ObjectiveWorkforce shortages in hospitals have necessitated a focus on recruitment and retention of health professionals. The aim of this systematic review was to synthesise literature relating to factors that affect recruitment and retention of allied health professionals working in hospital settings.MethodPubMed, CINAHL (via EbscoHost), Embase (via Elsevier), and Scopus Advanced Search databases were used to retrieve 1665 studies, of which 16 were included. Herzberg's two-factor theory was used to synthesise study findings and develop key themes.ResultsJob advancement, company policies, supervision (leadership), working conditions, salary, recognition, and growth opportunities were factors identified as affecting recruitment and retention.ConclusionIdentified factors are largely amenable to change and could contribute to a more sustainable allied health workforce in hospitals and enhance the quality of care. This research could significantly impact and enhance the evidence supporting interventions and strategies that are critical for retaining the allied health workforce in hospitals.

Objective'Placement poverty' refers to the financial burdens imposed upon students by the completion of mandatory professional placement. We aimed to identify the financial implications of mandatory professional placements on student wellbeing.MethodsA cross-sectional online survey (August 2023 to January 2024) completed during students' most recent professional placement in the final year of their degree. Eligible participants were health or teaching students studying at Australian and New Zealand universities in degrees requiring mandatory professional placement. Questions included total and accommodation costs, financial support, impact of finances on placement preferences, presence of food insecurity, and implications for student wellbeing.ResultsParticipants (n=530) were mostly health professional (65%) students (median, 25; interquartile range (IQR), 22-30 years, 95.3% domestic, 88.3% full time, 2.0% New Zealand). Health students had higher total costs (in Australian dollars) for the recent placement ($1500; IQR, 600-3453) compared to teaching students ($1200; IQR, 600-2757) (P=0.02), likely due to longer placement duration (6weeks for health students). A higher proportion of health students required financial support (P=0.0001). Placement preferences were always or sometimes (63.8%) determined by cost rather than learning opportunity. Food insecurity was experienced by most students (70.2%) (10.4% marginal, 32.1% moderate, 27.7% severe), with no difference by degree type. Thematic analysis identified themes of burnout, emotional distress, inability to focus on learning, postponing care of oneself, urgent need for financial support, unanticipated family and other circumstances, and worsened societal inequity.ConclusionsOur study identified widespread financial difficulty in students undertaking placement that adversely impacted personal wellbeing. Strategies are needed to support wellbeing and ameliorate the financial burden.

ObjectiveEnsuring equitable access to clinical trials for children from Indigenous and ethnically and linguistically diverse backgrounds should be central to clinical trial design. This review aims to expansively review the reporting of Indigenous status (Aboriginal and/or Torres Strait Islander origin), ethnicity, culture, location, language and country of birth in paediatric clinical trials with Australian sites.MethodsThis scoping review systematically searched PubMed, CINAHL and Embase for international clinical trials with Australian sites conducted between 2018 and 2022 involving children (aged <18years) to determine the reporting of Indigenous status, race, ethnicity, language and country of birth.ResultsOf the 262 studies included, 154 (58.8%) clinical trials did not report any of the variables of interest. When reported, terms used by authors were heterogeneous. 'Indigenous status' was most reported (n=40, 15.3%) and self-identification was the most common method to determine this (n=14, 35.9%). International clinical trials had higher rates of reporting for ethnicity, cultural background and race. Overall, more than 60 terms were used to categorise study participants in relation to 'Indigenous status', 'ethnicity and cultural background', 'race', 'race and ethnicity' or 'natural skin colour'.ConclusionsThis review demonstrated low rates of reporting of demographic variables in paediatric clinical trials. Clear reporting standards, partnering with consumers to co-design trials and self-identification during collection are required. Ensuring adequate access to clinical trials for Indigenous children and children from ethnically, linguistically and geographically diverse backgrounds is essential in building health equity and ensuring patient safety.

