​Patient as Partner

​Pathway to Transgender Health: A Community Model of Care

A collaboration by the Hunter Centre for Sex and Gender Diversity and HealthPathways Team

Recent epidemiological studies suggest 0.4-1.3% of the population identifies as transgender: that is a gender incongruent with that assigned to them at birth. Stigmatisation and difficulty accessing healthcare have resulted in high suicidality and mental health issues, HIV rates, and drug and alcohol use in trans people. Our local transgender community identified a lack of health-provider knowledge and absence of a referral pathway as barriers to essential healthcare in our health district.

This project delivered accessible transgender healthcare in partnership with the community by (a) education of the workforce to build capacity; (b) design of an accessible model of transgender health care from childhood across the lifespan, in collaboration with HNE HealthPathways. Our data demonstrates that health-providers increased their confidence to facilitate transgender care and improved their understanding of transgender medicine, including the importance of cancer screening. Our patient-centred pathway was the first guideline in Australia and has since been adopted across regions of Australia and New Zealand. The project has overcome the barriers identified by the community as key to delivery of transgender healthcare.

​Supporting Decision-Making for Early Stage Breast Cancer

This project aimed to develop and evaluate a decision aid designed to help women with early stage breast cancer become more involved in decisions about their treatment. This decision aid was developed specifically for the increasing proportion of women considering chemotherapy before surgery. Patients are unable to participate as fully as they would like in this complex decision. The project was a prospective, longitudinal cohort study to evaluate the acceptability and feasibility of the decision aid, along with several decision-related patient reported outcome measures. Of 51 patients who accessed the decision aid, 80% would recommend it to others. 89% of clinicians would use it routinely. Decision-related outcomes improved. This decision aid can be easily incorporated into routine workflow, to support patients as partners in healthcare.

​Guiding Sick Day Management: A Diabetes App for Patients and Parents

Management of Type 1 Diabetes (T1D) during illness requires adjustment of insulin and fluids to maintain blood glucose levels within a safe range and prevent Diabetic Ketoacidosis (DKA) and hypoglycaemia. Generic written sick day plans do not provide individualised guidance.

We developed a Diabetes Sick Day App (DiSiDa), to provide an interactive and engaging tool to assist parent's problem solve sick days.

An algorithm reflecting current best practice was developed and the app built to our specifications by a local IT developer. The app was widely tested by diabetes health care professionals and consumers. The app is progressively being rolled out to patients through the JHCH Paediatric Diabetes clinic.This project has resulted in an innovative method of supporting parents managing T1D in children.

​Integrated Health Care

​Aboriginal Ear and Eye Health Program 2015-2016

Aim: Early identification of hearing and vision issues of Singleton Aboriginal school students, and provide support and interventions to lessen the impact of chronic otitis media on health and learning. It is recognised - Aboriginal children are at greater risk of ear/ hearing and vision problems.   

Method: The program was developed by health and educational professionals to meet this aim. With the collaboration of Singleton Community Health staff, the Aboriginal Health Unit and the assistance of Aboriginal support teachers, this integrated school based program was introduced in 2015.

Result: A total of 209 ear and 161 eye assessments were conducted with more than one third of students requiring further evaluations.

Conclusion: Outcomes demonstrate the success of the program in meeting the stated aims.

​Improving Afghan Women’s Engagement with Maternity Services

In 2014 a community of Afghan refugees settled in Newcastle. Following this, a local health issue was identified as pregnant Afghan women were not engaging well with local antenatal care services. Antenatal care is a well-established means of improving maternal and perinatal outcomes.

This project set out firstly to identify any barriers associated with poor antenatal clinic attendance and then to address these barriers. The overall aim was to improve early engagement of Afghan women with antenatal care and increase their number of visits to the antenatal clinic.

A number of barriers were identified, not all of them cultural. Solutions were developed that have been shown to contribute to significant improvements in Afghan women’s attendance to antenatal care and their experience with Maternity services.

​Healthy Tums, Healthy Gums

Nutrition and oral health share a co-dependent relationship, with childhood decay 70% more common in vulnerable groups. A partnership was formed between HNE Oral Health and Tamworth Child and Family Dietetic Services to develop a strategy to enable individual capacity building of families. Stakeholder consultation engaged patients as partners and external agencies, resulting in the development of HTHG nutrition and oral health program that embeds and integrates healthy living messages. The program employs techniques to support low literacy and evaluation indicates 100% of families understand links between nutrition and oral health. The program has been delivered in Peel, Lower Mid North Coast and Greater Newcastle sectors. HTHG is now in a train the trainer model making the program highly transferable, with engaged external agencies including Family Action Centre University of Newcastle; Family Support Services; Benevolent Society; and recently Tasmania - Oral Health, Health, Education and NGO’s (Save the Children).

