Australian health review : a publication of the Australian Hospital Association
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Objective The aim of the present study was to determine the effects of hospital-based eHealth technologies on quality, safety and efficiency of care and clinical outcomes. Methods Systematic reviews and reviews of systematic reviews of eHealth technologies published in PubMed/Medline/Cochrane Library between January 2010 and October 2015 were evaluated. Reviews of implementation issues, non-hospital settings or remote care or patient-focused technologies were excluded from analysis. ⋯ Whether EMRs and CPOE can affect clinical outcomes or overall costs in the absence of auxiliary support systems, such as ePrescribing and CDSS, remains unclear. eHealth technologies are evolving rapidly and the evidence base used to inform clinician and managerial decisions to invest in these technologies must be updated continually. More rigorous field research using appropriate evaluation methods is needed to better define real-world benefits and harms. Customisation of eHealth applications to the context of patient-centred care and management of highly complex patients with multimorbidity will be an ongoing challenge.
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Objective The aim of the present study was to explore characteristics of interhospital transfers (IHT) and sharing of care among hospitals in New South Wales (NSW), Australia. Methods Data were extracted from patient-level linked hospital administrative datasets for separations from all NSW acute care hospitals from 1 July 2013 to 30 June 2015. Patient discharge and arrival information was used to identify IHTs. ⋯ What are the implications for practitioners? The findings of the present study suggest that different patterns of IHTs may not only have resulted from clinical priorities, but that organisational and regional preferences are also likely to be influential factors. Patient-centred IHTs and the development of guidelines need to be pursued to enhance the care and functionality of healthcare. Patient sharing should be acknowledged in hospital and regional performance profiling.
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Objectives The aims of the present study were to investigate doctors' attitudes regarding the discussion and writing of not for resuscitation (NFR) orders and to identify potential barriers to the completion of these orders. Methods A questionnaire-based convenience study was undertaken at a tertiary hospital. Likert scales and open-ended questions were directed to issues surrounding the discussion, timing, understanding and writing of NFR orders, including legal and personal considerations. ⋯ What are the implications for practitioners? The findings indicate the issues impeding decision making around cardiopulmonary resuscitation relate to poor knowledge of the law, particularly around the issue of consent and confounding NFR orders with provision of palliative care. Such barriers to the completion of NFR orders expose elderly in-patients to futile and burdensome resuscitation events. The findings suggest consideration be given to education and training materials to inform doctors about jurisdictional law regarding resuscitation documentation, support decision making around cardiopulmonary resuscitation and promote goals-of-care discussions on admission.
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Objective Government expenditure on and the number of aged care facilities in Australia have increased consistently since 1995. As a result, a range of aged care policy changes have been implemented. Data on demographics and utilisation are important in determining the effects of policy on residential aged care services. ⋯ The most significant finding of the study is that one-third of permanent residents had resided in an aged care facility for ≥3 years. These findings add to the overall picture of residential aged care utilisation in Australia. What are the implications for practitioners? The analyses outlined herein illustrate how community, health services and public health data can be utilised to inform policy, monitor progress and assess whether or not intended policy has had the desired effects on aged care services.