2023 MacHSR Future Leaders Cohort

Project title: Patient experience of discharge after surgery with opioids from Royal Melbourne Hospital

Opioid analgesia is a core component of effective perioperative pain management but, unfortunately, involves therapeutic risk. We have undertaken a traditional quality assurance cycle to scope perioperative opioid prescribing, use and handling, introduced stewardship measures and demonstrated improvements, but also persistent suboptimal practice. However, the measures to date have lacked understanding of the drivers of observed community opioid management in our patients. My proposal is developing a time-efficient evaluative framework to complement a traditional quality assurance cycle to explore patient perspectives on perioperative opioid stewardship measures.

Perioperative opioid stewardship is a health system and health service priority. My project will add context and understanding to the results produced in our earlier work. I am excited by the potential this approach has to be applied to other areas of clinical change, where quality assurance may be inadequate for a complete understanding.

I am also excited to work with leaders in health services research through MACH. I hope to both expand my research methodology skill base and my appreciation of how quantitative and qualitative methodologies can be optimally integrated to address complex problems.

Project title: Improving patient flow through fracture clinics

The current fracture clinic model is experiencing challenges to patient access and flow affecting patient care. Having an established therapist-led triaging process and structured pathway for patients with closed hand injuries will facilitate timely hand therapy services to patients enabling speedy recovery and reduce complication due to immobilisation, including weakness, stiffness and chronic pain. My project’s aim is reviewing current processes and using the current credentialed Advanced Practice Hand Therapist to develop and implement a Hand Therapy, Advanced Scope, Therapist-Led Fracture Clinic in association with the Orthopaedic Department at Werribee Mercy Hospital.

I hope to utilise my MacHSR expertise to design and set up a structured pathway of care for patients with closed hand injuries to ensure they receive clinically appropriate comprehensive care – that is, coordinated and delivered in a timely manner with the proposed therapist-led model of care. I also hope the Fellowship will help me identify the facilitating and constraining factors determining the development of this proposed allied health advance practice role with the fracture clinic.

Project title: Using data to identify complex patients

People presenting to hospital, especially general medicine, are increasingly older, frailer, and more complex. Unfortunately, there is no simple diagnostic test for complexity, so how do we identify those at risk of prolonged stay and hospital-acquired complications? We propose a unique big data solution: an algorithm combining natural language processing with demographic and clinical data to identify these patients on admission to hospital. Through transparent, consistent and reliable identification, we can prioritise these complex patients for specialised allied health management, aiming to maximise days at home, quality of life and enabling the person to live well in the community. These outcomes matter to patients and their families and have the potential to improve hospital flow.

Health services collect large amounts of data and I’m interested in finding ways to use this data to refine our service and improve patient outcomes.  I hope to refine the identification and selection of complex patients for future research within this population.  Identifying patients with the most complex needs and matching them with experienced allied health clinicians means we can expedite planning and successful discharge, benefiting patients and the health service.

Project title: De-implementation of gRip sOcks in-hosPital – The DROP study

Single-patient use non-slip or grip socks are regularly used in Victorian Hospitals to reduce the risk of slips and falls. A recent rapid review demonstrated there is no evidence that grip socks prevent inpatient falls, and global falls prevention guidelines do not recommend their use. This project will support the co-design of strategies to de-implement grip socks with input from key stakeholders and evaluate the impact of the de-implementation strategy at Western Health. Evaluation of the financial and environmental savings will occur. The de-implementation of grip socks would not only save the health service thousands of dollars per year but would contribute to sustainable practices in line with the Western Health sustainability plan.

Following the release of the Falls Improvement Plan in April 2022, local policies were updated to state that grip socks should not be used as an evidence-based falls prevention strategy. Despite this, product ordering has increased. Reducing product waste is a key objective in the Western Health and Department of Health’s sustainability plans. Grip socks are single patient use, with substantial financial and environmental costs. The de-implementation of grip socks would not only support the health service financially, but would also contribute to sustainable practices in terms of product manufacturing and disposal and ensure that Western Health is practicing in line with international recommendations.

Project title: Explore stakeholder perspectives in implementing patient-reported outcome measures in paediatric liver and heart transplant services

Solid-organ transplantation offers long-term survival for children, however, there is an increased risk of low health-related quality-of-life related to physical, psychosocial, cognitive, and school functioning compared to healthy peers. Patient-reported outcome measures (PROMs) collect these data. Integrating PROMs into routine can facilitate better communication with patients and their families, patient-centred care, and resource allocation to improve outcomes meaningful to patients. In Australia, PROMs integration in paediatric transplant care is not established. This project will explore stakeholder perspectives in PROMs implementation in transplantation services to understand barriers and facilitators to implementation, providing a framework for the development of a co-designed implementation strategy.

Ultimately, successful and sustainable implementation can inspire and provide evidence for spread of innovation to non-transplant services within the RCH, and to other paediatric services throughout Australia. I hope the skills and knowledge gained from the Fellowship will allow me to lead and support the implementation of PROMs throughout the institution, to support all patients to be able to thrive.

