PubMed Health⌕ Search

Biomedical subjects

Stephen Duckett

Publications and source records attributed to Stephen Duckett.

10 recordsLinked to original sources
PubMed2006

Measurement of adverse events using "incidence flagged" diagnosis codes.

OBJECTIVE: To compare two methods for identifying adverse events using routinely recorded hospital abstract data in all public and private hospitals in Victoria, Australia. METHODS: Secondary analysis of data on all admissions in the period 1 July 2000-30 June 2001 (n = 1,645,992) to estimate the rates of adverse events using International Classification of Diseases 10th Revision Australian Modification codes alone and in combination with an "incidence" data flag indicating complicating diagnoses which arise after hospitalization; rates of incidence and pre-existing adverse events, and rates for same-day and multi-day admissions. RESULTS: In total, 8% of all admissions were recorded with an adverse event. Use of ICD codes alone identified only 59% of the events identified using the combined method, giving a prevalence rate of only 5%. Incident cases, that is, those occurring in the index admission, represented 68% of identified adverse events. The adverse events incidence rate for multi-day admissions was significantly higher at 12%, compared with the same day rate of 0.4%. CONCLUSION: An "incidence flag" is essential to identify those adverse events for which a hospital has unambiguous responsibility. Using such a flag, secondary analysis of administrative data can provide hospital quality assurance programmes with a comprehensive view of all adverse events (not just "sentinel" events) at a reasonable cost and with more timely results than more intensive methods can achieve. Although the method is likely to underestimate the true rate of adverse events (in particular, by not capturing adverse events which only manifest after discharge), in this study of Australian hospitals, rates of adverse events were found to be similar to those derived from studies using manual review of patient records.

Hospitals, Private↗
PubMed2005

An online study of Australian Enrolled Nurse conversion.

AIM: This paper reports the findings of a study exploring the reasons why rural Enrolled Nurses have chosen to convert to level 1 of the nursing register. BACKGROUND: Whilst the Project 2000: A New Preparation for Practice report resulted in the cessation of second level or Enrolled Nurse training in the United Kingdom, Australia has continued to educate enrolled nurses. Currently Australia is facing critical shortages of level 1 nurses and nowhere is this more acute than in rural areas. There are indications that there are large numbers of rural Enrolled Nurses who are interested in 'converting' from level 2 to level 1 of the nursing register. METHOD: Using a computer program that facilitates engagement and interaction, an 'online' focus group was conducted with 38 Enrolled Nurses undertaking a conversion programme at a rural university in Victoria, Australia. During a period of 2 months the Enrolled Nurses participated in a discussion focusing on their reasons for undertaking a conversion programme. Their responses were categorized into five interrelated broad themes. FINDINGS: These Enrolled Nurses suggested that disillusionment with their role and role ambiguity were the primary reasons for their decision to undertake a conversion programme. All participants suggested that their scope of practice as an Enrolled Nurse is significantly broadened in rural areas. They argued that, following conversion, they are in an ideal position to manage the diversity of rural nursing practice. CONCLUSIONS: In Australia, Enrolled Nurse conversion has the potential to ease some of the workforce shortages, particularly in rural areas. By supporting Enrolled Nurses to undertake conversion programmes, rural areas may benefit from having nurses with the knowledge and skills to deal with the rural environment.

Australia↗
PubMed2005

Modeling the emergency ambulance pass-by of small rural hospitals in Victoria, Australia.

CONTEXT: Many small rural hospitals struggle to attract sufficient numbers of suitable patients. Inadequate patient throughput threatens the viability of these hospitals and, consequently, the financial, physical, and social well-being of the whole community. Anecdotal evidence suggests that many emergency ambulance patients are routinely taken past their local small rural hospital to the area's major receiving hospital. PURPOSE: To quantify the ambulance pass-by of local small rural hospitals and identify the factors that influence its occurrence. METHODS: Data were collected from the ambulance and hospital records of 3 small rural centers in central Victoria, Australia. RESULTS: Ambulances transport a significant number of patients past their local small rural hospitals to the area's major receiving hospital. This takes less time for paramedics than bringing a patient to the local hospital first if the patient is then redirected by that hospital to the larger hospital. There is an inverse relationship between the rate of cases in which the local hospital redirects ambulances to the regional hospital and the rate of ambulance crew decisions to use the local hospital. CONCLUSIONS: If some patients are being transported directly to the major receiving hospital because paramedics are considering their own time commitments when making patient transport decisions, this could have revenue implications for rural hospitals. Attracting appropriate local ambulance patients to the smaller hospitals may provide an income source that is currently lost to the crowded major receiving hospital's emergency department.

Ambulances↗
PubMed2004

A question of place: medical power in rural Australia.

