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Issue 45 March 2016
The Hospital Alliance for Research Collaboration
In the news
Workforce issues
Reducing readmissions
Spotlight on safety

Rethinking primary care

Professor Kevin Grumbach

The 20th century model for delivering primary care has to change to meet the needs of the 21st century, US expert Professor Kevin Grumbach told a HARC-sponsored symposium on the Patient-Centred Medical Home.

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Changing the way we deliver care

In this month’s HARC e-Bulletin, we report on a recent symposium that explored  the concept of the Patient-Centred Medical Home,  a new model of primary care that has been adopted in the US, and is widely-viewed as a way forward for delivering improved primary care in Australia.

We also look at some of the latest research on hospital readmissions. One study suggests one-quarter of readmissions could be prevented, while another shows imposing financial penalties on hospitals that exceed redadmission targets has had some success in the US.

Workforce issues are also in the spotlight. An Australian study reveals that nearly all doctors and nurses working in emergency departments have experienced verbal and physical aggression from alcohol-affected patients, impacting not only their own wellbeing but the quality of care they can provide to patients.

In our profile, we meet Lorraine Lovitt, the driving force behind the Clinical Excellence Commission's April Falls Day, which aims to raise awareness of falls prevention both in the community and the NSW health system on 1 April.

Please forward this edition of the Bulletin to colleagues who may be interested in joining the HARC Network. We’d love to hear your feedback or suggestions at

Megan Howe
Editor, HARC e-Bulletin

Push to rethink the way we provide primary care

The traditional, 20th century model for delivering primary care no longer works, a US expert told a recent HARC-sponsored symposium exploring the concept of the Patient-Centred Medical Home (PCMH).

Professor Kevin Grumbach, a family physician and a founding director of the Centre for Excellence in Primary Care at the University of California San Francisco School of Medicine, was addressing the symposium hosted by HARC and the Centre for Primary Health Care and Equity (CPHCE) at the University of NSW.

In the US, the role of primary care had become under-appreciated, under-supported and under-resourced, resulting not only a dearth of medical students choosing to become family physicians (or GPs), but an extremely high rate of burnout among doctors who did go into the specialty, he said.

Professor Grumbach said studies showed that for a GP to do all the necessary preventive care for their patients would take 7.4 hours a day, and to deliver the recommended chronic care services would take an additional 10.6 hours – meaning they needed 18 hours a day to adequately care for their patients.

“The 20th century model of primary care was not working in the 21st century. The model needed to change,” he said.

Under the country's Affordable Care Act, a model called the Patient-Centred Medical Home (PCMH) was adopted, under which patients are enrolled or “empanelled” with a primary care practice, which co-ordinates their care. The practice receives a payment per enrolled patient, which helps them to employ a team of health professionals to provide comprehensive care suited to their particular community.

Professor Grumbach said the central elements of the model were: a change in the way primary care is funded from a fee-for-service model to blended payments; the introduction of a team approach to providing care; a patient-centred approach, and a population-centred approach meaning doctors were proactive in identifying and providing care to all patients who needed it within their population.

“It is a more expensive model of primary care,” Professor Grumbach admitted. “The question is whether that investment in primary care is returned through reductions in other costs.”

He said the answer appeared to be ‘yes’, with a recently published review of evidence on the impact of patient-centred medical homes on cost and quality finding that in 21 of 23 studies that reported on cost measures, there were reductions in one or more cost measures, while 23 out of the 25 studies that reported on measures of healthcare use showed reductions in one or more health use measures.

Once patient-centred medical homes were established, networks of such "homes" could serve as data laboratories, or real-world “community laboratories”, to aggregate data that could be used to improve both practice and population health, Associate Professor Jennifer DeVoe told the symposium.

Professor DeVoe, a family physician and health service researcher at Oregon Health and Science University, said the PCMH model had enabled the establishment not just of “medical homes” but of a “village” of practices to share resources and data.

