Associate Professor Gary Morgan, Clinical Director, Division of Surgery & Anaesthetics, Westmead Hospital, Clinical A/Professor, University of Sydney
Associate Professor Arthur Richardson, Head of Upper GI Surgery, Westmead Hospital, A/ Professor, University of Sydney, Chair of the Surgical Services Taskforce
Clinicians have long recognised that health outcomes are ideally measured by high quality clinical data. Even better that such data can be used to benchmark performance against peers. Benchmarking can identify deficiencies in care and can provide opportunities for quality improvement. These opportunities have for the most part been sadly lacking for Australian surgeons.
In the United States during the 1980's, the Veterans Administration hospitals came under pressure from Federal authorities because of deficiencies in the results and quality of the surgical care provided. As a result of these criticisms, the National VA Surgical Risk study was developed and implemented. A simple formula was developed to assess outcomes:
Patient Factors + Effectiveness of Care + Random Variation = Outcome
From this work, it became clear that there was a need for a reliable surgical database to assess outcomes, to correct for patient morbidities and random events and to facilitate meaningful benchmarking. Due to the success of this work, the American College of Surgeons (ACS) expanded the program to private sector hospitals in North America and it was named the North American Surgical Quality Improvement Program (NSQIP). In 2016, there are more than 700 participating hospitals in North America and a small number outside the United States. Dr Clifford Ko is the ACS director of NSQIP and has made several trips to Australia to present the results and accomplishments of the program.
There have been many publications attesting to the efficacy of NSQIP. Complications of surgical procedures are a significant cause of poor outcomes and also lead to increased costs for the health service. It has been shown in the United States that post operative complications may increase the median cost of a procedure by up to five fold. This increase may be even higher if there is an unplanned readmission. It is estimated that participation in NSQIP may result in an average hospital having 250-300 fewer complication per year, less preventable deaths, significant improvements in patient satisfaction and a lower readmission rate with a shorter length of stay. The benefits are achieved by collecting high quality data that is then statistically risk adjusted so that a given hospital can see how they are performing in comparison to peer hospitals. A semi-annual report is generated each 6 months and hospitals can track their improvement according to the KPI selected. There is also the opportunity to use this data for other projects as it belongs to the participating hospital.
In New South Wales, there has long been concern amongst surgeons regarding the quality of the data collected. This is usually administrative data and is often felt by clinicians to be inaccurate and not relevant. There has been a need for high quality clinical data that can be used to drive quality improvement. It is impossible to improve if the relevant KPIs are not collected accurately. Additionally, quality in surgery and indeed future funding will increasingly be outcome based.
As such, there has been an interested group of surgeons within NSW who have felt that joining the NSQIP program will fulfill this need. NSQIP is a program that is verified and available for early roll out. Importantly, it provides risk adjusted benchmarking to best practice internationally. This may be particularly helpful in low volume high acuity procedures such as oesophagectomy and pancreatectomy. As a result of this clinical interest, the Agency for Clinical Innovation has sponsored a pilot program in NSW. The NSW consortium currently consists of Port Macquarie, Coff's Harbour, Nepean and Westmead hospitals.
The ACI has formed this local consortium, negotiated the license agreements and sponsored visits to NSW by Dr. Ko. The consortium members have also attended the annual NSQIP conference in Chicago last year and just recently in San Diego. Each of the participating hospitals have LHD executive sponsorship that has allowed employment of Surgical Clinical Reviewers (SCRs) who have been trained on line and who are now collecting data. The data is sent (appropriately de-identified) to the American College of Surgeons where data analysis occurs. The performance of the SCRs is monitored and revalidated continuously.
All the NSW sites have recently received the first semi-annual report looking at the individual hospitals as well as the consortium's performance. This has shown, despite the immaturity of the data, that our hospitals perform reasonably well, but with many areas of potential improvement. All the sites are anticipating that, as the datasets grow and the data becomes more robust, the project leaders will gain increasing confidence to disseminate the information to senior clinicians and allow them to identify areas of concern and thus develop quality improvement projects.
The ACI Surgical Services Taskforce is convinced that NSQIP is the way forward for quality improvement in surgery across the State. The participating hospitals are very grateful for the support provided by ACI and the LHDs in establishing the project, and look forward to a long and fruitful involvement with NSQIP.
