Clinical Excellence Showcase

The care of rheumatology patients can be complex, often requiring medications that need close monitoring and education to ensure best and safe outcomes.

There is often minimal time within the busy clinical outpatient setting to holistically review the patient's needs.

The rheumatology clinical nurse consultant telehealth service was introduced to achieve better patient outcomes and provide a comprehensive approach to the delivery of care to any individual anywhere. Ensuring that patients have a greater understanding of their rheumatological condition can lead to patient empowerment and better outcomes.

The implementation of the clinic via telehealth was to provide an alternative way to receive specialist nursing care. This also helps to reduce petrol and parking costs as well as having positive environmental implications. It also means that patients can receive holistic care wherever they may live and is particularly useful for those living in rural and remote areas. By offering telehealth, patients have less time off work which leads to more work productivity and time spent with family. It also means that the interval between patients being reviewed by the clinician can be increased as the telehealth service allows for interim follow up. This therefore allows for more patients to be reviewed in clinic by the nurse practitioner and other clinicians.

The RAID template was initially developed as part of the QI project for our Sunshine Coast Hospital and Health Service (SCHHS) Infectious Disease (ID) team.

Our aim was to develop “a user-friendly template to improve our ieMR documentation on the daily patient care record. In summary, by using the RAID template, overall documentation of invasive device, antibiotic indication and plan, assessment of DVT prophylaxis and ARP plan were universally improved from period 1 to 2. It is easy to use and reminds clinicians of this important aspect of patient care.

Consumers with Borderline Personality Disorder (BPD) make up 10% of the admissions and are at high risk of dying by suicide. People with BPD are often trapped in a revolving door situation to the Emergency Department (ED) and are not getting the treatment they needed due to stigma and lack of resources. The Living Well Team is a multidisciplinary team that adopted virtual care technology combined with evidence based psychological therapies specific to BPD, it is the first of its kind in Queensland. The Living Well Team (LWT) co-designed and delivered a flexible, peer-worker supported evidenced based therapeutic service to address the gap in service delivery that was placing increased pressure on emergency and acute mental health services. Since commencement the service has grown from 30 consumers during the period July – September 2021 (onboarding 10 each month) to achieve the aim of 60 consumers. In the 3 months prior to joining the LWT service, 10 of the 49 consumers (20.4%) had been admitted to acute inpatient care (20 admissions in total). Only four consumers (8.2%) were admitted to acute care following entry into the LWT (8 admissions in total). Consumers identified that engagement with the LWT was instrumental in keeping them out of hospital and improving their recovery journey.

We piloted/evaluated a coding framework that has simplified the coding process and enabled streamlined reporting of PREMs findings to consumers and staff (including an ability to compare trends over time). This framework has been implemented across four RBWH clinical service lines and has enabled a more structured and efficient solution to analysing qualitative PREMs data. Most importantly, it has created a solution to embed a person-centred lens in how health services interpret and analyse patient-reported feedback. It has enabled service lines to prioritise improvement projects in direct response to patient feedback not otherwise available through quantitative dashboards.

The PASS model of care is an end-to-end service for complex surgical patients, that is adaptable and transferrable model of care, led by a Care Coordination Nurse (CCN)

We have:

Developed a nurse led model to support safe, structured discharges for each patient

Scaled the CCN role across another surgical ward successfully

Created an integrated care approach with our community GP’s

The CCN role has:

Reduced length of stay for several complex diagnostic related group’s (DRG)

Released more to time to care for the primary nurses at the bedside

Established a successful succession program

Allowed nurses (both hospital and community) to work to top of scope

Ensured every patient has a discharge plan

Created discharge education and provided on the floor support for nursing, medical and allied health staff

Increased in patient and staff satisfaction

We aim to:

Establish an online discharge portal

Develop a discharge network for all ‘discharge’ nurses

Strengthen partnerships with the primary care sector, to sustain improvements in the patient care continuum with more connected community pathways

Establish a community home visiting service that would cater for the complex needs of surgical patients within the community, that has surgical governance

Establish Satellite Clinics

The vast majority of patients survive their ICU admission; however, the quality of survival is commonly suboptimal with a substantial proportion experiencing cognitive, physical, mental and/or psychological dysfunction and significant disability severely affecting the quality of life of the patient and their family. Emerging evidence suggests that the current bedspace environment contributes to these preventable adverse outcomes.

