Research Week Abstract Book - Northern Health

2013 

Research Week 

Abstract Book 

Broadmeadows Health Service 

Bundoora Extended Care Centre 

Craigieburn Health Service 

Panch Health Service 

The Northern Hospital

Our Vision 

Outstanding health care for 

our community 

Our Mission 

To provide people in Melbourne’s 

north with outstanding health care by: 

• Expanding from a great community based 

health service to a major university teaching 

health service. 

• Developing the services and the pathways to 

services that our community needs. 

• Embedding the best teaching and research 

practice in everything we do. 

• Cultivating a community of staff, patients and 

families who work together. 

Our Commitment 

• Passionate – we care 

• Dedicated – we are focused 

• Progressive – we look to improve 

• Collaborative – we are a team 

Our Priorities 

1. Provide a balanced mix 

of quality services. 

2. Fully utilise our resources and 

develop our infrastructure. 

3. Strengthen organisational capability. 

4. Attract and develop a high 

performing workforce.

contents 

appointments 

contents 

at Latrobe, Deakin and the University of Melbourne are held by many Northern Health staff and this is one of 

Research Week Abstract Book 

3 Introduction 

4 Event Schedule 

9 Abstracts 

11 Aged Care 

19 Chronic Disease Management 

27 Haematology 

35 Womens Health and Paediatrics 

35 Health Service Evaluation 

35 Orthopaedics 

the areas that we particularly wish to grow over the next few years. 

1

2 Research Week Abstract Book Northern Health 2013

Introduction 

Health Literacy And Clincial Handover - 

Bridging The Patient Safety Gap 

IntRODUCTION 

Northern Health Quality, Safety and Research Week 2013 provides an exciting demonstration of the growth and breadth of 

quality and research activities at Northern Health. The overall theme for the week is: Health Literacy and Clinical Handover 

– Bridging the Patient Safety Gap. 

Guest speakers this year include: Prof Christine Jorm, Professor Rachelle Buchbinder, Nathan 

Farrow and Katherine Stevens. 

Prof Christine Jorm 

Christine has doctorates in neuropharmacology and sociology with a background in Anaesthetics and patient quality and 

safety and has developed policy and strategy for the Australian Commission on Safety and Quality in Health Care. In 2010, 

Christine moved to the Sydney University where she developed and led the national Clinical Handover program. In 2012, 

she published the book ‘Reconstructing Medical Practice - Engagement, Professionalism and Critical Relationships in Health 

Care’. Christine is passionate about finding ways to enable the doctors of the future to better engage with and influence the 

healthcare system. During Quality, Safety and Research Week 2013 Christine will be speaking on ‘Clinical Hand-over and 

Patient Safety’. 

Prof Rachelle Buchbinder 

Rachelle Buchbinder is an Australian NHMRC Practitioner Fellow. She has been the Director of the Monash Department 

of Clinical Epidemiology since its inception in 2001 and Professor in the Monash University Department of Epidemiology 

& Preventive Medicine since 2007. She is a rheumatologist and clinical epidemiologist who combine clinical practice with 

research in a wide range of multidisciplinary projects relating to arthritis and musculoskeletal conditions. Rachelle will be 

speaking on a range of topics including: ‘Engaging with the Community’ and the ‘Evidence Practice Gap’. 

Mr Nathan Farrow 

Nathan is the National Trauma Quality Improvement Manager for the development of the Australian Trauma Quality 

Improvement Program (AusTQIP). He has overseen the risk management and quality improvement frameworks for one of 

the largest health services in Victoria. He has a background as a clinical nurse, specialising in critical care, emergency and 

trauma nursing, and nursing education. He has a Masters degree in Professional Education and Training and undertaken 

additional studies in Human Factors and Safety Management Systems. 

Katherine Stevens 

Katherine is a solicitor with Health Legal, and is also a qualified nurse who attained a Juris Doctor in Law in 2007. She was 

admitted to practice as an Australian Lawyer in 2009 and has extensive legal experience in Australia and the UK. Katherine’s 

time in nursing brings practical, real-life experience to her work as a lawyer. Katherine has assisted with matters before the 

Supreme Court, the County Court, the Magistrates’ Court and VCAT, as well as with coronial investigations and inquests. 

In addition, As part of the Quality and Risk/Research Study Day, Northern Health is pleased to present Hear Me, a powerful 

and innovative play that examines all the complex issues that arise when things go wrong in health care. 

Hear Me deals with the aftermath of a young patient’s death from the perspective of the patient’s mother, the CEO, the 

supervising doctor and his colleague. The play was written by Alan Hopgood, in collaboration with the Australian Institute for 

Patient and Family Centred Care. A facilitated discussion will follow the performance to examine the potential for improving 

the quality and safety of healthcare through communication, partnerships between patients, families and healthcare 

professionals, and staff culture. 

3

4 

Research Week Abstract Book Northern Health 2013

Introduction cont’d 

IntRODUCTION 

During Quality, Safety and Research Week 2013, a new round of Northern Health Small Research grants will be awarded. 

A number of the projects reported in this Abstract Book have developed from an initial small grant, which is an excellent 

opportunity for emerging researchers to develop research skills, often with mentoring of an experienced researcher, as well as 

providing a basis for building research track record to enable application for larger external grants. 

Northern Health research activity is supported through a range of other activities throughout the year, overseen by the 

Northern Health Research Committee. These range from providing research training opportunities, setting and working 

towards implementing organisational priorities and strategic directions, running a range of capacity building activities 

including providing formal and informal sessions to discuss research ideas, and mentoring clinicians with an interest in 

research. 

2013 has been another excellent year of research and quality activities for Northern Health. Please take the opportunity to 

review the abstracts in this book, and view the associated research posters on display throughout the week, and participate 

in the wide range of quality and research activities. 

Professor Peter Brooks 

Executive Director of Research 

Dr Anastasia Hutchinson 

Chair, Research Committee 

5

Event Schedule 

Date / Time Topic & Presenter Campus & Venue 

Wednesday 19/6/2013 

Set Up Posters etc. 

