IGP - Successful Applications

Implementation of Benign Paroxysmal Positional Vertigo (BPPV) Clinical Practice Guidelines across Rankin Park Physiotherapy Services

Saving Babies Brains: Intraventricular haemorrhage reduction in extremely premature neonates

Empowering Aboriginal communities: a strengths-based approach to co-designing cultural adaptations as part of the Healthy Beginnings for HNEKids Program

Consumer-informed Approach to Risk reduction Education for Stroke inpatients (CARES)

Improving timely access to emergency department care through an enhanced fast-track model of care

Improving accessibility and equity of John Hunter Hospital Complex Trauma Clinic by establishing a Trauma virtual care clinic for regional and remote patients (1 year pilot)

A crisis response to violence, abuse & neglect in HNE small sites: A Virtual Care trial

Anita Barbara - HNE Violence, Abuse and Neglect (VAN) Service, District Manager

Aims:

To trial a feasible and effective integrated crisis response to violence, abuse and neglect presentations at two District Hospitals in HNE.The project will build on a new face-to-face model to transition the service to a Virtual response, allowing access and equity of service across the District. The project aims to address the known and prioritised health issue of the experience of domestic and family violence and child protection concerns in our community and provide a primary and timely response to people in need.

Delivering timely, localised, subspecialist care to regional and rural stroke patients – locally co-ordinated stroke telehealth clinics

Dr Carlos Garcia-Esperon - JHH Neurology, Director Acute Stroke Services

Aims:

To rollout the hybrid telehealth model successfully piloted in Manning Base Hospital through three other hospitals in HNE located in the northern sector (Tamworth, Armidale and Moree Hospitals). These hospitals have a combined number of stroke admissions of >250 patients per year, and a very large representation of high-risk groups for stroke.

This project aims to determine the:

1. Clinic Utility: medication changes, requests for additional investigations, participation in stroke clinical trials
2. Clinic acceptability: Attendance rate
3. Process of care: Waiting time to first appointment, distance travelled
4. Patient satisfaction
5. Composite cardiovascular endpoint at 12 months

Introducing a Smoking Cessation Program into the Neonatal Intensive Care Unit

Dr Kaya Zawada - Neonatal Intensive Care (NICU), Neonatologist

Aims:

To introduce a structured and sustainable system for offering smoking cessation support to all parents who come through the NICU. The program would provide all parent smokers with initial counselling early in their NICU stay, and NRT if they choose this, with follow up for progress during their baby’s admission and on discharge home. The expected impact being a decrease in the number of babies that went home into a smoking household and suffered from potentially serious side effects of second-hand smoke.

Establishment of a JHH Polyp Surveillance Recall System

Bridie Ingham – JHH Outpatient Service, A/Service Manager

Aims:

1. Establish a streamlined recall system for patients requiring polyp surveillance via the John Hunter Hospital (JHH) and Belmont District Hospital (BDH) health care facilities.
2. Identify existing and future patients who would benefit from this model of care.
3. Maximise outpatient clinic appointment use by avoiding unnecessary appointments for polyp surveillance patients
4. Minimise lost to follow up and ensure surveillance colonoscopies are performed in line with the clinical practice guidelines for surveillance colonoscopy
5. Prevention of disease progression by adherence to clinically indicated surveillance protocols.

Aboriginal Clinical Immersive Program

Jacqueline Sherwood – Child Development Team (CDT), Senior Social Worker /Team Leader

Aims:

Improved confidence and competency when working with Aboriginal People and communities. Specifically, this project aims to expose clinicians to the implicit aspects of working with Aboriginal People that are often missed in explicit training programs. This is done by having a Aboriginal Clinician immersing themselves in all aspects of the team: clinical appointments, team meetings, general case discussions etc. so that CDT clinicians can see and experience working from a Aboriginal perspective. Furthermore it is anticipated that this will improve partnerships, competency, promotes long lasting change and improve the experience of care for Aboriginal children.

