MacHSR projects reducing burden of care on the frontline

Our first cohort of established frontline doctors, nurses and allied health professionals completed their MacHSR Future Leaders Program in 2023.

We catch up with two former Fellows who share how their MacHSR projects are working to improve the patient experience while reducing the burden of care in the clinic.

Cystic fibrosis virtual care

Children living with cystic fibrosis (CF) visit The Royal Children’s Hospital (RCH) four times a year for a review, meaning the burden of care falls solely on the family for most of the year.

“Many children were coming into clinic with persistent coughs, with some admitted to hospital,” says Jen Corda, Senior Respiratory Physiotherapist in the RCH Department of Physiotherapy (pictured left).

Ms Corda collaborated with CF clinicians, virtual care experts and parents of children with CF to create a remote monitoring system embedded in the RCH electronic medical record (EMR), which sends out a twice-weekly survey asking children and their families about daily symptoms.

“Our aim is detecting more pulmonary exacerbations and treating them sooner,” says Ms Corda.

If an exacerbation is detected, an individualised treatment plan is automatically sent.

“The system pulls information from the child’s EMR, such as specific medications and recommended changes to physiotherapy,” says Ms Corda.

“Parents have reported feeling less anxious about their child becoming unwell because they know the CF team are onto it.”

Ms Corda says having access to the ever-growing patient data collected by the system has benefits for the CF team and patients.

“This information guides individualised treatment plans and help us better understand patterns in the wider cohort.”

The fundamental design of the system can easily be applied to other disease cohorts – and they’ve already had interest from other hospital units.

“You could embed any survey using a patient-reported outcome measure,” says Ms Corda.

She says MacHSR gave her the skills and time to set up a rigorous evaluation.

“I also benefitted from MacHSR Director Harriet Hiscock’s incredible networks and vast experience in setting up trials.”

Despite completing her fellowship, Ms Corda says Professor Hiscock is still heavily involved in the project.

“We’re currently 10 months into the true pilot randomised control trial, which finishes in May.

“We’ll look at the system’s feasibility, acceptability and cost effectiveness, and decide whether we roll it out from there.”

Reducing waiting lists through increased day surgery

The pandemic has had an ongoing impact on the Royal Melbourne Hospital’s (RMH) ability to conduct elective surgery due to reduced staffing, inpatient bed availability and increased emergency surgery.

RMH Colorectal Surgeon Dr Tim Chittleborough is working to reduce surgical waitlists by changing some surgical procedures to day surgery.

When Dr Chittleborough first mentioned the idea back in 2021, RMH Director of Surgical Services and Victorian Department of Health Chief Surgical Advisor Professor Ben Thomson suggested he apply for MacHSR.

Dr Chittleborough says the fellowship provided much needed time away from clinical duties to dedicate to his project.

“While day surgery is normal for many minor procedures, my MacHSR project expanded that to other procedures, starting with gall bladders and inguinal hernias,” says Dr Chittleborough.

“We created an ‘opt out’ system, where day surgery is the default option unless the patient is over 80, has comorbidities or has no one to drive them home.”

Dr Chittleborough collaborated with RMH clinicians to standardise the criteria for nurse-led discharge.

“The nurses have reported the patient journey is much clearer. And patients like it too because there is education and support every step of the way.”

Dr Chittleborough says patient satisfaction for day surgery has been identical to an overnight stay.

“We’ve also had much less cancellations due to availability of beds,” he says.

While Dr Chittleborough has completed his fellowship, he’s continued to push the expansion of day surgery to procedures to include haemorrhoids, laminectomy and ACL repairs.

“Our next step is to expand into emergency surgery, encouraging discharge on the day of surgery following emergency gallbladder, appendix and hernia procedures,” he says.

Dr Chittleborough says he’s appreciative of the support he received during the fellowship.

“Chair of Surgery Professor Christobel Saunders AO really encouraged me to push forward with the project, and Associate Professor Nicole Rankin from the Department of Implementation Science gave me some great connections.

“The Fellowship gave weight to my position and has allowed me to become the RMH Day Surgery Champion I now am.”