 3,277, p < 0.05) and older age (F = 2.8, df = 2,301, p < 0.05) were associated with poorer outcomes. Long-term outcome was unrelated to endoscopic diagnosis. Those symptomatic were significantly more likely to be on proton pump inhibitors (PPIs) or Histamine2 Receptor Antagonists (H2RAs) than those who were asymptomatic. Use of PPIs at FU2 was associated with a significantly better outcome than use of H2RAs. However this impact was relatively small, with 69% of patients on PPIs and 84% on H2RAs symptomatic at FU2. Upper gastrointestinal symptoms prompting endoscopy are chronic for the majority of patients regardless of diagnosis. Endoscopic diagnosis is of limited value in predicting long-term outcomes. The association between poor outcome and use of H2RAs and PPIs challenges views about their long-term effectiveness in symptom control.

Do Electronic Discharge Summaries Contain More Complete Medication Information? A Retrospective Analysis of Paper versus Electronic Discharge Summaries

Publisher: SAGE Publications

Date: 10-2014

DOI: 10.1177/183335831404300301

Abstract: Complete, accurate and timely hospital discharge summaries are important for continuity of care. The aim of this study was to evaluate the effectiveness of an electronic discharge summary system in improving the medication information provided compared to the information in paper discharge summaries. We conducted a retrospective audit of 199 paper and 200 electronic discharge summaries from a 350-bed teaching hospital in Sydney, Australia. The completeness of medication information, and whether medication changes during the admission were explained, were assessed. Further, the likelihood of any incomplete information having an impact on continuity of care was assessed. There were 1352 and 1771 medication orders assessed in paper and electronic discharge summaries, respectively. Of these, 90.9% and 93.4% were complete in paper and electronic discharge summaries, respectively. The dose (OR 25.24, 95%CI: 3.41–186.9) and route (OR 8.65, 95%CI: 3.46–21.59) fields of medication orders, were more likely to be complete in electronic as compared with paper discharge summaries. There was no difference for drug frequency (OR 1.09, 95%CI: 0.77–1.55). There was no significant improvement in the proportion of incomplete medication orders rated as unclear and likely to impede continuity of care in paper compared with electronic discharge summaries (7.3% vs. 6.5%). Of changes to medication regimen, only medication additions were more likely to be explained in the electronic (n=253, 37.2%) compared to paper (n=104, 14.3%) discharge summaries (OR 3.14 95%CI: 2.20–4.18). In summary, electronic discharge summaries offer some improvements over paper discharge summaries in terms of the quality of medication information documented. However, explanations of changes to medication regimens remained low, despite this being crucial information. Future efforts should focus on including the rationale for changes to medication regimens in discharge summaries.

Trends in the utilization of diagnostic upper GI endoscopy in New South Wales, Australia, 1988 to 1998

Publisher: Elsevier BV

Date: 06-2002

DOI: 10.1067/MGE.2002.124634

Abstract: Upper endoscopy is frequently performed, yet there are few published data regarding utilization trends. Such data provide an indication of changes in clinical practice over time and identify subpopulations who may be underexposed or overexposed to the procedure. Time series data were analyzed for all diagnostic upper endoscopies performed on residents of an Australia state between mid 1988 and mid 1998. Endoscopy rates by age, gender, and patient status (public vs. privately insured) were calculated. In 1997/98 the endoscopy rate was 179 of 10,000. The majority were performed on publicly insured patients and women. Over the decade the rate increased by 128%. Rate increases were not constant across time, age, gender, or patient (insurance) status. The greatest increases occurred in the early to mid 1990s, and in patients less than 65 years of age. There was a greater increase (126%) among women 55 to 64 years of age compared with other age categories for both genders. Rates for publicly insured patients increased more than those for privately insured patients, particularly among in iduals in the age range 25 to 34 years. Rates for private patients increased more for women than men (81% vs. 59%). Rates of utilization of endoscopy increased dramatically during the period from 1988 to 1998, particularly during the earlier part of this decade. The cause(s) of the differences in subpopulation rates warrant investigation, as do their relationship to patient management and outcomes. These data provide opportunities for international comparisons.

Multi-method studies in health services research [3]

Publisher: Elsevier BV

Date: 10-2007

DOI: 10.1111/J.1753-6405.2007.00126.X

The impact of PACS on clinician work practices in the intensive care unit: A systematic review of the literature

Publisher: Oxford University Press (OUP)

Date: 09-02-2012

DOI: 10.1136/AMIAJNL-2011-000422

Inside the black box of comparative national healthcare performance in 35 OECD countries: Issues of culture, systems performance and sustainability

Publisher: Public Library of Science (PLoS)

Date: 28-09-2020

DOI: 10.1371/JOURNAL.PONE.0239776

Are two-person checks more effective than one-person checks for safety critical tasks in high-consequence industries outside of healthcare?

Publisher: Elsevier BV

Date: 2023

DOI: 10.1016/J.APERGO.2022.103906

Abstract: Double-checking has been used in high-consequence industries for decades. We aimed to determine the strength of the evidence-base regarding the effectiveness of double-checking which underpins its widespread adoption. We searched for quantitative studies of the effectiveness of two-person checking in industry sectors, excluding healthcare. We performed a systematic literature search across six databases and hand-searched key journals. We completed a narrative synthesis and quality assessment of the nine studies identified. Most studies were of fair quality. Two examined the use of two-person checks in aviation, three investigated tasks in chemical manufacturing, and four studies in psychology involved proofreading and visual search tasks. All studies found that the performance of two-people checking was not superior to that of one-person in detecting errors. Further research to compare the effectiveness of different checking processes along with factors which may support optimisation of safety checks in high-consequence industries is required.

Is there an association between out-of-pocket hospital costs, quality and care outcomes?

Publisher: Springer Science and Business Media LLC

Date: 13-09-2023

DOI: 10.1186/S12913-023-09941-3

Cue Utilization Differentiates Performance in the Management of Interruptions

Publisher: SAGE Publications

Date: 25-06-2020

DOI: 10.1177/0018720819855281

Abstract: To examine the role of cue utilization in the management of interruptions during a high workload, rail control simulation. High-risk, high-consequence environments are characterized by cognitively demanding, time-critical activities, in which operators are required to manage frequent interruptions under conditions of high workload. Interruptions are deleterious to performance as they impose excessive cognitive demand on limited working memory resources, thereby depleting residual resources for the primary task. Cue utilization may enable superior performance in managing interruptions through efficiencies gained by the application of implicit patterns stored in long-term memory. Two experiments were conducted. In Experiment 1, 46 university students undertook an assessment of cue utilization and subsequently engaged in a high workload, simulated rail control task while managing multiple interruptive tasks. Experiment 2 replicated and extended Experiment 1, wherein 52 university students completed a measure of cue utilization and engaged in a high workload, simulated rail control task while managing multiple interruptions and breaks. The analyses revealed that participants who demonstrated a greater capacity for cue utilization also demonstrated a reduced loss of performance following interruptions. The outcomes suggest a relationship between a greater capacity for cue utilization and superior performance in the management of interruptions in high workload conditions. Assessments of cue utilization may assist in the selection and training of operators in high-consequence, high-risk environments, to ensure efficient and accurate performance during the management of interruptions.

Nudge interventions to reduce unnecessary antibiotic prescribing in primary care: a systematic review

Publisher: BMJ

Date: 2023

DOI: 10.1136/BMJOPEN-2022-062688

Abstract: Antibiotic prescribing in primary care contributes significantly to antibiotic overuse. Nudge interventions alter the decision-making environment to achieve behaviour change without restricting options. Our objectives were to conduct a systematic review to describe the types of nudge interventions used to reduce unnecessary antibiotic prescribing in primary care, their key features, and their effects on antibiotic prescribing overall. Medline, Embase and grey literature were searched for randomised trials or regression discontinuity studies in April 2021. Risk of bias was assessed independently by two researchers using the Cochrane Effective Practice and Organisation of Care group’s tool. Results were synthesised to report the percentage of studies demonstrating a reduction in overall antibiotic prescribing for different types of nudges. Effects of social norm nudges were examined for features that may enhance effectiveness. Nineteen studies were included, testing 23 nudge interventions. Four studies were rated as having a high risk of bias, nine as moderate risk of bias and six as at low risk. Overall, 78.3% (n=18, 95% CI 58.1 to 90.3) of the nudges evaluated resulted in a reduction in overall antibiotic prescribing. Social norm feedback was the most frequently applied nudge (n=17), with 76.5% (n=13 95% CI 52.7 to 90.4) of these studies reporting a reduction. Other nudges applied were changing option consequences (n=3 with 2 reporting a reduction), providing reminders (n=2 2 reporting a reduction) and facilitating commitment (n=1 reporting a reduction). Successful social norm nudges typically either included an injunctive norm, compared prescribing to physicians with the lowest prescribers or targeted high prescribers. Nudge interventions are effective for improving antibiotic prescribing in primary care. Expanding the use of nudge interventions beyond social norm nudges could reap further improvements in antibiotic prescribing practices. Policy-makers and managers need to be mindful of how social norm nudges are implemented to enhance intervention effects.

The delivery of safe and effective test result communication, management and follow-up

Publisher: The Sax Institute

Date: 09-2023

DOI: 10.17061/PHRP3332324

Delivering safe and effective test-result communication, management and follow-up: a mixed-methods study protocol

Publisher: BMJ

Date: 02-2018

DOI: 10.1136/BMJOPEN-2017-020235

Abstract: The failure to follow-up pathology and medical imaging test results poses patient-safety risks which threaten the effectiveness, quality and safety of patient care. The objective of this project is to: (1) improve the effectiveness and safety of test-result management through the establishment of clear governance processes of communication, responsibility and accountability (2) harness health information technology (IT) to inform and monitor test-result management (3) enhance the contribution of consumers to the establishment of safe and effective test-result management systems. This convergent mixed-methods project triangulates three multistage studies at seven adult hospitals and one paediatric hospital in Australia. Study 1 adopts qualitative research approaches including semistructured interviews, focus groups and ethnographic observations to gain a better understanding of test-result communication and management practices in hospitals, and to identify patient-safety risks which require quality-improvement interventions. Study 2 analyses linked sets of routinely collected healthcare data to examine critical test-result thresholds and test-result notification processes. A controlled before-and-after study across three emergency departments will measure the impact of interventions (including the use of IT) developed to improve the safety and quality of test-result communication and management processes. Study 3 adopts a consumer-driven approach, including semistructured interviews, and the convening of consumer-reference groups and community forums. The qualitative data will identify mechanisms to enhance the role of consumers in test-management governance processes, and inform the direction of the research and the interpretation of findings. Ethical approval has been granted by the South Eastern Sydney Local Health District Human Research Ethics Committee and Macquarie University. Findings will be disseminated in academic, industry and consumer journals, newsletters and conferences.

Response to 'Regulatory influences on general practitioner service delivery in residential aged care'

Publisher: Wiley

Date: 06-2012

DOI: 10.1111/J.1741-6612.2012.00611.X

Troponin testing in the emergency department: A longitudinal study to assess the impact and sustainability of decision support strategies

Publisher: BMJ

Date: 12-03-2012

DOI: 10.1136/JCLINPATH-2011-200610

Abstract: To evaluate the impact of decision support on the proportion of troponin I (cTnI) tests and associated costs over the period 2000-7 for patients presenting with chest pain in an emergency department (ED) setting. A longitudinal study using linked data for patients presenting with chest pain from the ED and laboratory information systems of a metropolitan teaching hospital in Melbourne, Australia. The study period was ided into a pre-intervention period (2000-2), which contained no decision support an initial post period (2003-4) after the introduction of a quality improvement initiative (utilising a paper-based guideline, education, audit and feedback) about cTnI test ordering and the incorporation of the guideline as a decision support feature of the computerised provider order entry system followed by a post-modification period (2005-7) after the electronic decision support feature was modified to allow clinicians to bypass viewing the complete guideline. There was a significant fall in the proportion of cTnI tests ordered per patient presentation across the three periods-pre (2000-2), post (2003-4) and post-modification (2005-7)-from 7.3% to 4.1% and 2.8%, respectively. Analysis of costs showed significant reductions in the mean costs for cTnI tests per patient presentation from $A9.28 to $A8.54 and $A8.18, respectively, which amounted to a modest saving of $A13,251 since the initiation of decision support in 2003. Decision support systems are often part of multifaceted implementations undertaken over time. They require continuous monitoring and modifications to ensure optimal performance.

The impact of ear, nose and throat surgery on children's subsequent use of health services: An 8‐year cohort study

Publisher: Wiley

Date: 12-2009

DOI: 10.1111/J.1440-1754.2009.01606.X

Abstract: High rates of paediatric ear, nose and throat (ENT) surgery persist. Little is known about its impact on health service utilisation. This study investigated whether children who had ENT surgery used more health services prior to surgery (excluding the perisurgery period), and, if so, whether surgery resulted in reduced utilisation. A retrospective population cohort study of health services use (measured by Medicare claims) by 6239 New South Wales children from the time of their birth in January 1990 until December 1997. We compared: (i) number of claims during the 8-year period for the 359 children who had privately-funded ENT surgery (tonsillectomy, myringotomy or adenoidectomy) with claims made by 5880 children who did not have ENT surgery and (ii) among children who had surgery: we compared claims made before surgery with those made after surgery. Children who had privately funded ENT surgery (comprising 59% of all paediatric ENT surgery) used significantly more services than other children in total (103.8 claims vs. 57.1 over 8 years) and in each three months of age from birth to eight years, including services for non-ENT-related conditions. Tonsillectomy resulted in a decline in claims, but not to the level of children who did not have surgery. Most children who had myringotomy continued high-level health services use following surgery. High volume health services utilisation is a potential predictor of ENT surgery in this population. These results suggest a need to investigate non-clinical factors that influence service utilisation, which may include higher parental expectations or anxiety regarding their children's health.

Validation of the Work Observation Method By Activity Timing (WOMBAT) method of conducting time-motion observations in critical care settings: an observational study

Publisher: Springer Science and Business Media LLC

Date: 17-05-2011

DOI: 10.1186/1472-6947-11-32

Abstract: Electronic documentation handling may facilitate information flows in health care settings to support better coordination of care among Health Care Providers (HCPs), but evidence is limited. Methods that accurately depict changes to the workflows of HCPs are needed to assess whether the introduction of a Critical Care clinical Information System (CCIS) to two Intensive Care Units (ICUs) represents a positive step for patient care. To evaluate a previously described method of quantifying amounts of time spent and interruptions encountered by HCPs working in two ICUs. Observers used PDAs running the Work Observation Method By Activity Timing (WOMBAT) software to record the tasks performed by HCPs in advance of the introduction of a Critical Care clinical Information System (CCIS) to quantify amounts of time spent on tasks and interruptions encountered by HCPs in ICUs. We report the percentages of time spent on each task category, and the rates of interruptions observed for physicians, nurses, respiratory therapists, and unit clerks. Compared with previously published data from Australian hospital wards, interdisciplinary information sharing and communication in ICUs explain higher proportions of time spent on professional communication and documentation by nurses and physicians, as well as more frequent interruptions which are often followed by professional communication tasks. Critical care workloads include requirements for timely information sharing and communication and explain the differences we observed between the two datasets. The data presented here further validate the WOMBAT method, and support plans to compare workflows before and after the introduction of electronic documentation methods in ICUs.

A Practical Guide to Using Time-and-Motion Methods to Monitor Compliance With Hand Hygiene Guidelines: Experience From Tanzanian Labor Wards

Publisher: Johns Hopkins School Bloomberg School of Public Health, Center for Communication Programs

Date: 16-10-2020

DOI: 10.9745/GHSP-D-20-00221

Visualising clinical work in the emergency department: Understanding interleaved patient management

Publisher: Elsevier BV

Date: 09-2019

DOI: 10.1016/J.APERGO.2019.04.005

Abstract: We present a unique data visualisation approach, called workflow time charts, to illustrate the sequential and multi-dimensional nature of work in emergency departments. Using 40 h of data from direct observations of emergency physicians, we applied the charts to visualise patient-stratified physicians' work as a continuous temporal process, including distinguishing tasks of different types and representing external prompts (similar to interruptions) and multitasking performance. The charts showed frequent changes in the nature of observed activities, with interleaved multitasking a constant feature and external prompts often clustered in time. Evidence of seniority-related differences in work were apparent with consultants switching between more concurrent patients and receiving more frequent clinical prompts than junior physicians, illustrating their overseeing and advice-giving role. The ubiquity of interleaved multitasking suggests a need to focus on developing in idual strategies to support frequent cognitive switching. Work that appears fragmented at physician level may form part of a flexible and robust system, rather than an error-prone set of isolated in idual behaviours.

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.

Social network analysis of medication advice-seeking interactions among staff in an Australian hospital

Publisher: Elsevier BV

Date: 06-2010

DOI: 10.1016/J.IJMEDINF.2008.08.005

Abstract: To examine the medication advice-seeking network of staff in a hospital ward. Social network analysis was carried out in a renal ward of an Australian metropolitan teaching hospital. The medication advice-seeking interactions of doctors, nurses, allied health professionals (including a pharmacist) and a ward clerk were examined using data from questionnaires administered to staff. The questionnaire listed all staff who worked in the ward and sought information from respondents regarding their interactions with each staff member. Data were analysed using social network software, UCINET. Analyses performed included geodesic distance, network density, strength of ties, reciprocation of relations, and centrality of in iduals. NetDraw was used to produce social network diagrams. A very high response rate of 96% was achieved with 45 of 47 staff returning the questionnaire. On average, there is little interaction between each of the staff members in the medication advice-seeking network, with even less interaction between staff from different professional groups. Nurses are mainly located on one side of the network and doctors on the other. However, the pharmacist is quite central in the medication advice-seeking network as are some senior nurses and a junior doctor. When hospital clinical staff seek medication advice from other members of a ward it tends to be sought from those in their profession. However key in iduals in the ward are relied upon for the provision of medication advice by staff from all professions. Social network analysis can be used to examine the complex medication advice-seeking interactions amongst staff in a hospital ward, providing useful quantitative baseline data against which to compare the effect of interventions, such as an electronic medication system, on interactions.

Accuracy of provisional diagnoses of dyspepsia in patients undergoing first endoscopy

Publisher: Elsevier BV

Date: 03-2001

DOI: 10.1016/S0016-5107(01)70399-9

Abstract: This study assessed agreement between provisional and endoscopic diagnoses for patients with dyspepsia undergoing initial endoscopy, and examined variation between clinicians at 2 hospitals. This was a retrospective review of 423 consecutive patients. Crude percentage agreement ranged from 55% to 97%. Kappa scores revealed poor agreement: peptic ulcers (0.11: 95% CI [0.05, 0.17]) gastroesophageal reflux disease (0.29: 95% CI [0.20, 0.38]) benign esophageal stricture (0.33: 95% CI [0.08, 0.58]) and cancer (0.12: 95% CI [-0.12, 0.36]). Positive and negative predictive values for cancer and benign esophageal stricture showed that agreement for a negative diagnosis was almost perfect, whereas agreement for a positive diagnosis was low. Only 17% of patients with cancer were given an accurate provisional diagnosis. Accuracy of diagnosis did not vary substantially between hospitals. Crude percentage agreement is misleading. Emphasis should be placed on better prediction of cancer, benign esophageal stricture, and peptic ulcer disease. Accuracy of provisional diagnosis in everyday practice is no worse than that found in prospective studies in which clinicians knew a priori that diagnoses would be scrutinized. The difficulty of predicting diagnoses supports increased reliance on endoscopy.

Modeling the Association Between Home Care Service Use and Entry Into Residential Aged Care: A Cohort Study Using Routinely Collected Data

Publisher: Elsevier BV

Date: 02-2018

DOI: 10.1016/J.JAMDA.2017.08.004

Abstract: To examine home care service-related and person-based factors associated with time to entry into permanent residential aged care. Longitudinal cohort study using routinely collected client management data. A large aged care service provider in New South Wales and the Australian Capital Territory, Australia. A total of 1116 people aged 60 years and older who commenced home care services for higher-level needs between July 1, 2015 and June 30, 2016. Survival analysis methods were used to examine service-related and person-based factors that were associated with time between first home care service and entry into permanent residential aged care. Predictors included service hours per week, combination of service types, demographics, needs, hospital leave, and change in care level. Cluster analysis was used to determine patterns of types of services used. By December 31, 2016, 21.1% of people using home care services had entered into permanent residential care (n = 235). After adjusting for significant factors such as age and care needs, each hour of service received per week was associated with a 6% lower risk of entry into residential care (hazard ratio = 0.94, 95% confidence interval 0.90-0.98). People who were predominant users of social support services, those with an identified carer, and those born in a non-main English-speaking country also remained in their own homes for longer. Greater volume of home care services was associated with significantly delayed entry into permanent residential care. This study provides much-needed evidence about service outcomes that could be used to inform older adults' care choices.