Improving referral pathways for Early Intervention (EI) screening for children < 5 years in Armidale

Dr Elizabeth Cotterell – Armidale Paediatrics, Senior Staff Specialist

Aims:

1. To develop a referral pathway for children aged > 2years and < 5 years with developmental concerns as an integrated approach for allied health and paediatrician assessment.
2. To improve access through a clear intake process and appropriate assessment by a face to face screening clinic appointment for children who are eligible on the basis of agreed criteria with vulnerable families an identified focus.
3. To improve efficiency of clinician time, through referral onto National Disability Insurance Scheme (NDIS) EI pathways, further paediatrician diagnostic assessment or further allied health management.

The implementation of a multi-disciplinary Atrial Fibrillation (AF) clinic: A pilot Improvement program

Dr Trent Williams – Cardiology, Clinical Nurse Consultant / Clinical Health Services Research Fellow

Aims:

To determine the value based health care benefits in the introduction of a multidisciplinary AF clinic. Including:

1. Assessment of a new model of multi-disciplinary care to address the adverse outcomes of AF.
2. Comparison of the costs associated with the implementation of evidenced based care to the current model, to inform widespread implementation of this project.
3. Improvement of cardiovascular care, education, referral, support and long-term follow-up of AF patients that will shift the care paradigm to guideline based care to improve the long-term health outcomes of AF patients.

Evaluation of an online education program to improve the delivery of physical activity to students in the Hunter New England region.

Dr Nicole Nathan - HNE Population Health, Program Manager/Research Fellow.

Aim:

1. To assess whether an online multi-strategy implementation support model (lower cost, less resource-intensive and more accessible) is as effective in increasing teachers’ scheduling of physical activity as the current service delivery model (PACE).
2. To compare the costs associated with delivering the amended implementation support model compared to the current model.
3. To explore the acceptability, feasibility, appropriateness and fidelity of delivering the amended model to schools across HNE.

Rolling out online mental health triaging as a new business process

Dr Irosh Fernando - Staff Specialist Psychiatrist, HNE MH Service.

Aim:

1. Reduce triage time by shortening the clinical interview through the online assessment and easing the clinical documentation by prepopulating the assessment form.
2. Reduce the length of waiting time and call abandonment rate through the online assessment.
3. Improve the quality and comprehensiveness of the triage resulting in a better quality of care and decreased incidents of adverse outcomes.
4. Improve consumer engagement and satisfaction by empowering them to take an active role in their triage
5. Reduce costs to the system that are associated with MH triage, though better relative costs per patient.

Reducing perioperative pulmonary complications in people undergoing high-risk abdominal surgery

Dr Jennifer Mackney, HNE JHH Physiotherapy Sr Clinical Specialist and UoN School of Health Sciences.

Aim: The primary aim of this proposed improvement project is to examine the feasibility of delivering a preoperative physiotherapy education intervention to all patients undergoing UAS at JHH. The secondary aim is to identify if the intervention leads to a reduction in PPCs in the postoperative period until acute hospital discharge, and that an associated reduction in resource usage is conferred.

The acceptability, feasibility and effectiveness of a m-health service delivery model, incorporated into routine Child and Family Health model of care, to improve the provision of support provided to families in the First 2000 Days of life

Dr Rachel Sutherland - HNE Population Health, Program Manager.

Aim:

1. Increase the proportion of mothers that are receiving ongoing best practice care from CFHN at 6 months post-natal, aligning with the NSW Health First 2000 days policy.
2. Assess the feasibility and acceptability of the mHealth model of care which complements existing face to face model to CFH Nurses and mothers.

Chest Ultra-Sound Targeting Acute Respiratory Distress (CUSTARD) project

Dr Michael Zhang - HNE JHH Emergency Medicine Sr Staff Specialist.

Aim: The aim of this project is to promote the utilization of chest ultrasound on paediatric patients with respiratory distress. As a result, these patients will have be subject to less radiation and receive better clinical care from more effective clinical diagnosis.

