Showing papers in "Australian Health Review in 2006"

Redefining Health Care: Creating Value-Based Competition on Results

Abstract: A solution to get the problem off, have you found it? Really? What kind of solution do you resolve the problem? From what sources? Well, there are so many questions that we utter every day. No matter how you will get the solution, it will mean better. You can take the reference from some books. And the redefining health care creating value based competition on results is one book that we really recommend you to read, to get more solutions in solving this problem.

SMS text messaging improves outpatient attendance.

Abstract: Objective: To evaluate the operational and financial efficacy of sending short message service (SMS) text message reminders to the mobile telephones of patients with scheduled outpatient clinic appointments. Design: Cohort study with historical control. Setting: Royal Children's Hospital, Melbourne, Victoria. Patients: Patients who gave a mobile telephone contact number and were scheduled to attend an outpatient clinic at the Royal Children's Hospital, Melbourne in October, November and December 2004 (trial group) or in October, November and December 2003 (historical control group). Main outcome measures: Failure-to-attend (FTA) rate compared between the trial group, whose members were sent a reminder, and the historical control group, whose members were not sent a reminder. Financial benefits versus cost of sending reminders. Results: 22 658 patients with a mobile telephone contact number scheduled to attend an outpatient clinic appointment in October, November and December 2004 were sent an SMS reminder; 20 448 (90.2%) of these patients attended their appointment. The control group included 22 452 patients with a mobile telephone contact number scheduled to attend an appointment, with 18 073 (80.5%) patients attending. The FTA rate was significantly lower in the trial group than in the historical control group (9.8% v 19.5%; P<0.001). The cost of sending the SMS reminders was small compared with the increase in patient revenue and associated benefits generated as a result of improved attendance. Conclusions: The observed reduction in FTA rate was in line with that found using traditional reminder methods and a prior pilot study using SMS. The FTA reduction coupled with the increase in patient revenue suggests that reminding patients using SMS is a very cost effective approach for improving patient attendance. (author abstract)

Impact of streaming "fast track" emergency department patients

Abstract: Objective: Fast track systems to stream emergency department (ED) patients with low acuity conditions have been introduced widely, resulting in reduced waiting times and lengths of stay for these patients. We aimed to prospectively assess the impact on patient flows of a fast track system implemented in the emergency department of an Australian tertiary adult teaching hospital which deals with relatively few low acuity patients. Methods: During the 12-week trial period, patients in Australasian Triage Scale (ATS) categories 3, 4 and 5 who were likely to be discharged were identified at triage and assessed and treated in a separate fast track area by ED medical and nursing staff rostered to work exclusively in the area. Results: The fast track area managed 21.6% of all patients presenting during its hours of operation. There was a 20.3% (?18 min; 95%CI, ?26 min to ?10 min) relative reduction in the average waiting time and an 18.0% (?41 min; 95%CI, ?52 min to ?30 min) relative reduction in the average length of stay for all discharged patients compared with the same period the previous year. Compared with the 12-week period before the fast track trial, there was a 3.4% (?2.1 min; 95%CI, ?8 min to 4 min) relative reduction in the average waiting time and a 9.7% (?20 min; 95%CI, ?31 min to ?9 min) relative reduction in the average length of stay for all discharged patients. There was no increase in the average waiting time for admitted patients. This was despite major increases in throughput and access block in the study period. Conclusion: Streaming fast track patients in the emergency department of an Australian tertiary adult teaching hospital can reduce waiting times and length of stay for discharged patients without increasing waiting times for admitted patients, even in an ED with few low acuity patients.

Demographic change and the future demand for public hospital care in Australia, 2005 to 2050.

Abstract: Background: Over the next 45 years the Australian population will age rapidly as the baby boomer cohort moves into retirement and then old age. As the population ages there will be substantial growth in the demand for hospital bed-days, placing a corresponding demand on infrastructure and staffing. Methods: Australian Bureau of Statistics population projections to 2050 and Australian Institute of Health and Welfare public hospital bed-day data from 1993?94 to 2003?04 were used to develop models of future demand and examine the sensitivity of the results to model assumptions. Results: Over the long term, demand for public hospital bed-days was projected to grow faster than population growth. By 2050, ageing will increase the demand for bed-days by between 70% and 130% depending on the underlying assumptions, and the proportion of bed-days devoted to older people will increase from under 50% in 2005 to over 70%. Conclusions: Ageing of the population will increase the demand for health services just as it will become harder to recruit health professionals as the large baby boomer cohort retires from the health workforce. Accordingly, we need to plan now to ensure future needs of the ageing population are met.