Non-emergency patient transport: what are the quality and safety issues? A systematic review.

Publisher: Oxford University Press (OUP)

Date: 12-2011

DOI: 10.1093/INTQHC/MZQ076

Abstract: Patient transportation is an important component of health-care delivery however, the quality and safety issues relating to non-emergency patient transport services have rarely been discussed compared with the transport of emergency patients. This systematic review examines the factors associated with the quality and safety of non-emergency transport services. Medline, Pre-Medline, CINAHL and Embase databases were searched for publications between 1990 and September 2009. Articles investigating non-emergency hospital transport services. Study characteristic and outcome data were abstracted by one author and reviewed by a second and third author. Twelve articles from seven countries were included. Five studies examined issues relating to the structure of transport services, which focused on the use of policies and protocols to assist the transfer process. All studies addressed factors associated with the transfer process such as communication, appropriateness of personnel, time to arrange transfers, and the safety and efficiency of the process. Outcomes were measured in one study. Communication, efficiency and appropriateness are key factors that are advanced as impacting on the quality and safety of non-emergency transport services. Standardization of the non-emergency transport process shows promise in reducing risk and increasing efficiency. Applying information and communication technology to improve the quality of transport services has received little attention despite its potential benefits. Patient outcomes in relation to quality and safety of transport services are rarely measured. Available evidence suggests that safety of non-emergency patient transfers is sometimes compromised due to poor standardization and failures in communication processes.

Towards the delivery of appropriate health care in Australia

Publisher: AMPCo

Date: 07-2012

DOI: 10.5694/MJA12.10799

Effects of an electronic medication management system on pharmacists’ work in a paediatric hospital

Publisher: Wiley

Date: 10-07-2019

DOI: 10.1002/JPPR.1507

Changes in medication administration error rates associated with the introduction of electronic medication systems in hospitals

Publisher: BMJ

Date: 08-2020

DOI: 10.1136/BMJHCI-2020-100170

Abstract: Electronic medication systems (EMS) have been highly effective in reducing prescribing errors, but little research has investigated their effects on medication administration errors (MAEs). To assess changes in MAE rates and types associated with EMS implementation. This was a controlled before and after study (three intervention and three control wards) at two adult teaching hospitals. Intervention wards used an EMS with no bar-coding. Independent, trained observers shadowed nurses and recorded medications administered and compliance with 10 safety procedures. Observational data were compared against medication charts to identify errors (eg, wrong dose). Potential error severity was classified on a 5-point scale, with those scoring ≥3 identified as serious. Changes in MAE rates preintervention and postintervention by study group, accounting for differences at baseline, were calculated. 7451 administrations were observed (4176 pre-EMS and 3275 post-EMS). At baseline, 30.2% of administrations contained ≥1 MAE, with wrong intravenous rate, timing, volume and dose the most frequent. Post-EMS, MAEs decreased on intervention wards relative to control wards by 4.2 errors per 100 administrations (95% CI 0.2 to 8.3 p=0.04). Wrong timing errors alone decreased by 3.4 per 100 administrations (95% CI 0.01 to 6.7 p .05). EMS use was associated with an absolute decline in potentially serious MAEs by 2.4% (95% CI 0.8 to 3.9 p=0.003), a 56% reduction in the proportion of potentially serious MAEs. At baseline, 74.1% of administrations were non-compliant with ≥1 of 10 procedures and this rate did not significantly improve post-EMS. Implementation of EMS was associated with a modest, but significant, reduction in overall MAE rate, but halved the proportion of MAEs rated as potentially serious.

Implementing information and communication technology to support community aged care service integration: Lessons from an Australian aged care provider

Publisher: Ubiquity Press, Ltd.

Date: 10-04-2017

DOI: 10.5334/IJIC.2437

Cultures in hospitals and their influence on attitudes to, and satisfaction with, the use of clinical information systems

Publisher: Elsevier BV

Date: 08-2007

DOI: 10.1016/J.SOCSCIMED.2007.03.053

Abstract: Studies have identified the importance of hospitals' organisational culture in clinical information system diffusion, but few have quantified its role. This study measured organisational culture in two Australian hospitals to explore whether clinicians' perceptions of culture related to their attitudes to, and satisfaction with, a computerised provider order entry system (CPOE). Data were collected using the Organisational Culture Inventory and a user-satisfaction survey administered to a population of 249 clinicians from the two hospitals. One hospital used CPOE to order clinical laboratory and radiology tests and view results, and the other used the test viewing function only, the ordering facility being planned for later implementation. We found a relationship between culture and clinicians' attitudes, with those in the constructive culture hospital more likely to express positive attitudes towards CPOE, whereas those in the aggressive/defensive hospital were more likely to be negative. The relationship between culture and attitudes towards clinical information systems should be taken into account when planning for their adoption.

The potential impact of an electronic medication management system on safety‐critical prescribing errors in an emergency department

Publisher: Wiley

Date: 04-2019

DOI: 10.1002/JPPR.1455

Vital signs monitoring and nurse–patient interaction: A qualitative observational study of hospital practice

Publisher: Elsevier BV

Date: 04-2016

DOI: 10.1016/J.IJNURSTU.2015.12.007

Abstract: High profile safety failures have demonstrated that recognising early warning signs of clinical and physiological deterioration can prevent or reduce harm resulting from serious adverse events. Early warning scoring systems are now routinely used in many places to detect and escalate deteriorating patients. Timely and accurate vital signs monitoring are critical for ensuring patient safety through providing data for early warning scoring systems, but little is known about current monitoring practices. To establish a profile of nurses' vital signs monitoring practices, related dialogue, and adherence to health service protocol in New South Wales, Australia. Direct observations of nurses' working practices were conducted in two wards. The observations focused on times of the day when vital signs were generally measured. Patient interactions were recorded if occurring any time during the observation periods. Participants (n=42) included nursing staff on one chronic disease medical and one acute surgical ward in a large urban teaching hospital in New South Wales. We observed 441 patient interactions. Measurement of vital signs occurred in 52% of interactions. The minimum five vital signs measures required by New South Wales Health policy were taken in only 6-21% of instances of vital signs monitoring. Vital signs were documented immediately on 93% of vitals-taking occasions and documented according to the policy in the patient's chart on 89% of these occasions. Nurse-patient interactions were initiated for the purpose of taking vital signs in 49% of interactions, with nurse-patient discourse observed during 88% of all interactions. Nurse-patient dialogue led to additional care being provided to patients in 12% of interactions. The selection of appropriate vital signs measured and responses to these appears to rely on nurses' clinical judgement or time availability rather than on policy-mandated frequency. The prevalence of incomplete sets of vital signs may limit identification of deteriorating patients. The findings from this study present an important baseline profile against which to evaluate the impact of introducing continuous monitoring approaches on current hospital practice.

Can technology change the work of nurses? Evaluation of a drug monitoring system for ambulatory chronic disease patients

Publisher: Elsevier BV

Date: 03-2013

DOI: 10.1016/J.IJMEDINF.2012.11.009

Abstract: To evaluate the impact of an electronic drug monitoring system (eDMS) for ambulatory rheumatology patients on time nurses spent on, and the process of, drug monitoring. The study was conducted in the Rheumatology Department of a large metropolitan hospital. The eDMS, a module of the Hospital Clinical Information System (HCIS), was designed to allow electronic ordering and subsequent monitoring of ambulatory patients on long-term, immunosuppressive rheumatology medications. Quantitative measures collected before and after the intervention were: time spent on specific nursing activities who nurses spent time with format and location of documentation monitoring and patient throughput. Qualitative data from interviews and observations were collected to ascertain the impact of the eDMS on nurses' monitoring activities. Nurses spent significantly less time on medication monitoring tasks (33.1% versus 26.4%, P=0.003) and significantly more time on patient care (6.5-18.1%, P<0.0001) following implementation of the eDMS. Nurses also spent significantly more time with patients (7.7-19.8%, P<0.0001) and relatives (0.4-3.7%, P=0.01) after the system was implemented. The time saved on monitoring allowed the number of nurse directed clinics and patient throughput to increase following eDMS implementation. Qualitative data supported results from the timing study with nurses reporting that the monitoring process was more standardised, safer, took less time and simplified documentation. The eDMS was associated with a reduction in time spent on the complex task of medication monitoring allowing nurses to spend a greater proportion of their time on other patient care activities.

Interruptions and multitasking in surgery: a multicentre observational study of the daily work patterns of doctors and nurses

Publisher: Informa UK Limited

Date: 17-07-2017

DOI: 10.1080/00140139.2017.1349934

Abstract: The aim of this study was to obtain baseline data on doctors' and nurses' work activities and rates of interruptions and multitasking to improve work organisation and processes. Data were collected in six surgical units with the WOMBAT (Work Observation Method by Activity Timing) tool. Results show that doctors and nurses received approximately 13 interruptions per hour, or one interruption every 4.5 min. Compared to doctors, nurses were more prone to interruptions in most activities, while doctors performed multitasking (33.47% of their time, 95% CI 31.84-35.17%) more than nurses (15.23%, 95% CI 14.24-16.25%). Overall, the time dedicated to patient care is relatively limited for both professions (37.21%, 95% CI 34.95-39.60% for doctors, 27.22%, 95% CI 25.18-29.60% for nurses) compared to the time spent for registration of data and professional communication, that accounts for two-thirds of doctors' time and nearly half of nurses' time. Further investigation is needed on strategies to manage job demands and professional communications. Practitioner Summary: This study offers further findings on the characteristics and frequency of multitasking and interruptions in surgery, with a comparison of how they affect doctors and nurses. Further investigation is needed to improve the management of job demands and communications according to the results.

Optimising computerised decision support to transform medication safety and reduce prescriber burden: study protocol for a mixed-methods evaluation of drug–drug interaction alerts

Publisher: BMJ

Date: 08-2019

DOI: 10.1136/BMJOPEN-2018-026034

Abstract: Drug–drug interaction (DDI) alerts in hospital electronic medication management (EMM) systems are generated at the point of prescribing to warn doctors about potential interactions in their patients’ medication orders. This project aims to determine the impact of DDI alerts on DDI rates and on patient harm in the inpatient setting. It also aims to identify barriers and facilitators to optimal use of alerts, quantify the alert burden posed to prescribers with implementation of DDI alerts and to develop algorithms to improve the specificity of DDI alerting systems. A controlled pre-post design will be used. Study sites include six major referral hospitals in two Australian states, New South Wales and Queensland. Three hospitals will act as control sites and will implement an EMM system without DDI alerts, and three as intervention sites with DDI alerts. The medical records of 280 patients admitted in the 6 months prior to and 6 months following implementation of the EMM system at each site (total 3360 patients) will be retrospectively reviewed by study pharmacists to identify potential DDIs, clinically relevant DDIs and associated patient harm. To identify barriers and facilitators to optimal use of alerts, 10–15 doctors working at each intervention hospital will take part in observations and interviews. Non-identifiable DDI alert data will be extracted from EMM systems 6–12 months after system implementation in order to quantify alert burden on prescribers. Finally, data collected from chart review and EMM systems will be linked with clinically relevant DDIs to inform the development of algorithms to trigger only clinically relevant DDI alerts in EMM systems. This research was approved by the Hunter New England Human Research Ethics Committee (18/02/21/4.07). Study results will be published in peer-reviewed journals and presented at local and international conferences and workshops.

A longitudinal study over 5 to 10 years of clinical outcomes in women with idiopathic detrusor overactivity

Publisher: Wiley

Date: 07-12-2008

DOI: 10.1111/J.1471-0528.2007.01527.X

Abstract: To evaluate the long-term clinical outcome in women with idiopathic detrusor overactivity (IDO) and to identify significant prognostic factors. Longitudinal study incorporating retrospective case note review and a postal questionnaire. Tertiary referral urogynaecology clinic in Australia. Women with a sole urodynamic diagnosis of IDO. Audit of urodynamic records and case notes. Postal questionnaire incorporating validated disease-specific quality-of-life (QoL) instruments. Subjective assessment of overall improvement on a 4-point scale followed by scoring of short forms of the urogenital distress inventory and incontinence impact questionnaire. One hundred and thirty two women were identified following examination of 1975 consecutive records with 76 (67%) returning questionnaires. Median follow up was 8 years (6-9), and the duration of symptoms was 13 years (9-18). Improvement was achieved in 25 (35%) women. Disease symptoms fluctuated in severity and QoL were worse in nonresponders to therapy (P < 0.0001). Urge incontinence at presentation was associated with treatment failure (P = 0.001) as was nocturia (P = 0.04), but urodynamic variables were not associated with outcome. Only 3 of 46 (6.5%) women not responding to therapy thought that their symptoms would improve with time. IDO seldom resolves and fluctuates in severity. In idual response is unpredictable, although the presence of urge incontinence is associated with a significantly worse prognosis.

Retrospective analysis of factors influencing the implementation of a program to address unprofessional behaviour and improve culture in Australian hospitals

Publisher: Springer Science and Business Media LLC

Date: 07-06-2023

DOI: 10.1186/S12913-023-09614-1

Abstract: Unprofessional behaviour among hospital staff is common. Such behaviour negatively impacts on staff wellbeing and patient outcomes. Professional accountability programs collect information about unprofessional staff behaviour from colleagues or patients, providing this as informal feedback to raise awareness, promote reflection, and change behaviour. Despite increased adoption, studies have not assessed the implementation of these programs utilising implementation theory. This study aims to (1) identify factors influencing the implementation of a whole-of-hospital professional accountability and culture change program, Ethos , implemented in eight hospitals within a large healthcare provider group, and (2) examine whether expert recommended implementation strategies were intuitively used during implementation, and the degree to which they were operationalised to address identified barriers. Data relating to implementation of Ethos from organisational documents, interviews with senior and middle management, and surveys of hospital staff and peer messengers were obtained and coded in NVivo using the Consolidated Framework for Implementation Research (CFIR). Implementation strategies to address identified barriers were generated using Expert Recommendations for Implementing Change (ERIC) strategies and used in a second round of targeted coding, then assessed for degree of alignment to contextual barriers. Four enablers, seven barriers, and three mixed factors were found, including perceived limitations in the confidential nature of the online messaging tool (‘Design quality and packaging’), which had downstream challenges for the capacity to provide feedback about utilisation of Ethos (‘Goals and Feedback’, ‘Access to Knowledge and Information’). Fourteen recommended implementation strategies were used, however, only four of these were operationalised to completely address contextual barriers. Aspects of the inner setting (e.g., ‘Leadership Engagement’, ‘Tension for Change’) had the greatest influence on implementation and should be considered prior to the implementation of future professional accountability programs. Theory can improve understanding of factors affecting implementation, and support strategies to address them.

Implementing large-system, value-based healthcare initiatives: a realist study protocol for seven natural experiments

Publisher: BMJ

Date: 12-2020

DOI: 10.1136/BMJOPEN-2020-044049

Abstract: Value-based healthcare delivery models have emerged to address the unprecedented pressure on long-term health system performance and sustainability and to respond to the changing needs and expectations of patients. Implementing and scaling the benefits from these care delivery models to achieve large-system transformation are challenging and require consideration of complexity and context. Realist studies enable researchers to explore factors beyond ‘what works’ towards more nuanced understanding of ‘what tends to work for whom under which circumstances’. This research proposes a realist study of the implementation approach for seven large-system, value-based healthcare initiatives in New South Wales, Australia, to elucidate how different implementation strategies and processes stimulate the uptake, adoption, fidelity and adherence of initiatives to achieve sustainable impacts across a variety of contexts. This exploratory, sequential, mixed methods realist study followed RAMESES II (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) reporting standards for realist studies. Stage 1 will formulate initial programme theories from review of existing literature, analysis of programme documents and qualitative interviews with programme designers, implementation support staff and evaluators. Stage 2 envisages testing and refining these hypothesised programme theories through qualitative interviews with local hospital network staff running initiatives, and analyses of quantitative data from the programme evaluation, hospital administrative systems and an implementation outcome survey. Stage 3 proposes to produce generalisable middle-range theories by synthesising data from context–mechanism–outcome configurations across initiatives. Qualitative data will be analysed retroductively and quantitative data will be analysed to identify relationships between the implementation strategies and processes, and implementation and programme outcomes. Mixed methods triangulation will be performed. Ethical approval has been granted by Macquarie University (Project ID 23816) and Hunter New England (Project ID 2020/ETH02186) Human Research Ethics Committees. The findings will be published in peer-reviewed journals. Results will be fed back to partner organisations and roundtable discussions with other health jurisdictions will be held, to share learnings.

CareTrack: assessing the appropriateness of health care delivery in Australia

Publisher: AMPCo

Date: 11-2012

DOI: 10.5694/MJA12.11210

Computerized provider order entry systems - Research imperatives and organizational challenges facing pathology services

Publisher: Elsevier BV

Date: 2010

DOI: 10.4103/2153-3539.65431

What makes the health system tick?

Publisher: Oxford University Press (OUP)

Date: 12-2010

DOI: 10.1093/INTQHC/MZP055

Failure to utilize functions of an electronic prescribing system and the subsequent generation of ‘technically preventable’ computerized alerts

Publisher: Oxford University Press (OUP)

Date: 11-2012

DOI: 10.1136/AMIAJNL-2011-000730

Unprofessional behaviours experienced by hospital staff: qualitative analysis of narrative comments in a longitudinal survey across seven hospitals in Australia

Publisher: Springer Science and Business Media LLC

Date: 28-03-2022

DOI: 10.1186/S12913-022-07763-3

Abstract: Unprofessional behaviours of healthcare staff have negative impacts on organisational outcomes, patient safety and staff well-being. The objective of this study was to undertake a qualitative analysis of narrative responses from the Longitudinal Investigation of Negative Behaviours survey (LION), to develop a comprehensive understanding of hospital staff experiences of unprofessional behaviours and their impact on staff and patients. The LION survey identified staff experiences and perceptions related to unprofessional behaviours within hospitals. Two open-ended questions within the LION survey invited descriptions of unprofessional staff behaviours across seven hospitals in three Australian states between December 2017 and November 2018. Respondents were from medical, nursing, allied health, management, and support services roles in the hospitals. Data were qualitatively analysed using Directed Content Analysis (DCA). From 5178 LION survey responses, 32% ( n = 1636) of participants responded to the two open-ended questions exploring staff experiences of unprofessional behaviours across the hospital sites surveyed. Three primary themes and 11 secondary themes were identified spanning, i) in idual unprofessional behaviours, ii) negative impacts of unprofessional behaviours on staff well-being, psychological safety, and employee experience, as well as on patient care, well-being, and safety, and iii) organisational factors associated with staff unprofessional behaviours. Unprofessional behaviours are experienced by hospital staff across all professional groups and functions. Staff conceptualise, perceive and experience unprofessional behaviours in erse ways. These behaviours can be understood as enactments that either negatively impact other staff, patients or the organisational outcomes of team cohesion, work efficiency and efficacy. A perceived lack of organisational action based on existing reporting and employee feedback appears to erode employee confidence in hospital leaders and their ability to effectively address and mitigate unprofessional behaviours.

How much time do nurses have for patients? A longitudinal study quantifying hospital nurses' patterns of task time distribution and interactions with health professionals

Publisher: Springer Science and Business Media LLC

Date: 24-11-2011

DOI: 10.1186/1472-6963-11-319

Drug-drug interactions and their harmful effects in hospitalised patients: a systematic review and meta-analysis

Publisher: Springer Science and Business Media LLC

Date: 23-10-2018

DOI: 10.1007/S00228-017-2357-5

Abstract: Drug-drug interactions (DDIs) are often avoidable and, if undetected, can lead to patient harm. This review aimed to determine the prevalence of potential DDIs (pDDIs), clinically relevant DDIs (DDIs that could lead to measurable patient harm, taking into account the patient's in idual clinical profile) and DDIs that resulted in actual patient harm during hospitalisation. Four databases were scanned for English papers published from 2000 to 2016. Papers that reported prevalence of DDIs in the outpatient setting, at admission or discharge, involving only specific drugs, or in specific disease populations or age groups were excluded. Twenty-seven papers met the inclusion criteria and were graded for quality using the Critical Appraisal Skills Programme (CASP) cohort study checklist. Ten papers were rated as 'poor', 14 as 'fair' and only three papers as 'good'. Overall, the meta-analysis revealed that 33% of general patients and 67% of intensive care patients experienced a pDDI during their hospital stay. It was not possible to determine the prevalence of clinically relevant DDIs or DDIs that resulted in actual patient harm as data on these categories were limited. Of the very few studies that reported on harm, only a small proportion of DDIs were found to have resulted in actual patient harm. Standardisation of DDI definitions and research methods are required to allow meaningful prevalence rates to be obtained and compared. Studies that go further than measuring pDDIs are critically needed to determine the impact of DDIs on patient safety.