Increasing the ease and quality of mental health assessments and triaging using a mobile application: implementation in Telepsychiatry

Aim: 1) Reduce MH assessment time by at least 20 min through the online data collection and easing the clinical documentation by prepopulating the assessment form with the data.
2) Reduce ED wait time through the online assessment by increasing the clinician’s availability through increased efficiency and patient throughput.
3) Improve the quality and comprehensiveness of the MH assessment and its documentation resulting in a better quality of care and decreased incidents of adverse outcomes.
4) Improve consumer engagement and satisfaction by empowering the them to take an active role in their MH assessment.
5) Reduce the Did Not Wait numbers

CFHNS Telehealth Lactation Project

Aim: The pilot project will assess the feasibility, acceptability and potential efficacy of a multilevel approach to providing breasfeeding support, combining both universal and targeted strategies. The pilot study will be conducted in the Charlestown CFH clinic and aims to:
i) increase CFH nurse knowledge and confidence to deliver breastfeeding support
ii) assess the acceptability and feasibility of delivering specialized breastfeeding and lactation support to mothers via telehealth services from nurse and mothers perspective, and
iii) increase the duration of exclusive breastfeeding to align with recomendations (around 6 months)

The Healthtracker Project. Tracking surgical site infection post caesarean section through post hospital discharge surveillance.

Aim: The project aims to implement and test the feasibility of the HealthTracker SSI surveillance intervention in improving the identification of SSI surveillance in women who give birth by CS. This project will facilitate the provision of accessible data not previously available for accurate and ongoing post CS SSI monitoring, providing baseline SSI rates to increase awareness of true SSI rates and to evaluate the effectiveness of future evidence-based preventative practices. If successful, the team will apply for grants to implement on a larger scale

Co-designing solutions to improve the care of low back pain patients in the Emergency Department

Aim: Based on the locally sourced data we have we aim to pilot strategies to support ED management of LBP. The pilot aims to:

• Explore options (community-based and hospital-based) to reduce unnecessary LBP presentations
• Improve patient flow through the ED, by reducing wait time to appropriate analgesia and medical officer and physiotherapy review, and by optimising documentation
• Support ED clinicians to deliver optimal care
• Decrease the number of hospital admissions for LBP
• Optimise discharge time and offer a high quality discharge option for patients with LBP

Implementation of a web-based initiative to improve childcare service healthy eating policies and practices.

Team: A/Prof Luke Wolfenden (NHMRC Career Development Fellow; HNE Program Manager); Dr Alice Grady ( Post-doctoral Researcher); Dr Nicole Nathan (NHMRC Translating Research into Practice Fellow; HNE Program Manager); Ms Courtney Barnes (PhD Candidate; Project Officer); Ms Karen Gillham (Director, Health Promotion); Dr Jannah Jones (HNE Program Manager); MS Tameka McFayden (Aboriginal Public Health Nutritionist); Mr Christophe Lecathelinais (Statistician)

Aim: Overweight and obesity imposes significant economic and societal burden. Within HNE, high body mass index accounted for 46.1 deaths and almost 1000 hospitalisation / 100,000 population in 2016. Poor nutrition is one of the most important modifiable risk factors for the development of obesity. Australian children consume 35% of their daily energy intake from unhealthy foods, and less than 10% consume the recommended serves of vegetables. Indicators of a healthy diet among children is similarly low in NSW and disproportionately affects Aboriginal children. As early childhood is a formative time for developing healthy eating behaviours, strategies delivered to settings that access large segments of young children such as childcare services are crucial in reducing the burden from obesity. This grant will fund the team to explore the usefulness of an online program in supporting childcare services to create environments supportive of healthy eating.

