HARC eBulletin Quarterly e-Bulletin of the Hospital Alliance for Research Collaboration Issue 8 Welcome to our latest HARC eBulletin. In this eBulletin we highlight recent groundbreaking March reviews, research and reports that are relevant for Australian health policy deliberations. In 2009 this edition we report on new evidence for: acute geriatric units; a surgical checklist that has been shown to reduce deaths and complications that is being implemented across the NHS; Print Version processes to improve post-acute care such as discharge planning and telephone follow-up care. On to a sombre note, the news of Dr Anna Donald’s untimely passing was received by the Australian and international research, policy and clinical communities with great sadness. In our news section below we profile her obituaries in the British Medical Journal (by Richard Smith and Muir Gray) and Sydney Morning Herald that commend her unwavering dedication to improving health services by the application of best available evidence – a goal that resonates with HARC. We pass on our condolences to Anna’s family, friends and colleagues. Mary Haines, Health Services Research Director News NSW successful in latest round of NHMRC capacity building grants for population health and health services research This eBulletin is NSW has won five of nine capacity building grants totaling $18.2million. The successful grants produced by the include “OSPREY: Building capacity for research to improve health services for mothers, HARC Office at babies and children”, which brings together a team of investigators from the University of the Sax Institute. Western Sydney, the University of Sydney, the University of Western Australia and the Sax Institute. Through OSPREY, nine team investigators will develop as independent researchers, substantially boosting Australia’s capacity for health services research using linked routinely collected data, and focused on a “Healthy start to life”. For further information go to the NHMRC website by clicking here. [cited 2009 March 16] New reports from the CEC including the Quality Systems Assessment (QSA) Statewide Report available now One of the key recommendations of the NSW Patient Safety and Clinical Quality Program, following the Walker report into the Camden and Campbelltown hospitals, was the development of The Quality Systems Assessment Program (QSA). The QSA statewide report: summary of findings from the Area Health Services and the Children's Hospital Westmead presents the results of the QSA self-assessment survey conducted in late 2007; the very first census in New South Wales of quality and safety policies and their level of implementation. The report identifies areas of exemplary performance as well as areas for improvement and the results provide a baseline measure of the performance of AHS, Network/ Clusters, Facilities and Clinical Units in the implementation of various quality and safety programs and policies. The Quality Systems Assessment baseline survey was also undertaken by the Ambulance Service of NSW and Justice Health in February 2008. Also available from CEC is the report Between the Flags - The Way Forward which describes the agreed way forward to implement statewide change to help keep patients safe, together with a project report on the statewide initiative on the recognition and management of the deteriorating patient - Between the Flags Interim Project Report [PDF ~1672kb]. The full reports can be accessed by clicking the relevant link above. [cited 2009 March 16] Page 1 of 8 Two new reports available from The 45 and Up Study The 45 and Up Study, established and managed by the Sax Institute, is the largest cohort study in the southern hemisphere with 260,000 participants aged 45 years and over. The study is now fully established as an “open resource” for internationally leading research to help us understand how we can remain healthy and independent as we age. The research team have recently produced two reports that are available to be viewed online. They are ‘Achievements to December 2008’ and ‘The 45 and Up Study Responsible Conduct of Research Report’ which summarises the structures, policies and procedures that are in place to ensure the responsible conduct of research within the 45 and Up Study. To download these documents from the 45 and Up Study website click here. Dr Anna Donald, a pioneer in evidence based health care, loses battle against breast cancer The death of Anna Donald is a great loss for the field of evidence based health care. A Rhodes scholar and graduate of Oxford and Harvard, Anna published one of the first articles on the subject of evidence based medicine in 1995 while still a senior house officer; an article which has since been cited 661 times. She relentlessly pursued her conviction that a package of evidence-based interventions could make high quality care affordable for all, becoming a lecturer in health policy at University College London and founding co-editor of the journal Evidence Based Health Policy. In 1999 Anna co-founded Bazian, a company providing