She described how the PCMH model had enabled the establishment of a collaborative, practice-based research network called OCHIN, which was now linking data from the electronic patient records of one million patients who were enrolled with 300 primary care sites across 18 states in the US – most of which served vulnerable patient populations.

Australia was moving down the path towards the patient-centred medical home, the symposium heard, with a number of primary care reform projects already underway in NSW using PCMH principles.

Dr Liz Marles, former president of the Royal Australian College of General Practitioners (RACGP), said all the major Australian GP bodies had endorsed the PCMH model, but the way primary care was currently funded would need to change for the model to be adopted.

“There is a consensus that we want to move to a more blended payment model. I think things are going to change fairly quickly,” she said, adding that a system of voluntary pateint enrolment was also needed.

* Watch the video of Professor Grumbach's presentation.

(Professor DeVoe’s address to the symposium will be available soon)

NSW EDs face record demand

Pressure on NSW hospital emergency departments is increasing, with a record number of people seeking treatment in the final quarter of 2015, according to a report from the Bureau of Health Information (BHI).

During the October to December quarter, 664,837 patients visited emergency departments, an increase of 2% compared with the same quarter the previous year.

The report showed that the average time patients waited to start treatment in the ED was unchanged or one minute longer than in the same quarter last year across all urgency categories. And patients spent an average of two hours and 41 minutes in the ED ‒ three minutes longer than the same quarter last year.

The proportion of patients who left the emergency department within four hours of presentation dropped one percentage point to 74%. 

"NSW emergency departments continue to see more patients and more urgent cases,” said BHI Chief Executive Jean-Frederic Levesque.

BHI also released a Snapshot Report from a survey of more than 18,000 patients who visited NSW public hospital EDs in 2014 –15, which showed seven in 10 would speak highly of the ED following encounter.

Six in 10 patients said the care they received in the ED was very good and 31% said it was good. Two-thirds of patients said the ED definitely helped them and 71% said they definitely had trust and confidence in the ED doctors.

Half of patients said they were told “completely” about medication side effects and six in 10 said they were ‘definitely’ involved in decisions about their care, according to the report.

Compared to the first patient ED survey in 2013, the proportion of patients who chose the most positive response option increased for 14 out of the 38 questions, including the proportion of patients who said overall, care in the ED was very good and the percentage who said they were given enough privacy.

Campaign lists 61 more tests, treatments and procedures to avoid

Chest x-rays for uncomplicated bronchitis or for foot and ankle trauma, imaging for non-specific low back pain, and antibiotics for children with middle ear infections are among 61 tests, treatments and procedures that have been added to a list of medical interventions that may be unnecessary or could cause harm to patients.

The Choosing Wisely Australia campaign released its second wave of recommendations from an additional 14 Australian medical bodies, covering areas including ophthalmology, nursing, intensive care medicine, physiotherapy, pharmacy, surgery, infectious disease, haematology, dermatology and palliative care.

The campaign, which is aimed at sparking conversations between patients and clinicians about what care is truly necessary, is led by health professions and facilitated by NPS Medicine Wise. CEO Dr Lynn Weekes said 86 recommendations had been released since the campaign was launched last year.

“With two thirds of Australia’s medical colleges now committed to Choosing Wisely Australia, the initiative has grown to be an important force and voice in healthcare,” she said.

A total of 15% of the recommendations focus on the responsible use of antibiotics, including advice to ensure appropriate antibiotic use for urinary tract infections, upper respiratory infection, leg ulcers, epidermal cysts, acne and daily consideration of antibiotic de-escalation for intensive care patients.

The new wave also focuses on optimising end-of-life care, including recommendations on early discussion about advance care planning, early palliative care referral, use of oxygen for non-hypoxic patients and medication reviews to avoid drug interactions.

See the full list of recommendations: Tests, treatments, and procedures for healthcare providers and consumers to question

Expert outlines challenges in health system performance reporting

Professor Fabrizio Carinci would like to see health ministers around the world able to access data on the performance of public health systems on their mobile phones, in way that helps inform crucial policy decisions. 