Thursday 20/6/13 

8 am – 9.30 am Medical Rounds - MED UNIT 4 tnH Lecture Theatre 

10.30 am - 12 pm Interactive Workshop – Engaging with the Community – NCRC Seminar Room 

Health Literacy – Prof. R. Buchbinder 

12 pm - 1 pm HMOs – The Evidence Practice Gap – tnH Lecture Theatre 

Prof. R. Buchbinder 

2.30 pm – 4.30 pm Patient Education Workshop BECC – BECC PCW Meeting RM 

Prof. R. Buchbinder 

Friday 21/6/13 

12 pm – 1.30 pm “Just what you need for a successful Scholarly northern Clinical School 

Selective” Prof. R.Buchbinder 

Administration Building 

Monday 24/6/13 

11 am – 12.30 pm Cardiovascular – Advance Trainee Presentations- UNIT E Tute RM 

Prof. Bill Van Gaal, Director of Cardiology 

12.30 pm – 1.30 pm Angela Ruzzene ”Clinical handover” BECC Conference Room 

3 pm – 5 pm Meeting to Establish Centre for Advanced nCRC Seminar Room 

Cardiac Imaging – Peter Barlis 

Tuesday 25/6/1 

11.30 am – 12.30 pm Dr Mary Whiteside, Nadia Szwed, Fiona Holland BECC IT Training Room 

“Working with Cultural Diversity” 

Video linked to 

this session explores three different ways of working TNH Conference Room 4 

with cultural diversity in hospital and community 

health settings 

1 pm – 2 pm Poster display are “Staffed” by authors tnH Campus Front Foyer 

3 pm – 4 pm Professor Nora Shields, Rachel Ellis, Andrew Steel BECC IT Training Room 

“Consumer partnerships in health research - 

Video linked to 

two heads are better than one” TNH Conference Room 4 

Partnerships between researchers and consumers Rooms 1 and 2 

are becoming ever more important in health, and 

have the potential to result in innovative and workable 

outcomes. 

6 


Event Schedule cont’d 

event schedule 

Date / Time Topic & Presenter Campus & Venue 


8 am – 5 pm `Clinical Risk Management & Research Study Day See Attached Program 

5.30 pm – 6.30 pm Professor Christine Jorm --“Clinical Handover and TNH Lecture Theatre 

Patient Safety-Surgical Perspectives” – Surgical Forum 

Thursday 27/6/13 

8 am – 9 am “Medical Rounds – Clinical Handover and Patient Safety” TNH Lecture Theatre 

9.30 am - 11am Professor Christine Jorm and Ms Wanda Stelmach TNH Lecture Theatre 

“Handover Workshop” 

1.30 pm - 2.30 pm Clinical Trials Seminar/Discussion nCRC Seminar Room 

2 pm – 3 pm Angela Ruzzene “Clinical Handover” BHS Meeting Rooms 1 

and 2 

7

Clinical Risk Management & Research Study Day 

Wednesday, 26 June 2013 - TNH Lecture Theatre 

Effective Communication results in less Stuff Ups! 

Time Topic Presenter 


8:30 am – 8:35 am Opening and House keeping Janet Compton – CEO 

8:35 am – 8:45 am Person Centred Care/Incidents in a Day Maree Cuddihy 

8:45 am – 9:45 am Human Factors and Patient Safety nathan Farrow 

9:45 am - 10:15 am MORNING TEA (BY0) 

national Trauma Quality 

Improvement Manager 

10:15 am – 11:15 am Evidence/Practice Gap In Quality – How Can Professor Rachelle 

We Improve? 

Buchbinder Monash 

University 

11:15 am -12 pm Quality Improvement Projects northern Health staff 

• How To Deal With Frequent Flyers 

• SHINE Project 

• Allied Health Project 

12 pm -12:30 pm Lunch Provided 

12:30 pm – 2 pm PLAY - Hear Me 

Facilitated by Dr Catherine Crook 

Paediatrician, Director of Institute of Patient and Family Centred Care 

2:15 pm – 3 pm Health Legal – Consent and Documentation Katherine Stevens 

3 pm – 4 pm Open Disclosure Improving Patient Outcomes Assoc Professor 

Christine Jorm 

Clinical Handover 

the University of Sydney 

4 pm – 4:05 pm Closure Maree Cuddihy 

4:05 pm - 4:15pm Awards 

• Best NH Completed QI Project (Chosen Form Riskman) Janet Compton - CEO 

• Research Week poster Prizes 

• Small Grant Round 14 Successful applications announced 

Evaluation 

8 


ABSTRACTS 

Abstracts 

9

10 


Aged Care 

Aged Care 

Does physiotherapy (direCTed towards mobility) improve funCTion in 

older people with dementia? 

Simon S, Wortman H, Lenarcic C, Ostberg C, Lawler K. 

Background 

Dementia is highly prevalent in the growing population of elderly clients seen across the health care continuum by 

physiotherapists. Rehabilitation can be challenging due to the large spectrum of pyramidal and extrapyramidal signs, 

cognitive, communication and behavioral problems associated with the disease. 

Aim 

To review whether physiotherapy is effective in improving function for patients with dementia 

Methodology 

A literature review of articles published on CINAHL, EMBASE, MEDLINE, PSCYINFO. Dementia was searched with synonyms 

for mobility and exercise. Participants were over 65 year olds with dementia. Physiotherapy intervention included 1:1 or 

group therapy that was either exercise of functionally-based. Articles selected required outcomes to be related to physical 

impairment or reduced mobility. Articles were excluded if the subjects had acquired brain injuries, intellectual disabilities, or 

delirium in the absence of dementia; if outcomes were focused exclusively on cognition or behavior, or if intervention was 

exclusively pharmaceutical. 

Results 

Physiotherapy can be effective in clients with dementia. Therapy should be functional, use simple commands and 

include visual demonstration. Therapy was most effective when facilitated by clinicians regularly in a repetitive, structured 

environment. These clients may require a longer period of time to improve. There was no evidence suggesting physiotherapy 

was detrimental. Quality of the evidence was low. 

