Victorian Public Healthcare 05Awards Showcase Victorian Public Healthcare Awards Showcase Message from the Premier of

Victoria has one of the best health systems in the world. And the heart of that system is a dedicated workforce - doctors, nurses, allied health workers - who work tirelessly to save the lives of many Victorians and enhance the quality of life of many more. Through the 2005 Victorian Public Healthcare Awards we celebrate and pay tribute to those people and their achievements. From managing emergency and , to treating chronic and complex conditions, and preventing ill health, there is no doubt that public healthcare is one of the most challenging fi elds in which to work. Yet what is most impressive is the unerring commitment of those who work in our to making a difference to the lives of Victorians. As a community, we can take enormous pride in the expertise, ingenuity and dedication of our healthcare workforce. The Victorian Government is proud to honour the achievements of our public healthcare providers. Congratulations.

The Honourable Steve Bracks MP Premier of Victoria Message from the Minister for Health

The 2005 Victorian Public Healthcare Awards recognise the commitment of our healthcare professionals to quality, innovation and excellence. With more than 200 entries, we have seen an impressive array of innovative programs that are improving the lives of countless Victorians. Our and health services, both large and small, are at the forefront of delivery. In many cases, we are leading the country and the world. Like Austin Health’s Medical Emergency Team concept, which is to be introduced in 1000 hospitals in the United States. In , Barwon Health is at the forefront of overnight home haemodialysis, transforming the lives of people with kidney disease. Western District Health Service’s Sustainable Farm Families and Eastern Health’s Kool Kids Positive Parents are working closely with their communities to prevent health problems before they begin. And a dental program that reaches out to the homeless and other vulnerable Victorians is being run by Inner South Services. These are just some of the remarkable achievements that occur every day in our health system.

The Honourable Bronwyn Pike MP Minister for Health Introduction

The aims of the 2005 Victorian Public Healthcare The selection of fi nalists was undertaken by 95 judges Awards are to celebrate quality, innovation and from the sector, led by the Chair of Judging, Dr Norman excellence in public healthcare and to honour the Swan. The judges gave generously of their time to dedication and expertise of the people who provide complete the substantial task of assessing the entries. public healthcare to the Victorian community. The careful consideration the judges gave to each entry With nine categories plus Minister’s and Premier’s is refl ected in the calibre of the fi nalists and winners. awards, the Awards offer healthcare providers an The 2005 Victorian Public Healthcare Awards Showcase opportunity to be recognised for their commitment provides readers with a brief insight into the breadth, and dedication to providing the best possible care diversity and quality of the work happening every day in to the people of Victoria. our health services to improve the health and wellbeing It was an opportunity the healthcare sector embraced of the Victorian community. with great enthusiasm, with 203 entries submitted in this, the fi rst year of the awards. Contents

Showcase summary 1 Category 1 Excellence in care delivery 7 For outstanding achievement in appropriateness of care Category 2 Excellence in consumer participation 15 For outstanding achievement in engaging consumers in decision-making Category 3 Excellence in safety of care 29 For outstanding achievement in ensuring the safe progress of clients and patients through the healthcare system Category 4 Innovation in patient access 37 For outstanding achievement in maximising access to emergency and elective services in public hospitals Category 5 Innovation in models of care 49 For outstanding achievement in embracing new models of care for the benefi t of clients and patients Category 6 Innovation in information technology 59 For outstanding achievement in applying information technology to enhance client and patient care Category 7 Excellence in community relations 67 For outstanding achievement in communication, marketing, community awareness or health promotion Category 8 Excellence in continuity of care 75 For outstanding achievement in the integration and coordination of care Category 9 Innovation in workforce design 83 For outstanding achievement in implementing new and better ways of working Minister’s awards for outstanding staff achievement 91 Showcase summary

05 1 05Category awards

Category 1: Excellence Category 2: Excellence Highly commended in care delivery in consumer participation Getting mental health messages Category 2a: Excellence to young people: The Flipper Card Winner in consumer participation Barwon Health Dental makes a difference: in healthcare management Dental care for marginalised high St Vincent’s: Victoria’s fi rst Deaf and need client groups Winner hard of hearing friendly health service Inner South Community Health Services and community: St Vincent’s Health Working together to strengthen Highly commended service provision for Aboriginal Category 3: Excellence Faster Access to Stroke Therapies and Torres Strait Islander patients in safety of care St Vincent’s Health Eastern Health and Metropolitan Winner Ambulance Service Highly commended Austin Health Medical COACH: A telephone support and Health for Kids: Consumers Emergency Team training program for patients with and clinicians working together Austin Health coronary heart disease Southern Health St Vincent’s Health Highly commended Dementia care at Ballarat Reduction of unexpected cardiac The St Vincent’s Health Warfarin Health Services arrest and death among children Awareness Safety Program: Ballarat Health Services in hospital with a medical Reducing the frequency of harm emergency team Category 2b: Excellence in consumer to patients on warfarin The Royal Children’s Hospital involvement in their own care St Vincent’s Health Winner Working hand in hand: Sustainable Farm Families: The human Management of clinical aggression resource in the triple bottom line NorthWestern Mental Health, Health Western District Health Service Electronic medical handover Barwon Health

2 Category 4: Innovation Highly commended Category 6: Innovation in patient access Alexandra Eye Care Service in information technology Category 4a: Innovation in patient Alexandra District Hospital Winner access to emergency care Reducing hospital-initiated TOPHATS – The Orion, Peninsula Winner postponement for elective Health Advanced Technology Solution: Western Health Accelerated Care Through An innovative project to improve Emergency Program the continuum of care on the The Royal Children’s Hospital Category 5: Innovation in models of care Peninsula Health Highly commended Joint winner The Chronic Illness Re-admission Highly commended Changing practice: Developing Program: CHIRP Using Blackberry technology a cost-effi cient, outcome-rich, Barwon Health to support the patient care patient-oriented, overnight home delivery process The St Vincent’s Health Assessment, haemodialysis program Peninsula Health Liaison and Early Referral Team: Barwon Health Supporting people with complex Clinical impact of the Infectious care needs Joint winner Diseases Electronic Antibiotic Advice St Vincent’s Health Kool Kids Positive Parents program and Approval System (IDEA3S) Austin Health Category 4b: Innovation in Eastern Health patient access to elective care Personal Digital Assistant Program Highly commended Barwon Health Winner Outcomes of implementing The Southern Health model a tracheostomy review and of cataract care management service Southern Health Austin Health

3 05

Category 7: Excellence Highly commended in community relations Care in context Southern Health Winner The Men’s Shed and Improving diabetes care Men Behaving Positively Austin Health Peninsula Health Encouragement award Highly commended The importance of the therapeutic relationship Ambulance in Schools in effective case management Metropolitan Ambulance Service South East Advocacy and Support Service, Southern Health Community Kitchens Frankston Community Health Service Category 9: Innovation Peninsula Health in workforce design Category 8: Excellence Winner in continuity of care Primary contact orthopaedic physiotherapists improving care for patients on the orthopaedic Winner outpatients waiting list A best practice model of care for people Western Health with diabetes-related foot conditions across the hospital-community continuum Highly commended Partnerships in Health: Doutta Galla Community The challenge of sustaining a rural Health Service, Moreland Community Health Service, maternity service Melbourne Health and Royal District Nursing Service Bass Coast Regional Health

Physiotherapy: A new look service to care for our community Bendigo Health Care Group

4 0 Minister’s awards for outstanding staff achievement

Minister’s award for outstanding individual achievement Winner Professor Hatem H. Salem Director of Eastern Health

Highly commended Ingrid Plueckhahn Practice Development Nurse Peter McCallum Cancer Centre

Jenny Trezise Community Dietician Peninsula Health

Minister’s award for outstanding team achievement Winner DeBug Prevention program Austin Health

Highly commended An integrated, interdisciplinary approach to patient care Peninsula Health

Clinical Practice Improvement Unit The Royal Women’s Hospital

Aged Care Shared Care program Broadmeadows Health Service Northern Health 05 5 Victorian Public Healthcare Awards 0 Category 1 Excellence in care delivery

For outstanding achievement in appropriateness of care

Appropriateness of healthcare is about using evidence to do the right thing for the right person, in a timely fashion. It is essential that interventions performed for the treatment of a particular patient be selected based on the likelihood that the intervention will produce the desired outcome. This award recognises initiatives associated with appropriateness of care and tailoring treatment to the needs of individuals.

05 7 Winner Dental makes a difference: Dental care for marginalised high need client groups 05 Inner South Community Health Services

The broad aims of this program are to provide a positive image of among the client groups, enhance access to dental care, improve the likelihood of successful dental treatment, and to provide an opportunity for oral health instruction. The programs provide clients with access to dental screenings in local venues that are familiar to them, including rooming houses and special residential services. This is followed up with specialised clinics in which the particular needs of different groups can be addressed. There is an emphasis on raising awareness about oral hygiene and on preventative and restorative treatment, so that benefi ts of treatment may be long term. This is a unique collaboration between the dental program and other program areas. It develops awareness of dental health among the target groups and combines the expertise of different health and welfare professionals. Poor oral health impacts negatively on , speech, About us appearance, self-esteem, social interactions and life opportunities. Even something as basic as a smile may The Inner South Community Health Services dental be diffi cult for people who are self conscious of the poor service actively targets the most socially and condition of their teeth. This can have an adverse impact economically disadvantaged groups through special on their sense of hope for a better life. needs programs that deliver excellent quality, readily accessible services to high need, high risk clients The Inner South Community Health Services Dental who have no existing or alternate dental care options. Program faced the challenge of applying this philosophy to groups of clients who experience diffi culty in The programs are: accessing traditional dental services. The service chose • Homeless Youth Dental Clinic a community-based approach, in providing specialised • Dental Plus: HIV/AIDS positive clients programs for homeless young people, people who are • Dental Fix: for clients with alcohol and other HIV positive, people with alcohol or drug dependencies drug dependencies and clients with mental illnesses. • Dental as Anything: for mental health clients.

8 Abstract They were aware of the diffi culties their clients had in accessing regular dental health programs. The workers The special needs programs at Inner South Community discussed their concerns with the Dental Program team. Health Services (ISCHS) are based on the philosophy After a successful model was established for homeless that poor oral health impacts negatively on nutrition, youth, the model was applied and adapted to the needs speech, appearance, self esteem, social interactions of the other client groups. and life opportunities. Even something as basic as a smile may be diffi cult for people who are self conscious Strategy about the poor condition of their teeth. This can have an adverse impact on their sense of hope for a better life. The program uses a holistic approach to dental services for high need clients, involving a six-prong strategy: The special needs programs were developed to meet the needs of groups who did not access traditional • Outreach: to enhance accessibility, by going where dental health services due to social ostracism, fi nancial the clients are for initial assessment or referral constraints, infectious diseases or mental health. • Clinical care: the provision of treatment in special Strategies were devised to provide accessible dental needs clinics as soon as possible after assessment assessment and treatment for these groups. The • Collaboration: involving workers from other programs programs provide clients in these groups with access to provide ongoing awareness and support to high quality dental healthcare through a community- • Education: a strong focus on educating clients to based approach. be better able to maintain their dental health and Aim informing staff in clinical, community and residential services so that they can better support the dental The programs aim for better dental health outcomes health of their clients for people in the relevant client groups, and the involvement of their case workers in assisting these • Modelling: creating opportunities to expand service clients to maintain and improve their dental health models for other disadvantaged and vulnerable groups and to access dental health services. • Funding: development of a block funding model with Dental Health Services Victoria has resulted in a fee- Background free funding system which both facilitates client access The special needs programs originated from the to these programs and allows for the time-intensive concerns of ISCHS case workers working with homeless approach needed to engage and treat these high need youth, drug and alcohol dependent clients, HIV positive client groups. clients and people with a psychiatric illness.

9 Regular reviews of data on patterns of treatment, These fi gures represent provision of high quality dental liaison meetings with workers in other programs and health services to clients who would otherwise largely client satisfaction surveys are used to monitor quality not access such services. of provision and to identify emerging trends and needs Regular meetings and information sessions are held among the client groups. with case workers who work with these clients. These Outcomes and evaluation meetings provide information on dental health issues for the different client groups, and explore implications The programs have provided dental treatment for for the support case workers provide for their clients. a signifi cant number of people in the client groups. The programs have achieved a high profi le with case From July 2004 to June 2005, 1232 client have received workers across different agencies. treatment, with a total of 2516 client visits. From April to June 2005, the most recent quarter for Spread and sustainability which reports are available, the following treatments The program moved from an initial focus on homeless were provided by each program: youth to the development of programs for the other • Homeless Youth clinic: 33 patients were treated special needs groups. As the programs have become in 45 visits. There were 33 preventative treatments, more established they have reached a wider range of 72 restorative treatments, one addition to a denture, clients. For example, in the Dental as Anything program, and two extractions. outreach screenings for mental health clients were provided in 26 different supported residential services • Dental Plus: 120 patients were treated in 224 visits and hostels from July 2004 to June 2005, and 222 with 180 restorative treatments, 186 preventative patients were screened. treatments, 20 denture services and 26 extractions. Block grant funding has ensured the viability of these • Dental Fix: 74 patients were treated in 128 visits with programs, which could not otherwise be sustained, 100 restorative treatments, 75 preventative treatments due the nature and needs of these client groups. and 35 extractions. • Dental as Anything: 47 clients were screened in Contact outreach sessions. In clinical sessions 68 patients were treated in 118 appointments. These included Maureen Williams 114 diagnostic services, 107 restorative services, Inner South Community Health Services Dental Program 100 preventative services and 31 extractions. T: 03 9525 1300 E: [email protected] These numbers are lower than usual as the clinic was closed for ten days for refurbishment.

10 Highly commended Faster Access to Stroke Therapies , Eastern Health and Metropolitan Ambulance Service

Advances in clot busting (thrombolytic) therapy has These processes allowed her to receive the clot busting provided the fi rst acute treatment for stroke. Thrombolytic treatment, and today she is symptom free. At the launch therapy is a medication that quickly dissolves the blood of National Stroke Week she said: ‘I wouldn’t be here clot and can limit the amount of permanent disability today if they had not acted so quickly’. for some patients. However, this new treatment can The processes in place as part of the FAST study, a only be given within three hours of symptom onset, partnership with the Metropolitan Ambulance Service which requires prompt action by both patients and the and Box Hill Hospital, have resulted in successful healthcare system. implementation of thrombolytic therapy at the hospital, To prepare for this treatment at Box Hill Hospital, in improving patient outcomes, reducing in-hospital delays, conjunction with the emergency department and and maximising treatment options available. Metropolitan Ambulance Service, the department of neuroscience at Box Hill Hospital launched the Faster Contact Access to Stroke Therapies (FAST) study. The FAST study aimed to reduce delays within the emergency Christopher Bladin department to maximise the number of patients receiving Eastern Health T: 03 9895 3214 this treatment. E: [email protected] This was achieved through use of a paramedic assessment scale to assist in diagnosis of stroke, and an emergency department system to fast-track patient treatment in hospital. The results of this project clearly demonstrate how successful it has been. Annemarie, a 33-year-old stroke survivor, received clot busting therapy. The processes, in place as part of the FAST study, resulted in early identifi cation of her stroke by paramedics and rapid transport to hospital where she entered the fast-track system in the emergency department.

11 Highly commended COACH: A telephone support and training program for patients with coronary heart disease St Vincent’s Health

The Coaching Patients On Achieving Cardiovascular The COACH program is the result of PhD research Health (COACH) program is a telephone support conducted by St Vincent’s Health’s Dr Margarite Vale. and training program for patients with heart disease. The program is funded through the Department of A hospital-based ‘coach’ – usually a dietician or nurse Human Services Victorian Chronic and Complex – trains patients to actively pursue target levels for Care Program. their particular coronary risk factors. Risk factors include COACH is now running in three Melbourne tertiary high cholesterol, high blood pressure, smoking, high teaching hospitals in addition to St Vincent’s Hospital: dietary fat intake, higher than recommended waist Austin Hospital, , and The Alfred circumference and insuffi cient exercise. The patient Hospital. continues to see their usual doctor and specialists during the COACH program. Dr Vale is now researching how the COACH program’s ideas could be used to help improve the health of After patients have achieved the target levels for their patients with stroke, peripheral vascular disease, heart coronary risk factors, the cardiac coach continues to failure, diabetes and chronic obstructive airways disease. monitor and coach the patient for six months. The aim is for the patient to maintain their health achieved at six The Commonwealth Department of Health and Ageing months for the rest of their life. The coach contacts the is also looking at expanding the COACH program to other patient every six months to check on their progress. states and territories of .