The rate of missed test results in an emergency department an evaluation using an electronic test order and results viewing system

Publisher: Georg Thieme Verlag KG

Date: 2010

DOI: 10.3414/ME09-01-0011

Abstract: Objectives: 1) To measure the incidence and impact of missed radiology and microbiology test results in an emergency department with an electronic test order and results viewing system, and 2) to assess the average times from test order to test availability. Methods: The study was conducted in the emergency department (ED) of a 370-bed metropolitan teaching hospital in Sydney, Australia. A computerised provider order entry (CPOE) system was used to order all diagnostic tests and view all test results. For microbiology and radiology tests electronic results were then printed for ED patients not admitted to the hospital to allow ED physicians to document follow-up. All radiology (n = 197) and microbiology (n = 66) tests ordered and results received for discharged ED patients were collected for a seven-day period. We measured the: 1) proportion of radiology and microbiology test results without follow-up for discharged patients 2) impact of non follow-up on patient outcomes 3) average time from radiological examination and microbiology specimen collection to reporting of results and 4) average time from reporting of results to follow-up. Results: Two radiology (1.0%) and two microbiology reports (3.0%), all of which had negative findings, were never followed-up. Review of these patients’ medical records indicated there was no impact on patient outcomes or management. The average time from radiological examination to reporting of a result was 1.5 days, and from microbiology specimen collection to reporting was 2.5 days. Eighty-nine percent of radiology and 68% of microbiology results were followed-up on the same day that they were available to physicians. Conclusions: Our rates of missed test results are lower than those reported from studies where paper ordering and reporting systems were used. This suggests that the availability of CPOE systems may reduce the risk of these events. Electronic result delivery, with electronic endorsement to allow documentation of follow-up of test results, may provide additional efficiency benefits and further reduce the risk of test results which are not followed up.

Providing outpatient cancer care for CALD patients: a qualitative study.

Publisher: Springer Science and Business Media LLC

Date: 09-08-2021

DOI: 10.1186/S13104-021-05724-3

Abstract: There have been few descriptions of how outpatient cancer care is provided to patients from culturally and linguistically erse (CALD) communities. As populations who experience disparities in cancer care access and outcomes, deeper understanding is needed to help identify those factors which can shape the receipt of multidisciplinary care in ambulatory settings. This paper reports on data collected and analysed as part of a multicentre characterisation of care in Australian public hospital cancer outpatient clinics (OPCs). Analysis of data from our ethnographic study of four OPCs identified three themes: “Identifying CALD patient language-related needs” “Capacity and resources to meet CALD patient needs”, and “Making it work for CALD communities.” The care team comprises not only clinicians but also families and non-clinical staff OPCs serve as “touchpoints” facilitating access to a range of therapeutic services. The findings highlight the potential challenges oncology professionals negotiate in providing care to CALD communities and the ways in which clinicians adapt their practices, formulate strategies and use available resources to support care delivery.

Counting the costs of accreditation in acute care: an activity-based costing approach

Publisher: BMJ

Date: 09-2015

DOI: 10.1136/BMJOPEN-2015-008850

A National Comparison of Health Information Management Students' Career Expectations and Anticipated Involvement in Professional Activities

Publisher: SAGE Publications

Date: 12-2000

DOI: 10.1177/183335830002900406

Abstract: The aim of this paper is to present the results of a survey of Australian health information management students relating to their career aspirations and expectations and anticipated involvement in professional activities following graduation. To explain reasons for the differences in results between states and student years, interviews were conducted with academic staff and other health information management educators. Three hundred and sixty three students completed the questionnaire in 1996, which represented a response rate of 86%. It was found that the majority of students thought they had made the correct career choice and were confident they would find full-time employment within six months of graduation. A high percentage of students also indicated that they would undertake continuing education after graduation. There was less support for involvement in the activities of their professional association, particularly at a national level. Students in New South Wales and Queensland indicated that they would be significantly less likely to work in the field of health information management for the rest of their careers. They also reported they would be significantly less likely to conduct research in an area related to health information management. Victorian students were significantly more likely to present a paper at a conference than students from Queensland, New South Wales or Western Australia. Western Australian students were significantly more likely to report that they would undertake postgraduate studies compared to students from the other three states.

Leveraging new information technology to monitor medicine use in 71 residential aged care facilities: variation in polypharmacy and antipsychotic use

Publisher: Oxford University Press (OUP)

Date: 08-06-2018

DOI: 10.1093/INTQHC/MZY098

Abstract: The aim of this study was to use routinely collected electronic medicines administration (eMAR) data in residential aged care (RAC) to investigate the quality use of medicines. A cross-sectional analysis of eMAR data. 71 RAC facilities in New South Wales and the Australian Capital Territory, Australia. Permanent residents living in a participating facility on 1 October 2015. None. Variation in polypharmacy (≥5 medications), hyper-polypharmacy (≥10 medications) and antipsychotic use across facilities was examined using funnel plot analysis. The study dataset included 4775 long-term residents. The mean resident age was 85.3 years and 70.6% of residents were female. The median facility size was 60 residents and 74.3% were in metropolitan locations. 84.3% of residents had polypharmacy, 41.2% hyper-polypharmacy and 21.0% were using an antipsychotic. The extent of polypharmacy (69.75-100% of residents), hyper-polypharmacy (38.81-76.19%) and use of antipsychotic medicines (0-75.6%) varied considerably across the 71 facilities. Using eMAR data we found substantial variation in polypharmacy, hyper-polypharmacy and antipsychotic medicine use across 71 RAC facilities. Further investigation into the policies and practices of facilities performing above or below expected levels is warranted to understand variation and drive quality improvement.

Prescribing an IV in an electronic medication system: What could possibly go wrong?

Publisher: Macquarie University

Date: 2022

DOI: 10.25949/N04Z-4Y85

Disentangling quality and safety indicator data: A longitudinal, comparative study of hand hygiene compliance and accreditation outcomes in 96 Australian hospitals

Publisher: BMJ

Date: 23-09-2014

DOI: 10.1136/BMJOPEN-2014-005284

Clinical Decision Velocity is Increased when Meta-search Filters Enhance an Evidence Retrieval System

Publisher: Oxford University Press (OUP)

Date: 09-2008

DOI: 10.1197/JAMIA.M2765

Critical incidents and journey mapping as techniques to evaluate the impact of online evidence retrieval systems on health care delivery and patient outcomes

Publisher: Elsevier BV

Date: 02-2007

DOI: 10.1016/J.IJMEDINF.2006.03.006

Abstract: Online evidence retrieval systems are a potential tool in supporting evidence-based practice. Effective and tested techniques for assessing the impact of these systems on care delivery and patient outcomes are limited. In this study we applied the critical incident (CI) and journey mapping (JM) techniques to assess the integration of an online evidence system into everyday clinical practice and its impact on decision making and patient care. To elicit incidents semi-structured interviews were conducted with 29 clinicians (13 hospital physician specialists, 16 clinical nurse consultants (CNCs)) who were experienced users of the online evidence system. Clinicians were also asked questions about how they had first used the system and how their use and experiences had changed over time. These narrative accounts were then mapped and scored using the journey mapping technique. Clinicians generated 85 critical incidents. Three categories of impact were identified: impact on clinical practice, impact on in idual clinicians and impact on colleagues through the dissemination of information gained from the online evidence system. One quarter of these included specific ex les of system use leading to improvements in patient care. Clinicians obtained an average journey mapping score of 22 out of a possible score of 36, demonstrating a good level of system integration. Average scores of doctors and CNCs were similar. However in iduals with the same scores often had very different journeys in system integration. The CI technique provided clear ex les of the way in which system use had influenced practice and care delivery. The JM technique was found to be a useful method for providing a quantification of the different ways and extent to which, clinicians had integrated system use into practice, and insights into how system use can influence organisational culture. The development of the journey mapping stages provides a structure by which the program logic of a clinical information system and its desired outcomes can be made explicit and be based upon users' experiences in everyday practice. Further work is required using this technique to assess its value as an evaluation method.

Mobile and fixed computer use by doctors and nurses on hospital wards: multi-method study on the relationships between clinician role, clinical task, and device choice.

Publisher: JMIR Publications Inc.

Date: 04-08-2009

DOI: 10.2196/JMIR.1221

Social networks and cognitive function in older adults receiving home- and community-based aged care.

Publisher: Elsevier BV

Date: 07-2020

DOI: 10.1016/J.ARCHGER.2020.104083

Emergency doctors' strategies to manage competing workload demands in an interruptive environment: An observational workflow time study

Publisher: Elsevier BV

Date: 2017

DOI: 10.1016/J.APERGO.2016.07.020

Abstract: An observational workflow time study was conducted involving doctors in the emergency department (ED) of a large Australian hospital. During 121.7 h across 58 sessions, we observed interruptive events, conceptualised as prompts, and doctors' strategies to handle those prompts (task-switching, multitasking, acknowledgement, deferral and deflection) to assess the role of multiple work system factors influencing doctors' work in the ED. Prompt rates varied vastly between work scenarios, being highest during non-verbal solo tasks. The propensity to use certain strategies also differed with task type, prompt type and location within the department, although task-switching was by far the most frequent. Communicative prompts were important in patient treatment and workload management. Clinicians appear to adjust their communication strategies in response to contextual factors in order to deliver patient care. Risk due to the interruptive nature of ED communication is potentially outweighed by the positive effects of timely information transfer and advice provision.

Social interactions and quality of life of residents in aged care facilities

Publisher: Public Library of Science (PLoS)

Date: 29-08-2022

DOI: 10.1371/JOURNAL.PONE.0273412

Abstract: The relationship between social contact and quality of life is well-established within the general population. However, limited data exist about the extent of social interactions in residential aged care facilities (RACFs) providing long-term accommodation and care. We aimed to record the frequency and duration of interpersonal interactions among residents in RACFs and identify the association between residents’ interpersonal interactions and quality of life (QoL). A multi-methods study, including time and motion observations and a QoL survey, was conducted between September 2019 to January 2020. Thirty-nine residents from six Australian RACFs were observed between 09:30–17:30 on weekdays. Observations included residents’ actions, location of the action, and who the resident was with during the action. At the end of the observation period, residents completed a QoL survey. The proportion of time residents spent on different actions, in which location, and with whom were calculated, and correlations between these factors and QoL were analysed. A total of 312 hours of observations were conducted. Residents spent the greatest proportion of time in their own room (45.2%, 95%CI 40.7–49.8), alone (47.9%, 95%CI 43.0–52.7) and being inactive (25.6%, 95%CI 22.5–28.7). Residents were also largely engaged in interpersonal communication (20.2%, 95%CI 17.9–22.5) and self-initiated or scheduled events (20.5%, 95%CI 18.0–23.0). Residents’ interpersonal communication was most likely to occur in the common area (29.3%, 95%CI 22.9–35.7), residents’ own room (26.7%, 95%CI 21.0–32.4) or the dining room (24.6%, 95%CI 18.9–30.2), and was most likely with another resident (54.8%, 95%CI 45.7–64.2). Quality of life scores were low (median = 0.68, IQR = 0.54–0.76). Amount of time spent with other residents was positively correlated with QoL (r = 0.39, p = 0.02), whilst amount of time spent with facility staff was negatively correlated with QoL (r = -0.45, p = 0.008). Our findings confirm an established association between social interactions and improved QoL. Opportunities and activities which encourage residents to engage throughout the day in common facility areas can support resident wellbeing.

Call for discussion about the framework for categorizing economic evaluations of health information systems and assessing their quality

Publisher: Oxford University Press (OUP)

Date: 2014

DOI: 10.1136/AMIAJNL-2013-002240

Prescribers’ reported acceptance and use of drug-drug interaction alerts: An Australian survey

Publisher: SAGE Publications

Date: 2022

DOI: 10.1177/14604582221100678

Abstract: Drug-drug interaction (DDI) alerts are frequently included in electronic medical record (eMR) systems to provide users with relevant information and guidance at the point of care. In this study, we aimed to examine views of DDI alerts among prescribers, including junior doctors, registrars and senior doctors, across Australia. A validated survey for assessing prescribers’ reported acceptance and use of DDI alerts was distributed among researcher networks and in newsletters. Fifty useable responses were received, more than half ( n = 28) from senior doctors. Prescribers at all levels expected DDI alerts to improve performance but junior doctors reported that this was at a high cost, with respect to time and effort. Senior doctors and registrars reported rarely reading alerts and rarely changing prescribing decisions based on alerts. Respondents identified a number of problems with current alerts including limited relevance, repetition, and poor design, highlighting some clear areas for alert improvement.

Is evidence of effectiveness a driver for clinical decision support selection? A qualitative descriptive study of senior hospital staff

Publisher: Oxford University Press (OUP)

Date: 2022

DOI: 10.1093/INTQHC/MZAD004

Abstract: Limited research has focused on understanding if and how evidence of health information technology (HIT) effectiveness drives the selection and implementation of technologies in practice. This study aimed to explore the views of senior hospital staff on the role evidence plays in the selection and implementation of HIT, with a particular focus on clinical decision support (CDS) alerts in electronic medication management systems. A qualitative descriptive design was used. Twenty senior hospital staff from six Australian hospitals in New South Wales and Queensland took part in a semistructured interview. Interviews were audio-recorded and transcribed, and a general inductive content analysis approach was used to identify themes. Participants acknowledged the importance of an evidence base, but reported that selection of CDS alerts, and HIT more broadly, was rarely underpinned by evidence that technologies improve patient care. Instead, investments in technologies were guided by the expectation that benefits will be achieved, bolstered by vendor assurances, and a perception that implementation of HIT is unavoidable. Postponing implementation of a technology until an evidence base is available was not always feasible. Although some technologies were seen as not requiring an evidence base, stakeholders viewed evidence as extremely valuable for informing decisions about selection of CDS alerts. In the absence of evidence, evaluation or monitoring of technologies postimplementation is critical, particularly to identify new errors or risks associated with HIT implementation and use. Increased transparency from vendors, with technology evaluation outcomes made directly available to healthcare organizations, may result in less reliance on logic, intuition, and vendor assertions and more evidence-based selection of HIT.

Are operating room distractions, interruptions and disruptions associated with performance and patient safety? A systematic review and meta-analysis

Publisher: Oxford University Press (OUP)

Date: 04-2021

DOI: 10.1093/INTQHC/MZAB068

Abstract: The operating room is a complex environment in which distractions, interruptions and disruptions (DIDs) are frequent. Our aim was to synthesize research on the relationships between DIDs and (i) operative duration, (ii) team performance, (iii) in idual performance and (iv) patient safety outcomes in order to better understand how interventions can be designed to mitigate the negative effects of DIDs. Electronic databases (MEDLINE, Embase, CINAHL and PsycINFO) and reference lists were systematically searched. Included studies were required to report the quantitative outcomes of the association between DIDs and team performance, in idual performance and patient safety. Two reviewers independently screened articles for inclusion, assessed study quality and extracted data. A random-effects meta-analysis was performed on a subset of studies reporting total operative time and DIDs. Twenty-seven studies were identified. The majority were prospective observational studies (n = 15) of moderate quality. DIDs were often defined, measured and interpreted differently in studies. DIDs were significantly associated with extended operative duration (n = 8), impaired team performance (n = 6), self-reported errors by colleagues (n = 1), surgical errors (n = 1), increased risk and incidence of surgical site infection (n = 4) and fewer patient safety checks (n = 1). A random-effects meta-analysis showed that the proportion of total operative time due to DIDs was 22.0% (95% confidence interval 15.7–29.9). DIDs in surgery are associated with a range of negative outcomes. However, significant knowledge gaps exist about the mechanisms that underlie these relationships, as well as the potential clinical and non-clinical benefits that DIDs may deliver. Available evidence indicates that interventions to reduce the negative effects of DIDs are warranted, but current evidence is not sufficient to make recommendations about potentially useful interventions.

Standardising the Classification of Harm Associated with Medication Errors: The Harm Associated with Medication Error Classification (HAMEC)

Publisher: Springer Science and Business Media LLC

Date: 23-04-2019

DOI: 10.1007/S40264-019-00823-4

Reducing dyspepsia costs in the community

Publisher: BMJ

Date: 10-2002

DOI: 10.1136/GUT.51.4.613

Quality and safety in residential aged care

Publisher: Wiley

Date: 22-03-2023

DOI: 10.1111/IMJ.16052

Abstract: In Australia, 243 000 in iduals live in approximately 2700 residential aged care facilities yearly. In 2019, a National Aged Care Mandatory Quality Indicator programme (QI programme) was implemented to monitor the quality and safety of care in facilities. To examine the validity of the QI programme indicators using explicit measure review criteria. The QI programme manual and reports were reviewed. A modified American College of Physicians Measure Review Criteria was employed to examine the QI programme's eight indicators. Five authors rated each indicator on importance, appropriateness, clinical evidence, specifications and feasibility using a nine‐point scale. A median score of 1–3 was considered to not meet criteria, 4–6 to meet some criteria and 7–9 to meet criteria. All indicators, except polypharmacy, met criteria (median scores = 7–9) for importance, appropriateness and clinical evidence. Polypharmacy met some criteria for importance (median = 6, range 2–8), appropriateness (median = 5, range 2–8) and clinical evidence (median = 6, range 3–8). Pressure injury, physical restraints, significant unplanned weight loss, consecutive unplanned weight loss, falls and polypharmacy indicators met some criteria for specifications validity (all median scores = 5) and feasibility and applicability (median scores = 4 to 6). Antipsychotic use and falls resulting in major injury met some criteria for specifications (median = 6–7, range 4–8) and met criteria for feasibility and applicability (median = 7, range 4–8). Australia's National QI programme is a major stride towards a culture of quality promotion, improvement and transparency. Measures' specifications, feasibility and applicability could be improved to ensure the programme delivers on its intended purposes.

Designing clinical indicators for common residential aged care conditions and processes of care

Publisher: Oxford University Press (OUP)

Date: 04-2022

DOI: 10.1093/INTQHC/MZAC033

Abstract: People who live in aged care homes have high rates of illness and frailty. Providing evidence-based care to this population is vital to ensure the highest possible quality of life. In this study (CareTrack Aged, CT Aged), we aimed to develop a comprehensive set of clinical indicators for guideline-adherent, appropriate care of commonly managed conditions and processes in aged care. Indicators were formulated from recommendations found through systematic searches of Australian and international clinical practice guidelines (CPGs). Experts reviewed the indicators using a multiround modified Delphi process to develop a consensus on what constitutes appropriate care. From 139 CPGs, 5609 recommendations were used to draft 630 indicators. Clinical experts (n = 41) reviewed the indicators over two rounds. A final set of 236 indicators resulted, mapped to 16 conditions and processes of care. The conditions and processes were admission assessment bladder and bowel problems cognitive impairment depression dysphagia and aspiration end of life alliative care hearing and vision infection medication mobility and falls nutrition and hydration oral and dental care pain restraint use skin integrity and sleep. The suite of CT Aged clinical indicators can be used for research and assessment of the quality of care in in idual facilities and across organizations to guide improvement and to supplement regulation or accreditation of the aged care sector. They are a step forward for Australian and international aged care sectors, helping to improve transparency so that the level of care delivered to aged care consumers can be rigorously monitored and continuously improved.

Use of on-line evidence databases by Australian public health practitioners

Publisher: Informa UK Limited

Date: 06-2004

DOI: 10.1080/14639230410001723437

Technology meets tradition: The perceived impact of the introduction of information and communication technology on ward rounds in the intensive care unit

Publisher: Elsevier BV

Date: 09-2017

DOI: 10.1016/J.IJMEDINF.2017.04.004

Abstract: Public policy in many health systems is currently dominated by the quest to find ways to 'do more with less'-to achieve better outcomes at a reduced cost. The success or failure of initiatives in support of this quest are often understood in terms of an adversarial dynamic or struggle between the professional logics of medicine and of management. Here, we use the case of the introduction of information and communication technology (ICT) to a well-established ritual of medical autonomy (the medical ward round) to articulate a more nuanced explanation of how and why new ways of working with technology are accepted and adopted (or not). The study was conducted across four intensive care units (ICUs) in major teaching hospitals in Sydney, Australia. Using interviews, we examined 48 doctors' perceptions of the impact of ICT on ward round practice. We applied the concept of institutional logics to frame our analysis. Interview transcripts were analysed using a hybrid of deductive and inductive thematic analysis. The doctors displayed a complex engagement with the technology that belies simplistic characterisations of medical rejection of managerial encroachment. In fact, they selectively welcomed into the ward round aspects of the technology which reinforced the doctor's place in the healthcare hierarchy and which augmented their role as scientists. At the same time, they guarded against allowing managerial logic embedded in ICT to de-emphasise their embodied subjectivity in relation to the patient as a person rather than as a collection of parameters. ICT can force the disruption of some aspects of existing routines, even where these are long-established rituals. Resistance arose when the new technology did not fit with the 'logic of care'. Incorporation of the logic of care into the design and customisation of clinical information systems is a challenge and potentially counterproductive, because it could attempt to apply a technological fix to what is essentially a social problem. However, there are significant opportunities to ensure that new technologies do not obstruct doctors' roles as carers nor disrupt the embodied relationship they need to have with patients.