​Translational Research

Dextrose Gel: Reducing Neonatal Admissions to NICU

Prevalence rates of mild to moderate Neonatal Hypoglycaemia are increasing due to the increasing incidence of preterm birth, maternal obesity and gestational diabetes. In JHH the standard treatment for neonatal Hypoglycaemia was to supplement breast milk or formula feeds with additional formula. Supplementing breast feeds with formula can be traumatic for some mothers as it is known to impact negatively on the initiation and establishment of breastfeeding.  Babies with persistent low blood glucose levels are admitted to the nursery for increased monitoring and medical intervention, thus separating mothers and their babies, interfering with early bonding and further disrupting breastfeeding establishment.

The aim of this new evidence based change intervention was to assess if results from a New Zealand trial, published in 2013 would be transferrable to JHH maternity setting and effectively reduce admissions to NICU for hypoglycaemia.

​Participatory Action Research to guide Aboriginal health resources

Traditionally, Aboriginal and Torres Strait Islander communities educate their people through stories, art and lived experience of people in their community. Health resources for Aboriginal and Torres Strait Islander people needs to be developed using these approaches to make the resources culturally appropriate and enduring over time.  Participatory Action Research (PAR) was used to develop and evaluate culturally appropriate educational resources for stroke. Research Topic Yarning (RTY) was used to engage the community and collect data. PAR and RTY are considered a collaborative and safe way to uncover vital information and concepts to underpin resource development. PAR reflects the way Aboriginal people embrace learning through action, collective decision-making and empowerment, which occurs via group activity over time. This process can be translated across communities.

​Supporting Lifestyle and Activity Modification after Transient Ischemic Attack (SLAM-TIA)

Aim: Despite the known efficacy of education-exercise programs on improving cardiovascular health, none exist for HNE LHD TIA patients. Supporting Lifestyle and Activity Modification after TIA (SLAM-TIA) developed by the Community Stroke Service fills this service gap.

Methods: SLAM-TIA is a group stroke-prevention, education-exercise program delivered in a community gym twice weekly over 6 weeks and supplemented with fortnightly telehealth coaching.

Results: Patients (n=24, median age 73) have made clinically meaningful improvements in 6 Minute Walk Test distance (37m (95% CI -9.3 to 83.4), p=0.1) and statistically significant reductions in systolic (13.0mmHg (95% CI 8.1 to 17.8), p<0.001) and diastolic blood pressure (8.3 mmHg (95% CI 4.1 to 12.6), p<0.001).

Conclusion: SLAM-TIA is an effective model to improve patient morbidity through better cardiovascular health.

​Transforming Health

​Telehealth – Virtually Transforming our Care to Aged Care

Clinical handover is high risk for complex frail residential aged care facility (RACF) patients. Hospitalisation risk includes falls, delirium and pressure injuries. Belmont Hospital in partnership with Anglican Care has incorporated video telehealth to the assessment of acutely unwell residents requiring transfer to ED as well as bedside discharge handover model when residents are returning home from hospital or being newly admitted to a RACF. Visual assessment facilitates higher levels of communication, aiming to decrease hospital presentation of RACF residents. The program has improved the quality of handover from hospital to RACF, along with emergency calls from RACF to Hospital ED, and allowing greater participation of family and carers.

Twenty-six telehealth calls have occurred with regular partnership meetings resulting in a 30% reduction in ED presentations.

​Improving Theatre Efficiency Through Smarter Scheduling

Aim: To improve theatre efficiency at The Maitland Hospital.

Method: The Operating Suite model of care was re-designed by using more accurate procedure times for list scheduling, and shifting the model from one emergency theatre and two elective theatres, to three elective theatres in the morning and three emergency theatres in the afternoon.

Results:  Despite 5% more emergency surgical procedures in 2016, average access time to emergency surgery was improved from 17.1 hours to 14.6 hours. More emergency surgery (7%) was done in-hours. There was an 11% reduction in average length of stay for emergency surgical patients, resulting in 1190 bed days saved.