Brain drain of doctors from southern Africa: brain gain for Australia.

Abstract: "Brain drain" is the depletion or loss of intellectual and technical personnel. The United Nations defines it as a one-way movement of highly skilled people from developing to developed countries that only benefits the industrialised (host) world. Today, brain drain is a major problem facing less developed countries, while Australia and other developed countries are the beneficiaries. Brain drain is reported to have direct negative impact on the population's health status in the donor country, with associated consequences for the productivity and welfare of the population. This paper reports on a qualitative study to understand the key factors behind brain drain from the perspective of the migrating doctor, and to consider possible solutions. Interviews were conducted with doctors who have migrated to Australia from southern Africa to explore reasons for brain drain. Specifically, the study tests the supposition that push factors play a much greater role than pull factors, and identifies which push factors are most important. Strategies to prevent brain drain from this depleted labour region are considered.

Routine outcome measurement in public mental health: results of a clinician survey.

Abstract: This paper explores the attitudes of mental health workers in one public mental health service towards the implementation and use of routine outcome measurement Two years after their introduction into routine clinical practice, there were equal numbers of positive and negative observations from clinicians about the clinical value of the clinician-rated outcome measures, while more positive observations were made about value of the consumer-rated outcome measure The most frequent observation from clinicians in relation to making outcome measures more useful to them in clinical practice was that more training, particularly refresher training, is needed In addition, clinicians indicated that more sophisticated support which assists them to understand the meaning and possible use of outcome measure ratings is required

People under 60 living in aged care facilities in Victoria.

Abstract: Objective: To describe the characteristics of people under 60 years of age living in residential aged care in Victoria and to examine the occupational participation of younger residents in aged care facilities by measuring their social contact, participation in recreation and community access. Methods: A survey was sent to the Directors of Nursing at all 803 Commonwealth Department of Health and Aged Care registered aged care facilities in Victoria. Results: The survey had a 78% response rate and information was provided about the characteristics of 330 people under 60 years with high clinical needs residing in aged care facilities. This sample was extremely isolated from peers, with 44% receiving a visit from a friend less often than once per year. Sixteen per cent of residents participated in a recreation activity less than once per month and 21% went outside less than once per month. Of the sample, 34% almost never participated in any community-based activities such as shopping, leisure or visiting friends and family. Conclusion: Over one third of younger people in aged care are effectively excluded from life in our community. Most younger residents are socially isolated and have limited opportunities for recreation. Placement of younger people in aged care facilities is inappropriate, and alternative care

Methods for the Economic Evaluation of Health Care Programmes

Abstract: Methods for the economic evaluation of health care programmes Drummond M, Schulper M, Torrance G, O'Brien B and Stoddart G 3rd edition, Oxford University Press, 2005 ISBN: 019-852945-7. RRP $99.95. 350 pages AS THE NAME SUGGESTS, Methods for the economic evaluation of health care programmes, third edition, is a recently updated and revised textbook that explores the various forms of economic evaluation - applied to the health care setting. However, at first glance, the title of this book could be slightly misleading. One might even mistake it for being yet another introductory text in health economics! Indeed, it is quite the contrary, as the authors have gone beyond merely describing methods of economic evaluation, to critically evaluating the methods per se. The authors have managed to deliver a comprehensive text which enables its readers to reach beyond the basics of economic evaluation and ultimately prepare themselves for some "handson" experience when dealing with contentious or "thorny" issues in the real world. There are currently a number of good introductory texts in health economics and this book is clearly intended as a supplement (and not a substitute) for these. The text comprises 11 chapters in which the following key points are covered: * A quick introduction to the basic forms of evaluation; * A guide to critically appraising economic evaluations; * Four chapters discussing the methodological issues in the main forms of evaluation; * Two chapters exploring the use of the main approaches for data collection in economic evaluation; and * Two final chapters dealing with the presentation and use of economic evaluation results, followed by the author's own "survival guide" for evaluators. The first two chapters provide a brief overview of the book, followed by a short introduction to the basic methods of economic evaluation. The authors also touch on some of the issues to be discussed in later chapters. Chapter 3 provides a comprehensive checklist for assessing economic evaluations, followed by supportive notes to each question, and critical appraisal exercises at the end of other chapters (3, 5 and 6). Chapters 4, 5, 6 and 7 are spent discussing the four main forms of economic evaluation - cost analysis, cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis - and form the main part of the book. The allocation of overhead costs and discussion on estimating productivity changes are dealt with well in Chapter 4. Chapter 5 introduces the notion of "net benefits" as a proxy for measuring the "value for money" of health care programmes. A very strong theoretical grounding for cost-utility analysis has been incorporated into Chapter 6, and this is followed by some useful exercises on calculating quality-adjusted life-years and healthy-year equivalents. Chapter 7 introduces and explores the measurement technique of "willingness-to-pay", and Chapters 8 and 9 effectively deal with analysing patient-level data and decision-analytic modelling. The remaining two chapters discuss the problems, potential and transferability of economic evaluation results to other settings (Chapter 10) and, finally, the economic evaluators "survival guide" in Chapter 11. The text has been written by internationally recognised health economics "gurus" in a clear and concise manner and, at times, the authors have even added their own cheeky touch of humor. …