A systems science perspective on the capacity for change in public hospitals

Publisher: Springer Science and Business Media LLC

Date: 24-03-2017

DOI: 10.1186/S13584-017-0143-6

Video Research in Health: Visibilising the Effects of Computerising Clinical Care

Publisher: Emerald

Date: 03-08-2006

DOI: 10.3316/QRJ0602015

Abstract: This paper discusses video ethnography as part of a multimethod study of the introduction of information technology to streamline pathology test order entry in hospitals and its effect on the work of pathology laboratory scientists. The paper opens with an overview of video research in health care settings. After acknowledging the limitations inherent in video data, the paper offers a description of how video footage served to enhance insight in three ways. First, the footage enhanced the researchers’ own appreciation of the significance of particular facets of the data, which led them to reassess information collected through interviewing, focus groups and research field notes. Second, the footage enhanced the pathology laboratory scientists’ appreciation of the problems they experienced when incorporating the new information technology into their daily work practice, by enabling them to articulate these problems to outside researchers. Third, by being watched (by the video camera) and by watching themselves perform their work they were enabled to redesign their practices. The paper suggests that, as a result of interactively performing their work in front of the camera, the scientists came to apprehend their practices ‘from under a different aspect’. The paper concludes that by allowing video ethnography as a research method to remain underdefined and emergent, the modality of engagement and uptake shown by participants in the video research can be considered as a further enriching aspect of video ethnography as a research process.

The efficiency–thoroughness trade-off after implementation of electronic medication management: a qualitative study in paediatric oncology

Publisher: Oxford University Press (OUP)

Date: 09-2020

DOI: 10.1093/INTQHC/MZAA086

Abstract: The efficiency–thoroughness trade-off (ETTO) principle proposes that people and organizations are often required to make a trade-off between being efficient and being thorough, as it is difficult to be both efficient and thorough at the same time. This study aimed to compare pre- electronic medication management system (EMMS) expectation of how an EMMS is likely to impact on efficiency and thoroughness to post-EMM experiences of an EMMS and the ETTO. Qualitative interview study. A paediatric oncology cancer centre in a large paediatric tertiary teaching hospital in Sydney, Australia. Forty-four semi-structured interviews with doctors, nurses and pharmacists six months prior to and two years following implementation of an EMMS. Prior to EMM implementation, staff identified a number of areas of work where both efficiency and thoroughness were expected to improve with EMM. These included ease of accessibility of the medication record, and organization and legibility of medication information. Following EMMS implementation, staff reported improvements in these areas. However, the EMMS was perceived to drive thoroughness (safety) benefits at the expense of efficiency (time). Measures to improve safety in the EMMS enforced processes that required time, such as medication double-checking procedures. Overall, staff were aware of the competitive interplay between thoroughness and efficiency and reported that introduction of an EMMS had imposed processes that favoured improvements in thoroughness at the expense of efficiency.

The impact of interruptions on clinical task completion

Publisher: BMJ

Date: 12-05-2010

DOI: 10.1136/QSHC.2009.039255

Abstract: Interruptions and multitasking are implicated as a major cause of clinical inefficiency and error. The aim was to measure the association between emergency doctors' rates of interruption and task completion times and rates. The authors conducted a prospective observational time and motion study in the emergency department of a 400-bed teaching hospital. Forty doctors (91% of medical staff) were observed for 210.45 h on weekdays. The authors calculated the time on task (TOT) the relationship between TOT and interruptions and the proportion of time in work task categories. Length-biased s ling was controlled for. Doctors were interrupted 6.6 times/h. 11% of all tasks were interrupted, 3.3% more than once. Doctors multitasked for 12.8% of time. The mean TOT was 1:26 min. Interruptions were associated with a significant increase in TOT. However, when length-biased s ling was accounted for, interrupted tasks were unexpectedly completed in a shorter time than uninterrupted tasks. Doctors failed to return to 18.5% (95% CI 15.9% to 21.1%) of interrupted tasks. It appears that in busy interrupt-driven clinical environments, clinicians reduce the time they spend on clinical tasks if they experience interruptions, and may delay or fail to return to a significant portion of interrupted tasks. Task shortening may occur because interrupted tasks are truncated to 'catch up' for lost time, which may have significant implications for patient safety.

Analysing 'big picture' policy reform mechanisms

Publisher: Wiley

Date: 04-11-2015

DOI: 10.1111/HEX.12300

Communication interventions to improve adherence to infection control precautions: A randomised crossover trial

Publisher: Springer Science and Business Media LLC

Date: 06-02-2013

DOI: 10.1186/1471-2334-13-72

Computerised pathology test order entry reduces laboratory turnaround times and influences tests ordered by hospital clinicians: A controlled before and after study

Publisher: BMJ

Date: 16-02-2006

DOI: 10.1136/JCP.2005.029983

Future health services managers' and health information managers' views on information technology: a pilot survey.

Publisher: SAGE Publications

Date: 06-1996

DOI: 10.1177/183335839602600208

Abstract: This pilot survey examined the views of a s le of health service managers (HSMs) and health information managers (HIMs) undertaking tertiary studies about the application of information technology (IT) in health care. The survey was based on a questionnaire designed as part of a 1994 study of health service executives (HSEs) commissioned by the Australian College of Health Service Executives (ACHSE). We examined views about current and future IT expenditure, satisfaction with IT, impact of IT on quality and efficiency and the future use of electronic medical records and optical disk storage. Results identify differences and some similarities between respondent groups on these issues. The paper explores these differences and similarities and provides insight into the views held by future HSMs and HIMs.

MED13/378

Publisher: JMIR Publications Inc.

Date: 19-09-1999

DOI: 10.2196/JMIR.1.SUPPL1.E56

Experiences of peer messengers as part of a professional accountability culture change program to reduce unprofessional behaviour

Publisher: CSIRO Publishing

Date: 27-04-2023

DOI: 10.1071/AH22191

Abstract: Objective Professional accountability programs are designed to promote professional behaviours between co-workers and improve organisational culture. Peer messengers play a key role in professional accountability programs by providing informal feedback to hospital staff about their behaviour. Little is known about the experiences of messengers. This study examined the experiences of staff who delivered messages to peers as part of a whole-of-hospital professional accountability program called ‘Ethos’. Methods Ethos messengers (EMs) across eight Australian hospitals were invited to complete an online survey. The survey consisted of 17 close-ended questions asking respondents about their experiences delivering messages to peers and their perceptions of the Ethos program. Four open-ended questions asked respondents about rewarding and challenging aspects of being a peer messenger and what they would change about the program. Results Sixty EMs provided responses to the survey (response rate, 41.4%). The majority were from nursing and medical groups (53.4%) and had delivered 1–5 messages to staff (57.7%). Time as an EM ranged from less than 3 months to more than 12 months. A majority had been an EM for more than 12 months (80% n = 40). Most agreed they had received sufficient training for the role (90.1% n = 48) and had the skills (90.1% n = 48), access to support (84.9% n = 45) and time to fulfil their responsibilities (70.0% n = 30). Approximately a third (34.9% n = 15) of respondents indicated that recipients were ‘sometimes’ or ‘never’ receptive to messages. Challenging aspects of the role included organising a time to talk with staff, delivering feedback effectively and communicating with peers who lacked insight and were unable to reflect on their behaviour. Conclusions Skills development for peer messengers is key to ensuring the effectiveness and sustainability of professional accountability programs. Training in how to deliver difficult information and respond to negative reactions to feedback was identified by EMs as essential to support their ongoing effectiveness in their role.

Economic evaluation of Australian acute care accreditation (ACCREDIT-CBA (Acute)): Study protocol for a mixedmethod research project

Publisher: BMJ

Date: 2013

DOI: 10.1136/BMJOPEN-2012-002381

The impact of health information technology on the management and follow-up of test results

Publisher: Oxford University Press (OUP)

Date: 11-04-2019

DOI: 10.1093/JAMIA/OCZ032

Abstract: To investigate the impact of health information technology (IT) systems on clinicians’ work practices and patient engagement in the management and follow-up of test results. A search for studies reporting health IT systems and clinician test results management was conducted in the following databases: MEDLINE, EMBASE, CINAHL, Web of Science, ScienceDirect, ProQuest, and Scopus from January 1999 to June 2018. Test results follow-up was defined as provider follow-up of results for tests that were sent to the laboratory and radiology services for processing or analysis. There are some findings from controlled studies showing that health IT can improve the proportion of tests followed-up (15 percentage point change) and increase physician awareness of test results that require action (24–28 percentage point change). Taken as whole, however, the evidence of the impact of health IT on test result management and follow-up is not strong. The development of safe and effective test results management IT systems should pivot on several axes. These axes include 1) patient-centerd engagement (involving shared, timely, and meaningful information) 2) diagnostic processes (that involve the integration of multiple people and different clinical settings across the health care spectrum) and 3) organizational communications (the myriad of multi- transactional processes requiring feedback, iteration, and confirmation) that contribute to the patient care process. Existing evidence indicates that health IT in and of itself does not (and most likely cannot) provide a complete solution to issues related to test results management and follow-up.

A hybrid health service accreditation program model incorporating mandated standards and continuous improvement

Publisher: Wiley

Date: 05-06-2016

DOI: 10.1002/HPM.2301

Abstract: The study aim was to investigate the understandings and concerns of stakeholders regarding the evolution of health service accreditation programs in Australia. Stakeholder representatives from programs in the primary, acute and aged care sectors participated in semi-structured interviews. Across 2011-12 there were 47 group and in idual interviews involving 258 participants. Interviews lasted, on average, 1 h, and were digitally recorded and transcribed. Transcriptions were analysed using textual referencing software. Four significant issues were considered to have directed the evolution of accreditation programs: altering underlying program philosophies shifting of program content focus and details different surveying expectations and experiences and the influence of external contextual factors upon accreditation programs. Three accreditation program models were noted by participants: regulatory compliance continuous quality improvement and a hybrid model, incorporating elements of these two. Respondents noted the compatibility or incommensurability of the first two models. Participation in a program was reportedly experienced as ranging on a survey continuum from "malicious compliance" to "performance audits" to "quality improvement journeys". Wider contextual factors, in particular, political and community expectations, and associated media reporting, were considered significant influences on the operation and evolution of programs. A hybrid accreditation model was noted to have evolved. The hybrid model promotes minimum standards and continuous quality improvement, through examining the structure and processes of organisations and the outcomes of care. The hybrid model appears to be directing organisational and professional attention to enhance their safety cultures. Copyright © 2015 John Wiley & Sons, Ltd.

Interruptions and Multitasking in Clinical Work: A Summary of the Evidence

Publisher: Springer International Publishing

Date: 2019

DOI: 10.1007/978-3-030-16916-9_7

Just visiting: A qualitative study of Australian allied health professionals' experiences working in residential aged care facilities during the COVID‐19 pandemic

Publisher: Wiley

Date: 15-06-2023

DOI: 10.1111/AJAG.13217

Abstract: Internationally, the COVID‐19 pandemic has negatively impacted health professionals' experiences of delivering effective care. The experiences of health professionals are important: poor experience has been associated with poorer patient outcomes and high staff turnover. This study aimed to narratively explore the impact of the COVID‐19 pandemic on the experience of delivering allied health (AH) care in Australian residential aged care (RAC). Semistructured interviews were conducted in February–May 2022 with AH professionals who had experience working in RAC during the pandemic. Interviews were audio‐recorded, transcribed verbatim and thematically analysed in NVivo 20. Twenty‐five per cent of interview transcripts were independently analysed by three researchers to create a coding structure. Three themes were identified from interviews with 15 AH professionals to describe experiences delivering care pre‐COVID‐19, during COVID‐19, and perceptions of care delivery in future. Prepandemic AH in RAC was believed to be under‐resourced, delivering low‐quality and reactive care. During the pandemic, pauses in, and the slow resumption of, AH services exacerbated professionals' feelings of being undervalued in resident care and in the workforce. Participants were optimistic about the impact AH could have in RAC in future if practice was embedded, multidisciplinary and funded appropriately. AH professionals' experiences of delivering care in RAC are often poor, regardless of the pandemic. Further research on multidisciplinary practice and health professional experience in RAC is needed.

A multimethod research investigation of consumer involvement in Australian health service accreditation programmes: The ACCREDIT-SCI study protocol

Publisher: BMJ

Date: 2012

DOI: 10.1136/BMJOPEN-2012-002024

Ageing well

Publisher: Springer Science and Business Media LLC

Date: 12-03-2019

DOI: 10.1186/S12877-019-1094-2

International Comparison of Six Basic eHealth Indicators Across 14 Countries: An eHealth Benchmarking Study

Publisher: Georg Thieme Verlag KG

Date: 18-11-2020

DOI: 10.1055/S-0040-1715796

Abstract: Background Many countries adopt eHealth applications to support patient-centered care. Through information exchange, these eHealth applications may overcome institutional data silos and support holistic and ubiquitous (regional or national) information logistics. Available eHealth indicators mostly describe usage and acceptance of eHealth in a country. The eHealth indicators focusing on the cross-institutional availability of patient-related information for health care professionals, patients, and care givers are rare. Objectives This study aims to present eHealth indicators on cross-institutional availability of relevant patient data for health care professionals, as well as for patients and their caregivers across 14 countries (Argentina, Australia, Austria, Finland, Germany, Hong Kong as a special administrative region of China, Israel, Japan, Jordan, Kenya, South Korea, Sweden, Turkey, and the United States) to compare our indicators and the resulting data for the examined countries with other eHealth benchmarks and to extend and explore changes to a comparable survey in 2017. We defined “availability of patient data” as the ability to access data in and to add data to the patient record in the respective country. Methods The invited experts from each of the 14 countries provided the indicator data for their country to reflect the situation on August 1, 2019, as date of reference. Overall, 60 items were aggregated to six eHealth indicators. Results Availability of patient-related information varies strongly by country. Health care professionals can access patients' most relevant cross-institutional health record data fully in only four countries. Patients and their caregivers can access their health record data fully in only two countries. Patients are able to fully add relevant data only in one country. Finland showed the best outcome of all eHealth indicators, followed by South Korea, Japan, and Sweden. Conclusion Advancement in eHealth depends on contextual factors such as health care organization, national health politics, privacy laws, and health care financing. Improvements in eHealth indicators are thus often slow. However, our survey shows that some countries were able to improve on at least some indicators between 2017 and 2019. We anticipate further improvements in the future.

Junior doctors’ prescribing work after-hours and the impact of computerized decision support

Publisher: Elsevier BV

Date: 10-2013

DOI: 10.1016/J.IJMEDINF.2013.06.014

Abstract: computerized provider order entry (CPOE) systems with integrated decision support (DS) can reduce prescribing errors, but their impact may vary depending on the clinical setting. This study aimed to assess the impact of partial implementation of CPOE on junior doctors' prescribing work after-hours and to examine differences in junior doctors' use of DS during transcribing and their own prescribing tasks. Twelve junior doctors at a 350-bed teaching hospital in Sydney, Australia were shadowed between 16:30 and 22:30 over eight weeks for 65 h. CPOE was available on all wards except for the emergency department (ED). All medication tasks, computerized alerts, prescriber responses, and uses of reference material were recorded. Of 306 medication orders entered into the CPOE, 78.4% were transcribed from paper ED charts. A total of 113 alerts were triggered, most (78%) were read but only 6 (5%) resulted in prescribers changing an order. Reference material was accessed three times more frequently when junior doctors made their own prescribing decisions than when they transcribed other doctors' orders, but a similar proportion of alerts was read during decision-making and transcribing tasks. Junior doctors spent most of their after-hours prescribing time transcribing other doctors' orders. This is a new task brought about by partial CPOE implementation. Junior doctors read computerized alerts and used online reference material to support their decision-making. However they rarely made changes to a medication order following alert generation, suggesting the alert information was often not clinically relevant.

Longitudinal study of user experiences of a CPOE system in a pediatric hospital

Publisher: Elsevier BV

Date: 2018

DOI: 10.1016/J.IJMEDINF.2017.10.018

Abstract: To explore the views of nurses and doctors during the early stages of implementation of a computerized provider order entry (CPOE) system in a pediatric hospital and to examine changes in perceptions and reported behaviors as use of the CPOE system became routine. Semi-structured interviews were undertaken at four time points following CPOE implementation: during week one, week three, week six and then six months following implementation. In total, 122 users were interviewed. Interviews were audio-recorded and transcribed verbatim. Emergent themes were mapped to the Extended Technology Acceptance Model (e-TAM). Initial perceptions were driven by unfamiliarity with the system. As users became more proficient and efficient in using the CPOE system, additional safety benefits become apparent. However, accompanying increased reports of benefits were reports of usability problems and new types of errors arising from CPOE use. Reports of workarounds appeared for the first time at 6-month interviews. These workarounds were adopted to allow routine work to continue and to attenuate some of the perceived negative consequences of CPOE, including delayed medications and reduced patient interaction. This study is one of the first to examine changes in perceptions of CPOE at multiple points, demonstrating the trajectory of changes in views over time. It provides new information about the time point at which workarounds begin to be embedded in practice and are potentially most receptive to identification and remediation. It suggests an adaptive implementation and support program would be beneficial, as reported difficulties and concerns change during the first six months of use.

The influence of computerized decision support on prescribing during ward-rounds: Are the decision-makers targeted?

Publisher: Oxford University Press (OUP)

Date: 11-2011

DOI: 10.1136/AMIAJNL-2011-000135

Policy Delusions and Dutiful Daughters: Imagined Versus Real Care Integration for Older People

Publisher: Springer International Publishing

Date: 2021

DOI: 10.1007/978-3-030-81093-1_4

Empiric Clustering of Dyspepsia into Symptom Subgroups: a Population-based Study

Publisher: Informa UK Limited

Date: 2002

DOI: 10.1080/003655202760230874

Abstract: Different definitions of dyspepsia are applied by researchers yet measurement of the influence of these on prevalence estimates is uncertain. Despite continued debate regarding dyspepsia subgroups, few studies have used a data-drive approach to assess the existence and relevance of symptom clusters. We aimed to address both these issues. A random population s le (n = 2300) identified in New South Wales. Prevalence estimates of dyspepsia were calculated by applying four standardized dyspepsia definitions. Principal components analyses, using firstly the presence/absence of symptoms and then secondly severity of symptoms, were undertaken to determine if symptom factors existed. Prevalence estimates ranged from 11% to 36%. Similar prevalence rates for men and women were observed for all definitions except Rome II. Over one-third of respondents nominated heartburn or epigastric pain as their most bothersome symptom. However, 22% of respondents were unable to answer this question. The principal components analysis produced four symptom factors: a nausea factor, dysmotility-like dyspepsia (early satiety and fullness), ulcer-like (epigastric pain and bloating) and reflux-like (heartburn and acid regurgitation). However, the factors accounted for less than 50% of the variance. Similar factors were identified in men and women for dysmotility-like and reflux-like dyspepsia. Use of presence/absence or severity of symptoms made little difference to the symptom factors produced or the amount of variance explained. The prevalence of dyspepsia depends on the definition applied. While there is some empirical evidence of symptom subgroups, they appear to be of little clinical utility.