Contact Dr Margarite Vale Program Manager, COACH St Vincent’s Health T: 03 9288 2750 E: [email protected]

12 Highly commended Reduction of unexpected cardiac arrest and death among children in hospital with a medical emergency team The Royal Children’s Hospital

Regrettably, unexpected cardiac arrest occurs in very Compared with a period before operation of the new sick children in hospitals worldwide. Sometimes it medical emergency team, the rate of unexpected cardiac occurs without warning and cannot be predicted but arrest during operation of the new system decreased at other times warning signs provide an opportunity by 40 per cent and death decreased by approximately to give assistance before cardiac arrest occurs. 55 per cent. Sometimes, delay in obtaining assistance is the result Although no other paediatric hospitals have tried this of communication diffi culties when staff are busy or not system, the concept of a paediatric medical emergency contactable or when they are unable to recognise early team was adapted from successful similar systems changes in a child’s condition. in a few Australian and British adult hospitals. The The Royal Children’s Hospital devised a method for Royal Children’s Hospital has found that it is better for staff to quickly recognise the warning signs of impending the children in its care if it empowers staff to request cardiac arrest and enable them to get help quickly assistance early, before cardiac arrest occurs. without having to discuss a child’s condition with senior colleagues. Contact Hospitals, like many organisations, have hierarchical Dr James Timbals systems of behaviour. The Royal Children’s Hospital The Royal Children’s Hospital changed the behaviour of its organisation. Any staff T: 03 9345 5221 member, no matter how junior, is now authorised to E: [email protected] summon immediate senior expert medical and nursing assistance of a medical emergency team if certain physiological criteria are observed or if the staff member is concerned about the child’s condition.

13 Victorian Public Healthcare Awards 0 Category 2 Excellence in consumer participation

For outstanding achievement in engaging consumers in decision-making

These awards recognise the formal processes, policies and programs instituted by healthcare providers to ensure that consumers are integral to the management, decision-making and planning in a healthcare organisation. The category also recognises initiatives implemented by healthcare providers to ensure that clients and patients are effectively informed and involved in all aspects of their care. Two awards are presented: a. Consumer participation in healthcare management b. Consumer involvement in their own care.

05 15 Winner Excellence in consumer participation Hospital and community: Working together to strengthen service provision for Aboriginal and Torres Strait Islander patients 05 St Vincent’s Health

The review recommended that St Vincent’s Health have a consistent approach to Aboriginal health services across the whole organisation. The review highlighted the importance of relationships with the Aboriginal community. St Vincent’s Health set up a new committee that is a partnership with the local Aboriginal community. The committee meets monthly and will make sure that the recommendations are acted on. St Vincent’s Health has set up working groups about human resources issues (for orientation, ATSI recruitment and cultural awareness training) and discharge planning. St Vincent’s Health has also set up a new position – In Victoria, a new Aboriginal health quality framework the Aboriginal Policy and Strategic Planning Offi cer – and new guidelines for hospitals – the Improving Care to coordinate initiatives. for Aboriginal and Torres Strait Islander Patients (ICAP) – recommend ways to improve health services About us for Aboriginal patients. St Vincent’s Health provides adult acute medical The guidelines and framework highlight the importance and surgical services, sub-acute care, diagnostics, of relationships between hospitals and local Aboriginal community-based services, mental health, palliative organisations. and residential care. It operates services from 15 sites in the cities of Yarra, Darebin and Boroondara, including In 2005, St Vincent’s Health studied its Koori Hospital St Vincent’s Hospital – a major tertiary teaching hospital. Liaison Offi cer program and the organisation’s existing St Vincent’s Health has 4700 staff, equating to about practices. St Vincent’s Health worked with an Aboriginal 3160 equivalent full time employees. St Vincent’s consultant, key Aboriginal community organisations Health’s mission and values compel the organisation and the peak Aboriginal community health organisation to provide particular care for marginalised and on the review. disadvantaged people. The most important part of the review was interviews with Aboriginal patients, local organisations and St Vincent’s Health staff.

16 Abstract • To examine factors at St Vincent’s Health including: St Vincent’s Health is Victoria’s largest metropolitan – Indigenous identifi cation and data collection provider of acute, adult Aboriginal and Torres Strait – staff values, skills, knowledge and Aboriginal Islander (ATSI*) healthcare. St Vincent’s Health believes cultural awareness that, for Aboriginal patients and families, ‘cultural safety’ – existing relationships and collaboration with is linked to the strength of relationships between the Aboriginal organisations. health service and Aboriginal organisations. This means that multifaceted consultation with local Aboriginal Background organisations is essential. The St Vincent’s Health initiative was inspired by From February to July 2005, St Vincent’s formally the 2002 ATSI Accreditation Project, which developed reviewed its Koori Hospital Liaison Offi cer (KHLO) an accreditation framework for public hospitals program. The review was conducted in partnership providing services for Aboriginal patients. The project with an Aboriginal consultant. The review team sought recommended accurate Aboriginal identifi cation, comments from Aboriginal patients, community services data collection, appropriate service provision and the and health service staff about existing services and development of community relationships. relationships and areas for improvement. In 2004 the Victorian Department of Human Services St Vincent’s Health is acting on the review’s adopted the framework and implemented the Improving recommendations to strengthen service provision to Care for ATSI Patients (ICAP) guidelines. These require Aboriginal patients. It has implemented new processes Victorian acute care facilities to develop plans addressing and arrangements and is establishing and building the framework criteria. dialogue with the Aboriginal community. In response, St Vincent’s Health reviewed the KHLO Aim program and existing practices. The review was overseen by the KHLO program’s advisory committee and the • To improve service provision to Aboriginal patients. newly established St Vincent’s Aboriginal Health • To create change that can extend across the whole Advisory Committee, which includes senior staff and of St Vincent’s Health, putting into action Victoria’s representatives from Aboriginal community-controlled new policies on Aboriginal health. health organisations and the KHLO program.

* In this application ATSI people will be referred to by the term Aboriginal.

17 Strategy All identifi ed stakeholders were approached by the project consultants and they agreed to participate The extensive formal review was collaborative in either focus groups or face–to–face or telephone and involved an Aboriginal consultant and internal interviews. St Vincent’s Health consultant. The project’s steering committee was established with representation from Outcomes and evaluation senior management, the KHLO program, ICAP and the peak community health body, the Victorian Aboriginal The review gave a voice to those best placed to Community Controlled Health Organisation (VACCHO). identify St Vincent’s Health’s strengths and weaknesses – patients, representatives of Aboriginal community The project had four phases: organisations and staff. 1. review of Victorian and Australian Aboriginal The review found that St Vincent’s Health has good health policies systems and practice to record Aboriginal patients. 2. review and analysis of St Vincent’s Health’s A broad range of units/programs treat Aboriginal Aboriginal patient data patients, with high numbers in the emergency, general 3. stakeholder consultation with patients, medical, cardiac and mental health units and outpatients. community agencies and staff The review highlighted areas for improvement: 4. analysis and write up of the review report, • Patients identifi ed staff’s limited understanding including the recommendations submitted of Aboriginal culture and the need for improved liaison to the St Vincent’s Health executive. with Aboriginal organisations about discharge planning, Following recommendations from the KHLO, a total continuity of care and outpatient follow-up. of 55 stakeholders agreed to participate in the review, • Community organisations urged St Vincent’s Health representing: to take a ‘whole of health service approach’ and to • key local Aboriginal local organisations (N=13) seek Aboriginal community participation in future developments. They encouraged clearly defi ned • a broad cross-section of St Vincent’s Health staff KHLO functions, increased resources and maintenance including clinicians, managers, emergency and various of KHLO community linkages. They emphasised program personnel, patient services clerks (responsible community-controlled health organisation involvement at admission for Aboriginal identifi cation) and many in discharge planning and initiatives to improve others (N=34) awareness of and access to St Vincent’s Health services. • a consecutive sample of Aboriginal inpatients (N=8).

18 • All respondents identifi ed the need for formal cultural awareness training. • Ninety-seven per cent of staff respondents believed Aboriginal patients had specifi c requirements including fl exible, responsive services and improved communication (particularly about processes). • Ninety-four per cent of staff respondents saw a strong connection between a ‘culturally safe’ environment and better health outcomes. Spread and sustainability St Vincent’s Health’s executive is committed to the Aboriginal health strategy. St Vincent’s Health’s Aboriginal Health Advisory Committee was established during the review and meets monthly. The committee is a partnership, with equal representation from St Vincent’s Health and Aboriginal organisations. The meeting location rotates between organisations. St Vincent’s Health and Aboriginal community-controlled health organisations co-chair the committee. Contact The committee will drive the review’s recommendations Sonia Posenelli and has formed two working groups – discharge planning Chief Social Worker (Acute) and human resources (for recruitment, orientation and St Vincent’s Health cultural awareness training). T: 03 9288 3438 E: [email protected] St Vincent’s Health has created a new position for an Indigenous person, the Aboriginal Policy and Strategic Planning Offi cer, to coordinate initiatives.

19 Highly commended Health for Kids: Consumers and clinicians working together Southern Health

Only patients and their families know what it’s like Dr Harris says the program’s participants come from to experience the ups and downs of a hospital stay. different backgrounds and have varying experiences in So when it comes to improving children’s health services, a hospital environment. Some have children with chronic it makes sense to ask the advice of parents who, with illnesses and often visit Southern Health. their children, have experienced the system fi rst hand. ‘Others have come to hospital with their children Headed by Project Manager Claire Harris, Health for once or twice and others have never had to bring their Kids in the South East (HFK) aims to improve children’s children to hospital,’ Dr Harris says. ‘They all bring unique health services by having parents contribute to their perspectives, ideas and enthusiasm.’ operation. The project team asked parents or carers to Parents can contribute in many ways – attending become involved and, as a result, the HFK Consumer meetings, completing surveys, joining committees or Group has about 20 members and the Newborn Services ‘patient tours’ where they follow a hypothetical patient Parent Group 25 members. HFK can now garner parents’ through the hospital and provide feedback. The results opinions and use their feedback when planning changes have been so constructive that many suggested changes or developments to the service. have already been implemented. ‘The HFK consumers feel their feedback has been effective in developing new services, clinical guidelines and patient information materials and they have also enjoyed the process,’ says Dr Harris.

Contact Dr Claire Harris Centre for Clinical Effectiveness Monash Institute of Health Services Research T: 03 9594 7576 E: [email protected]

20 Highly commended Dementia care at Ballarat Health Services Ballarat Health Services

Achieving the best quality care for people with dementia There has been signifi cant positive practice and culture and their carers has been a focus at Ballarat Health change in staff and an improvement in carer satisfaction Services for many years. Memory and thinking diffi culties and perception of care. The pilot was concluded in June such as dementia and confusion are common in hospital 2004 and the model has been rolled out to the sub-acute settings, but they are often diffi cult to recognise. If staff units of Ballarat Health Services. In the coming year are not aware there is a problem they cannot provide the Ballarat Health Services will lead a partnership to additional assistance required by the patient or further extend this successful model of care for people their carer. with dementia. In May 2003, Ballarat Health Services ran a series of focus groups comprising people with dementia and their Contact carers in order to identify key issues related to acute Meredith Theobald hospital care. An all-of-hospital education program Cognition Nurse Consultant and a bedside Cognitive Impairment Identifi er were Ballarat Health Services generated from this engagement of consumers. A series T: 03 5320 3652 of education sessions was delivered to clinical and E: [email protected] non-clinical staff who have contact with patients with memory and thinking diffi culties. The bed-based Cognitive Impairment Identifi er was introduced to the ward setting to alert staff to patients’ particular needs.

21 Winner Consumer involvement in their own care Sustainable Farm Families: The human resource in the triple bottom line 05 Western District Health Service

The challenge for Sustainable Farm Families was to recognise the health of the human resource in a farming context as a core component to farming family success. Farmers spend more on nutrition and health advice for cows and sheep than they do for their families. By working with farmers and industry groups, Sustainable Farm Families has been able to address inequities and empower individual and family members to change. It has been a great success story and an excellent model of consumer participation and empowerment, with change occurring at individual, couple, family, community and industry levels. About us ‘No point in having a healthy bottom line if you’re not there to enjoy it’ is the catchcry of the Sustainable Western District Health Service is a referral centre Farm Families project. and regional trauma service primarily for the Southern Grampians–Glenelg sub-region and is also the major The Sustainable Farm Families project grew out of a provider of primary health and aged care services in the glaring awareness that poor farming family health and Southern Grampians Shire. wellbeing impacted not only on individuals, but their families, farms, communities and health services. It has two campuses with the main campus for Two healthcare professionals, Susan Brumby and Stuart specialist acute, aged care and primary health located Willder, linked their knowledge of men’s health, women’s at the Hamilton Base Hospital, with both Penshurst health and agriculture and previous experiences in and Coleraine campuses functioning as multipurpose intensive care, education and farming with a farmer facilities with services and support from the main benchmarking group called Farm Management 500, campus. which was keen to have healthcare indicators in farm Western District Health Service employs more than business planning. 700 staff and has an operating revenue budget of Farm businesses refer to the triple bottom line – approximately $44 million. 1. fi nancial, 2. natural resource and 3. human. The human side of the triple bottom line was pretty sick and for many reasons had been diffi cult to address successfully.

22 Abstract Aim The Sustainable Farm Families project has engaged The catchcry of the Sustainable Farm Families is consumers – farming families – in decision making about ‘No point in having a healthy bottom line if you’re not their family health, wellbeing and safety. After two years there to enjoy it’. The initiative seeks to improve the the project has demonstrated signifi cant change in the health and wellbeing of farming families by taking the health status of farmers. It is based on a comprehensive triple bottom line reporting format that farmers are framework of community health promotion that familiar with and placing it in a health context. The project empowers farmer (consumer) knowledge and skills, aims to ensure that every participating farmer and family collects physical assessment data and tracks it over will have a healthy triple bottom line and live to enjoy it. three years, strengthens community action and planning, uses inter-sectoral collaboration, provides an evidence Background base for farming family health and shares knowledge The poor state of rural health, especially in the farming with other health professionals. community was identifi ed as an area needing attention The project has experienced increased consumer and intervention. The approach was to develop an (farmer) demand, planning and participation. Due to initiative which would provide farming families with the strong farmer involvement Sustainable Farm Families improved access to health and information in a format has been extended to the Victorian dairy industry. that was familiar to them and which had farmer and Workshop evaluation across both the Sustainable Farm industry support. Families and Sustainable Dairy Farm Families shows that Farming families have often been overlooked because 100 per cent of farmers would recommend the program of their geographic location and modes of operation. to other farmers and feel more empowered about their Akin to small business, with the attendant challenge of personal health. balancing familial and economic relationships, farmers The strength of the program lies in farmer involvement in are geographically isolated and lack the opportunities their healthcare and ongoing management. A total of 321 people in town and urban settings have to access health farmers from 112 Victorian districts have participated. services. Sustainable Farm Families recognises farmers work together to address issues of common concern relating to their farming practice and require specifi c strategies to address their poor health outcomes.

23 Farmers, farm industry representatives, farming consultants, health professionals, training organisations, a university researcher, lobby groups, occupational health and safety representatives and government agencies were involved in the planning stages of the project. Strategy Sustainable Farm Families has been developed and refi ned over a number of iterative stages. Theoretical models support the process of engagement, consumer participation, behaviour change and evaluation. Demographics are collected on the Department Progress is tracked over three years, including: of Human Services Service Coordination Tools. • annual physical assessment each year for three years The key tasks include: • provision of information and skill development • establishment of a project steering committee workshops on rural health with farmer representatives • use of an evidence-based resource manual with • obtaining ethics approval and identifi cation learning logs of indicators for referral • one-on-one 20–minute assessment with a health • development of the Sustainable Farm Families professional resource kit trialled with farmers • action planning and annual review against • completion of participant health assessment a behaviourally–anchored scale baseline, health conditions and behaviour • local capacity development, including focus groups • identifi cation of demographic, farming and storytelling opportunities and locational characteristics • workshop process evaluation and review. • establishment of an evaluation framework Both quantitative and qualitative data is collected and for measuring process, impact and outcome. changes to farmer health monitored over time. Farmer feedback is reviewed and changes made as required. The Sustainable Farm Families project has been delivered across 16 areas nominated by farmers and their industry groups.

