Projects

Click on the following image to view a short video abstract of this project.  (Video to uploaded shortly)

The gold standard for Autism assessment involves a multidisicplinary team comprising a paediatrician, psychologist, occupational therapist and speech therapist. Due to many factors including recruitment, mounting a full team for each assessment can prove challenging. Rather that cancelling assessments, we revised our model of care.

To provide coordinated, person-centred care to families and children undertaking Autism assessment, particularly in the setting of incomplete multidisciplinary teams and staffing challenges.

We have recruited and employed Allied Health Assistants (AHAs) to gather important information about children so they can be best matched with an Autism assessment team containing the necessary health professionals. AHAs triage the waitlist, gather medical, family and developmental information, observations from teachers amongst other information as recommended by best practice guidelines. AHAs communicate with families on the waitlist about when they are likely to be seen and direct them to services and information when needed. For example, if a child has experienced trauma, it is important that a psychologist with skills in this area of childhood development is involved in their team. The information is reviewed by a senior allied health clinician and matched with the best-fit team.

From 2021 to current, of the 460 Autism assessments competed, 202 of those did not have a complete multidispclinary team. Children have been matched to a team that will provide them an effective service, appropriate to their unique health needs without compromising quality of care.

Utilising Allied Health Assistants to collect pertinent information for Autism assessment and using this information to match children to the relevant team has ensured that 202 Autism assessments have proceeded, despite not having a full staff team. Matching the unique needs of the child and family to the available resources has allowed us to deliver services to a high standard, without a full team, and without disadvantaging children and families.

We are proud to have helped 202 children by providing them a comprehensive,  Autism assessment with recommendations that support access to therapies, and improved their journey through the health system. Accessing early intervention services saves money in healthcare through the trajectory of a child’s life, and we strive to support access to equitable and effective care.

Click on the following image to view a short video abstract of this project. (Video to be uploaded soon)

Health service organisations have a duty of care to provide nationally consistent standards to all consumers. Western Health prides itself on the application of these standards to all our patients, including the smallest and the youngest in Newborn Services.

To ensure that we are adhering to these national standards, the health service undergoes an accreditation process; a self and external peer assessment to evaluate quality and safety of health care services using the National Safety and Quality Health Service (NSQHS) Standards as a quality assurance guide for all health services.

Accreditation is commonly perceived as a stressful time for all staff. The feeling of knowledge or clinical assessment can adversely impact staff’s performance and delivery of care.

To ensure that all Newborn Services staff are equipped with the key knowledge necessary to highlight how our care provision meets each standard set by NSQHS. To remind staff that accreditation in Newborn Services (NBS) in business as usual. To reduce the fear/anxiety that staff experience in the lead up to the accreditation due to a sense of unpreparedness and lack of knowledge about the NSQHS standards.

Initiative 1

NBS introduce the NSQHS standards board. Located in the foyer of NBS the board displays each of the eight standards and provides brief descriptions on the ways in which NBS staff meet each standard in our every day care. Along with being located in a high traffic area, the board is brightly coloured and uses photos to demonstrate activities aligned with each standard, making it both informative and visually engaging. The NBS leadership team review and update as care in NBS evolves. Staff are encouraged to review the board and to refer to it during accreditation as a tool for assistance when addressing how we meet particular standards.

Initiative 2

Development of NBS specific versions of the Western Health (WH) NSQHS Standards at a Glance tool. The tool was then emailed to all of the nursing and medical staff, printed and hung in the meeting room, printed and used as place mats in the staff room and rotated weekly. Staff are reminded and encouraged at the monthly unit meeting to utilise both resources. Along with the many resources provided by the WH organisation.

The initiative is ongoing in the lead up to accreditation. Staff feedback is very positive, and other units have heard about and since utilised this approach to develop their own versions.

The NSQHS standards board provides support to staff and transparency to consumers. Staff feel more confident and less anxious about accreditation, improving their emotional and physical wellbeing, performance and work quality. Greater understanding of the NSQHS standards encourages staff to develop ideas which will lead to future quality improvement projects further enhancing the care we provide to newborns and their families at Western Health.

