Abstract The impact of shorter hospital lengths of stay on patient outcomes at discharge from acute care after knee arthroplasty was investigated in a prospective observational outcome study at three Melbourne public hospitals during a 5-month period from October 1999 to March 2000. The participants were 105 consecutive patients (35 at each hospital), with a mean age of 71 years. Outcome measures were length of stay, destination (home or rehabilitation) and functional mobility at discharge from the acute care facility. During the study period mean hospital length of stay across the three hospitals was 6.5 days, more than 30% less than the Victorian average for the preceding year. This was associated with high rates of discharge to rehabilitation facilities (mean 64%), with rates varying between the three hospitals (97%, 57% and 40%). However, in each hospital, one-third of this group had already achieved a level of independent functional mobility adequate for discharge home, highlighting an apparent influence of non-clinical factors on discharge decisions, including pressure to decrease length of stay, hospital policy and availability of a rehabilitation bed. Ways of achieving discharge directly home for a greater number of patients following knee arthroplasty and of determining optimal length of stay are discussed.
Journal of Quality in Clinical PracticeVolume 21, Issue 1-2 p. 21-21 Commentary – Diabetes in general practice: Tongans in Tonga and South Auckland Jeff Flack FRACP, MM, Director, Diabetes Centre, Bankstown-Lidcombe Hospital, Locked Bag 1600, Bankstown, NSW 2200, Australia (Email: Jeff.Flack@swsahs.nsw.gov.au)Search for more papers by this author Jeff Flack FRACP, MM, Director, Diabetes Centre, Bankstown-Lidcombe Hospital, Locked Bag 1600, Bankstown, NSW 2200, Australia (Email: Jeff.Flack@swsahs.nsw.gov.au)Search for more papers by this author First published: 28 June 2008 https://doi.org/10.1111/j.1440-1762.2001.00401.pp.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume21, Issue1-2March/June 2001Pages 21-21 RelatedInformation
Journal of Quality in Clinical PracticeVolume 21, Issue 3 p. 89-91 Aspects of the Pharmaceuticals Benefits Scheme Peter Baume AO, MD, BS, HonLittD, FRACP, Hon FRACGP, FAFPHM, Peter Baume AO, MD, BS, HonLittD, FRACP, Hon FRACGP, FAFPHM The Social Policy Research Centre, The University of New South Wales, Sydney, Australia (Email: p.baume@unsw.edu.au) p.baume@unsw.edu.au)Search for more papers by this author Peter Baume AO, MD, BS, HonLittD, FRACP, Hon FRACGP, FAFPHM, Peter Baume AO, MD, BS, HonLittD, FRACP, Hon FRACGP, FAFPHM The Social Policy Research Centre, The University of New South Wales, Sydney, Australia (Email: p.baume@unsw.edu.au) p.baume@unsw.edu.au)Search for more papers by this author First published: 12 January 2002 https://doi.org/10.1046/j.1440-1762.2001.00419.x EDITORIAL NOTE This paper was contributed at my request because I attended the presentation of the paper at the Australian Health Policy Institute at the University of Sydney in May 2001. It needs to be stated that a drug company representative strongly disagreed with Professor Baume’s approach. I will leave it to the reader to determine his or her own views about the State subsidising low cost, non-life-saving drugs. John Duggan, Editor Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume21, Issue3September 2001Pages 89-91 RelatedInformation
Clinical Sports Medicine has been fully updated from the popular 2nd edition (2000). It is even more practical, now superbly illustrated, easy-to-read and packed with substantially updated and new material. There are samples of several chapters online including the whole Pain in the Achilles region chapter. This book describes a completely symptom-oriented approach to treating clinical problems.
Health practitioners often regard complaints about the quality of patient care in a negative light. However, complaints can indicate strategies to improve care. Therefore, an audit was undertaken of all formal complaints about patient care at a major Australian hospital over a 30-month period. The profile of complainants, the reasons for complaints, and the outcome were analysed. A total of 1308 complaints, concerning the care of 1267 patients, were received. The complaint rate was 1.12 per 1000 occasions of service. In all, 57% of complaints were lodged by advocates and 71% of complaints related to poor communication or to the treatment provided. In 97% of occasions, an explanation and/or an apology resulted. To date, no complaint has proceeded to litigation. Complaints are potentially useful quality assurance tools and can identify remediable system flaws. Health professionals and employers should understand why patients complain and be able to respond appropriately.