24 Outcomes and evaluation Waist measurement greater than 102cm decreased from 42 per cent of men to 17 per cent. For women, it fell Outcomes include: from 34 per cent to 28 per cent. In year two, referrals • increased knowledge of health, wellbeing, farm safety, to healthcare services dropped from 81 per cent of diet and nutrition, stress and gender specifi c health participating men to 45 per cent. For women, referrals issues evidenced by pre and post test questionnaires fell from 84 per cent to 48 per cent. • improved baseline health indicators across seven benchmarks Spread and sustainability • positive evaluations of Sustainable Farm The Sustainable Farm Families is currently piloting a train Families workshops process the trainer program (funded through the Department of Human Services) to assist with sustaining the initiative • consumers/farmers linked into local health service beyond the current funding support. • built capacity across rural disciplines and industries The Western District Health Service is currently • ninety–four per cent of farmers participating identifi ed investigating innovative ways to continue to support areas to improve health, stress and safety working with farming families to address their continuing • strong governance model with four farmer health needs. representatives on the steering committee Tools and techniques are currently being tested for • excellent intersectoral collaboration with over transferability and repeatability in the Victorian dairy 20 organisations now involved in the Sustainable industry with great success. These tools include pre and Farm Families projects (health, farmer groups, post knowledge questionnaires, health indicators, farm industry, university, training, government, lobby safety questionnaires, workshop evaluation, referral groups, growers). process and action plan and achievement ratings for farmers. Farmer health indicators between years one and two showed signifi cant improvements. For example, cholesterol levels decreased such that men with blood Contact cholesterol greater than 5.5mmol decreased from Susan Brumby 45 per cent to 30 per cent of all men participating. Western District Health Service For women, blood cholesterol as a percentage of all T: 03 5551 8460 women participating decreased from 42 to 32 per cent. E: [email protected]

25 Highly commended Getting mental health messages to young people: the Flipper Card Barwon Health

Christopher Scanlan from Barwon Health recalls the in distributing the card, this new resource is proving very moment the idea for the Flipper Card came to him: popular and useful for young people seeking help for ‘I was sitting on the couch, watching television with my mental health issues. nine year old daughter, Ruby. She was distracted by a Feedback from young people and schools indicates that promotional card advertising the 2002 Let’s Read expo. the card has engaged young people and they fi nd it fun, I was intrigued by the clever design and impact of the cool, informative and a novel means of receiving health ‘Flipper Card’. An inspirational moment occurred as information. Information from teachers confi rms that I realised the enormous potential and possibilities young people are keeping the cards and that it provides the card had as a vehicle for promoting mental health them with a valuable help-seeking tool around mental messages to young people.’ health issues. Focus groups run with young people Three years later, 45,000 cards have been printed and 12 months after receiving the card confi rm that distributed to young people across the Barwon South students are aware of peers who have used the card West region and the card is being customised to suit to seek assistance. other localities. The card has received international recognition, awarded Thanks to the generous support of Rotary clubs and the a silver medal for Mental Health Promotion at last year’s School Focused Youth Service, the creativity of their Mental Health Services Conference of Australia and graphic designer, Emily Strain, and the work of schools New Zealand. Discussions are underway with key stakeholders regarding the potential for statewide or national distribution.

Contact Christopher Scanlan Barwon Health Mental Health Service T: 03 5226 7410 E: [email protected]

26 Highly commended St Vincent’s Health: Victoria’s fi rst deaf and hard of hearing friendly health service St Vincent’s Health

St Vincent’s Health has successfully become Victoria’s The model includes: fi rst Deaf and hard of hearing friendly health service. • staff education, tailored to the health sector This means St Vincent’s Health has the physical resources, staff skills and expertise to provide high • equipment and technology quality, accessible healthcare to people who are • documentation and resources to support Deaf or hard of hearing. and sustain the project. St Vincent’s Health committed to becoming a Deaf and hard of hearing friendly health service to fulfi l its values Contact of compassion, justice, human dignity, excellence and Neth Hinton unity. The mission and values of the Sisters of Charity Director, Aged Care and Allied Health are about providing compassionate healthcare to people St Vincent’s Health who might not otherwise receive the care they need. T: 03 9288 3933 The St Vincent’s Health Deaf and hard of hearing friendly E: [email protected] health service model was developed in collaboration with organisations representing the Deaf and hard of hearing.

27 Victorian Public Healthcare Awards 0 Category 3 Excellence in safety of care

For outstanding achievement in ensuring the safe progress of clients and patients through the healthcare system

All healthcare providers seek to ensure the safe progress of clients and patients through all parts of the system. This award recognises initiatives to reduce risk to healthcare consumers. This can relate to, but need not be limited to, the health system’s known areas of risk: infection, blood, medication, falls and pressure ulcers.

05 29 Winner Austin Health Medical Emergency Team 05 Austin Health

Many patients in hospital develop cardiac arrests, The Austin Hospital intensive care unit (ICU) was die unexpectedly or develop serious complications instrumental in introducing a medical emergency team after major surgery. (MET) service that responded to signs of deterioration In many patients these serious adverse events are in patients by deploying intensive care expertise to the preceded by warning signs such as low blood pressure, bedside in a few minutes. a fast heart or breathing rate, or a state of confusion. Austin Hospital studied this system and its effects and The routine response is to go through a time-honoured was able to show a dramatic decrease in cardiac arrests, but outdated approach which requires a hierarchy surgical deaths and complications in a before–and– of response that is often too slow to respond to crises, after study. leading to delays in care.

30 The MET at the Austin Hospital has, over the past four Abstract years, delivered urgently needed care to more than Objective: To determine the effect of an ICU-based 3000 patients. It has been associated with a close to medical emergency team on cardiac arrests and overall two-thirds reduction in the number of cardiac arrests hospital mortality. occurring in the wards and with a signifi cant reduction in the mortality of patients having major surgery. It is Design and setting: Prospective controlled before estimated that, because of the MET, approximately (1.5.1999 to 31.8.1999)–and–after (1.11.2000 to 100 cardiac arrests have been prevented each year since 28.2.2001) trial in university-affi liated hospital. 2000. In July 2005, for the fi rst time in six years (since Patients: Consecutive patients admitted to hospital formal counting began), the hospital experienced no during a four–month control phase (n=21,090) and cardiac arrest related deaths for a whole calendar month. during a four–month intervention phase (20,921). The publications which resulted from this work have had Main outcome measures: Number of cardiac arrests, a signifi cant impact worldwide and have contributed to number of patients dying after cardiac arrest, number the introduction of medical emergency teams in Australia, of post-cardiac arrest bed days and overall number Canada, the United Kingdom and the United States of of hospital deaths. America. The Institute for Health Improvement in Boston Results: In the control period there were 63 cardiac has taken up the concept and is now introducing medical arrests, which decreased to 22 during the intervention emergency teams in 1000 US hospitals. period (relative risk reduction, RRR: 65 per cent; About us p<0.0001). There were 37 deaths due to cardiac arrests in the control period and 16 during the intervention Austin Health, one of Australia’s leading teaching period (RRR: 56.%; p=0.0055). Survivors of cardiac arrest facilities and medical research centres, comprises in the control period required a total of 163 ICU post- three hospitals, the Austin Hospital, the Heidelberg cardiac arrest bed days versus 33 in the intervention Repatriation Hospital and the Royal Talbot Rehabilitation period (RRR: 79.%; p<0.0001) and a further 1353 hospital Centre. It has 930 beds across the three campuses and bed days versus 159 in the intervention period (RRR: provides acute tertiary referral services, an extensive 88.%; p<0.0001). There were 302 deaths during the range of specialty and super-specialty services, mental control period and 222 during the intervention period health services and subacute services including aged (RRR: 26.%; p=0.0042). care, rehabilitation and . Conclusions: The introduction of an ICU-based medical emergency team in a teaching hospital reduced the incidence of in-hospital cardiac arrests, the number

31 of deaths due to them, the bed occupancy related to their staff felt comfortable calling for assistance knowing occurrence and overall in-hospital mortality commenced that they would not be blamed for the patient 09/2000, fi ve years on. becoming unwell. Aim Implementation of the medical emergency team concept took nine months. Approval was initially sought The aim of this initiative was to make hospital care safer from the hospital chief executive and the medical in acutely ill patients and patients having major surgery. director. Approval of the concept was then sought from Austin Health was striving to reduce the overall mortality department heads and unit managers (medical and by 50 per cent and was successful in achieving this. nursing). Education sessions for all hospital medical, nursing and allied health staff were then conducted Background and letters were sent to staff informing them of the The inspiration behind this project was seeing patients change in hospital policy. The theme was that it was being admitted to the intensive care unit having suffered no longer acceptable for patients to unexpectedly die serious adverse events on the general ward areas that while in hospital. The no-blame culture was well accepted were possibly preventable. It was thought that the system and the MET calls were promoted as learning sessions for was failing patients because a hierarchy tree of calling general staff in how to prevent and treat critical illness. junior staff before calling senior staff for assistance was The Medical Emergency Team Response is a service employed. Hence, if the bedside carers of patients could provided in inpatient areas. A MET call is triggered from call for assistance from critical care staff prior to the a ward when patients meet certain physiological criteria progression of the illness to a cardiac arrest, deaths may (HR <40 or >130, SBP <90, RR <8 or >30, SpO2 <90% not occur. Professor Rinaldo Bellomo and Registered on high fl ow oxygen, UO <50 ml over 4 hours), have a Nurse Donna Goldsmith were initially involved in the sudden change in conscious state, or if the nursing staff planning of the project; however, support from the are unduly worried about the patient. The ICU registrar, whole hospital was sought very early on in the project medical registrar and designated ICU nurse (with an to ensure hospital-wide acceptance. emergency drug pack) immediately attend to assess Strategy the problem. They will institute emergency management in collaboration with the parent unit to make the patient The strategy used to implement the Austin Hospital safe and to prevent worsening of the patient’s condition MET was that of complete culture change. It not only and/or cardiac arrest. The patient may require ICU or empowered the staff caring for the unwell patient at the high dependency unit admission. bedside, but it also created a no-blame culture so that

32 Outcomes and evaluation automatic biochemical calling criteria, an ICU liaison nurse and participation in the Safer Systems Saving Lives The benefi ts to patients have been clearly demonstrated initiative to reduce the mortality rate even further. in publication. To summarise, there were 63 cardiac arrests in the control period, which decreased to 22 The publication of data about the impact of the MET during the intervention period (relative risk reduction, concept has had a signifi cant impact worldwide and has RRR: 65%; p<0.0001). There were 37 deaths due to contributed to the introduction of medical emergency cardiac arrests in the control period and 16 during the teams in Australia, Canada, the United Kingdom and intervention period (RRR: 56.%; p=0.0055). Survivors of the United States of America. The Institute for Health cardiac arrest in the control period required a total of Improvement in Boston has taken up this concept and 163 ICU post-cardiac arrest bed days versus 33 in the is now introducing medical emergency teams in 1000 intervention period (RRR: 79.%; p<0.0001) and a further US hospitals. 1353 hospital bed days versus 159 in the intervention period (RRR: 88.%; p<0.0001). There were 302 deaths Contact during the control period and 222 during the intervention Rinaldo Bellomo period (RRR: 26.%; p=0.0042). Austin Health Unpublished data that are more qualitative in nature T: 03 9496 5992 includes the hospital-wide acceptance of the MET. E: [email protected] A recent survey of over 300 nurses showed that the nurses at Austin Hospital are very supportive of the concept and use discretion in making the calls. They also feel that they are not blamed for any deterioration in a patient’s condition and that they use MET calls as a learning experience. Spread and sustainability The Medical Emergency Team at the Austin Hospital has been sustained for fi ve years now. Education and training for new and existing staff occurs regularly. The MET concept has spread to Austin Health’s sub-acute campus, The Repatriation Hospital and the results, although not published, are similar to those at the Austin Hospital. The next step in the MET process will be introducing

33 Highly commended Working hand in hand: Management of Clinical Aggression NorthWestern Mental Health, Melbourne Health

Providing a safe and secure environment that enables The Management of Clinical Aggression (MoCA) project mental health staff to practice to the best of their abilities identifi es four domains that help to conceptually and training is a challenging objective that NorthWestern understand the components and constructs required Mental Health has identifi ed as a priority. Furthermore to make sense and address the problem of workplace work structures and environments that enable staff to aggression. perform at their best have a signifi cantly positive effect A specifi cally designed and carefully rolled out policy on clinical outcomes for the consumers of the service. is the cornerstone and the start to a ‘day one’ of being The causation of violence in the workplace is multi- able to implement and monitor all activity associated factorial and requires a systemic approach to identify with aggression management. Staff need training in the hazards and approaches to manage the issues. the skills and objectives, and an orientation to the The complexity of the challenge is to equip staff with values and philosophy articulated by the policy in order the repertoire of skills to therapeutically manage to consistently incorporate this into clinical practice. aggression in the workplace. The treatment of mentally The overall strategy will be linked to existing and unwell people requires an intricate balance of rights proposed evaluation systems in order to monitor process, and responsibilities for both staff and consumers. outcomes and to give meaning and momentum. The way forward for all concerned is to develop and maintain approaches that integrate the rights of staff Contact and consumers, collaboratively capture the concerns Brian Jackson of both and give defi nition and support for solutions NorthWestern Mental Health to become an integral and repeating dynamic. T: 03 9342 8228 E: [email protected]

34 Highly commended Electronic medical handover Barwon Health

In 2004 the medical handover system was born because In addition, as on-call periods are often busy, a handover doctors at Barwon Health recognised the real possibility system that identifi es the patients most in need of review of patients being harmed if doctors did not have all the and the required decisions helps doctors set priorities information they needed to provide safe care, regardless to ensure the patients most in need are seen. of the time of day or day of the week. Barwon Health’s information technology team, supported Junior doctors in hospitals cannot work 24 hours a day, and worked with the electronic medical handover team seven days a week. When they go off duty, some form of to develop and implement a successful and fi scally information handover to the doctor covering the next shift responsible handover system. Together they have achieved is necessary to ensure the safety and continuity of care. a level of communication between covering and treating With moves to reduce junior doctors’ working hours, the teams not previously possible. number of times information needs to be handed over is increasing. Sometimes the quality of information is poor. Contact Lack of information when a patient needs urgent and David Watters often unexpected care is a well-known clinical risk. Barwon Health T: 03 5226 7899 E: [email protected]

35 Highly commended The St Vincent’s Warfarin Awareness Safety Program: Reducing the frequency of harm to patients on warfarin St Vincent’s Health

St Vincent’s Health is committed to improving medication The results: safety for patients. St Vincent’s Health ran the Warfarin • WASP has achieved an improvement in communication Awareness Safety Program (WASP) in 2004 as part with GPs. In 2004, just 50 per cent of GPs were sent of the Quality and Safety Council’s Medication Safety a discharge summary about their patient on warfarin. Breakthrough Collaborative. The aim was to reduce the In 2005, this had improved to 80 per cent. frequency of harm to patients on warfarin by improving the quality of information they receive. • Feedback from GPs shows that patients on warfarin are now having fewer complications after they leave Warfarin is a medication that hinders the formation hospital. of blood clots. Many people refer to these kinds of as ‘blood thinners’, although they do not actually cause the blood to become less thick, only Contact less able to clot. Chris Holland The WASP team aimed to: Clinical Risk Manager St Vincent’s Hospital • give patients taking warfarin better information T: 03 9288 3101 to take home with them E: [email protected] • improve communication with patients’ general practitioners (GPs). The team introduced: • new patient information sheets, which were also translated into community languages • a comprehensive staff education program • changes to the information collected on the computer system’s discharge summary; that is, is the summary of treatment emailed or faxed to the patient’s GP when they leave hospital • WASP cards to remind staff to complete all of the information for the discharge summary • new methods to make sure staff ask the patient for their GP’s name. 36 0 Category 4 Innovation in patient access

For outstanding achievement in maximising access to emergency and elective services in public hospitals

Public health services strive to offer equitable access to their services on the basis of patient need. These awards recognise innovative ways of managing access to emergency and elective services in public hospitals. Two awards are presented: a. Access to emergency care b. Access to elective care

05 37 Winner Innovation in access to emergency care Accelerated Care Through Emergency 05 The Royal Children’s Hospital

Children with chronic, complex and severe conditions A group of parents from the Association for Children can unfortunately be frequent visitors to The Royal with a Disability worked with The Royal Children’s Children’s Hospital’s emergency department. Prior to Hospital staff to improve the experience of these children the Accelerated Care Through Emergency (ACE) Program, and their families. The result was the ACE Program, when these children arrived at the hospital needing funded by the Department of Human Services, in which urgent care their families would have to explain things families have 24 hour access via mobile phone to a care they had explained many times before. coordinator. The care coordinator provides support and advice and liaises with the many health professionals involved in the child’s care.

38 As a result, 40 per cent of calls to ACE are resolved Abstract without a visit to emergency, as specialist advice can The Accelerated Care Through Emergency Program, be provided in other ways. If a visit to emergency is initiated in 2001, uses a community-centred approach still required, when an ACE registered child arrives the to reduce emergency department presentations fi le is ready, paperwork processed and a database of and hospital admissions for children with complex specialised treatments is available to progress care. and chronic medical and surgical conditions. It has For parents like Peter Phillips, whose daughter Lauren developed a coordinated approach towards the provision comes to The Royal Children’s Hospital often, a and implementation of healthcare for a culturally distressing and time-consuming visit is either avoided diverse group of families who frequently present to the or made easier. Peter says ‘it provides a great deal of emergency department due to the multifaceted nature of confi dence and peace of mind knowing your child is their child’s illness. More than 200 children are currently cared for by friendly and familiar staff who acknowledge enrolled in the program, which now receives recurrent and respect your skills as a parent and carer’. funding through the Department of Human Services. The Department of Human Services-funded ACE Program The ACE Program: began in 2001. It now supports more than 200 Victorian • has reduced the use of the emergency department children and their families. and inpatient services through provision of on-call About us specialised triage and support The Royal Children’s Hospital is a specialist paediatric • provides a prioritised emergency department service hospital that provides a full range of clinical services, for ACE families when they do need to attend the tertiary care and illness prevention programs for children emergency department and adolescents. It has an average of 253 beds, treats • supports and enhances the capacity of families to approximately 32,000 in-patients, 56,000 emergency manage their children’s conditions in the community attendances, and 200,000 outpatient appointments. • has created clearer clinical pathways to deliver better The Royal Children’s Hospital has 3000 staff. continuity of care. The Royal Children’s Hospital is internationally recognised as a leading centre for research and education, having partnerships with the Murdoch Children’s Research Institute and the . Patients are referred from all over Australia and the Asia Pacifi c.