 Rowell, KS, et al. 'Use of National Surgical Quality Improvement Program Data as a Catalyst for Quality Improvement.'Journal of the American College of Surgeons.204(6): 1293-1300; June 2007
 Merkow RP et al. 'Underlying Reasons Associated With Hospital Readmission Following Surgery in the United States.' JAMA. 2015;313(5):483-495
Welcome to the October issue of Clinician Connect
by Nigel Lyons – Agency for Clinical Innovation
In the four years that I have been Chief Executive at the ACI, I have seen many changes both within the health system and the Agency itself that show how many truly passionate people are working to improve healthcare delivery in NSW.Our organisation has been committed to supporting a focus on health system improvement through the implementation of initiatives in partnership with Local Health Districts and Primary Health Networks, while strengthening the clinician and consumer led focus that began with the Greater Metropolitan Clinical Taskforce back in 2001. In addition to the work of our Clinical Networks, Taskforces and Institutes, I have seen the development and maturing of the ACI's capability to support the implementation of these improvement initiatives across the state. The expertise of the ACI now includes health economics and evaluation, patient experience and consumer engagement, telehealth, integrated care, patient reported measures, knowledge sharing through our Innovation Exchange portal, and capability building through our Centre for Healthcare Redesign program. This expertise allows the ACI to ensure that we are meeting the needs of Local Health Districts as we plan and deliver our work. The staff at the ACI have consistently shown their dedication to the values of our organisation, working collaboratively with our partners and demonstrating an impressive level of knowledge, skill and professionalism. Our people make up the core of the ACI and our abilities as an organisation, and we are fortunate to have such an exceptional team. I have also been impressed by the ongoing commitment of the clinicians, consumers and managers who volunteer their time to come together to improve patient experience and outcomes. I urge anyone who is keen to make a difference to get involved with an ACI Network, Taskforce or Institute and help shape the future direction of the ACI. As an organisation we've taken every opportunity to refine what we do in order to learn and grow, and it is time for the ACI to continue to grow as I step away to take up the position of Deputy Secretary, Strategy, Planning and Resources at the NSW Ministry of Health. I have every confidence that I leave the organisation in capable hands and that it will continue to be an integral part of improving the way healthcare is delivered in NSW. Thank you to everyone who has been a part of my time at the ACI. I look forward to continuing to work with the system to deliver real improvements to patients across NSW in my new role.
Dr Nigel Lyons
Chief Executive, ACI
Comment by the Chair
by Prof Brian C McCaughan - Chair of the Agency for Clinical Innovation Board
As Board Chair it has been my pleasure to work with Nigel Lyons over the last four years in his capacity of CEO of the Agency for Clinical Innovation. During that time I have witnessed first-hand Nigel's ability to work co-operatively with people throughout the health system and synthetise ideas into an implementable policy to benefit the patients of New South Wales in terms of their clinical care.
Nigel's decision early in his career to devote his future as a medical practitioner to improving patient care and service improvement through system change has proved a fortuitous one for New South Wales Health and ACI has certainly benefited greatly from his intelligent, collaborative and approachable style of leadership. This has enabled him to achieve many goals throughout his career and most particularly in ACI where this has earned him a legion of devoted staff.
In particular his guidance and management of the ACI has seen the organisation develop into a hub of creativity and insight leading a dedicated team of health professionals and manages to achieve many outstanding results. These results have led to a direct improvement in patient care in many different clinical areas across New South Wales Health.
As one of his senior network managers says of him, "Nigel is a blend of appropriate professionalism and humanity". This is not always found in people at Nigel's level in the system.
I would particularly like to highlight Nigel's efforts and success in working collaborately with the CEC and especially in the interaction of these two organisations with the LHDs in terms of achievable outcomes.
I firmly believe that capable people must be always ready to move on and take up new challenges, and Nigel and I have spoken about this at length over the years. In accepting the position of Deputy Secretary at the Ministry Nigel has taken the appropriate next step in his career development and I am sure that we will continue to interact directly with him and with his knowledge of all that ACI can offer, I am sure he will be liaising with us for assistance both in this position and in his further career progression, which we will all watch with great interest.
The staff at the ACI have farewelled him in their own way and on behalf of the Board I would like to wish him every success in his future endeavours and most importantly thank him so much for all that he has done in his four years at this Agency for Clinical Innovation.
Acute Care Taskforce update Co-Chairs: Vicki Manning and Jeremy Wilson
Acute Care Taskforce Manager
Medical Assessment Unit Forum 2016
More than 130 Medical Assessment Unit (MAU) clinicians, consumers and managers attended the 2016 MAU Forum at the Kirribilli Club on Friday, 23 September 2016.
The event included presentations on NSW Ministry of Health initiatives such as the 90 day challenge, Hospital in the Home and Patient Flow Portal, as well as clinicians from John Hunter, Westmead, Bankstown, Liverpool and Blacktown Hospitals sharing their models, successes and challenges.
The Descriptive Analysis of MAUs was distributed to LHD/SHN Chief Executives via the ACI and NSW Ministry of Health late last week. Authors Frances Group International (FGI) gave an overview of the process undertaken and the data presented from their analysis. The recommendations from the report were shared with the group and a workshop session jointly led by the ACI and Ministry of Health explored the ways units could address and plan further improvement strategies.
With the use of an online question and polling system the forum was very interactive for all participants, with early feedback for the event very positive.
For further information, please contact the Manager.
Aged Health Network update Co-Chairs: Bill Thoo and Viki Brummell
Launch of Allies in Dementia Care resources
The ACI Aged Health recently partnered with Alzheimer's Australia to develop two guides which highlight the many ways in which allied health professionals contribute to the everyday lives of people living with dementia, their carers and families.
Better health for people living with dementia: A guide on the role of allied health professionals provides information and ideas for doctors, nurses and allied health professionals about a range of evidence-based allied health interventions that support people living with dementia and their carers.
Allied health professionals and you: A guide for people living with dementia and their carers empowers consumers to partner with allied health professionals to live life to the fullest. An estimated 1.2 million people are involved in the care of a person with dementia and require as much support as possible in this challenging role. The consumer guide covers topics for carers and the people living with dementia such as adjusting to change, health and wellbeing, speaking up, living at home with dementia, what allied health is and how it can help, and how to find a relevant allied health professional.
The guides were developed by the ACI Aged Health Network's Allied Health Subgroup and funded by Alzheimer's Australia National Quality Dementia Care Initiative, with support from J.O & J.R Wicking Trust., Widespread consultation, including people with dementia, carers and allied health professionals was undertaken as part of the development process.