Research confirms that laparoscopic cholecystectomy (LC) results in shorter lengths of hospital stay and earlier return to usual activity than the traditional cholecystectomy procedure. Research in this area, however, focuses more on the medical aspects of patient recovery, but very few studies have evaluated how these patients manage their recovery at home or what types of problems they encounter. A total of 28 LC patients were randomly assigned to two groups: (1) 23 h stay (overnight) in a general surgical ward or (2) day procedure unit (DPU) stay. Data was collected by a self-administered Postoperative Symptoms Diary and telephone interview. Results showed no significant difference between the two groups of patients recovery symptoms scores. Problems with mobility, pain and elimination recorded the highest mean scores for both groups of patients. Overnight patients also experienced problems with tiredness and eating. All DPU patients were able to manage their postoperative symptoms, compared to only 44% of patients who had stayed in overnight. Carer assistance was needed with regard to activities of daily living, child care and reassurance. Results showed that with careful selection of patients, LC cases performed as day procedures did not impact at all on the patients' recovery trajectory.
Journal of Quality in Clinical PracticeVolume 21, Issue 1-2 p. 25-25 Commentary – Process of audit in medical practice Andrew Child MMBS(Hons), FRANZCOG, FRCOG, Andrew Child MMBS(Hons), FRANZCOG, FRCOG Director of Obstetrics and Gynaecology, King George V Memorial Hospital for Mothers and Babies, Missenden Road, Camperdown, NSW 2050, Australia (Email:childa@rpamail.cs.nsw.gov.au)Search for more papers by this author Andrew Child MMBS(Hons), FRANZCOG, FRCOG, Andrew Child MMBS(Hons), FRANZCOG, FRCOG Director of Obstetrics and Gynaecology, King George V Memorial Hospital for Mothers and Babies, Missenden Road, Camperdown, NSW 2050, Australia (Email:childa@rpamail.cs.nsw.gov.au)Search for more papers by this author First published: 28 June 2008 https://doi.org/10.1111/j.1440-1762.2001.00398.pp.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume21, Issue1-2March/June 2001Pages 25-25 RelatedInformation
Mass radiographic screening for tuberculosis has lost favour in many countries. The aim of this study was to determine whether the continued practice of such screening of prospective students at the University of the West Indies was warranted by assessing the yield and the cost of the programme in our setting. In a cross- sectional retrospective study, 12,662 chest X-ray reports collected over the period 1989-1997 were studied. No active case of tuberculosis was detected. Three students reported a previous history of tuberculosis and 10 students had a positive family history of tuberculosis. Three hundred and ninety-nine clinically insignificant abnormalities were reported, such as mild scoliosis and calcified foci. Routine radiological screening of prospective students at the University of the West Indies for tuberculosis has an extremely low yield, places the students at unnecessary risk of radiation exposure and should be discontinued.
The efficacy of Helicobacter pylori eradication for H. pylori associated duodenal ulcer disease is beyond dispute. However, little attention has been paid to how feasible it is in primary care to undertake H. pylori eradication for patients with a past history of peptic ulcer disease. Patients identified by computer search of three general practices with a documented history of peptic ulcer disease were invited to attend for H. pylori testing and eradication therapy if H. pylori positive. A total of 101 patients were identified from a combined practice size of 24,780 of whom 34 were eligible for testing. Twenty-one per cent (seven patients) declined testing, 3% (one patient) refused therapy and another 21% (seven patients) were H. pylori negative. Helicobacter pylori eradication was highly successful (95%) and had an effect on prescription and reconsultation rates at 12 months. Eradicating H. pylori in patients with a past history of peptic ulcer disease not associated with non-steroidal anti-inflammatory drug ingestion is a challenging goal in general practice.