Conclusion: Accurate procedure times and a split elective/emergency theatre model can deliver improved care, at the right place, at the right time.

​Tenterfield, Telehealth and Nutrition: Dietetics a New Way

Armidale community health dietitians in partnership with Tenterfield community health staff have established a dietetics outreach service to the Tenterfield community.  Utilising telehealth for clinical dietetics consultations has meant that this service is provided in an efficient and timely manner. By eliminating four hours travel time per clinic it has doubled the number of clients that can be seen in an ordinary working day. A strong partnership has been established between the Tenterfield community nurse, the administration staff and the Armidale dietetics team driven by the dedication of all involved to provide the local Tenterfield community with a dietetics service when previously there were no local options.

​Enhancing the Patients' Experience through the Arts

​Measuring Happiness via Music & Memory Program in Aged Care

The aim of the project is to assess if the application of individualised music sessions provided via iPods can improve a resident’s happiness following the music’s intervention. The method was to assess the resident pre and most music session, asking the resident how they were feeling or by observation by a person known to the resident, using modified Wong-Baker FACES tool. The results showed overall positive improvements in happiness post individualised music sessions from 41% who reported/assessed to be ‘a little, fairly or very happy’ pre music session to 86% post session. In conclusion, the use of individualised music therapy for evoking memories and feelings improved in the overall happiness of residents in aged care.

​Music group activity on a mental health inpatient unit

Aim: To implement a music group on our mental health inpatient unit, using existing staff and resources, and to then formally study the impact of the activity.

Method: We set up a music group which runs for an hour, twice a week, led by staff members, who provide a choice of music, teach the songs, and lead the singing on either piano or guitar. We then conducted a mixed method study to evaluate the activity.

Results: The music group we set up continues and is well received and attended. The qualitative and quantitative results of our study were very positive.

Conclusion: We successfully implemented a therapeutic music group activity on our ward, which has been beneficial for patients, staff morale and the ward milieu.

​Collaborative Team

Door to drug time for Sepsis patients: doing it better at Belmont

AIM: to reduce time to first antibiotics for patients presenting to Belmont Emergency Department with sepsis

METHOD: The BH Sepsis lead worked collaboratively with key stakeholders to implement a multimodal approach to raising clinician awareness of the importance of early recognition and treatment of sepsis. Interventions included regular audits; targeted education programs for clinical staff, Sepsis September - a month dedicated to sepsis awareness and education; BH Sepsis Road show, and the introduction of a Sepsis Education Board in the Emergency Department

RESULTS: Belmont ED has seen a reduction in time to first antibiotics from a median time of 254 minutes in 2012 to 36 minutes in 2017. [Target best practice is 60min or less].

CONCLUSION: A shift in culture has occurred in the Emergency Department with use of the sepsis pathway now embedded as routine best practice. 

​Improving access to Urgent Care – Gastroenterology Outpatient Service

Aim: Reduce the time that patients who are triaged as ‘urgent’ (appointment within 30 days) wait for an initial appointment at JHH Gastroenterology Outpatient service.

Method: Redesign of triage and intake processes to reduce variation in practice within the Gastroenterology team to improve access to specialist care for patients requiring review within 30 days.

Results: Activity data collected pre and post implementation of process change has identified significant improvement in access and wait times. Post implementation, urgent patients wait a median of 26 fewer days to access an initial appointment. The number of urgent patients seen for an initial appointment has increased by 63% 

Conclusion: Taking a standardized, team based approach to managing the outpatient wait list for appointment has significantly improved access and wait times for patients categorized as needing an urgent appointment.

​Let’s Eat Together: Rural Feeding Assessment Clinic 

Client feedback and clinical reflection suggested that families with pediatric feeding issues currently needed to wait on multiple lists and attend multiple appointments. This multidisciplinary feeding clinic assessment model was trialled to reduce client wait times for multidisciplinary care, improve the consumer experience, provide clinical care coordination and ultimately improve patient outcomes.

A multidisciplinary clinic (Dietetics, Speech, and Occupational Therapy) was established with a centralised intake and triage point, and simultaneous assessment by all professionals.  Retrospective data collected  indicated reduced client waiting time to access a comprehensive multidisciplinary assessment  and   reduction in the direct occasions of service a client needed to attend, thus reducing travel time and expense.  Client feedback has indicated positive experiences around reduced waiting times and simplification of the service for clients.