The effect of computerized provider order entry systems on clinical care and work processes in emergency departments: A systematic review of the quantitative literature

Publisher: Elsevier BV

Date: 06-2013

DOI: 10.1016/J.ANNEMERGMED.2013.01.028

Abstract: We undertake a systematic review of the quantitative literature related to the effect of computerized provider order entry systems in the emergency department (ED). We searched MEDLINE, EMBASE, Inspec, CINAHL, and CPOE.org for English-language studies published between January 1990 and May 2011. We identified 1,063 articles, of which 22 met our inclusion criteria. Sixteen used a pre ost design 2 were randomized controlled trials. Twelve studies reported outcomes related to patient flow/clinical work, 7 examined decision support systems, and 6 reported effects on patient safety. There were no studies that measured decision support systems and its effect on patient flow/clinical work. Computerized provider order entry was associated with an increase in time spent on computers (up to 16.2% for nurses and 11.3% for physicians), with no significant change in time spent on patient care. Computerized provider order entry with decision support systems was related to significant decreases in prescribing errors (ranging from 17 to 201 errors per 100 orders), potential adverse drug events (0.9 per 100 orders), and prescribing of excessive dosages (31% decrease for a targeted set of renal disease medications). There are tangible benefits associated with computerized provider order entry/decision support systems in the ED environment. Nevertheless, when considered as part of a framework of technical, clinical, and organizational components of the ED, the evidence base is neither consistent nor comprehensive. Multimethod research approaches (including qualitative research) can contribute to understanding of the multiple dimensions of ED care delivery, not as separate entities but as essential components of a highly integrated system of care.

Preventing dangerous intraspinal injections

Publisher: Macquarie University

Date: 2022

DOI: 10.25949/DY3F-PA76

Volume, rates, source and types of add-on pathology test requests across five hospitals

Publisher: Walter de Gruyter GmbH

Date: 2012

DOI: 10.1515/CCLM-2011-0756

The impact of nurse practitioners on care delivery in the emergency department: A multiple perspectives qualitative study

Publisher: Springer Science and Business Media LLC

Date: 22-09-2013

DOI: 10.1186/1472-6963-13-356

Underlying risk factors for prescribing errors in long-term aged care: A qualitative study

Publisher: BMJ

Date: 14-10-2016

DOI: 10.1136/BMJQS-2015-004589

Abstract: To identify system-related risk factors perceived to contribute to prescribing errors in Australian long-term care settings, that is, residential aged care facilities (RACFs). The study used qualitative methods to explore factors that contribute to unsafe prescribing in RACFs. Data were collected at three RACFs in metropolitan Sydney, Australia between May and November 2011. Participants included RACF managers, doctors, pharmacists and RACF staff actively involved in prescribing-related processes. Methods included non-participant observations (74 h), in-depth semistructured interviews (n=25) and artefact analysis. Detailed process activity models were developed for observed prescribing episodes supplemented by triangulated analysis using content analysis methods. System-related factors perceived to increase the risk of prescribing errors in RACFs were classified into three overarching themes: communication systems, team coordination and staff management. Factors associated with communication systems included limited point-of-care access to information, inadequate handovers, information storage across different media (paper, electronic and memory), poor legibility of charts, information double handling, multiple faxing of medication charts and reliance on manual chart reviews. Team factors included lack of established lines of responsibility, inadequate team communication and limited participation of doctors in multidisciplinary initiatives like medication advisory committee meetings. Factors related to staff management and workload included doctors' time constraints and their accessibility, lack of trained RACF staff and high RACF staff turnover. The study highlights several system-related factors including laborious methods for exchanging medication information, which often act together to contribute to prescribing errors. Multiple interventions (eg, technology systems, team communication protocols) are required to support the collaborative nature of RACF prescribing.

Measuring quality of gout management in residential aged care facilities

Publisher: Oxford University Press (OUP)

Date: 2022

DOI: 10.1093/RAP/RKAC091

Abstract: Gout, a common form of arthritis, can be controlled successfully with pharmacotherapy and is thus an ideal model for examining chronic disease management. Our aim was to examine treatment of gout evaluated in accordance with general management guidelines for gout as applied to Australian residential aged care facilities. Electronic health record data linked with aged care clinical notes and electronic medication administration information (11 548 residents in 68 residential aged care facilities, & years of age) were interrogated to identify people with gout, other chronic conditions and gout medication use. The outcomes examined were the proportion receiving urate-lowering therapy (ULT preventative medication) and/or colchicine/non-steroidal anti-inflammatory drug (NSAID) (to treat gout flares), the number of ULT and colchicine/NSAID treatment episodes (periods of continuous days of medication use) and the duration of these treatment episodes. The cohort included 1179 residents with gout, of whom 62% used a ULT, with a median of one episode of use for a very short duration [median = 4 days, median of use in total (i.e. repeated use) = 52 days]. Among residents with gout, 9% also used colchicine or an NSAID. Female residents were less likely to receive ULT and for shorter periods. Nearly one-third of residents with gout did not receive ULT. In those receiving ULT, recurrent short courses were common. Overall, management of gout in aged care residents appears to be suboptimal, largely owing to intermittent and short exposure to ULT, and with female residents at greater risk of poor gout management.

A systematic review of the outcomes reported in trials of medication review in older patients: the need for a core outcome set

Publisher: Wiley

Date: 18-01-2017

DOI: 10.1111/BCP.13197

Measuring clinical workflow to improve quality and safety

Publisher: Springer International Publishing

Date: 15-12-2021

DOI: 10.1007/978-3-030-59403-9_28

Abstract: This chapter aims to illustrate the methodologies of time and motion research, the observation of clinical care activities in the field and its limits, strengths and opportunities. We discuss how such studies can be used to address questions related to the quality of care and to examine the relationships between clinical workflow and safety. Further, the chapter provides specific ex les of the application of time and motion studies, the practical challenges and results obtained.

Therapy-based allied health delivery in residential aged care, trends, factors, and outcomes: a systematic review

Publisher: Springer Science and Business Media LLC

Date: 28-08-2022

DOI: 10.1186/S12877-022-03386-9

Abstract: Allied health professionals in residential aged care facilities (RACFs) make important contributions to the physical and mental wellbeing of residents. Yet to date, health services research in RACFs has focused almost exclusively on nursing disciplines. This review aims to synthesise the current evidence on allied health services in RACF specifically, how therapy-based allied health is delivered, what factors impact the quantity delivered, and the impact of services on resident outcomes and care quality. Empirical peer-reviewed and grey literature focusing on allied health service delivery in RACFs from the past decade was identified through systematic searches of four databases and over 200 targeted website searches. Information on how allied health delivered, factors impacting service delivery, and impact on resident outcomes were extracted. The quality of included studies was appraised using the Mixed Methods Appraisal Tool (MMAT) and the AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) checklist. Twenty-eight unique studies were included in this review 26 peer-reviewed and two grey literature studies. Sixteen studies discussed occupational therapy and 15 discussed physiotherapy, less commonly studied professional groups included dieticians ( n = 9), allied health assistants ( n = 9), and social workers ( n = 6). Thirteen studies were assigned a 100% quality rating. Levels of allied health service provision were generally low and varied. Five studies examined the association between system level factors and allied health service provision, and seven studies examined facility level factors and service provision. Higher levels of allied health provision or access to allied health services, specifically physiotherapy, occupational therapy, and nutrition, were associated with reduced falls with injury, improved care quality, activities of daily living scores, nutritional status, and meal satisfaction in five studies. Evidence on how allied health is delivered in RACFs, and its impact on resident health outcomes, is lacking globally. While there are some indications of positive associations between allied health staffing and resident outcomes and experiences, health systems and researchers will need commitment to consistent allied health data collection and health services research funding in the future to accurately determine how allied health is delivered in RACFs and its impact on resident wellbeing.

Controlled pre-post, mixed-methods study to determine the effectiveness of a national delirium clinical care standard to improve the diagnosis and care of patients with delirium in Australian hospitals

Publisher: BMJ

Date: 2018

DOI: 10.1136/BMJOPEN-2017-019423

Abstract: Delirium, an acute confusional state, affects up to 29% of acute inpatients aged 65 years and over. The Australian Delirium Clinical Care Standard (the Standard) contains evidence-based, multicomponent interventions, to identify and reduce delirium. This study aims to: (1) conduct a controlled, before-and-after study to assess the clinical effectiveness of the Standard to improve diagnosis and treatment of delirium (2) conduct a cost-effectiveness study of implementing the Standard and (3) evaluate the implementation process. The study will use a controlled, preimplementation and postimplementation mixed-methods study design, including: medical record reviews, activity-based costing analysis and interviews with staff, patients and their family members. The study population will comprise patients 65 years and over, admitted to surgical, medical and intensive care wards in four intervention hospitals and one control hospital. The primary clinical outcome will be the incidence of delirium. Secondary outcomes include: length of stay, severity and duration of delirium, inhospital mortality rates, readmission rates and use of psychotropic drugs. Cost-effectiveness will be evaluated through activity-based costing analysis and outcome data, and the implementation process appraised through the qualitative results. Ethics approval has been received for two hospitals. Additional hospitals have been identified and ethics applications will be submitted once the tools in the pilot study have been tested. The results will be submitted for publication in peer-reviewed journals and presented to national and international conferences. Results seminars will provide a quality feedback mechanism for staff and health policy bodies.

The impact of computerised physician order entry systems on pathology services: A systematic review

Publisher: Elsevier BV

Date: 07-2007

DOI: 10.1016/J.IJMEDINF.2006.02.004

Abstract: Computerised physician order entry (CPOE) systems hold the promise of significant improvements to health care delivery and patient care. The implementation of such systems is costly and complex. The purpose of this paper is to review current evidence of the impact of CPOE on hospital pathology services. This paper presents a review of the literature (1990-August 2004) about CPOE systems and identifies indicators for measuring the impact of CPOE on pathology services. Nineteen studies which contained some form of 'control' group, were identified. They featured a variety of designs including randomised controlled trials, quasi-experimental and before and after studies. We categorised these into three groups: studies comparing pathology CPOE systems (with no decision support) to paper systems pathology CPOE systems (with decision support) to paper systems and pathology CPOE systems with specific pathology features compared to systems without those features. We identified 10 areas of impact assessment and 39 indicators used to measure the impact of CPOE on different stages of the pathology test ordering and reporting process. We conclude that while some data suggest that CPOE systems are beneficial for clinical and laboratory work processes, these data are limited, and further research is needed. Few data are available regarding the impact of CPOE on patient outcomes.

The impact of electronic meal ordering systems on hospital and patient outcomes

Publisher: Elsevier BV

Date: 09-2019

DOI: 10.1016/J.IJMEDINF.2019.06.023

Abstract: Malnutrition is a serious clinical issue associated with adverse patient and hospital outcomes. Hospitals need to consider interventions that support the provision of optimal nutritional management and care for patients. Electronic meal ordering (EMO) systems provide an alternative to traditional paper-based meal ordering with the capacity to support appropriate orders, monitor nutritional status, and potentially improve clinical outcomes. This review aimed to identify the impact of EMO systems on hospital and patient outcomes. We sought quantitative evidence (peer-reviewed and grey literature) from studies evaluating EMO systems in healthcare facilities, published after 1999 and available in the English language. We identified 23 studies evaluating one of three distinct EMO system-supported models: spoken menu, room service, and self-service. While limited, the evidence indicated that EMO systems were associated with: improved patient satisfaction decreased food waste increased consumption and, for spoken menus, more time with patients. There was no substantive evidence of impact on clinical outcomes. Whether EMO systems meet their potential to support nutritional monitoring and positively impact clinical outcomes remains unanswered within the evidence. Thus, policy makers and hospital management currently have a poor evidence base upon which to make decisions about the value of implementing EMO. Whether these systems can provide support and guidance to patients during meal ordering, improve order appropriateness and accuracy through compliance checking, identify patients in need of dietary education or those at risk of malnutrition are critical areas of focus for future research.

Explaining emergency physicians’ capacity to recover from interruptions

Publisher: Elsevier BV

Date: 11-2022

DOI: 10.1016/J.APERGO.2022.103857

Abstract: To assess whether the capacity to utilize cues amongst emergency physicians is associated with differences in the capacity to recover performance following an interruption. Interruptions are implicated in errors in emergency medicine due to the cognitive load that they impose on working memory, resulting in a loss of performance on the primary task. The utilization of cues is associated with a reduction in cognitive load during the performance of a task, thereby enabling the allocation of residual resources that mitigates the loss of performance following interruptions. Thirty-nine emergency physicians, recruited at a medical conference, completed an assessment of cue utilization (EXPERTise 2.0) and an online simulation (Septris) that involved the management of patients presenting with sepsis. During the simulation, physicians were interrupted and asked to check a medication order. Task performance was assessed using scores on Septris, with points awarded for the accurate management of patients. Emergency physicians with higher cue utilization recorded significantly higher scores on the simulation task following the interruption, compared to physicians with lower cue utilization (p = .028). The results confirm a relationship between cue utilization and the recovery of performance following an interruption. This is likely due to the advantages afforded by associated reductions in cognitive load. Assessments of cue utilization may assist in the development of interventions to support clinicians in interruptive environments.

Interpreting social network metrics in healthcare organisations

Publisher: Elsevier BV

Date: 04-2011

DOI: 10.1016/J.SOCSCIMED.2011.01.029

Abstract: Social network analysis is an increasingly popular sociological method used to describe and understand the social aspects of communication patterns in the health care sector. The networks studied in this area are special because they are small, and for these sizes, the metrics calculated during analysis are sensitive to the number of people in the network and the density of observed communication. Validation is of particular value in controlling for these factors and in assisting in the accurate interpretation of network findings, yet such approaches are rarely applied. Our aim in this paper was to bring together published case studies to demonstrate how a proposed validation technique provides a basis for standardised comparison of networks within and across studies. A validation is performed for three network studies comprising ten networks, where the results are compared within and across the studies in relation to a standard baseline. The results confirm that hierarchy, centralisation and clustering metrics are highly sensitive to changes in size or density. Amongst the three case studies, we found support for some conclusions and contrary evidence for others. This validation approach is a tool for identifying additional features and verifying the conclusions reached in observational studies of small networks. We provide a methodological basis from which to perform intra-study and inter-study comparisons, for the purpose of introducing greater rigour to the use of social network analysis in health care applications.

Computerized Clinical Decision Support Systems for the Early Detection of Sepsis Among Adult Inpatients: Scoping Review (Preprint)

Publisher: JMIR Publications Inc.

Date: 17-06-2021

DOI: 10.2196/PREPRINTS.31083

Abstract: epsis is a significant cause of morbidity and mortality worldwide. Early detection of sepsis followed promptly by treatment initiation improves patient outcomes and saves lives. Hospitals are increasingly using computerized clinical decision support (CCDS) systems for the rapid identification of adult patients with sepsis. his scoping review aims to systematically describe studies reporting on the use and evaluation of CCDS systems for the early detection of adult inpatients with sepsis. he protocol for this scoping review was previously published. A total of 10 electronic databases (MEDLINE, Embase, CINAHL, the Cochrane database, LILACS [Latin American and Caribbean Health Sciences Literature], Scopus, Web of Science, OpenGrey, ClinicalTrials.gov, and PQDT [ProQuest Dissertations and Theses]) were comprehensively searched using terms for sepsis, CCDS, and detection to identify relevant studies. Title, abstract, and full-text screening were performed by 2 independent reviewers using predefined eligibility criteria. Data charting was performed by 1 reviewer with a second reviewer checking a random s le of studies. Any disagreements were discussed with input from a third reviewer. In this review, we present the results for adult inpatients, including studies that do not specify patient age. search of the electronic databases retrieved 12,139 studies following duplicate removal. We identified 124 studies for inclusion after title, abstract, full-text screening, and hand searching were complete. Nearly all studies (121/124, 97.6%) were published after 2009. Half of the studies were journal articles (65/124, 52.4%), and the remainder were conference abstracts (54/124, 43.5%) and theses (5/124, 4%). Most studies used a single cohort (54/124, 43.5%) or before-after (42/124, 33.9%) approach. Across all 124 included studies, patient outcomes were the most frequently reported outcomes (107/124, 86.3%), followed by sepsis treatment and management (75/124, 60.5%), CCDS usability (14/124, 11.3%), and cost outcomes (9/124, 7.3%). For sepsis identification, the systemic inflammatory response syndrome criteria were the most commonly used, alone (50/124, 40.3%), combined with organ dysfunction (28/124, 22.6%), or combined with other criteria (23/124, 18.5%). Over half of the CCDS systems (68/124, 54.8%) were implemented alongside other sepsis-related interventions. he current body of literature investigating the implementation of CCDS systems for the early detection of adult inpatients with sepsis is extremely erse. There is substantial variability in study design, CCDS criteria and characteristics, and outcomes measured across the identified literature. Future research on CCDS system usability, cost, and impact on sepsis morbidity is needed. R2-10.2196/24899

Middle manager responses to hospital co-workers’ unprofessional behaviours within the context of a professional accountability culture change program

Publisher: Springer Science and Business Media LLC

Date: 20-09-2023

DOI: 10.1186/S12913-023-09968-6

The impact of electronic prescribing systems on pharmacists’ time and workflow: protocol for a time-and-motion study in English NHS hospitals: Table 1

Publisher: BMJ

Date: 10-2015

DOI: 10.1136/BMJOPEN-2015-008785

The General Practice and Residential Aged Care Facility Concordance of Medication (GRACEMED) study

Publisher: Elsevier BV

Date: 11-2020

DOI: 10.1016/J.IJMEDINF.2020.104264

At the grassroots of home and community-based aged care

Publisher: BMJ

Date: 11-2019

DOI: 10.1136/BMJOPEN-2018-028754

Abstract: (1) To describe the processes used to plan and conduct a stakeholder forum in aged care as a means of informing future uptake of consumer participatory research. (2) To discuss how capturing and drawing on stakeholders’ experiences of aged care can generate new research ideas and inform the delivery of more person-centred aged care services. A stakeholder forum was conducted as part of Ageing Well, a 2-year project evaluating the value and impact of social participation and quality of life tools as part of routine community aged care assessments at a large Australian provider. The forum was codesigned with community aged care clients and care coordinators and aimed to coproduce implementation strategies with a targeted representation of stakeholders. The stakeholder forum was developed using five key principles of consumer engagement activities: purposeful, inclusive, timely, transparent and respectful. The forum fostered an environment of mutual respect and collective inquiry to encourage contributions from all participants. This article outlines practical guidance on using a consumer engagement framework and the lessons learnt. The stakeholder forum facilitated an understanding of consumers’ needs and existing gaps in aged care services and the circumstances that can enable or hinder the delivery and implementation of these services. This collective information can guide future research and policy at institutional, regional and national committees that relate to aged care. ACTRN12617001212347

A mixed-methods study evaluating the impact of an excursion-based social group on quality of life of older adults

Publisher: Springer Science and Business Media LLC

Date: 10-06-2021

DOI: 10.1186/S12877-021-02295-7

Abstract: Social isolation is an increasing concern for older adults who live in the community. Despite some availability of social support programs to address social isolation, their effectiveness is not routinely measured. This study aimed to evaluate an innovative excursion-based program offering unique social experiences to older adults receiving aged care services. This six-month before and after mixed-methods study evaluated the outcomes of an Australian excursion-based program which offered social and physical outings to bring older adults receiving aged care services into the wider community. The study combined two parts: Part 1 was a pre-post survey assessing the quality of life of older adults who received the excursion-based program for 6 months ( n = 56 two time-points, analysed using signed rank test) and Part 2 involved qualitative in-depth, semi-structured interviews ( n = 24 aged care staff, older adults and carers analysed using thematic analysis). Older adults experienced a significant increase in quality of life scores ( p 0.001) between baseline and 6 months. Interviews confirmed these observations and suggested that benefits of participation included increased opportunities for social participation, psychological wellbeing, physical function, and carer respite. Interviews also revealed being in a group setting, having tailored, convenient and accessible activities, alongside supportive staff were key drivers in improving the wellbeing of participants. Participating in an excursion-based community program may improve wellbeing in older adults. Aging policy should focus on prioritizing initiatives that promote social connectivity with the wider community and assist in improving outcomes for older adults.

Longitudinal variation in pressure injury incidence among long-term aged care facilities

Publisher: Oxford University Press (OUP)

Date: 04-05-2018

DOI: 10.1093/INTQHC/MZY087

Abstract: To examine variation in pressure injury (PI) incidence among long-term aged care facilities and identify resident- and facility-level factors that explain this variation. Longitudinal incidence study using routinely-collected electronic care management data. A large aged care service provider in New South Wales and the Australian Capital Territory, Australia. About 6556 people aged 65 years and older who were permanent residents in 60 long-term care facilities between December 2014 and November 2016. Risk-adjusted PI incidence rates over eight study quarters. Incidence density over the study period was 1.33 pressure injuries per 1000 resident days (95% confidence interval (CI) = 1.29-1.37). Funnel plots were used to identify variation among facilities. On average, 14% of facilities had risk-adjusted PI rates that were higher than expected in each quarter (above 95% funnel plot control limits). Ten percent of facilities had persistently high rates in any three or more consecutive quarters (n = 6). The variation between facilities was only partly explained by resident characteristics in multilevel regression models. Residents were more likely to have higher-pressure injury rates in facilities in regional areas compared with major city areas (adjusted incidence rate ratio = 1.25, 95% CI = 1.04-1.51), and facilities with persistently high rates were more likely to be located in areas with low socioeconomic status (P = 0.038). There is considerable variation among facilities in PI incidence. This study demonstrates the potential of routinely-collected care management data to monitor PI incidence and to identify facilities that may benefit from targeted intervention.

