Health service evaluation
Health services research uses the principles of implementation science to evaluate health and social care interventions, policies and service models, as the basis for effective and efficient person-centred care.
Improving wound healing
Historically, wound management has focussed on compression therapy, venous surgery and exercise therapy. Electric stimulation is another approach used to improve circulation in the leg, with the potential to heal chronic wounds in some individuals.
A randomised controlled trial is investigating the effectiveness of electric stimulation and compression therapy. Participants in the experimental group will use a portable electric stimulation device that can be self-administered in the home setting four times daily for 20 minutes per session. The number of wounds that heal and the percentage of wound size change will be monitored for 14 weeks. The clinical and cost effectiveness of the treatments will be determined.
Alarm fatigue in critical care
When clinicians are exposed to an excessive number of alarms, desensitisation can occur, leading to alarm fatigue. This research examines alarm fatigue in intensive care and cardiac units and considers the frequency of alarms, and the most common and critical types of alarms.
Peer Assisted Learning
This interventional study examines the impact of a Peer Assisted Learning program in the Alfred Intensive Care Unit. Outcomes will focus on key quality indicators for patient care (pressure ulcer prevalence and traumatic brain injury guideline compliance) together with workforce measures pertaining to clinician learning and workplace culture.
Reducing waiting time for ambulatory and community services
Reducing waiting lists in outpatient and community healthcare is critical for clients and health providers. Early access to services reduces anxiety, improves quality of care and may lead to improved outcomes for patients.
The Specific Timely Appointments for Triage (STAT) project used an evidence-based model of access and triage to manage demand. The model provides analysis of supply and demand; a one-off intervention to address backlog; creation of clinician schedules which reserve new patient appointments; simplification of intake; and a shifting of caseload management to prioritise decisions on service delivery rather than initial intake.
STAT was tested in a large trial involving eight community-based health services and more than 3000 patients. It reduced waiting time by 34%.
STAT has been widely translated into practice in Victoria. Eastern Health offer training and have published a handbook. Further trials of the model are underway in a medical outpatient clinic and in paediatric community health services.
Translating research into practice in allied health services
Fostering a research culture among allied health professionals is key to achieving evidence-based outcomes that improve health services. Eastern Health’s Allied Health Clinical Research Office has contributed significantly to the scholarship in this area. Their studies offer other organisations a model of best practice.
A systematic review of literature published in the Australian Health Review in 2016 showed that organisations that invest in research and/or provide research opportunities for staff are more likely to have improved performance on measures including patient mortality, staff satisfaction and retention, and organisational efficiency.
Understanding the allied health workforce is also key to developing a research culture. In another study, only 15% of allied health professionals rated themselves as ‘very interested‘ in research. Strategies targeting this group led to measurable changes in reported research experience over time.
Since 2008, the Allied Health Clinical Research Office has coordinated a “Stepping into Research Training Scheme,” using group training and one-to-one mentoring to take participants through the process of writing a systematic review of the literature. Two evaluations of the program have shown an increase in measurable research outputs from participants. The model has also been successfully implemented in another health service setting.
The Research Office also investigated the cultural shift required to improve the uptake of evidence-based practice. The study found that evidence-based practice was not highly valued by clinicians and managers or viewed as a core component of clinical care. Achieving higher uptake of evidence-based practice among allied health clinicians, they suggest, requires a cultural shift that places higher value on these activities.
Weekend allied health services
Many inpatients receive little or no rehabilitation on weekends. This project assessed the effects of weekend inpatient rehabilitation on functional independence, quality of life, and length of stay, compared to five weekdays of rehabilitation.
The trial randomly allocated 996 rehabilitation inpatients to receive additional allied health services from Monday to Saturday, or usual-care rehabilitation services from Monday to Friday. Patients in the weekend therapy group were discharged about two days earlier at a higher level of function, with benefits sustained for six months after discharge. The service was cost effective with benefits to the patient and savings to the health service.
Evidence from this trial has been used to inform the Standards for the provision of Inpatient Adult Rehabilitation Medicine Services in Public and Private Hospitals published by the Royal Australasian College of Surgeons.
A subsequent trial sought to identify if similar benefits could be observed in geriatric patients. Results suggested that Saturday services did not reduce length of stay or total cost in this group but may have reduced re-admissions in the 30 days following discharge.
Australian Hospital Patient Experience Questionnaire Set
Led by Cathy Jones from Healthscope and with support from Professor Meg Morris and her team, Healthscope is obtaining feedback from thousands of patients on the positive and negative experiences associated with being in hospital as measured by the national tool, the Australian Hospital Patient Experience Question Set (AHPEQS).
The AHPEQS project provides insight into patient perspectives on service quality and outcomes, through the eyes of the consumer. This is the largest dataset analysed for this new patient survey, that commenced in January 2019.
The team have evaluated over 95,000 AHPEQS surveys to date. Findings will identify which aspects of care have the greatest impact on the patient experience, allowing health service providers to further refine quality and safety standards. They will also inform future national approaches for AHPEQS and can inform global policies and procedures on measuring patient experience as the basis for quality care.
Evidence-based, person-centred care
A workforce that understands and generates evidence is one that achieves best practice in person-centred care. This project aims to acknowledge, respect and work through the barriers and opportunities to achieve evidence-based practice.
