Clinical Excellence Showcase

As always, we'll see out the Showcase with The Great Debate. Known to entertain more than inform, this year's debate asks whether Australia is the best place for clinicians to live and work. Joining us this year is another stellar line up of some of Queensland's best and brightest (and unusually, most are surgeons!) Affirmative team (yes, Australia is the best place to live and work): Dr Emilia Dauway, Director of Surgery at QEII Jubilee Hospital Dr Bernie Whitfield, Director of ENT at Logan Hospital Dr Rob Franz, Medical Director General Surgery at The Prince Charles Hospital. Negative team (no, Australia is not the best place to live and work): Associate Professor Robyn Littlewood, CEO Health and Wellbeing Queensland Dr Diana Tam, Consultant Breast and Endocrine Surgeon Associate Professor Cath McDougall, Chief Medical Officer for Queensland Health. Chaired by the Deputy Director-General herself, Dr Helen Brown, this year's Great Debate is sure to highlight the pros and pitfalls of our beautiful country!

Climate change is one of the most important challenges the world is facing currently. Climate change negatively impacts on health worldwide. To address climate change is our professional obligation. SWAPNET has established an Environmental Accountability Working Group with the aim to engage clinicians, HHSs and facilities to promote change and to develop comprehensive resources to support improvement and to lead the way to encourage other networks to also take up the challenge.

Traditionally long-term antibiotic therapy for significant infections has been given intravenously (IV). Current evidence now supports the utilisation of highly bioavailable oral antibiotic (HBOA) therapy substituting for most of the IV course. This includes quinolones, sulphonamides, tetracyclines, macrolides, azoles, lincosamides, rifamycins and oxazolidinones classes of antibiotics. HBOA therapy allows the patient to receive treatment in their own home, potentially return to work, removes the risk of long lines, and achieve therapeutic goals. However, treatment may be for several months and side effects may arise at any time; some potentially avoidable with early recognition. We established a Complex outpatient antibiotic therapy (CoPAT) service that monitor's patients on HBOA at home. This manages in a timely fashion any adverse outcomes to allow ongoing achievement of therapeutic goals, prevention of hospital admission and reduction of overall care costs. It also allows standardisation of the follow-up care provided.

Obesity places a significant burden on Australia's healthcare system. Currently at The Princess Alexandra Hospital (PAH), local antimicrobial guidelines do not provide advice on dosing for obese patients. Instead, clinicians are directed to utilise standard dosing advice which has been developed and tested in non-obese patients, thus adopting a one-size-fits-all dosing mentality. The aim of this project was to determine the proportion of admitted patients at the Princess Alexandra Hospital receiving antimicrobial therapy, who are classed as obese (BMI >30kg/m2) as well as audit the current prescribing patterns of antimicrobial dosing in obese patients at the PA Hospital. As a result of the audit findings, it was clear there was a severe lack in dosing advice in this cohort of patients and that antimicrobial dosing most commonly followed standard dosing guidelines with no consideration for the patient's weight. Therefore, guidelines for the dosing of antimicrobial recommendations in obese patients were drafted and are currently awaiting publication.

Children's Health Queensland Hospital and Health Services (CHQHHS) has empowered its workforce, young people, families and care partners to pursue innovative ways to minimise their environmental impact of our health care service. We have established an Environmental Stewardship Network, the ‘CHQ Green Team', which has grown to over 200 active members who work together to meet the targets set out in the CHQHHS Environmental Sustainability Plan 2021-2024. CHQ Green Team initiatives have resulted in emission reductions, improved energy efficiency and waste reduction at the Queensland Children's Hospital (QCH) in South Brisbane. This has established QCH as an international example for sustainable healthcare service delivery, both financially and environmentally. CHQ Green Team initiatives support local businesses and circular economy jobs while also shifting current practices and improving Queensland's environmental performance. CHQ showcases sustainable leadership that has successfully diverted 491 tonnes of waste from landfill and generated and saved over $580 000 in 2021/22. Our sustainability success story can be shared and adopted across other Queensland Health Hospitals and Health care services.