The guides were launched at the Northern Sydney Primary Health Network (PHN) Ageing Strategy Network Meeting on 14 September and are now available to access at:
- ACI: www.aci.health.nsw.gov.au/resources/aged-health/allied-health/allies-in-dementia
- Alzheimer's Australia: www.fightdementia.org.au/about-dementia
Thank you to the consumers and allied health professionals who contributed, especially the Steering Committee: Atosha Clancy, Jamie Hallen (Co-Chair), Jacki Wesson, Elaine Todd (Co-Chair), Jenny Henderson Joan Jackman, Michelle Frawley.
Award for Lismore CHOPs team
Congratulations to the Lismore Care of Confused Hospitalised Older Persons (CHOPs) Team who were awarded the Best clinical practice improvement initiative at the Northern NSW Local Health District 2016 Quality Awards.
Thank you to Anne Moehead, Allison Wallis and the C7 staff, Kym Hickey and C8 staff, Sue Milne and the ASET Team, who have been leading CHOPs at Lismore Base Hospital.
On Thursday, 11 August 2016, the NSW Dementia Care Competency and Training Network delivered dementia e-learning facilitator training at ACI. This partnership with the NSW Dementia Care Competency and Training Network is an important collaboration to support professional development and a community of practice for our CHOPs teams. We plan to run more in 2017. For more information on the NSW Dementia Care Competency and Training Network visit the website at dementiacare.health.nsw.gov.au.
Thank you and farewell
The Aged Health Network would like to thank Barbara Anderson, Aged Care Unit, NSW Ministry of Health, for her contribution to the Aged Health Executive and Network since the Network's inception in 2003. Barbara has been an active member of the Aged Health Executive and her knowledge of the aged care system has been invaluable.
Barbara has recently retired, and we wish her well with her future plans.
The ACI was proud to partner with the Clinical Excellence Commission to co-sponsor the APAC Forum 2016, held in Sydney from 12 – 14 September 2016. The Forum saw almost 1500 attendees come together to discuss the latest trends and in innovation in healthcare.
APAC Forum 2016 covered a diverse range of topics of interest to healthcare professionals, managers and consumers including innovation, quality and safety, data and measurement, consumer engagement, Aboriginal health and wellbeing, and patient experience. Keynotes were presented by Ko Awatea's Jonathan Gray, inspirational trauma survivor and pilot Janine Shepherd, Yale biosocial expert Nicholas Christakis, and Myriad Genetic's Johnathan M. Lancaster.
Several ACI staff members presented during the various sessions, including:
- Jenni Johnson, Network Manager, ACI Pain Management Network
- Chris Ball, Program Manager, ACI Clinical Program Design and Implementation, CPDI
- Estelle Marque, A/Redesign Manager, ACI Centre for Healthcare Redesign
- Jenny Preece, Network Manager, ACI Rural Health Network
- Glen Pang, Network Manager, ACI Aged Health Network
- John Marshall, Data Governance and Analysis Officer, CPDI
- Tracey Szanto, Network Manager, ACI Intellectual Disability Network
- Mel Tinsley, Program Manager, Patient Reported Measures
The APAC Forum Gala Dinner was held at Doltone House during the evening of the second day. The Gala Dinner provided an opportunity for attendees to network with their peers while also recognising the great work of the organisations who submitted for the Ko Awatea Excellence and Innovation Awards, with winners announced on the night.
Congratulations to the Local Health District (LHD) teams who won the following awards:
Award for Leading Sustained Quality Improvement (Individual)
Marcia Ingles, Belmont Hospital, Hunter New England Local Health District – Reducing door-to-drug time for sepsis patients in Belmont Hospital Emergency Department: a quality improvement project with the Clinical Excellence Commission's Sepsis Kills program.
Award for Assuring Quality of Healthcare Standards (Team/Organisation)
Western Sydney Local Health District (WSLHD) and Health Infrastructure NSW – Consumer Engagement in Blacktown and Mount Druitt Hospitals Expansion Project.
Award for Working Seamlessly Across Organisations
Mid North Coast Local Health District (Australia) – Nambucca Valley Healthy Kids Bus Stop.
Award for Citizens at the Centre of Service Re-Design and Delivery
North West Cancer Centre, Radiation Oncology Video Team, Tamworth Hospital, Hunter New England Local Health District.
Improving Patient Safety (Team/Organisation)
St. Vincent's Hospital, Sydney, Introducing Evidence Based Pain Management Guidelines for Elderly Patients with Fractured Neck or Femur.
Videos and posters from the Forum, including several ACI posters, are now available on the Ko Awatea website.
Blood and Marrow Transplant Network update John Kwan and Elizabeth Newman
Blood and Marrow Transplant Network Manager
Blood and Marrow Transplant Symposium
The Network's annual Blood and Marrow Transplant (BMT) Symposium was held on Friday, 9 September 2016. The Symposium was well-attended, with 120 participants from across all NSW BMT Units, including medical, nursing, allied health, laboratory, quality management, research, and pharmacy, in attendance.
The Symposium provided an opportunity for state-of-the-art information and current research to be shared in a collaborative forum not otherwise available to this niche group of clinicians.
Topics relevant to the wide range of disciplines working in BMT were covered including TCells, infectious diseases in immunocompromised patients, outcomes of BMT for autoimmune diseases, marrow processing innovations, and latest information on extra-corporeal photophoresis.
