2019 Improvement and Innovation Awards

Winner: 

(UN)Constrained: a Constraint-Induced Movement Therapy (CIMT) program 

Elise Klumpees-Grant, The Sutherland Hospital 

Aim: To develop a sustainable model for providing a CIMT program within South Eastern Sydney Local Health District (SESLHD) by December 2018. 

Method: 

• Project officer appointed using TIIC funding 
• Develop resources - intranet/internet site, education tutorials, assessment booklets, patient information sheets/workbooks 
• Physiotherapists and occupational therapists from Prince of Wales Hospital, St George Hospital and Sutherland Hospital engaged and educated 
• Student workforce established to assist the program to be run at all three sites throughout 2018 
• Recruited 18 patients from SESLHD; all received CIMT by November 2018 
• Patient assessments completed and improvements were made 

Results: Standardised and self-rated assessments demonstrate improvements in upper limb performance during functional tasks. Patient satisfaction with the program was high, and staff satisfaction with their unnderstanding, knowledge and confidence in providing CIMT improved. Three CIMT programs in SESLHD are confirmed for 2019. 

This winner also received the Board Member's Choice Peak Award 

Finalists: 

Neonatal CPR training for parents

KweeBee Lindrea, Royal Hospital for Women

Prior to the project, one facilitator was training parents in the Newborn Intensive Care Unit (NICU) on first aid in neonatal cardio-pulmonary resuscitation (CPR). No set criteria was used to define infants at risk and training was ad-hoc, occurring prior to infants’ discharge home.

Criteria for parental training was changed from at-risk infants to all infants admitted to the NICU. The structured training is provided by multiple facilitators who are accredited by CPR Kids. Parents are offered first aid CPR training, managing choking and safe sleeping prior to discharge home.

Dad left holding the family - a recovery video

Melissa Coates, Mental Health Service 

The Eastern Suburbs Mental Health Service Perinatal Mental Health (PIMHS) team have created an innovative, easily accessible electronic resource that provides a hopeful recovery message to fathers who care for partners experiencing severe and complex perinatal mental illness.

The PIMH team have supported numerous fathers whose partners receive care for severe, complex or acute perinatal mental health disorders e.g. postpartum psychosis. These fathers/partners are suddenly required to care for their unwell partner and new born infant, while struggling to cope with the shock of this situation.

Few psycho-educational resources exist to assist this specific population of fathers to understand, cope and care for their infant, partner and family.
Three broad aims of the fathers’ video include:

• Increase fathers’ resilience
• Increase fathers’ knowledge regarding perinatal mental illness and recovery
• Promote the father/infant relationship

You can see the video here.

Winner: 

A two-year analysis of iREAP

Annabel Kingsford, Uniting War Memorial Hospital 

Aim: The Integrated Rehabilitation and Enablement Program (iREAP) delivers eight-weeks of intervention, with coordinated access to a multi-disciplinary team to build self-management and enablement skills in an older population. 

Method: 18-months of client data was collected and used to examine pre and post intervention measures of frailty, physical function, frequency of falls and quality of life among iREAP participants. 

Results: Improvements in the Patient Activation Measure, Timed Up and Go, 6 minute walk test and reported falls were noted in participants during the first 18 months of iREAP. In addition, there were significant increases in a number of domains within the quality of life measures. 

Conclusion: The innovative model achieved by iREAP has offered clients with complex health an anticipatory approach that empowers them in managing their healthcare. 

Finalists: 

Delivering new model of care for patients presenting to the emergency department following sexual assault

Karen Lambert - South Sydney Sexual Assault Service

Aim: To provide timely, high quality and cost-effective medical services to sexual assault victims

Method: Southern Sydney Sexual Assault Service (SSSAS) with the St George Hospital Emergency Nurse Practitioners (SGH EDNP), introduced a Sexual Assault Nurse Examiner (SANE)/Nurse Practitioner (NP) model of care in November 2018. 