39 Aim Strategy The aims of the ACE Program are to: The key to the success of the ACE Program is the • reduce the use of the emergency department and provision of a dedicated mobile phone service which inpatient services through effective care coordination gives families 24-hour access to an ACE care coordinator. The care coordinators use a synchronised triage • support and enhance the capacity of families to approach to: manage their children’s conditions in the community • provide support and advice to families • reduce waiting times and the number of people involved in each presentation to the emergency • utilise the services of the emergency department, department outpatient and allied health teams • enhance proactive management of health needs. • liaise with Home and Community Care staff, hospital specialists and general practitioners. Background If a hospital presentation is required, the care Families whose children have chronic, complex and coordinators ensure a streamlined process in the multifaceted illnesses were the inspiration for this emergency department, notifying the emergency program. These families, who are frequent visitors department of the family’s pending arrival, arranging for to the hospital, were experiencing long delays in the the child’s fi le to be available and organising admission emergency department and multiple consultations with paperwork if necessary. staff during every visit. In addition, family expertise in The development of a database has enabled specialised their own child’s management was not being suffi ciently treatment requirements for each child to be available recognised by staff. to the care coordinators on palm pilots. The database, These issues were identifi ed over some years by The devised in conjunction with families, care coordinators Royal Children’s Hospital staff and consumer groups. and medical staff, is regularly reassessed. It provides The ACE Program was designed in partnership with the a prospective plan for the child’s potential care needs, Association for Children with a Disability, the Chronic with strategies that have, in the past, assisted in Illness Alliance and The Royal Children’s Hospital avoiding a presentation to the emergency department. Community Advisory Committee. It was made possible Regular evaluation of how the program impacts on through the Department of Human Services Designing families and the emergency department, together with Care funding. training of the emergency department staff, has meant that the program is embedded within the department.

40 Outcomes and evaluation Spread and sustainability The ACE Program has been monitored on a wide range The ACE Program has recurrent funding through HARP of quantitative and qualitative variables every six months and has successfully been incorporated into both the through the Hospital Admission Risk Program (HARP) emergency department and the broader hospital. In evaluation process. 2004–05 the program has expanded to include the An average of 40 per cent of the calls received by employment of: the care coordinators result in families avoiding a • a staff member to assist in discharge coordination presentation to the emergency department, with for this group of families a consequent reduction in admissions, through: • an emergency department-based social worker to • advice and support provided by the care coordinators support the psychosocial needs of frequent presenters, • advice from specialist consultants with the aim of further reducing emergency department presentations. • a referral to a general practitioner or community health service. The ACE Scoping Process Project report, the fi rst stage in a process which aims to provide ACE-like services The decision to provide a 24-hour service has been to all patients with frequent unplanned admissions, reinforced by the fact that approximately 60 per cent has recently been completed. of the calls received are after hours. The development of the program has led to a signifi cant Contact increase in family satisfaction (compared to the pre-ACE evaluation survey) and a decrease in time waiting to be Robyn Hayles seen by medical staff in the emergency department from The Royal Children’s Hospital 30 minutes pre-inception to approximately 19 minutes T: 03 9345 5695 E: [email protected] currently. Qualitative feedback also indicates that families feel more supported and empowered to manage their child’s care needs at home. The strong emphasis of the ACE Program on teamwork and communication has also led to the development of closer links with community service providers, ensuring that they also feel supported in the care of these children.

41 Highly commended The Chronic Illness Re-admission Program: CHIRP Barwon Health

The Chronic Illness Re-admission Program (CHIRP©) The CHIRP passport information is completed in is a fully evaluated and streamlined system providing a partnership with the parents, the child and their smooth and fast transition from home to urgent medical paediatrician, encouraging active involvement of families care and/or inpatient admission for children with chronic in the treatment process. illness. CHIRP expedites and personalises what can be Evaluation data shows a dramatic decrease in reported a laborious, stressful time to the parents, the child and waiting times in the emergency department for CHIRP the immediate health carers who may be unfamiliar families; parents feeling more positively about their with the case or condition. level of involvement in decision making about their The primary tool of the program is the CHIRP Passport, child’s ongoing care, more confi dent in how they care a small laminated card identifying the child and recording for their child and their level of comfort in the hospital the child’s photo, doctors, diagnosis, past history, family environment. Parents also feel better about the medical history, allergies and current emergency treatments. care given to their child, their emotional wellbeing and It is carried by the parent or child, presented to staff attitude to both themselves and their child. medical staff wherever they travel around the world, CHIRP has been instrumental in establishing an and regularly updated. environment that is familiar, comfortable and empowering for families that often experience stressful, laborious, burdensome and tragic circumstances. One of the CHIRP families captured the very essence of the program: ‘He always had his own choices in life. Through the CHIRP program he made his own choices in death; we thank God for CHIRP’.

Contact Karen Morison Barwon Health T: 03 5246 5130 E: [email protected]

42 Highly commended The St Vincent’s Assessment, Liaison and Early Referral Team: Supporting people with complex care needs St Vincent’s Health

The Assessment, Liaison and Early Referral Team (ALERT) ALERT works in the emergency department and with started at St Vincent’s Hospital in 2000. ALERT was St Vincent’s Health’s general medical services and many funded by a modest internal grant to create a way to community services. improve access to emergency and elective services ALERT has been very successful, with clients recording a by improving the care of people with particular needs. large reduction in emergency department presentations, Today, ALERT is an interdisciplinary team providing risk hours in the emergency department, separations and screening, case management support and outreach total time in hospital. This is obviously better for the services for people who come to the St Vincent’s clients and also frees up St Vincent’s Health’s services Hospital emergency department with issues relating to: for other patients. • a history of drug and alcohol problems • a history of homelessness Contact • mental health issues outside the scope Rebecca Power of other mental health services ALERT Program Manager • disability St Vincent’s Health • aged care. T: 03 9288 2266 E: [email protected]

43 Winner Innovation in access to elective care The Southern Health model of cataract care 05 Southern Health

The Cranbourne Integrated Care Centre Regional Eye Service annually audits patient outcomes following cataract surgery and has demonstrated that the surgical and clinical outcomes are within international benchmark standards. About us The Southern Health Ophthalmology Unit (SHO) provides paediatric and adult emergency, surgical and outpatient services to Southern Health campuses in the southern metropolitan health area. It is the second largest provider Few elective surgical procedures in Australia are in of public ophthalmology surgical services in Victoria and, more demand than cataract operations, and relatively in 2004, managed 2057 inpatient separations including few services can offer booked dates for pre-admission 1687 day-case cataract procedures and 2500 VACS assessment and surgery. occasions of service. The majority of day-case surgery Southern Health’s objective is to give people with is performed at Cranbourne Day Surgery, with more cataracts an eye test, a diagnosis, adequate information complex cases attending the Moorabbin campus. to decide on surgery, the opportunity to have surgery Abstract on an agreed date, and preoperative tests and eye measurements at a ‘one-stop’ pre-assessment clinic. In 2001 the SHO transferred 94 per cent of its surgical The Cranbourne Integrated Care Centre Regional Eye services to a new day-surgery service at Cranbourne Service model of cataract care enables patients to Integrated Care Centre. In 2002 a model of cataract be treated much sooner, often after a wait of only a care based on evidence-based clinical pathways was few weeks. The majority (96 per cent) of patients are introduced, designed to reduce both waiting times and admitted as day cases with an overall length of stay of the number of patient visits, as well as increase the about 2.5 hours, and an average surgical procedure time number of operations performed. In 2002 Southern of 30 minutes. Most patients attend a postoperative Health was designated an Elective Surgery Access clinic one week following surgery and are discharged Service centre for ophthalmology services. to their referring ophthalmologist or optometrist, maintaining continuity of care. Patients are back home faster, recovering faster and average waiting times are more than halved.

44 Due to its operational effi ciency and cost effectiveness, At SHO, Associate Professor Ian Favilla adopted many SHO became a regional service provider in the southern of the recommended guidelines from the UK National metropolitan health area in 2003. For the period Health Service’s Action on Cataracts program to reduce January to June 2004, the model of care reduced the waiting times. In particular, increasing operating capacity median waiting time for cataract surgery from 336 and enabling direct community referral by optometrists days to 58 days in a Rural Patient Initiative at Ballarat and ophthalmologists to an interdisciplinary pre- Health Services. Southern Health Ophthalmology admission clinic, thus reducing number of patient visits, currently maintains the shortest time to treatment for with nurse-led pre and post assessment and discharge. cataract surgery in metropolitan Victoria. Some aspects of the model have been adopted by other hospital Strategy ophthalmology units. Under guidelines established at an interdisciplinary workshop, ophthalmologists and optometrists can refer Aim patients directly to a pre-admission clinic. At this one The aim is to signifi cantly improve access to treatment interdisciplinary clinic patients receive an ophthalmic for people needing cataract surgery by reducing waiting examination, biometry, triage of their health status for times for the initial appointment and subsequent anaesthesia, give informed consent and are given the operation by providing quality high-volume cataract date of their surgery. Patients complete both general surgery in an economic and resource-effi cient model. health status (SF-12) and visual function (VF-14) quality Following surgery, the person should have improved of life questionnaires, and these patient-oriented vision, regained independence and enhanced quality measures are considered in the surgical decision. of life. Surgery is performed as a day-case procedure and Background patients are discharged by the nurse after postoperative assessment. Surgical throughput is increased by high Cataract surgery is the most common major surgical rates of surgery and mostly cataract-only surgical lists. procedure performed in Australia. With the population Patients generally attend one postoperative review and ageing, the relative number of cataracts will double over attend their referring clinician for a later assessment. the next 50 years. Cataract surgery has the longest Patients submit follow-up SF-12 and VF-14 quality of life median and 90th percentile waiting times for all surgical questionnaires four months postoperatively. specialties in Australia. Access problems for cataract surgery are the long waiting times for assessment, low day-surgery rates, and multiple postoperative reviews.

45 The success of this model is based on an interdisciplinary is the shortest in the metropolitan region. The wait for team of health professionals with fl exible roles who a pre-admission appointment is around seven weeks. see themselves as part of a wider system delivering The current growth of cataract surgery is 7 per cent per an integrated service to each patient. annum, and 30 per cent of all cataract surgery performed The introduction of patient-oriented measures was in southern metropolitan health area in 2004 was at another key factor in its success. Cranbourne Day Surgery. Outcomes and evaluation Spread and sustainability An audit of cataract surgery for 2004 demonstrated that In the 2000–01 year when the Ophthalmology Unit fi rst surgical outcomes, including adverse surgical events, started operating at Cranbourne Day Surgery, around compare favourably with international benchmarks, 550 cataract operations were performed, increasing to showing that changes such as nurse-led discharge and 1636 in 2002–03 and 1720 during 2004. This has shown minimisation of postoperative visits to a one-week review that the initiative has been sustained, with an increase are acceptable processes. Of the patients attending the in the number and productivity of surgical sessions. With pre-admission clinic, 87 per cent were booked for surgery, a regional projected cataract growth rate of 9 per cent confi rming that optometrist referral is a resource- annually, it will become increasingly necessary to provide effi cient model. care in a resource-effi cient manner. Clinical and patient outcomes from a randomly selected This model of care is reproducible, as it involves a sample of patients found a signifi cant improvement in change in clinical care pathways and processes that unaided visual acuity postoperatively, with 70 per cent could be adopted in other ophthalmic institutions or achieving 6/12 or better (legal driving vision), increasing other surgical specialties. from 22 per cent preoperatively. Patient-oriented outcome measures, such as visual Contact function measured with the VF-14 quality of life Ian Favilla questionnaire, increased from a mean of 69 per cent Ophthalmology Unit preoperatively to 84 per cent. Those who drove a Southern Health car reported a marked improvement postoperatively. T: 03 5990 6262 Preoperatively more than 50 per cent reported at least E: [email protected] moderate diffi culty with fi ne close work tasks, reducing to around 25 per cent postoperatively. The current surgery waiting time median of fi ve weeks

46 Highly commended Alexandra Eye Care Service Alexandra District Hospital

Many people would think that establishing a specialist drastically reduced. Three years ago, community eye care service, including surgery, in a small rural members frequently waited up to 10 months for an health service would be impossible. Thanks to state and outpatient appointment and up to two years for cataract federal rural health support programs, a generous local surgery. Those days are now over with waiting times for community and a ‘can do’ attitude, the Alexandra District outpatients down to two to four weeks and waiting times Hospital has achieved the impossible. for surgery at four to eight weeks. In 2003 a research project conducted by the University Feedback to the hospital from consumers of the service of Melbourne on the health of the Alexandra community has been outstanding. The benefi ts to individuals in terms discovered that eye problems were the highest rating of improving quality of life, independence and safety are medical condition for adults (39 per cent). At around considerable. the same time, the Commonwealth Department of Health was developing the Medical Specialist Outreach Contact Assistance Program to help rural communities access specialty medical services. Alexandra District Hospital Heather Byrne was successful in gaining support for the inclusion of an Alexandra District Hospital T: 03 5772 0900 eye specialist. E: [email protected] Later that year the hospital entered into negotiations with Dr Christopher Chesney, a specialist ophthalmologist, to provide a visiting consultation service to the people of the Murrindindi Shire. The service proved extremely popular and before long the hospital was receiving multiple community donations to expand the service. A submission to the Victorian Government’s Rural Patient Initiative Program was successful in attracting funding to commence eye surgery. Surgical instruments and equipment were purchased from community donations and surgery began in October 2003. The hospital now performs well over 200 eye surgical procedures per year, mostly cataract surgery. In two years, more than 2000 outpatient consultations have been provided. Waiting times have also been

47 Highly commended Reducing hospital-initiated postponements for elective surgery Western Health

Prior to July 2004, Western Health’s elective surgery The results include: average waiting time and hospital-initiated postponement • minimal impact on emergency access rate was increasing. The hospital-initiated postponement rate reached 50 per cent in June 2004. • surgical patient length of stay decreased by 1.2 days In July 2004 an elective surgery policy was developed collaboratively with surgeons, nurses and booking staff. • surgical operations performed increased The policy directed that for any elective surgical case to through improved theatre utilisation be postponed, authority was required from a divisional or • improved patient satisfaction clinical director. The Western Health executive and board • average waiting times for elective surgery supported the implementation of the policy. for category 2 patients decreased by 10 days To ensure clinicians retained the ability to appropriately • improved clinician and clerical staff satisfaction. treat surgical patients, a range of alternatives to In a signifi cant achievement, the hospital-initiated cancellation were explored. These included alternate list postponement rate has decreased to and been availability in or out of hours, consideration of the patient sustained at less than 8 per cent. being offered surgery at another campus and the surgery being performed by another surgeon. Contact Claire Culley Western Health T: 03 8345 3262 E: [email protected]

48 0 Category 5 Innovation in models of care

For outstanding achievement in embracing new models of care for the benefi t of clients and patients

Healthcare providers now offer many services outside traditional healthcare settings while working to improve outcomes for clients and patients. This award recognises innovative approaches to providing new models of care that allow clients and patients to return to their community or their daily lives sooner.

05 49 Joint winner Changing practice: Developing a cost-effi cient, outcome-rich, patient-oriented, overnight home haemodialysis program 05 Barwon Health

The team believes they have since developed an enlightened program, acknowledging self-reliance and encouraging self-belief among patients. They have shown that many patients can take charge of their own treatment and achieve improvements in quality of life, wellness, self-pride and self-determination that were previously impossible under conventional dialysis regimes. The patients, a brave and courageous group, trusted the team and worked with them to prove NHHD a successful and fi scally responsible advance. Together For decades, haemodialysis has been an unimaginative, they have demonstrated clinical outcomes and freedoms repetitive and unsatisfactory treatment aimed simply at unachievable in standard dialysis programs. The sustaining life – but not quality of life. Dialysis programs subsequent depth of NHHD penetration and the uptake had, in general, imposed an institutionalised approach of its treatment principles across Australia and overseas onto a captive patient population. The Renal Unit at has been an added bonus for the team. believed that, where possible, their About us patients deserved better and they looked for a better way. The Barwon Health Renal Unit manages all facets of In 1998, the early report of a Canadian trial of extended chronic kidney disease and provides for all conventional hour and frequency overnight dialysis attracted their dialysis modalities and transplantation management for interest. Their program – nocturnal home haemodialysis Geelong and regional western Victoria. Haemodialysis (NHHD) - where eight to nine hours, six nights a week (approximately 115 patients) and peritoneal dialysis of overnight home-based treatment replaced the (approximately 25 patients) are supported by one in- conventional daytime facility-based regime of four centre and two satellite centres in Geelong and three hours, three times a week, reported exceptional clinical satellites in regional towns. Three sessional nephrologists outcomes. It promised to be the quantum change and 20 equivalent full-time nursing staff spread across all the Renal Unit had been seeking. dialysis services provide the unit workforce.

