Travis Review: interim report

The Travis Review was commissioned by the Minister for Health to conduct an independent statewide census of bed and theatre capacity, and to provide recommendations on how to increase the capacity of Victorian hospitals. Terms of reference The terms of reference for the Travis Review are to: 1. Perform a statewide census of hospital capacity including bed, theatre and emergency department capacity and other services that may be substitutes for traditional inpatient care. 2. Consider issues, opportunities and challenges to measuring existing capacity, drawing on local, national and international policy perspectives. 3. Develop recommendations on how to optimise Victoria’s health system capacity in the short term (specifically through allocating additional recurrent funding and minor capital expenditure as required) that can be actioned in the 2015–16 State Budget. 4. Consider the current progress in implementing process redesign methodologies across the Victorian public hospital system and make recommendations on how this can be strengthened to optimise the capacity of hospitals to treat the Victorian community into the future. 5. Call for public submissions from stakeholders for redesign projects or other innovative models of care that increase hospital capacity and make recommendations on their suitability to optimise the capacity of hospitals to treat the Victorian community into the future. 6. Provide an interim report on the census results by end of March 2015 and a final report by the end of June 2015 to the Minister for Health. The interim report This report completes the first three of the above terms of reference, with the remaining items to be completed in the final report due at the end of June 2015. The report contains a number of recommendations for consideration by the Minister for Health

Emergency TeleOrthoPaedics m-health system for wireless communication links

For the first time, a complete wireless and mobile emergency TeleOrthoPaedics system with field trials and expert opinion is presented. The system enables doctors in a remote area to obtain a second opinion from doctors in the hospital using secured wireless telecommunication networks. Doctors can exchange securely medical images and video as well as other important data, and thus perform remote consultations, fast and accurately using a user friendly interface, via a reliable and secure telemedicine system of low cost. The quality of the transmitted compressed (JPEG2000) images was measured using different metrics and doctors opinions. The results have shown that all metrics were within acceptable limits. The performance of the system was evaluated successfully under different wireless communication links based on real data

Variability of extracorporeal cardiopulmonary resuscitation utilization for refractory adult out-of-hospital cardiac arrest: an international survey study.

Objective: A growing interest in extracorporeal cardiopulmonary resuscitation (ECPR) as a rescue strategy for refractory adult out-of-hospital cardiac arrest (OHCA) currently exists. This study aims to determine current standards of care and practice variation for ECPR patients in the USA and Korea. Methods: In December 2015, we surveyed centers from the Korean Hypothermia Network (KORHN) Investigators and the US National Post-Arrest Research Consortium (NPARC) on current targeted temperature management and ECPR practices. This project analyzes the subsection of questions addressing ECPR practices. We summarized survey. Results: Overall, 9 KORHN and 4 NPARC centers reported having ECPR programs and had complete survey data available. Two KORHN centers utilized extracorporeal membrane oxygenation only for postarrest circulatory support in patients with refractory shock and were excluded from further analysis. Centers with available ECPR generally saw a high volume of OHCA patients (10/11 centers care for \u3e75 OHCA a year). Location of, and providers trained for cannulation varied across centers. All centers in both countries (KORHN 7/7, NPARC 4/4) treated comatose ECPR patients with targeted temperature management. All NPARC centers and four of seven KORHN centers reported having a standardized hospital protocol for ECPR. Upper age cutoff for eligibility ranged from 60 to 75 years. No absolute contraindications were unanimous among centers. Conclusion: A wide variability in practice patterns exist between centers performing ECPR for refractory OHCA in the US and Korea. Standardized protocols and shared research databases might inform best practices, improve outcomes, and provide a foundation for prospective studies

Approach to Assessing the Preparedness of Hospitals to Power Outages

Within the secondary impacts of electricity blackouts, it is necessary to pay attention to facilities providing medical care for the population, namely the hospitals. Hospitals represent a key position in the provision of health care also in times of crisis. These facilities must provide constant care; it is therefore essential that the preparedness of such facilities is kept at a high level. The basic aim of this article is to analyse the preparedness of hospitals to power outages (power failures, blackouts) within a pilot study. On that basis, a SWOT analysis is used to determine strengths and weaknesses of the system of preparedness of hospitals to power outages and solutions for better security of hospitals are defined. The sample investigated consists of four hospitals founded by the Regional Authority (hospitals Nos. 1-4) and one hospital founded by the Ministry of Health of the Czech Republic (hospital No. 5). The results of the study shows that most weaknesses of the preparedness of hospitals are represented by inadequately addressed reserves of fuel for the main backup power supply, poor knowledge of employees who are insufficiently retrained, and old backup power supplies (even 35 years in some cases)