BackgroundOccupational violence (OV) is a significant workplace issue that affects 62% of healthcare workers globally. An Ambassador is a new role that focuses on preventing OV in healthcare settings. They proactively engage with patients and visitors, using behavioural strategies to redirect or de-escalate people who may be of concern. This pilot study evaluated the introduction of an Ambassador in an acute inpatient hospital setting.MethodsA cross-sectional multiple-method evaluation was conducted in three surgical wards in a major metropolitan hospital in Australia from December 2020 to February 2021. Data from security records, incident reports and staff surveys were collected before and during the pilot. The survey included multiple-choice and open-ended questions. Quantitative data were analysed in SPSS, and qualitative data were analysed using thematic analysis.ResultsAfter the 3 month pilot, a significant decrease was seen in security calls (from 111 to 44, a decrease of 60%, χ2=28.96, P<0.001) and incident reports (from 20 to 6, a decrease of 70%, χ2=7.54, P=0.006). Staff surveys showed an increased awareness of OV as a workplace issue (from 60% to 82%, χ2=7.65, P=0.005). The qualitative analysis identified three main themes: professional roles and functions, key personnel characteristics, and suggestions for future implementation.ConclusionsAn improvement was seen in the staff perception of safety and a reduction in organisational metrics related to OV. Future research is required to evaluate program effectiveness across different wards and settings.Application to practiceThe success of the Ambassador program relies on selecting the right candidates, providing clear role descriptions, offering appropriate training and ensuring adequate support resources.

PurposeThe purpose of this article is to examine and discuss the literature regarding emergency department (ED) transfers from residential aged care with a focus on reducing potentially avoidable transfers to enhance care experiences, safety, and outcomes.DesignResearchers experienced in evidence synthesis and policy research in the aged care space reviewed the literature about residential aged care transfers to EDs, including factors underlying transfers and interventions to reduce transfers.FindingsTransfers to EDs from aged care are common. They can be harmful, distressing, costly, and have a variety of negative impacts on residents, staff, and the aged care and health system. High rates of potentially avoidable or unwarranted transfers suggests the presence of systemic issues, including the lack of sufficient staffing levels and skills mix with the requisite knowledge, training, resources, and support. Reforms are required to improve staffing levels and skills mix, enhance access to on-site and in-reach clinical expertise, provide access to quality improvement initiatives, and engage consumers to ensure shared decision-making. Further research is also required to help determine the best approach to reducing unnecessary hospital transfers from aged care considering the specific scopes of practice of aged care workers.ConclusionWhile some transfers from residential aged care to EDs are necessary, many do not represent safe, dignified care for older people. Unwarranted transfers are burdensome and risky and should be minimised through the provision of a range of reforms including sufficient staffing, resources, and support, that allow for the delivery of care in place where appropriate.

Australia has world-class education for healthcare professionals and is recognised for its strength in digital health research but is yet to fill some important gaps in training healthcare professionals in the safe implementation and use of digital technologies. In this case study, we bring together the perspectives of clinicians, health system leaders, and academics to guide efforts in establishing a digitally enabled workforce in Australia. Building on published evidence, our recommendations include leveraging on recent momentum, building strong partnerships with healthcare organisations, academia, and the digital health industry, and ultimately an expansion of a digitally enabled clinical informatics and digital health workforce.

ObjectiveThis study aimed to determine the number of visitors to an acute hospital, the time of visit, destination, and details of parking over the same period.MethodsA prospective observational pilot study in a large metropolitan public hospital in Australia was performed. The research team observed all visitors over a 14-day period between 17 and 30 October 2022 counting the people visiting relatives or friends of admitted hospital patients as well as those visiting outpatient clinics during the observation period. Other outcome measures included time of the visit, destination, and estimated costs of parking.ResultsDuring the 14 days of observation there were 18,066 visitors, averaging 1290 per day. The majority were visitors to inpatients (62.2%, 11,232, averaging 802 per day). Those attending outpatients were less (37.8%, 6834, averaging 668 per weekday). The estimated average parking cost was A$18.10 per day normally and A$11.85 for concessions.ConclusionsThis was the first known study on hospital-wide visiting in Australia or globally. These findings would be important for addressing issues such as hospital planning, and for future research including the impact of visiting on patient outcomes, the patient and community experience, and the expectations and experience of hospital visitors.