Borderline Personality Disorder (BPD) is a complex and serious psychiatric condition with significant morbidity and mortality. It is often characterised by a severely and persistently impaired psychosocial functioning and a high risk for self-harm and suicide, resulting in the high consumption of healthcare resources. Access to evidence-based interventions for Borderline Personality Disorder (BPD) is still highly limited in the current Australian health service system. Specialist mental health services are dominated by a generic case management model, with a lack of specific treatment modalities and staff struggling to provide psychologically focussed interventions. Similarly, non-government organisations (NGOs) report a lack of capacity, competence and confidence when working with consumers living with BPD. Despite people with BPD commonly having multiple contacts with mental health services, an audit within Metro South Hospital and Health Service (MSHHS) found that access to evidence-based treatment for this group of patients was highly limited in the Brisbane South region. The need for all workers to be able to therapeutically respond to consumers needs, and better access to appropriate intervention intensities was required. Using a stepped workforce capability framework the project aimed to increase the overall workforce capability to intervene effectively. In addition to develop higher level skillsets across NGO and public mental health and greater treatment access across the spectrum of care needs. Outcomes were significant and have directly impacted the ability of staff to provide good care from thsoe with BPD and related disorders. Over 350 NGO and MSHHS frontline staff completed training to achieve a practice-informed level of DBT capability. The project's activities were highly valued in terms of content and presentation. Most participants reported greater use of and capability with Dialectical Behaviour Therapy (DBT)-informed practice and improved care coordination after training attendance. The significant improvements in the self-efficacy of participants that were identified immediately following training attendance appear to have been maintained in the short term. Almost 100 people attended advanced forms of training that will enable them to run DBT-informed groups, and in some cases provide individual comprehensive therapy. These individuals will serve as DBT leaders and champions who can support the maintenance of each service's improved capability. There are new programs accessable to those with BPD in the region.

Healthcare services continue to face significant challenges to providing access to care and delivering care. Acceptance and utilisation of virtual options during the last three years has expanded as a result of the COVID pandemic. Conversely, waiting lists for surgical care have increased as a result of the pandemic. Leveraging these two competing factors, a multi-disciplinary team reimagined the surgical patient pathway to create efficiencies and improved access to care. Key stakeholder engagements across multiple business units were undertaken to inform each aspect of the implementation plan, including modifications to systems (iEMR, scheduling, booking), development of decision-making resources and frameworks, re-imaging workflows to maximise care value and virtual care opportunities, reviewing and reducing the physical footprint (through transition to virtual care touchpoints).

Where and how we care for preterm babies in South-East Queensland requires urgent review. Increased demand for service, improved survival rates, increased complexity of premature and sick newborns and a specialist nursing shortage has seen burgeoning pressure on large tertiary units, such as ours: The Grantley Stable Neonatal Unit (GSNU) at the Royal Brisbane and Women's Hospital (RBWH). Emerging evidence indicates that early discharge of physiologically stable, pre-term neonates is safe and cost-effective when appropriate in-home supports are in place (Brooten 1986; Cruz 1997; Collins et al, 2015). Given the comfort and psychological safety of the home environment, we anticipated enhanced parent-infant bonding. Health system level improvements, such as increased capacity within the Neonatal Unit would also result if we adopted similar models. In late 2021, the Women's and Newborn Service, Hospital in the Home project (NeoHOME and MatHOME) was successfully granted SEED funding from the Metro North Hospital and Health Service (MNHHS) Innovation Program. With their support and guidance, two arms of the project were developed (maternity and neonatal) and NeoHOME was born. The objectives of NeoHOME are: safe and effective care in the home for preterm neonates improved parental satisfaction, wellbeing and self-efficacy in addition to reduced financial burden, associated with long-term hospitalisation reduction in occupied bed days with anticipated improvements to capacity and staffing demands Clinical implementation commenced 4-months ago, and 61 neonates have been cared for in the home.

Preoperative pathology is an important component of the assessment of patients prior to elective surgery. Ordering routine preoperative pathology is listed by bodies such as the Australian and New Zealand College of Anaesthetists (ANZCA) and Choosing Wisely Australia as one of the top five practices anaesthetists should avoid (Choosing Wisely Australia 2017). The aim of this project was to evaluate current local practice for preoperative pathology at the Pre-Anaesthetic Evaluation Unit (PAEU) at the Sunshine Coast University Hospital (SCUH). The priority for improving patient care was to ensure local practice was in line with evidence-based guidelines, was sustainable and patient focused.

Intravenous iodinated contrast is commonly and routinely used in abdominal imaging computed tomography (CT) to demonstrate patient's anatomy and visualise and pathology. Historically, a fixed volume of contrast is used for abdominal CT. However, this fixed dose approach means small patients are typically overdosed, resulting in excessive enhancement of the abdominal organs. Conversely, larger patients are underdosed which results in scans that have less than ideal enhancement. The idea of a simple weight-based contrast regimen was proposed by our team as a solution to this problem. A review of other Queensland Health sites indicated that most medical imaging departments were using fixed volume or simplified 2- or 3-step volume protocols (e.g., small, medium, and large patients). A thorough literature review was conducted to see if there was evidence to support a more tailored approach. The literature suggested that a weight-adjusted contrast dosing protocol can objectively provide more consistent vessel and solid organ enhancement and subjectively improve image quality across a spectrum of body weights. In addition, it could reduce the amount of total contrast used, saving money and reducing waste. The issue with the current body of literature is that there is no consensus as to the ideal enhancement of the image, in other words how the image should look. It is largely dependent on the country of the study and the patient demographics of that region. As a result of this, our team decided to conduct our own study to determine if the patient specific approach could work at our site. Our team consisted of radiographers, radiation physicists and radiologists. A weight-based contrast protocol was established by our team based on 1ml of contrast per kilogram of patient weight in 10kg increments and was rolled out across the department. Quantitative and qualitative data was collected to compare the fixed dose vs weight-based methods and analysed. The main aim of this clinical audit was to determine whether a weight-based contrast regimen in abdominal CT can provide more consistently enhanced images for our clinicians across the spectrum of patient sizes. In addition, can the change in practice reduce contrast wastage and therefore costs. If so, the weight-based protocol could be implemented across more Queensland health sites to improve the quality of the abdominal CT scans we perform statewide.