Hospitalized patients who require admission to residential care are often thought to make prolonged and inappropriate use of hospital resources. There are no Australian data on the factors that contribute to length of hospital stay for such patients. The aim of this study was to determine the timing of critical steps in discharge planning for hospitalized patients who need residential care. We prospectively audited 100 consecutive referrals to an Aged Care Assessment Team (ACAT) from one acute hospital in South Australia. Case notes were examined to determine the timings of critical events in discharge planning. We found 47% of patients were discharged to a nursing home, 16% to a hostel, 11% died, 10% returned home and 16% went to another facility. The average length of hospital stay was 27.2 days, and an average of 8.4 days elapsed before a decision to seek residential care was first recorded. A further 4.5 days elapsed before ACAT referral, 4.6 days before ACAT approval and 9.7 days before a residential care bed became available. We conclude that people admitted to our hospital from the community and who subsequently need residential care, spend 36% of their stay awaiting a residential care bed. Most of their hospital stay has elapsed before residential care is considered necessary and referral and approval processes have been activated. Strategies to reduce length of stay should perhaps focus on the earlier recognition of the need for residential care and accelerated referral and assessment processes. Earlier involvement by social work and occupational therapy should be considered.
Since the introduction of the Emergency Services Enhancement Program (ESEP) in Victoria in 1995, improvements have been demonstrated in the indicators relating to Emergency waiting times, ambulance bypass rates and inpatient bed access block. This study focuses on staff perceptions of changes in these indicators, factors perceived to influence performance improvements and the extent to which ESEP is perceived to have contributed to overall patient care. A questionnaire was directed at four focus groups within each of the hospitals participating in ESEP. These were Chief Executive Officers, Emergency Department Directors and Nurse Unit Managers, bed coordinators and personnel from the Emergency Department floor. A total of 101 staff responded. Emergency Department staff were generally accurate in their perceptions of performance changes. The most important factors effecting the changes were perceived to be changes in staff profile, management of patient flow through the department, changes in administrative policies and changes in work practices. Staff perceived that patient care has improved by 10% since 1995 and that ESEP has contributed 8% of this improvement. Staff have perceived improvements in ESEP performance indicators consistent with actual changes. The possible mechanisms by which these changes have occurred are presented and discussed. Factor analysis indicated that changes perceived to be most likely to result in improvements were: changes in staff profile (seniority), managing the flow of patients through emergency departments, changing administrative policies, changes in work practices and changes in staff numbers. Improvements in patient care were considered partly due to ESEP. In addition, ESEP has raised awareness of quality management issues.
The objective of this study was to examine the reliability, effectiveness, accuracy and timeliness of hospital to general practitioner (GP) information transfer by discharge summaries produced in a general public hospital in New South Wales, Australia. A retrospective audit of 569 patient discharge summaries and related medical records with a targeted GP interview was performed to determine receipt and clinical value of the recorded information. The main outcome measure was the number and quality of discharge summaries received by patient-nominated GPs. Summaries written for patients discharged from hospital were estimated to be received by the patient-nominated GP in 27.1% of cases. Discharge summaries audited were rated as being 63.6% accurate, with errors occurring in all facets of production. The current method of discharge summary production and distribution is unacceptable. The high number of errors (36.4%) and the low rate of receipt (27.1%), indicates that resources invested in the production of the discharge summary could be better utilized to improve information transfer.
The deluge of new initiatives, proposals and recommendations for solving the problems required to improve patient safety and quality of health care continues unabated. Implementing the proposed solutions for improving patient safety and quality of care requires setting priorities for action throughout the different levels of the health-care system. Currently, we face the dilemma of having to set priorities from the plentiful themes that are intuitively sensible and well accepted. There is an increasing number of examples of using systematic processes which contain explicit and transparent criteria for priority setting in patient safety and quality initiatives. These should be more widely adopted and become a key requirement for all future proposals for improving patient safety and quality of health care.
Assessment of quality in the private practice setting may be difficult. The author has taken the view that service delivery is a key outcome of private clinician practice. A method of assessing service delivery in a private consultant physician practice setting is described.
Using clinical practice improvement methodology, a project was undertaken to reduce the incidence of surgical wound infections following elective hip and knee replacement surgery. A team was established, key measures for improvement were identified, strategies for change were developed and an action plan was implemented. Outcomes for this project included a reduction in the rate of clean surgical wound infection for joint replacement surgery from 28% to zero. Average length of stay for total hip replacement surgery was reduced from 13.9 to 9.3 days and from 14.6 to 10.4 days for total knee replacement surgery. Guidelines for patient selection were developed along with a protocol for the management of preparation to prevent urinary tract infections. Post-discharge surveillance and a preoperative rehabilitation and exercise programme have been implemented. There is potential for wider uptake and implementation of the quality principles described herein.