Conclusion 

Physiotherapy can be beneficial to clients with dementia. Functional based assessment and treatment were shown as most 

effective. Cognitively impaired clients can achieve results similar to cognitively intact clients, but may require a longer length 

of stay. 

11

Aged Care 

LOOKING FOR SEIZures IN DemenTIA 

Lim S & Pearson K. 

Background 

Seizures are known to be more common in patients with dementia compared with the general elderly population, however 

little clarity exists regarding its epidemiology, diagnosis and management. 

Aim 

This paper evaluates the presentation of both tonic-clonic seizures as well as non-convulsive occipital epileptiform activity 

in an elderly gentlemen with advanced Alzheimer’s disease complicated by behavioural and psychological symptoms of 

dementia (BPSD). The role of electroencephalography (EEG) in diagnosing non-convulsive seizures amongst demented 

individuals who are otherwise unable to describe symptoms of altered perceptions or fluctuating consciousness is discussed. 

Methodology 

A comprehensive systematic review of the literature was performed using the search terms ‘epilepsy’, ‘occipital seizures’, 

‘dementia’ and ‘anti-epileptic medication’ in Ovid Medline and PubMed. References from each article were searched for 

further studies of interest. 

Results 

Eighty-five publications were shortlisted for review in the following domains: 

1. Seizures in the elderly with dementia 

2. EEG in seizure evaluation 

3. Treatment of epilepsy in elderly patients with dementia 

Occipital seizures were diagnosed in the context of an abnormal EEG with behaviour suggestive of visual hallucinations in 

the elderly patient described. The subsequent commencement of anti-epileptic medications led to improved compliance with 

care and reduced BPSD. 

Conclusion 

Increased awareness regarding diagnosis and treatment of non-convulsive seizures in elderly patients with dementia can 

lead to better care through reducing anti-psychotic use for agitation otherwise attributed to BPSD. The EEG can be a useful 

tool in diagnosing focal epileptiform activity in the absence of clinical signs of seizures. 


Aged Care 

Aged Care 

A COMParison OF OUTCOMES ASSOCIATED WITH ADDinG A HOMEbaseD 

EXERCise ProGRAM (heP) TO A GrouP EXERCise ProGRAM 

(GEP) FOR ClienTS ATTENDinG COMMUNITY THERAPY SERVICes (CTS) AT 

broaDmeaDOWS HEALTH SERVICE (bhs). 

Whitbourne C, Koh KWZ, Lawler K, Cooke S, Terkely R, Hill K. 

Background 

Many clients referred to BHS have balance impairments, are vulnerable to falling and serious injuries. Evidence indicates that 

at least 50 hours of exercise is required for lasting changes to balance and reduce falls risk. 

Aim 

To analyse if the addition of HEP improves balance outcomes more than a GEP in isolation (usual care) for patients with 

balance impairments. 

Methodology 

Twenty-three participants with similar baseline characteristics (p>0.05) were recruited prospectively for our randomisedcontrolled 

trial with concealed allocation and assessor blinding. Usual care included a 6-8 week GEP (one hour weekly). The 

intervention group also completed 2 home-based physiotherapy sessions to tailor a HEP for clients to complete daily and 

record in a diary until 3 month follow-up. Outcome measures included the Balance Outcome Measure for Elder Rehabilitation 

(BOOMER) and force platform measures using the Neurocom Balance Master, taken pre, post and 3 months. 

Results 

Currently eighteen participants have completed post-group analysis, sixteen have completed 3 month follow-up. After 

8-weeks both groups showed statistically significant gains on BOOMER (n=14 p=0.016, n=9 p=0.011 for control and 

intervention groups respectively) and were similar at 3 months. At 3 months, the only statistically significant differences 

between groups were Neurocom limits of stability reaction time on right (n=15, p=0.009), left (n=15, p=0.011) and 

composite scores (n=13, p=0.008) all in favour of the experimental group. 

Conclusion 

The addition of HEP to GEP is similar to a GEP in isolation (usual care). Recruitment of further participants will add to this 

studies power. Further studies may identify the long-term benefits for clients with balance impairments. 

13

Aged Care 

ProVISION OF HOME BASED REHABILITATION TO IMProVE FUNCTIONAL 

inDEPenDenCE AND ABILITY TO MANAGE AT HOME FOLLOWING HOSPITAL 

DISCHARGE 

Hull S, Gale J, Gibson A, Hill K, Hutchison A, Lawlor V, McLoughlan A, Penberthy L, Tully N. 

Background 

The Extended Rehabilitation in the Home (ERITH) service was developed to provide patients with timely access to home 

based rehabilitation to prevent readmissions to the emergency department. 

Aim 

To evaluate the effectiveness of the ERITH service in improving client’s functional independence and ability to manage at 

home following hospital discharge. 

Methodology 

Provision of home based Occupational Therapy and/or Physiotherapy following discharge from the emergency department, 

short stay unit or the acute geriatric unit. Pre and post Timed Up and Go (TUG) outcome measures were recorded. Phone 

interviews were completed at one and twelve months post intervention. 

Results 

113 clients consented to take part in the evaluation. A mean improvement of 11 seconds (33%) was recorded in the TUG. 

82% of participants showed a decrease in emergency department presentations. 10% of participants reported having had a 

fall(s) within one month post intervention, which increased to 28% by 12 months. At twelve months 89% of participants felt 

they were managing at home, 76% were compliant with therapist recommendations, and 78% rated the ERITH service as 

beneficial. 10% of participants were excluded from the evaluation due to readmission within the intervention period. 

Conclusion 

The ERITH service is effective at improving client’s functional independence and ability to manage at home following hospital 

discharge evidenced by a decrease in emergency department presentations. A clinically significant improvement was 

recorded in the TUG and participants reported a high level of compliance with therapist recommendations, ability to manage 

at home, and satisfaction with the ERITH service. 

14 


Aged Care 

Aged Care 

FALLS TRENDS WITHIN PhysioTHERAPY: 

A RETROSPECTIVE ANALYSIS 

Lam J, Chapman S, Penberthy L & Tzerefos R. 