The service operates within NP clinical hours with an on-call service covering NP rostering gaps. SSSAS staff were trained in Early Evidence Kit (EEK) collection, ensuring forensic evidence is not lost.

Results: EDNPs are now qualified SANEs and manage the forensic, medical treatment needs of patients, reducing waiting times and improving service delivery (during examinations and in court reports) and consistency in follow up

Conclusion: An holistic, patient-centred and trauma informed service which assists in recovery and legal processes.

Streamlining care for women with pelvic disorders 

Hannah Graetz, Royal Hospital for Women 

With increasing prevalence, burden and distress associated with urinary incontinence and pelvic organ prolapse, the aim of this project was to streamline care to increase access to the right care at the right time for women with pelvic floor disorders.

A review of the literature, advanced practice physiotherapy models of care and local service challenges informed the development of a new model of care to address service challenges and enable safe, effective and efficient care. This model was implemented and the outcomes achieved include a reduction in the overall length of care, adherence to best practice, significant improvement in clinical outcomes, high patient satisfaction & an increase in referrals made by GPs for women with pelvic floor disorders.

Winner: 

Integrated approach to reduce infection related harm post Coronary Artery Bypass Graft (CABG) 

Belinda Boston, St George Hospital 

A rise in deep sternal wound infections in 2016 and 2017 at St George Hospital following CABG surgery has led to the introduction of a bundle approach to reduce incidence. Deep wound infections cause great pain and suffering for our patients and increases length of stay with return to theatres costing up to and in excess of $40,000 per episode. A multi-disciplinary approach including a dedicated consumer representative has led to major reductions in number of deep wound infections with the introduction of multiple measures such as chest binders, improved antibiotics stewardship, new operating theatre, heater cooler devices and cleaning regimes,  pre-operative swabbing and load reduction and district guidelines have been introduced there have been 0 cases since November 2017.

Finalist: 

Clinical Engineering - identification and prevention of invasive blood pressure overshoot 

Camillo Pavan, Prince of Wales Hospital 

An acute significant patient safety risk was identified due to overshoot in invasive blood pressure readings at Prince of Wales Hospital; arterial lines were giving falsely elevated systolic pressures of up to 80mmHg. The risk to patient safety was twofold; the risk of undertreating true hypertension resulting in cardia, aortic, cerebrovascular rupture or overtreatment of falsely elevated pressures resulting in hypo-perfusion and multi-organ ishaemia. 

The issue was not successfully resolved by local clinicians and equipment manufacturers over many months. The clinical engineering department was then engaged and lead the investigation of the cause of the overshoot which lead to a novel report to the TGA. Ulimately the entire campus was migrated to a new transcuser supplier, eliminating the risk. 

Winner:

Test and Treat - A hepatitis C screening and treatment service in suburban needle and syringe program

Caroline James, Primary Integrated Community Health 

Aim: To allow clients of Kirketon Road Centre South Needle and Syringe Program (NSP) to easily access Hepatitis C screening and treatment in a familiar environment, free of stigma and discrimination, otherwise felt in mainstream healthcare settings.

Method: Clients are invited to the clinic for screening by NSP staff that are well known to them and who they have a trusting rapport with. This is an incentivised program where clients receive a shopping voucher for attendance.  The clinic is supported by a Hepatology Clinical Nurse Consultant and Staff Specialist from St George Gastroenterology Department. Clients complete pre and post-test surveys.

Result: The service commenced in April 2017 and has evolved into a monthly clinic in the NSP. To date, 34 clients have been reviewed with 31 screened for viral hepatitis and 34 assessed for liver fibrosis. One client was diagnosed with hepatitis B (3%), 15 (48%) clients with hepatitis C and 5 with cirrhosis. 11 (73%) people commenced HCV treatment, of whom 10 (91%) completed treatment and 1 was lost to follow-up. 34 (100%) clients completed surveys.

Conclusion:  This is an extremely effective model to engage and retain a marginalised group of people into testing and treatment for Hepatitis C. 