Routine outcome measurement in public mental health--what do clinicians think?

Abstract: IN ORDER TO FULLY EVALUATE and manage a service, one should be able to answer all parts of the question ?Who receives what services, from whom, at what cost, and with what effect??1 While there is good information on the first four elements, mental health services generally do less well in demonstrating the effectiveness of what they do, and it is here that routine outcome measurement (ROM) can make a contribution. Despite the very real progress that has been made in implementing ROM in Australia it is evident from a variety of sources, formal and informal, that not everyone is convinced of its necessity or value.

Challenges in implementing evidence-based practice into mental health services.

Abstract: This paper highlights challenges in implementing mental health policy at a service delivery level. It describes an attempt to foster greater application of recovery-orientated principles and practices within mental health services. Notwithstanding a highly supportive policy environment, strong support from service administrators, and an enthusiastic staff response to training, application of the training and support tools was weaker than anticipated. This paper evaluates the dissemination trial against key elements to promote sustained adoption of innovations. Organisational and procedural changes are required before mental health policies are systematically implemented in practice.

Non-traumatic spinal cord injury: what is the ideal setting for rehabilitation?

Abstract: Objective: To survey rehabilitation physicians about management of patients with non-traumatic spinal cord injury (NTSCI) Methods: Postal and email survey of Australian physicians treating adult inpatients in neurological rehabilitation or Spinal Injury Units (SIUs) 59/69 returned surveys met inclusion criteria 75% (44) of respondents were from neurological rehabilitation units (response rate 72%) and 25% (15) were from SIUs (response rate 94%) Outcomes were: incidence of NTSCI, opinion regarding ideal setting for NTSCI inpatient rehabilitation, and availability of key services for NTSCI patients in neurological rehabilitation units Results: Estimated incidence of NTSCI was 26/million adults/year 60% of NTSCI patients were managed in general neurological rehabilitation units The majority of respondents (85% (50/59); 95% CI, 73%?92%) believed that the most appropriate setting for NTSCI rehabilitation was either an SIU or a neurological team that specialises in NTSCI patients Neurological rehabilitation units offered NTSCI patients the following services: education regarding coping with NTSCI and preventing complications (55% [18/33]); specialised wheelchair and seating prescription (85% [28/33]); Environmental Control Unit training (36% [12/33]); and bladder training (97% [32/33]) Conclusions: The most appropriate setting for rehabilitation of NTSCI patients is either a dedicated SIU or a neurological rehabilitation team that specialises in NTSCI The organisation of inpatient rehabilitation services for NTSCI patients in Australia should be improved

The feasibility of implementing an electronic prescribing decision support system: a case study of an Australian public hospital.