ObjectivesFrailty is associated with significant mortality and morbidity in hospitalised patients. We describe physiotherapy and occupational therapy practices in hospitalised frail patients and examine the role of early intervention.MethodsWe performed a prospective, observational cohort study in a medical assessment unit in a tertiary care hospital. Patients with COVID-19 infection were excluded. Frailty was measured by the Clinical Frailty Scale (CFS). Early allied health intervention was defined as involvement within 48h of admission. Demographic data, clinical diagnoses, time spent with physiotherapy and occupational therapy, CFS, hospital length of stay and outcomes were recorded and analysed.ResultsA total of 356 patients were categorised into non-frail (CFS score <5) and frail (CFS score ≥5) groups. The prevalence of frailty was 68% (n=241). Physiotherapy (77.2%) and occupational therapy (75.5%) reviews were more frequent in frail patients than in non-frail patients. Frail patients who had allied health involvement within 48h of admission had a significant reduction in their hospital length of stay (mean reduction of 7.3days, 95% CI: 0.53, 14, P=0.035) and a 2.44% reduction in the relative risk of developing pressure injuries (95% CI: 1.31, 4.53). There was no statistically significant differences in outcomes with allied health intervention for non-frail patients and patients who require residential aged care facility level care.ConclusionsAllied health have a key role in the management of frailty. Early allied health intervention was associated with a reduced hospital length of stay as well as a reduced incidence of pressure injury in frail patients.

ObjectiveStaff wellness rounding (SWR) is a process in which healthcare leaders have real-time conversations with healthcare workers (HCW) to identify safety and wellness issues. This study examined the experience of multidisciplinary healthcare leaders, who were not trained in psychology, who delivered SWR during the surge phase of the COVID-19 pandemic.MethodsA mixed methods approach was used. Phase 1 included a survey of HCW who participated in SWR during July-October 2021. Phase 2 included semi-structured interviews of leaders who delivered SWR.ResultsThere were 403 respondents to the survey, with 169 participants (41.9%) being eligible for the study. More than 67% of eligible respondents would recommend SWR to other colleagues, and 77.5% reported that SWR provided an opportunity to escalate issues or concerns about COVID-19. Eleven SWR leaders were interviewed about their experience of leading SWR. Four key themes were identified: SWR (1) offered a defined process for communication between executive leaders and HCW; (2) enabled escalation and actioning of issues to and from executive teams in the organisation; (3) required flexible scheduling to meet varied work schedules of HCW; and (4) required the leaders to have a core set of skills and competencies.ConclusionThis study examined the contribution that an SWR intervention can make to support HCW wellbeing during crisis-type events. The model facilitated interactions between executive leaders, managers and frontline staff. It fostered collegiality with peers, managers and leaders, supported recognition and acknowledgment of peers and used available resources effectively to support staff wellness during the surge phase of the COVID-19 pandemic.

ObjectiveThis study tests a model to improve the management of patients with an osteoporotic fracture.MethodsPatients with fractures potentially due to osteoporosis were identified from imaging reports using computerised near natural language processing. A coordinator notified the referring GP about the finding and provided follow-up to remind GPs of the need for management. This provided an opportunity to assess action taken by the GP.ResultsNear natural language processing efficiently detected fractures in patients at risk of osteoporosis. GPs reported that they are managing osteoporosis in over 40% of patients identified. Notification of GPs coincided with a small increase in osteoporosis management.ConclusionInformation technology can identify patient populations with clinically important risks such as osteoporosis. Methods to engage GPs to optimally address this risk have yet to be developed.