Finalist: 

Happy Hour! A novel intevention targeting increased fluid intake in hospitalised adults requiring fluid modification

Elarne Westwood and Claire Douglas, St George Hospital and Prince of Wales Hospital 

Dehydration is common in patients with swallowing difficulties and is associated with multiple adverse health outcomes. Patients may be prescribed thickened fluids to assist with the management of swallowing difficulties, which further contributes to reduced fluid intake.

Baseline data revealed Aged Care patients requiring thickened fluids at St George Hospital (SGH) on average met only 20% of their daily estimated fluid requirements (EFR). In the Stroke Unit at Prince of Wales Hospital, patients requiring thickened fluids were only meeting 30% of their fluid requirements. 

This project investigated the impact of providing a novelty non-alcoholic ‘Happy Hour’ drinks trolley on the fluid intake of inpatients requiring thickened fluids. Evaluation of the project found patient’s fluid intake more than doubled and overall improved engagement, enjoyment and social interaction.

Nursing staff reported satisfaction with the new service and an increased awareness of the importance of promoting oral hydration. A non-alcoholic ‘Happy Hour’ drinks trolley is a simple innovation to significantly increase fluid intake and hospital experience of older adult inpatients requiring thickened fluids.

Winner: 

The St George Emergency Department NAWHL: The Night AirWay HuddLe

Dr Andew Cooke, St George Hospital 

The narwhal is a tusked porpoise closely related to the beluga. Recognisable by its spiralled horn the creature is fabled to possess magical qualities.  Scientists have come to understand that the narwhal tusk plays an important part in critical communication between members of the pod in the challenging depths of the Artic Ocean. 

In an attempt to improve communication in another challenging situation - out of hours critical airway procedures in the Emergency Department (ED) - we introduced our own narwhal or the Night AirWay HuddLe (the NAWHL).   Our aim was to establish a dedicated out of hours airway huddle that would provide overnight resuscitation team members with an opportunity to pre-identify aspects of their proposed care which might directly impact upon patient safety.  

Adopting quality improvement methodology and after pre-project stakeholder engagement we rolled out the NAWHL in June 2018.  In the four months after the launch, we audited the NAWHL’s impact (compliance rate, sentinel and adverse event trends) and also undertook staff surveys before and after the project to measure perceived effects of change.   To date the surrogate markers of change have been promising.   The NAWHL has now become a sustainable part of our ED’s patient safety culture.

Finalist: 

Local solution to violence prevention and management

Sarah Dunn, Prince of Wales Hospital 

Aim: To develop violence prevention and management strategies on our ward and improve patient and staff safety

Method: A mixed-methods approach was undertaken to implement and evaluate changes to current ward escalation, management and culture of violence and aggression 

Results:

• Development of a working party
• Review of local code black clinical business rule and district policy 
• Enrolment of all staff to 1 day violence prevention and management course 
• Implementation of open forum table top exercises with MDT and nursing 
• Review of code black and aggression data through IIMs 
• Development of local flowchart, risk assessment and behaviour management plan template, addition to our ward safety huddle 
• Development of a welcome to the ward brochure where zero tolerance is communicated. 

Conclusion: This program is ongoing and early evaluation suggests wide benefits for both individual staff and patients in violence prevention and management on Dickinson 4. This program has been implemented within existing resources and offers a translational blueprint for other wards at Prince of Wales Hospital. 

Winner: 

The Nursewell app in practice, more than an app

Suzanne Murray, Nursing and Midwifery

The Nursewell app was developed using evidence-based research identified through the New South Wales Fit for the Future survey¹ which identified key areas of poor health in nurses. Interventions incorporated into the app provide users with a means to improve their health and physical and psychological wellbeing and safety of nurses and midwives.

Launched in May 2017 the app has been downloaded 4031 times (as of April 2019) and is used throughout the SESLHD as part of well-being projects such as the Kind Minds and Pilates projects which have demonstrated an impact on nurses mental and physical health. The SESLHD Nurse engagement survey indicated that 39% of nurses who had heard of the app had downloaded it.  On average 80% of those that used the Nursewell app described the sections in the app as moderately to extremely useful.