The “ICU of the Future” project is a Queensland led, international, patient centred, multi-disciplinary and intersectoral project. Using co-design to incorporate the patient’s needs, the project team has redesigned and rebuilt two ICU bedspaces at the TPCH. This pioneering and ambitious innovation project aims to demonstrate how optimising the ICU environment will enable best practice care and lead to improved patient outcomes and experiences.

The Community Hearing Screening Program was initiated in 2017 with the vision to provide equitable and accessible post-natal hearing screening services and timely detection of hearing loss for all Queensland children. Preliminary findings of this pilot model demonstrate sustainable and low-cost care including:

Detection rate of permanent hearing loss at 7.4/1000 children

Childhood Community Hearing Clinics found 29 of these permanent hearing losses

Department of Education clinics found 9 of these permanent hearing losses

Of these, 3 children have entered the Queensland Children’s Hospital Hearing Implant Program as hearing loss was very significant.

Total ‘pass and discharge’ rate is approximately 75% with 65% discharged after first screen. As well as providing a timely and accessible service to families, there was significant reduction on public hospital audiology departments waitlists.

For many families there is a disconnect between having a baby in hospital and accessing services afterwards, including the Child Health Service. Families often experience difficulty knowing who can help and health literacy is low.

AEDC data shows that up to 20-30% of children from some suburbs in the Logan area are “not school ready” and are vulnerable on 2 or more of the 5 key domains of early childhood development- well above the national average of 11%. The Journey Facilitator is in a unique position to be influenced by and have influence on both families, children and health care professionals across multiple sites. The Journey Facilitator is instrumental in developing processes that foster collaborative relationships to achieve the quadruple aim of health care (improve clinical outcomes and population health; enhance clinician and consumer experience; promote streamlining of services reducing health care costs and waste).

Strategies that successfully mitigate the potential stress for children and families in the ED through the use of developmentally appropriate approaches are an essential element of holistic high-quality care. Child life therapy aims to combine the biomedical model of care with the developmentally tailored, individualised, play-based psychosocial model of care, to minimise the negative impact of potentially painful and anxiety-provoking healthcare procedures. The Child Life Therapist (CLT) role was introduced as a pilot project at The Prince Charles Hospital (TPCH) Children's Emergency Department (CED) in July 2022 to integrate a developmentally sensitive play-based approach to the clinical care of paediatric patients from infants to 16 years of age. The aim was to facilitate inclusive opportunities for ALL children to play, learn and participate in their health care. While the project is still in its early stage, positive outcomes have been highlighted by the service users. Feedback from the multidisciplinary team highlighted the contribution of the CLT in supporting clinical efficiency and patient flow.

Most commonly, women opting for surgical management of miscarriage require an inpatient procedure under general anaesthetic in the operating theatre (known as a suction curette). This requires several hospital visits and the women encounter several different clinicians during their stay. The majority of this experience is navigated without the comfort of a support person.

MVAC is a procedure also used for the management of miscarriage, retained products of conception and termination of pregnancy. It is performed with a hand operated vacuum syringe under local anaesthetic in an outpatient setting. The procedure is recommended by the World Health Organisation for uterine evacuation and is used in many countries as an alternative to suction curette under general anaesthetic (GA). At the time of this abstract submission, uptake is high, patient satisfaction is over 95%, complication rates are equivalent to management in theatre and several other hospitals around Queensland have approached our department with the view of adopting this innovative service.