Updates from the various working groups in the ACI BMT Network were also presented, as well as from donor and transplant registries.
The ACI BMT Quality Management Team supported four BMT Programs through their national accreditation (NATA) assessments and one through international accreditation (FACT) early this September. Congratulations to the Nepean, Wollongong, Westmead Hospitals and the Sydney Children's Hospital Westmead / Prince of Wales programs on achieving a high level of compliance.
Clinicians in these locations have been pleased to have the support from the Quality Management Team, which provides a standardised program across 12 units in NSW. A strong focus of the team is identifying opportunities for improvement and supporting local teams to develop and implement actions to address these areas.
Congratulations to everyone on excellent results.
New Network Manager
Michelle Frawley has recently moved from her position as BMT Network Manager to work on a range of clinical initiatives across the ACI Acute Care Portfolio. Michelle has been in the role since September 2015, and her dedication and strong support of the Network will be missed. Best of luck in your new role Michelle.
Welcome to Fidye Westgarth, who has taken on the role of Network Manager for the Network.
Fidye has a wealth of experience with the ACI and has worked as Network Manager for the ACI Renal Network for the past 10 years. Recently Fidye stepped away from the Renal Network and will now be managing the BMT Network alongside the Radiology and Nuclear Medicine Networks. Fidye has already met with a number of the BMT working groups and is working on a range of projects. Welcome Fidye.
Centre for Healthcare Redesign
Centre for Healthcare Redesign Manager
CHR School Graduation
31 participants from NSW health facilities were awarded a Diploma of Project Management by NSW Minister for Health Jillian Skinner at a ceremony celebrating their graduation from the ACI Centre for Healthcare Redesign (CHR) Diploma Program in Sydney's CBD on 19 August.
Speaking at the event, Minister Skinner said the eleven projects across ten local health districts, specialty health networks and a pillar agency were examples of how the NSW health system works collaboratively with frontline staff to support innovation and improvement across the system.
The ACI Centre for Healthcare Redesign Diploma Program is an intensive 20 week course which provides the latest knowledge and training in project management, clinical redesign and change management to build the capability of healthcare staff in NSW. Graduates of the program are awarded an accredited Diploma of Project Management through a partnership with the University of Tasmania.
The CHR School supports local healthcare staff to identify, design and implement innovative improvements for patients and carers. Networking, shared learning and working collaboratively with patients, clinicians and management to improve healthcare are a strong focus of the course.
During the program, healthcare staff are supported with comprehensive training from the ACI CHR team, workplace mentoring by local healthcare redesign managers, and sponsorship from a local senior executive.
To date, the program has seen more than 550 improvement leaders developed across a range of metropolitan, rural and statewide health services from NSW and interstate.
Visit this page for more information on the ACI Centre for Healthcare Redesign Diploma Program.
The 6th ACI Co-Chairs Forum was held at the ACI offices on Monday, 22 August. The Forum was attended by 58 Co-Chairs, Network Managers and ACI Executive Team members.
Co-Chairs Forums are an opportunity for all ACI Network, Taskforce and Institutes to come together with ACI Network Managers and the Executive Team to network, learn more about current work being undertaken, and to help shape the future direction of the organisation.
One of ACI's priorities is to support work addressing unwarranted clinical variation (UCV) through the Reducing Unwarranted Clinical Variation Taskforce. UCV is defined as 'variation that cannot be explained by the condition or the preference of the patient; it is variation that can only be explained by differences in health system performance (ACSQHC)'.
A key theme of the August Forum was to explore the ACI approach to UCV, and its potential applications in other clinical areas. Attendees provided useful feedback on the proposed approach, which will be incorporated before a final approach is confirmed.
Drug and Alcohol Network update Co-Chairs: Tony Gill and Jo Lunn
Drug and Alcohol Network Manager
The inaugural ACI Drug and Alcohol Innovation Forum was held on 11 August 2016 at the Kirribilli Club.
Attendees at the inaugural ACI Drug and Alcohol Network Forum. Photos: A. Langton.
With 170 people registered to attend on the day and more than 100 sites live streaming, the forum brought together a range of innovative projects from the NSW Drug and Alcohol sector and created an opportunity to network, share ideas and be inspired.
A shortlist of five potential initiatives to be taken forward by the Network was presented to the audience, both in the room and online. These initiatives included:
- Drug and Alcohol Shared Care – An Evaluated Partnership Between Public and Primary Health Care Services in South Eastern Sydney LHD
- The Speak Out Dual Diagnosis Program – Responding to Co-existing Issues of Drug and Alcohol and Mental Health - Weave Youth and Community Services
- Cognitive Remediation – Improving Clients' Capacity to Successfully Engage in Drug and Alcohol Treatment – We Help Ourselves and Advanced Neuropsychological Treatment Services
- Parenting With Feeling – A Targeted Parenting Program for Parents who use Substances and their Infants – Hunter New England LHD
- S-Check – An Innovative Service Model to Attract Stimulant Users – St Vincent's Hospital Network.
A key principle of the Drug and Alcohol Network is that its members drive the direction of work and are active participants in the decision-making process around how the Network invests time and resources.
The Forum provided Network members, present and virtually, with an opportunity to vote for a future Network initiative. Members were asked to vote for the project they believed had the most potential to lead to real changes and improvements in drug and alcohol service delivery, and the one that would have the greatest benefit for clients.
The project chosen on the day to take forward is Cognitive Remediation – Improving Clients' Capacity to Successfully Engage in AOD Treatment.