The use and predictive performance of the Peninsula Health Falls Risk Assessment Tool (PH-FRAT) in 25 residential aged care facilities

Publisher: Springer Science and Business Media LLC

Date: 04-2022

DOI: 10.1186/S12877-022-02973-0

Abstract: The Peninsula Health Falls Risk Assessment Tool (PH-FRAT) is a validated and widely applied tool in residential aged care facilities (RACFs) in Australia. However, research regarding its use and predictive performance is limited. This study aimed to determine the use and performance of PH-FRAT in predicting falls in RACF residents. A retrospective cohort study using routinely-collected data from 25 RACFs in metropolitan Sydney, Australia from Jul 2014-Dec 2019. A total of 5888 residents aged ≥65 years who were assessed at least once using the PH-FRAT were included in the study. The PH-FRAT risk score ranges from 5 to 20 with a score 14 indicating fallers and ≤ 14 non-fallers. The predictive performance of PH-FRAT was determined using metrics including area under receiver operating characteristics curve (AUROC), sensitivity, specificity, sensitivity Event Rate(ER) and specificity ER . A total of 27,696 falls were reported over 3,689,561 resident days (a crude incident rate of 7.5 falls /1000 resident days). A total of 38,931 PH-FRAT assessments were conducted with a median of 4 assessments per resident, a median of 43.8 days between assessments, and an overall median fall risk score of 14. Residents with multiple assessments had increased risk scores over time. The baseline PH-FRAT demonstrated a low AUROC of 0.57, sensitivity of 26.0% (sensitivity ER 33.6%) and specificity of 88.8% (specificity ER 82.0%). The follow-up PH-FRAT assessments increased sensitivity ER values although the specificity ER decreased. The performance of PH-FRAT improved using a lower risk score cut-off of 10 with AUROC of 0.61, sensitivity of 67.5% (sensitivity ER 74.4%) and specificity of 55.2% (specificity ER 45.6%). Although PH-FRAT is frequently used in RACFs, it demonstrated poor predictive performance raising concerns about its value. Introducing a lower PH-FRAT cut-off score of 10 marginally enhanced its predictive performance. Future research should focus on understanding the feasibility and accuracy of dynamic fall risk predictive tools, which may serve to better identify residents at risk of falls.

A cross-country time and motion study to measure the impact of electronic medication management systems on the work of hospital pharmacists in Australia and England

Publisher: Elsevier BV

Date: 09-2019

DOI: 10.1016/J.IJMEDINF.2019.06.011

Abstract: Qualitative studies have provided important insights into how hospital pharmacists' work changes when electronic medication management (EMM) systems are introduced. Quantitative studies of work practice change are rare. Despite the use of EMM systems internationally, there are no cross-country comparative studies of their impact on health professionals' work. We aimed to quantify and compare the type and magnitude of changes in hospital pharmacists' work pre- and post-EMM implementation in two countries. Parallel, direct observational, time and motion studies of pharmacists in Australia and England pre- and post-EMM implementation. 20 pharmacists were observed: 9 in an Australian 440-bed hospital (155 h) and 11 pharmacists in a 500-bed English hospital (258 h). The Work Observation Method By Activity Timing (WOMBAT) software was used to collect observational data. Proportions of observed time in 11 tasks by study period (pre- versus post-EMM) and site, time spent with others or alone, and using different tools (e.g computers, paper) were calculated. Magnitude of changes between pre- and post-EMM by task and country were determined using z-tests for proportions adjusting for multiple testing. At baseline, Australian and English pharmacists spent the greatest proportion of time in medication review. Post-EMM, time in medication review (Australia 21.6%-27.5% England 27.1%-33.8%) and history-taking (Australia 7.6%-13.3% England 19.5%-28.9%) significantly increased. Despite country differences in these tasks at baseline, the magnitude of changes did not significantly differ. English pharmacists increased time engaged in medication discussions with patients post-EMM (from 5.9% to 10.8% p = 0.01). The Australian rate did not change (18.0%-27.2% p = 0.09), but was higher at baseline. Post-EMM, Australian pharmacists spent 63.4% of time working alone, compared to 92.0% for English pharmacists. EMM systems impacted the same core areas of work and had a similar magnitude of effect on pharmacists' work in both countries. Anticipated reductions in medication review and history taking were not observed.

Impact of Medication Reconciliation and Review on Clinical Outcomes

Publisher: SAGE Publications

Date: 21-07-2014

DOI: 10.1177/1060028014543485

Abstract: Objective: To examine the evidence regarding the effectiveness of medication reconciliation and review and to improve clinical outcomes in hospitals, the community, and aged care facilities. Data Source: This systematic review was undertaken in concordance with the PRISMA statement. Electronic databases, including MEDLINE, PsycINFO, EMBASE, and CINAHL were searched for relevant articles published between January 2000 and March 2014. Study Selection and Data Extraction: Randomized and nonrandomized studies rating the severity of medication discrepancies and medication-related problems identified during medication reconciliation and/or review were considered for inclusion. Data were extracted independently by 2 authors using a data collection form. Data Synthesis: Of the 5292 articles identified, 83 articles met the inclusion criteria. Medication reconciliation identified unintentional medication discrepancies in 3.4% to 98.2% of patients. There is limited evidence of the potential of these discrepancies to cause harm. Medication reviews identified medication-related problems or possible adverse drug reactions in 17.2% to 94.0% of patients. The studies reported conflicting findings regarding the impact of medication review on length of stays, readmissions, and mortality. Conclusions: The evidence demonstrates that medication reconciliation has the potential to identify many medication discrepancies and reduce potential harm, but the impact on clinical outcomes is less clear. Similarly, medication review can detect medication-related problems in many patients, but evidence of clinical impact is scant. Overall, there is limited evidence that medication reconciliation and medication review processes, as currently performed, significantly improve clinical outcomes, such as reductions in hospital readmissions.

Observational Tools That Quantify Nontechnical Skills in the Operating Room: A Systematic Review

Publisher: Elsevier BV

Date: 03-2020

DOI: 10.1016/J.JSS.2019.10.012

Abstract: Errors and adverse events in the operating room (OR) are associated with not only poor technical performance but also deficits in nontechnical skills (NTSs). Numerous tools have been developed to assess NTS in the OR. Our aim was to conduct a systematic review of observational tools and report on their implementation and psychometric properties to guide healthcare professionals, educators, and researchers in tool selection and use. A systematic literature search (January 1, 1990-May 28, 2019) was conducted across databases (MEDLINE, Embase, CINAHL, and PsycINFO) and reference lists of included studies. Reviewers independently screened articles for inclusion, assessed study quality, and extracted data. Thirty-one tools were identified across 88 studies, most commonly conducted in a real-world OR (n = 50), involving two observers (n = 50). The NTS of in iduals (n = 62) were assessed more often than that of subteams (n = 21) or entire teams (n = 20). The NOn-Technical Skills for Surgeons demonstrated content validity, concurrent validity, predictive validity, and face validity across a range of studies. Oxford NOn-TECHnical Skills demonstrated content validity, concurrent validity, and predictive validity with good inter-rater reliability and test-retest validity. The NOn-Technical Skills for Surgeons has the strongest evidence of validity and reliability for assessing in iduals, whereas the most robust tool for evaluating teams was Oxford NOn-TECHnical Skills. We recommend continued investigation of these observational tools regarding their feasibility and reproducibility of methods. Further research is needed to determine the training requirements for observers and the potential of video and audio recordings in the OR.

A simulation framework for mapping risks in clinical processes

Publisher: Oxford University Press (OUP)

Date: 05-2011

DOI: 10.1136/AMIAJNL-2010-000075

Failure to follow-up test results for ambulatory patients: A systematic review

Publisher: Springer Science and Business Media LLC

Date: 20-12-2012

DOI: 10.1007/S11606-011-1949-5

Use of information and communication technologies to support effective work practice innovation in the health sector

Publisher: Springer Science and Business Media LLC

Date: 08-11-2009

DOI: 10.1186/1472-6963-9-201

What Alert Thresholds Should Be Used to Identify Critical Risk Results: A Systematic Review of the Evidence

Publisher: Oxford University Press (OUP)

Date: 11-2016

DOI: 10.1373/CLINCHEM.2016.260638

Abstract: Pathology laboratories are required to immediately report results which indicate a patient is at critical risk, but there is little consensus about what values are deemed critical. The aim of this review was to systematically review the literature on alert thresholds for common chemistry and hematology tests in adults and to provide an explicit and ranked source of this evidence. The literature search covered the period of 1995–2014. Evidence sources were critically appraised and ranked using the 1999 Stockholm hierarchy for analytical performance specifications in laboratory medicine modified for establishing decision limits. The 30 most frequently reported laboratory tests with alert thresholds are presented with evidence rankings. Similar thresholds were reported in North America, Europe and Asia. Seventy percent of papers reported thresholds set by in idual institutions, while 18% contained thresholds from surveys of laboratories or clinicians. Forty-six percent of the papers referred to 1 or both of the 2 American laboratory surveys from the early 1990s. “Starter sets” of alert thresholds were recommended by 6 professional bodies, 3 of which were collaborations between pathologists and clinicians. None of the 9 outcome studies identified dealt with confounding factors. Recommendations by professional bodies based on outdated surveys of the former state of the art or consensus are currently the best sources of evidence for laboratories to build their alert list. Well-designed outcome studies and greater collaboration between clinicians and the laboratory are needed to identify the most appropriate alert thresholds that signify actionable, critical or significant risk to patient well-being.

Who Gets a Laboratory Test in Hospital, Why, and How Often? A Retrospective Observational Study of 4 Australian Hospitals

Publisher: Oxford University Press (OUP)

Date: 06-06-2019

DOI: 10.1373/JALM.2018.028688

Abstract: Laboratory providers are challenged with the need to deliver improvements in the efficiency and effectiveness of laboratory services. Initiatives have been set to reduce the inappropriate use of tests however, empirical evidence about the rate and frequency of laboratory tests in hospitals has not been widely available. This study used data linkage techniques to investigate laboratory test use among Australian inpatients. A retrospective observational study was conducted across 3 metropolitan and 1 rural hospital, all serviced by a single laboratory provider. Data for all admitted inpatients between January 2008 and December 2013 were extracted and linked to determine the proportion of admissions with a laboratory test, number of tests per admission, and time to first test. This study included 521480 admissions. Of these, 83.7% had a pathology test. Newborns and neonates had the lowest percentage of admissions with tests (35.2%), whereas admissions for diseases and disorders of the hepatobiliary system and pancreas had the highest (97.5%). Patients had a median of 12 tests per admission. Patients 80-84 years of age had the highest rate of tests per admission (median, 19 interquartile range, 9-36). Forty-nine percent of patients' first tests occurred within 2 h of admission, increasing to 69.9% within 4 h. The vast majority of patients admitted to hospital received laboratory tests. Higher laboratory testing rates were observed with increasing age. These findings can be used to define and compare laboratory testing among inpatients and help identify sources of variation in laboratory testing.

Towards an understanding of the information dynamics of the handover process in aged care settings-A prerequisite for the safe and effective use of ICT

Publisher: Elsevier BV

Date: 07-2012

DOI: 10.1016/J.IJMEDINF.2012.01.013

Abstract: Poor clinical handover has been associated with inaccurate clinical assessment and diagnosis, delays in diagnosis and test ordering, medication errors and decreased patient satisfaction in the acute care setting. Research on the handover process in the residential aged care sector is very limited. The aims of this study were to: (i) Develop an in-depth understanding of the handover process in aged care by mapping all the key activities and their information dynamics, (ii) Identify gaps in information exchange in the handover process and analyze implications for resident safety, (iii) Develop practical recommendations on how information communication technology (ICT) can improve the process and resident safety. The study was undertaken at a large metropolitan facility in NSW with more than 300 residents and a staff including 55 registered nurses (RNs) and 146 assistants in nursing (AINs). A total of 3 focus groups, 12 interviews and 3 observation sessions were conducted over a period from July to October 2010. Process mapping was undertaken by translating the qualitative data via a five-category code book that was developed prior to the analysis. Three major sub-processes were identified and mapped. The three major stages are Handover process (HOP) I "Information gathering by RN", HOP II "Preparation of preliminary handover sheet" and HOP III "Execution of handover meeting". Inefficient processes were identified in relation to the handover including duplication of information, utilization of multiple communication modes and information sources, and lack of standardization. By providing a robust process model of handover this study has made two critical contributions to research in aged care: (i) a means to identify important, possibly suboptimal practices and (ii) valuable evidence to plan and improve ICT implementation in residential aged care. The mapping of this process enabled analysis of gaps in information flow and potential impacts on resident safety. In addition it offers the basis for further studies into a process that, despite its importance for securing resident safety and continuity of care, lacks research.

Interventions to address unprofessional behaviours between staff in acute care: what works for whom and why? A realist review

Publisher: Springer Science and Business Media LLC

Date: 31-10-2023

DOI: 10.1186/S12916-023-03102-3

Double dose trouble: systemic intranasal medication: Can you spot the problem?

Publisher: Macquarie University

Date: 2022

DOI: 10.25949/PRND-F975

Ambulance officers' use of online clinical evidence

Publisher: Springer Science and Business Media LLC

Date: 27-07-2006

DOI: 10.1186/1472-6947-6-31

Effective notification of important non-urgent radiology results: A qualitative study of challenges and potential solutions

Publisher: Wiley

Date: 27-01-2014

DOI: 10.1111/1754-9485.12156

Abstract: We report on the implementation of a Radiology Notification System (RNS), set up by the medical imaging department of a major Sydney teaching hospital in March 2010. This study aimed to investigate the views of the medical imaging department staff about: (i) the results follow-up problem encountered by the medical imaging department prior to the implementation of the RNS (ii) what changes occurred following implementation of the RNS and (iii) suggestions for improving the RNS. This is a cross-sectional qualitative study incorporating semi-structured interviews with 16 staff (15 radiologists and 1 clerk) after the implementation of the RNS. Interviews were conducted in August/September 2011. The reasons behind the development of the RNS were related to: (i) major existing problems with the communication of results between the imaging department and hospital wards (ii) cumbersome and inefficient paper-based notification systems and (iii) the absence of standardised guidelines and procedures for radiology test notification and follow-up. The RNS managed to free up a significant proportion of radiologist time, resulting in greater efficiencies. Study participants also highlighted a number of areas for improvement, including the need for a 24-h service, feedback and acknowledgement of test results by clinicians and the standardisation of test management definitions and procedures. Test management systems can play an important part in enhancing safe and effective communications between wards and hospital departments. However, their uptake and sustainability will require the establishment of a multidisciplinary and hospital-wide collaboration that includes clinicians.

Understanding the work of case managers in Australian community aged care

Publisher: CSIRO Publishing

Date: 2020

DOI: 10.1071/AH20078

Abstract: ObjectiveThe aim of this study was to quantify the work activities of community aged care case managers and assess changes following consumer-directed policy reforms. MethodsA longitudinal, time and motion study was performed, with direct observation (n=339h) of case managers undertaking work in the office or in the community. We compared the distribution of proportions of time spent across seven broad work task categories during May–August 2014 (P1) and May–October 2016 (P2). ResultsOffice time was primarily consumed by communication (43.7%) and documentation (33.3%) tasks. Documentation increased substantially from P1 to P2 (29.4% vs 37.0% respectively P& .001), with more time spent on the subtask of recording information (18.0% vs 24.5% respectively P=0.039). Travel (45.9%) and communication (41.0%) accounted for most community time. Time in communication increased from P1 to P2 (37.3% vs 48.4% respectively P=0.047), with more time allocated to client communication (14.6% vs 31.7% P& .001). Case managers spent 33.6% of community time in clients’ homes (median 25.2min per client 22.8 vs 30.1min in P1 and P2 respectively) and visited a median of two clients per day (3 vs 1 visits per day in P1 and P2 respectively). ConclusionsThis study provides the first quantification of task–time distribution among this workforce and how work patterns have changed during a time of significant policy reform and operational changes within the community aged care sector. What is known about the topic?Early qualitative studies gauging case managers’ perceptions of the effect of consumer-directed care reforms on their work activities indicate an increase in time spent working directly with aged care clients. However, there is no existing quantitative evidence examining changes to case managers’ work activities. What does this paper add?By capturing timed, multidimensional data, this study provides new quantitative evidence of how case managers distribute their time on work activities in office and community settings. Further, the results provide an indication of changes in work task–time distribution over a 2-year period when significant policy reforms and operational changes occurred. Amid a changing aged care landscape, how and with whom case managers spend their time was found to shift, with an increase in time spent recording information and communicating with clients identified. What are the implications for practitioners?This study demonstrates that direct observational studies provide important evidence of the ways in which policy and organisational changes affect community aged care case managers’ work activities in practice. Triangulating this quantitative evidence with existing qualitative accounts of policy impact can further allow assessment of how complex reforms may affect everyday work. For policy makers and aged care organisations, such evidence can help discern whether policies and changes are having their desired effects, as well as providing insights as to why or why not.

The 40 health systems, COVID-19 (40HS, C-19) study

Publisher: Oxford University Press (OUP)

Date: 30-11-2021

DOI: 10.1093/INTQHC/MZAA113

Abstract: The health, social and economic consequences of the severe acute respiratory syndrome coronavirus (SARS-CoV-2, henceforth COVID-19) pandemic have loomed large as every national government made decisions about how to respond. The 40 Health Systems, COVID-19 (40HS, C-19) study aimed to investigate relationships between governments’ capacity to respond (CTR), their response stringency, scope of COVID-19 testing and COVID-19 outcomes. Data over March and April 2020 were extracted for 40 national health systems on prepandemic government CTR (Global Competitiveness Index), stringency measures (Oxford COVID-19 Government Response Tracker Stringency Index), approach to COVID-19 testing and COVID-19 cases and deaths (Our-World-in-Data). Multidimensional scaling (MDS) and cluster analysis were applied to examine latent dimensions and visualize country similarities and dissimilarities. Outcomes were tested using multivariate and one-way analyses of variances and Kruskal–Wallis H tests. The MDS model found three dimensions explaining 91% of the variance and cluster analysis identified five national groupings. There was no association between national governments’ prepandemic CTR and the adoption of early stringent public health measures or approach to COVID-19 testing. Two national clusters applied early stringency measures and reported significantly lower cumulative deaths. The best performing national cluster (comprising Australia, South Korea, Iceland and Taiwan) adopted relatively early stringency measures but broader testing earlier than others, which was associated with a change in disease trajectory and the lowest COVID-19 death rates. Two clusters (one with high CTR and one low) both adopted late stringency measures and narrow testing and performed least well in COVID-19 outcomes. Early stringency measures and intrinsic national capacities to deal with a pandemic are insufficient. Extended stringency measures, important in the short term, are not economically sustainable. Broad-based testing is key to managing COVID-19.

Applying a human factors approach to improve usability of a decision support system in tele-nursing

Publisher: Elsevier BV

Date: 06-2017

DOI: 10.1016/J.COLEGN.2016.02.001

A realist evaluation of the role of communities of practice in changing healthcare practice

Publisher: Springer Science and Business Media LLC

Date: 23-05-2011

DOI: 10.1186/1748-5908-6-49

Allied health in residential aged care: Using routinely collected data to improve funding opportunities

Publisher: Wiley

Date: 07-09-2022

DOI: 10.1111/AJAG.13136

Abstract: Consumers and providers have long been advocating for increased access to and delivery of allied health services in Australian residential aged care (RAC). There is significant evidence that allied health interventions are effective however, there is limited evidence on the benefit of routine day‐to‐day allied health service delivery in RAC. This information is critical to effectively inform funders and policy advisors of the necessity of allied health in RAC. To improve arguments for future funding opportunities, providers, facilities and consumers need to partner together to use routinely collected, yet disparate, data, in electronic health and billing records, to improve data collection practices and evidence generation on allied health in aged care.