Professor Carinici, Professor of Health Systems and Policy at the University of Surrey and member of the OECD Health Care Quality Indicators Expert Group and Advisory Panel on Health Information infrastructure, visited Australia last month and led a HARC roundtable on the revised OECD Health Systems Performance Framework.

In the latest video in our HARC “Five Questions” series, he discusses why public performance reporting is so important, and outlines some of the challenges in comparative public reporting at a global level.

One of the most critical challenges is to make active use of health performance data so it is not just “the yellow pages of health information”, but is used to improve health services, Professor Carinci says.

“One of the key challenges is to create interfaces that are strong enough, but easy to use,” he says.

“I would like to see health ministers from all camps actually able to use their mobile [phone] to make substantial use of this information for their work – considering that many policy makers may not be specialists in clinical sector, but have to make important decisions.”

* Watch the video 


ED staff impacted by alcohol-induced aggression

The vast majority of doctors and nurses working in emergency departments (EDs) have experienced verbal and physical aggression from patients affected by alcohol, according to an Australian study. And the experience impacts not only staff wellbeing, but the quality of care they can give patients, the study found.

If I am out of uniform I do not have to tolerate these behaviours and have a course of action; if I am in uniform, I am fair game  
'Disturbing' findings

A total of 2002 ED doctors and nurses in Australia and New Zealand were surveyed in 2014 about their experience of alcohol-related violence and their perceptions of how such violence affected the functioning of the emergency department.

Findings in the MJA showed that 97.9% of respondents had experienced alcohol-related verbal aggression in the last year, and 92.2% had experienced physical aggression.  Four in 10 clinicians experienced physical aggression weekly or monthly – a finding described by the authors as “disturbing”.

The study also showed that 87% of respondents had felt unsafe in the presence of an alcohol-affected patient, with nurses most affected.

One female ED nurse wrote :”If I am out of uniform I do not have to tolerate these behaviours and have a course of action; if I am in uniform, I am fair game”.

The ED staff said alcohol-related presentations not only had a negative impact on their own wellbeing and job satisfaction, but on ED waiting times, on other patients in the waiting room and on the care of other patients.

“The need to divert resources disrupts or delays care for other patients. Effects on the welfare of and care for other patients, particularly vulnerable groups, are further exacerbated by the disruptive and antisocial behaviours of alcohol-affected people in EDs,” the authors wrote.

They study authors said health service managers must ensure a safe working environment for staff, and said the study highlighted the need for a cultural shift.

“A comprehensive public health approach to changing the prevailing culture that tolerates alcohol-induced unacceptable behaviour is required,” they wrote.

Egerton-Warbuton D, Gosbell A, Wadsworth A, Moore K, Richardson D, et al. Perceptions of Australasian emergency department staff of the impact of alcohol-related presentations. MJA 2016;204(4):155.e1‒e.6


More nurses means less deaths: study

Hospitals in which each registered nurse cares for six or fewer patients have significantly lower patient mortality rates than those where nurses care for 10 or more patients, a UK study shows.

But higher numbers of less qualified healthcare support workers (HCSWs) were associated with higher rates of inpatient death, the study found, prompting a warning about moves to substitute HCSWs for nurses.

Researchers analysed associations between mortality rates and staffing by nurses, medical doctors and support workers  across 137  hospital trusts, with close to 10 million medical admissions and more than nine million surgical admissions over two years.

Among patients in medical wards, they found higher mortality was associated with a greater number of occupied beds cared for by each registered nurse and each doctor. Where medical wards had an average of six or fewer patients per registered nurse, the mortality rate was 20% lower than in those with more than 10 patients per nurse.

There were similar patterns in surgical wards, although the results weren’t as significant, according to findings in BMJ Open. However, hospital trusts with more healthcare support workers per bed had higher rates of mortality among medical patients.

The findings come amid debate about nurse numbers and nurse-to-patient ratios, with the NSW Nurses & Midwives Association campaigning for improved and extended mandated minimum nurse-to-patient ratios. 