Many thanks to all those involved in the planning of the Forum and on the day, and sincere congratulations to We Help Ourselves (WHOs) and Advanced Neuropsychological Treatment Services (ANTS) for their winning project.
Drug and Alcohol Primary Health Network Workshop
The Network hosted a Drug and Alcohol Primary Health Network (PHN) Workshop held at the ACI on 29 August 2016.
The aim of this day was to provide expertise to PHNs in both Drug and Alcohol treatment types (evidence and evaluation) and Drug and Alcohol Service Planning. The workshop provided an opportunity for PHNs to communicate with their peers and collaborate on Drug and Alcohol planning and commissioning processes which are currently underway.
All PHNs in NSW were represented on the day as well as the Commonwealth Department of Health and the NSW Ministry of Health. Many thanks to all those who made the time to attend, particularly the National Drug and Alcohol Research Centre (NDARC) who led the discussion.
For more information, contact the Manager.
Farewell Nigel Lyons
ACI Chief Executive Dr Nigel Lyons has stepped away from the organisation to take up the role of Deputy Secretary, Strategy and Resources for NSW Health.
Nigel started with the ACI in February 2012 and has overseen several restructures which saw the ACI triple in size and take on a number of functions which previously sat with NSW Ministry of Health and other partners. The ACI is now responsible for 38 Clinical Networks, Taskforces and Institutes, as well as several key functions which service the NSW health system including service redesign and evaluation, implementation, knowledge sharing, capability building, health economics and analysis, and specialist advice on healthcare.
Nigel's vision has seen a strong focus on building effective partnerships across the system, operating as an agile and responsive organisation to meet the needs of our stakeholders, and driving system improvement through innovative collaborations.
A number of workplace improvement initiatives have also been implemented at the ACI during Nigel's time at the helm. Developing a collaborative learning environment with the opportunity for professional growth has led to the implementation of learning circles, cultural respect training, all staff forums, values and behaviours awards, and a comprehensive performance review and development framework.
Nigel is well known at the ACI for his friendly, calm and approachable nature, as well as a big sense of humour. He will be missed around the office.
Donald MacLellan, Director of the ACI Surgery, Anaesthesia and Critical Care Portfolio, will be Acting as Chief Executive of the ACI until future arrangements are confirmed.
The ACI is pleased to welcome Shona Dutton to the role of Director, Strategy Planning and Communications (SPC).
Shona has extensive experience across national, state and local levels, having held positions with the Ministry of Health Government Relations Branch, the National Health Performance Authority, Eastern and South Eastern Sydney Medicare Locals, and the former Divisions of General Practice.
Her experience includes strategic and business planning, stakeholder engagement, research and evaluation, performance reporting, change management, quality improvement and capacity building. She recently completed her PhD, examining methods for increasing the uptake of physical activity assessment in primary care. This work was underpinned by her Masters of Public Health, and undergraduate qualifications as an Exercise Physiologist.
As Director of SPC, Shona is a member of the ACI Executive Team and will play an important role in shaping the future strategic direction of the ACI. Welcome Shona.
Vale Kate Needham
Kate Needham, who was Executive Director of the ACI's predecessor GMCT, and the ACI for 11 years until 2012, died recently after a protracted illness.
In his farewell to Kate in 2012, Nigel acknowledged 'her dedication and commitment to the ACI and its preceding entities and her role in leading the creation of new clinical networks and successfully increasing the number from 14 to 24'.
She had also continually championed the research potential of the ACI and promoted the concept of clinical networks translating 'evidence into practice'. Kate embodied the spirit of clinician engagement and the importance of their involvement from the ground up. Her legacy is reflected in the success of so many networks that have implemented important changes in health services right across NSW.
Kate is survived by her husband Rob, four children and grandchildren. Those who knew her will miss her true survivor spirit. Vale Kate.
Intensive Care Coordination and Monitoring Unit update
The new ICUConnect discussion forum went live on 25 July after an extensive planning process and collaborative work between the ACI web team and the Intensive Care Coordination and Monitoring Unit (ICCCMU) team.
ICUConnect is virtual community of multidisciplinary professionals from a diverse range of intensive care services in Australia and internationally.
The virtual community was first established in 2003 with 130 senior nursing clinicians from the 46 NSW Intensive Care Units (ICUs). Membership grew quickly, with around 2000 members currently active on the portal.
The transition to the discussion forum format in early July was made to improve accessibility and functionality for members and enable storage of shared resources.
ICUConnect is managed by ICCMU and aims to improve the outcomes of critically ill patients by facilitating knowledge sharing and supporting the delivery of evidence-based practice across the intensive care community.
Membership includes clinicians, managers, academics and industry partners from across Australasia and overseas. Key benefits of the membership include:
- Networking 24/7 with intensive care colleagues.
- Keeping up to date with best practice by having an opportunity to discuss clinical practices with colleagues and clinical experts.
- Early notification of emerging safety issues affecting ICUs via the Safety blog.
ICUConnect has been internationally recognised for providing a collaborative learning environment for ICU clinicians. Publications highlighting ICUConnect include:
- Building a statewide knowledge network for clinicians in intensive care units: Knowledge brokering and the NSW Intensive Care Coordination and Monitoring Unit (ICCMU) Australian Critical Care 2008 21(1) 29–37
- Analysis of the Social Network Development of a Virtual Community for Australian Intensive Care Professionals Computers, Informatics, Nursing 2014, 32(11): 536-544
If you have an interest in Intensive Care and would like to join the discussion forum, please submit an expression of interest via the ICUConnect page.
