Research points a way ahead: Safer care, reduced waiting times

12 June, 2018

‘Research published in the latest issue of Australian Health Review (AHR) points the way to some interesting opportunities to improve various aspects of hospital activity—and make them more efficient’, according to the AHR’s chief editor, Professor Gary Day.

AHR is the Australian Healthcare and Hospitals Association’s peer-reviewed academic journal. 

‘They are not necessarily complicated ideas. One study, from a combined US–Australia author team, including from private health insurer HCF, found that telephone support given by registered nurses to patients recently discharged from Australian private hospitals reduced 28-day readmission incidence by 29%.’

‘It seems that this kind of clinician support during this very critical transition period can have far-reaching positive effects,’ Professor Day said.

‘The base readmission rate in the study was nearly 20%—similar to what has been observed in the US. So a 29% reduction on this rather high base rate is very welcome.’

A study from a Monash University team looked into Mortality and Morbidity Reviews (MMRs). These are conducted by clinicians in various care settings, and particularly where a death might be associated with events that are preventable. The aim of most reviews is to educate other clinicians and improve patient care.

The research team found that while MMRs undoubtedly contributed to reduced mortality and improved patient care, formal evidence on outcomes was sparse, and there was little consistency in the way MMRs were conducted. The team found that MMRs could be improved if conducted by multidisciplinary review teams that included those with most contact with the patient in question. MMRs would also be improved if focused on education and quality improvement rather than the actions of individuals, and if they followed a hospital-wide standard format.

A Queensland-based research team investigated all aspects of outpatient waiting times. This is a problem common to most countries that seek to provide universal access to health care, including Australia. After screening 152 previous articles on the topic, 38 were chosen for review to see if there were any consistent approaches or themes that resulted in reduced waiting times.

Rationalising referrals, triaging of patients and wait list audits were found to have most effect on waiting times. But other/some studies were of the view that triaging put most patients at an unintended disadvantage because they are not deemed ‘urgent’. A single queue with advanced access was seen to be a better use of scarce resources. Advanced access involves keeping schedules mostly unbooked each day and relying on walk-up/phone-in traffic on the day.

Better capacity in the primary care sector to manage patients in the community would result in further improvement to outpatient waiting times. Extending the scope of practice of non-medical health professionals was also found to improve waiting times without detriment to patient outcomes, as could automated processes such as eReferrals, telemedicine and patient text messaging.

Other articles available through Open Access (free of charge) include a University of Queensland study on integrated healthcare and supportive housing for people who are homeless, and an examination of suicide research and funding in New Zealand.

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