In Australia, like many countries, government, medicine and the community have maintained an interdependent and symbiotic relationship based on mutual resource dependency and reciprocity. The services of medicine have been indispensable to government and the community and in return medicine has achieved power, elitism and financial gain. Traditionally, doctors have controlled and directed medical knowledge in an absolute manner and this has been the basis of increasing power and dominance. There are, however, claims that medicine's power and dominance over the health care system is being eroded by the emergence of major social trends. The corporatization of medicine, manageralism and proletarianization are touted as factors that are increasingly countervailing medical dominance and power. Whilst it could be suggested that as these trends become more firmly established government and the community gain greater discretionary control over how the resources of medicine can be allocated and utilized, this article argues that the geographic and social dimensions of the community in which doctors practice must be considered. Using a qualitative descriptive approach research was conducted in rural Victoria, Australia. The overall aim of the study was to identify the issues that impact upon service delivery in rural hospitals. The most significant issue that emerged related to medical relationships. The results of this research indicate that in this rural area the power of medicine is strengthened and institutionalized by geographically determined resource control. The sustainability of rural communities is linked to the ability of the town to attract and retain the services of a doctor. Crucial shortages of rural doctors provide medicine with a mandate to dictate the way in which medical resources will be allocated and used by hospitals and the community. Organizations that control critical resources are in an extremely powerful position to control others. Doctors in rural Victoria maintain a position of strength and use their power to exert control over the state, the community and the hospital. Although medical power and dominance may be declining in some areas, in rural Victoria it remains firmly entrenched.

Community Participation↗
PubMed2004

Therapy outcome measures for allied health practitioners in Australia: the AusTOMs.

OBJECTIVE: The aim of this study was to develop a valid and reliable measure of therapy outcome for three allied health professions in Australia: speech pathology, occupational therapy, and physiotherapy. The Australian Therapy Outcome Measures (AusTOMs) enable measurement of the differences in client profiles and patterns of services provision across health care settings. In this paper we describe phase 1 of the study: the development and preliminary validation of the AusTOMs. METHOD: The UK TOMs, developed by Enderby, were scrutinized by the research team. A pilot core scale was developed, based on the structure of the TOM. Focus groups of expert clinicians for each profession, across the state of Victoria in Australia, analysed and refined the scales further. A mail-out survey was then sent to therapists across Australia to assess both face and content validity of the AusTOMs. MAIN RESULTS: A new tool, the AusTOM, was developed and tailored to the needs of each profession, with input from specialist clinicians and allied health researchers. The face and content validity of the new scales were assessed, and good consensus was obtained for the wording and content validity of the scales. The discriminative validity, concurrent validity, and reliability of the tool are now being evaluated. CONCLUSION: We have produced an outcome measure in the Australian context for speech pathology, physiotherapy, and occupational therapy. There are six speech pathology scales, nine physiotherapy scales, and 11 occupational therapy scales in the AusTOMs. A clinician chooses the relevant scale(s) for the client (based on the goals of therapy) and makes a rating across all domains for each scale. Further papers will report on the reliability, validity, and clinical usefulness of the AusTOMs.

Australia↗
PubMed2003

Educating for rural nursing practice.

BACKGROUND: Rural hospitals in Australia, as in many countries, face challenges in ensuring that appropriate, quality services are provided. AIMS: The overall aim of this study was to explore the issues that impact on the ability of rural hospitals to provide effective health care. METHODS: We used a qualitative descriptive method and purposive sampling, and conducted interviews in hospitals in rural Victoria, Australia. The data collected enabled major issues that impact on hospital service delivery to be identified. Using thematic analysis, global themes were extracted and organized around a thematic network. FINDINGS: The workforce was an important theme. Whilst the impact of medical shortages on hospital function has been considered in other studies, little consideration has been given to the rural nursing workforce. The need to maintain an appropriately educated rural nursing workforce emerged as one of the major issues that impact on rural hospital service delivery. In Australia, there has been a great deal of discussion about the educational preparation required for rural nursing practice, with the emphasis on postgraduate study. However, the majority of rural nurses do not have postgraduate qualifications and face significant barriers in obtaining them. Although the vast majority of literature claims that postgraduate preparation is vital for rural nursing practice, this research suggests that the future rural nursing workforce will be recruited from undergraduate courses in regional universities. However, there is a need to include specific theoretical and operational preparation in undergraduate education, to enable nurses to make the transition to rural practice more readily. CONCLUSIONS: Rural nurses are central to the delivery of health services in rural hospitals. Future rural nursing recruitment and retention hinges on ensuring that they have the confidence, knowledge and skills to deliver safe, appropriate and effective care.

Curriculum↗
PubMed2003

Orthopaedic GP Fellowship: does it work?

BACKGROUND: General practitioners (GPs) see a significant number of musculoskeletal problems in their daily caseload. However, orthopaedic training often forms a relatively small part of their undergraduate and postgraduate training. METHODS: A training fellowship for GPs was set up in Warrington to improve management of patients with common orthopaedic complaints in the primary care setting, and to facilitate more appropriate referrals to orthopaedic surgeons. Following the fellowship, GP referral patterns were examined. RESULTS: It was found that the GP fellows were managing many conditions more appropriately, either conservatively, or with skills learnt during the fellowship. There was an increase in the number of referred cases being listed for surgery indicating a more appropriate referral pattern to hospital. CONCLUSIONS: The Orthopaedic GP Fellowship has improved patient management in primary care and helped GPS better identify those patients who need to be referred for a specialist orthopaedic opinion.

Ambulatory Care↗
PubMed2002

Funding Victoria's public hospitals: the casemix policy of 2000-2001.

On 1 July 1993 Victoria became the first Australian state to use casemix information to set budgets for its public hospitals commencing with casemix funding for inpatient services. Victoria's casemix funding approach now embraces inpatient, outpatient and rehabilitation services.

Adolescent↗