50 Abstract Aim The Barwon Health Renal Unit has pioneered, developed Dialysis is the most chronic, costly and lifestyle-intrusive protocols, publicised and led a national ‘revolution’ in of all medical therapies with current four to fi ve hour dialysis management with the introduction of nocturnal daytime treatments, three days each week, for life. home haemodialysis (NHHD). NHHD has proven to Safe, extended hour, home-based overnight treatment be a quantum leap in dialysis care and has resulted offers both vastly improved metabolic profi les and in a level of clinical wellbeing, symptom resolution, the return of daytime, waking-hour freedom opening patient autonomy, self esteem and a return-to-work rate up new possibilities for lives previously ruled by previously not seen in dialysis populations. institutionalised care. In addition, NHHD has been delivered at a signifi cant cost Background reduction compared with conventional haemodialysis (CHD) satellite and in-centre modalities. Early dialysis was characterised by slow, eight to 10 hour, alternate nightly, overnight treatment. In the 1970s, After starting an eight hours a night, six nights a week dialysis became a daytime four hours, three times a NHHD program in 2001, the Barwon Health program week therapy, but this introduced stricter diet and fl uid has grown such that now approximately 25 per cent restrictions, post-dialysis torpor and lifestyle restriction. of all haemodialysis is at home through the night. This The 1990s saw rising dialysis morbidity and mortality compares to less than 0.5 per cent in the United States, being directly linked to shortened dialysis duration. around 5 per cent in Canada and around 14 per cent in Australia and New Zealand. Other Australian and New Some centres rekindled efforts to extend time and Zealand units are now following the Geelong Hospital frequency though, in practice, this meant returning lead with all states now actively encouraging NHHD to overnight therapy. Coincidentally though, dialysis programs in most health networks. technology had advanced suffi ciently for this to be possible in safety and at home. Restoring daytime freedom has enhanced the lifestyle and capacity for work previously denied most dialysis patients. The Geelong Hospital team argued successfully for Department of Human Services support and, with Ethics Committee approval and informed consent, began NHHD in 2001.

51 Strategy Outcomes and evaluation Conventional haemodialysis seeks to remove all The benefi ts of nocturnal home haemodialysis are accumulated waste and fl uid – a 168 hours per week profound, with around 25 per cent of Geelong Hospital’s subliminal process with normal kidneys – in 12 often haemodialysis patient pool at home on NHHD. Indeed, brutal treatment hours each week. By contrast, the more Barwon Health believes up to 30–40 per cent of all frequent and longer the dialysis process, the more gentle, haemodialysis patients are potentially suitable. physiological and less symptomatic the outcome. The prime outcomes have been: Longer dialysis time is, however, a patient’s greatest • the normalisation of phosphate metabolism, the fear. As a result, the key to engaging our patient group abolition of the need for phosphate binder agents, was clear: providing a simple, encouraging explanation the normalisation of parathyroid hormone levels and, of how overnight dialysis can be self-managed safely in on serial bone densitometry, the reversal of progressive the home while abolishing dialysis-related symptoms, osteopenia/osteoporosis restoring dietary and daytime freedoms, allowing for realistic employment opportunities, reducing social • the control of volume overload, the abolition of security dependence and enhancing self-reliance antihypertensive medication requirements and, on and self-determination. To this end: serial echocardiography, a regression in left ventricular hypertrophy · dialysis was simplifi ed into everyday language • a normalising trend in B2 microglobulin · a website, www.nocturnaldialysis.org, was established with an active and participatory audience Australia and • an improvement in general wellbeing and nutritional worldwide and has grown to become the most used and cognitive function as measured by the KDQoL NHHD website on the internet. guidelines. In addition, a detailed research proposal was submitted • an observed reduction in hospital bed-days to the Ethics Committee and to the Department of (NHHD: 1.3 bed-day equivalents compared to CHD: Human Services. Lectures to local Rotary Club groups 11.0 bed-day equivalents) and other support bodies yielded generous start-up • a reduction in social security dependence and funds. Medical and nursing visits to the Canadian source re-engagement in the workforce unit in Toronto where NHHD fi rst began allowed for • an overall marked reduction in cost per patient per technical protocol development based on their sound year from reduced nursing wage and infrastructure experience. A research nurse appointment ensured expenditure with a comparative cost of $12.98 per hour careful data collection and analysis.

52 for nocturnal home haemodialysis versus $58.15 per hour of conventional haemodialysis • un-partnered patients, previously prevented from home dialysis, now safely dialysing alone at home due to the slow, gentle, normovolaemic nature of NHHD. Several patients now dialyse safely, alone, during sleep. Spread and sustainability More than 26 peer reviewed papers and abstracts and more than 70 national and international invited lectures from the Geelong Hospital team has led a resurgence of interest in NHHD as the optimal dialysis modality. From the fi rst Geelong Hospital NHHD patient in 2001, more than 200 conventional haemodialysis patients in all states have now transferred to NHHD Australia-wide (ANZDATA) making NHHD the fastest growing dialysis modality. Similar growth is occurring overseas. The hospital’s own program continues to expand and now exceeds 25 per cent of all haemodialysis. Comparative studies between alternate night NHHD (Monash) and six nights a week NHHD (Geelong) suggest both are far superior to CHD, with six nights a week the optimal therapy.

Contact John Agar Nocturnal Haemodialysis Program, Renal Unit The Geelong Hospital, Barwon Health T: 03 5226 7499 E: [email protected]

53 Joint winner Kool Kids Positive Parents 05 Eastern Health

The Kool Kids Positive Parents program is part of the aggressive and often fi nd it hard to make friends Child and Adolescent Mental Health Service at Eastern because they can be angry and unpredictable. When Health. It is a new program, an early intervention these behaviours are a problem in their lives, we call the and prevention project designed to reduce severe behaviours ‘conduct disorders’. The program aims to behaviour disorders. work collaboratively with the children, schools, parents When children have such diffi culties they fi nd it hard to and communities to get in early and help the children listen and think before they act. They can be very take charge of their feelings, thinking and actions and to change their behaviour problems.

54 Initial analysis of the program shows a reduction in 155 primary schools in the Eastern Health region from the degree of children’s conduct and peer relationship 2004–07. Initial analysis of outcome data shows a problems according to both parent and teacher ratings. reduction in the degree of conduct and peer relationship This includes areas such as fi ghting with others, getting problems according to both parent and teacher ratings. angry with others, being fi dgety and over-active. Aim About us KKPP aims to reduce the impact, both emotional and Eastern Health Child and Adolescent Mental Health economic, of conduct disorders on young people, Service (EHCAMHS) provides mental healthcare to their families and the general community. It aims to the children and adolescents of the central and outer build awareness so that these children are not seen as east region of Melbourne. This includes a comprehensive naughty but as having developmental diffi culties. It aims range of outpatient services, backed by outreach to increase the competence of parents and schools in services, a day program and inpatient services. promoting children’s pro-social skills. A new program, Kool Kids Positive Parents, began in 2004. A team of 4.6 clinicians provides school-based Background early intervention to children and their families. The outer area of the eastern metropolitan region has particular needs based on its rates of disruptive Abstract behaviour disorders and social morbidity. Around Kool Kids Positive Parents (KKPP) is an early intervention 40 per cent of the referred clients to Eastern Health project for children with emerging conduct disorders. CAMHS have externalising problems and many of these It aims to reduce the impact and prevalence of emerging young people are subsequently diagnosed with attention conduct disorders in primary school aged children. defi cit hyperactivity disorder, oppositional defi ant Based on partnerships between parents, mental health, disorder or conduct disorders. Once established these education, and welfare services, evidence-based disorders are diffi cult to treat and there is often a waiting treatment approaches are utilised to make an impact list for service. By providing early intervention in local with schools and families as well as the individual schools, children who are at risk can be assisted by the children. KKPP departs from traditional clinic-based signifi cant adults in their daily life before their problems services offered in CAMHS by meeting families together become entrenched. with local school personnel, and by working with those at risk of the disorder rather than those in whom it is well established. This program is being rolled out in

55 Strategy This included areas such as fi ghting with others, getting angry with others, being fi dgety and over-active. With support from the Department of Education regional For many children, the behaviour problems moved from offi ce, school principals are provided with information the ‘clinical’ to the non-clinical range. It was found about the KKPP program. Those schools which express that 69 per cent of children were rated in the clinical interest in running the program are provided with or borderline category of problem behaviours on the information and training sessions for their staff. Children ‘strengths and diffi culties questionnaire’ prior to the at high risk of conduct disorders between prep and grade program. This percentage was reduced to 29 per cent two are identifi ed. Interviews to engage with the parents after the completion of the program. Qualitative feedback of children identifi ed as at risk by the school are then was also positive from teachers, parents and the children carried out. themselves. Interest from other areas of Victoria has Group programs provide the vehicle for delivering the also been received. interventions for both children and parents. Interventions are organised according to three levels: universal, Spread and sustainability targeted, and indicated. A KKPP clinician together with a Sustainability is an integral part of the KKPP philosophy member of the school staff provide a 12-week social and of seeking to share mental health skills with personnel emotional problem-solving group for identifi ed children. in schools who will continue with the program even after An eight-week group program for their parents, aimed KKPP staff have left the school. Parents, too, will have at helping them to develop pro-social and coping skills developed additional competencies that can be used in through positive parenting, is run jointly by KKPP staff an ongoing way for the benefi t of their children. Manuals and community agency or school welfare staff. for the child and parent groups were developed to closely Classroom-based consultations are provided to the fi t the particular needs of this client group and to assist child’s teacher to foster a concerted approach across personnel in continuing the interventions without direct school and home in the development of pro-social skills KKPP involvement. Ongoing support has been offered by in the selected children. Feedback on the child’s progress KKPP staff to facilitate continuation of the program. is facilitated within the partnerships at the end of the service delivery period. Contact Outcomes and evaluation Leanne Beagley Child and Adolescent Mental Health Services Initial analysis of the outcome data shows a reduction Eastern Health in the degree of conduct and peer relationship problems T: 03 9843 1200 according to both parent and teacher ratings. E: [email protected]

56 Highly commended Outcomes of implementing a tracheostomy review and management service Austin Health

Tracheostomy is a life saving procedure where an This new model of care has proven to be a better way artifi cial airway is created and a tube inserted into the to manage these complex patients with high care needs. windpipe to allow patients to breathe more easily. These The team prevents adverse events, removes patients require care from a number of experts who must the tracheostomy tube as safely and quickly as possible work closely together. Austin Health cares for about 200 and is a source of information about best practice patients a year who have a tracheostomy tube in their in tracheostomy management. airway. The Tracheostomy Review and Management Service (TRAMS) formed an expert team of doctors, Contact nurses, speech pathologists and physiotherapists to care for these patients. Tanis Cameron Austin Health The tracheostomy service hoped to demonstrate that T: 03 9496 3095 a dedicated tracheostomy team would improve patient E: [email protected] care. The team cares for all patients with tracheostomy who are not in the intensive care unit (ICU) and provides consultation, support and education to staff and families. The program is a great success. Tracheostomy tubes come out 10 days sooner. Patients leave ICU 30 hours sooner and the hospital nine days earlier. The removal of the tube is a great step forward for patients; while it is in place they may not be able to speak or eat, which can cause great anxiety. There are now fewer complications in caring for these patients on the wards. The team has developed policies to guide the care of patients with a tracheostomy, improving the safety and quality of the care they receive at Austin Health.

57 Victorian Public Healthcare Awards 0 Category 6 Innovation in information technology

For outstanding achievement in applying information technology to enhance client and patient care

Delivering high quality health services is critically dependent on the availability of appropriate and timely information to clinicians, clients, patients and the public. Such information is vital to decision-making about prevention, diagnosis, and appropriate management of healthcare. This award recognises innovative use of information technology to improve client and patient care.

05 59 Winner TOPHATS –The Orion, Peninsula Health Advanced Technology Solution: An innovative project to improve the continuum of care on the Mornington Peninsula 05 Peninsula Health

Of the discharge summaries that had been received only 27 per cent were suffi ciently legible. Many respondents had received discharge summaries up to three months post-discharge. Peninsula Health sought to improve this critical area of patient care and identifi ed a health information technology vendor with a track record of collaborative partnerships at the acute care–primary care interface. Peninsula Health’s original goal was to implement an electronic discharge summary (EDS) solution in order to improve communication between Peninsula Health and GPs from its referral base. The project enabled the generation of electronic discharge summaries and e–prescribing. EDS is now providing information critical to the continuity of patient care. EDSs are guaranteed to Like most healthcare organisations, information sharing arrive at the GP’s surgery within 24 hours of the patient’s between Peninsula Health and local general practitioners discharge, and in many cases the EDS will have been (GPs) until the middle of 2002 was largely paper- received by the GP even before the patient arrives home based. A survey conducted by Peninsula Health and from hospital. The technology signifi cantly improves the the Mornington Peninsula Division of General Practice timeliness and legibility of discharge information. revealed that only 16 per cent of the GP respondents had received a patient discharge summary within three days The point-and-click system enables clinicians to rapidly of the patient’s discharge. create legible typed summaries, accurately detailing the patient’s episode of care. Information from the hospital’s pathology, radiology, pharmacy and patient administration systems populates the EDS automatically. Discharge summaries are sent electronically to the patient’s GP either via automatic fax transmission or directly to the GP’s patient management system (for example, Medical Director) using a secure network.

60 About us point-and-click method of creating discharge summaries. Upon discharge, the summary is transmitted to the Peninsula Health provides a comprehensive range of GP’s surgery via automatic fax or directly to their health services to over 300,000 people. Peninsula Health desktop computer via a secure network, HealthLink. comprises two public hospitals, an inpatient palliative Net. The project is an outstanding illustration of effective care unit, hospital and community-based psychiatric collaboration between an acute healthcare provider, the services, inpatient and day service rehabilitation health information technology industry and the primary facilities, nursing homes, hostels, aged care units and care sector. community health programs. Services are also delivered in peoples’ homes. The health service is active in both Aim clinical education and medical research and is the largest employer on the Peninsula with 4028 staff. The project aim was to improve continuity of patient care by: Abstract • enhancing the quality and timeliness of discharge Poor communication between hospitals and general information communicated to primary care practitioners (GPs) is an obstacle to effective integrated practitioners healthcare (Schollay, et al, 2002). A number of authors • reducing discharge medication prescribing errors have also highlighted the serious limitations of our • providing enhanced clinician access to patient current system of handwritten discharge summaries laboratory and radiology results. (Spatz,et al, 2001; Wilson, et al, 2001). The TOPHATS project delivered a fully integrated clinical information Background system designed to enhance the continuity of patient A survey conducted in 2002 by Peninsula Health and care by improving the communication of discharge the Mornington Peninsula Division of General Practice information between Peninsula Health and GPs on the (MPDGP) revealed that only 16 per cent of the GP Mornington Peninsula. respondents had received a patient discharge summary The system uses browser-based technology (Concerto™, within three days of the patient’s discharge. Of the Orion Systems International) to integrate multiple discharge summaries that had been received only hospital information systems, including an e–prescribing 27 per cent were legible. In terms of completeness component, providing clinicians with a seamless ‘single and content, only 40 per cent of all discharges were patient view’ information system. The e–discharge deemed to be useful. Many respondents had received component provides clinicians with an easy to use, discharge summaries up to three months post-discharge.

61 Peninsula Health sought to improve this critical area Currently, the TOPHATS project team is working closely of patient care and identifi ed a health information with our clinical champion, acute care specialists and technology vendor with a track record of collaborative GP representatives to develop e–discharge templates partnerships at the acute care–primary care interface. for specialty units (for example, , and With the Department of Human Services, Peninsula respiratory) and to improve recording of GP details within Health’s board, and executive support, the Director the patient administration system. These templates are of Information Management, Director of Respiratory designed to capture specifi c clinical information deemed Medicine and the Manager of Computer Services were necessary to further improve the quality of care for instrumental in instigating the project. acute patients. Strategy Outcomes and evaluation In light of the GP survey evidence, Peninsula Health General practitioners from the Mornington Peninsula examined a number of potential solutions. In consultation have been subsequently re-surveyed. These results with the MPDGP, it was decided that the Concerto™ revealed a marked improvement in both timeliness and clinical information system (Orion Systems International) quality of discharge information. Fifty-four per cent of represented the solution of choice. The TOPHATS respondents considered the e–discharge always useful project commenced in February 2002. Interfaces to the in patient care. In addition, the hospital has seen a hospital’s patient master index, pharmacy database, drug demonstrable decrease (approximately 19 per cent) compendium, radiology database and external pathology in the number of discharge medication errors. Ward provider’s database were constructed over the ensuing pharmacists have also reported time savings in the four months. A train the trainer program was conducted dispensing process. in house. The system went live in two pilot wards in early Monthly audits of discharge summaries together with July 2002. Following the pilot, the production system was reporting of timeliness of summaries have been used made available to all acute care areas in August 2002 to further drive quality improvement. Results indicate and has now been rolled out to all clinical areas. that 80 to 90 per cent of all e–discharges are sent The system provides clinicians with a set of clinical within 24 hours of discharge. Peninsula Health has been information tools including e–discharges, e–prescribing using these data to benchmark against other Victorian for discharge medications as well as a clinical document hospitals in the area of e–discharges. In addition, a novel viewer that offers radiology reporting and cumulation and incentive system has been implemented to encourage charting of pathology results. junior medical staff to improve the quality of discharge summaries.