Abstract: Medication errors are common in public hospitals, with the majority at the prescribing stage of the medication pathway. Electronic prescribing decision support (EPDS) is a rules-based computer system that can be used by clinicians to warn against such errors to improve patient safety and support staff workflows. Despite its apparent advantages, this technology has not been widely adopted in Australian public hospitals for inpatient prescribing. A case study using Sauer's (1993) Triangle of Dependencies Model was conducted in 2003 into the feasibility of implementing an EPDS system at an Australian public hospital in New South Wales. It was found not feasible to implement an EPDS at the hospital studied due to the legacy patient administration system, low availability of information technology on the wards, differing stakeholder views, legislation, and the Independent Pricing and Regulatory Tribunal of NSW report recommendations. A statewide standard was preferred, with an agreed specification framework identifying basic core data items and functions that an EPDS must meet which can then be used by area health services to: (i) choose a solution which best meets their contextual needs; and (ii) engage vendors to tender for building an open source (non-proprietary) system based on the specification framework.

Models of psychological service provision under Australia's Better Outcomes in Mental Health Care program.

Abstract: The Access to Allied Psychological Services component of Australia's Better Outcomes in Mental Health Care program enables eligible general practitioners to refer consumers to allied health professionals for affordable, evidence-based mental health care, via 108 projects conducted by Divisions of General Practice. The current study profiled the models of service delivery across these projects, and examined whether particular models were associated with differential levels of access to services. We found: 76% of projects were retaining their allied health professionals under contract, 28% via direct employment, and 7% some other way; Allied health professionals were providing services from GPs' rooms in 63% of projects, from their own rooms in 63%, from a third location in 42%; and The referral mechanism of choice was direct referral in 51% of projects, a voucher system in 27%, a brokerage system in 24%, and a register system in 25%. Many of these models were being used in combination. No model was predictive of differential levels of access, suggesting that the approach of adapting models to the local context is proving successful.

Enhancing Palliative Care Delivery in a Regional Community in Australia

Abstract: Although access to palliative care is a fundamental right for people in Australia and is endorsed by government policy, there is often limited access to specialist palliative care services in regional, rural and remote areas. This article appraises the evidence pertaining to palliative care service delivery to inform a sustainable model of palliative care that meets the needs of a regional population on the mid-north coast of New South Wales. Expert consultation and an eclectic literature review were undertaken to develop a model of palliative care service delivery appropriate to the needs of the target population and resources of the local community. On the basis of this review, a local palliative care system that is based on a population-based approach to service planning and delivery, with formalized integrated network agreements and role delineation between specialist and generalist providers, has the greatest potential to meet the palliative care needs of this regional coastal community.

Adverse events in Victorian admissions for elective surgery

Abstract: Objectives: To investigate a method to identify and understand patterns of adverse events by utilising secondary data analysis; to identify the types of complications associated with elective surgery; to identify any specific ?adverse eventprone? elective procedures; and to consider the implications of these patterns for hospital patient safety programs. Setting: Public hospitals in Victoria. Design: Secondary analysis of data on acute hospital admissions for elective surgery in the period 1 July 2000 to 30 June 2001, for nonobstetric patients older than 15 years (n = 177 533). Main outcome measures: Estimated rates of adverse events for the most commonly performed elective surgery procedures; frequency of the most commonly recorded adverse event types. Results: Of all admissions, 15.5% had at least one complication of care. The most frequent firstrecorded single complication code, in 9.6% of cases with a complication, was ?Haemorrhage and haematoma complicating a procedure?. The most common adverse event categories were cardiac and circulatory complications (23%), symptomatic complications (18%), and surgical and drug-related complications (17%). The procedure blocks most frequently associated with an adverse event were coronary artery bypass surgery (67%), colectomy (52%), hip and knee arthroplasty (42% and 36%, respectively), and hysterectomy (20%). The types of complications associated with the four most adverse eventprone procedures were cardiac arrhythmias, surgical adverse events (haemorrhage or laceration), intestinal obstruction, anaemia, and symptomatic complications. Conclusion: Routinely collected data are valuable in obtaining information on complication types associated with elective surgery. International Classification of Diseases codes and surgical procedure ?blocks? allow very sophisticated investigation of types of complications and differences in complication rates for different surgical approaches. The usefulness of such data relies on good documentation in the medical record, thorough coding and periodic data audit. The limitations of the method described here include the lack of follow-up after discharge, variable coding standards between institutions and over time (potentially distorting information on rates), lack of information on the causative factors for some adverse events, and a limited capacity to support investigation of particular cases. Hospitals should consider monitoring complication rates for individual elective procedures or blocks of similar procedures, and comparing adverse event rates over time and with peer hospitals as an integral part of their patient safety programs.