Background 

Falls are a common problem in hospitals. Although strategies are in place to minimise falls in physiotherapy interventions, 

they still occur. 

Aim 

To examine what happened when patients fell during Physiotherapy and to identify trends in falls within physiotherapy 

interventions. 

Methodology 

A retrospective observational descriptive study was conducted. Reports of patients who had falls while performing 

physiotherapy interventions with a physiotherapist during the period of October 2010 to September 2012 and were recorded 

in Victorian Health Information Management System (VHIMS) were thematically analysed. Descriptive data were compiled 

and reported in aggregated numbers or themes. 

Results 

A total of 30 records of falls related to physiotherapy were identified. Most falls were reported by junior staff (50%) and 

occurred whilst the patient was mobilising, transferring, practicing steps or doing squats. 47% of falls occurred in subacute 

wards. 93% of falls occurred during individual physiotherapy interventions, only 7% falls occurred during group exercise 

setting. Sliding forward when sitting on edge of bed/chair/wheelchair and knee/leg giving way were the most common 

cause/mechanism of falls. Fatigue was the main contributing factor. Secondary contributing factors were lower limb 

weakness, behavioural component and impulsiveness. Possible minimizing factors reported by reporters were having a 

second person to assist, education of patient and staff, resting patient, closely supervising/monitoring patients and modifying 

task/intervention. 

Conclusion 

This study shows that performing functional activities and lower limb giving way are the main causes of falls occurring within 

physiotherapy. Patient fatigue appears to be a main contributing factor to falls during physiotherapy interventions. 

15

Aged Care 

ABSTRACT OF A Case STUDY COMParinG USUAL Care EXERCise AND BRAIN 

TRAINING EXERCises IN THE MANAGemenT OF KNEE OSTEOARTHRITIS 

Harms AD 1 , Stanton TR 2,3, Moseley LG 2,3 , Hau R. 1 

1 

Northern Health, Melbourne 

2 

The Sansom Institute for Health Research, The University of South Australia, Adelaide 

3 

Neuroscience Research Australia, Sydney 

Background 

Central sensitisation including disrupted cortical body schema is known to occur in chronic pain states and may contribute to 

osteoarthritis pain. 

Aim 

Case study using brain training exercises in osteoarthritic knee pain. 

Methodology 

Design: Case study, recruited from a replicated case series study using a randomised cross-over design comparing a usual 

care exercise programme (2 weeks) and brain training exercises (2 weeks) consisting of left/right judgments (pictures of left 

or right feet). Usual care was the first intervention. The participant was followed up at six months. Participant: A 71 year old 

lady with a three year history of right knee pain and known osteoarthritis Outcome measures: Knee pain rating with visual 

analogue scale, knee two point discrimination threshold, left/right judgment accuracy and speed, daily medication 

Results 

Baseline, knee pain 46/100mm, paracetamol 3990mg, ibuprofen 800mg, two point discrimination threshold 97mm, Left/right 

judgment accuracy right images 70% and left images 90% correct, reaction time 2.0 secs. Following two weeks of usual 

care: (17/100mm, paracetamol 2660mg, ibuprofen 400mg) two point discrimination 81mm, left/right accuracy (right 100%, 

left 80%) and reaction time increased to 2.4secs. Following brain training: pain and medication use decreased (0/100mm, 

paracetamol 665mg only), two point discrimination and left/right judgment similar (78mm, 90% right, 90% left), speed 

improved (1.5secs). At six month follow-up: pain remained at 0/100mm and no medication. Large decreases in two point 

discrimination occurred (52mm). Left/right judgment accuracy decreased (right 75%, left 83%) although speed improvements 

remained (1.6secs). 

Conclusion 

Brain training exercises may play a role in management of some presentations of osteoarthritic knee pain. 


Aged Care 

17

18 


Chronic Disease Management 

A SYSTEMATIC REVIEW OF ACUPunCTURE OR Dry NEEDlinG FOR TREATMENT 

for PeoPle WITH PHANTom LIMB Pain. 

O’Neill P. 

CHROnIC DISEASE Management 

Background 

Phantom limb pain affects up to 80% of all people with limb amputations. 1 Patients seek out a variety of treatments 

including acupuncture.2 

Aim/ Question 

Is needle acupuncture or dry needling an effective treatment for people with phantom limb pain following major limb(s) 

amputation? 

Methodology 

Databases searched (1972-2012): CINAHL, MEDLINE, AMED, psycINFO, Cochrane Library, Chartered Society of 

Physiotherapy Catalogue, PEDro and the Internet. Key words:- phantom limb pain, and acupuncture or dry needling. Included 

papers on needle acupuncture or dry needling to treat phantom pain (major limb amputations only). Electro-acupuncture 

included if combined with needling techniques. Outcomes were pain measures. Papers were systematically reviewed. 

Results 

Nine papers all single or multiple case studies of low to moderate levels of quality were identified 2-9 including 21 participants 

in total. Seventeen participants had lower limb amputations, three had upper limb amputations and one had quadruple 

amputations. Most amputations were trauma or cancer related and two participants had vascular causes. No studies used 

dry needling. All used traditional Chinese medicine points, some with a western clinical reasoning model. Six studies used 

needles only, three combined this with electro-acupuncture. 5-7 Two participants’ pain did not change however all others 

described a reduction or disappearance of phantom limb pain. No study described long term follow-up. 

Conclusion 

There is insufficient evidence that acupuncture or dry needling is an effective treatment for the treatment of phantom limb 

pain following major limb amputation. There is a need for further high level research with long-term evaluation. 

19


YOU CAN DO IT TOO! THE DEVELOPMENT OF A SATELLITE MOTor NEURONE 

Disease CliniC IN MELBOURNE 

Howe J 1 , Bennett R 2 , Jeffress S 2 , Lamont R 2 , Mills P 2 , Ng K 2 . 