The authors said the study could not demonstrate causation, and there was not enough evidence to identify safe staffing thresholds across different types of wards, but it showed the level of registered nurse staffing was a crucial factor.

“Current policies geared towards substituting HCSW for registered nurses should be reviewed in light of this evidence,” they wrote.

Griffiths P, Ball J, Murrells T, Jones S, Rafferty AM. Registered nurse, healthcare support worker, medical staffing levels and mortality in English hospital trusts: a cross-sectional study. BMJ Open 2016:6:e008751. Doi: 10.1136/bmjopen-2015- 008751


Aggression pushes doctors away from patient care

Doctors who are exposed to aggression in the workplace are more likely to intend to cut their clinical workload or walk away from patient care in the future, an Australian study shows.

The survey of 9951 GPs, GP registrars, specialists, hospital non-specialists and specialists in training was conducted as part of ongoing the Medicine in Australia: Balancing Employment and Life (MABEL) study.

They were asked about exposure to workplace aggression, including verbal or written abuse, threats, intimation or harassment as well as physical threats or violence, and their workforce participation intentions.

After adjusting for other factors like wellbeing and work conditions, the study showed that exposure to aggression was associated with a greater likelihood of doctors intending to reduce their clinical workload and of them intending to leave patient care within five years, according to findings in Australian Health Review.

The authors suggested clinicians might reduce the amount of direct clinical care activities they undertake by increasing managerial, administrative, teaching or research activities, and others may leave the profession altogether.

They urged reforms such as financial incentives to improve work health and safety, especially in smaller private practice settings, and the introduction of legislative provisions aimed at reducing workplace aggression in medical and other healthcare settings.

“Exposure to workplace aggression presents a risk to the retention of medical practitioners in clinical practice and a potential risk to community access to quality medical care,” they wrote. ”More concerted efforts in preventing and minimising workplace aggression in clinical medical practice are required.”

Hills DJ. Association between Australian clinical medical practitioner exposure to workplace aggression and workplace participation intentions. Australian Health Review 2016:40:36‒42.


One in four readmissions could be prevented

About one quarter hospital readmissions within 30 days of discharge could be prevented, a new study suggests.

In the HOMERUN study, US researchers studied 1000 general medicine patients who were readmitted within 30 days of being discharged from 12 hospitals. They surveyed patients and physicians, reviewed patient records and conducted case reviews to determine if each readmission was preventable and what factors contributed to it.

The reviewers assessed that 27% of readmissions were potentially preventable, with half of those thought to result from gaps in care during the initial inpatient stay, according to findings in JAMA Internal Medicine.

The most common factors associated with potentially preventable readmissions included inappropriate decisions by the emergency department to admit the patient, the patient’s inability to keep appointments after discharge, premature discharge from the hospital and the patient’s lack of awareness of how to contact doctors after discharge.

Areas that needed improvement to reduce such readmissions included improved communication among healthcare teams and between health professionals and patients, greater attention to patients’ readiness for discharge, enhanced disease monitoring and better support for patient self-management, the authors suggested.

Auerbach AD, Kripalani S, Vasilevskis EE, Sehgal N, Lindenauer PK, et al. Preventability and Causes of Readmissions in a National Cohort of General Medicine Patients. JAMA Intern Med 2016 [Internet] doi:A10.1001/jamainternmed.2015.7863


Model predicts patients at risk of avoidable readmissions

A simple predictive model can accurately identify patients at high risk of preventable hospital readmission, according to a US study that suggests such patients could be targeted for intensive transitional care.

Researchers studied 112,136 adults discharged from nine hospital medical wards across four countries to validate a model called the “HOSPITAL score”.