Future directions for Victoria's public maternity services: is this "what women want"?

Abstract: Background: Several state governments are once again reviewing policies for the provision of maternity care. This paper presents findings from a state-wide Victorian survey of recent mothers conducted in 2000 regarding women’s experiences of antenatal care. We also offer some reflections on the way in which results from this and earlier Victorian surveys have been used, somewhat selectively, to support the State Government’s new framework for maternity services, while other issues highlighted in the survey results have been overlooked. Design: Population-based postal survey mailed to Victorian women who gave birth in a 2-week period in September 1999, 5–6 months after childbirth. Results: 42% of women attending a public hospital clinic described their antenatal care as “very good” compared with 73% of women attending a birth centre, 59% attending private practitioners for antenatal care but receiving public intrapartum care (combined care), 56% attending a midwives clinic, 53% receiving shared care and 84% of women receiving private maternity care. The social characteristics of women enrolling in different models of care do not explain these differences. Immigrant women were much less likely to be happy with their care in pregnancy than Australian-born women, with no improvement in rat

Nursing morale: what does the literature reveal?

Abstract: There is increasing attention to nursing workforce issues such as recruitment, retention, turnover, workplace health and safety issues and their impact on quality patient care. A number of these problems have been linked to poor morale. While there has been a lack of consensus on the determinants of morale, it is clear that the outcomes of poor morale not only add considerable cost to the organisation but also impact negatively on patient care. This article provides a systematic overview of the literature surrounding nursing morale and the variables identified in the literature that impact upon morale, and discusses the implications for future research.

Balancing the balanced scorecard for a New Zealand mental health service.

Abstract: Given the high prevalence of mental disorders, there is a need to evaluate mental health services to ensure they are efficient, effective, responsive and accessible. One method that is being used is the ?balanced scorecard? which uses performance indicators in four quadrants to assess various dimensions of service provision. This case study describes the steps taken by a New Zealand mental health service to improve service management through greater use of key performance indicators in relation to preset targets using this approach.

Reducing aggressive behaviour and staff injuries: a multi-strategy approach

Abstract: OBJECTIVE: To evaluate the impact of a multi-strategy approach on the management of patient aggression and staff injury rates at a stand-alone mental health facility. METHODS: A multi-strategy aggression management program was developed and introduced over a 2-year period. The program had four components; staff education/training, a staff support program, risk assessment tools, and a computerised incident monitoring system. Aggressive incidents by patients, staff injuries due to patient aggression and compensation payments to staff for the 2-year period before implementation of the aggression management program were compared with the 3-year period following implementation of the program. RESULTS: There was a significant decrease in the number of staff injuries reported in the 3-year period following the implementation of the aggression management program. Although the number of aggressive incidents reported did decrease over the study period, the decrease was not statistically significant. CONCLUSIONS: Despite the increasing acuity of the clients at the study facility, there was a significant decrease in staff injuries due to aggressive behaviour. The strategies implemented seem to offset the potential for violence. It is likely that the combined impact of the strategies is greater than the impact of individual strategies implemented consecutively. Language: en

National Case Management Standards in Australia — purpose, process and potential impact

Abstract: The use of case management has been increasing within Australia. The Case Management Society of Australia was established in 1996 to promote the developing case management profession and the viability of the service model in coordinating care and resources for clients with complex needs. In an effort to unify the debate around what is expected of a case manager, the Society has reviewed its interim standards of practice. This paper explains the purpose, process and potential impact of the National Standards of Practice for Case Management. The intent of this article is to describe a process that unifies a diverse range of professionals and non-professionals who practise under the banner of case management. The Standards are not described in detail in this article but are available at .

Building health informatics skills for health professionals: results from the Australian Health Informatics Skill Needs Survey.

