Australian health review : a publication of the Australian Hospital Association
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There is pessimism regarding the ability of the Acute Health Sector to manage access block for emergency and elective patients. Melbourne Health suffered an acute bed crisis in 2001 resulting in record ambulance diversions and emergency department (ED) delays. We conducted an observational study to reduce access block for emergency patients whilst maintaining elective throughput at Melbourne Health. ⋯ Theatre cancellations were also minimised. We conclude that access block can be improved by clinician-led implementation of proven process improvements over a short time frame. The ability to sustain change over the longer term requires further study.
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The objective of the project was to evaluate a pilot Post Acute Community Care (PACC) program for orthopaedic patients. A series of cross-sectional surveys elicited responses of patient and home carer needs and GP and hospital staff acceptability while a cost-minimisation analysis compared the average cost of the PACC program with general orthopaedic hospital care. Patients were classified according to Australian National Diagnosis Related Groups (DRGs). ⋯ Only 3% of patients had an unplanned readmission to hospital. Patients and carers expressed a number of unmet needs. This study confirms the popularity of early discharge schemes with patients, and provides little evidence of adverse health outcomes or that the burden of care is shifted to carers in a way that is unacceptable for this older population.
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Hospital-specific outcome measures based on routine data are useful for stimulating interest in quality of care and for suggesting avenues for more in-depth analyses. They might also identify serious, once-in-a-lifetime failures of health care. ⋯ This is because differences in outcome measures across hospitals can be due to differences in types of patients seen (casemix), differences in data quality, and the play of chance; rather than differences in the quality of care. End-users of such analyses should be aware of these technical difficulties, otherwise skilled health workers in high-quality hospitals might be subjected to unwarranted criticism.
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Comparative Study
Funding Victoria's public hospitals: the casemix policy of 2000-2001.
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Safe and high quality health care is an objective that everybody supports. With so much written about it and everybody committed to it, why are we still struggling to achieve it? The successful acceptance and adoption of casemix provides some clues as to the answer. ⋯ The lessons from the casemix story can be applied to advance the safety and quality agenda. A good place to start is a determined campaign focussing on improving safety.