Social Participation Among Older Adults Receiving Community Care Services

Publisher: SAGE Publications

Date: 29-07-2021

DOI: 10.1177/0733464820938973

Abstract: Aged care services have the potential to support social participation for the growing number of adults aging at home, but little is known about the types of social activities older adults in community care are engaged in. We used cluster analysis to examine the current profiles of social participation across seven domains in 1,114 older Australians, and chi-square analyses to explore between-group differences in social participation and sociodemographic and community care service use. Two distinct participation profiles were identified: (a) connected, capable, older rural women and (b) isolated, high-needs, urban-dwelling men. The first group had higher levels of engagement across six social participation domains compared with the second group. Social participation among older adults receiving community care services varies by gender, age, in idual care needs, and geographical location. More targeted service provision at both the in idual and community levels may assist older adults to access social participation opportunities.

Influence of serum iron test results on the diagnosis of iron deficiency in children: a retrospective observational study

Publisher: BMJ

Date: 07-2021

DOI: 10.1136/BMJOPEN-2020-046865

Abstract: Serum iron results are not indicative of iron deficiency yet may be incorrectly used to diagnose iron deficiency instead of serum ferritin results. Our objective was to determine the association between serum iron test results and iron-deficiency diagnosis in children by general practitioners. A retrospective observational study of 14 187 children aged 1–18 years with serum ferritin and serum iron test results from 137 general practices in Victoria, Australia, between 2008 and 2018. Generalised estimating equation models calculating ORs were used to determine the association between serum iron test results (main exposure measure) and iron-deficiency diagnosis (outcome measure) in the following two population groups: (1) iron-deplete population, defined as having a serum ferritin µg/L if aged years and µg/L if aged ≥5 years and (2) iron-replete population, defined as having a serum ferritin µg/L. 3484 tests were iron deplete and 15 528 were iron replete. Iron-deplete children were less likely to be diagnosed with iron deficiency if they had normal serum iron levels (adjusted OR (AOR): 0.73 95% CI 0.57 to 0.96). Iron-replete children had greater odds of an iron-deficiency diagnosis if they had low serum iron results (AOR: 2.59 95% CI 1.72 to 3.89). Other contributors to an iron-deficiency diagnosis were female sex and having anaemia. Serum ferritin alone remains the best means of diagnosing iron deficiency. Reliance on serum iron test results by general practitioners is leading to significant overdiagnosis and underdiagnosis of iron deficiency in children.

Nuclear medicine incident reporting in Australia: Control charts and notification rates inform quality improvement

Publisher: Wiley

Date: 06-2015

DOI: 10.1111/IMJ.12758

Abstract: Australia has a statutory incident reporting system for radiopharmaceutical maladministrations, but additional research into registry data is required for the purpose of quality improvement in nuclear medicine. We (i) used control charts to identify factors contributing to special cause variation (indicating higher than expected rates) in maladministrations and (ii) evaluated the impact of heterogeneous notification criteria and extent of underreporting among jurisdictions and in idual facilities, respectively. Anonymised summaries of Australian Radiation Incident Register reports permitted calculation of national monthly maladministration notification rates for 2007-2012 and preparation of control charts. Multivariate logistic regression assessed the association of population, insurance and regulatory characteristics with maladministration notifications in each Australian State and Territory. Maladministration notification rates from two facilities with familiarity of notification processes and commitment to radiation protection were compared with those elsewhere. Special cause variation occurred in only 3 months, but contributed to 21% of all incidents (42 of 197 patients), mainly because of 'clusters' of maladministrations (n = 24) arising from errors in bulk radiopharmaceutical dispensing. Maladministration notification rates varied significantly between jurisdictions (0 to 12.2 maladministrations per 100 000 procedures (P < 0.05)) and in idual facilities (31.7 vs 5.8 per 100 000 χ(2) = 40 1 degree of freedom, P < 0.001). Unexpected increases in maladministration notifications predominantly relate to incident 'clusters' affecting multiple patients. The bulk preparation of radiopharmaceuticals is a vulnerable process and merits additional safeguards. Maladministration notification rates in Australia are heterogeneous. Adopting uniform maladministration notification criteria among States and Territories and methods to overcome underreporting are warranted.

iPad use at the bedside: A tool for engaging patients in care processes during ward rounds?

Publisher: Wiley

Date: 10-2014

DOI: 10.1111/IMJ.12518

Abstract: Previous work has examined the impact of technology on information sharing and communication between doctors and patients in general practice consultations, but very few studies have explored this in hospital settings. To assess if, and how, senior clinicians use an iPad to share information (e.g. patient test results) with patients during ward rounds and to explore patients' and doctors' experiences of information sharing events. Ten senior doctors were shadowed on ward rounds on general wards during interactions with 525 patients over 77.3 h, seven senior doctors were interviewed and 180 patients completed a short survey. Doctors reported that information sharing with patients is critical to the delivery of high-quality healthcare, but were not seen to use the iPad to share information with patients on ward rounds. Patients did not think the iPad had impacted on their engagement with doctors on rounds. Ward rounds were observed to follow set routines and patient interactions were brief. Although the iPad potentially creates new opportunities for information sharing and patient engagement, the ward round may not present the most appropriate context for this to be done.

Protocol for the quick clinical study: A randomised controlled trial to assess the impact of an online evidence retrieval system on decision-making in general practice

Publisher: Springer Science and Business Media LLC

Date: 24-08-2006

DOI: 10.1186/1472-6947-6-33

Understanding communication networks in the emergency department

Publisher: Springer Science and Business Media LLC

Date: 12-2009

DOI: 10.1186/1472-6963-9-247

Examining challenges to reliability of health service accreditation during a period of healthcare reform in Australia

Publisher: Emerald

Date: 16-11-2015

DOI: 10.1108/JHOM-02-2015-0034

Abstract: – Health systems are changing at variable rates. Periods of significant change can create new challenges or lify existing barriers to accreditation program credibility and reliability. The purpose of this paper is to examine, during the transition to a new Australian accreditation scheme and standards, challenges to health service accreditation survey reliability, the salience of the issues and strategies to manage threats to survey reliability. – Across 2013-2014, a two-phase, multi-method study was conducted, involving five research activities (two questionnaire surveys and three group discussions). This paper reports data from the transcribed group discussions involving 100 participants, which was subject to content and thematic analysis. Participants were accreditation survey coordinators employed by the Australian Council on Healthcare Standards. – Six significant issues influencing survey reliability were reported: accreditation program governance and philosophy accrediting agency management of the accreditation process, including the program’s framework survey coordinators survey team dynamics in idual surveyors and healthcare organizations’ approach to accreditation. A change in governance arrangements promoted reliability with an independent authority and a new set of standards, endorsed by Federal and State governments. However, potential reliability threats were introduced by having multiple accrediting agencies approved to survey against the new national standards. Challenges that existed prior to the reformed system remain. – Capturing lessons and challenges from healthcare reforms is necessary if improvements are to be realized. The study provides practical and theoretical strategies to promote reliability in accreditation programs.

Stakeholder perspectives on implementing accreditation programs: A qualitative study of enabling factors

Publisher: Springer Science and Business Media LLC

Date: 24-10-2013

DOI: 10.1186/1472-6963-13-437

Interruptions are significantly associated with the frequency and severity of medication administration errors

Publisher: Wiley

Date: 15-03-2013

DOI: 10.1002/NUR.21522

Data sources and research tools for human factors

Publisher: CRC Press

Date: 22-11-2018

DOI: 10.1201/9781315116549

Hospitalisations before and after entry into a residential aged care facility: An interrupted time series analysis

Publisher: Wiley

Date: 20-10-2023

DOI: 10.1111/AJAG.13249

Interruptions versus breaks: The role of cue utilisation in a simulated process control task

Publisher: Wiley

Date: 29-11-2021

DOI: 10.1002/ACP.3766

Abstract: Although interruptions and breaks are similar insofar as they both offer a momentary recess from the primary task, the premise for the activity in which the operator engages differs. Interruptions impose the requirement to direct resources to complete a task, while breaks offer the opportunity for suspended goal rehearsal. The aim of this study was to investigate differences in resumption lags following “interruptions” and “breaks,” and whether cue utilisation moderates this relationship. Seventy‐nine university students completed an assessment of cue utilisation and managed scheduled and unscheduled interruptions and breaks during a 35‐min rail control simulation. The analyses revealed that participants who recorded higher cue utilisation recorded shorter resumption lags following scheduled, rather than unscheduled interruptions. Participants who recorded lower cue utilisation recorded shorter resumption lags following breaks compared to interruptions, irrespective of the administration. The results suggest that scheduled interruptions and breaks offer the opportunity for suspended goal rehearsal.

The impact of rapid molecular diagnostic testing for respiratory viruses on outcomes for emergency department patients

Publisher: AMPCo

Date: 05-03-2019

DOI: 10.5694/MJA2.50049

The Epidemiology of Peptic Ulcer Mortality 1953–1989: A Birth Cohort Analysis

Publisher: Oxford University Press (OUP)

Date: 1993

DOI: 10.1093/IJE/22.6.1085

Abstract: Peptic ulcer (PU) disease is the cause of substantial morbidity and mortality in a number of countries including Australia. Despite diagnostic and treatment advances, sustained mortality from PU disease has been reported. To understand this problem a birth cohort analysis using the Median Polish Technique (MPT) was performed on 36 years of mortality data from New South Wales, Australia. The MPT allows cohort effects to be quantified, yet has rarely been applied to mortality data. Birth cohort effects detected using graphical presentation of mortality data for duodenal (DU) and gastric ulcer (GU) mortality data for both males and females, were supported by the results obtained using the MPT. The DU mortality rates for females increased significantly over the 36-year period. This increase can be explained by the presence of a birth cohort effect, with women born between 1898 and 1913 having a greater risk of dying from DU than preceding or subsequent generations. Cohort effects in GU and DU mortality data for males and in GU mortality for females were also present, although these were masked by the overall decline in PU mortality rates. The results support the findings of other studies of birth cohort effects in PU mortality data from England, Europe and Japan, and provide support for the existence of environmental factors which resulted in increased PU mortality among specific birth cohorts. Demonstration of these birth cohort effects should influence the theories of PU disease aetiology and prevention and should be considered in developing approaches for further research.

Service provider perceptions of transitioning from audio to video capability in a telehealth system: A qualitative evaluation

Publisher: Springer Science and Business Media LLC

Date: 14-08-2017

DOI: 10.1186/S12913-017-2514-7

Exploring sub-optimal use of an electronic risk assessment tool for venous thromboembolism

Publisher: Elsevier BV

Date: 07-2016

DOI: 10.1016/J.APERGO.2016.01.003

Abstract: International guidelines and consensus groups recommend using a risk assessment tool (RAT) to assess Venous Thromboembolism (VTE) risk prior to the prescription of prophylaxis. We set out to examine how an electronic RAT was being used (i.e. if by the right clinician, at the right time, for the right purpose) and to identify factors influencing utilization of the RAT. A s le of 112 risk assessments was audited and 12 prescribers were interviewed. The RAT was used as intended in only 40 (35.7%) cases (i.e. completed by a doctor within 24 h of admission, prior to the prescription of prophylaxis). We identified several reasons for sub-optimal use of the RAT, including beliefs about the need for a RAT, poor awareness of the tool, and poor RAT design. If a user-centred approach had been adopted, it is likely that a RAT would not have been implemented or that problematic design issues would have been identified.

A mechanism for revising accreditation standards: A study of the process, resources required and evaluation outcomes

Publisher: Springer Science and Business Media LLC

Date: 21-11-2014

DOI: 10.1186/S12913-014-0571-8

What is multidisciplinary cancer care like in practice? a protocol for a mixed-method study to characterise ambulatory oncology services in the Australian public sector

Publisher: BMJ

Date: 10-2019

DOI: 10.1136/BMJOPEN-2019-031179

Abstract: An understanding of the real-world provision of oncology outpatient services can help maintain service quality in the face of escalating demand and tight budgets, by informing the design of interventions that improve the effectiveness or efficiency of provision. The aims of this study are threefold. First, to develop an understanding of cancer services in outpatient clinics by characterising the organisation and practice of multidisciplinary care (MDC). Second, to explore the key areas of: (a) clinical decision-making and (b) engagement with patients’ supportive needs. Third, to identify barriers to, and facilitators of, the delivery of quality care in these settings. A suite of mixed-methods studies will be implemented at six hospitals providing cancer outpatient clinics, with a staged roll-out. In Stage One, we will examine policies, use unstructured observations and undertake interviews with key health professionals to characterise the organisation and delivery of MDC. In Stage Two, observations of practice will continue, to deepen our understanding, and to inform two focused studies. The first will explore decision-making practices and the second will examine how staff engage with patients’ needs both studies involve interviews, to complement observation. As part of the study of supportive care, we will examine the implications of an introduction of patient-reported measures (PRMs) into care, adding surveys to interviews before and after PRMs roll-out. Data analysis will account for site-specific and cross-site issues using an adapted Qualitative Rapid Appraisal, Rigorous Analysis approach. Quantitative data from clinician surveys will be statistically analysed and triangulated with the related qualitative study findings. Ethical approval was granted by South Eastern Sydney Local Health District Human Research Ethics Committee (no. 18/207). Findings will be shared with participating hospitals and widely disseminated through publications and presentations.

Do online information retrieval systems help experienced clinicians answer clinical questions?

Publisher: Oxford University Press (OUP)

Date: 31-01-2005

DOI: 10.1197/JAMIA.M1717

The impact of a health IT changeover on Medical Imaging Department work processes and turnaround times: A mixed method study

Publisher: Georg Thieme Verlag KG

Date: 2015

DOI: 10.4338/ACI-2015-01-RA-0014

Abstract: Objectives: To assess the impact of introducing a new Picture Archiving and Communication System (PACS) and Radiology Information System (RIS) on: (i) Medical Imaging work processes and (ii) turnaround times (TATs) for x-ray and CT scan orders initiated in the Emergency Department (ED). Methods: We employed a mixed method study design comprising: (i) semi-structured interviews with Medical Imaging Department staff and (ii) retrospectively extracted ED data before (March/ April 2010) and after (March/April 2011 and 2012) the introduction of a new PACS/RIS. TATs were calculated as: processing TAT (median time from image ordering to examination) and reporting TAT (median time from examination to final report). Results: Reporting TAT for x-rays decreased significantly after introduction of the new PACS/RIS from a median of 76 hours to 38 hours per order (p .0001) for patients discharged from the ED, and from 84 hours to 35 hours (p .0001) for patients admitted to hospital. Medical Imaging staff reported that the changeover to the new PACS/RIS led to gains in efficiency, particularly regarding the accessibility of images and patient-related information. Nevertheless, assimilation of the new PACS/RIS with existing Departmental work processes was considered inadequate and in some instances unsafe. Issues highlighted related to the synchronization of work tasks (e.g., porter arrangements) and the material set up of the work place (e.g., the number and location of computers). Conclusions: The introduction of new health IT can be a “double-edged sword” providing improved efficiency but at the same time introducing potential hazards affecting the effectiveness of the Medical Imaging Department. Citation: Georgiou A, Prgomet M, Lymer S, Hordern A, Ridley4 L, Westbrook J.The impact of a health IT changeover on Medical Imaging Department work processes and turnaround times: a mixed method study. Appl Clin Inform 2015 6: 443–453 0.4338/ACI-2015-01-RA-0014

The impact of computerized provider order entry systems on medical-imaging services

Publisher: Oxford University Press (OUP)

Date: 08-03-2011

DOI: 10.1136/AMIAJNL-2010-000043

Measuring the financial and productivity burden of paediatric hospitalisation on the wider family network

Publisher: Wiley

Date: 19-04-2018

DOI: 10.1111/JPC.13923

International survey of COVID-19 management strategies

Publisher: Oxford University Press (OUP)

Date: 20-11-2020

DOI: 10.1093/INTQHC/MZAA139

Abstract: While in idual countries have gained considerable knowledge and experience in coronavirus disease of 2019 (COVID-19) management, an international, comparative perspective is lacking, particularly regarding the measures taken by different countries to tackle the pandemic. This paper elicits the views of health system staff, tapping into their personal expertise on how the pandemic was initially handled. From May to July 2020, we conducted a cross-sectional, online, purpose-designed survey comprising 70 items. Email lists of contacts provided by the International Society for Quality in Health Care, the Italian Network for Safety in Health Care and the Australian Institute of Health Innovation were used to access healthcare professionals and managers across the world. We snowballed the survey to in iduals and groups connected to these organizations. Key outcome measures were attitudes and information about institutional approaches taken media communication how acute hospitals were re-organized primary health organization personal protective equipment and staffing and training. A total of 1131 survey participants from 97 countries across the World Health Organization (WHO) regions responded to the survey. Responses were from all six WHO regions 57.9% were female and the majority had 10 or more years of experience in healthcare almost half (46.5%) were physicians and all other major clinical professional groups participated. As the pandemic progressed, most countries established an emergency task force, developed communication channels to citizens, organized health services to cope and put in place appropriate measures (e.g. pathways for COVID-19 patients, and testing, screening and tracing procedures). Some countries did this better than others. We found several significant differences between the WHO regions in how they are tackling the pandemic. For instance, while overall most respondents (71.4%) believed that there was an effective plan prior to the outbreak, this was only the case for 31.9% of respondents from the Pan American Health Organization compared with 90.7% of respondents from the South-East Asia Region (SEARO). Issues with swab testing (e.g. delay in communicating the swab outcome) were less frequently reported by respondents from SEARO and the Western Pacific Region compared with other regions. The world has progressed in its knowledge and sophistication in tackling the pandemic after early and often substantial obstacles were encountered. Most WHO regions have or are in the process of responding well, although some countries have not yet instituted widespread measures known to support mitigation, for ex le, effective swab testing and social control measures.

Harnessing the potential of electronic general practice pathology data in Australia: An examination of the quality use of pathology for type 2 diabetes patients

Publisher: Elsevier BV

Date: 09-2020

DOI: 10.1016/J.IJMEDINF.2020.104189

A work observation study of nuclear medicine technologists: Interruptions, resilience and implications for patient safety

Publisher: BMJ

Date: 05-10-2017

DOI: 10.1136/BMJQS-2016-005846

Allied health professionals’ use of online evidence: a survey of 790 staff working in the Australian public hospital system

Publisher: Elsevier BV

Date: 05-2004

DOI: 10.1016/J.IJMEDINF.2003.12.017

Comprehensive Researcher Achievement Model (CRAM): A framework for measuring researcher achievement, impact and influence derived from a systematic literature review of metrics and models

Publisher: BMJ

Date: 03-2019

DOI: 10.1136/BMJOPEN-2018-025320

Abstract: Effective researcher assessment is key to decisions about funding allocations, promotion and tenure. We aimed to identify what is known about methods for assessing researcher achievements, leading to a new composite assessment model. We systematically reviewed the literature via the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols framework. All Web of Science databases (including Core Collection, MEDLINE and BIOSIS Citation Index) to the end of 2017. (1) English language, (2) published in the last 10 years (2007–2017), (3) full text was available and (4) the article discussed an approach to the assessment of an in idual researcher’s achievements. Articles were allocated among four pairs of reviewers for screening, with each pair randomly assigned 5% of their allocation to review concurrently against inclusion criteria. Inter-rater reliability was assessed using Cohen’s Kappa (ĸ). The ĸ statistic showed agreement ranging from moderate to almost perfect (0.4848–0.9039). Following screening, selected articles underwent full-text review and bias was assessed. Four hundred and seventy-eight articles were included in the final review. Established approaches developed prior to our inclusion period (eg, citations and outputs, h-index and journal impact factor) remained dominant in the literature and in practice. New bibliometric methods and models emerged in the last 10 years including: measures based on PageRank algorithms or ‘altmetric’ data, methods to apply peer judgement and techniques to assign values to publication quantity and quality. Each assessment method tended to prioritise certain aspects of achievement over others. All metrics and models focus on an element or elements at the expense of others. A new composite design, the Comprehensive Researcher Achievement Model (CRAM), is presented, which supersedes past anachronistic models. The CRAM is modifiable to a range of applications.

Tackling the wicked problem of health networks: the design of an evaluation framework

Publisher: BMJ

Date: 05-2019

DOI: 10.1136/BMJOPEN-2018-024231

Abstract: Networks are everywhere. Health systems and public health settings are experimenting with multifarious forms. Governments and providers are heavily investing in networks with an expectation that they will facilitate the delivery of better services and improve health outcomes. Yet, we lack a suitable conceptual framework to evaluate the effectiveness and sustainability of clinical and health networks. This paper aims to present such a framework to assist with rigorous research and policy analysis. The framework was designed as part of a project to evaluate the effectiveness and sustainability of health networks. We drew on systematic reviews of the literature on networks and communities of practice in health care, and on theoretical and evidence-based studies of the evaluation of health and non-health networks. Using brainstorming and mind-mapping techniques in expert advisory group sessions, we assessed existing network evaluation frameworks and considered their application to extant health networks. Feedback from stakeholders in network studies that we conducted was incorporated. The framework encompasses network goals, characteristics and relationships at member, network and community levels, and then looks at network outcomes, taking into account intervening variables. Finally, the short-term, medium-term and long-term effectiveness of the network needs to be assessed. The framework provides an overarching contribution to network evaluation. It is sufficiently comprehensive to account for many theoretical and evidence-based contributions to the literature on how networks operate and is sufficiently flexible to assess different kinds of health networks across their life-cycle at community, network and member levels. We outline the merits and limitations of the framework and discuss how it might be further tested.