Intellectual Disability Network update Co-Chairs: Les White and Maria Heaton
Intellectual Disability Network Manager
Global Partnerships in Intellectual Disability Health: Enhancing research, policy and practice in NSW
The latest developments in the health of people with intellectual disability were presented by leading international speakers in a symposium jointly sponsored by NSW Ageing, Disability and HomeCare (ADHC) and the ACI on August 22.
The Symposium saw attendees come together to explore opportunities in this complex clinical area. Themes for the symposium included mental health and challenging behaviour, health promotion, translating research to practice, and genetics.
Fiona McKenzie shared what she values as a person with intellectual disability when interacting with health services, while carers joined experts in panel discussions. Hearing from local experts and international speakers from the UK, Canada and the United States made for interesting discussions, also allowing the opportunity to network with colleagues from across the health, education, disability, and justice sectors, as well as the community. This comes at a time when the Network is shaping its current work to give guidance to the system on the delivery of NSW health services at a local level.
View the presentations from the Symposium.
Institute of Trauma and Injury Management
Welcome Kelly Dee
The Institute of Trauma and Injury Management (ITIM) team is pleased to announce the appointment of Kelly Dee to the position of Clinical Review Officer. Kelly has a background as an Emergency Nurse and Trauma Case Manager at Royal North Shore Hospital, with recent experience in simulation, education and clinical governance.
Kelly will be working collaboratively with ITIM and the Trauma Network to develop and implement strategic projects that monitor and improve the quality of both adult and paediatric trauma services across NSW. This includes monitoring, reporting and review of incidents, trauma system morbidity data, and potentially preventable and preventable deaths across the adult and paediatric NSW trauma systems.
Farewell Kellie Wilson
Farewell to Kellie Wilson, who has left the organisation after three years in her role dedicated to patient safety and clinical review.
Kellie has more than 20 years' experience in critical care and paediatric surgical nursing, with 10 years dedicated to the care of paediatric trauma patients as the Trauma Clinical Nurse Consultant and Acting Director of Trauma at Sydney Children's Hospital, a level 1 Paediatric Major Trauma Service.
Kellie has extensive experience within the NSW and Australasian Trauma System, including representation on a wide range of committees, working parties and taskforces with publications to her credit, and has presented in a wide range of forums.
Kellie is steadfastly committed to the further development of accessible, quality trauma care across the NSW health system.
We wish Kellie the best of luck in her new adventures returning to the paediatric clinical setting.
Aboriginal Car Seat Grant
In 2015, the ITIM Aboriginal Trauma Research Grant program provided two grants of $10,000 to the Illawarra Aboriginal Medical Service (AMS) and the Orange Aboriginal Medical Service.
As a result, the Illawarra AMS team commenced the Aboriginal Child Seat Restraint Project. As part of the project the AMS has held several educational events, engaging more than 300 consumers.
During these events the attendees were educated on all aspects of child seat restraints, with sessions including:
- Qualified car seat installers checking and fitting car seat restraints in attendees vehicles.
- Targeted education, including short films and educational material.
- Training for Medical Service employees to check and/or fit restraints at the point of interaction with consumers.
Thanks to these events, they were able to identify incorrect or faulty restraints in attendee's vehicles and rectify the situation, providing injury prevention.
NSW Trauma App
The ITIM is pleased to announce that the second version of the NSW Trauma App is now available for download.
Further development and enhancements of the App have been implemented following feedback from clinicians.
Additionally, there is now a user video that highlights the many features available for use and provides a walkthrough of the App.
More information is available on the NSW Trauma App webpage.
Trauma clinical incidents
The ITIM team has recently engaged with the Clinical Excellence Commission (CEC) Root Cause Analysis (RCA) Review Committee to assist with the review of clinical incidents related to the care of trauma patients.
Where necessary, cases are then cross-referred to the ITIM Clinical Review Committee for commentary and further analysis.
This interagency collaborative is enhancing the level of consultancy and interrogation of cases to better inform system improvement in the care of injured patients across the pre-hospital and hospital settings.
Falls from Ladders Research
The Ladder-related injuries in New South Wales study, by Jenny Miu, Michael M Dinh, Kate Curtis and Zsolt J Balogh, was recently published in the Medical Journal of Australia. This study demonstrates that:
falls from ladders are a significant cause of serious injury and have been increasing in number across Australia.
As a result of the study, ITIM has developed a project in collaboration with Monash University which seeks to reduce the number and severity of injuries from ladder falls in the home environment.
More information and the full study are available on the ladder safety projects page.
Falls Resulting in Major Trauma Infographic
ITIM recently released a Falls Resulting in Major Trauma infographic which highlights data relating to the the increasing number of serious to severe injuries being sustained from falls.
The infographic can be found alongside the road injury infographic, on the ITIM webpage.
Live streaming of Trauma Evenings
In the past 12 months, ITIM has live streaming the trauma education seminars, with the objective of increasing access to trauma education for regional, rural and remote locations.
Over the past seven events, analysis of the livestreaming links show:
- 3,990 views of the live stream feeds
- 60,502 minutes viewed
- 1,288 views post event (50 separate videos)
- 80% views are from Australia
In the coming year ITIM will continue this initiative, with some locations hosting pizza and seminar nights to coincide with the live streaming of the trauma evening to increase the reach of the initiative.
