Australian health review : a publication of the Australian Hospital Association
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This study aimed to better understand the carbon emission impact of haemodialysis (HD) throughout Australia by determining its carbon footprint, the relative contributions of various sectors to this footprint, and how contributions from electricity and water consumption are affected by local factors. ⋯ State-by-state contributions of energy and water use to the carbon footprint of satellite HD appear to vary significantly. Performing emissions planning and target setting at the state level may be more appropriate in the Australian context. What is known about the topic? Healthcare provision carries a significant environmental footprint. In particular, conventional HD uses substantial amounts of electricity and water. In the UK, provision of HD and peritoneal dialysis was found to have an annual per-patient carbon footprint of 7.1t CO2-eq. What does this paper add? This is the first carbon-footprinting study of HD in Australia. In Victoria, the annual per-patient carbon footprint of satellite conventional HD is 10.2t CO2-eq. Notably, the contributions of electricity and water consumption to the carbon footprint varies significantly throughout Australia when local factors are taken into account. What are the implications for practitioners? We recommend that healthcare providers consider local factors when planning emissions reduction strategies, and target setting should be performed at the state, as opposed to national, level. There is a need for more comprehensive and current emissions data to enable healthcare providers to do so.
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Comparative Study
Hospital readmission among older adults with congestive heart failure.
To examine the factors associated with unplanned readmission among older adults with congestive heart failure (CHF) within 28 days of discharge from an index admission, within a large Australian health service. ⋯ The high risk of patients being readmitted from acute, subacute and aged-care services requires further review as these readmissions may be avoidable. It may also be useful to develop a readmission risk screening tool so that patients at risk of readmission can be identified. What is known about this topic? Older adults with CHF are likely to experience multiple readmissions to hospital. There have been several studies conducted on hospital readmissions; however, generalising the findings is problematic due to the use of variable definitions of what constitutes a readmission. What does this paper add? This paper addresses the absence of Australian research comparing groups of older patients with CHF who are readmitted to hospital with those who are not readmitted. It also adopts one of the more frequently used definitions of readmission to aid in future comparability of research. What are the implications for practice? Further work is necessary to improve discharge planning and effectively manage chronic illnesses such as CHF in patients' homes. It may be useful to develop a readmission risk screening tool for staff of inpatient medical wards so that these at-risk patients can be identified before discharge.
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This study aimed to measure the prevalence of malnutrition risk and assessed malnutrition in patients admitted to a cancer-specific public hospital, and to model the potential hospital funding opportunity associated with implementing routine malnutrition screening. ⋯ Early identification of malnutrition may expedite appropriate nutritional management and improve patient outcomes in addition to contributing to casemix-based reimbursement funding for health services. A successful business case for additional clinical resources to improve nutritional care was aided by demonstrating the link between malnutrition screening, hospital reimbursements and improved nutritional care. What is known about the topic? It is known that between 20 and 50% of hospital patients are malnourished and oncology patients are 1.7 times more likely to be malnourished than are other hospitalised patients. Despite the existence of practice guidelines for malnutrition screening of at-risk oncology patients, these are not routinely implemented. Identification of malnutrition in hospitalised patients is linked to casemix funding via DRG. Casemix reimbursement for malnutrition can be enhanced if: (1) malnutrition risk is identified; (2) malnutrition is diagnosed; (3) the word 'malnutrition' and an associated action plan is documented in the medical record; and (4) malnutrition is recognised and recorded by the clinical coder. Amendments to the ICD-10-AM in 2008 allowing malnutrition to be recognised as a complication for coding when it is documented by a dietitian in the medical history has hospital reimbursement implications for dietetic practice. Reimbursement potential for malnutrition has been calculated in public hospitals in Australia with varying results. What does this paper add? This paper reports the components of a successful business case made to enhance resources for identification and treatment of malnutrition on the basis of improved treatment as well as enhanced reimbursement potential resulting from changes to the ICD-10-AM. The present study adds to the body of literature showing that malnutrition coding contributes to casemix funding in Australian public hospitals, as well as internationally, and highlights the previously unreported opportunity for a cancer-specific health service. This work demonstrated that reassignment of a DRG based on a diagnosis of malnutrition altered the overall casemix funding value for 12% of audited patients. This compares with the findings of other authors who demonstrated hypothetical DRG changes and financial reallocation. What are the implications for practitioners? This paper highlights that practitioner-centred strategies are needed to enhance malnutrition identification, diagnosis, documentation and coding to maximise casemix reimbursement and better treat malnutrition in hospitals. Strategies include education of the dietetics, medical and health-information workforce. This manuscript provides a description of the conduct of quality-improvement activities that may support successful business cases for increased dietetic resources in future.
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A trial of a new model of triage (Specific and Timely Appointments for Triage: STAT) at a community rehabilitation program (CRP) reduced the mean time to first appointment from 17.5 to 10.0 days. However, quantitative findings reveal little about the impact of the system on those who used it. We aimed to explore the experiences of patients and clinicians following the introduction of STAT. ⋯ The qualitative data provide context to the quantitative results by showing that the changes that reduced waiting times were also well accepted and perceived to be beneficial by both patients and clinicians. What is known about the topic? Triage systems are widely used but can contribute to inefficiencies in health care. An alternative method of triage (STAT) using early allocation to face-to-face appointments has been shown to reduce waiting times in a community rehabilitation service. What does this paper add? This paper explains and adds important context to the quantitative findings by exploring the perceptions of the staff and patients who experienced both the existing and alternative models of triage. What are the implications for practitioners? The STAT model was well received by staff and patients, suggesting that this simple intervention was a feasible and effective method of reducing waiting times for community rehabilitation, and may be applicable to other services that share similar features.