The care of rheumatology patients can be complex, often requiring medications that need close monitoring and education to ensure best and safe outcomes. There is often minimal time within the busy clinical outpatient setting to holistically review the patient's needs. The rheumatology clinical nurse consultant telehealth service was introduced to achieve better patient outcomes and provide a comprehensive approach to the delivery of care to any individual anywhere. Ensuring that patients have a greater understanding of their rheumatological condition can lead to patient empowerment and better outcomes. The implementation of the clinic via telehealth was to provide an alternative way to receive specialist nursing care. This also helps to reduce petrol and parking costs as well as having positive environmental implications. It also means that patients can receive holistic care wherever they may live and is particularly useful for those living in rural and remote areas. By offering telehealth, patients have less time off work which leads to more work productivity and time spent with family. It also means that the interval between patients being reviewed by the clinician can be increased as the telehealth service allows for interim follow up. This therefore allows for more patients to be reviewed in clinic by the nurse practitioner and other clinicians.

The RAID template was initially developed as part of the QI project for our Sunshine Coast Hospital and Health Service (SCHHS) Infectious Disease (ID) team. Our aim was to develop “a user-friendly template to improve our ieMR documentation on the daily patient care record. In summary, by using the RAID template, overall documentation of invasive device, antibiotic indication and plan, assessment of DVT prophylaxis and ARP plan were universally improved from period 1 to 2. It is easy to use and reminds clinicians of this important aspect of patient care.

Consumers with Borderline Personality Disorder (BPD) make up 10% of the admissions and are at high risk of dying by suicide. People with BPD are often trapped in a revolving door situation to the Emergency Department (ED) and are not getting the treatment they needed due to stigma and lack of resources. The Living Well Team is a multidisciplinary team that adopted virtual care technology combined with evidence based psychological therapies specific to BPD, it is the first of its kind in Queensland. The Living Well Team (LWT) co-designed and delivered a flexible, peer-worker supported evidenced based therapeutic service to address the gap in service delivery that was placing increased pressure on emergency and acute mental health services. Since commencement the service has grown from 30 consumers during the period July – September 2021 (onboarding 10 each month) to achieve the aim of 60 consumers. In the 3 months prior to joining the LWT service, 10 of the 49 consumers (20.4%) had been admitted to acute inpatient care (20 admissions in total). Only four consumers (8.2%) were admitted to acute care following entry into the LWT (8 admissions in total). Consumers identified that engagement with the LWT was instrumental in keeping them out of hospital and improving their recovery journey.

We piloted/evaluated a coding framework that has simplified the coding process and enabled streamlined reporting of PREMs findings to consumers and staff (including an ability to compare trends over time). This framework has been implemented across four RBWH clinical service lines and has enabled a more structured and efficient solution to analysing qualitative PREMs data. Most importantly, it has created a solution to embed a person-centred lens in how health services interpret and analyse patient-reported feedback. It has enabled service lines to prioritise improvement projects in direct response to patient feedback not otherwise available through quantitative dashboards.

The PASS model of care is an end-to-end service for complex surgical patients, that is adaptable and transferrable model of care, led by a Care Coordination Nurse (CCN) We have: Developed a nurse led model to support safe, structured discharges for each patient Scaled the CCN role across another surgical ward successfully Created an integrated care approach with our community GP's The CCN role has: Reduced length of stay for several complex diagnostic related group's (DRG) Released more to time to care for the primary nurses at the bedside Established a successful succession program Allowed nurses (both hospital and community) to work to top of scope Ensured every patient has a discharge plan Created discharge education and provided on the floor support for nursing, medical and allied health staff Increased in patient and staff satisfaction We aim to: Establish an online discharge portal Develop a discharge network for all ‘discharge' nurses Strengthen partnerships with the primary care sector, to sustain improvements in the patient care continuum with more connected community pathways Establish a community home visiting service that would cater for the complex needs of surgical patients within the community, that has surgical governance Establish Satellite Clinics

The vast majority of patients survive their ICU admission; however, the quality of survival is commonly suboptimal with a substantial proportion experiencing cognitive, physical, mental and/or psychological dysfunction and significant disability severely affecting the quality of life of the patient and their family. Emerging evidence suggests that the current bedspace environment contributes to these preventable adverse outcomes. The “ICU of the Future” project is a Queensland led, international, patient centred, multi-disciplinary and intersectoral project. Using co-design to incorporate the patient's needs, the project team has redesigned and rebuilt two ICU bedspaces at the TPCH. This pioneering and ambitious innovation project aims to demonstrate how optimising the ICU environment will enable best practice care and lead to improved patient outcomes and experiences.