Increasing the ease and quality of mental health assessments and triaging using a mobile application: implementation in Tele psychiatry

Team: Dr Irosh Fernando (Staff Specialist Psychiatrist, Newcastle Community Mental Health Service HNELHD); Associate Professor Lisa Lampe (Staff Specialist Psychiatrist; Site Coordinator of Training; Head of Discipline of Psychiatry, School of Medicine and Public Health); Laureate Professor Robert Sanson-Fisher (Director, Health Behaviour Research Group); Associate Professor Mariko Carey (Researcher, Health Behaviour Research Group); Dr Chris Oldmeadow (Director, Clinical Research and Statistical Support Unit); Penny Reeves (Health Research Economist); Phillip Collard (Manager); Dr Rahul Gupta (Clinical Lead NMHEC-RAP Tele psychiatry Service; Staff Specialist Psychiatrist); Kate Simpson (Clinical Coordinator Mental Health Line (MHL) and Northern Mental Health Emergency Care-Rural Access Program (NMHEC-RAP)); Dr Cyriac Mathew (Clinical Director, Staff Specialist Psychiatrist); Dr Agatha Conrad (Research Manager); Fionna Murphy (Service Director); Sharon Eriksson (Nurse Unit Manager); Martin Feenstra (Clinical Nurse Specialist 2); Kim Stewart (Nurse Unit Manager); Dr John Towney (Lecturer in Aboriginal Health); Todd R. Heard (Clinical Leader / Senior Psychologist);

Aim: 1) Improve the quality and safety of mental health assessments
2) Increase consumer engagement
3) Reduce clinician time
4) Reduce length of stay in ED

Fixing a wee problem – will broader implementation of our evidence-based Structured urinary Continence Assessment and Management Plan intervention improve continence care for HNELHD patients? (I-SCAMP)

Team: Dr Di Marsden (Manager Professional Education and Development); Kerry Boyle (I-SCAMP Project Officer / Stroke Coordinator); Louise Jordan (retired- previously Manager Clinical Service Delivery); Judith Dunne (Clinical Nurse Consultant Rehabilitation); Jodi Shipp (Clinical Nurse Educator); Sally Ormond (Stroke Coordinator); Amanda Styles (Rehabilitation Clinical Nurse Consultant); Jackie Birnie (Stroke Coordinator); Michelle Paul (Nurse Practitioner); A/Prof Michael Pollack (Clinical Lead / Senior Rehabilitation Staff Specialist); Prof Dominique Cadilhac (Head of Translational Public Health Research Division, Stroke and Aging Research Group / Head Public Health and Health Services Research (Stroke Division) and Implementation Science Lead, Monash University); A/Prof Jed Duff (School of Nursing, University of Newcastle); Kimberley Veitch (on Maternity leave- Acting Sub-acute Stroke Research Program Manager); Annalese Johnson (Acute Stroke Research Manager)

Aim: I-SCAMP is a real-world, non-controlled, before- and after- implementation research project, being conducted on 15 wards at 12 hospitals across 2 states. The aim of the project is to increase the proportion of inpatients who receive urinary continence assessment, diagnosis and a management plan, as well as to increase the skills, knowledge and confidence of clinicians. The project team led by the Hunter Stroke Service (HNELHD), includes clinicians and managers from the participating hospitals, academics, ACI Stroke and Rehabilitation Network Managers and the Stroke Foundation. The team has synthesised the best-available evidence for inpatient urinary continence assessment, diagnosis, and management into the intervention. The intervention consists of the Structured urinary Continence Assessment and Management Plan (SCAMP) form, its associated clinical guideline, and education modules. It is targeted at clinicians working on the wards/ units. The project team is using evidence-based implementation approaches. Their strategies include building a community of practice, audit and feedback, education and training, ward manuals/ resources, and site champions. The team is collecting data, including medical record audits and clinician questionnaires, before- and after-implementation and after a maintenance period. They are also conducting an economic evaluation. Most wards have begun implementation, and are already starting to see practice changes. The team look forward to sharing the results for this project that is addressing a common but often taboo subject.

Penicillin and Cephalosporin Antibiotic Allergy De-labelling in the Perioperative Setting

Team: Dr Benjamin Pons (Anaesthetic Registrar); Prof. Josh Davis (Infectious Diseases Senior Staff Specialist); Paul Healey (Director Peri-Operative Medicine); A/Prof Michael Boyle (Allergy and Immunology Senior Staff Specialist); A/Prof Ross Kerridge (Senior Staff Specialist Anaesthetist); Dr Catherine Berry (Infectious Diseases Staff Specialist); Christine Mcintosh (Perioperative Nurse Unit Manager).