ObjectiveTo evaluate the feasibility of twice daily rehabilitation in older patients admitted to an acute care of the elderly (ACE) hospital ward.MethodThis was a prospective single-site, cohort study of twice daily interventions provided by ACE physiotherapists, occupational therapists and/or allied health assistants in an ACE hospital ward. The feasibility of twice daily therapy was evaluated using a range of outcomes including satisfaction, fidelity and limited efficacy.ResultsA total of 220 patients were included (median age 86 [IQR 81-91]years, 54% female, with a median length of hospital stay of 7 [IQR 5-10] days). Twice daily therapy was delivered on 71% (n=757) of patient admitted weekdays (fidelity). Moderate-to-large effect sizes were observed in patient functional and mobility measures during their hospital stay and most patients (74%) were able to be successfully discharged home (limited efficacy). Both staff and patients reported high levels of satisfaction with physiotherapy and occupational therapy while on the ACE ward.ConclusionTwice daily therapy with acutely hospitalised elderly patients is feasible, facilitated discharge home, and is associated with high patient and staff satisfaction.

ObjectiveIn Australia, accurate case ascertainment of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) diagnoses for disease surveillance and control purposes requires the use of multiple data sources, including RHD registers and hospitalisation records. Despite drawing on multiple data sources, the true burden of ARF/RHD is likely to be underestimated.MethodsThis study used capture-recapture methods to quantify the missing number of ARF/RHD cases in data from hospitals and jurisdictional RHD registers. Linked datasets comprised reported cases of ARF/RHD in register records and administrative hospital data.ResultsCapture-recapture analyses indicated the total number of new ARF/RHD cases in three Australian jurisdictions (Queensland, South Australia and Western Australia), among people aged 3-54years, was 3480 (95% CI=3366-3600) during 2011-2016. This included 894 (25.7%) individuals who were not listed in either the hospital or register datasets. Non-Indigenous, urban and older people with ARF/RHD were least likely to be identified in either the hospital or register data sources.ConclusionsThe 894 likely ARF/RHD cases our analyses detected that are not included in the routine surveillance datasets are concerning and quantify the magnitude and characteristics of under-notification to RHD registers in Australia, especially for groups that are not typically at high risk of ARF.

ObjectiveThis study aims to describe the pattern and trends in acute rheumatic fever (ARF)/rheumatic heart disease (RHD)-related hospitalisations and costs for Australians aged <65 years.MethodsThis retrospective linked data study measured trends in hospitalisations and costs for ARF, RHD and complications of ARF/RHD in Northern Territory, South Australia, Western Australia, Queensland and New South Wales between 1 July 2012 and 30 June 2017. Persons with ARF/RHD were identified from RHD registers and/or hospital records.ResultsOver the 5-year study period, 791 children, aged <16years (86.3% Indigenous), and 2761 adults, aged 16-64years (44.8% Indigenous), were hospitalised for ARF, RHD or associated complications. On average there were 296 paediatric admissions per year, increasing 6.1% annually (95% CI: 2.4-9.6%, P=0.001) and 1442 adult admissions per year, increasing 1.7% annually (95% CI: 0.1-3.4%, P=0.03). Total 5-year costs were AU$130.6m (AU$17.6m paediatric, AU$113.0m adult). Paediatric costs were mostly for ARF-related admissions whereas adult costs mostly involved valvular surgery. Emergency admissions and air ambulance transfers were common, particularly for non-metropolitan residents.ConclusionsSuccessful ARF/RHD prevention would deliver significant hospital cost savings. Investment in primary and specialist health care in regional areas may reduce emergency admissions and regional transfers, further reducing hospital burden.

ObjectiveTelepsychiatry consultations grew rapidly with increased total consultations and reduced face-to-face consultations following the pandemic-triggered expansion of Medicare Benefits Schedule (MBS) telehealth items. It was unclear how much telehealth expansion independently impacted overall and face-to-face consultation trends after accounting for lockdown severity.MethodsWe extracted monthly MBS Item Reports for psychiatric consultations (January 2012-December 2023). The monthly average Stringency Index (SI) for Australia represented lockdown severity from January 2020 to December 2022. A dichotomous variable denoted telehealth expansion (March 2020 onward). We constructed consecutive multiple linear regression models for combined consultations and face-to-face consultations to include seasonality, trend, SI, and telehealth expansion. We compared model performance using information criteria.ResultsMedian monthly total consultations increased from 148,413 (Interquartile range, IQR: 138,219-153,709) pre-expansion (January 2012-February 2020) to 173,016 (IQR: 158,292-182,463) post-expansion (March 2020-December 2023). Contrarily, median monthly face-to-face consultations decreased from 143,726 (IQR: 135,812-150,153) to 99,272 (IQR: 87,513-107,778). Seasonality and trend were present in both time series. The time series regression model with expansion but excluding SI best explained all consultations, while both telehealth expansion and SI were significant in the best-fit model for face-to-face consultations.ConclusionMBS telehealth expansion was associated with total and face-to-face consultations independent of lockdown severity changes. Policy changes allowing wider access to new telehealth services have possibly led to increased uptake of psychiatric care and addressed previously unmet needs.