Click on the following image to view a short video abstract of this project.

Prioritising the care of critically unwell infants admitted to Newborn Services (NBS) is of paramount importance. These fragile infants demand the expertise of highly specialized and skilled staff equipped with a broad spectrum of knowledge and abilities. Advanced communication techniques are required to impart vital information in complex healthcare settings such as NBS and can pose a significant risk to patient safety if inadequately delivered. Optimising systems of communication and handover play an instrumental role in reducing errors, by facilitating the accurate and efficient transfer of information amongst all members of the multidisciplinary care team. The benefits of an optimised handover format and communication culture align with Western Health’s strategic vision for prioritising patient outcomes, safety and wellbeing.

Problem Statement

A review of cases in the departmental Morbidity and Mortality meeting identified opportunities to improve communication and handover processes amongst nurses, junior medical staff, and senior medical staff.

To improve multidisciplinary communication and handover processes within Newborn Services, through the implementation of four initiatives:

1. Consistent start time of ward rounds;
2. Coordination of nursing breaks;
3. A structured communication aid; and

Weekly nurse-led handover during ward rounds

In the neonatal field, this project is a world-first innovation which will distinguish Western Health as leaders in neonatal quality improvement and care.

Benefits to Western Health:

• Enhanced patient safety through reduced risk of errors and adverse events
• Creating a positive work environment though collaboration and teamwork
• Operational efficiency therefore enhancing resource allocation
• Enhancing Western Health’s reputation for providing high-quality care

Expected Benefits to Patients:

• Higher quality of care with fewer communication-related errors and improved handovers
• Reducing miscommunication-related incidents that can negatively impact patient outcomes
• Parents may experience increased involvement leading to improved satisfaction

Reducing length of stay due to timely and efficient care

This project is ongoing

Click on the following image to view a short video abstract of this project. (Video to be uploaded soon)

Since the introduction of the National Disability Insurance Scheme (NDIS), Western Health has experienced a 680% increase in patients accessing disability supports.  This has placed increased pressure on health teams, particularly Social Work and Occupational Therapy to meet the demands of this growing, complex population. Initially, NDIS patients were admitted to the Inpatient Rehabilitation (IPR) ward for discharge planning, however as numbers increased NDIS patient now receive discharge planning across inpatient settings. This was increasingly challenging to support with no central coordination and limited NDIS experience external to IPR.

To provide a co-ordinated approach to discharge planning for NDIS patients; increasing timely access to the NDIS and reducing length of stay.

In April 2023, NDIS lead roles were launched, a senior Occupational Therapist and Social Worker. The roles work in collaboration across inpatient settings, identify NDIS eligible patients early and support multidisciplinary teams to provide timely implementation of the NDIS pathway.  The leads provide expert advice and consultation, they escalate barriers and provide education.

Since 2022, Western Health has seen an increase in the number of patients requiring NDIS per month, however since the introduction of the lead roles these numbers are trending down. This is due to patients commencing on the pathway on average, 5 days earlier and a reduction in length of stay (LOS). In 2022 the average LOS was 151 days, in 2023 the average is 98 days, a reduction of 53 days.

Data to date demonstrates that dedicated NDIS lead roles can increase timely interface with the NDIS and reduce LOS. Ongoing work is required to build capacity in staff to ensure they have the skills and confidence to meeting the needs of NDIS patients.

NDIS patients across inpatient services are receiving coordinated, person-centred and right care led by highly skilled and dedicated NDIS leads. The roles have reduced the time a patient spends in hospital and has ensured sustainable discharge plans, so patients can continue to achieve their goals in the community.

Click on the following image to view a short video abstract of this project. (Video to be uploaded)

A gap was identified in the absence of childbirth education services for expectant mothers having their baby at Joan Kirner Women’s and Children’s (JKWC). Previously, JKWC recommended attending external providers for childbirth classes. To address this, the Ambulatory Team at JKWC is conducting a research study, testing two different models of childbirth education. The aim is to determine which model better prepares women for labour and birth and leads to improved birthing outcomes, ultimately informing future offerings by Western Health.