The HOSPITAL score is easy to use and can be calculated before discharge, which makes it a practical tool for identifying patients at high risk for preventable readmission  
Measuring seven factors

The score is based on assessing the following seven, readily available clinical predictors:

• Low haemoglobin at discharge
• Discharge from an oncology service
• Low sodium level at discharge
• Procedure during the index admission
• Type of admission (urgent or emergent)
• Number of admissions during the past 12 months
• Length of stay

Within 30 days after discharge, 15% or patients in the study were readmitted, and 9.7% had a potentially avoidable readmission, according to findings in JAMA Internal Medicine.

The HOSPITAL score was used to classify the patients into three risk categories: low, intermediate and high risk of being readmitted within 30 days of discharge. The researchers found that the estimated proportion of potentially avoidable readmissions in each risk category matched the observed proportion, meaning the HOSPITAL score had good discriminatory power to predict potentially avoidable readmissions.

Overall, patients with a potentially avoidable readmission more often had an urgent or emergent index admission, were more frequently discharged from an oncology service, had a length of stay greater than five days, had more hospitalisations in the past year, more often had a procedure, and more often had a low haemoglobin or low sodium level at discharge, the study found. 

“The HOSPITAL score is easy to use and can be calculated before discharge, which makes it a practical tool for identification of patients at high risk for preventable readmission and the timely administration of high-intensity interventions designed to  improve transitions of care,” the authors wrote.

Jacques DD, Williams MV, Robinson EJ, Zimlichman E, Aujesky D, et al. International Validity of the HOSPITAL Score to Predict 30-Day Potentially Avoidable Hospital Readmissions. JAMA Intern Med 2016 [Internet] doi:10.1001/jamainternmed.2015.8462


Financial penalties for excess readmissions pay dividends

A US program which hits hospitals with financial penalties if their readmission rates for certain conditions exceed expectations has led to marked reductions in such readmissions, two studies show.

Since 2013, the Hospital Readmissions Reduction Program, created under the US Affordable Care Act (ACA), has penalised hospitals with higher than expected 30-day readmission rates for acute myocardial infarction, heart failure and pneumonia by cutting a percentage of Medicare payments to the hospital. Readmissions following total hip or knee replacement and admission for chronic obstructive pulmonary disorder (COPD) were added to the list in 2015.

Researchers analysed 3387 hospitals, finding that from 2007 to 2015, readmission rates for targeted conditions declined from 21.5% to 17.8%, while rates for non-targeted conditions declined from 15.3% to 13.1%, according to findings in the New England Journal of Medicine.

The study found that the readmissions fell quickly shortly after the introduction of the ACA, especially for targeted conditions, then continued to fall, but at a slower rate for both targeted and non-targeted conditions.

The study found no evidence to support concerns that hospitals were achieving the lower readmission rates by keeping returning patients in observation units rather than formally readmitting them to the hospital.

“Readmissions trends are consistent with hospitals responding to incentives to reduce readmissions, including the financial penalties for readmissions under the ACA,” the authors wrote.

The findings were echoed in a separate study published in International Journal for Quality in Health Care, which also showed that there had been a significant decrease in excess readmissions for pneumonia, acute myocardial infarction and heart failure in hospitals between 2013 and 2015 as a result of the Hospital Readmission Reduction Program. The effect of the program on excess readmissions was greater for small hospitals, public hospitals and hospitals in rural areas, it found.

Zucherman RB, Steven MPH, Seingold SH, Orav SEJ, Ruhter J, et al. Readmissions, observation and the Hospital Readmissions Reduction program. NEJM 2016 [Internet] DOI: 10.1056/NEJMsa1513024

Lu N, Huang K-C, Johnson JA. Reducing excess readmissions: promising effect of hospital readmissions reduction program in US Hospitals. International Journal for Quality in Health Care 2016;28(1);53‒8


Parents a source of valuable data on kids’ adverse events

Families are an untapped source of data about adverse events among hospitalised children, according to a study in which one in 11 families reported that their child experienced a safety incident while in hospital.

The researchers surveyed 383 parents of children in two general paediatric units at a US children’s hospital about whether their child had experienced any safety incidents during their hospitalisation. Physician reviewers then classified the incidents as medical errors, (harmful or non-harmful), other quality issues or exclusions.