ObjectiveThis study aimed to compare the costs and clinical outcomes of treating patients with retinal diseases requiring surgery managed locally in Darwin through a visiting subspecialist ophthalmology service or transferred to interstate tertiary eye centres.MethodsA retrospective analysis of a case series of 70 consecutive patients presenting to the Royal Darwin Hospital for vitreo-retinal surgery during the calendar years 2018 and 2019 was performed.ResultsTwenty-two of the 29 patients in the transfer group had a retinal detachment and five vitreous haemorrhage. The 41 patients managed in Darwin had a range of diagnoses. Surgical success, complications and costs were similar.ConclusionThere were excellent clinical outcomes and a minimal insignificant difference in costs.

ObjectiveThe introduction and implementation of voluntary assisted dying (VAD) legislation represents a major shift in Australian health policy. Given potential repercussions for health professionals, understanding how they are being affected by this legislation is important to guide future policy and legislative changes. This study aims to explore the perspectives and experiences of Australian health professionals on VAD and compare impacts on those working under different state legislation in Victoria and WA.MethodsData were collected using a cross-sectional survey design, targeting health professionals nationally, primarily doctors and nurses. The survey had closed and open-ended response options, was informed by previous publications and was piloted prior to further roll-out. Recruitment was via professional networks and social media. Quantitative data were descriptively analysed and qualitative data were coded using NVivo and thematically analysed.ResultsThere was a final sample size of 223. Impacts on clinicians identified include inadequate remuneration, a need for ongoing support and the recognition of barriers to mandatory training.ConclusionsImpacts on health practitioners, if not addressed, have future implications for workforce sustainability. Increasing numbers of trained VAD practitioners may enable distribution of clinical load and prevent burnout. VAD practitioners are not being appropriately remunerated, which could be addressed by introducing dedicated Medicare Benefits Schedule items for VAD. Attention should also be given to incentivising training, including continuing professional development accreditation and appropriate funding. Strategies to support staff could include debriefing, mentoring, peer support and psychological consultations.

Living Well, Living Longer (The Program) is an integrated care strategy to improve the physical health of people living with severe mental illness within a public mental health service. The significant life expectancy gap experienced by this cohort is largely attributed to higher rates of cardiovascular disease and modifiable risk factors. The Program addresses this by guiding people through the four stages of screening, detection, treatment initiation, and ongoing management of coexisting chronic health conditions. The Program adopted an integrated care approach to ensure the provision of appropriate and coordinated care across hospital and primary care services. Key care pathways include a cardiometabolic health assessment clinic, shared care with general practitioners, oral health services partnership and employment of peer support workers, dietitians, exercise physiologists, and smoking cessation to provide targeted community support and interventions. There has been strong engagement with the care pathways introduced since The Program's inception in 2013 and evaluation is currently underway to consider the impact on cardiometabolic health outcomes for participants. Critical to The Program's effectiveness has been engagement with lived experience expertise, multidisciplinary collaboration, and strong executive support. However, significant challenges persist amid an Australian public health crisis characterised by reducing rates of free primary healthcare access for people living with severe mental illness and enduring communication challenges between primary and secondary health services. With the implementation of MyMedicare and the imminent Single Digital Patient Record across NSW Health, we stand at a critical juncture. It is imperative to establish robust systems to enhance care for this vulnerable population.