Childbirth education serves various purposes, including educating women and their birth partners on labour physiology, facilitating informed decision-making, preparing for early parenting, reducing perinatal morbidity and mortality, influencing positive health behaviors, and building social support networks.

Ten midwives, divided into two streams, have been trained to deliver childbirth education. The first stream was developed collaboratively with key stakeholders and consumer representatives, incorporating extensive feedback from surveys, focus groups, and stakeholder meetings. It covers labor, birth, breastfeeding, and early parenting with a focus on inclusive education and shared decision-making.

The second stream, provided by Hypnobirthing Australia – The Positive Birth Program, equips parents with techniques for calm birthing.

Both education formats involve 11 hours of contact with a midwife. Classes are offered in a hybrid model, with a mix of in-person and online sessions. Participants are asked to complete three short electronic surveys before, after, and 4 weeks post-birth.

Since starting in October 2023, families have reported feeling more prepared, empowered, and excited for birth. Ongoing evaluation of participant surveys and birth outcomes will continue.

This initiative addresses a longstanding gap in the provision of childbirth education, enabling the JKWC to offer education in-house. The pilot program aims to tailor education to the community’s needs and enhance satisfaction and outcomes.

Our co-designed program prioritizes person-centered care, emphasizing shared decision-making and inclusive language. Collaborating with Baby Makes 3, a government-led family violence prevention program, ensures a respectful approach. On-site education, specific to Western Health, enhances patient satisfaction. We promote safety by educating families on when to seek medical attention. Classes are affordable and accessible, with discounts for health care card holders.

Click on the following image to view a short video abstract of this project. (Video to be added soon)

Vaginal pessaries are a widely used and effective conservative management option for pelvic organ prolapse (POP). However, the fitting process and requirement for ongoing regular patient reviews (usually 6 monthly) to minimise adverse events associated with pessary use is labour intensive. Urogynaecology and Gynaecology medical staff currently perform this role at Western Health (WH). These specialities have extensive wait lists and limited capacity which can impact the timeliness of pessary review and poses a potential safety risk for women. This demand was known prior to COVID and has been exacerbated further by the pandemic.

To address timely care, the Women’s Health Physiotherapy (WHP) team successfully applied for an advanced practice innovation grant offered by the Department of Health (DoH) Allied Health Workforce to design and implement a designated Pelvic Organ Prolapse PhysiotherapY Led Pessary (POPPY) Clinic.

Excitingly, this is the first pessary clinic in a public health setting led by Allied Health clinicians in Victoria (possibly Australia!).

A Physiotherapy Led pessary clinic is feasible and provides timely, safe, and effective evidence-based care for women diagnosed with POP who utilise a pessary.

A secondary predicted outcome is to increase medical speciality appointment capacity and to positively impact wait lists, reducing numbers and time to new appointment.

Funding was received to design and implement the clinic between January 2023 and June 2024.

Following key stakeholder, consumer and subject expert consultation, a model of care was developed. Escalation processes for patients requiring medical review, a staff competency and credentialing package and patient resources including translated options (Chinese, Vietnamese, Macedonian, Burmese, Arabic).

Planned formal evaluation of the POPPY clinic will determine its fesiability by:

• Quantification of demand for pessary review appointments
• Acceptability of the service for consumers and staff
• Clinic practicality (defining the patient population suitable for physiotherapy led care Vs those requiring medical management of their pessary and associated pelvic health conditions.

5 training clinics were conducted and 2 WHPs have been formally credentialed in pessary management. The independent POPPY clinic commenced weekly operation on 5th September 2023.

Preliminary results to date demonstrate:

• POPPY clinic has provided 64 occasions of service (46 new, 18 review appointments) to women with pessaries insitu waiting for care on planned medical appointment lists.
• 60% (26/46) of women waiting for care were overdue for their expected pessary medical review appointment when seen in POPPY clinic (average 8 months overdue, range 1-30 months), demonstrating the need for better access for timely pessary review for women.
• 100% of patients to date are highly satisfied with their care received in the clinic.
• 15/46 patients (30%) have required medical escalation and review.