evidence-based consulting and analysis to support the rational assessment, configuration and commissioning of health care services. When Anna was diagnosed with metastatic breast cancer in February 2007 she continued her search for better understanding of sickness and health through her terminal illness, reporting her findings in a series of 22 blog entries called “from the other side” for the BMJ. You can read Anna’s obituary in the BMJ and find links to her blogs here: http://www.bmj.com/cgi/content/full/338/feb04_1/b436 or read her obituary in the Sydney Morning Herald here: http://www.smh.com.au/national/obituaries/rhodes-scholar-fought-to- find-truth-20090212-85wc.html?page=-1 [cited 2009 March 16] Review Round-up Acute geriatric units produce a functional benefit and increase the likelihood of living at home This systematic review and meta-analysis published in the British Medical Journal found that, for older patients (65 yrs+) with acute medical disorders, admission to acute geriatric units increased the likelihood of living at home at discharge and lowered the risk of functional decline compared with conventional hospital care. Frequency of admission to a nursing home did not differ between patients from acute geriatric and conventional care units at discharge or at three months post-discharge. There was no significant difference in case fatality, either in hospital or three months after discharge. In addition, there was a trend towards a reduced length of stay and a slight, yet significant, reduction in cost associated with treatment in acute geriatric units. Twelve articles, involving 11 studies comprising: five randomised trials; four non- randomised trials; and two case-control studies met the inclusion criteria. The majority of studies were conducted in the US with the remaining four in Australia, Canada, Sweden and Peru. Baztán J, Suárez-García F, López-Arrieta J, Rodríguez-Mañas L, Rodríguez-Artalejo F. Effectiveness of acute geriatric units on functional decline, living at home, and cased fatality among older patients admitted to hospital for acute medical disorders: meta-analysis. BMJ. 2009; 338:b50. Available at: http://www.bmj.com/cgi/content/full/338/jan22_2/b50 [cited 2009 March 16] Page 2 of 8 WHO aims to meet policy makers requirements with the launch of a new series of policy briefs The World Health Organisation European Ministerial Conference on “Health Systems, Health and Wealth” in Tallinn, Estonia, 25-27 June 2008, was the launching ground for a new series of policy briefs. These useful briefs were developed in a joint project between the Health Evidence Network and the European Observatory on Health Systems and Policies. The series aims to meet policy makers’ requirements by presenting a rigorous review of available research evidence written in accessible language and presented in a consistent format. Nine joint policy briefs have been published bringing together key evidence, potential policy options for best practice and strategies for improving health system performance. Topics include: How can optimal skill mix be effectively implemented and why? How can the settings used to provide care to older people be balanced? How can the migration of health service professionals be managed so as to reduce any negative effects on supply? and Do lifelong learning and revalidation ensure that physicians are fit to practice? The briefs are available at: http://www.euro.who.int/HEN/policybriefs/20080814_2 [cited 2009 March 16] Research Round-up Surgical safety checklist reduces deaths and complications An estimated 234 million operations are performed globally each year. Surgical complications are common yet data suggests at least half are avoidable, findings which prompted the World Health Organisation to develop guidelines identifying multiple recommended practices to ensure patient safety worldwide. This study, published in the New England Journal of Medicine, aimed to compare the rate of complications, including death, during hospitalisation and within 30 days of operation prior to and after an intervention to implement a 19 point surgical safety checklist. This prospective study compared patient outcomes in a pre-intervention cohort and a post- intervention cohort. Data were collected between October 2007 and September 2008, from eight hospitals in eight cities around the world with diverse economic circumstances and populations that participated in the World Health Organisation’s Safe Surgery Saves Lives program. Data were collected at baseline (pre-intervention) on 3733 consecutively enrolled non-cardiac patients aged 16 or over and post-intervention on a further 3955 patients. Postoperative complication rates fell at all sites after the introduction of the checklist, on average by 36%. The total in-hospital rate of death fell from 1.5% to 0.8%. Furthermore, overall rates of surgical-site infection and unplanned reoperation significantly declined. Introduction of the WHO Surgical Safety Checklist was associated with marked improvements in surgical outcomes in both high and low incomes sites.