Few studies have explored the knowledge, perceptions and satisfaction of ethnic women in relation to early obstetric discharge. The aim of this study was to form a profile of Vietnamese mothers who opt for early postpartum discharge, and to identify factors associated with those decisions. Focus group discussions, in-depth interviews and survey questionnaires were utilized to collect information from a sample of 160 mothers. Sixty mothers (38%) opted for early discharge (< 48 h). Factors strongly associated with early discharge were poor comprehension of English (OR=6.58, 95% CI=1.81, 24.02), very low level of education (OR=3.10, 95% CI=1.55, 6.20) and first time mother (OR=2.70, 95% CI=1.15, 4.27). The in-depth interviews identified further factors driving early discharge, including fear and anxiety when having to approach staff for assistance, and perceptions of disempowerment within culturally unfamiliar hospital surroundings. The findings in this study ought to alert administrators and clinicians to possible negative drivers for the choice of early postpartum discharge by Vietnamese mothers.
The objective of this study was to compare health-care use and satisfaction with health-care providers between depressed and non-depressed women in the first 4 months after childbirth. Sixteen weeks after delivery a questionnaire, which included the Edinburgh Postnatal Depression Scale (EPDS) and items about health-care use and satisfaction, was mailed to women who attended the antenatal clinic, Royal Women's Hospital, Brisbane. Completed questionnaires were returned by 574 (86.4%) of the 664 women surveyed. During the study period most women (91%) visited a general practitioner at least once and 117 (12%) saw their doctor on five or more occasions. A total of 118 (20.7%) scored above 12 on the EPDS. Depressed women were more likely to visit a psychiatrist (OR, 9.2; 95% CI, 4.3-19.6), social worker (OR, 6.1; 95% CI, 3.3-11.1), postnatal depression group (OR, 4.0; 95% CI, 1.3-12.6), paediatrician (OR, 2.5; 95% CI, 1.6-3.9), or a general practitioner (OR, 2.1; 95% CI, 1.4-3.2) than non-depressed women. Twenty-two (18.5%) of the depressed women had contact with a psychiatrist. Compared with non-depressed women, those scoring above 12 on the EPDS were less satisfied with the services of general practitioners (P=< 0.000), paediatricians (P=0.002), Nursing Mothers' Associations of Australia (P=0.043) and obstetricians (P=0.045). Postpartum depression leads to an increase use of health-care services and has a negative effect on satisfaction with some services.
Organizations that have engaged consumers in their work using traditional patient satisfaction tools have accomplished a number of significant outcomes. However, organizations are now being challenged to move into more meaningful collaborations with consumers regarding evaluating and improving services. This study describes and evaluates the effectiveness of consumer partnerships established to cover a project that lasted for about 4 months. Surveys were conducted with staff and consumers involved in the project. Structured questionnaires were used for both groups and the consumers were invited to focus interviews to explore specific issues. Issues regarding recruitment, preparation and management of consumers are important if satisfactory outcomes are to be realised. Further, staff attitudes and behaviours were examined that indicated staff shared the view that engagement of consumers was a worthwhile exercise. Quality consumer collaborations can bring about organizations being a highly valued community assets.
Journal of Quality in Clinical PracticeVolume 21, Issue 1-2 p. 16-16 Commentary – What’s in a word? Beverley Raphael MD, Beverley Raphael MD Centre for Mental Health, NSW Health Department, 73 Millar St, North Sydney, NSW 2060, Australia (Email: braph@doh.health.nsw.gov.au)Search for more papers by this author Beverley Raphael MD, Beverley Raphael MD Centre for Mental Health, NSW Health Department, 73 Millar St, North Sydney, NSW 2060, Australia (Email: braph@doh.health.nsw.gov.au)Search for more papers by this author First published: 28 June 2008 https://doi.org/10.1111/j.1440-1762.2001.00393.pp.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume21, Issue1-2March/June 2001Pages 16-16 RelatedInformation
