2024 MacHSR Future Leaders Cohort

Project title: De-implementing unnecessary pelvic x-rays during the initial trauma assessment in the emergency department

Major trauma from car accidents, falls or other forms of misadventure is a common presentation to the ED at RMH. When these patients present they get a range of tests to work out where they might have injuries. Some of these tests – namely the x-rays and CT scans that are undertaken – provide overlapping results. This project aims to work out whether the number of pelvic x-rays that are undertaken in patients injured by trauma can be safely reduced. This will reduce radiation to patients, hospital costs and the staff time used by these potentially unnecessary tests.

Health service research is an essential skill for healthcare staff wanting to improve the efficiency and effectiveness of care they provide to patients on a day-to-day basis. This will in turn ensure patient outcomes are optimised, costs are minimised and care is streamlined. I hope that once I have completed the fellowship, I can use the skills I have learned to conduct further health services research within the Royal Melbourne emergency department and as a collaborative effort across departments and assist others to learn this essential research skill.

Project title: Reducing financial and environmental costs in the ICU to accelerate Western Health towards a more sustainable health service

Sustainability needs to be at the forefront of healthcare research to combat the climate crisis we find ourselves in. Every day, hospitals across the country throw out unused, unopened consumables that have simply gone out of date on the shelf. This is wasteful, zero value healthcare. This project will review and adjust the purchasing of all consumables in the ICU, ensuring stock never goes to landfill unopened. Scale up across Western Health and statewide using a stock swap meet system will be investigated, and the resulting environmental and monetary savings analysed.

The Critical Care community needs a nursing leader to help drive sustainable ideas throughout intensive cares all over the country. I want to be this leader. By participating in the MacHSR Future Leaders program, I can learn how to be that leader. Western Health Intensive Care Services are already at the forefront of sustainable healthcare but we need strong nursing leaders to push this across Australia.

Project title: Web-based screening and intervening for cancer-related cognitive impairment following chemotherapy for aggressive lymphoma: a randomised pilot trial

Cancer-related cognitive impairment (CRCI) is a distressing and disabling treatment side-effect reported by people undergoing treatment, however, this burden is compounded by a lack of evidence for CRCI management. This study proposal will embed cognitive assessment and rehabilitation at treatment completion and has the potential to transform the quality of life and cognitive outcomes for people living with lymphoma.

This prestigious fellowship will enable me to explore an evidence-based solution to cancer-related cognitive impairment, which is experienced by many people affected by cancer, and take steps towards delivering innovative care and becoming a leader in Health Services Research.

Project title: Optimising future fertility and pregnancy outcomes after caesarean section at the Mercy Hospital Women – Can a uterine niche be avoided?

C-section is the most common major operation at Mercy Health and in the world. A growing body of evidence suggests that the impact of the caesarean scar or “uterine niche” – a defect in the myometrium, may cause infertility, increase the risk of uterine rupture risk and the risk of life threatening placental adhesive disorders. I will investigate whether an alternative surgical technique can minimise the rates and degree of niche’s formed after c-section at Mercy Health, with the aim of improving reproductive outcomes in women who deliver by caesarean.

I am excited to undertake the MacHSR Future Leader Fellowship to benefit from the support and mentorship it offers. When navigating through the sometimes-difficult terrain of health research, it is easy to take a wrong turn, and as a result a project with great potential can suffer. Expert guidance for early career researchers is essential. I hope to further my research experience under the structure of MACH and the MacHSR Future Leaders Fellowship so that my project is more likely to flourish. This will benefit women, the health service, and in future other ECRs to whom I can pass on this knowledge and support.

Project title: An Evaluation of the Victorian Virtual Specialist Consults (VVSC) at Northern Health

The Victorian Virtual Specialist Consults (VVSC) service launched in early 2023 in response to the difficulties with access to specialist clinics, exacerbated by the COVID-19 pandemic. VVSC is a virtual model of care supporting GPs to access specialist advice for patients in a timely manner, thereby reducing both referral rates to outpatient clinics and hospital admissions and improving consumer satisfaction. VVSC utilises a synchronous model, providing GPs and nurse practitioners with immediate answers to help manage complex patients in the community. This project will involve a robust evaluation of this service at Northern Health. It is anticipated that the results will showcase the effects of the service on the wider community and guide future development to ensure it is of value to the healthcare ecosystem.

Participation in the Fellowship will support a robust evaluation of the VVSC service and the wider implications of virtual care delivered directly to patients in their community. I am hoping that once I have grasped the skills to evaluate a service, I can apply them to the current service program that I am working on or assist others within the health service.

Project title: Conversion of uncomplicated Major Benign Gynaecology overnight surgery to same-day-surgery

Historically, Major Gynaecology surgery has had the inherent requirement of an overnight hospital admission following a patient’s elective surgery, however, some organisations have recently explored and implemented a same-day-surgery model of care. This project will focus on the conversion of uncomplicated Major Benign Gynaecology overnight surgery to same-day-surgery, with the aim of solving this problem via a PDSA approach with continual evaluation and analysis of findings, impacting changes to the proposed pathway. A same-day-surgery model of care would have a significant impact on the Royal Women’s Hospital as an organisation and is supported by literature as the next progression following implementation of an Enhanced Recovery After Surgery (ERAS) care pathway that is currently in place.