The Community Hearing Screening Program was initiated in 2017 with the vision to provide equitable and accessible post-natal hearing screening services and timely detection of hearing loss for all Queensland children. Preliminary findings of this pilot model demonstrate sustainable and low-cost care including: Detection rate of permanent hearing loss at 7.4/1000 children Childhood Community Hearing Clinics found 29 of these permanent hearing losses Department of Education clinics found 9 of these permanent hearing losses Of these, 3 children have entered the Queensland Children's Hospital Hearing Implant Program as hearing loss was very significant. Total ‘pass and discharge' rate is approximately 75% with 65% discharged after first screen. As well as providing a timely and accessible service to families, there was significant reduction on public hospital audiology departments waitlists.

For many families there is a disconnect between having a baby in hospital and accessing services afterwards, including the Child Health Service. Families often experience difficulty knowing who can help and health literacy is low. AEDC data shows that up to 20-30% of children from some suburbs in the Logan area are “not school ready” and are vulnerable on 2 or more of the 5 key domains of early childhood development- well above the national average of 11%. The Journey Facilitator is in a unique position to be influenced by and have influence on both families, children and health care professionals across multiple sites. The Journey Facilitator is instrumental in developing processes that foster collaborative relationships to achieve the quadruple aim of health care (improve clinical outcomes and population health; enhance clinician and consumer experience; promote streamlining of services reducing health care costs and waste).

Strategies that successfully mitigate the potential stress for children and families in the ED through the use of developmentally appropriate approaches are an essential element of holistic high-quality care. Child life therapy aims to combine the biomedical model of care with the developmentally tailored, individualised, play-based psychosocial model of care, to minimise the negative impact of potentially painful and anxiety-provoking healthcare procedures. The Child Life Therapist (CLT) role was introduced as a pilot project at The Prince Charles Hospital (TPCH) Children's Emergency Department (CED) in July 2022 to integrate a developmentally sensitive play-based approach to the clinical care of paediatric patients from infants to 16 years of age. The aim was to facilitate inclusive opportunities for ALL children to play, learn and participate in their health care. While the project is still in its early stage, positive outcomes have been highlighted by the service users. Feedback from the multidisciplinary team highlighted the contribution of the CLT in supporting clinical efficiency and patient flow.

Most commonly, women opting for surgical management of miscarriage require an inpatient procedure under general anaesthetic in the operating theatre (known as a suction curette). This requires several hospital visits and the women encounter several different clinicians during their stay. The majority of this experience is navigated without the comfort of a support person. MVAC is a procedure also used for the management of miscarriage, retained products of conception and termination of pregnancy. It is performed with a hand operated vacuum syringe under local anaesthetic in an outpatient setting. The procedure is recommended by the World Health Organisation for uterine evacuation and is used in many countries as an alternative to suction curette under general anaesthetic (GA). At the time of this abstract submission, uptake is high, patient satisfaction is over 95%, complication rates are equivalent to management in theatre and several other hospitals around Queensland have approached our department with the view of adopting this innovative service.

The TCHHS ENT program adopts a generalist model of integrated specialist level care. This model allows our team to address the inequitable distribution of specialist level Ear, Nose and Throat services through remote Queensland, whilst also clinically supporting understaffed and under resourced primary health care centres. TCHHS ENT 2022: Referrals received: 445 Occasions of Service provided: 1300+ Communities served: 32 Surgical Procedures performed Locally: 54 94% of care kept locally and provided on country (i.e % of patient care prevented from being referred onwards to tertiary referral centres) Patient service satisfaction: (Check up Patient Reported Experience Measures Report) 89% of patients surveyed felt very safe with staff 89% of patients surveyed felt very respected by staff 89% of patients surveyed felt their emotional needs were completely looked after (eg: having family or people they knew travel with them) 89% of patients surveyed said their treatment was properly explained so they completely understood what was happening 89% of patients surveyed always felt included in decision-making about their treatment 100% of patients surveyed felt completely comfortable telling the staff about their health information 100% of patients surveyed would be likely to recommend this surgery service to family or friends

Internationally, there are over 200 Take Home Naloxone (THN) programs that provide opioid overdose prevention education and supply of naloxone, the antidote to an opioid overdose. However, prior to our project, it was fairly difficult for consumers to access these programs or where there was an intervention, no medication was supplied. Staff in Metro North Health navigated our way to obtaining permission to supply naloxone and deliver opioid overdose prevention interventions (or THN for short) to consumers of alcohol and drug services. We trained all nurses within 3 large outpatient opioid treatment centres (some of the largest in treatment clinics in Australia) to be able to deliver the intervention. And across a pilot period during COVID-19, we were able to deliver 100 life-saving interventions to our consumers. This resulted in 4 lives saved during the pilot period.