Aim: Antibiotic allergy labels to penicillin or cephalosporins are common. Approximately 15% of perioperative outpatients have an allergy label to these types of antibiotics with up to 90% no longer being truly allergic. Unfortunately, these patients often receive alternative antibiotic treatments that are suboptimal and associated with worse outcomes.
Our project aims to improve prescribing of recommended antibiotics for surgery by introducing a perioperative penicillin and cephalosporin allergy “de-labelling bundle”. This bundle involves assignment of allergy risk, on-site oral allergy testing or referral to an allergy specialist. Non-allergic patients will have their allergy label updated on hospital electronic records and a letter sent to their General Practitioner. By de-labelling resolved allergies, our project aims to optimise antibiotic prescribing for surgery as well as for future indications.

Improving timely access to young people's transgender health services: a novel web-based approach.

Team: Katie Wynne, Liz Nunn (HCSGD committee and CNC Paediatrics JHCH), Luke Wolfenden (A/Prof Behavioural Science, University of Newcastle), Ben Britton (Senior Clinical & Health Psychologist, Consultation Liaison Psychiatry), Patricia Crock (A/Prof Paediatric Endocrinologist JHCH), Wez Saunders (HCSGD committee and ACON Hunter), Yolande Goodyear (HCSGD committee and Child & Adolescent Psychiatrist CAMHS Hunter Valley), Lucas Coleman (Manager Communication, Fundraising and Volunteering , Children, Young People and Families Health Services), Sandra Fitzgerald (HNE HealthPathways), Kaete Walker (HCSGD President and HNE Mental Health Services), Judy Luu (HCSGD committee and Endocrinologist), Suzanne Marchant (HCSGD and parent support group), Jay Majella (HCSGD committee and Social Services), Jo Mills (HSCGD Committee and Service Effectiveness Specialist: Youth, Homelessness & MCIS), Steve Kelly (HSCGD Committee and Principle GP), Prudence Lopez (HMRI and Paediatric Endocrinologist), Mathew Watson (Physician JHH Obstetrics and Gynaecology), Maansi Arora (Medical Student University of New England) and Tinashe Dune (Senior Lecturer in Interprofessional Health Sciences, Western Sydney University).

Aim: Although an evidence-based care pathway exists, local community and GPs report a lack of knowledge, recommendations and awareness of services, preventing access to local transgender healthcare. This project aims to assess the impact of a web-based behaviour change program on reducing time taken from presentation to specialist care.

Toward Excellence in Eczema: Improving the outcomes of care for children and adolescents (0-16 years) with severe eczema  via a multidisciplinary severe eczema clinic (MD SE Clinic).

Team:  Jan Belcher (Clinical Nurse Consultant, Paediatric Allergy / Immunology, Department, John Hunter Children's Hospital), Emily Easman (Clinical Nurse Consultant, Paediatric Immunology, JHCH),Dr Rani Bhatia (Dietitian, Paediatric Allergy Immunology, JHCH), Dr John Relic (Dermatologist, JHH), Michelle Perrin (Child Life Therapist, JHCH), Dr Gena Lieschke & Michelle Giles (Nursing and Midwifery Research Centre  NMRC), Kamana Bantawa (Nursing and Midwifery Research Centre  NMRC).

Aim: Pilot a new model of care (MoC) for managing children and adolescents (0-16 years) with severe eczema. The MoC will consist of an integrated, coordinated multidisciplinary, multimodal approach to care delivery. This integrated and comprehensive approach will increase compliance to and effectiveness of treatment(s), resulting in improved patient and family outcomes.

A pilot feasibility randomized controlled trial of targeting patients’ own pre-illness basal blood pressure during management of shock in ICU.