The study showed that 8.9% of parents reported a total of 37 safety incidents, 62% of which were determined to be medical errors by physician review, 24% which were deemed to be other quality problems, and 14% were classified as neither.

Findings in JAMA Pediatrics showed that more than half of parent-reported medical errors were also documented in the patient’s medical record. After validation, the medical error rate was found to be 6 per 100 admissions, with a preventable adverse event rate of 1.8 per 100 admissions.

Children who experienced medical errors appeared to have longer lengths of stay in hospital than those who didn’t experience mistakes, and they were more likely to have a complex, chronic condition including metabolic or neuromuscular conditions.

The authors said the results suggested further communication between parents and physicians and nurses around safety may be beneficial, and noted that even parent concerns that were not strictly safety related could provide useful information to help improve the quality and safety of care provided to children.

“Ultimately, while family error reporting should not replace active surveillance, hospitals may wish to consider more actively involving families in the surveillance process,” the authors wrote.

“Family members can be crucial partners not only in reporting but also in ensuring the safety of hospitalised patients.”

Khan A, Furtak, SL, Melvin P, Rogers JE, Schuster MS, et al. Parent-reported errors and adverse events in hospitalised children JAMA Pediatr. 2016. [Internet] doi:10.1001/jamapediatrics.2015.4608


Our $1.2 billion medication-related admissions bill

An estimated 230,000 medication-related hospital admissions occur in Australia each year at a cost of $1.2  billion, a new review suggests.

Researchers from the University of South Australia synthesised new evidence on medication errors and adverse drug reactions that occur at the various stages of the patient’s hospital stay, with a previous review conducted in 2008.

They found that 2‒3%, of all hospital admissions were medication-related, meaning 230,000 patients are admitted to hospital each year as a result of medication errors, based on 2011‒12 figures.

With an average cost per admission of $5204, the annual cost of medication-related admissions was estimated at $1.2 billion, according to findings in the International Journal of Evidence-Based Healthcare.

The researchers also analysed literature on medication errors that occur throughout the patient’s hospitalisation, finding that two in three patients experienced medication errors – such as medicines being omitted from the medication history – upon admission to hospital.

While in hospital, up to one clinical prescribing error occurred per patient, and errors during the administration of medicine occurred in about 9% of cases. Upon discharge, there were up to two medication errors per patient.

The researchers said the extent of medication-related problems needed to be interpreted with caution, given the increasingly complex nature of healthcare. However, tackling the issue would require an “ongoing commitment and coordinated effort by government, health professionals, consumers, researchers and health services”.

“The synthesis of evidence from this review suggests that problems with medication safety encountered by patients as they move through the acute care setting in Australia still represents a significant challenge,” they wrote.

Roughead E, Semple SJ, Rosenfeld, E. The extent of medication errors and adverse drug reactions throughout the patient journey in acute care in Australia. International Journal of Evidence-Based Healthcare 2016 [Internet] doi: 10.1097/XEB.0000000000000075


Communication a key factor in errors, say patients

Communication errors are a major cause of adverse events in primary care, according to a review of patient’s perceptions of safety incidents. The systematic review of 19 studies found patients were able to identify events traditionally recognised as adverse events, such as delayed or wrong diagnosis and medication dispensing errors.

Our results suggest that patient safety does not only consist of prevention from technical medical errors but also includes a wide range of service and quality problems  
Patients raise service, quality concerns

However, patients were mostly concerned about service and quality problems with their healthcare, which they perceived as safety threats, according to findings in BMC Family Practice.

“Our results suggest that patient safety does not only consist of prevention from technical medical errors but also includes a wide range of service and quality problems,” the authors wrote.

Problems included deficits in doctor-patient relationship, such a lack of respect, time pressure, rudeness, or breaches of confidence; co-ordination and access to care.

Communication problems were highlighted by patients as one of the most significant factors in both the incidence and the severity of adverse events, the authors said.