Project title: Coordinated follow up of infants exposed antenatally to alcohol and other drugs

Infants who are antenatally exposed to alcohol and other drugs (AOD) are highly vulnerable and at risk of adverse developmental outcomes. This population of infants is incredibly vulnerable and under-researched. It is difficult to screen for developmental concerns in a cohort where there is often poor health literacy, and where limited engagement with services may impact on timely identification of developmental concerns and early support or intervention. It is therefore paramount that we offer streamlined, coordinated and multidisciplinary services that improve equity of access to, and provision of, developmental monitoring and support services to infants who are antenatally exposed to AOD. The goal is to reduce the variation in service delivery, thereby providing the opportunity to improve developmental outcomes for this highly vulnerable population and ensuring there are appropriate supports in place for them and their families to break the intergenerational cycle of adversity.

This project will involve working collaboratively with the Women’s Alcohol and Drug Service Team at The Royal Women’s Hospital to improve the care of newborns exposed to AOD in the antenatal period. I hope the Fellowship Program will allow us to improve referral pathways and ensure these highly vulnerable infants receive coordinated, multidisciplinary follow up which supports development and facilitates timely referral to developmental support services in the community where indicated.

Project title: Transforming malignant pleural effusion management: Innovative, digitally enabled models moving care from hospital to home

Malignant pleural effusion (MPE) is the build-up of fluid in the chest cavity due to advanced cancer. MPE is common and is associated with frequent hospitalisation, debilitating symptoms and a poor prognosis. In Australia, MPE management remains fragmented, with different care models employed across health services resulting in low-quality care and poor outcomes.

An indwelling pleural catheter (IPC) is an alternative procedure that places a small, semi-permanent catheter under local anaesthetic to drain the fluid. Utilisation of IPCs is poor despite high-quality evidence they are safe, reduce the need for further invasive pleural intervention and hospitalisation in comparison to standard of care. Most health services are not equipped with the expertise or resources to support IPC in the community, instead preferring a more invasive and costly surgical approach to MPE management.

My vision is to transform MPE care by using innovative, digitally enabled models to move MPE care from hospital to home. The MacHSR Fellowship will enhance my knowledge, research and leadership skills and grow my collaborative networks towards clinical translation of this new model of care.

Project title: Routine Patient Reported Outcome Measures for women undergoing breast cancer surgery: setting up a PROMS platform to encompass patient-centred care, health service quality improvement and research

In Australia the 5-year survival from breast cancer in Australia is 92% but the the real-time burden of the disease and the treatment, is not well understood or acted upon when patients may need it most. Although Patient Reported Outcomes (PROMs) has been used in specific groups of women across the Parkville Precinct, we seek to establish equitable access for all patients undergoing breast cancer treatment. We aim to use PROMS to identify areas of distress and unmet needs in real time, and in addition, set up a platform for future research and service evaluation across the Breast Service.

I hope to establish routine PROMS capture and use for all patients who have had breast surgery across the Parkville Precinct as a model for real-time intervention. I hope the fellowship will allow me to set up a program that can meet future research needs and help in the design to assess whether the program provides value-added care.

Project title: Building research capacity in general practice: Identifying strategies to integrate research into routine practice

Primary care plays a vital role in the Australian Healthcare System and can improve patient outcomes with better management of chronic disease and effective longitudinal care. However, there are challenges in system interventions involving general practice. As General Practice is a relatively young discipline with less dedicated health research funding, embedding research activity including system change into practice is not routine and can be challenging. I am interested in exploring modifiable organisational factors within a practice that enable us to create a business model and organisational culture that integrates research into GP work, suitable to all practices accounting for their heterogeneity.

I will explore what GPs and practice staff think health services research is, and what value it has and explore the factors that would enable research to be embedded as a routine activity within the practice. Identifying the enablers and barriers in the system will result in recommendations for interventions targeted at making practices research ready for health service research, and proactively joining practice-based research networks.

Project Title: Defining the burden of artefactual troponin elevation on hospital resource management in the ED

Cardiac troponin is a pivotal biomarker used to detect myocardial injury in the assessment and diagnosis of acute coronary syndrome (ACS). In a sizeable group of patients, however, ‘interference’ with troponin measurement causes troponin elevation in the absence of acute myocardial injury. By causing troponin elevation, troponin assay interference erroneously stratifies patients as high risk, precluding early rule-out and necessitating continuous cardiac monitoring and further investigation. A proportion of patients with troponin interference unnecessarily undergo CT and direct coronary angiography, which exposes them to risk and wastes health sector resources.

This project will examine the prevalence and impact of troponin interference in the Emergency Department (ED). We will determine how frequently troponin interference occurs in patients undergoing troponin testing in ED, and the downstream impact on patient management and health sector costs. Our ultimate goal is to deliver a cost-effective method to detect troponin interference in real-time, thereby improving clinical management of ACS and resource allocation in the ED. Aligning directly with a key strategic objective of SVHM to promote clinical innovation and deliver safe, high-quality care, our findings will be relevant to healthcare services throughout Australia and worldwide that are affected by troponin interference.