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The Royal Australasian College of Physicians (RACP) has recently issued a position statement titled 'Using artificial intelligence in clinical practice', which provides a framework for the safe and ethical integration of artificial intelligence (AI) into physician practice. The statement outlines core principles for implementing, interacting with and monitoring AI tools to ensure they enhance rather than replace clinical judgement, protect patient safety and privacy and abide by ethical and regulatory standards. It identifies important benefits, such as increased administrative efficiency and improved support for clinical decision-making, while cautioning against risks such as algorithmic bias, data breaches and medicolegal liabilities. The statement also offers enabling strategies to overcome various barriers such as biased or inaccurate tools, professional and public resistance to the use of AI and adverse environmental impacts. The RACP advocates for physicians to engage in AI development and implementation using an agile human-in-the-loop approach that prioritises patient safety, clinical governance, professional training and collaboration with stakeholders.
Objectives To determine the feasibility, uptake, safety, effectiveness and acceptability of nursing students and allied health assistants (AHAs) delivering additional exercise sessions during inpatient geriatric rehabilitation and to assess whether this model improved patient and health service outcomes compared with usual care.Design Prospective pre–post implementation evaluation.Setting A single secondary-care geriatric subacute rehabilitation ward in metropolitan Australia.Participants All patients aged ≥65 years admitted with deconditioning, falls or hip fracture who were able to weight-bear were eligible. Exclusion criteria included inability to participate in exercise or medical instability. Sixty-four participants were included in the pre-implementation cohort and 115 in the implementation cohort (91% uptake).Interventions Nursing students were supported to deliver up to two additional weekday exercise sessions alongside usual physiotherapy care and AHAs delivered one additional weekend exercise session. Implementation strategies were informed by the Consolidated Framework for Implementation Research and included staff orientation, training, supervision and structured verbal and written handovers. The intervention was delivered over a 6-month period.Outcome measures Primary outcomes were feasibility and uptake. Secondary outcomes included safety (falls and medical emergency calls), effectiveness (functional independence, mobility, discharge destination and subacute length of stay) and acceptability.Results Nursing students delivered 13 exercise sessions in total, indicating low feasibility, whereas AHA-led sessions were delivered consistently, with participants receiving one additional session during a mean 15-day admission. No statistically significant differences were observed in functional independence, mobility, discharge destination or length of stay (LOS) (implementation: mean 15.5 days, SD 11.2; pre-implementation: mean 16.4 days, SD 12.4). Falls incidence decreased from 52 events pre-implementation to 38 during implementation, although this did not reach statistical significance. The study was not powered to detect small differences, and CIs were not calculated.Conclusions Using nursing students to deliver additional therapy sessions was not feasible, whereas AHA-led sessions were easier to implement. The intervention was safe. The fidelity of the nursing student-led component was compromised by multiple personal, service and system-level factors.
In Australia, as in many other jurisdictions, people with low-trauma hip fractures often stay in hospital for extended periods, even when medically stable, increasing risk of hospital-related complications and increasing healthcare costs. In this context, we sought to determine the feasibility of a targeted hospital-in-the-home program following low-trauma hip fracture (LTHF). We conducted a prospective, quasi-experimental (consumer-choice) feasibility study at a tertiary metropolitan hospital, [ANONYMISED], Australia. All local community-dwelling patients with LTHF, 22/7/24–30/11/24, planning return to the community, were potentially eligible for inclusion. The intervention comprised a multidisciplinary early supported physical hospital discharge program (HITH4Hips) delivered to eligible patients who agreed to participation; the control comprised those who were eligible but declined. Primary feasibility and several secondary outcomes were mapped to select elements of the validated RE-AIM framework: reach (characteristics, initial eligibility at screening and final eligibility [able to transfer], consent), effectiveness (‘success rate’, length of stay LOS (acute, and physical in-hospital), hospital-acquired complications (HACs), opioid consumption; patient-reported pain control, health-related quality of life [EQ-Today], falls efficacy, experience measures, health service use, medication costs), patient acceptability, implementation (carer burden, fidelity). Adoption and maintenance outcomes were explored qualitatively, and reported separately. Amongst 101 patients with LTHF screened, 42/101 were initially eligible, 32/101 remained HITH-eligible, 22/32 consented (chose HITH4Hips). Of these, 19/22 consenting transferred onto HITH4Hips (mean age 77.6 years, 53
Objectives To explore the experiences of patients, carers, nursing students, and health care workers of the BOOST 2.0 implementation trial in the subacute geriatric rehabilitation ward and understand the factors influencing uptake and sustainability.Methods This research is a qualitative study using a thematic analysis approach. Semistructured individual and focus group interviews were conducted with various stakeholders who were involved in the implementation trial. A total of 11 focus groups and 31 individual interviews were included in the present study, which were recorded, transcribed verbatim, and coded using reflexive thematic analysis. After themes were constructed using open coding, they were presented using the Consolidated Framework for Implementation Research. Participant validation was conducted with members of the research team who were not involved with coding to ensure accuracy of the research findings.Results Three key themes were developed: (1) perceptions about the BOOST 2.0 intervention, (2) perceptions of the implementation strategy of BOOST 2.0, (3) BOOST 2.0 within the inner (ward) and outer (hospital) setting. Patients, carers, nursing students, and health care workers perceived that the BOOST 2.0 intervention would increase patient physical activity on the ward and facilitate quicker discharges. The use of nursing students to deliver exercise therapy was hindered by a perceived lack of confidence and clinical experience, conflicting clinical priorities, and placement policies. The use of allied health assistants was more acceptable to staff and patients due to their exposure to the ward.Conclusion This study provides insights into how the alternative health workforce can deliver health interventions in hospitals. Further research is needed to explore the effectiveness of using a diverse clinical workforce to deliver interventions that can improve outcomes for patients.