Redesign of computerized decision support to improve antimicrobial prescribing

Publisher: Georg Thieme Verlag KG

Date: 07-2017

DOI: 10.4338/ACI2017040069

Abstract: Objective: To determine the impact of the introduction of new pre-written orders for antimicrobials in a computerized provider order entry (CPOE) system on 1) accuracy of documented indications for antimicrobials in the CPOE system, 2) appropriateness of antimicrobial prescribing, and 3) compliance with the hospital’s antimicrobial policy. Prescriber opinions of the new decision support were also explored to determine why the redesign was effective or ineffective in altering prescribing practices. Methods: The study comprised two parts: a controlled pre-post study and qualitative interviews. The intervention involved the redesign of pre-written orders for half the antimicrobials so that approved indications were incorporated into pre-written orders. 555 antimicrobials prescribed before (September – October, 2013) and 534 antimicrobials prescribed after (March – April, 2015) the intervention on all general wards of a hospital were audited by study pharmacists. Eleven prescribers participated in semi-structured interviews. Results: Redesign of computerized decision support did not result in more appropriate or compliant antimicrobial prescribing, nor did it improve accuracy of indication documentation in the CPOE system (Intervention antimicrobials: appropriateness 49% vs. 50% compliance 44% vs. 42% accuracy 58% vs. 38% all p .05). Via our interviews with prescribers we identified five main reasons for this, primarily that indications entered into the CPOE system were not monitored or followed-up, and that the antimicrobial approval process did not align well with prescriber workflow. Conclusion: Redesign of pre-written orders to incorporate appropriate indications did not improve antimicrobial prescribing. Workarounds are likely when compliance with hospital policy creates additional work for prescribers or when system usability is poor. Implementation of IT, in the absence of support or follow-up, is unlikely to achieve all anticipated benefits. Citation: Baysari MT, Del Gigante J, Moran M, Sandaradura I, Li L, Richardson KL, Sandhu A, Lehnbom EC, Westbrook JI, Day RO. Redesign of computerized decision support to improve antimicrobial prescribing. Appl Clin Inform 2017 8: 949–963 0.4338/ACI2017042017040069

Evaluation of the accuracy of diagnostic coding for influenza compared to laboratory results

Publisher: Springer Science and Business Media LLC

Date: 22-05-2021

DOI: 10.1186/S12911-021-01531-9

Abstract: Assessing the accuracy of diagnostic coding is essential to ensure the validity and reliability of administrative coded data. The aim of the study was to evaluate the accuracy of assigned International Classification of Diseases version 10-Australian Modification (ICD-10-AM) codes for influenza by comparing with patients’ results of their polymerase chain reaction (PCR)-based laboratory tests. A retrospective study was conducted across seven public hospitals in New South Wales, Australia. A total of 16,439 patients who were admitted and tested by either cartridge-based rapid PCR or batched multiplex PCR between January 2016 and December 2017 met the inclusion criteria. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ICD-10-AM coding using laboratory results as a gold standard . Separate analyses were conducted to determine whether the availability of test results at the time of hospital discharge influenced diagnostic coding accuracy. Laboratory results revealed 2759 positive influenza cases, while ICD-10-AM coding identified 2527 patients. Overall, 13.7% (n = 378) of test positive patients were not assigned an ICD-10-AM code for influenza. A further 5.8% (n = 146) patients with negative test results were incorrectly assigned an ICD-10-AM code for influenza. The sensitivity, specificity, PPV and NPV of ICD-10-AM coding were 93.1% 98.9% 94.5% and 98.6% respectively when test results were received before discharge and 32.7% 99.2% 87.8% and 89.8% respectively when test results were not available at discharge. The sensitivity of ICD-10-AM coding varied significantly across hospitals. The use of rapid PCR or hospitalisation during the influenza season were associated with greater coding accuracy. Although ICD-10-AM coding for influenza demonstrated high accuracy when laboratory results were received before discharge, its sensitivity was substantially lower for patients whose test results were not available at discharge. The timely availability of laboratory test results during the episode of care could contribute to improved coding accuracy.

Medication administration in Australian residential aged care: A time-and-motion study

Publisher: Wiley

Date: 14-04-2021

DOI: 10.1111/JEP.13393

Charting a course through the health care policy maze

Publisher: Wiley

Date: 06-1994

DOI: 10.1111/J.1467-8500.1994.TB01889.X

Imaging for patients presenting to an emergency department with back pain: Impact on patient pathway.

Publisher: Wiley

Date: 05-05-2016

DOI: 10.1111/1742-6723.12602

Abstract: The objective of the present study is to quantify utilisation of imaging for patients presenting to an ED with back pain, their characteristics and dispositions. A retrospective cohort study of 1132 ED presentations for back pain to an Australian metropolitan ED in 2013 was performed. Patient demographics, rates of radiography, computed tomography or magnetic resonance imaging and rates of subsequent admission and ED re-presentation were analysed. Patients aged 26-35 years were the largest group presenting with back pain (19.4% of presentations), with the majority being female (52.3%). Imaging was requested at 29.5% (n = 334) of presentations (radiography n = 297 advanced imaging n = 63). Patients over 70 years had higher imaging rates than younger patients (49.4% vs 25.5%, P < 0.001). Imaging was not associated with attendance during or outside office hours (29.3% vs 31.8%, P = 0.4). Of presentations, 34.1% resulted in admission, with no association between imaging and admission (31.8% vs 36.0%, P = 0.2) or ED re-presentation for back pain in the same year (6.5% vs 9.7%, P = 0.09). This study provides benchmark data on the use of imaging for back pain in an Australian ED, an area which has been largely unexplored. The rate of imaging in the ED was higher than previously reported in a General Practice setting. Consistent with guidelines, patients older than 70 were more than twice as likely to receive imaging compared to younger patients. It was beyond the scope of the current study to determine whether these images were clinically indicated and further research is required to determine if initiatives to reduce imaging in this population are warranted.

Changes in unprofessional behaviour, teamwork, and co‐operation among hospital staff during the COVID‐19 pandemic

Publisher: Wiley

Date: 14-09-2022

DOI: 10.1111/IMJ.15913

Abstract: A survey administered to staff at five hospitals investigated changes in unprofessional behaviour, teamwork and co‐operation during the COVID‐19 pandemic. From 1583 responses, 76.1% (95% confidence interval (CI): 74.0–78.2%) reported no change or a decrease in unprofessional behaviours. Across all professional groups, 43.6% ( n = 579, 95% CI: 41.0–46.3%) reported improvements in teamwork and co‐operation. Findings suggest that intensifying work demands, such as those resulting from the pandemic, are not a major trigger for unprofessional behaviour, and root causes lie elsewhere.

The Effect of Laboratory Testing on Emergency Department Length of Stay: A Multihospital Longitudinal Study Applying a Cross‐classified Random‐effect Modeling Approach

Publisher: Wiley

Date: 2015

DOI: 10.1111/ACEM.12565

Restructuring as gratification

Publisher: SAGE Publications

Date: 12-2005

DOI: 10.1258/JRSM.98.12.542

Changes, disruption and innovation

Publisher: Elsevier BV

Date: 2012

DOI: 10.4103/2153-3539.95128

Effectiveness of guidelines on persistent glue ear in children

Publisher: BMJ

Date: 16-03-2002

DOI: 10.1136/BMJ.324.7338.673

Examining barriers to healthcare providers’ adoption of a hospital-wide electronic patient journey board

Publisher: Elsevier BV

Date: 06-2018

DOI: 10.1016/J.IJMEDINF.2018.03.007

Abstract: The dynamic environment that characterizes patient care in hospitals requires extensive communication between staff. Electronic status board applications are used to improve the flow of communication in hospitals. To date there has been limited work exploring the adoption of these applications in general acute ward settings. This study aimed to identify barriers to the adoption of an electronic patient journey board (EPJB) Data were collected at a large public teaching hospital in Sydney, Australia. The EPJB was implemented across all hospital wards with the aim of improving multidisciplinary communication in wards. Observations (29.5 h) and contextual interviews (n = 33) with hospital staff were conducted in two acute wards of the hospital. Two manual whiteboards were used on wards, in addition to the EPJB, to compensate for information not being available or accessible on the EPJB. Despite the stated purpose of the EPJB, the tool did not appear to support team communication on wards. Barriers to adoption and optimal use of the EPJB included inappropriate location and configuration of the system, limitations in information timeliness, quality and lack of customisation (for different user groups), inconsistent information updates and the absence of a shared understanding of the purpose of the EPJB among the various user groups. Multiple socio-technical barriers influenced uptake and optimal use of the EPJB by healthcare providers. Engaging users early in the design and implementation of electronic status board applications is required to ensure effective use of these complex interventions on general wards.

Preventable adverse drug events among inpatients

Publisher: American Academy of Pediatrics (AAP)

Date: 09-2018

DOI: 10.1542/PEDS.2018-0805

Abstract: Patient harm resulting from medication errors drives prevention efforts, yet harm associated with medication errors in children has not been systematically reviewed. To review the incidence and severity of preventable adverse drug events (pADEs) resulting from medication errors in pediatric inpatient settings. Data sources included Cumulative Index of Nursing and Allied Health Literature, Medline, Scopus, the Cochrane Library, and Embase. Selected studies were published between January 2000 and December 2017, written in the English language, and measured pADEs among pediatric hospital inpatients by chart review or direct observation. Data extracted were medication error and harm definitions, pADE incidence and severity rates, items required for quality assessment, and s le details. Twenty-two studies were included. For children in general pediatric wards, incidence was at 0 to 17 pADEs per 1000 patient days or 1.3% of medication errors (of any type) compared with 0 to 29 pADEs per 1000 patient days or 1.5% of medication errors in ICUs. Hospital-wide studies contained reports of up to 74 pADEs per 1000 patient days or 2.6% of medication errors. The severity of pADEs was mainly minor. Limited literature on the severity of pADEs is available. Additional study will better illuminate differences among hospital wards and among those with or without health information technology. Medication errors in pediatric settings seldom result in patient harm, and if they do, harm is predominantly of minor severity. Implementing health information technologies was associated with reduced incidence of harm.

Nudging hospitals towards evidence‐based decision support for medication management

Publisher: AMPCo

Date: 30-03-2019

DOI: 10.5694/MJA2.50028

Perceptions of the effect of information and communication technology on the quality of care delivered in emergency departments: A cross-site qualitative study

Publisher: Elsevier BV

Date: 02-2013

DOI: 10.1016/J.ANNEMERGMED.2012.08.032

Abstract: We identify and describe emergency physicians' and nurses' perceptions of the effect of an integrated emergency department (ED) information system on the quality of care delivered in the ED. A qualitative study was conducted in 4 urban EDs, with each site using the same ED information system. Participants (n=97) were physicians and nurses with data collected by 69 detailed interviews, 5 focus groups (28 participants), and 26 hours of structured observations. Results revealed new perspectives on how an integrated ED information system was perceived to affect incentives for use, awareness of colleagues' activities, and workflow. A key incentive was related to the positive effect of the ED information system on clinical decisionmaking because of improved and quicker access to patient-specific and knowledge-base information compared with the previous stand-alone ED information system. Synchronous access to patient data was perceived to lead to enhanced awareness by in idual physicians and nurses of what others were doing within and outside the ED, which participants claimed contributed to improved care coordination, communication, clinical documentation, and the consultation process. There was difficulty incorporating the use of the ED information system with clinicians' work, particularly in relation to increased task complexity duplicate documentation, and computer issues related to system usability, hardware, and in iduals' computer skills and knowledge. Physicians and nurses perceived that the integrated ED information system contributed to improvements in the delivery of patient care, enabling faster and better-informed decisionmaking and specialty consultations. The challenge of electronic clinical documentation and balancing data entry demands with system benefits necessitates that new methods of data capture, suited to busy clinical environments, be developed.

Health care participants' dualism: are new sub-species evolving?

Publisher: SAGE Publications

Date: 02-2007

DOI: 10.1258/JRSM.100.2.78

Use and Evaluation of Computerized Clinical Decision Support Systems for Early Detection of Sepsis in Hospitals: Protocol for a Scoping Review (Preprint)

Publisher: JMIR Publications Inc.

Date: 09-10-2020

DOI: 10.2196/PREPRINTS.24899

Abstract: epsis is a leading cause of death in hospitals, with high associated costs for both patients and health care systems worldwide. Early detection followed by timely intervention is critical for successful sepsis management and, hence, can save lives. Health care institutions are increasingly leveraging clinical data captured in electronic health records for the development of i computerized clinical decision support /i (CCDS) systems aimed at enhancing the early detection of sepsis. However, a comprehensive evidence base regarding sepsis CCDS systems to inform clinical practice, research, and policy is currently lacking. his scoping review aims to systematically describe studies reporting on the use and evaluation of CCDS systems for early detection of sepsis in hospitals. he methodology for conducting scoping reviews presented by the Joanna Briggs Institute Reviewer’s Manual and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) will be used and adapted as guides. A comprehensive literature search of 10 electronic databases will be conducted to identify all empirical quantitative and qualitative studies that investigate the use of CCDS systems for early detection of sepsis in hospitals. Detailed inclusion and exclusion criteria have been developed. Two reviewers will independently screen all articles based on these criteria. Any discrepancies will be resolved through discussion and further review by a third researcher if required. lectronic database searches have retrieved 12,139 references after removing 10,051 duplicates. As of the submission date of this protocol, we have completed the title and abstract screening. A total of 372 references will be included for full-text screening. Only 15.9% (59/372) of these studies were focused on children: 11.0% (41/372) for pediatric and 4.8% (18/372) for neonatal patients. The scoping review and the manuscript will be completed by December 2020. esults of this review will guide researchers in determining gaps and shortcomings in the current evidence base for CCDS system use and evaluation in the early detection of sepsis. The findings will be shared with key stakeholders in clinical care, research, policy, and patient advocacy. RR1-10.2196/24899

CareTrack: Assessing the appropriateness of health care delivery in Australia

Publisher: AMPCo

Date: 07-2012

DOI: 10.5694/MJA12.10510

How does antibiotic use in Australian residential aged care compare globally?

Publisher: Elsevier BV

Date: 11-2021

DOI: 10.1016/J.IDH.2021.09.036

Reducing antibiotic prescribing using nudges: A systematic review of interventions in primary care

Publisher: Elsevier BV

Date: 11-2021

DOI: 10.1016/J.IDH.2021.09.037

Computerized Clinical Decision Support Systems for the Early Detection of Sepsis Among Pediatric, Neonatal, and Maternal Inpatients: Scoping Review

Publisher: JMIR Publications Inc.

Date: 06-05-2022

DOI: 10.2196/35061

Abstract: Sepsis is a severe condition associated with extensive morbidity and mortality worldwide. Pediatric, neonatal, and maternal patients represent a considerable proportion of the sepsis burden. Identifying sepsis cases as early as possible is a key pillar of sepsis management and has prompted the development of sepsis identification rules and algorithms that are embedded in computerized clinical decision support (CCDS) systems. This scoping review aimed to systematically describe studies reporting on the use and evaluation of CCDS systems for the early detection of pediatric, neonatal, and maternal inpatients at risk of sepsis. MEDLINE, Embase, CINAHL, Cochrane, Latin American and Caribbean Health Sciences Literature (LILACS), Scopus, Web of Science, OpenGrey, ClinicalTrials.gov, and ProQuest Dissertations and Theses Global (PQDT) were searched by using a search strategy that incorporated terms for sepsis, clinical decision support, and early detection. Title, abstract, and full-text screening was performed by 2 independent reviewers, who consulted a third reviewer as needed. One reviewer performed data charting with a s le of data. This was checked by a second reviewer and via discussions with the review team, as necessary. A total of 33 studies were included in this review—13 (39%) pediatric studies, 18 (55%) neonatal studies, and 2 (6%) maternal studies. All studies were published after 2011, and 27 (82%) were published from 2017 onward. The most common outcome investigated in pediatric studies was the accuracy of sepsis identification (9/13, 69%). Pediatric CCDS systems used different combinations of 18 erse clinical criteria to detect sepsis across the 13 identified studies. In neonatal studies, 78% (14/18) of the studies investigated the Kaiser Permanente early-onset sepsis risk calculator. All studies investigated sepsis treatment and management outcomes, with 83% (15/18) reporting on antibiotics-related outcomes. Usability and cost-related outcomes were each reported in only 2 (6%) of the 31 pediatric or neonatal studies. Both studies on maternal populations were short abstracts. This review found limited research investigating CCDS systems to support the early detection of sepsis among pediatric, neonatal, and maternal patients, despite the high burden of sepsis in these vulnerable populations. We have highlighted the need for a consensus definition for pediatric and neonatal sepsis and the study of usability and cost-related outcomes as critical areas for future research. RR2-10.2196/24899

Sepsis epidemiology in Australian Public Hospitals, a nationwide longitudinal study (2013-2018)

Publisher: Elsevier BV

Date: 11-2021

DOI: 10.1016/J.IDH.2021.09.032

Association of interruptions with an increased risk and severity of medication administration errors

Publisher: American Medical Association (AMA)

Date: 26-04-2010

DOI: 10.1001/ARCHINTERNMED.2010.65

Abstract: Interruptions have been implicated as a cause of clinical errors, yet, to our knowledge, no empirical studies of this relationship exist. We tested the hypothesis that interruptions during medication administration increase errors. We performed an observational study of nurses preparing and administering medications in 6 wards at 2 major teaching hospitals in Sydney, Australia. Procedural failures and interruptions were recorded during direct observation. Clinical errors were identified by comparing observational data with patients' medication charts. A volunteer s le of 98 nurses (representing a participation rate of 82%) were observed preparing and administering 4271 medications to 720 patients over 505 hours from September 2006 through March 2008. Associations between procedural failures (10 indicators eg, aseptic technique) and clinical errors (12 indicators eg, wrong dose) and interruptions, and between interruptions and potential severity of failures and errors, were the main outcome measures. Each interruption was associated with a 12.1% increase in procedural failures and a 12.7% increase in clinical errors. The association between interruptions and clinical errors was independent of hospital and nurse characteristics. Interruptions occurred in 53.1% of administrations (95% confidence interval [CI], 51.6%-54.6%). Of total drug administrations, 74.4% (n = 3177) had at least 1 procedural failure (95% CI, 73.1%-75.7%). Administrations with no interruptions (n = 2005) had a procedural failure rate of 69.6% (n = 1395 95% CI, 67.6%-71.6%), which increased to 84.6% (n = 148 95% CI, 79.2%-89.9%) with 3 interruptions. Overall, 25.0% (n = 1067 95% CI, 23.7%-26.3%) of administrations had at least 1 clinical error. Those with no interruptions had a rate of 25.3% (n = 507 95% CI, 23.4%-27.2%), whereas those with 3 interruptions had a rate of 38.9% (n = 68 95% CI, 31.6%-46.1%). Nurse experience provided no protection against making a clinical error and was associated with higher procedural failure rates. Error severity increased with interruption frequency. Without interruption, the estimated risk of a major error was 2.3% with 4 interruptions this risk doubled to 4.7% (95% CI, 2.9%-7.4% P < .001). Among nurses at 2 hospitals, the occurrence and frequency of interruptions were significantly associated with the incidence of procedural failures and clinical errors.

Macquarie University

Location: Australia

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University Of Sydney

Location: Australia

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Linkage Projects - Grant ID: LP0347042

Start Date: 2003

End Date: 12-2011

Amount: $502,228.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP0775532

Start Date: 06-2007

End Date: 12-2010

Amount: $427,266.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP160100211

Start Date: 12-2016

End Date: 05-2021

Amount: $362,000.00

Funder: Australian Research Council

Discovery Projects - Grant ID: DP0666600

Start Date: 07-2006

End Date: 12-2009

Amount: $336,000.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP100200586

Start Date: 07-2010

End Date: 06-2015

Amount: $1,450,000.00

Funder: Australian Research Council

Discovery Projects - Grant ID: DP160100943