62 Another signifi cant outcome of the project has been the introduction of perhaps Australia’s fi rst fully integrated, multidisciplinary e–discharge summary in our rehabilitation, aged and palliative care areas. Where GPs previously received a series of discharge letters, they now receive this information in one, holistic, aggregated summary. Anecdotal feedback from GPs has been very positive. Spread and sustainability Peninsula Health made a commitment to deploy the clinical information system enterprise–wide. The e–discharge and e–prescribing systems are now available in all clinical units throughout the organisation. These clinical tools have been accepted as an integral part of routine clinical practice at Peninsula Health. Ongoing funding for the maintenance and upgrading of the system together with salaries for support staff is now a budget line item for the organisation. Additional functionality, such as medication management, e–orders for laboratory and radiology services and disease management/clinical pathways are planned for implementation over the next two to three years.

Contact Bob Ribbons Peninsula Health T: 03 9784 7598 E: [email protected]

63 Highly commended Using Blackberry technology to support the patient care delivery process Peninsula Health and Metropolitan Ambulance Service

A partnership between Peninsula Health and the Patient registration information is pulled to a database Metropolitan Ambulance Service is helping people that measures the patient’s frequency of presentation. avoid a trip to hospital. If the patient has presented more than six times in the The partnership is built on cutting edge technology – past 12 months then an email is automatically sent to the a hand-held computer. RAD team that informs the team of the patient’s arrival, current location, working diagnosis and any alerts that Metropolitan Ambulance Service drivers are able to keep the patient may have. The RAD team is then able refer the in touch with Peninsula Health’s Response Assessment patient directly to the Complex Care Program for ongoing and Discharge (RAD) team through the computers. case management. The RAD team receives referrals from the Metropolitan Through the partnership, and the use of hand held Ambulance Service about patients whose needs can be computers, RAD has referred 700 patients to the Complex met in the community preventing a trip to the emergency Care Program in the past 11 months. These patients have departments of Frankston or Rosebud Hospitals. The then received a case management service to reduce the hand-held computers are also used when patients number of times they need to present to an emergency present to the emergency department. department.

Contact Brendon Gardner Peninsula Health T: 03 9788 1277 E: [email protected]

64 Highly commended Clinical impact of the Infectious Diseases Electronic Antibiotic Advice and Approval System (IDEA3S) on appropriate antibiotic prescribing and rapid quality audits Austin Health

Improving the prescribing of antibiotics in hospitals is It can be a stand alone system, which may be useful crucial to decreasing the emergence of resistant and for smaller hospitals without the back up of infectious diffi cult to treat germs. The Infectious Diseases Electronic diseases doctors, or can be incorporated into a hospital’s Antibiotic Advice and Approval System (IDEA3S) was computer network. The list of antibiotics and indications developed to streamline a system that required doctors can be easily modifi ed to suit each organisation. to seek phone approval before prescribing certain In addition to good infection control, controls on restricted antibiotics. While the phone system worked, antibiotic use will reduce the likelihood of multiply it generated about 3500 phone calls to the hospital’s resistant germs which can cause serious . Infectious Diseases area per year, equivalent to about three weeks of a physician’s time spent entirely on the phone, which negatively impacted on their Contact work effi ciency. M L Grayson IDEA3S provides rapid, online antibiotic advice and Austin Health T: 03 9496 6676 approval and incorporates clinical information of a E: [email protected] national standard. It also allows for quick and easy audits of antibiotic prescribing and provides data to educate doctors to improve appropriateness of prescribing. After 18 months of use, IDEA3S has replaced about half of the phone-based approvals which has meant that the infectious diseases doctors can put greater focus on patients with complex infections. At the same time, tight control of antibiotics has been maintained and the quality of prescribing has increased. IDEA3S is user friendly and has been made available to any healthcare organisation free of charge. It can be easily downloaded free of charge from the website: www.debug.net.au/pharmacy/pharmacy.html.

65 Highly commended Personal Digital Assistant Program Barwon Health

In 2003 Barwon Health supported its Department of The feedback from the registrars was remarkably Anaesthesia in developing and introducing a Personal positive. The features the registrars were enthusiastic Digital Assistant-based program to enable registrars about were the ability to identify competence at and specialists to collect exposure and performance procedural performance, to easily collect such data and report incidents occurring in their daily work. performance data, the facility to privately examine The program was developed in the Department of performance and case exposure data and to collect Anaesthesia from a paper-based data collection. The data for many years. A comment that was commonly program enabled anaesthetists to collect data at the heard was ‘I will want to collect this data for the point of care, which they trusted and would therefore rest of my life not just when I am a registrar’. trust any analysis of the data. This commitment to lifelong data collection represents a cultural change that some senior The program enabled anaesthetists to upload data to medical experts have said will take a secure database, linked to a web page. The database two generations; with this program undertook simple analysis of the data and produced it took six weeks. industrial quality assurance performance charts. This enables an anaesthetist to monitor their performance The program has since been introduced extremely accurately and detect improvements and to where trainees deterioration in their performance of set tasks. and specialists use it.

Contact Associate Professor Steve Bolsin Department of Anaesthesia, Geelong Hospital Barwon Health T: 03 5226 7430 E: [email protected]

66 0 Category 7 Excellence in community relations

For outstanding achievement in communication, marketing, community awareness or health promotion

This award recognises excellence in engaging the healthcare provider’s local community through external activities such as community awareness campaigns, media liaison, fundraising events and health promotion initiatives.

05 67 Winner The Men’s Shed and Men Behaving Positively 05 Peninsula Health

Most men will admit they spend more time and money community groups and small business has resulted in taking care of their car than they do on their own health more men spending more time on their health needs. – but that’s changing on the Mornington Peninsula. The Frankston Men’s Shed and Men Behaving Positively A series of successful men’s health initiatives spearheaded health forums have succeeded in reaching men with by Peninsula Health and strongly supported by local social, mental and physical health issues, an often government, the Frankston Magistrates Court, neglected group.

68 The Men’s Shed opened in January 2005 after three years The health service is active in both clinical education of planning and fundraising. The Men’s Shed is a place and medical research and is the largest employer on where men from all ages of the community can attend the Peninsula with 4028 staff. and share stories, hobbies and experiences, with a focus on good health and wellbeing. Activities include building, Abstract woodworking, gardening, computers, arts and crafts, To promote men’s health and wellbeing, two public health pottery and mentoring, with referrals received from the initiatives captured the imagination and support of the local community, case managers or men themselves. local community – the Frankston Men’s Shed and the The Shed, which is open fi ve days a week with a Men Behaving Positively health forums. coordinator present on three days, has been fi tted Wide support from groups such as Frankston Council, with woodworking machinery and other equipment Rotary, Bunnings and the Frankston Magistrates Court donated by local businesses and the Frankston have ensured both projects have succeeded in reaching Community Rehabilitation Service. men with social, mental and physical health issues. Two public health forums were held during Mental Health Week in 2004, and the second in May 2005 Aim with over 1000 men and women attending. The 2005 The key aim was to raise awareness of men’s health and forums focused on depression and attracted the largest wellbeing by providing opportunities for men to reduce attendance of any recent men’s health forum held risk behaviours, and to promote positive mental health. in Victoria. This was achieved through structured education and community participation linked to local health services. About us This has encouraged men to take responsibility for their Peninsula Health provides a comprehensive range own health. of health services to more than 300,000 people. Peninsula Health comprises two public hospitals, an Background inpatient palliative care unit, hospital and community- A needs assessment in 2002 revealed disturbing based psychiatric services, inpatient and day service images of men’s health in the Frankston area. Apart rehabilitation facilities, nursing homes, hostels, aged care from the pub, few meeting places exist to connect men units and community health programs. Services are also with physical, social and mental health issues, despite delivered in peoples’ homes. Frankston having a higher than average percentage of men with mental health and drug and alcohol issues.

69 Social determinants of health factors were prevalent, and the local business community. A major public including unemployment, homelessness, fi nancial issues, meeting was held with these groups and members social isolation and family breakdown. A signifi cant of the local public, some of whom now act as volunteers number of presentations to to the Men’s Shed. emergency department were identifi ed as men with A steering committee convened and met regularly. drug and alcohol issues or attempted suicide. Analysis Funding submissions met with early success from also indicated issues of retirement adjustment, chronic Frankston and Mornington Primary Care Partnership, disease and social disconnection. Frankston Rotary and local government. Further funding Working with the local community, including service fl owed and Peninsula Health allocated land allowing clubs and businesses, the Frankston Men’s Shed has the project to proceed. been successfully established. Extending from the needs analysis and the Men’s Shed Public health forums targeting men’s health, were also initiative, the Men Behaving Positively forum initiative delivered with strong community participation, under the grew with enthusiastic support from an engaged banner of ‘Men Behaving Positively’. community. Two successful forums were held in 2004 and 2005, strongly supported by a total of over 1000 Strategy participants, cementing it as an annual event. Following the generation of the initial concept, validation was undertaken through a needs analysis. Outcomes and evaluation This assessment identifi ed men’s health gaps and Men attending the Men’s Shed program are either the opportunities to better socially connect men to referred by health workers or are self referred, with community and local health services. Key themes were a screening process ensuring suitability. More than a high incidence of drug and alcohol abuse, physical, 200 initial referrals were received. social and mental health issues, generating ideas for Programs on offer include woodworking, gardening, information sharing, linkages and networks. cooking, computers, pottery, mentoring and group work. Consultation with community stakeholders about the Health workers and case managers are reporting that outcome of the needs analysis was undertaken with the Men’s Shed is an excellent resource, well suited Frankston Rotary, Frankston City Council, Psychiatric for a wide range of activities and well coordinated in a Disability Support Services, the Brotherhood of St male only environment that assists them in their case Laurence, the local Magistrates Court, Victoria Police, management role.

70 Feedback from clients confi rms that men feel Spread and sustainability comfortable in the Shed as it provides an opportunity to Strong funding support has and continues to be socialise and participate. Additionally, the Shed supports received to support the Men’s Shed initiative. The carers as a valuable respite option. Department of Veteran Affairs has provided seed funding Evaluation is ongoing and has a focus on impact, to allow the appointment of a coordinator for a 12-month process and outcome methods, considering quality of period. Ongoing funding support for this position is being life, social connections, improved health and behaviour, sought from a number of sources including government and satisfaction with the program. Further interest and non-government agencies. has been expressed by La Trobe University School of The Frankston Magistrates Court continues regular Behavioural Sciences to undertake evaluation of impact monthly donations, service clubs continue to fundraise, and outcomes. and local businesses continue donations of equipment Linked to this initiative, two public health forums have and materials. been instrumental in raising public awareness of men’s Funding for the men’s health forums has been secured health issues and strengthening relationships between through sponsorship by the same services and Peninsula Health, other health and welfare agencies and organisations who support the Men’s Shed. Financial the community. Evaluations from attendees were very and other resources were obtained from external sources positive, enabling the committee to plan a further Men including: Frankston and Seaford Rotary, Frankston City Behaving Positively forum in June 2006 (Men’s Health Council, Frankston Pines Project, Frankston Magistrates Week). Local general practitioners, health workers, media Court, Bunnings Hardware, Frankston RSL, Rotaloo Pty and members of State Parliament have praised these Ltd, Department of Veteran Affairs, A and M Sheds Pty forums as both informative and innovative. Ltd, , Gardening Australia, Frankston and Mornington Primary Care Partnerships, Nepean Air Conditioning Pty Ltd, Bakker Concreting Pty Ltd , Riley Electricals Pty Ltd, and Snow Plumbing Pty Ltd.

Contact Greg Holding Peninsula Health T: 03 9784 7777 E: [email protected]

71 Highly commended Ambulance in Schools Metropolitan Ambulance Service

There are few stories more inspiring than those involving The Metropolitan Ambulance Service has worked hard young children saving the lives of family members with to integrate the program with the school curriculum, acts of courage that belie their years. allowing the ambulance theme to tie in to various school In almost every case, the children who have done so subjects including health and science. Although the had been instructed in the correct way to respond to program is educationally based, it is delivered in a fun an emergency by their school or an emergency services and exciting manner. representative. This life saving information is vital to The Metropolitan Ambulance Service’s experience with empower our children to deal responsibly with situations the program shows that children are willing learners, are that are far removed from normal daily experience. fascinated by the scenarios and keen to discover what The Ambulance in Schools program educates children, they can do in an emergency. By the end of the program their teachers and parents in how to identify and the students are able to accurately identify when it is minimise risks and what to do in an emergency. It also appropriate to call an ambulance and can correctly provides a great kick-start for family discussion about demonstrate the skills they need to do this. medical emergency planning at home. Developing the program and seeing it being successfully delivered to so many students has been a highlight for Metropolitan Ambulance Service community education and development staff. The Metropolitan Ambulance Service is very proud of the program and look forward to seeing it grow further in years to come.

Contact Emily England Metropolitan Ambulance Service T: 03 9840 3311 E: [email protected]

72 Highly commended Community Kitchens Frankston Community Health Service, Peninsula Health

The Community Kitchens project involves helping Evaluation reveals benefi ts for participants including individuals or groups with common backgrounds or improvements in social skills, teamwork and leadership interests to set up and run cooking groups. Community skills as well as further developing budgeting, cooking Kitchens are not cooking classes or soup kitchens, but and shopping skills. An integral part of the Community opportunities for people to socialise and cook before Kitchens project is to utilise existing community enjoying delicious, affordable and nutritious meals with resources and to create partnerships to support others. sustainability and limit requirements for ongoing funding Many kitchens buy and cook in bulk to allow the support. production of many meals at low cost. Participants usually take extra meals home to enjoy on subsequent Contact days. The participants have ownership over their kitchen Jenny Trezise and direct how they would like it to run. Frankston Community Health Service T: 03 9784 8125 E: [email protected]

73 Victorian Public Healthcare Awards 0 Category 8 Excellence in continuity of care

For outstanding achievement in the integration and coordination of care

Continuity of care ensures the best possible results and satisfaction for clients and patients. This award recognises initiatives which improve outcomes for clients and patients through effective coordination between care providers.

05 75 Winner A best practice model of care for people with diabetes related foot conditions across the hospital-community continuum Partnerships in Health: A collaboration between Doutta Galla Community Health Service, 05 Moreland Community Health Service, Melbourne Health and the Royal District Nursing Service

The collaborative nature of the service brings together the best of both the acute and community approaches. Analysis shows a reduction in hospitalisation from 15.7 days in the control group to 10.1 days following establishment of the Diabetic Foot Unit (DFU). The number of amputations was signifi cantly reduced. Furthermore, the development of this multidisciplinary healthcare continuum has also resulted in improved wound healing rates, reductions in hospitalisations and high levels of client satisfaction. Clients report improved quality of life and increased ability to self-care. This novel model of healthcare, which embraces the three principles of best practice (patient-centred, evidence-based and collaborative) has not only achieved signifi cant improvements for patients, but it has been Individuals with diabetes have a 15 per cent lifetime risk designed to be rolled out so that similar achievements of developing a foot ulcer, resulting in more than 100,000 can be achieved at other health institutions. amputations annually in the United States. Although we have the knowledge to heal approximately 90 per cent of About us such ulcers, amputation and admission rates for these The Diabetes Foot Disease Service is a collaboration conditions continue to increase. between Doutta Galla and Moreland community health With this in mind an evidence-based clinical guideline services, The Royal Melbourne Hospital and Royal District was devised for the assessment, investigation and Nursing Service. Services ‘follow the patient’ as they management of individuals who developed a diabetes- move from hospital inpatient and outpatient services, related foot complication. The clinical guideline was to fi ve community based clinics and clients’ homes. implemented by a service continuum that included a The multidisciplinary team of health professionals multidisciplinary team of health professionals within the manage approximately 300 individuals with severe acute hospital setting and additional specialist services diabetes-related foot complications each year from within the community that could implement further acute the culturally diverse and socially disadvantaged north and preventive foot care. The latter strategy was a western suburbs of Melbourne. crucial step in breaking the cycle of repeated ulceration, admission and requirement for further amputations.