Finalist: 

Keeping our staff in mind  (KoSIM) 

Dr Jackie Curtis, Mental Health Services 

Aim: KoSiM aims to improve the physical health of mental health staff through a targeted lifestyle intervention, and staff capability (attitudes, knowledge, confidence) regarding lifestyle interventions for patients.

Method: 212 staff, (clinical and non-clinical) were offered the KoSiM five-session individualised lifestyle intervention (physical activity and nutritional counselling) delivered by the Keeping the Body in Mind team (nurses, exercise physiologists and dietitians). Assessments were at baseline, post-intervention and at 4-month follow-up.

Results: Staff waist circumference significantly reduced, and cardiorespiratory fitness significantly increased. Sedentary time and total energy intake significantly decreased. Staff capability (attitudes, knowledge, confidence) significantly improved.

Conclusion: A brief lifestyle intervention for SESLHD mental health service staff significantly increased the capability of the staff to improve physical health outcomes for themselves and potentially for their patients.

Winner: 

NSW Overdose Response with Take Home Naloxone (ORTHN) 

Professor Nick Lintzeris, Drug and Alcohol Services 

Opioid overdoses are increasing across Australia and worldwide. Take Home Naloxone (THN) programs are effective in reducing overdose related deaths.

The ORTHN project involved the rollout and evaluation of a brief THN program to multiple Local Health Districts across NSW, targeting people at ‘high risk’ of opioid overdose. One highlight of the program involved credentialing nurses and health workers to provide the intervention and naloxone, rather than the previous doctor-only model.

THN was delivered to 616 clients by credentialed health workers and the evaluation demonstrated significant improvements in attitudes towards THN in staff and clients. In the 3 month follow up 9 successful overdose reversals occurred. Economic analyses indicate this is a highly cost-effective program. This model of care is now being rolled-out NSW-wide.

Finalist: 

AI enabled patient communications: using voice recognition technology to improve patient care and their healthcare experience

Liezel Dimal, Prince of Wales Hospital 

DeloitteASSIST, an Artificial Intelligence (AI) enhanced voice recognition device was piloted in the Spinal Unit at Prince of Wales Hospital over 4 weeks in April 2018 and continues to be operational today. It enables patients who have limited mobility to request assistance without the need to press a button. 

Feedback from patients and staff using this device has largely been positive. Patients are reporting an enhanced ward experience. Pilot response times are significantly lower than the industry benchmark, which impacts patient safety. Data is collected and analysed leading to better work flow and the potential for improved workforce planning. 

Winner: 

PACER - Police, Ambulance, Clinical, Early, Response 

Angela Karooz, Mental Health Services 

PACER is a Police and Mental Health Service (MHS) response activated by police, targeting peak demand times, offering on-scene and telephone assistance in the community. The pilot is implemented within the St George (STG) MHS.

PACER incorporates:

• a Mental Health (MH) Clinician as a secondary response
• assessment in the community at time of crisis
• real time social and clinical information

PACER provides person-centred trauma informed care, reducing Emergency Department (ED) presentations, increasing out of hospital referral capabilities.

Evaluation demonstrates:

• cross-agency and informed response to people experiencing MH crisis
• avoidance of ED presentations
• early links to community and welfare services
• provision of alternate pathways to care
• early de-escalation, avoiding coercive measures
• reductions in ED presentations via Police and Ambulance
• reduced demand on agencies including Police time on scene

This winner also received the Consumer's Choice peak award. 

Finalist: 

Mindfulness intervention in CALD communities program 

Lisa Woodland, Primary Integrated and Community Health 

The program comprises an in-language five week group mindfulness program for Arabic and Bangla speaking communities; supported by homework activities and translated audio and written resources.

Over the past two years, the program has been delivered to 24 groups, comprising 219 participants. Results for both Arabic speaking and Bangla speaking participants demonstrate a significant decrease in:

• depression, anxiety and stress 
• psychological distress 
• days of inability to work/cutting down work due to mental health issues 

The Mindfulness Program represents a culturally acceptable, low intensity mental health intervention that has high levels of community engagement and participant retention in hard to reach communities.