Abstract: Objective: To ascertain health professionals’ perceptions of health informatics skills required in their roles. Design: A paper-based survey with a stratified random sample of Australian health professionals and a web-based survey open to all Australian health professionals were conducted. Measurement: A questionnaire on the health professionals’ perceived degree of competency required for a total of 69 specific skills in five skill categories based on the International Medical Informatics Association’s (IMIA) set of recommendations on education and IMIA’s scientific map. Results: 462 health professionals responded to the paper-based questionnaire, and 167 respondents to the Internet questionnaire. I nternet respondents reported higher required degrees of competency for specific health informatics and information technology skills than paper respondents, while paper respondents valued clinical skills higher than the Internet respondents. Conclusion: Health professionals increasingly use information technology (IT), and some also deploy, research or develop health care IT. Consequently, they need to be adequately educated for their specific roles in health informatics. Our results inform developers of educational programs while acknowledging the diversity of roles in health informatics and the diversity of pathways towards a

Predictors of failure by medical practitioners to report suspected child abuse in Queensland, Australia

Abstract: Objective: The goal of this investigation was to examine the level of notification of child abuse and neglect and the perceived deterrents to reporting by medical practitioners, who a're mandated to report their suspicions but might choose not to do so. Design: A random sample of medical practitioners was surveyed. About three hundred medical practitioners were approached through the local Division of General Practice. 91 registered medical practitioners in Queensland, Australia, took part in the study. Results: A quarter of medical practitioners admitted failing to report suspicions, though they were mostly cognisant of their responsibility to report suspected cases of abuse and neglect. Only the belief that the suspected abuse was a single incident and unlikely to happen again predicted non-reporting (X2 [1, N =89] =7.60, p<0.01). No gender, age or parent status differences were found between reporters and non-reporters. Conclusions: Although the rate of non-reporting shows improvement from previous research, it is still at an unacceptable level. The failure to report appears to result not from judgement about the presence or absence of indicators of child abuse and neglect but a threshold that moves individuals to act on their suspicions. Professional development should focus on some of the fallacies which often influence medical practitioners' decisions. Aust Health Rev 2006: 30(3): 298-304

Australia's National Suicide Prevention Strategy: the next chapter.

Abstract: Australia's National Suicide Prevention Strategy (NSPS) is about to move into a new funding phase. In this context this paper considers the emphasis of the NSPS since its inception in 1999. Certain high-risk groups (particularly people with mental illness and people who have self-harmed) have been relatively neglected, and some promising approaches (particularly selective and indicated interventions) have been under-emphasised. This balance should be re-dressed and the opportunity should be taken to build the evidence-base regarding suicide prevention. Such steps have the potential to maximise the impact of suicide prevention activities in Australia.

Stakeholder concerns about Australia's mental health care system.

Abstract: There is growing community and professional concern that the Australian mental health care system requires substantial reform. In response to these concerns, a Senate Select Committee on Mental Health has been commissioned to conduct an inquiry into the provision of mental health services. The current study involved a content analysis of 725 submissions received by the Committee, and highlighted significant areas for reform. People with mental illness face difficulties in accessing mental health care, the care they do receive is of varying quality and poorly coordinated, and necessary services from other sectors, such as housing, are lacking. These problems may be exacerbated for particular groups with complex needs or heightened levels of vulnerability. The system requires reorienting towards the consumers and carers it is designed to serve, and needs stronger governance, higher levels of accountability and improved monitoring of quality. These findings are discussed in the context of the recent acknowledgement of mental health as an issue by the Council of Australian Governments (COAG), which has called for an action plan to be prepared for its consideration by June 2006.

Online referral and OPD booking from the GP desktop

Abstract: The Brisbane Inner South E-referral Project (BISEP) developed an application which allowed general practitioners, from their desktop, to successfully search for and book an available hospital outpatient appointment for patients with suspected cancer, send the referral electronically, and inform the patient of both the appointment and referral during the consultation. The hospital changed their outpatient department processes to allow such functionality for local GPs with patients with suspected cancer, working from a mutually agreed set of best practice referral criteria. A group of 19 GPs participated in an 11-week pilot implementation of the application, and were enthusiastic about continuing and expanding the approach. Patient satisfaction measures post intervention indicated that they perceived no major disadvantage in this form of outpatient department referral.