To view a live strean feed or post-event recording of an ITIM trauma education event, visit the ITIM events webpage.
Patient Reported Measures Program
Patient Reported Measures Program Manager
The NSLHD Osteoarthritis Chronic Care Program – A realisation of collecting and using Patient Reported Measures
The Northern Sydney Local Health District (NSLHD) Osteoarthritis Chronic Care Program (OACCP) is an evidence based, integrated model of care which improves the interdisciplinary coordination of care for individuals with hip and knee osteoarthritis. Its primary goals are to reduce pain, enhance function, improve quality of life, slow down disease progression, and ultimately empower individuals to self-manage their condition. The local team has incorporated the patient's voice into their practice through the utilization of conditioned-specific, validated Patient Reported Outcome Measures (PROMs) that guide appropriate referral and inform clinicians and participants of their progress.
The OACCP collects a number of outcome measures, including the Hip dysfunction Osteoarthritis Outcome Scores (HOOS) and the Knee injury Osteoarthritis Outcome Scores (KOOS), which measures participants' pain, function and quality of life in reference to their affected joint. The measures are taken at each appointment to help guide appropriate treatment modalities and referral pathways. More than a third of hip patients reported an improvement in their pain outcomes during the course of the program. Subsequent indicators of functionality in daily living were also reported to have the greatest outcome for patients at Royal North Shore (RNS) Hospital out of all sites involved in the program. Additionally, the program has recently begun collecting Patient Reported Experience Measures (PREMs), moving towards building these into continuous improvement and progression of the program.
The OACCP team has been committed to the collection and use of PRMs for more than a year and continues to work across the LHD to implement PRMs as part of the program, incorporating it into business as usual, in partnership with the ACI PRMs team.
Further achievements of include:
- Being nominated to present to The Australian Council on Healthcare Standards as an example of a new innovative program.
- Seven peer reviewed research papers and four conference abstracts published since the OACCP's inception.
The program is in the final stages of a database built in the electronic medical record that will store and integrate PRMs and will have capacity to generate automated letters to primary care via secure messages using ARGUS.
Primary Health Care Excellence Awards
The North Coast Primary Health Network (NCPHN) hosted an inaugural Primary Health Care Excellence Awards on Friday, 9 August to honour the partnerships, teams and individuals who are committed to finding new ways to keep the people in our communities healthy and out of hospital.
Two separate ACI led initiatives were recognised at the awards, jointly winning the Innovation, Integration and Partnership category.
Congratulations to Kiel Hennessy and the ACI Chronic Care for Aboriginal People team, with the Casino 1 Deadly Step event, and Robyn Speerin and our Musculoskeletal Network, with redesigning Musculoskeletal models of care on the Mid North Coast, on winning the award with their partner organisations.
You can see more about the words and the winning submissions at www.ncphn.org.au/excellence
Radiology Network and Nuclear Medicine Network update
Radiology and Nuclear Medicine Network Manager
Co-Chairs: Barry Soans and Phillip McConnell (Radiology)
Barry Elison and Elizabeth Bailey (Nuclear Medicine)
The Fact Sheets can be printed on a single page and provide information that has been written in consumer friendly language for the following topics:
|Angiogram||Angioplasty and stent insertion||Barium test|
|Biliary (HIDA) scan||Biopsy guided by CT or ultrasound||Bone mineral density test|
|Bone scan||Carotid stent insertion||CT scan|
|Drainage guided by CT or Ultrasound||Embolisation||Gallium scan|
|Gastric emptying study||Gated heart pool scan||Hysterosalpingogram|
|Injection guided by CT, ultrasound or X-ray||Iodinated contrast (dye)||Lung scan|
|Lymphoscintigraphy (sentinel lymph node scan)||Mammogram||Medical imaging tests for children|
|Metaiodobenzylguanidine (MIBG) scan||Magnetic resonance imaging (MRI) scan||Myocardial perfusion scan|
|Nuclear medicine procedures||Nuclear medicine therapy||Parathyroid scan|
|Positron emission tomography (PET) scan||Plain X-ray||Renal scan|
|Thyroid scan||Ultrasound scan||Pregnancy ultrasound|
|Transrectal ultrasound||Transvaginal ultrasound||White blood cell scan|
In addition, the Nuclear Medicine Technologists Group have prepared a Clinician Fact Sheet on radiation exposure and dosage from nuclear medicine procedures.
Thank you to everyone who has contributed to this large piece of work. It is wonderful to have collaborative input from so many units across NSW.
The Fact Sheets will be published on the ACI Renal Network resources page in mid October.
Network Manager news
Welcome to Fidye Westgarth, who has moved into the role of Network Manager for the ACI Radiology and Nuclear Medicine Networks.
Fidye has a wealth of experience with the ACI and has worked as Network Manager for the ACI Renal Network for the past 10 years. Recently Fidye stepped away from the Renal Network and will now be managing the ACI Blood and Marrow Transplant (BMT) Network alongside the Radiology and Nuclear Medicine Networks.
Spinal Cord Injury Network update Co-Chairs: James Middleton and Louise Kelly
Spinal Cord Injury Network Manager
In celebration of World Spinal Cord Injury Day on 5 September 2016 and Spinal Cord Injury Awareness Week 2016, the ACI State Spinal Cord Injury Service (SSCIS) released a new toolkit aimed at supporting the psychosocial needs of people living with a spinal cord injury (SCI).