The Women's and Children's service at the Sunshine Coast University Hospital is applying choosing wisely principles and best evidence-based practice to provide targeted surveillance for the high-risk population of very preterm and very low birth weight infants. We have transformed a low value, high volume blanket follow-up pathway into a streamlined prioritised model of care focused on providing early detection of adverse neurodevelopmental outcomes and excellence in service delivery for our families impacted by preterm birth. Implementation of our results enables reduction in expensive time-consuming follow-up of infants with a high chance of a typical outcome, allowing targeted follow-up based on prognostic outcomes (very low, low, moderate and high risk of developmental delay).

We have managed to embed a physiotherapy outpatient clinic within a Queensland Correctional facility. We are not aware of another at this stage. In recent years Queensland Health has become responsible for all on-site prison medical centres. The High Security Woodford Correctional Centre -- which is one of few with a Maximum-Security wing – has become part of the CKW health service. Thus far Physiotherapy services to Woodford have required individual inmates to be transported to unsecured outpatient areas in Caboolture Hospital. This at great cost, Woodford and Queensland Health resources, logistical and inherent safety issues and resultant low attendance. 38 clients accessed service over 16 weeks with 1–5 appointments each. Inmates in all facility areas including maximum-security unit the accessed service. All client respondents rated service good/very good. 100% said service met their needs. The project was a success on all measures and funding has been provided for a one day per week physio clinic to continue within our prison health centre.

Research indicates that good healthcare for adolescents and young adults (AYA) differs from paediatric, adult and geriatric care, and that the design and delivery of AYA appropriate care is in its infancy. To address the gap in understanding what good AYA healthcare looks like for West Moreton youth, a Youth Advisory Council (YAC) was established in 2021. West Moreton Health (WMH) launched its inaugural YAC with members aged 16 to 30 years. The YAC includes young people from diverse cultural backgrounds, socio-economic backgrounds, health service needs and four members residing at the BYDC.

Gaining more weight than recommended and poor nutrition in pregnancy are key risk factors for the development of metabolic disease such as gestational diabetes mellitus (GDM), hypertension and obesity in mothers and future metabolic disease in offspring. Dietary counselling and weight monitoring are effective at improving nutritional intake and reducing weight gain above recommendations. However, women classified as being above a healthy weight before pregnancy experience greater barriers to achieving nutrition and weight gain recommendations, have a lower confidence to achieve health goals and require more intensive support. A face-to-face model of care to reduce gestational weight gain (GWG) in women living with a body weight above recommended at our metropolitan tertiary hospital was poorly attended, and less than 10% of eligible women were referred. We used implementation science principles and existing evidence to address existing barriers to care to develop and implement an evidence-based nutrition service into routine antenatal care for high-risk women.

Retinopathy of Prematurity (ROP) is a retinal disease affecting premature infants and remains one of the leading causes of childhood blindness world-wide. The early detection and treatment of severe disease is crucial to prevent vision loss, however screening is difficult due to lack of manpower and subjectivity of diagnosis. Our project aims to determine whether ROP.AI, an artificial intelligence algorithm developed to detect features of severe ROP, can perform as well as five expert ophthalmologists from across Australia. We found that ROP.AI was able to detect severe ROP with high sensitivity (84%) and negative predictive value (96%) compared to expert ophthalmologists. These findings demonstrate the vast potential ROP.AI holds to alleviate current limitations in ROP screening. Further algorithm training and prospective evaluation may see it be implemented as a decision support tool in the very near future.

We developed the Allied Health Demand and Capacity Management Tool (AHDC) on the System View platform (Healthcare Logic). The tool allows for real-time visibility of patient demand for acute allied health services and the capacity (FTE) of allied health professionals to meet that demand. Additionally, it provides an 'Executive View' dashboard that shows demand and resourcing allocation across two hospital sites and identifies allied health responses to demand (reallocation, prioritisation, trends analysis). After 18 months of profession group trials and collecting clinical consumer feedback, The AHDC tool has been implemented into business as usual across six allied health professions (physiotherapy, occupational therapy, psychology, social work, speech pathology, and nutrition) working within the acute medical units. Staff have reported that the AHDC tool is quick and easy to access, use and navigate. The tool has benefits for patients, clinicians, and management as it ensures that patients receive the right services at the right time. By providing a coordinated approach to managing the demand for allied health services, the tool is improving patient outcomes and increasing the efficiency of allied health resource allocation.