"There's no point in complaining, nothing changes": rural disaffection with complaints as an improvement method

Abstract: Objective: To validate earlier findings that lack of access to health services is the most likely issue of complaint by rural consumers, and that lack of knowledge about how to make effective complaints and scepticism that responses to complaints bring about service improvement account for the under-representation of complaints from rural consumers. Design: Unaddressed reply-paid mail survey to 100% of households in small communities, and 50%, 20% or 10% in progressively larger communities. Setting: Eight communities in the Loddon-Mallee region of Victoria. Participants: 983 householders most responsible for the health care of household members, responding to a mailed questionnaire. Main outcome measures: Issues of complaints actually made; issues of unsatisfactory situations when a complaint was not made; reasons for not complaining; to whom complaints are made; and plans for dealing with any future complaint. Results: Earlier findings were confirmed. Lack of access to health services was the most important issue, indicated by 54.8% of those who had made a complaint, and 72% of those who wanted to but did not. The most common reason given for not complaining was that it was futile to do so. Lack of knowledge of how to make effective complaints which might contribute to the quality assurance cycle was evident. Conclusions: Rural consumers? disaffection with health complaints as a means to quality improvement poses a significant barrier to consumer engagement in quality assurance processes. Provider practices may need to change to regain community confidence in quality improvement processes. CONSUMER VIEWS ABOUT the quality of health services provide a valuable source of information to those concerned with accountability and quality assurance in service provision.1,2 When such views are expressed as complaints which are responded to in ways which focus on quality improvement rather than allocation of blame, opportunities may arise to improve the quality of health services for all consumers.3,4

Scheduling unplanned surgery: a tool for improving dialogue about queue position on emergency theatre lists.

Abstract: Theatre use is heavily influenced by the presentation and scheduling of emergency cases for unplanned surgery. This research guided the development of a triage standard for scheduling emergency surgery in New South Wales public hospitals and aimed to contribute to a better understanding of decisionmaking practices. An emergency-surgery survey asked questions about urgency of a set of clinical conditions and appropriate time frames for patients to receive surgical treatment for these conditions. Surveys were distributed via 71 NSW public hospitals. A total of 198 decision makers responded: surgeons (42.8%), anaesthetists (24.7%), and nurses (32.5%). Principal component analysis was applied to reduce the data to three urgency classifications, and analysis of variance was used to assess variance of opinions between professional groups. The data suggested that the parameters that distinguish the codes (1, very urgent; 2, semi-urgent; 3, least urgent) were not unequivocally apparent. Although there was a consistent approach to the ?urgency 1? and ?urgency 3? categories, there were significant differences between responses when determining ?urgency 2?. The data indicated that when making decisions, anaesthetists act as intermediaries between surgeons and nurses. There was significant disparity between individuals when respondents were asked to state an ideal time for the commencement of surgery and the maximum length of time that the surgery could wait. This presented a need for a risk assessment tool to be incorporated when developing a dynamic prototype triage instrument.

Ethico-legal issues in relation to end-of-life care and institutional mental health.

Abstract: Objectives: In view of the fact that there is a higher mortality rate for individuals with serious mental illness and that people with mental illness suffer excess mortality due to physical illness, the lack of attention to end-of-life care for patients with a serious mental illness needs addressing. This article seeks to put these issues on the agenda by beginning to explore important ethico-legal issues at the interface of palliative care and institutional mental health. Methods: Data were collected from eight qualitative interviews conducted with mental health professionals at The Park, Centre for Mental Health, Queensland. The interviews were recorded verbatim, coded and thematically analysed. Results: The findings highlight the inherent tension at the interface of compassionate, patient-centred end-of-life care and the participants' perception of the legal restraints imposed by virtue of being in a mental health institution. This article examines the participants' perceptions of the legal restraints curtailing the provision of palliative care in a mental health institution and considers these findings within an understanding of the limitations imposed by law. Our hope and expectation in undertaking this exploration is to clarify the legal limitations that operate to restrict the type of end-of-life care that can be offered to mental health patients, in order to provide an informed basis for practice. (author abstract)

Ethnicity, deprivation and mental health outcomes

Abstract: Aims: To describe and measure differences between ethnic groups on standard measures of mental health outcome. Methods: Clinical staff in eight New Zealand Health Districts collected consumer outcomes data at the start, end and review of episodes of care. Consumers were allocated to one of three ethnicity groupings ? Maori, Pacific Island and ?All Other?. Results: There were large differences between the three ethnicity groupings on the measures. Maori and Pacific Island consumers appeared to demonstrate more psychotic phenomena and overall worse scores, and the All Other group, more depression. Changes in scores between start and end of episodes of care were proportionately similar across the three groups. Differences between ethnic groupings varied according to socio-economic deprivation level. Conclusions: Potential reasons for some of the effects observed are discussed, including differing pathways to care, clinician and selection bias, and differing models of mental health.