1 

Calvary Health Care Bethlehem 

2 

Home and Community Care (HACC) Allied Health Team, Bundoora Extended Care Centre, Northern Health 

Background 

Patients with Motor Neurone Disease (MND) faced difficulties in receiving coordinated care in the northern suburbs of 

Melbourne. Thus a multidisciplinary satellite MND clinic was set up in 2005 as a joint venture between Calvary Health Care 

Bethlehem, Bundoora Extended Care Centre, the Victorian Respiratory Support Service and the Motor Neurone Disease 

Association of Victoria. 

Aim 

To determine if a multidisciplinary satellite MND clinic is a positive model of care and if the quality of services meet the needs 

of patients with MND and their carers. 

Methodology 

An exploratory study of an existing service was conducted. Data of patients with MND who attended the satellite MND 

clinic was analysed between 2008 and 2011. Data included total patients seen, interventions provided, number of allied 

health encounters and phenotypes of MND. A satisfaction survey with implied consent stated at the cover sheet was also 

completed to look at patient satisfaction of services provided. 

Results 

Phenotype data indicated that the clinic services a normal MND population. From 2009 to 2011, over 58% of patients had 

involvement from four or more allied health disciplines (N=84). Results from the satisfaction survey indicated 88% of current 

patients (N=12) had a high level of satisfaction of services received. 

Conclusion 

This multidisciplinary clinic demonstrates a positive model of care. There is a high level of patient satisfaction with this model 

of care in the management of MND. A similar clinic in Geelong is now in development, you can do it too! 

20 



APProPriaTE OR NOT? A SURVEY OF ANTIMICrobial PresCribinG AT THE 

NORThern HOSPITal 

Chhanabhai A 1 , Hume S 2 , Jeremiah C 2 , Yeung L 1 . 

1 

Pharmacy Department, Northern Health 


2 

Department of Medicine, Northern Health 

Background 

Antimicrobial resistance is a growing problem globally, and is compounded by a lack of new antimicrobials in the drug 

development pipeline. There is good evidence that regional antimicrobial resistance rates correlate with corresponding 

regional antimicrobial consumption. Up to 50% of antimicrobials used in hospitals in Australia and overseas are considered 

inappropriate and are associated with adverse patient outcomes, while also driving resistance. 

Aim 

To conduct a baseline survey of antimicrobial prescribing trends at The Northern Hospital (TNH) and identify areas that could 

be targeted for quality improvement through Northern Health’s antimicrobial stewardship program. 

Methodology 

Two teams, each consisting of an infectious diseases physician and a pharmacist, reviewed the charts of randomly selected 

inpatients throughout TNH. When the patient was prescribed an antimicrobial, the team reviewed the patient’s notes and 

pathology investigations and assessed the appropriateness of the antimicrobial. Where possible, the Australian Therapeutic 

Guidelines: Antibiotic Version 14 was used as the reference standard. 

Results 

Thirty of 80 (37.5%) patients surveyed were on at least one antimicrobial. The indication for the antimicrobial was documented 

in 24 (80%) patients. In thirteen patients (43.3%), the prescribed antimicrobial was considered inappropriate. Categories of 

inappropriate antimicrobial prescribing included: antimicrobials not indicated, inappropriately broad-spectrum antimicrobials 

and extension of surgical prophylaxis beyond 24 hours. 

Conclusion 

The results show there are a number of areas in which the prescribing of antimicrobials can be improved to optimise patient 

outcomes while minimising unintended consequences of antimicrobial use. These areas will provide targets for future 

antimicrobial stewardship activities within the hospital. 

21


PRESCRIBING EVIDENCE-baseD MEDICINE IN HEART FAILURE: A PhysiCian- 

TARGETED INTERVENTION 

Chua C, Hutchinson A, Tacey M, Lim K, Aboltins C. 

Background 

Exacerbation of heart failure is a major cause of hospitalisation and readmissions worldwide. Despite strong evidence 

recommending the use of beta-blockers and angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor 

blockers (ARB) in chronic heart failure management, these medications have been under-utilised. 

Aim 

To evaluate the effectiveness of a quality improvement initiative targeted at physicians on prescription of beta-blockers and 

ACEi/ARB for heart failure management in a hospital setting. 

Methodology 

A prospective audit of medical records was conducted at The Northern Hospital between January 2009 and April 2012. 

Data regarding the use of beta-blockers and ACEi/ARB were randomly collected from approximately 10% of patients 

discharged every month from each general medical and aged care unit with a primary diagnosis of heart failure. A two-staged 

intervention was carried out. From November 2009 to December 2010, a heart failure management protocol was established 

and presented during Grand Rounds and junior doctor education sessions. The second stage commenced in February 2011 

and consist of three-monthly feedback meetings for each participating medical unit. 

Results 

A significant rise in the prescription rates for both beta-blockers (p=0.014) and ACEi/ARB (p=0.002) was identified in the 

first six months. However no further significant changes were seen during the remaining period of the initial intervention. The 

second stage of the intervention resulted in a significant upward trend for ACEi/ARB prescription rates (p


INTRODUCTION OF A MULTIDisCIPlinary KNEE OSTEOARTHRITIS (oa) GrouP 

ProGRAM IN COMMUNITY THERAPY SERVICes (CTS) TO IMProVE PATIENT 

ACCess TO CONSERVATIVE MANAGemenT, SELF-rePorTED UNDersTANDinG 

TO SELF-MANAGE, FUNCTIONAL MOBILITY AND QualiTY OF LIFE (QOL) AT 

broaDmeaDOWS HEALTH SERVICE (bhs). 


Koh KWZ, & Stillman M. 

Background 

Patients referred to BHS CTS with knee OA were categorised as a low priority contributing to significant time waiting for 

conservative management. As a result they were unable to access therapy prior to their follow up specialist appointments. 

Aim 

To improve patient access to physiotherapy, knowledge in self-management, functional outcomes and quality of life (QoL) 

through the introduction of a multidisciplinary knee OA group program. 

Methods 

Patients from the CTS BHS waitlist consented to a knee OA group program during 2012. The group ran once a week over 

4 weeks and included education and exercise. Education sessions included information on OA, activities of daily living, 

exercise, weight management and supplements. Exercise included tailored strength, balance and flexibility exercises. 

