Australian health review : a publication of the Australian Hospital Association
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The Medical Assessment and Planning Unit (MAPU) model provides a multidisciplinary and 'front end loading' approach to acute medical care. The objective of this study was to evaluate the impact of a 10-bed MAPU in Royal Melbourne Hospital (RMH) on hospital length of stay. ⋯ The reductions in length of stay are likely to be of clinical significance at the emergency department (ED) level. The MAPU model also contributes to providing care appropriate care for older admitted patients.
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International medical graduate (IMG) specialists in anaesthesia need education to be part of the assessment process for pre-registration college fellowship. Fellowship of the anaesthetic college is required in Australia for registration as a specialist in this field. ⋯ We also offer an IMG specialists' view of this perceived problem. It highlights their difficulties in obtaining adequate supervision and education.
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The Garling Report, published in November 2008, was a public inquiry into the provision and governance of Acute Care Services in New South Wales Public Hospitals. Garling's 139 recommendations, aimed at modernising clinical care and equipment, include better supervision of junior staff, multidisciplinary teamwork, structured clinical handover and improved culture within health services. ⋯ Given the importance of ward rounds in planning and evaluating treatment, implementation of these recommendations will require further evidence, engagement of senior clinicians and cultural change. This article discusses some of the barriers to Garling's recommendations.
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Chronic disease represents a significant challenge to the design and reform of the Australian healthcare system. The Medicare Benefits Schedule (MBS) provides a framework of numerous chronic disease management programs; however, their use at the patient level is complex. ⋯ As demonstrated by this case study, under certain circumstances the provision of truly integrated care to this hypothetical patient would constitute an 'exceptional circumstance' under the MBS. Although quality improvement efforts can improve functioning within the limitations of the current system, system-wide reforms are necessary to overcome complexity and fragmentation.
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There is considerable variation in the timing of elective pre-labour caesarean section at term where there is no immediate threat to the life of the mother or baby. Given the outcomes, elective or pre-labour caesarean section ought not be offered or performed before 39 completed weeks' gestation. Primary data sources indicated that the rate of term elective caesarean sections with no medical indication undertaken before 39 weeks' gestation at our institution was ~30% in 2005 and 2006. ⋯ Over the 6-month period, the rate of elective caesarean section with no medical indication done before 39 weeks' gestation in the target group fell to 10%. Over the same timeframe the number of admissions to the neonatal nursery of term babies born by caesarean section at less than 39 weeks fell to zero. Although the numbers are small and not statistically significant, this work suggests implementation across larger jurisdictions or states could result in significant improvements in clinical outcomes.