76 Abstract Aim The Diabetes Foot Disease Service was created in The project aims to provide evidence-based, best 2002 to improve outcomes for individuals with diabetes- practice management across the care continuum related foot complications. The service is provided by for people with diabetes-related foot complications. a multidisciplinary team: endocrinologists, a rehabilitation This new strategy aims to reduce the need for specialist, vascular surgeons, podiatrists, a clinical hospitalisation, reduce the incidence of amputations, psychologist, dietician and nurse wound consultants. improve wound healing, prevent or restrict the It operates within The Royal Melbourne Hospital (six progression of diabetes-related foot disease and dedicated beds and a specialist outpatient clinic) and improve clients’ quality of life. across north western Melbourne in fi ve community health sites, plus visits to clients’ homes. Background The service has achieved statistically signifi cant Despite being responsible for more than 100,000 improvements in clinical outcomes: reduced amputation amputations in the United States annually, diabetes- rates, improved wound healing and improved wound related foot complications have been poorly addressed. prevention. Other benefi ts include high client satisfaction, The need for a diabetes-specifi c foot service was improved quality of life and clients’ capacity to identifi ed in 2001 when an audit revealed 25 per cent of self-manage. all Royal Melbourne Hospital inpatients had diabetes and, of these, 20 per cent had a related foot complication, with The service has demonstrated reductions in hospital an inappropriately high amputation rate of 26 per cent of admissions and in lengths of hospitalisation, with a all inpatients with a diabetes-related foot complication. 15 per cent reduction in emergency department presentations, 24 per cent reduction in admissions and The development of the Diabetes Foot Disease reduced length of stay from 16 to 10 days, on average. Service entailed: Evaluation and development of the service continues • creation of an evidence-based, multidisciplinary, so that further gains can be achieved. clinical guideline for inpatient assessment, investigation and management of this client group • improved provision of community services, to break the cycle of gradual deterioration and need for re- admission due to the lack of appropriate community-based services.

77 The service was developed as a collaboration between • clients being encouraged to become active the hospital, community health services and the Royal participants in the multidisciplinary team so that District Nursing Service and funded by the Hospital the best possible outcomes can be achieved Admission Risk Program from 2002. • an educational program for general practitioners Strategy to promote best practice management • consumer and stakeholder questionnaires The strategy included: and focus groups to improve the service • the creation of an innovative, evidenced-based clinical • careful monitoring and evaluation of practice and guideline for the management of diabetes-related foot clinical outcomes, and impact on hospital admission complications and emergency department presentations • involvement of partner agencies, general practice, • the development of discharge packs, including a and inpatient specialties in service development magnifying mirror, nail fi le, emergency dressings for • creation of the Diabetic Foot Unit (DFU) at future complications, to enhance self-management. The Royal Melbourne Hospital • workshops and case conferences between acute Outcomes and evaluation and community services, which have improved service In the fi rst four months of the inpatient service, integration and care continuity 78 individuals were admitted and 52 managed in • accessible, specialist community services to maintain the specialist clinic. Peripheral neuropathy, peripheral clients safely in the community vascular disease, ulceration and infection were assessed more frequently in the DFU compared to control. Rates of • evolution from a ‘foot’ focus to holistic care, to prevent ordering HbA1c improved and lipid profi les signifi cantly the development of future foot and other diabetes- increased. All other investigations, including MRIs and related complications peripheral angiograms did not increase in the DFU • adequate funding to provide high cost treatments as investigations were now tailored to the individual’s and dressings to enhance wound healing condition. • high use of interpreters to meet needs of culturally and linguistically diverse clients

78 The mean length of stay decreased from 15.7 to 10.5 Outcomes have been presented to various professional days following the introduction of the DFU. The number forums and diabetes conferences. The guideline has been of amputations signifi cantly reduced. There was a published in the international journal, Diabetic Medicine. non-signifi cant reduction in major amputations but a Several Victorian health services propose to implement signifi cant reduction in minor amputations. this service. Ninety-two per cent of clients had a history of ulceration This model of care continues to be evaluated and improved prior to enrolment. Seventy-fi ve per cent did not develop to achieve sustained improvements in outcomes. a new wound over the course of each six month evaluation period. Forty-six per cent had a history of Contact amputation prior to enrolment. Only 6 per cent have required an amputation since enrolment. Quality of Jane Gilchrist life scores at six months indicated improvement in the Melbourne Health T: 03 9342 7820 ‘physical’ (health) domain. E: [email protected] There was a 15 per cent reduction in the emergency department presentations and 24 per cent reduction in foot-disease related admissions in the 12 months post-enrolment, compared to 12 months pre-enrolment. Spread and sustainability The service is believed to be the fi rst truly multidisciplinary, cross-sector service of its kind in Australia. It is also the fi rst to use an evidence-based clinical guideline to encourage a global approach to clinical assessment, investigation and management of diabetes-related foot complications, while the collaborative nature of the service brings together the best of both the acute and community approaches. The model has been designed to enable it to be rolled out to other services.

79 Highly commended Care in Context Southern Health

Care in Context was developed by Southern Health been able to look after the house either internally or to provide better services to people who have chronic externally, is suffering from depression, has a poor diet, and complex health needs. lack of exercise, and does not manage medication very Rather than just the medical health issues being well. Care in Context is able to assist the person over a addressed in a hospital setting, Care in Context helps period of six to 12 months, helping them to address all people to take control of their own health. This is of these issues, and therefore help them to improve their achieved by looking at all the issues that might be quality of life. impacting on their health, and assisting them to use a Care in Context is part of a new system to improve range of services located in the community. An example healthcare for people living in the southern metropolitan might be that a person has been suffering from chronic region of Melbourne. asthma for years and frequently attends the emergency department, and may be admitted to hospital. The person Contact would be assisted to recover from the acute asthma attack, perhaps be provided with some asthma education Anne Parkes and sent home. Closer investigation reveals that the Southern Health T: 03 9554 8777 person lives alone with very few supports, has not E: [email protected]

80 Highly commended Improving diabetes care Austin Health

In 2002, Austin Health was successful in receiving optimally during their stay and that discharge planning funding from the Department of Human Services as is streamlined. Patients may be linked to the North East part of the Hospital Admission Risk Program (HARP). Diabetes Service if ongoing assessment and care The resulting HARP Improving Diabetes Care project, is required. which is now in its fourth year, is a collaboration between Through involvement with the North East Diabetes Austin Health, the Northern and North East Valley Service, strong links have been established between Divisions of General Practice and the Banyule, Darebin Austin Health, local community health services and and Nillumbik community health services. local general practitioners. A major outcome of this project has been the establishment of the North East Diabetes Service, with Contact the entry point being the Diabetes Complications and Assessment Service (DCAS). DCAS provides patients Carolyn Hines with a comprehensive ‘one stop shop’ assessment for the Austin Health T: 03 9496 5439 complications of diabetes at several convenient locations E: [email protected] in the north east region of Melbourne. At their DCAS appointment, patients are assessed by a multidisciplinary team in terms of all clinical and self-management indicators relevant to optimal diabetes management. Following the appointment, patients are given the option of accessing other diabetes services, such as diabetes education programs and podiatry services. Another outcome of the program has been the introduction of the unique Diabetes Care Coordinator role. The role sits within the acute wards of Austin Health and ensures that inpatients with diabetes are managed

81 Encouragement award The importance of the therapeutic relationship in effective case management South East Advocacy and Support Service, Bunurong Community Care, Southern Health

The South East Advocacy and Support Service (SEAS) SEAS had been running for two years when, in 2003, was established with the client in clear focus. The primary further extension to the service was developed. The demographic was to be the aged and disabled in the Medical and Allied Health Support Service is an initiative community who were at risk of homelessness. The team to provide coordinated medical and allied health access. of workers designed brochures, calling cards, policy and SEAS clients often have no way of navigating the complex procedures to refl ect an approach that was not only public health system; for example, cataract surgery client-centred but mindful of the psychodynamics of a on one eye needs a total of eight appointments client who had not been able to achieve, or maintain, a that have to be attended in a specifi c timeframe. ‘home’. People that are now assisted by SEAS had been Convalescence requires specifi c support and falling through the gaps of existing service systems; they care. Without transport, organisation, had become the most marginalised in the community. interpretation and communication of In the south east region of Victoria no extended services medical directives, and follow up, the to the homeless existed, so a casework service was an client would not be able to receive essential basic. this treatment. SEAS provides a fl exible practical, open-ended, SEAS generalist case management and therapeutic relationship that provides solutions to the very specifi c Medical and Allied Health each individual client’s challenges to achieve housing Access Service provides a streamlined security and improved healthcare. SEAS case workers service of interventions that ensure client- can provide complex interagency advocacy, direct centred continuity of care that ensures clients to necessary medical treatment, help pack up housing security and access to health a fl at, transport clients to look at new accommodation, services. Each client has a ‘person’ that take them shopping for clothes; the list goes on. All is equipped to resolve the individual issues interventions from assessment to discharge provide that have originated in a referral to SEAS. clients with a relationship with one worker. SEAS has no budget for the purchase of services, all Contact solutions are worked out with the client, not purchased Kris Lomax for them. South East Advocacy and Support Service T: 03 8792 2356 E: [email protected] 82 0 Category 9 Innovation in workforce design

For outstanding achievement in implementing new and better ways of working

New approaches to staff and role development can lead to better outcomes for clients and patients, promote greater work satisfaction for healthcare professionals and contribute to more effi cient and sustainable services. This award recognises innovative approaches to workforce design.

05 83 Winner Primary contact orthopaedic physiotherapists improving care for patients on the orthopaedic outpatient waiting list 05 Western Health

An initiative was introduced in February 2005 managing patients on the waiting list. Research from whereby two senior physiotherapists worked alongside the United Kingdom suggested that highly experienced orthopaedic surgeons in a weekly outpatients clinic at physiotherapists could assist with management of Western Health. In 2004, some patients were waiting orthopaedic outpatient waiting lists, provide effective more than 18 months to see an orthopaedic doctor in patient care, free surgeon time to see more appropriate outpatients, which for many patients resulted in ongoing patients, improve patient satisfaction and contribute pain and worsening of their condition. As such, there was to cost savings for the organisation. a need to investigate an alternative model for

84 Many patients have had the opportunity to see an Abstract experienced physiotherapist much earlier than if they A new initiative was introduced whereby two experienced had waited to see a doctor. Comparisons between the physiotherapists worked in an advanced scope alongside management of the doctors and physiotherapists has orthopaedic surgeons in an outpatient clinic. The aims shown that doctors are much more likely to choose of the physiotherapy clinic were to assist in addressing surgery as a form of treatment, rather than fi rst trialling a lengthy orthopaedic outpatient waiting list and a conservative option such as physiotherapy. Patients to provide a more challenging and stimulating role seen by the physiotherapists experienced signifi cant for senior physiotherapists. improvements in pain, mobility, and ability to participate in daily functions, and as such have been very satisfi ed From February to July 2005, 136 patients were seen with the new service. The senior physiotherapists by the primary contact orthopaedic physiotherapists involved have also been excited with the new service (PCOPs), many of which were referred to standard as it has provided them with a more challenging and physiotherapy. On average, the PCOP patients received stimulating role. an appointment 26 weeks earlier than if they had waited to see a doctor. Analysis revealed that surgeons were About us much more likely to choose surgery over conservative Western Health is a provider of health services in management as a form of treatment than the PCOPs. the western metropolitan region of Melbourne and There were signifi cant improvements associated with incorporates , Western Hospital, conservative management for disease-specifi c measures The Williamstown Hospital, Reg Geary House and of impairment and activity limitation. Hazeldean nursing homes, and DASWest. Western Health General practitioners (GPs), patients and the PCOPs has around 4500 employees and provides services to expressed a high level of satisfaction with the initiative. around 567,000 people. Outpatient services across As a result of the positive outcomes, a decision has been Western Health account for 41 per cent of attendances, made for the physiotherapy clinic to continue. with an average of 287 outpatients each day.

85 Aim working in an extended scope have been able to assist with orthopaedic outpatient demand management For orthopaedic outpatients participating in the initiative, in Great Britain, which provided a basis for the the main aims were: current initiative. • to improve waiting time from GP referral to appointment Strategy • to improve patient and GP satisfaction In the design and planning phase, the initial concept • to improve functional capacity through provision was proposed by the physiotherapists, with feedback of conservative management (physiotherapy) obtained from a range of stakeholders through group presentations and individual meetings. Stakeholders • to reduce the number of patients requiring surgery were very willing to explore an alternative model to • to improve job satisfaction for experienced address the waiting list issue. Prior to implementation, orthopaedic physiotherapists. other tasks undertaken included the scoping of duties required of the PCOPs and competency checking. Background Endorsement from clinical governance committees Orthopaedic outpatient waiting times had increased was also required. signifi cantly, causing the waiting list to extend to The actual strategy involved two PCOPs assessing and 18 months in 2004, making it the longest delay for any managing new referrals to the orthopaedic outpatient clinic at Western Health. Many GPs and patients were clinic by undertaking a clinical examination, ordering complaining about the decline in physical function that appropriate tests, making a provisional diagnosis and was occurring as a result of the wait. Many referrals on arranging appropriate treatment interventions. As such, the waiting list were for conditions that could respond the PCOPs functioned in a similar manner to the medical to physiotherapy. However, as is common practice staff. Sometimes the PCOPs deemed that a surgical in Victorian hospitals, physiotherapists worked as review was required, but many patients were referred secondary practitioners and could only receive referrals to standard physiotherapy and were reviewed by the once reviewed by an orthopaedic doctor. PCOPs after 10 weeks. The patients managed by the The impact on patient care prompted the PCOPs were determined according to a triage system physiotherapists and orthopaedic unit to seek with the inclusion criteria related to conditions not a different model for managing these patients. obviously requiring surgical intervention in the near A literature review demonstrated that physiotherapists future.

86 The progress of the implementation was tracked through A survey revealed that the PCOPs experienced more regular meetings with the PCOPs and orthopaedic job satisfaction as a result of being able to fully utilise surgeons, which led to minor changes in protocol. Various their clinical skills. measures relating to waiting times were collected as well as clinical outcome measures. A formal review of the Spread and sustainability initiative was undertaken after fi ve months. As a result of the positive outcomes, a decision to continue the initiative was made by the Physiotherapy Outcomes and evaluation Department with support from the orthopaedic Over the fi ve-month period, the 136 PCOP patients unit and clinical governance committee. The small had an average wait of 30 weeks between referral and amount of physiotherapy resources involved in this appointment compared with the predicted average project is sustainable through some effi ciencies made waiting time of 56 weeks had they remained on the in physiotherapy outpatients by enhancing group waiting list to see a surgeon. treatments. Informal patient feedback suggested a high level of The PCOPs have not been seeing all patients that fi t the satisfaction with the initiative. A signifi cant proportion triage criteria due to limited resources. A business case of GP questionnaires were returned with responses has been submitted for additional resources and suggesting that all were satisfi ed with the PCOP is currently being processed. management. PCOPs could also play an important role in emergency There were signifi cant improvements post-physiotherapy departments. Discussions with emergency department intervention for disease-specifi c measures of impairment stakeholders are currently being undertaken. and activity limitation, but no change for quality of life measures. Contact Surgeons were less likely to refer to physiotherapy and Jennifer Maciel more likely to choose surgery as a treatment modality. Western Health Five per cent of the initiative patients were placed T: 03 8345 6661 on the surgical waiting list compared with 35 per cent E: [email protected] for a similar population of doctor-managed patients. Ninety-one per cent of the initiative patients were referred to physiotherapy, versus 30 per cent for the doctor cohort.

87 Highly commended The challenge of sustaining a rural maternity service Bass Coast Regional Health

Bass Coast Regional Health is a major public healthcare informed choices about their care with continuity provider within the Bass Coast Shire in South Gippsland. of carer being provided by the midwives. The service area for the region is the fastest growing This has been an exciting journey for Bass Coast in rural Victoria and covers an area of 865 square Regional Health which has resulted in increased kilometres. satisfaction for women and midwives, improved clinical In May 2003, Bass Coast Regional Health launched its outcomes and secured the future for midwives at Bass Team Maternity Care Model on International Midwives Coast Regional Health. Day to ensure the long term viability of the maternity This would not have been achievable without the service. The maternity service had been previously support of all staff but in particular the four midwives threatened with closure due to staffi ng sustainability and who participated in the pilot and whose experience has inability to recruit new midwives. Other factors prompting shown that this model makes use of the complementary development of a new model included the lack of ability skills of general practitioners, midwives and allied to provide women-centred care and lack of continuity health providers. It promotes multidisciplinary learning of carer. respect and trust between parties. It fully embraces the It was anticipated that a collaborative team approach principles of women-centred birth. It encourages equal would enable women in the Bass Coast Shire to make relationship partnerships, with women being informed and able to make decisions about their care options. It has resulted in increased job satisfaction for the team midwives. A patient was so impressed with the care she received she nominated the team for a State Nursing Excellent Commitment Award resulting in a commendation in the category of improving the patient and client experience through innovative practice.