The evidence-based practice program will include plan-do-study-act cycles to achieve evidence-based practice. Mentors will be trained to identify enablers and barriers, and supported to undertake projects that ensure patients receive the best possible care. Projects include scoping the literature on hospital in-reach for residential aged care, water immersion for labour and birth, and the prevention of post-partum haemorrhage.
The impact of COVID-19 on the rate of hospital acquired complications
The COVID-19 pandemic has put increasing pressure on hospitals systems. In preparation for the COVID 19 pandemic, hospitals across the Victorian Health system have undergone a number of changes. As a result of these changes some hospitals have reported a relative increase of hospital acquired complications since the commencement of the pandemic.
There are a number of potential contributing factors that may have led to this increase, including changes in the design of wards; staff redeployment across wards; increased patient acuity; and restrictions in family visitation. The aim of this single site, two phased, mixed methods study is to understand how the COVID-19 pandemic has impacted on hospital acquired complications and to explore reasons for these changes.
Nursing students and hands-on skills in the time of social distancing
The COVID-19 pandemic has demanded that nurse educators and students respond to rapidly changing social and clinical circumstances. Students are usually prepared for clinical placements during hands-on clinical skills labs, but due to social distancing policies, these were cancelled. Active learning classrooms, where role modelling of interpersonal skills accompanies teaching of complex nursing procedures, have been replaced by video tutorials filmed in the days before lockdown.
The aim of this study is to explore nursing students' experiences of online learning of clinical skills, identify the barriers to and facilitators of online learning, and understand how performance during clinical placement has been altered by the challenges of the global pandemic.
Research capacity of allied health clinicians
A lack of research experience is considered a barrier to research engagement among allied health clinicians.
Understanding factors related to research interest, confidence and experience, as well as barriers to research among allied health clinicians, may inform the development and implementation of targeted intervention strategies to improve research capacity. This can facilitate clinician-led research, and result in more efficient, evidence-based healthcare delivery for consumers.
The aim of this study is twofold: to describe factors associated with research interest, confidence and experience in allied health clinicians at Northern Health, and evaluate current levels of research capacity among allied health clinicians.
The results will help research staff plan and review targeted research training initiatives that are appropriate to the level of staff experience or interest. The results may also inform further training initiatives.
Accessing, interpreting and applying health information during a pandemic
The coronavirus pandemic (COVID-19) has required consumers to find and apply health and behaviour information rapidly, and to change the way they engage with health professionals.
The internet is a primary source of information for many people. While offering benefits, information can also be hard to navigate, complex in nature, potentially untrustworthy and sometimes misleading. This is challenging for older people with multiple chronic conditions who have low levels of health literacy, and who now find themselves the most at risk of dying from COVID-19.
The aim of this study is to understand how adults over 65 years with multiple co-morbidities access, interpret and use information to make healthcare and health behaviour decisions during COVID-19. Key findings will be used to co-design a series of interventions with patients and allied health clinicians, aimed at improving health literacy of vulnerable populations during pandemics.
Nursing experience and practice during COVID-19
This project, led by Associate Professor Louise Ward (La Trobe University), explores nursing experience and practice during the COVID-19 pandemic. The project will potentially identify the significant contribution of nurses and innovations in practice that will assist us to better respond to similar world health crises.
Strengthening Hospital Responses to Family Violence
This project, led by Dr Caroline Fisher (Royal Melbourne Hospital), is part of the “Strengthening Hospital Responses to Family Violence” initiative, in partnership with the Victorian State Government. Other partners include Tweddle Child and Family Health Service, Dental Health Services Victoria and North Western Mental Health. The studies contributing to this project have been designed to provide baseline data on the staff training required to address the complex problems associated with family violence.
The project will build knowledge and confidence in the area of family violence to address issues in an evidence-based manner. It will also identify barriers to working effectively in the family violence domain and inform evaluation of the “Strengthening Hospital Responses to Family Violence” initiative. A priority shall be consumer studies about screening for violence, and whether individuals feel supported and assisted if a disclosure of family violence is made.
Evaluation of cultural awareness training at the Royal Melbourne Hospital
This cultural awareness study, led by Professor Karen Willis, measured the outcomes of a tailored cultural awareness education and training program at the Royal Melbourne Hospital. The report and recommendations have been presented to the Royal Melbourne Hospital Aboriginal and Torres Strait Islander Working Group, with plans to incorporate the findings into local and national policies.
Your Views Matter: Exploring the experiences and satisfaction of parents with infants admitted to Newborn Services at the Women’s
Each year, the Women’s admits more than 1600 babies to Newborn Services. Around 35% are discharged home directly from Newborn Services. The remainder are transferred to a lower level special care unit closer to the family’s home when they no longer require tertiary medical neonatal care.
Families can suffer long-term consequences from their baby’s stay in neonatal intensive care, which lasts long after the acute admission period. Affects include the health of individual family members (particularly mothers), family function and coping with baby care.
Your Views Matter is exploring the satisfaction, experiences and needs of parents whose babies have been admitted to Newborn Services to inform the way future care is provided, and collecting key clinical outcomes e.g. infant feeding at six months post birth.
Find out more about this research project, including its partners and researchers.