BackgroundBenefits of effective team-based working in healthcare settings are well established, with the ultimate form being transdisciplinary teams. Achieving transdisciplinary teams at the large organisation or system level has not been extensively studied.PurposeTo examine and describe exemplar organisations where transdisciplinary working was enabled and that can be reproduced in other organisations.MethodsAn expert panel reached consensus on three healthcare organisations in the USA that exemplified transdisciplinary working. Available public information about each organisation was reviewed and site visits with direct observation and interviews were conducted with two of the three exemplar sites (the third completed remotely due to the onset of COVID-19). The process of immersion-crystallisation was used to review the collated material and to identify key themes that were then repeatedly checked with the expert panel.ResultsConsistent themes were identified across all three organisations, although they each arrived at these commonalities via distinctly different routes. All had a clear and shared creation story as to how they came about as an entity, which was supported by consistent longitudinal leadership. This enabled an environment whereby each organisation created its own language that reflected their culture as an organisation, thus continually reinforcing the uniqueness of their organisation.ConclusionsLarge healthcare organisations can achieve the concepts of transdisciplinary practice. While no single achievement pathway was identified, common themes noted were a clear creation story, consistent leadership, and building a language that reflected the organisation.

ObjectiveDetailed quantifications of the environmental footprint of operations that include surgery, anaesthesia, and engineering are rare. We examined all such aspects to find the greenhouse gas emissions of an operation.MethodsWe undertook a life cycle assessment of 10 patients undergoing total knee replacements, collecting data for all surgical equipment, energy requirements for cleaning, and operating room energy use. Data for anaesthesia were sourced from our prior study. We used life cycle assessment software to convert inputs of energy and material use into outputs in kg CO2e emissions, using Monte Carlo analyses with 95% confidence intervals.ResultsThe average carbon footprint was 131.7kg CO2e, (95% confidence interval: 117.7-148.5kg CO2e); surgery was foremost (104/131.7kg CO2e, 80%), with lesser contributions from anaesthesia (15.0/131.7kg CO2e, 11%), and engineering (11.9/131.7kg CO2e, 9%). The main surgical sources of greenhouse gas emissions were: energy used to disinfect and steam sterilise reusable equipment (43.4/131.7kg CO2e, 33%), single-use equipment (34.2/131.7kg CO2e, 26%), with polypropylene alone 13.7/131.7kg CO2e (11%), and the knee prosthesis 19.6kg CO2e (15%). For energy use, the main contributors were: gas heating (6.7kg CO2e) and heating, cooling, and fans (4kg CO2e).ConclusionsThe carbon footprint of a total knee replacement was equivalent to driving 914km in a standard 2022 Australian car, with surgery contributing 80%. Such data provide guidance in reducing an operation's carbon footprint through prudent equipment use, more efficient steam sterilisation with renewable electricity, and reduced single-use waste.

IntroductionLabour costs are a key driver of healthcare costs and a key component of economic evaluations in healthcare. We undertook the current study to collect information about workforce costs related to clinical genomic testing in Australia, identifying key components of pay scales and contracts, and incorporating these into a matrix to enable modelling of disaggregated costs.MethodsWe undertook a microcosting study of health workforce labour costs in Australia, from a health services perspective. We mapped the genomic testing processes, identifying the relevant workforce. Data was collected on the identified workforce from publicly available pay scales. Estimates were used to model the total cost from a public health services employer perspective, undertaking deterministic and probabilistic sensitivity analyses.ResultsWe identified significant variability in the way in which pay scales and related conditions are both structured and the levels between jurisdictions. The total costs (2023-2024 Australian dollars) ranged from 160,794 (113,848-233,350) for administrative staff to 703,206 (548,011-923,661) for pathology staff (full-time equivalent). Deterministic sensitivity analysis identified that the base salary accounts for the greatest source of uncertainty, from 24.8% (20.0-32.9%) for laboratory technicians to 53.6% (52.8-54.4%) for medical scientists.ConclusionVariations in remuneration levels and conditions between Australian jurisdictions account for considerable variation in the estimated cost of labour and may contribute significantly to the uncertainty of economic assessments of genomic testing and other labour-intensive health technologies. We outline an approach to standardise the collection and estimation of uncertainty for Australian health workforce costs and provide current estimates for labour costs.