Outcomes included waiting time, patient survey on self-management, 6-minute walk test (6MWT) and Knee Osteoarthritis 

Outcome Score (KOOS). 

Results 

Twenty patients joined the program resulting in decreasing the waiting time from 12 months in 2011 to 4 weeks by the end 

of 2012. A Wilcoxon signed-ranked test showed statistically significant improvements in patients’ understanding of selfmanagement 

(n=9, p=0.015). There was no significant difference in 6MWT. Only sports/recreation (n=8, p=0.011) and QoL 

(n=8, p=0.026) in KOOS showed statistical significance. 

Conclusion 

A multidisciplinary knee OA group program greatly improves patients’ access to conservative management. Results suggest 

improvements in patients’ understanding to self-manage, as well as QoL and sports/recreation domains of KOOS. Further 

studies should address the high drop-outs rates, assess long-term effect and compare findings to non-group conservative 

management. 

23


SURGICAL INTERVENTION FOR COMPleX AND RECurrenT FOOT ULCeraTION: A 

liTERATURE REVIEW AND 2 Case STUDies 

Jilbert E, Harper K, Morphet A, Gazarek J. 

Background 

Surgical intervention for complex or recurrent foot ulceration attributed to deformity is developing as an integral part of 

management for diabetes-related foot ulcers (DRFUs). A multidisciplinary approach to DRFU management has long been 

established as best practice for achieving optimal patient outcomes and promoting limb salvage. Surgical intervention is 

increasingly being utilized, with aims to reduce or correct foot deformity, thereby promoting ulcer healing and preventing 

recurrence. 

Case Study 

Case A: 60yo with type 2 diabetes mellitus (DM), rheumatoid arthritis and bilateral Charcot Neuroarthropathy (CN). CN 

resulted in foot deformity and recurrent DRFU. Multiple offloading modalities were trialed, including total contact cast (TCC), 

CAM walker, felt padding, Darco surgical shoes and foot orthoses. Various offloading modalities achieved healing of the 

DRFU, but no modality proved to maintain the healed site. Surgical intervention involved excision of plantar medial cuneiform 

spur. DRFU healed and remains healed 26 weeks post surgery. 

Case B: 44yo with type 2 DM and previous toe amputations secondary to osteomyelitis. The amputations resulted in foot 

deformity and DRFU overlying the fourth metatarsal head. Conservatively, DRFU healed when managed via TCC, but recurred 

as soon as step down measures were implemented. Surgical intervention included debridement of soft tissue and fourth 

metatarsal head. DRFU healed and remains healed 25 weeks post surgery. 

Conclusion 

These cases highlight the effectiveness of surgical intervention in chronic and recurrent DRFU where non-surgical treatment 

methods have been exhausted; but may also indicate potential for earlier surgical review when deformity is a causative factor. 

Positive patient outcomes have been achieved using this multidisciplinary approach to care. 

24 



25

26 


Haematology 

HaematOLOGY 

THE IMPlemenTATION OF A NURSE-leD TRANSFUSION SUPPorT ProGRAM IN 

THE Day ONCOLOGY UNIT. 

Gwynne M, Hayes L, Probst K, 

Northern Health, Cancer Services, Epping, VIC, Australia 

Background: 

As the haematology service at Northern Health expands so has the demand on haematology supportive therapy for non 

malignant and malignant haematological conditions. 

Frequent blood transfusion coordination can be complicated and at times confusing for patients. The implementation of a 

structured program was required to enable the patient to become involved in their transfusion needs. 

Aim: 

To effectively manage the increasing volume of patients requiring transfusion support at Northern Health, through the use of 

CHARM. 

Method: 

Data collection was performed over a three year period of the number of blood transfusions administered in Day Oncology 

over 2 campuses. (TNH & CHS) 

Literature review was conducted and current practices from external sources were explored. 

Results: 

The data collection revealed a 45% increase in blood transfusion administration from 2010 – 2012. 

CHARM was utilized by haematologist to create transfusion pathways with indicated parameters for transfusion. This allowed 

nursing staff to monitor transfusion frequency and organize blood test, transport and assess supportive care needs in 

advance. A data base was created to maintain a record of patient’s requirements. 

A Transfusion Support Program Nursing Documentation Tool was developed to record information in scanned medical 

records. 

Conclusion: 

Implementation of a Transfusion Support program has enabled effective management of patient’s care improving quality of 

life and decreased hospital overnight admissions. Further evaluations will be performed as the program expands. Currently 

15 patients are monitored through the program for their transfusion needs. 

27

Haematology 

IMProVING Pre ChemoTHERAPY EDUCATION ProCess FOR PATIENTS IN THE 

Day ONCOLOGY UNIT 

Gwynne M, Probst K, Edwards M, Cooney M. 

Background: 

Pre chemotherapy education is an integral part of patients’ treatment journey. Education in the Day Oncology Unit was 

performed on the day of the patients’ first treatment, with an allocated time frame of 30 minutes. Concerns were raised from 

nursing staff that patients’ anxiety levels were high and too much information was given on their first treatment, resulting in 

patients’ feeling overwhelmed. 

Staff also felt that 30 minutes was not enough time to interact and allow the patient quality time to raise their concerns, 

Aims: 

To provide a structured chemotherapy education process, allowing sufficient time for nurse and patient, provide a physical 

space away from treatment area for education and to decrease patient anxiety prior to treatment. 

Method: 

A project group was formed, and literature reviews were conducted. A study conducted by Peter MacCallum Cancer Institute 

in 2008 on ‘Reducing Stress in Patients Undergoing Chemotherapy’ was reviewed, as well as relevant oncology evidence 

based websites. 

Results: 

Based on the literature review, in January 2012 a new process for education was implemented. 

Patients are scheduled for pre chemotherapy education 2 days prior to treatment for an allocated time frame of 1 hour with 

a nurse. An education room has been established in the unit for privacy. Patients are given a “Looking after Yourself during 

Chemotherapy” DVD prior to their education session along with a questionnaire to be completed raising any concerns or 

fears they may have. 