Contact Janet Lodge Director of Nursing Bass Coast Regional Health T: 03 5671 3222 E: [email protected]

88 Highly commended Physiotherapy: a new look service to care for our community Bendigo Healthcare Group

The availability of physiotherapists in rural and regional The new model has provided some pleasing additional areas has been diminishing. The ageing population and bonuses. It has resulted in consistent service provision professional workforce attrition is expected to create for the community, minimal periods of staff vacancy, further strain on services and affect the capacity of the high levels of staff skill, enhanced capacity to respond Bendigo Healthcare Group to care for its community. to changing health service demands, broadened patient In the face of a severe physiotherapist shortage, the care options and improved work enjoyment for staff. workforce model of the physiotherapy service at Bendigo Healthcare Group has undergone a successful change. Contact The aim of this initiative was to create a sustainable Melanie Taylor workforce model which enabled continuous provision Bendigo Health Care Group of high quality physiotherapy patient services for our T: 03 5454 9029 community, and created a stimulating and satisfying E: [email protected] environment for staff. The key driver was to sustain existing services, and to retain the existing staff who were struggling to deliver services to their satisfaction. Out of a traditional model of physiotherapists and assistant staff, a new model has slowly been built. The new model has: • a non-clinical assistant for equipment and facility maintenance, linen change and stock control • well-trained and skilled clinical physiotherapy assistants who supervise and assist patients with their physiotherapy programs • physiotherapists who are now able to use their high levels of skill to the maximum • exercise therapists who are relatively new in the health industry and who specialise in the design, prescription and delivery of exercise for rehabilitation • exercise therapy assistants to support their work.

89 Victorian Public Healthcare Awards 0 Minister’s awards for outstanding staff achievement

For outstanding achievement by staff in delivering care for clients and patients. Two awards are presented:

a. Minister’s award for outstanding individual achievement b. Minister’s award for outstanding team achievement

05 91 Winner Professor Hatem Salem, Director of Medicine 05 Eastern Health

Hatem Salem has been the Professor of Medicine at Box Hill Hospital since 1988 when he was awarded a Personal Chair in Medicine from . In 2000, he was also appointed to the role of Director of Medicine for Eastern Health. He is a haematologist by training, with a primary interest in the fi eld of thrombosis. Box Hill Hospital is a 366-bed acute tertiary referral hospital and a major teaching hospital for Monash University. Eastern Health is the major public sector provider of acute, sub-acute and mental health services in the eastern metropolitan region with fi ve major sites, the largest of which is Box Hill Hospital. Nomination Professor Salem has made an outstanding contribution to the community of Box Hill Hospital for more than 15 years and to the wider community in medical education, training and research for over 30 years. Under Professor Salem’s leadership, Box Hill Hospital has Minister’s award been transformed from a general community hospital to for outstanding a tertiary referral hospital with a reputation for excellence in clinical care. He is esteemed by his patients whom he individual achievement treats with dignity and respect and he is acknowledged as an exemplary role model by junior and senior clinical staff across the organisation. Professor Salem has an active involvement in the teaching of medical students and training of junior doctors. During his time at Box Hill Hospital he has established medical specialty training programs for junior doctors including a highly successful physician training program. He is an excellent teacher and gives generously of his time to support and advise his students.

92 Professor Salem has an international academic Professor Salem’s commitment to medicine extends reputation, having established the Australian Centre beyond the hospital and university and into the for Blood Diseases where he is Executive Director. His community. His keen interest in community education research pursuits have also led to the establishment means he is a regular speaker at community forums of the Eastern Clinical Research Unit which is one of and with community healthcare providers on clinical the largest clinical trial units in Australia. His research haematological conditions. He also has a particular has contributed signifi cantly to the knowledge base interest in the ethics of medical research, a subject on clotting disorders which leads to the development on which he has given numerous presentations. of new treatments for thrombotic conditions. Hatem Salem is currently the President of the Australasian Community impact Society of Hemostasis and Thrombosis, and Vice President of the 2005 Congress of the International Society of Professor Salem has been instrumental in establishing Hemostasis and Thrombosis Congress in Sydney. He Box Hill Hospital as a hospital that is highly valued by has published in excess of 140 peer reviewed articles in the local community. Under his guidance, the clinical international journals, received many awards and grants care provided at Box Hill Hospital has fl ourished with throughout his career, and has supervised the training the establishment of new services to meet the healthcare of many PhD graduates. He is a Fellow of the Royal needs of the population. The culture of the hospital has Australasian College of Physicians and the Royal College also developed under his infl uence, becoming one that of Pathologists of Australia, a licentiate and member values excellence in clinical care and therefore is open of the Royal College of Physicians (UK) and a member to peer review in the continual pursuit of improved of the Royal College of Surgeons (London). patient outcomes. Through his dedication to teaching and education, numerous talented medical practitioners have been trained and many have been recruited to the staff of Box Hill Hospital to provide public clinical services to the community. Professor Salem’s academic standing has also led to the establishment of an active research community within Box Hill Hospital, enabling the translation of basic research into clinical practice.

93 Highly commended Ingrid Plueckhahn, Practice Development Nurse Peter MacCallum Cancer Centre

At Peter MacCallum Cancer Centre, Ms Plueckhahn has also initiated the development of a new role – the Smoking Cessation Support Nurse Coordinator. This work complements her position at QUIT Victoria, where she acts as a QUITline adviser and health professional educator. Ms Plueckhahn also contributed to the writing of the coursework for the ‘Nursing people with lung cancer’ postgraduate subject at La Trobe University and provides students with academic support and conducts formal assessments. Ms Plueckhahn epitomises excellence in clinical practice and energy in her commitment to improving the wellbeing of patients with cancer. Her work has made an enormous contribution to the nursing profession, in particular cancer nursing, by providing a health promotion model in an acute cancer facility. Ms Plueckhahn’s dedication and innovative approach Ingrid Plueckhahn has 30 years nursing experience, to patients with cancer is an example for others to follow. including 15 years dedicated to caring for patients Her work at Peter Mac and Quit not only involves direct with cancer. As Practice Development Nurse, her patient contact but also gives her the opportunity to focus is to improve patient outcomes through share her expertise with other health professionals. developing patient-centred and evidence-based To this end she is able to touch the broader community, approaches to care. developing a growing number of health professionals and counsellors that will continue to apply the methodology and practices she uses in their own interactions with patients.

94 Highly commended Jenny Trezise, Community Dietician Peninsula Health

Community kitchens bring together groups of people with similar backgrounds or interests to cook and socialise; in so doing they can deliver important life skills and help improve the overall health and wellbeing of participants, their families and the wider community. In 2003 Ms Trezise was awarded a Victorian Travelling Fellowship by the Department of Human Services and travelled to Canada to study the concept of community kitchens. On her return, inspired by what she had seen, Jenny developed plans to establish community kitchens in the Frankston community. In 2004, Peninsula Health was funded to establish six pilot community kitchens. Ms Trezise established partnerships with a number of community groups to help establish the initiative: the Brotherhood of St Laurence, City Life, Peninsula Care House, Frankston Community Health and Mahogany Neighbourhood House. Jenny Trezise holds a Bachelor of Applied Science In August 2005 the Community Kitchens initiative was in Human Movement and a Master of Nutrition and awarded a National Heart Foundation Kellogg Local Dietetics and is a community dietician with the Frankston Government Award which recognises great projects Community Health Service. She has been the inspiration that organisations are delivering in their communities and driving force behind the development of the to promote and improve heart health. The award Community Kitchens initiative, which is supported acknowledged the strong collaboration with like- by 25 community groups in the Frankston area. minded community-based organisations in reaching Based on her knowledge of the high rates of obesity, local communities. heart disease, diabetes, depression, social isolation and food insecurity in the southern metropolitan region of Melbourne, Ms Trezise was keen to develop a program that could make a difference.

95 Winner DeBug Infection Prevention program Infectious Diseases, Infection Control and Pharmacy departments, 05 Austin Health

The DeBug Infection Prevention team consists of members of the Infectious Diseases, Infection Control and Pharmacy departments and was formed in 2001 to reduce the rate of hospital-acquired infections (HAIs) at Austin Health. It has four key goals: 1. to better understand the epidemiology of HAIs, especially methicillin-resistant staphylococcus aureus (MRSA) 2. to establish a simple and reliable method of measuring MRSA infection rates 3. to develop a practical and effective multi-modal intervention to reduce the rate of HAIs, including implementation of a culture change program Minister’s award to improve hand hygiene compliance among healthcare workers for outstanding 4. to improve patient understanding about HAIs team achievement and how to reduce them. Nomination

M Lindsay Grayson, Director, Infectious Diseases Although MRSA is the leading cause of HAIs in Australia, Paul D R Johnson, Deputy Director, Infectious Diseases identifying effective means of controlling its spread have Rhea Martin, Head, Infection Control Practitioner, Infection Control proven diffi cult. Deidre Edmonds, Infection Control Practitioner, Infection Control In a spirit of open disclosure and system change, the Sandi Gamon, Infection Control Practitioner, Infection Control DeBug Infection Prevention (DIP) team, with full executive Libby Grabsch, Infection Control/Microbiology support, implemented a practical and robust method Tim Brown, Research Nurse, Infectious Diseases of accurately assessing the impact of MRSA at Austin Barrie Mayall, Microbiologist, Microbiology Health and introduced a multi-modal culture change Kent Garrett, Head, Pharmacy Department program to reduce the spread of this pathogen. Sue Kirsa, Pharmacist, Pharmacy Department Marie O’Brien, Secretary, Infectious Diseases

96 The DeBug Infection Prevention program is the single Community impact most effective infection control strategy introduced in MRSA is the leading cause of hospital-acquired infections Australia in the past quarter century. and related deaths in Australia and is largely transmitted The DIP program was truly a team effort. With no suitable from patient–to–patient on the hands of healthcare alcohol-chlorhexidine hand-rub solution available, the workers and contaminated shared hospital equipment. Austin Health Pharmacy Department developed a new The Austin Health DIP program has clearly demonstrated product called DeBug™ that was safe, effective and that improved awareness and education of healthcare gained excellent staff acceptance. workers and their patients regarding the importance of The Infectious Diseases and Microbiology departments appropriate hand hygiene compliance and other related developed and validated a simple computer-based infection control activities results in substantial and method of accurately measuring MRSA infection rates sustained reductions in MRSA infections – an estimated based on routinely available data. 53 patients were prevented from developing MRSA blood Infection Control staff developed a standardised, stream infections during the three-year program. validated assessment tool for accurately measuring hand The DIP program is also notable because many of the hygiene compliance by healthcare workers when caring methods and tools developed are suffi ciently simple, for patients. This tool is now the accepted standard practical and robust that they can be readily adopted and for measuring hand hygiene compliance in Victorian implemented by other Australian healthcare providers. hospitals. The on-line hand hygiene credentialing program is The DIP team designed and implemented the multi- designed to be accessible to both healthcare workers modal culture change program that involved improving and the general public as a learning tool and education hand hygiene compliance, alcohol cleaning of all shared resource. The DIP team has been responsible for patient equipment, targeted decolonisation of MRSA- developing a program that has the potential to result colonised patients and the introduction of an on-line in sustained hand hygiene culture change and reduced hand hygiene credentialing program to improve infection rates of HAIs throughout Australia. control education. This credentialing program is now mandatory for all Austin Health staff. The DIP program has been highly successful, resulting in a more than 50 per cent reduction in serious MRSA infections and sustained hand hygiene culture change. Results will soon be published in the Medical Journal Australia.

97 Highly commended Integrating Care Team Peninsula Health

Peninsula Health’s Integrating Care Team (ICT) is a cohesive, interdisciplinary team whose services extend across the health service and beyond, with outreach into the community and residential care sectors. The ICT has implemented innovative models of care based on best practice principles which are currently being replicated statewide and internationally. The team has implemented these new models within a patient- centred framework and has received excellent feedback from consumers and carers. The ICT has grown and developed over the past fi ve years to a point today where it is an integral part of

Belinda Berry, Response, Assessment and Discharge the way Peninsula Health manages client care. The Judith Whitfort, ACCESS team is a dedicated group of clinicians respected by Julie Grant, Care Coordination both the health service and its consumers. They have Jenny Chapman, Residential Outreach identifi ed ways of improving care to their clients and Paul Colosimo, Residential and Complex Care have incrementally built on their strategies until they Marlena Galluccio, Complex Care reach across the continuum from the acute and Alicia Gray, Post Acute Care sub-acute health system to the community and residential care sectors. The team’s achievements include an outreach service to residential care facilities, incorporating falls prevention, acute medical intervention and dementia management, which sees 35 patients per month and has reduced admissions by 30 per cent. The team has also enabled a reduction in waiting time for inpatients needing residential care: from 93 patients waiting in December 2002 with an average length of stay of 73.8 days to 14 patients waiting in August 2005 with an average length of stay of 12 days.

98 Highly commended Clinical Practice Improvement Unit The Royal Women’s Hospital

The Royal Women’s Hospital established the Clinical Practice Improvement Unit (CPIU) in August 2004, to be piloted for two years in Maternity Services with a remit to reduce maternal morbidity and improve health outcomes for women and babies. The CPIU brings The Royal Women’s Hospital’s multidisciplinary clinicians together with dedicated time, support and resources. The CPIU works alongside clinical staff to bridge the gap between evidence of effective clinical practice and its implementation, with attention to teaching junior health professionals. Members of the group individually and collectively have made substantial contributions over time to quality and Lisa Begg, Clinical Director safety and maternity services, including the development Lynne Rigg, Senior Project Offi cer of Maternity Services Clinical Indicators and the Three Advisory Group Members: Centre Guidelines on Antenatal Care. Jeremy Oats, Clinical Director Women’s Services The CPIU’s fi rst task was to reduce the rate of post Fiona Cullinane, Director, Delivery Suites partum haemorrhage. Along with other Australian tertiary Penny Sheehan, Consultant Obstetrician hospitals, the rate of post partum haemorrhage had been Faris Al-Shammaa, Junior medical staff steadily increasing. As a result of the Unit’s interventions, Sue McDonald, Professor, Midwifery, La Trobe University the post partum haemorrhage rate for women having a Tanya Farrell, Director, Women’s Services normal vaginal birth at The Royal Women’s Hospital has Jenny Ryan, Unit Manager, Ward 44 decreased from 17.8 per cent in August 2004 to 10.8 per Mary Draper, Director, Clinical Governance cent in August 2005, with a steadily decreasing trend. Les Reti, Clinical Lead, Clinical Governance Most importantly, the severity of the haemorrhage (the amount of blood lost) is also decreasing. These results show that the hospital’s clinicians are identifying and managing a post partum haemorrhage more promptly. It should be noted that this was achieved during a time when The Royal Women’s Hospital managed the highest number of births in seven years, with an increase of nearly 1000 births over two years.

99 Highly commended Aged Care Shared Care Team Broadmeadows Health Service, Northern Health

The interdisciplinary Aged Care Shared Care (ACSC) team was established in 2002 and funded through the Hospital Admission Risk Program. The program endeavours to ensure that older people at risk of hospitalisation have their health issues addressed so that they can continue to function within the community, with minimal disruption to their routine. A comprehensive geriatric assessment by an interdisciplinary team is at the core of the ACSC model. The team works closely with general practitioners (GPs) in the northern region, recognising that the GP Louise Shanahan-McKenna, Podiatrist/Team Leader is responsible for the ongoing care of the patient. Kerryn Davis, Physiotherapist There are a further three components to this model: Tina Perna, Community Nurse fi rstly, an ‘at-risk registry’ that monitors patients through Cheryl Donohue, Clinical Nurse Consultant phone contact and provides updated care plans to Cathy Naidu, Social Worker ensure that their functioning is optimised; secondly, Caterina Yeung, Dietician a volunteer program that provides support to patients Dr Kwang Lim, Geriatrician who require assistance with transport to commute to and Dr Rabin Sinnappu, Physician from appointments; and thirdly, emergency department Sue Gusman, Volunteer Coordinator educational sessions that are provided to aged care Monica Polimeni, Administration Support workers in residential care facilities. The ACSC clinical team has shown outstanding commitment to the model of care. It is this commitment that has resulted in the successes of the program. One of the team’s strengths has been its rapid response to referrals, seeing all urgent patients within 48 hours of referral. The clinical team has provided treatment to more than 1000 older people living in the communities of Hume and Moreland. The work of the team means that a patient’s GP is supported by a skilled team able to provide a range of services, including specialist medical, nursing, physiotherapy and occupational therapy.

100 Thank you to all who participated in the 2005 Victorian Public Healthcare Awards Published by the Victorian Government Department of Human Services, Melbourne, Victoria © Copyright State of Victoria 2005 This publication is copyright, no part may be reproduced by any process except in accordance with the provisions of the Copyright Act 1968. Authorised by the State Government of Victoria, 555 Collins Street, Melbourne. This document may also be downloaded from the Department of Human Services web site at www.health.vic.gov.au/healthcareawards November 2005 (050607)

Disclaimer The 2005 Victorian Public Healthcare Awards Showcase is published by the Department of Human Services for the purpose of disseminating information for the benefi t of the healthcare sector and the public. It comprises edited entries submitted by health services for consideration in the 2005 Victorian Public Healthcare Awards. However, the Department of Human Services does not guarantee, and accepts no legal liability whatsoever arising from or connected to, the accuracy, reliability, currency or completeness of any material contained in this book. The Department of Human Services recommends that readers exercise their own skill and care with respect to their use of this information and carefully evaluate the accuracy, currency, completeness and relevance of the material for their purposes. This book is not a substitute for independent advice and readers should obtain any appropriate professional advice relevant to their particular circumstances. The material in this book may include the views or recommendations of third parties, which do not necessarily refl ect the views of the Department of Human Services, the Victorian Government, or indicate its commitment to a particular course of action.