They said integrating patients' perspectives broadened the existing understanding of adverse events in outpatient care and should be considered as a complementary measuring tool to traditional measures of adverse events.

Lang S, Valesco Garrido M, Heintze C. Patients’ view of adverse events in primary and ambulatory care: a systematic review to assess  methods and the content of what patients consider to be adverse events. BMC Family Practice 2016;17;6 [Internet] DOI: 10.1186/s12875-016-0408-0


Primary care for chronic disease 'needs overhaul'

Chronic failure in primary care”, a report released by the Grattan Institute, argues that ineffective management of chronic disease costs the Australian health system more than $320 million each year in avoidable hospital admissions. At best, Australia’s primary care system provides only half the recommended care for many chronic conditions, the report states, urging a move away from the current fee-for-service funding model, towards a broader payment for integrated team care. 

Download report

Immunisation highs and lows

Many areas of Australia are failing to meet childhood immunisation targets, according to this report from the National Health Performance Authority. In 2014‒15, the percentage of one-year-old children who were fully immunised ranged from 88% to 94% across the 31 Primary Health Networks. There was even greater variation in immunisation rates across postcodes. More than 1200 postcodes had rates below 95%, and more than 100 had rates below 85% ‒ falling well short of an agreed national aspirational target of full immunisation for 95% of children.

Download report

Report reveals rising suicide rate

Heart disease, dementia, stroke, lung cancer and chronic lower respiratory diseases remain the top five leading causes of death in Australia, accounting for more than one third of all deaths, according to the latest data from the Australian Bureau of Statistics. The report on causes of death finds that as life expectancy continues to increase the incidence of diseases such as dementia have increased. But among people 15‒44 years of age, suicide was the leading cause of death ‒ the highest rate of suicide deaths recorded in the past 10 years. 

Download report

The way ahead in patient safety

This report on the way forward for patient safety has been released by the National Institute for Health Research (NIHR) Patient Safety Translational Research Centre at Imperial College London and Imperial College Healthcare NHS Trust. It says there is a need for a ‘toolbox’ for patient safety which includes using digital technology to improve safety; providing robust training and education, and strengthening leadership at the political, organisational, clinical and community levels.

Download report

Lorraine Lovitt  

Lorainne Lovitt

NSW Falls Prevention Program Leader

Clinial Excellence Commission

Falls are no joking matter for April Fall’s Day leader

On 1 April  each year, Lorraine Lovitt and her team are focussed on the very serious business of preventing falls among the state’s ageing population.

Ms Lovitt, NSW Falls Prevention Program Leader with the Clinical Excellence Commission, will this year be overseeing her 9th April Falls Day, an event that aims to raise awareness about falls among both health service staff and the broader community.

She says the event was initiated by the Northern Sydney Area Health Service, before being adopted by the CEC. It has gone from strength to strength, with staff across the state embracing the day in novel ways ranging from running cake stalls to wearing awareness-raising T-shirts, decorating their wards, running forums for the general community and even arranging a flash mob of school children demonstrating the four steps that are recommended to improve balance and strength and prevent falls.

“We wanted to engage with staff in a more interesting way to talk about falls,” she says. “Falls prevention is a serious issue but it can be a light-hearted way to raise awareness – we once had a doctor who dressed up as Humpty Dumpty.”

Engaging patients, families and carers

The 2016 April Fall’s Day theme is “Share the Care:  Falls Prevention is Everyone’s Business” and the event is  supported by resources including posters, screen savers and brochures aimed at staff and patients, families and carers, community services and the general community.

Ms Lovitt says she has been liaising with NSW Health carer support officers in each LHD as well as Carers NSW to promote this year’s event, which will focus on the fact that everyone from the hospital cleaner to the nursing staff to the patient’s family and carers has a role to play in preventing falls.

“We have been increasingly focusing on how we engage with patients and their family and carers,” she says. “They know important information about the patient that can help health services to reduce their risk of falls.”