A patient satisfaction survey was conducted in November 2012, highlighting that patients were 100% satisfied with the 

education process and they felt the content of information given was very helpful. 

Conclusion: 

Nursing staff reported a significant change in patient anxiety levels on the day of treatment when education had been 

conducted 2 days prior. Staff expressed that the extended time frame allowed them to deliver a more comprehensive 

education to the patient and they did not feel under pressure, or rushed. 

Improving the education process has provided patients with confidence, better understanding and reduced anxiety levels for 

their first treatment. 

28 


Haematology 

HaematOLOGY 

HIGH-DOSE METHOTREXATE FOR THE TREATMENT OF RELAPseD Csn ERDheim 

CHESTER Disease 

Ho P and Smith C. 

Background 

Erdheim-Chester disease (ECD) is a rare non-Langerhan’s histiocytosis with multi-system involvement including central 

nervous system (CNS) disease which confers a poorer prognosis. There is no definitive treatment for ECD, though interferonalpha 

may be useful for non-CNS disease, if given for more than 3 months. 

Case Report 

A 60-year old lady with a 5-year history of stable non-CNS ECD presents with 4 days of diplopia and right arm numbness. 

Neurological examination revealed a horizontal gaze palsy and right arm paraesthesia. The MRI demonstrated extensive 

brainstem/cerebellar lesion but the PET/CT revealed stable systemic disease. CSF analysis showed raised protein (3.12g/L) 

but no evidence of infection or malignancy. 

During the first 72-hour period, the patient developed dysarthria and ataxia, necessitating urgent treatment. Interferon-alpha 

was not ideal due to its slow onset of action and poor CNS penetration. 

High-dose methotrexate was chosen due to its excellent CNS penetration and known therapeutic effect on CNS lymphoma. 

This treatment arrested the rapid progression and led to significant improvement in her speech and ataxia. A post-induction 

MRI showed a reduction in the size of the brainstem/cerebellar lesion and CSF protein reduced. 

The patient remained stable with ongoing high-dose methotrexate for 4 months, but subsequently developed new right-sided 

weakness and an increase in the size of her brainstem lesion. She is currently being treated with interferon-alpha. 

Conclusion 

We describe a case of CNS relapse of ECD in the setting of well controlled systemic disease. High-dose methotrexate was 

an effective initial salvage agent but further systemic treatment (e.g. interferon-alpha) may be necessary for a sustained longterm 

response. 

29

Haematology 

A RETROSPECTIVE EValuaTION OF HAEMAToloGICAL AND INFECTIVE 

COMPliCATIONS OF FLUDarabine, CYCloPhosPhamiDE AND RITUXIMAB (FCR) 

CombinaTion Chemo-immunoTheraPhy 

Ho P, Romero S, Grigg A and Tam C. 

Background 

Fludarabine, cyclophosphamide and rituximab (FCR) is commonly used for the treatment of chronic lymphocytic leukaemia 

(CLL). It is associated with infective and haematological complications with increasing anecdotal evidence of severe aplasia 

and death. However, the incidence and clinical significance of these complications remain unclear. 

Aim 

Determine the haematological and infective complications associated with FCR treatment. 

Methodology 

Retrospective analysis of patients receiving FCR treatment. Haematology complications were graded based on WHO 

classification. Late onset neutropenia (LON) was defined as grade III-IV neutropenia developing after four weeks following 

cessation of therapy. Patients were followed up for 12 months. 

Results 

47 patients (33M, 14F) with median age 63 (40-83). 32 patients received FCR for CLL while 15 were treated for other 

non-Hodgkin lymphomas. Febrile neutropenia occurred in 20% of patients with a per cycle rate of 5.8%. Neutropenic 

complications were worse in later cycles. 

No severe aplasia or aplastic death were identified, however Grade I-II bi-cytopenia was not uncommon. 43% of patients 

developed grade III-IV LON (median 74 days; ANC = 0.5). Risk factors included female sex and increasing number of FCR 

cycles. Age and ANC during chemotherapy did not confer an increased risk. Opportunistic infection rates were low (1%) with 

no cases of pneumocystic jirovec pneumonia. 

Conclusion 

FCR chemotherapy appears to be well tolerated with a relatively low rate of febrile neutropenia, comparable to similar 

chemotherapy regimens. However, rituximab related late-onset neutropenia is more common with fludarabine based (43%) 

compared to non- fludarabine-based chemotherapy (3-25%). Further evaluation and data collection will be undertaken. 

30 


Haematology 

HaematOLOGY 

Intermittent Granulocyte-Colony Stimulating FaCTor (G-Csf) 

Maintains Dose Intensity After ABVD Therapy Complicated By 

Neutropenia 

Ho P, Sherman P and Grigg A. 

Background 

G-CSF is commonly used to maintain dose-intensity in patients receiving ABVD for Hodgkin lymphoma (HL). However, 

some studies suggest that dose-intensity can be maintained without G-CSF, with minimal incidence of febrile neutropenia. 

Moreover, G-CSF is expensive (approximately A$1925 for pegfilgrastim and A$1050 for 7 days of 300ug filgrastim per cycle) 

and is associated with side-effects including bone pain and increased risk of bleomycin-related lung toxicity. Intermittent 

G-CSF may be an effective compromise, given that G-CSF effect on granulocyte precursors in-vitro persists for 4-5 days 

after administration and intermittent scheduling is effective in maintaining dose-intensity in breast cancer patients receiving 

adjuvant chemotherapy. After a promising pilot study using intermittent G-CSF for ABVD complicated by neutropenia, this 

schedule has been used at physician discretion at RMH. 

Aim 

To compare the efficacy of daily/pegylated versus intermittent G-CSF protocols between 1996 and 2009. 

Method 

Retrospective analysis of the incidence of neutropenia, treatment delays and febrile neutropenia in patients receiving different 

G-CSF schedules. 