Isabelle (Isa) has been a consumer representative for Headspace Bondi Junction, and a member of the Youth Reference Group (YRG) for over three years. Isa is an inspiring and innovative young leader, being one of twelve people chosen initially for the inaugural YRG in 2015, and only one of two to successfully retain this position the following year. Isa has provided leadership to SESLHD, participating in consumer forums, and providing ideas for the Youth Mental Health First Aid project. She has been a consumer representative for the entire project, including training as a Youth Mental Health First Aid facilitator.

Professor of Renal Medicine, Senior Staff Nephrologist & Obstetric Medicine Physician and Medical Director, St George Hospital. 

Professor Mark Brown provides excellence in service to support staff, patients, carers and families who are suffering with renal disease, or hypertension in pregnancy.

He has provided over 40 years of service at St George Hospital and has held multiple teaching and leadership roles. In 2018 Professor Brown received the Order of Australia for his significant contributions to the field of medicine and nephrology, particularly hypertension in pregnancy. His work is highly recognised at a local, national and international level.

Professor Brown is a positive role model for all staff who work alongside him. He is highly supportive, inspires new medical students and fellow colleagues and has created positive workforce changes at the NSW Health level. 

Wendy has provided inspiration and leadership, working at the Kirketon Road Centre (KRC) for over twenty years. She brings warmth, humour, expertise, professionalism, compassion and sharp intelligence to her role as the Clinical Services Manager. This has ensured that KRC has maintained its acknowledged position as a world class Primary Heath Care Centre providing innovation and excellence to marginalised and disadvantaged populations.

Working closely with the Director, Dr Phillip Read, Wendy supports KRC staff to provide a consistent excellent standard of care to clients across all of KRC clinical services and Outreach programs.

Classifying admitted patient activity accurately is core to NSW Activity Based Funding (ABF) and budget allocation. Clinical coders are responsible for sorting clinical concepts of disease, injury and interventions into code from the medical record using a classification system. These codes relate to the budget allocations for the hospitals.

The Coding team has closely collaborated with clinicians and hospital management to improve the quality of clinical documentation for coding and to optimise the ABF.  The team partnered with SESLHD workforce services to develop workforce planning and retention strategies to enhance staff skills, team satisfaction and improve the Coding work environment.

Winners: 

Osteoarthritis Chronic Care Program (OACCP) Enhancement

Erica Morgan - The Sutherland Hospital 

The OACCP has been operating at The Sutherland Hospital since 2011, supporting patients with knee and/or hip osteoarthritis residing in the St George/Sutherland regions.

Our aims were to meet the demand of new referrals, reduce patient waiting times, collect Patient Reported Outcome Measures (PROMs) electronically and produce patient educational material.

A business case submitted to request utilisation of Leading Better Value Care (LBVC) funding allowed us to increase staffing, purchase equipment and produce resources. 

Fifty-four more patients attended OACCP in 2018 compared to 2017, average waiting times are reduced and over 250 PROMIS29 surveys have been collected since July 2018.

HOPE: Helping Older People with End-stage Kidney Disease (ESKD)

Professor Mark Brown - St George Hospital 

Aim: To improve symptom burden and quality of life for elderly patients with advanced ESKD managed without dialysis after shared decision making.

Methods: Our Renal Supportive Care (RSC) program provides integrated renal, palliative, dietetic and social work support for patients and their families; we measured symptoms using POS-S(renal) and Quality of Life (QOL) using SF-36.

Results: We published data on 122 non-dialysis pathway patients, average age 82, 34% well nourished, 57% with 2 or more co-morbidities. Median survival -16 months; 32% survived >12 months.75% had stable or improved symptoms and 58% stable or improved QOL over 12 months.

Conclusions: Elderly ESKD patients in our RSC program survive longer than expected, the majority with good symptom control and QOL without dialysis