You may be aware either personally, or professionally of the electrocardiogram or ECG, which is used to measure various electrical properties of heart. In psychiatry, many of our medication uniquely affect the intrinsic timing of the heart's electrical system and its especially important to monitor these readings when commencing or changing mediations. However, until recently, this level of community monitoring was difficult, especially in a region such as a far north Queensland where the sheer size and remoteness of the communities we serve often act as barriers to health care access and equity. However, there is a new, game-changing, ultra-portable Bluetooth ECG device which is both medical grade and approved by the Australian Therapeutic Goods Administration (TGA) and FDA in the USA. This new device delivers a digital six-lead ECG in just 30 seconds, without the need for invasive procedures, sticky dots or leads, and can be completed with the patient clothed. Its ultra-portable design measures only 10cm by 5cm which makes it easy to use in a variety of clinical settings and can be easily distributed to community teams! What makes this device more compelling is that it only cost $300. We think this is a game-changing device and has the potential to revolutionise the way we deliver healthcare to rural and remote areas where access to traditional ECG machines and routine cardiac monitoring is limited and will deliver significantly improvements in the screening and detection of cardiovascular risk for psychiatric patients.

Bookings and Referrals Centre (BARC) staff receive approximately 2,500 phone calls per week. To address all these different types of enquiries, the team previously had to access more than seven distinct systems, making the provision of patient care inefficient and slow. This led to the design of our solution, Kirra, which replaces these multiple systems previously needed to manage outpatient waitlist and bookings with a single, fully integrated web application. Efficiency gains to meet service demand: Streamlined and automated processes to release workforce capacity to enable our staff to work at top of scope and return time to care.

In-hospital suicides are often associated with occurring in the evening and during night shifts when there is reduced staff supervision. During these times of high risk, suicides occur in isolated areas of the ward such as bathrooms and single rooms. In this study, a prototype for a Remote Patient Monitoring (RPM) system was developed for early detection of suicidal behaviour in a hospital based mental health facility.

The introduction of an Undergraduate Student in Nursing (USIN) model of care for ECG performance was implemented. We have contracted 2.96FTE USiN to work 2 shifts 7days a week to implement a new waiting room model of care. The model of care is deliberately procedure/guideline driven given the limited scope of practice for the USIN group. All category 2 chest pain patients are ordered and ECG by the triage nurse and referred to the USIN for completion. We have set up a direct line of review for the ECGs with a dedicated SMO allocated to review ensuring quality review is undertaken. Using a USIN to perform the task of an ECG, similar to a technician position, has freed up nursing time to perform critical thinking and clinical prioritisation within the waiting room. From a fiscal point of view, the USiN is also cheaper to add to a work force already stretched from budget perspective. It has seen an improvement in time-to-treat, specifically for the cohort of ATS Category 2 chest pain presentations. The key achievements to date, are an overall improvement in patient safety, improvement in time-to-treat measures and an immeasurable improvement in staff morale.

Primary Contact Hand Therapy (PCHT) is an innovative role substitution model of care led by Allied Health clinicians at Gold Coast Health. It was established in December 2018 in response to the Ministerial Taskforce to expand the scope of practice for Allied Health professionals.

In May 2021, headaches were the single most common referral to the SCHHS neurology outpatient department, with most headache referrals listed as cat-2. There were long-standing issues regarding access to neurology services on the Sunshine Coast, with demand continuing to exceed supply, despite significant investment in SMO FTE and clinic availability. The cat-2 clinic wait-times were over the recommended time-frame of 90-days. Furthermore, it was believed that a significant number of these headache referrals were being insufficiently and/or inappropriately managed in the community. The MPSC headache pilot trial had significantly greater than expected initial success, with 1 in 3 patients (34%) discharged following targeted active treatment. This represents a significant number of patients who did NOT require a neurology appointment. Refinement of the pathway may push these numbers higher. Owing to the success of the pilot, the MPSC headache clinic has become a permanent feature of neurology outpatients, with recurrent funding afforded.

Embedding a quality improvement culture improves overall care, service delivery and organisational culture and has even been shown to be associated with increased survival in neonates. The Sunshine Coast Hospital and Health Service paediatric and neonatal departments have implemented and grown a culture of quality improvement (QI) through two major activities.

The Virtual Fracture Clinic (VFC) model launched in August 2022 and in the first 6 months, 386 new patient referrals have been managed under the mode. and freed up the equivalent of 6 fracture clinics per month. This has meant that there has been a reduction in the amount of fracture clinics needing to be overbooked. Financially it has been determined that the VFC model is saving our health $28,800 per year in patient travel costs as well as generating revenue of approximately $61,440 in its first year. In total the finance department has calculated that between savings and revenue the department will be $132,004 better off each year.