This project is currently in the implementation phase, with formal evaluation due in May 2024. We hope to demonstrate a sustainable model, with eventual integration of the POPPY Physiotherapy led pessary clinic into usual care delivery within the current Western Health Urogynaecology and Gynaecology services beyond the end of the project funding period.

This project aligns with person centered care for women (improved resources, education and access to pessary care), safe  care (timely pessary review and escalation pathways), co-ordianted care (model of care that facilitates medical, nursing and physiotherapy communication and timely, efficient care) as well as right care (appropriately trained Physiotherapists delivering effective and satisfactory care).

Click on the following image to view a short video abstract of this project. (Video to be uploaded soon)

During COVID, the FH Tranist Lounge was disestablished. In October 2022, a Footscray Hospital Transit Lounge was reminagined and revitalised and opened up in a new location with a new model of care.

To improve patient flow throughout the hospital.

The FH TL provides the following services:

• An admission area for 4 to 5 clinically suitable patients from the Emergency Department who are waiting for an inpatient bed to be available.
• A discharge area for confirmed discharged patients that are awaiting transport, prescriptions, etc.
• An area for patient to receive care while transiting between sites.
• An area for elective admissions to await an inpatient bed.

It has the ability to provide a location for all cohorts of patients, as they are located in a ward environment.

The Transit Lounge staff proactively pull patients from the wards and ED using MIYA and Firstnet. They work collaboratively with the Access Team to ensure their focus is where it is needed for maximum impact.

Through providing this alternative location for our patients the Transit Lounge has:

• Assisted in reducing the number of greater than 24 hour stays in both Footscray and Sunshine Hospitals
• Created early morning flex capacity to assist in ambulance offloading
• Decreased the length of stay of patients in the emergency department
• Avoided unnecessary presentations to the Emergency Department by diverting elective and inter hospital transfers to the Transit Lounge
• Reduced the number of outliers created as flex capacity allows time for appropriate bed to be created
• Decreased the length of stay of patients are in an inpatient bed

Transit lounge has improved patient flow thought the hospital.

Transit Lounge allows us to deliver best care to more of our consumers thought achieving its outcomes.

Click on the following image to view a short video abstract of this project. (Video to be uploaded soon)

A significant minority suffer prolonged and disabling grief after the death of a loved one.  There is consensus that experiencing a sudden, traumatic or unexpected death increases vulnerability to prolonged grief.

Anecdotal reports from staff and patients reflect inconsistent bereavement care when sudden, unexpected or traumatic deaths occur in hospital.

The project team attempted to explore the psychosocial response to those who experienced these types of deaths at Western Health (WH).

Our project aimed to measure sudden, unexpected and traumatic deaths occurred at Western Health (WH) and identify if psychosocial support was provided.

The Plan, Do, Study, Act (PDSA) framework was utilised by the team to guide the project.

The initial problem was there was no data available on if, where and how psychosocial support was provided when a sudden, unexpected or traumatic death occurred at WH. (Plan)  A bespoke audit tool guided bereavement data collection(Do) and the results were analysed. (Study) An action plan is in development to address the issues identified. (Act)

1001 deaths occurred over 12 months in the hospital, 582 were randomly selected for the retrospective audit. 23% of these deaths were classified sudden, unexpected or traumatic and nearly ½ were not reviewed by psychosocial support clinicians. The highest number of these deaths were on the Sunshine Intensive Care Unit (ICU), with only 14% seen by psychosocial support clinicians.  The ward with the most deaths, the Palliative Care had 95% patients reviewed by a psychosocial support clinician, despite a much lower percentage experiencing sudden, unexpected or traumatic deaths.  Low rates of Advance Care Planning was identified across the board.

Our project highlighted inconsistent access to psychosocial bereavement clinicians and bereavement information for patients and their loved ones, plus potential under utilisation of psychosocial clinician services in areas where sudden, unexpected or traumatic deaths were more prevalent.

The quality cycle needs to continue to implement changes to address these inconsistencies and optimise outcomes for the bereaved in our community.

Identified areas of high bereavement needs and optimise referral, access and delivery of psychosocial support.