Team: Dr Rakshit Panwar, Dr Ken Havill (ICU Director and Senior Staff Specialist, JHH), Prof John Attia (Professor, Medicine and Clinical Epidemiology, HMRI), Prof Andrew Boyle (Professor of Cardiology, JHH).

Aim: This pilot RCT aims to determine whether patients' pre-illness basal mean perfusion pressure (MPP) can be targeted during management of shock in ICU. We hypothesize that targeting a patient's own pre-illness basal MPP will reduce the variable degree of BP-deficit that is inadvertently accepted in conventional care.

Increasing the ease and quality of acute referrals to specialist psychiatric care and initial assessment using an internet-based application.

Team: Dr Irosh Fernando (Staff Specialist Psychiatrist Conjoint Lecturer, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle Associate Professor), Lisa Lampe (Discipline of Psychiatry, School of Medicine and Public Health, University of Newcastle), Dr Cyriac Matthew (Clinical director and staff specialist psychiatrist, Newcastle Mental Health Service, Hunter New England Local Area Health District), Fionna Murphy (Clinical Coordinator, Newcastle Mental Health Service, Hunter New England Local Area Health District).

Aim: Our aim is to develop a mobile/web-based system for psychiatric triaging and initial assessment. The clinical information gathered from the patient, carers, and GPs separately via a guided online process, is integrated into a triaging document which is used by the clinician to complete the initial assessment efficiently and effectively.

TAPP (Telehealth Active Pain Program) into TIPS (Tamworth Integrated Pain Service): Innovative pain management group program in Rural/Regional NSW.

Team: Dr Hema Rajappa (Team Leader), Vickie Croker  (Operations Manager and Clinical Nurse Consultant), Kathleen Baker (Clinical Nurse Specialist,  Paul Riley (Clinical psychologist).

Aim: To develop and implement an innovative multidisciplinary pain management group program 'TAPP into TIPS' for patients with chronic non-cancer pain living in Regional and Rural NSW,  using telehealth as a mode of delivery.

A new model of care for preparing patients for home peritoneal dialysis.

Team: Gemma Fogarty (A/Clinical Nurse Consultant - Nephrology Department - MI&S HNELHD, Ginger Chu (CNC Nephrology MI&S HNELHD & Clinical Research Fellow), Peter Sinclair (Lecturer School of Nursing & Midwifery Faculty of Health & Medicine The University of Newcastle; Honorary Research and Innovation Conjoint  Hunter New England Local Health District), Sarah Crawford (Team Leader HTU Nephrology MI&S), Sarah Woolgar-Robe,(A/Team Leader HTU Nephrology MI&S), Carla Silva (Renal Outreach Social Worker Wansey Community Dialysis Centre), Nina Hodge (Occupational Therapist HTU Nephrology MI&S), Kelly Adams Nurse Manager Home & Satellite Dialysis Services HNELHD Renal Stream Coordinator Nephrology MI&S JHH).

Aim: Improve the patient learning experience by ensuring they are given educational material prior to attending face-to face training for peritoneal dialysis (PD). Reduce patient anxiety by creating part of the learning experience in the patient's home environment. Reduce training time required in the health care facility.

Telehealth and store-and-forward technology to improve access to the John Hunter Hospital Ear Nose and Throat Service (ENT).

Team: Dr Niall Jefferson (ENT Head of Department),  Bridie Ingham (JHH Outpatient Service Clinical Coordinator), Greg Bourke (Transitional Nurse Practitioner ENT), Ashley Young ( Senior Clinical Business Analyst, Clinical Telehealth), Jenny Rutherford (Clinical Business Analyst, Clinical Telehealth), Dr Maree Puxty (GP and HNECCPHN Clinical Council lead).

Aim: The aim of this project is to increase access to the John Hunter Hospital ENT Outpatient Service for rural and remote paediatric patients utilising store-and-forward and telehealth technologies. Additionally, the project aims to ensure sustainability by upskilling local health practitioners in assessing and managing patients with ENT-related issues.