The Care Collective aims to improve access to primary health care and coordination of care for those people in the Caboolture hospital catchment living with Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure (CHF), falls and dementia. The concept of the Care Collective offers a new way of connecting services and supports that are already in place and encourages and enables information sharing. The number of emergency department presentations per month has significantly reduced after referral to the Care Collective. On average patients had a 83% reduction in ED attendances. There has been a 56% increase in the proportion of patients with zero or one ED presentation per month and no patients with more than three presentations per month after referral to the Care Collective.

Mater at Home Direct was created specifically to assist lower acuity Triple Zero callers to circumnavigate access barriers by re-orientating the traditional pre-hospital care pathway. This innovative model provides consumers with timely and more appropriate care, by taking the “care” to the consumer rather than transporting the consumer to the “care” (hospital). The service provides quality, same-day, multidisciplinary care to patients over 16 years old, in the comfort of their own home, across Mater at Home's broad catchment, which spans four different Hospital and Health Service (HHS) areas – from Ipswich (west) to the Bay (east); Burpengary (north) to Jimboomba and Pimpama (south). Mater at Home Direct has facilitated access to care for over 150 low priority Triple Zero callers since July 2022. In that time 82% of referred Triple Zero callers have accessed their care in their home. This translates to avoiding QAS dispatch and a subsequent transfer to ED.

The model has been effective at increasing both ED and inpatient capacity. This has reduced unnecessary patient transport – positively impacting the ambulance service and patient experience and avoiding non-value adding handover. A 12 month analysis of post implementation data shows that from commencement of the EDLS on the 18 October 2021 to 17 October 2022, the initiative has: Diverted 2737 patients to all three providers an average of 53 patients per week Admitted 1658 of those patients (61 per cent) to receive inpatient care

Hospital admissions for complications of cirrhosis continue to rise nationally due to the epidemics of alcohol use disorder and obesity related liver disease. Due to the unstable nature of chronic liver disease up to 30% of patients need to be readmitted within 30 days of discharge. Why is this? Firstly, patients with chronic liver disease develop fluid in the abdomen - ascites. This is uncomfortable and often requires drainage (paracentesis). Secondly these very sick patients can rapidly deteriorate, often before they can be seen in the liver clinic leading to an ED presentation. Can this be avoided? Yes - what if we were able to rapidly review recently discharged patients on the ward within a few days of discharge? What if we could accommodate patients at short notice on the ward for paracentesis when needed rather than patients needing to present to the ED? We developed a ward based ambulatory care facility for liver patients and we think we have made a difference.

Overcrowded Emergency Departments, growing prevalence of chronic disease and higher consumer expectations for quality health care, coupled with the rising cost of health care within limited budgets, poses significant challenges (Trankle, Usherwood, Abbott & Roberts et al., 2019). The Prince Charles Hospital Rapid Access Clinic provides an alternative pathway to hospital admission or extended waiting in the Emergency Department for patients that require review within 2-5 days.

First presented back in 2019, the model has evolved from a combined hospital and community initiative to a unique, co-designed model providing a person-centred, comprehensive case management approach. Over the years, Working Together to Connect Care has been proven to reduce health system usage for this cohort and provide a socially oriented alternative model of care.

In 2023, Dragon Medical One from Mackay Hospital and Health Service returns to the stage. Having taken out last year's Best Presentation Award, it's no surprise this simple but innovative voice-to-text technology has expanded from in its initial application in the Mackay Hospital Emergency Department, to other wards and even other hospitals.

There is a real risk that ‘wellbeing' is becoming just ‘another thing to do'. What do we mean when we talk about wellbeing? What are the metrics to measure wellbeing? Is it a survey or a ‘feeling'? In this episode, Liz Crowe explores the science and myths of wellbeing for staff working in healthcare. She will look at the practicalities and pressures of embedding wellbeing into the busy clinical settings of health and provide some practical solutions. Wellbeing will be explored through the lens of language, autonomy, time, energy, humour, creativity and social relationships.

Now in it's seventh year, the Clinical Excellence Showcase proudly welcomed teams from across the state to share the incredible work happening in Queensland. In addition to over 40 inspiring frontline clinicians shining a light on how they're changing the way we do things, the jam-packed program included the annual Great Debate, a pair of Where are they now sessions and all-round amazing human Dr Liz Crowe talking about wellbeing! Season 5 of the Clinical Excellence Showcase Podcast - Learn – Partner – Innovate - commences Wednesday 31 May 2023, so make sure you subscribe now to avoid missing out!

Clinical Excellence Queensland is proud to present the Clinical Excellence Showcase once again. This year's event will take place on Tuesday 23 and Wednesday 24 May at the Royal International Convention Centre, Brisbane. To best capture as much of the incredible work happening in Queensland as we can, we've kept this year's event theme broad: Learn – Partner – Innovate. This year we present the annual Great Debate, a pair of Where are they now sessions and all-round amazing human Dr Liz Crowe talking about wellbeing. And of course, over 40 of your colleagues will share how they're changing the way we do things, for the better! Our much-loved format remains the same, with sessions rolling out on the pod in June 2023 so hit subscribe so you don't miss a thing!

