The future of patient safety worldwide

The global patient safety movement started with the publication of the Institute of Medicine’s landmark report To Err is Human back in 1999.  Since then, patients in health systems all over the world are sill being harmed.

Now, the The NIHR Imperial Patient Safety Translational Research Centre (PSTRC) in the UK (part of the NHS) has released its Patient Safety 2030 report.  "This paper and the Summit it informs are only small steps toward the goal of continuously reducing harm; the hope is that they spark increased energy to catalyse true change and provide an accessible summary of the challenges and most promising solutions in patient safety."

The authors of the report recommend a strategy that includes a systems approach, a culture of quality and safety based on positive reinforcement rather than blame, a partnership with patients and a bias towards action rather than inaction. There must also be a true effort to include middle and low-income countries in a global push.

Cost-effectiveness of National Hand Hygiene Initiative

Arlington County/flickr CC BY-SA

A recent paper in the open access journal, PLoS ONE, has evaluated the cost-effectiveness of the National Hand Hygiene Initiative implemented from 2009-2012 in Australia. The outcome used was healthcare associated Staphylococcus aureus bacteraemia,and the eight existing state and territory hand hygiene programs were compared. 

The study covered 1,294,656 admissions from the 50 largest Australian hospitals and the authors ultimately concluded that “The Australian National Hand Hygiene Initiative was cost-effective against an Australian threshold of $42,000 per life year gained.”

Graves N, Page K, Martin E, Brain D, Hall L, Campbell M, et al.  Cost-Effectiveness of a National Initiative to Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated Staphylococcus aureus Bacteraemia.  PLoS ONE. 2016;11(2):e0148190.

Pancreatic cancer - four subtypes identified

A study recently published in the journal Nature, Genomic analyses identify molecular subtypes of pancreatic cancer, indicates that there are four different subtypes of pancreatic cancer. As one of the most aggressive and complex cancers, this detailed genetic study could have major implications on the way it is treated in the future.

If you find the Nature article overly-scientific, there is a useful summary of the findings in plain English published in The Conversation: Pancreatic cancer is really four separate cancers: study.  Author Ivy Shih interviewed one of the main researchers, Sean Grimmond, who is Director of Research for the Centre for Cancer Research at the University of Melbourne.  He said that the results may open new avenues for clinical trials and drug designs to better combat the disease.

Bailey, Peter et al.  Genomic analyses identify molecular subtypes of pancreatic cancer Nature 531, 47–52 (03 March 2016) doi:10.1038/nature16965.  (Request this article from your Librarian if you do not have access to the full text.)

Joanna Briggs short courses in EBP

The Joanna Briggs Institute (JBI) is offering a range of education and training courses for clinicians, managers, educators, academics and students from the fields of nursing, allied health, medicine, information science and the health sciences. There are various start dates for 2016 and all the courses are held at the Institute in Adelaide.

The Clinical Leadership Program is a one day program, in which participants learn skills such as how to create a positive and professional culture in their workplace, manage difficult behaviour, build productive teams and implement change.

The Comprehensive Systematic Review Training Program can be undertaken for 1, 3 or 5 days and participants learn how to develop a focussed question and then find, synthesise and evaluate the literature.

The six month Evidence-Based Clinical Fellowship Program teaches participants to lead their clinical team in an evidence implementation project of their design, audit for improvement and publish their findings. The program involves two five-day intensive training workshops at the Institute and a work-place evidence-based implementation project in the intervening months.  

Evidence based standards for burns

A paper recently published in the Medical Journal of Australia outlines the treatment variations of burns in Australia and New Zealand.  The data has been gathered over the past four years from the Burns Registry of Australia and New Zealand, which has identified "considerable variation in practice" and "significant variations in outcomes that are not explained by simple difference is casemix alone".  

As a result of these fiindings, the Australian and New Zealand Burn Association has launched the Burns Quality Improvement Program (BQIP), which aims to develop evidence-based standards of care.

Cleland H, Greenwood JE, Wood FM, Read DJ, She RW, Maitz P, et al. The Burns Registry of Australia and New Zealand: progressing the evidence base for burn care.  Medical Journal of Australia. 2016;204(5):195.  http://dx.doi.org/10.5694/mja15.00989

Prostate Cancer Guideline

The Prostate Foundation of Australia has released a new guideline titled Clinical practice guidelines PSA Testing and Early Management of Test-Detected Prostate Cancer.
The Guideline is freely available to download here.

Clinical Practice Guidelines for Dementia in Australia

The new Clinical Practice Guideline for Dementia details the optimal diagnosis and management in community, residential and hospital settings. The guidelines have been approved by the National Health and Medical Research Council.
The guidelines provide 109 recommendations, categorised as evidence-based recommendations (formulated after a systematic review of the evidence), consensus-based recommendations (formed where a systematic review has failed to identify sufficient studies to inform a recommendation) and practice points (based on expert opinion).
The guidelines recommend a systematic approach to diagnosing dementia; this includes patient and informant history taking, cognitive assessment, medication review, blood tests and computed tomography or magnetic resonance imaging to exclude other cerebral pathologies.

