Clinical Excellence Showcase

In-hospital suicides are often associated with occurring in the evening and during night shifts when there is reduced staff supervision. During these times of high risk, suicides occur in isolated areas of the ward such as bathrooms and single rooms. In this study, a prototype for a Remote Patient Monitoring (RPM) system was developed for early detection of suicidal behaviour in a hospital based mental health facility.

The introduction of an Undergraduate Student in Nursing (USIN) model of care for ECG performance was implemented. We have contracted 2.96FTE USiN to work 2 shifts 7days a week to implement a new waiting room model of care. The model of care is deliberately procedure/guideline driven given the limited scope of practice for the USIN group. All category 2 chest pain patients are ordered and ECG by the triage nurse and referred to the USIN for completion. We have set up a direct line of review for the ECGs with a dedicated SMO allocated to review ensuring quality review is undertaken. Using a USIN to perform the task of an ECG, similar to a technician position, has freed up nursing time to perform critical thinking and clinical prioritisation within the waiting room.

From a fiscal point of view, the USiN is also cheaper to add to a work force already stretched from budget perspective. It has seen an improvement in time-to-treat, specifically for the cohort of ATS Category 2 chest pain presentations. The key achievements to date, are an overall improvement in patient safety, improvement in time-to-treat measures and an immeasurable improvement in staff morale.

Primary Contact Hand Therapy (PCHT) is an innovative role substitution model of care led by Allied Health clinicians at Gold Coast Health. It was established in December 2018 in response to the Ministerial Taskforce to expand the scope of practice for Allied Health professionals.

In May 2021, headaches were the single most common referral to the SCHHS neurology outpatient department, with most headache referrals listed as cat-2. There were long-standing issues regarding access to neurology services on the Sunshine Coast, with demand continuing to exceed supply, despite significant investment in SMO FTE and clinic availability. The cat-2 clinic wait-times were over the recommended time-frame of 90-days. Furthermore, it was believed that a significant number of these headache referrals were being insufficiently and/or inappropriately managed in the community. The MPSC headache pilot trial had significantly greater than expected initial success, with 1 in 3 patients (34%) discharged following targeted active treatment. This represents a significant number of patients who did NOT require a neurology appointment. Refinement of the pathway may push these numbers higher. Owing to the success of the pilot, the MPSC headache clinic has become a permanent feature of neurology outpatients, with recurrent funding afforded.

Embedding a quality improvement culture improves overall care, service delivery and organisational culture and has even been shown to be associated with increased survival in neonates. The Sunshine Coast Hospital and Health Service paediatric and neonatal departments have implemented and grown a culture of quality improvement (QI) through two major activities.

The Virtual Fracture Clinic (VFC) model launched in August 2022 and in the first 6 months, 386 new patient referrals have been managed under the mode. and freed up the equivalent of 6 fracture clinics per month. This has meant that there has been a reduction in the amount of fracture clinics needing to be overbooked. Financially it has been determined that the VFC model is saving our health $28,800 per year in patient travel costs as well as generating revenue of approximately $61,440 in its first year. In total the finance department has calculated that between savings and revenue the department will be $132,004 better off each year.

The Care Collective aims to improve access to primary health care and coordination of care for those people in the Caboolture hospital catchment living with Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure (CHF), falls and dementia. The concept of the Care Collective offers a new way of connecting services and supports that are already in place and encourages and enables information sharing. The number of emergency department presentations per month has significantly reduced after referral to the Care Collective. On average patients had a 83% reduction in ED attendances. There has been a 56% increase in the proportion of patients with zero or one ED presentation per month and no patients with more than three presentations per month after referral to the Care Collective.

Mater at Home Direct was created specifically to assist lower acuity Triple Zero callers to circumnavigate access barriers by re-orientating the traditional pre-hospital care pathway. This innovative model provides consumers with timely and more appropriate care, by taking the “care” to the consumer rather than transporting the consumer to the “care” (hospital).

The service provides quality, same-day, multidisciplinary care to patients over 16 years old, in the comfort of their own home, across Mater at Home’s broad catchment, which spans four different Hospital and Health Service (HHS) areas – from Ipswich (west) to the Bay (east); Burpengary (north) to Jimboomba and Pimpama (south).

Mater at Home Direct has facilitated access to care for over 150 low priority Triple Zero callers since July 2022. In that time 82% of referred Triple Zero callers have accessed their care in their home. This translates to avoiding QAS dispatch and a subsequent transfer to ED.

The model has been effective at increasing both ED and inpatient capacity. This has reduced unnecessary patient transport – positively impacting the ambulance service and patient experience and avoiding non-value adding handover. A 12 month analysis of post implementation data shows that from commencement of the EDLS on the 18 October 2021 to 17 October 2022, the initiative has:

Diverted 2737 patients to all three providers an average of 53 patients per week

Admitted 1658 of those patients (61 per cent) to receive inpatient care

Hospital admissions for complications of cirrhosis continue to rise nationally due to the epidemics of alcohol use disorder and obesity related liver disease. Due to the unstable nature of chronic liver disease up to 30% of patients need to be readmitted within 30 days of discharge. Why is this? Firstly, patients with chronic liver disease develop fluid in the abdomen - ascites. This is uncomfortable and often requires drainage (paracentesis). Secondly these very sick patients can rapidly deteriorate, often before they can be seen in the liver clinic leading to an ED presentation. Can this be avoided? Yes - what if we were able to rapidly review recently discharged patients on the ward within a few days of discharge? What if we could accommodate patients at short notice on the ward for paracentesis when needed rather than patients needing to present to the ED? We developed a ward based ambulatory care facility for liver patients and we think we have made a difference.