As always, we closed the Showcase with The Great Debate. Known to entertain more than inform, this year's debate takes a slightly controversial twist asking the question: “City versus Country – does more money and resources for the cities mean better healthcare for everybody?” Joining us this year is another stellar line up of some of Queensland's best and brightest! Affirmative team (yes, it does mean better healthcare): Dr Catherine McDougall, Clinical Lead Getting it Right First Time Queensland Dr Chris May, former Clinical Lead, Clinical Excellence Queensland Dr Tanya Kelly, Chair Queensland Clinical Senate and Anaesthetist, Sunshine Coast Hospital and Health Service Negative team (no, it does not mean better healthcare): Dr Marlow Coates, Executive Director Medical Services Torres and Cape Hospital and Health Service Dr Alexander Kochi, Emergency Medicine Staff Specialist, Cairns and Hinterland Hospital and Health Service Dr Carl de West, Clinical Director Specialist Medical Services, Gold Coast Hospital and Health Service Chaired by Professor Keith McNeil, Deputy Director-General Prevention Division and Chief Clinical Information Officer Queensland Health, this year's Great Debate is sure to ignite some fireworks!

This session explores several Hospital in the Home (HiTH) models in Queensland, taking a proverbial 'look under the hood' to find out what works and why, and the many benefits of this hospital avoidance model. About the panel Melissa (Mel) McCusker is the Assistant Director of Nursing for the Acute Care@Home, COVID@Home and CHIP services in Metro South Health. Melissa was employed in the original pilot program for HITH in Metro South in 2007 and has been instrumental in the development of the service including the pilots of Criteria Led Discharge, telehealth and Remote Patient Monitoring. The Remote Patient Monitoring trial for HITH patients in partnership with Telstra Health and the Department of Health which was the first of its kind in Australia for HITH patients. Her clinical experience spans medical, critical care, post-acute and general practice nursing and she is a member of the HITH Society of Australasia and currently involved with statewide HITH working group. About the facilitators Laureen Hines is currently a Director in Clinical Excellence Queensland's Healthcare Improvement Unit. Laureen has more than 20 years' experience in nursing and leadership across the care continuum and departmental level. As the Queensland executive lead for Hospital in the Home (HITH), she has extensive HITH experience and has been instrumental in leading HITH reform within the Queensland context. Dr Theodore Chamberlain is the Statewide Hospital in the Home (HITH) Clinical Lead for Clinical Excellence Queensland. Theodore Chamberlain is a founding fellow of the Australian College of Rural and Remote medicine (ACRRM) with a long history of rural practice and a career involving education, teaching, innovation and transformation. His interests are broad and in addition to a fellow of ACRRM, is a member of the International Society of Bayesian Analysis (ISBA), member of the Movement Disorder Society of Australia and New Zealand (MDSANZ), member of the Hospital in the Home Society Australasia and a FORTH innovation consultant.

This presentation centres on Queensland Health's vision to transform the health system by embedding genomics and precision health into routine healthcare delivery. Ides will show how innovative projects intersect and align to the broader agenda and that importantly, the only way we can enable innovation in this complex ecosystem is to support innovation everywhere but making sure the areas and teams are connected. This means that ultimately, system capability is advanced and able to deliver personalised early diagnosis, intervention and treatment, resulting in optimised patient experience and outcomes and reducing low value and harmful care.

Foot disease is a common, costly and complex complication of many chronic diseases which may result in lower limb amputation. Early identification and timely referral of patients with acute foot disease has been shown to reduce hospitalisation and associated lower limb amputations rates. Of the 218 lower limb amputations performed in the Townsville Hospital and Health Service (THHS), 27 per cent were performed on patients residing in rural or remote post codes and 26 per cent identified as First Nations. The Feet First Project trained Allied Health Assistants (AHA) and Indigenous Health Workers (IHW) in foot risk stratification screening and low risk foot care in each rural THHS site, providing rural consumers with equitable access to a quality, culturally appropriate foot screening and care service that identifies and manages foot disease in a timely manner.

Paediatric feeding disorders can impact a range of children and access to care may be difficult for families. In this presentation, Madeline will share research findings into the barriers families face in accessing feeding care, including the use of telepractice as a potential model to help reduce some of these difficulties. In the study, the feeding skills of 30 bottle-feeding infants and 40 children cup drinking/eating solids were simultaneously assessed by a speech pathologist in their home and via telepractice to compare assessment findings. Results indicated high reliability for most assessment elements; indicating that assessments conducted via telepractice were comparable to assessments conducted in person. In addition, parents and clinicians reported high satisfaction with the telepractice model.