There is however, a significant amount of trauma associated with acquiring a SCI, and many people will struggle to manage the grief for the loss of both their current way of life and their potential future life. Some will adapt more easily, while others will experience depression and other mental health issues. All will need support to transition to an entirely new, different and often challenging lifestyle.
To help address these challenges for SCI patients, their families and carers, the ACI's SSCIS Psychosocial Strategy has developed a toolkit to support clinicians in understanding and managing psychosocial issues associated with acute and long-term SCI.
The Emotional Wellbeing Toolkit: A Clinicians Guide to working with Spinal Cord Injury initiative covers topics such as managing grief and trauma, common psychological and emotional issues experienced by people with a SCI, and strategies for handling challenging behaviours.
The Toolkit also highlights ways to distinguish between grief and depression, and has a number of brief standardised tools to help clinicians assess mood, anxiety, pain, trauma, substance use and psychosis.
The steering committee responsible for the development of the Toolkit has included experts such as clinical psychologists, allied health professionals and nurses, as well as strong representation and input from SCI consumers.
The production of the Toolkit and related materials was undertaken with the support of the Prince of Wales Foundation from the David Z Burger Foundation.
Stroke Network update Co-Chairs: Nadia Burkolter and Martin Jude
The annual SMART STROKES Conference was held in Canberra at the end of August, attracting more than 360 delegates. ACI Stroke Network Manager Kate Jackson attended on behalf go the Network.
Attendees had the opportunity to hear from inspiring international and national speakers across the program, which included seven keynote speakers, six concurrent sessions, sixty abstract presentations, and thirty-six poster presentations.
The focus of the conference was to provide clinicians with practical, informative ways to enhance stroke services at their individual sites. The feedback from the conference to date has been extremely positive and a feeling of reinvigoration and excitement to try things at 'their own hospitals' was evident throughout the two days. The trade component of the conference was one of the largest ever.
The 2017 Conference will be heading to QLD with the venue and dates for the conference to be confirmed in the coming weeks.
Congratulations Mark Longworth
Network Manager Kate Jackson, Director of Acute Care Daniel Comerford and ACI Rehabilitation Network Manager Claire O'Connor attended the Stroke Recovery Association's official launch of Stroke Week at Parliament House in Sydney recently. Stroke Week was launched by Governor General Peter Hurley, who acknowledged former ACI Stroke Network Manager Mark Longworth's commitment to improving stroke care across NSW. Mark was presented with a Stroke Recovery Association Award for sustained contribution to stroke care. Congratulations Mark!
Staff Spotlight: Renee Fortunato
What are you working on at the ACI?
Since starting as an Evaluation Analyst at the ACI 6 months ago, I have been involved in the evaluation process of a number of diverse ACI programs. I am in a 10 month traineeship position with the Health Economics and Evaluation Team, with the aim of developing evaluation skills within the NSW Health system which has been a great opportunity. The aim of this evaluative work is to determine where and how the program being evaluated has met its intended outcomes and importantly what can still be improved in the future in this or similar programs. Working in Evaluation at the ACI is really interesting as it involves a unique exposure to many of the great programs across the ACI.
Two examples of these larger ACI projects/programs I have been involved in include;
- Planning the next stage of the Evaluation of the ACI Minimum Standards for the Management of Hip Fracture in the Older Person. This has involved the development of an evaluation plan designed so that we can understand the variation in the application and outcomes of the standards state-wide. This plan is also hoping to explore and develop our understanding of what hospital factors have been important in supporting success and are related to the positive changes and impacts intended by the program.
- The other major ACI project I have been involved is the evaluation of the NSW Level 4 Intensive Care Service Model for Adults. This has involved the analysis and interpretation of qualitative data collected from hospital clinician/manager focus groups and surveys. This will help provide an important insight into clinicians and managers perspectives of programs and improvements to improve patient outcomes.
What is your professional background (prior to coming to the ACI)?
I am currently on secondment from the position of Head of Department, Physiotherapy at Campbelltown and Camden hospital in South Western Sydney Local Health District. I have also completed a Masters in Health Service Management in 2014/15 which provided me with a much broader understanding of the health system as a whole. As Physiotherapy Head of Department I enjoyed supporting and seeing the development of physiotherapy staff and working with them in the design, implementation and evaluation of service improvements in collaboration other multidisciplinary team members. Now that I think back, many of these improvements have been supported by the expertise and support provided by the ACI networks and taskforces including areas such as hip fracture, osteoarthritis, osteoporosis, tracheostomy, and health economics.
Tell us an interesting fact about yourself?
I enjoy getting out in the national park with good friends and catching up while trail running. The coastal track in the Royal National Park is my favourite.
Values and Behaviour Award
Congratulations to Kelly Cridland, Manager of the ACI Intensive Care Coordination and Monitoring Unit (ICCMU), who was presented with the ACI Award for Values and Behaviours at a recent all staff meeting.
Promoting and recognising our shared values though the workplace is important in continuing to create a positive and supportive working environment. The ACI Values and Behaviours Awards provide an opportunity to recognise staff who consistently demonstrate our shared values and behaviours.
Nominations for the award are open to all ACI staff. People working within the organisation are given the opportunity to highlight individuals in recognition of their achievements in the demonstration of the ACI values and behaviours charter each quarter.
Kelly was nominated for the award due to her outstanding respect, professionalism and leading collaboration across multiple portfolios and stakeholders for a very complex ICU project in an exemplary way. Congratulations Kelly!