Hospital admissions due to falls are increasing at a rate of around 3% per year and falls are one of the most common adverse events within the hospital setting, she says.

“We’re in a shifting environment,” she says. “I see us as pioneering healthcare here – for the first time, we have large numbers of older people who are frailer, they are living longer and they have complex morbidities. It is important we have really good engagement with their families and carers to deliver good, safe healthcare.”

The broader picture

Preventing falls is among a long list of challenges Ms Lovitt has taken on since starting her career as a registered nurse and midwife in NSW hospitals.

She has worked in a variety of hospitals and community settings, developed clinical resources for the University of New South Wales Medical School around nurse engagement, run healthy lifestyle programs for the elderly; been nurse unit manager in a rehabilitation hospital, a clinical nurse consultant in aged care and Area Co-ordinator of aged care, as well as developing the first NSW state-wide discharge policy.

She was in the vanguard of the innovative ComPacks program to facilitate safe and early discharge of eligible patients from hospital by providing access to a short-term package of community care, and was among the small group of staff that have been at the CEC since its launch within Sydney Hospital in 2004.

“My career has just evolved as paths have opened up for me,” she says, adding that she has always been drawn to roles that enable her to take a long-term view of patient care with a particular focus on improving care for older people. 

“I have a sensitivity to understanding how we try to look at a person more holistically and provide safe care,” she says.

“Longer term care (across settings) is where I feel my skills are – I’m interested in the broader picture."

Pain Network: Annual planning day

This annual workshop hosted by the NSW Agency for Clinical Innovation is an opportunity for consumers and staff interested in the progress of the NSW pain plan to come together to explore specific topic areas. In 2016, the main topic areas are adolescents and young people with chronic pain and progress in the primary care sector.

6 April, Sydney
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Stroke Reducing Unwarranted Clinical Variation Forum
28 April, Sydney
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This forum held by the NSW Agency for Clinical Innovation will provide an overview of the Stroke Clinical Variation Statewide Strategy, which is aimed at ensuring the delivery of best quality care through a process that regularly assesses clinical variation, determining and correcting its causes through a quality improvement process on a site-by-site basis. The forum is aimed at doctors, nurses, allied health professionals and managers who work in NSW health services.

Forum: Improving Outcomes in Older Surgical Patients

This forum hosted by the Concord Medical Education Centre is aimed at clinicians, nursing staff, allied health workers and health researchers. Associate Profesor Amir Ghaferi from the University of Michigan will discuss his seminal research into the concept of 'failure to rescue" and factors contributing to increased surgical motality in older patients. Email via "read more" link (right) for further details.

29 April, Sydney
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2016 Patient Experience Symposium
5–6 May, Sydney
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The Agency for Clinical Innovation and The Clinical Excellence Commission (CEC), in partnership with the Office of Kids and Families, Cancer Institute NSW, Bureau of Health Information, Health Education and Training Institute, Nursing and Midwifery Office, with support of Health Consumers NSW, are co-hosting this symposium to be held at the Australian Technology Park, Everleigh, Sydney. The event will be an opportunity for clinicians, consumers and managers to hear from experts in the field and to share local innovations in improving patient experience and outcomes.

2016 Primary Health Care Research Conference

This 2016 PHC Research Conference has the theme “Reform and innovation in PHC policy and practice” and aims to provide an opportunity for national knowledge exchange for people working across the primary healthcare frontline. Delegates from research as well as practice, policy, management and consumer/community fields are set to debate the latest quality peer-reviewed PHC research.

8–9 June, Canberra
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APAC Forum
12–14 September, Sydney
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Registrations are now open for the APAC Forum health improvement conference, which is being held in Sydney for the first time and is themed: “Exploring new frontiers ‒ creating your blueprint for a healthy future”. The forum aims to attract health  leaders, policy makers, patients, consumers, carers, doctors, nurses, allied health and quality improvement specialists, providing a platform to improve the health and wellbeing of the population.
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