I believe the introduction of the same-day-surgery project at the Royal Women’s Hospital could have considerable impact to the ways in which care is provided to our patients, including many subsequent benefits as identified and supported within the literature. The ERAS project at the Royal Women’s Hospital has successfully demonstrated its positive impact, not only through key performance indicators (KPIs), but also via patient reported outcome and experience measures (PROMs and PREMs). By utilising a same-day-surgery approach, the Royal Women’s Hospital would reduce the throughput of patients from Theatre to the ward, therefore reducing the requirement of beds, and the subsequent bed pressures associated with elective overnight stays. Not only would this create a positive financial saving for the Women’s, as the overall beds per night cost would be reduced under this model of care, but it also presents an excellent opportunity to revisit our current surgical processes and ensure that current models of care are utilising the best evidence available. When partnered with the ERAS pathway, there is very tangible evidence for a substantial impact to our patients and organisation as a whole.

Project title: Improving Pathway to Good Health clinical practices through clinician and consumer perspectives

The multi-disciplinary Pathway to Good Health Clinics provide health assessments for children and young people who have entered statutory care on Child Protection orders. We have been delivering this clinic for over a decade, but previously insecure funding has hampered any quality assurance activities. Clinic processes and practices have not been reviewed since the clinic commenced and there was minimal co-design at the commencement of the clinic. Funding has been obtained for a state-wide rollout of out-of-home care assessment clinics and the establishment of the Victorian Centre of Health Leadership for Children in Care at RCH. As we begin our role in providing statewide clinical leadership for such clinics, it is time to ensure that we are implementing services of high quality that are trauma-informed and meet the needs of all involved. This project will use health services research methodology to evaluate current practices within the Pathway to Good Health Clinic, and to co-design improvements. It will compare current practice to national recommendations and explore the perspectives of all key stakeholders to identify potential improvements for future implementation. It aims to incorporate the voices of children and young people to ensure that we are designing and delivering services that best meet their needs.

The quality improvements directly arising from this project will benefit our RCH Pathway to Good Health Clinic directly.  The project will also develop and test a model of clinic evaluation that can be applied to other clinics within our department and beyond at RCH. My role as Paediatric Lead within the Victorian Centre of Health Leadership for Children in Care provides an opportunity to disseminate the findings to the clinics beyond the hospital and broaden the impact. For me personally, the fellowship will develop my health services research skills to move from understanding challenges within healthcare to designing, implementing and testing solutions.

Project title: SMOOTH: Systematic Measurement of Outcomes in Occupational Therapy Health Services – A co-design study for sustainable implementation

Hospital occupational therapy addresses patients’ participation restrictions in essential life tasks and thereby plays a crucial role in safe and sustainable discharges. Occupational therapy input is linked to reduced length of stay and readmission rates. Current occupational therapy practices typically use informal assessments despite strong recommendations for standardised outcome measures, leading to inaccuracies in forecasting patients’ needs and resulting disparity in resource allocation. The Functional Autonomy Measurement System (SMAF), a valid and reliable outcome measure, may address this gap. This project targets knowledge translation to implement the SMAF to rationalise occupational therapy services, and thereby ensure the right patient receives the right services at the right time aiding SMOOTH resource allocation.

I expect a myriad of benefits will flow from the Fellowship not only to me as a clinician-based researcher, but more broadly to St Vincent’s Hospital Melbourne. Most prominently, I hope to see the streamlining of occupational therapy service provision in response to uniform use of the SMAF. Further, I hope to share key learnings in knowledge translation for this systemic problem more broadly influencing wider health networks. Personally, I hope to better my research skills and leadership in this area to guide and support other allied health clinicians at my organisation to drive innovative and effective research, targeting excellence in patient care.

Project title: Clinical practice patterns and learning behaviours of post-Fellowship vocationally registered Australian General Practitioners (GPs) in primary care dermatology

This project investigates the clinical practice patterns and learning behaviours of Australian GPs in primary care dermatology. By examining the barriers and facilitators GPs face in managing dermatological conditions, it aims to develop targeted educational interventions that enhance their diagnostic and management capabilities. This research not only seeks to improve dermatology care in general practice but also aims to alleviate the burden on specialist services, ultimately seeking to benefit patient outcomes and healthcare system efficiency.

Participation in the MacHSR Future Leaders Fellowship program will enhance my leadership and research skills through its opportunities for mentoring, networking, and hands-on skills-building. The project is anticipated to benefit the University of Melbourne’s Department of General Practice and Primary Care, in addition to the wider Australian general practice community, through enabling the development of targeted primary care dermatology interventions to improve GPs’ confidence and capabilities in dermatology.

Project title: Prioritising patient communication to support equitable access to healthcare

While an artificial airway (breathing tube) provides vital breathing assistance, these patients experience profound difficulty communicating due to the presence of the tube in their airway. This results in inequitable access to healthcare and an inability to engage in healthcare decision-making. There are a range of communication interventions available, but currently there is no comprehensive systematic approach to enabling patients to communicate. This project aims to quantify the extent of this unmet need, identify the barriers and facilitators to a health-service wide targeted communication strategy and implement this. The expected impact is that patient communication will be prioritised, care will be patient-driven and patients will be partners in their healthcare.

Individually, I look forward to learning more about how health system-wide processes, structures and behaviours can be examined and modified in order to improve health-related outcomes, and then having the opportunity to apply this knowledge directly within this current project and future work. From a health service perspective, I anticipate that having clinicians trained in health service research methods with practical application will enhance innovative care practices and improved patient outcomes in the future.