Deprivation as an outcome determinant in emergency medical admissions

Background: Deprivation in the general population predicts mortality. We have investigated its relevance to an acute medical admission, using a database of all emergency admissions to St James’ Hospital, Dublin, over a ten year period (2002-2011). <p/>Methods: All emergency admissions, based on geocoding of residence, were allocated to a Small Area Health Research Unit (SAHRU) division, with a corresponding deprivation index. We then examined this index as a univariate (unadjusted) and independent (adjusted) predictor of 30-day in-hospital mortality. <p/>Results: The 30-day in-hospital mortality, over the 10 year period was higher, for those in the upper half of the deprivation distribution (9.6% vs 8.6%: p = 0.002). Indeed, there was a stepwise increase in 30-day mortality over the quintiles of deprivation from 7.3% (Quintile 1) to 8.8%, 10.0%, 10.0% and 9.3% respectively. Univariate logistic regression of the deprivation indices (quintiles) against outcome showed an increased risk (p = 0.002) of a 30-day death with OR’s respectively (compared with lowest deprivation quintile) of 1.23 (95% CI 1.07, 1.40), 1.41 (95% CI 1.24, 1.60), 1.41 (95% CI 1.24, 1.61) and 1.30 (95% CI 1.14, 1.48). The deprivation index was an independent predictor of outcome in a model when adjusted for illness severity and co-morbidity. The fully adjusted OR for a 30-day death was increased by 31% (p=0.001) for patients in the upper half of the deprivation index distribution (OR 1.31: 95% CI 1.20, 1.44). <p/>Conclusion: Deprivation independently of co-morbidity or acute illness severity is a powerful outcome predictor in acute medical admissions

Cost comparison of orthopaedic fracture pathways using discrete event simulation in a Glasgow hospital

Objective: Healthcare faces the continual challenge of improving outcome whilst aiming to reduce cost. The aim of this study was to determine the micro cost differences of the Glasgow non-operative trauma virtual pathway in comparison to a traditional pathway. Design:  Discrete event simulation was used to model and analyse cost and resource utilisation with an activity based costing approach. Data for a full comparison before the process change was unavailable so we utilised a modelling approach, comparing a Virtual Fracture Clinic (VFC) to a simulated Traditional Fracture Clinic (TFC). Setting:  The orthopaedic unit VFC pathway pioneered at Glasgow Royal Infirmary has attracted significant attention and interest and is the focus of this cost study. Outcome measures: Our study focused exclusively on non-operative trauma patients attending Emergency Department or the minor injuries unit and the subsequent step in the patient pathway. Retrospective studies of patient outcomes as a result of the protocol introductions for specific injuries in association with activity costs from the models.ResultsPatients are satisfied with the new pathway, the information provided and the outcome of their injuries (Evidence Level IV). There was a 65% reduction in the number of first outpatient face-to-face attendances in orthopaedics. In the VFC pathway, the resources required per day were significantly lower for all staff groups (p=<0.001). The overall cost per patient of the VFC pathway was £22.84 (95% CI: 21.74, 23.92) per patient compared with £36.81 (95% CI: 35.65, 37.97) for the TFC pathway.  Conclusions:  Our results give a clearer picture of the cost comparison of the virtual pathway over a wholly traditional face-to-face clinic system. The use of simulation-based stochastic costings in healthcare economic analysis has been limited to date, but this study provides evidence for adoption of this method as a basis for its application in other healthcare settings

A survey of health care models that encompass multiple departments

In this survey we review quantitative health care models to illustrate the extent to which they encompass multiple hospital departments. The paper provides general overviews of the relationships that exists between major hospital departments and describes how these relationships are accounted for by researchers. We find the atomistic view of hospitals often taken by researchers is partially due to the ambiguity of patient care trajectories. To this end clinical pathways literature is reviewed to illustrate its potential for clarifying patient flows and for providing a holistic hospital perspective

Using discrete event simulation (DES) to manage theatre operations in healthcare: An audit-based case study

This paper discusses the application of Discrete Event Simulation (DES) in modelling the complex relationship between patient types, case-mix and operating theatre allocation in a large National Health Service (NHS) Trust in London. The simulation model that was constructed described the main features of nine theatres, focusing on operational processes and patient throughput times. The model was used to test three scenarios of case-mix and to demonstrate the potential of using simulation modelling as a cost effective method for understanding the issues of healthcare operations management and the role of simulation techniques in problem solving. The results indicated that removing all day cases will reduce patient throughput by 23.3% and the utilization of the orthopaedic theatre in particular by 6.5%. This represents a case example of how DES can be used by healthcare managers to inform decision making

RESPOND – A patient-centred program to prevent secondary falls in older people presenting to the emergency department with a fall: Protocol for a multi-centre randomised controlled trial

Introduction: Participation in falls prevention activities by older people following presentation to the Emergency Department (ED) with a fall is suboptimal. This randomised controlled trial (RCT) will test the RESPOND program which is designed to improve older persons’ participation in falls prevention activities through delivery of patient-centred education and behaviour change strategies. Design and setting: An RCT at two tertiary referral EDs in Melbourne and Perth, Australia. Participants: Five-hundred and twenty eight community-dwelling people aged 60-90 years presenting to the ED with a fall and discharged home will be recruited. People who: require an interpreter or hands-on assistance to walk; live in residential aged care or >50 kilometres from the trial hospital; have terminal illness, cognitive impairment, documented aggressive behaviour or history of psychosis; are receiving palliative care; or are unable to use a telephone will be excluded. Methods: Participants will be randomly allocated to the RESPOND intervention or standard care control group. RESPOND incorporates: (1) home-based risk factor assessment; (2) education, coaching, goal setting, and follow-up telephone support for management of one or more of four risk factors with evidence of effective intervention; and (3) healthcare provider communication and community linkage delivered over six months. Primary outcomes are falls and fall injuries per-person-year. Discussion: RESPOND builds on prior falls prevention learnings and aims to help individuals make guided decisions about how they will manage their falls risk. Patient-centred models have been successfully trialled in chronic and cardiovascular disease however evidence to support this approach in falls prevention is limited. Trial registration. The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000336684)