The full guidelines can be accessed via the Australian Clinical Practice Guidelines portal .

Unnecessary Care: the Choosing Wisely Campaign

The Choosing Wisely Australia campaign has released 61 recommendations of tests, treatments and procedures that may not be necessary and could cause harm to Australian patients as the global healthcare initiative continues to expand and gain momentum in Australia.  The Choosing Wisely Campaign is an initiative of NPS Medicine Wise. 

Choosing Wisely website.

Surgery in the Elderly

The British Journal of Surgery has published a free issue titled Surgery in the Elderly, which includes topics such as:

• Surgery for an ageing population
• Systematic review and meta-analysis of risk factors for postoperative delirium among older patients undergoing gastrointestinal surgery
• Molecular and biological hallmarks of ageing
• Characteristics, incidence and temporal trends of sepsis in elderly patients undergoing surgery.

Special Issue: Surgery in the elderly. British Journal of Surgery, January 2016. 103(2),p e7–e124.

"Ice" - concerns and responses

An editorial recently published in the Medical Journal of Australia describes the patterns of increasing use of methamphetamine over the past then years but argues that we can do something about it.  “Ice” (crystal methamphetamine): concerns and responses is by Margaret Hamilton and Adrian Dunlop, who write, "Methamphetamine has been around for some time. Although it is now available in a crystal form that is more potent and more readily smoked than earlier forms, no-one should feel impotent in the face of widespread alarmist commentary about this drug."   

The authors discuss the recent National Ice Taskforce Report in an attempt to explain the evidence of more regular and greater levels of dependent use among people who use the drug. They call for governments, health services and the community in general to respond to these problems promptly.

Creating choice in end of life care

The Australian Centre for Health Research has released a report about end of life care and the pressures it is under in Australia.  Conversations: creating choice in end of life care, by Rebecca Bartel, finds that conversation can be the principle inexpensive step to reforming the systems we have in place and ensuring that people have greater choice.

Bartel argues that the community needs to talk about dying.  Many Australians are dying in ways they would not choose - we are often receiving care we don't want in places where we don't want it. The evidence shows that open conversations about death, dying and bereavement are vital to the long-term health and well being of individuals and communities and we are not currently doing it well. "It is clear that sharing our preferences for what we’d like at the end of our life is the most important – and costly – conversation that Australia is not having".

Hospitals in Australia series

Australia is in the midst of a health funding crisis, with Federal and State governments battling over who should fix the increasing problems of overcrowded emergency departments, lengthening surgical waiting lists and other issues. This week The Conversation has been running a series of articles about hospitals in Australia, aiming to explain why hospitals are struggling and what can be done about it.
 

There are several articles available.  The Infographic: a snapshot of hospitals in Australia is a great place to start, showing how we use and pay for our hospitals.  Michael Vagg, a clinician from Barwon Health, has written From triage to discharge: a user's guide to navigating hospitals, and Stephen Duckett from the Grattan Institute tells us The problems with Australia's hospitals – and how they can be fixed. Helen Dickinson from the University of Melbourne looks into Why do we wait so long in hospital emergency departments and for elective surgery? and today, Karen Willis and Sophie Lewis compare systems with What are better, public or private hospitals?  

Patient safety tools and resources

 AHRQ  in the US has created tools to help your hospitals to educe readmissions, hospital-acquired conditions—including infections—and improve health literacy, patient/family engagement, and boost quality performance. All of our tools are evidence-based and available at no charge.

Patient Safety Measure Tools & Resources

Admitted patient care 2014-15: Australian hospital statistics

The Australian Institute of Health and Welfare has just released a new report "Admitted Patient Care 2014-15: Australian hospital statistics".

 In 2014-15, there were about 10.2 million separations in Australia's public and private hospitals: about 6.0 million of these occurred in public hospitals; 94% of separations were for acute care and 4% for rehabilitation care.

 Between 2010-11 and 2014-15: the number of separations increased overall by 3.5% on average each year, by 3.2% for public hospitals and by 4.0% for private hospitals, private health insurance funded separations increased by an average of 5.9% each year and; public patient separations increased by 2.7% each year.

AIHW catalogue number HSE 172

Download report: Admitted patient care 2014-15: Australian hospital statistics

Series of National Guidelines (SoNGs)

The Australian Department of Health has developed the Series of National Guidelines (SoNGs) in consultation with the Communicable Diseases Network Australia (CDNA) in order to provide nationally consistent advice and guidance to public health units in responding to a notifiable disease event. "These guidelines capture the knowledge of experienced professionals, built on past research efforts, and provide advice on best practice based upon the best available evidence at the time of completion."

Some of the more recent SoNGs include:

• Dengue National guidelines for public health units - 31/07/2015
• Hepatitis C National guidelines for public health units - 1/09/2015
• Psittacosis (Ornithosis) National guidelines for public health units - 23/02/2016