Results 

848 cycles in 85 patients (M:F 43:42; median age = 32 (range:14-71) years) with predominantly stage II/III HL were 

evaluated. The median neutrophil count when cycle 1B was due was 0.9 (range:0-18.7). Most patients(86%) received 

G-CSF, generally commencing during cycle 1B. Intermittent G-CSF (typically given on days 4,8,12) was used in 452 cycles 

compared with 99 cycles for daily/pegylated G-CSF. Febrile neutropenia occurred in 2 and 0 cycles respectively and no 

treatment delays due to neutropenia occurred in either group. After intermittent G-CSF, the median neutrophil count was 7.3 

(range:1.4-47.1x10 9 /L) when chemotherapy was next due, similar to other G-CSF regimens. The cost difference between 

pegfilgrastim and three doses of 300ug filgrastim per cycle over 11 cycles ( i.e. cycles 1B-6B ) was A$16500. 

Conclusion 

Intermittent G-CSF is effective in maintaining dose-intensity in patients receiving ABVD, resulting in substantial cost savings. 

31

Haematology 

THROMBIN GeneraTION MAYBE A BETTER SURROGATE MEASURE OF IN-VIVO 

ANTICOAGulaTION IN THE ERA OF NEW ORAL ANTICOAGulanTS (noaC) 

Ho P, Donnan G and Smith C. 

Background 

The in-vivo therapeutic range between effective anticoagulation and excess bleeding is narrow, and often requires monitoring. 

Traditionally, the international normalized ratio (INR) of 2.0-3.0 has been a crude surrogate, but only measures the time to 

the start of clot formation without evaluating total clot formation, and cannot be used for evaluating anticoagulants other than 

warfarin. 

The arrival of New Oral Anticoagulants (NOACs) has highlighted the need for better anticoagulation tests, particularly since 

reversal agents are unavailable. Thrombin generation (TG) is a new laboratory investigation using Calibrated Automated 

Thrombogram (CAT©) which measures total thrombin formation, an end-product of the coagulation cascade, and may 

provide a more holistic measure of in-vivo anticoagulation. 

Aim 

To determine the therapeutic range of TG parameters based on the current “gold-standard” therapeutic INR range of 2.0-3.0 

for warfarin, as well as describe TG parameters with enoxaparin and rivaroxaban. 

Methods 

De-identified INR and spiked plasma samples of rivaroxaban and enoxaparin were evaluated for thrombin generation 

parameters using the CAT©. 

Results 

37 INR samples (range: 1.0-4.2) were evaluated. The therapeutic INR range (2.0-3.0) correlated with median ETP of 

364 (range: 203–595) nM.min and thrombin peak of 177 (range: 87-200) nM, with a clear distinction from normal INR. 

Rivaroxaban-spiked plasma were evaluated and produced a more concave curve with a marked decrease in thrombin peak 

but without difference in ETP. Enoxaparin-spiked plasma produced curves similar to warfarin. 

Conclusion 

TG maybe a better surrogate measure of in-vivo anticoagulation. Further evaluation of TG parameters with NOACs, using a 

therapeutic warfarin INR of 2.0-3.0 as a gold standard, may help determine the therapeutic range for these new agents. 


HaematOLOGY 

33

34 


Women’s Health and Paediatrics 

MULTILINGUAL ToileTING PosTER IMProVES KNOWLEDGE OF CORRECT 

DEFECATON TECHNIQUE IN POSTnaTal WOMEN 

Schofield C. 

Women’s Health AND PAEDIAtrics 

Background 

Chronic straining at stool is a major risk factor for development of pelvic floor muscle dysfunction. Yet many women are 

unaware that using the correct defecation technique can improve bowel evacuation, help avoid straining and protect the 

pelvic floor. 

Aim 

To determine whether the introduction of a multilingual “correct toileting position” poster improves knowledge of correct 

defecation technique in postnatal women on the Maternity and Women’s Health Unit (MWHU). 

Methodology 

This project was undertaken on the MWHU at The Northern Hospital between May and July 2012. 

Baseline data was collected over four consecutive weeks. Postnatal patients were interviewed by the ward physiotherapist 

and asked to demonstrate correct defecation technique, and where they had learned this technique. 

A multilingual “correct toileting position” poster was then placed in each of the bathrooms on the MWHU. 

Following the introduction of the poster, the ward physiotherapist collected the same data from a new cohort of postnatal 

patients over four consecutive weeks. 

Results 

Results from 66 women were included in the baseline data, and results from 46 women were included in the postintervention 

data. In both groups the majority of women spoke English (77% in the baseline group and 75% in the postintervention 

group) 

At baseline only 21% of patients were able to demonstrate correct defecation technique, compared with 61% in the postintervention 

group. Of this, 93% stated that they had learned the technique from the poster. 

Conclusion 

Introduction of a multilingual toileting technique poster significantly improved knowledge of correct defecation technique in 

postnatal patients on the MWHU at TNH. 

35


THE DOWN-TRANSFER OF INFANTS FROM TERTIARY NICus TO SCNS: THE 

PerCEPTIONS AND OPinions OF HEALTH Professionals’ ON ParenTS’ 

Transfer EXPERIENCES 

Ramudu L 1, McDonald S 2 , Thomas S3. 

1 

Education Department, The Northern Hospital 

2 

La Trobe University/Mercy Hospital for Women 

3 

Monash University 

Background 

Health professionals (HPs) have always acknowledged that the down-transfer of infants from a Neonatal Unit (NICU) to a 

Special Care Nursery (SCN) is a difficult period for parents. This study will enable all HPs to be cognisant of the individual 

needs of families in all aspects of the down-transfer process. 

Aim 

The aim of this study was to explore the views of health professionals (HPs) at the NICUs and SCNs, and to gain an insight 

into their perspectives of parents’ experiences. 

Methodology 

A descriptive exploratory qualitative method was utilised in this study. An Interview Schedule was used to elicit the opinions of 

80 HPs through focus groups at six study sites. The common themes were analysed and categorised using directed content 

analysis. 

Results 

The four main themes categorised were Causes of Transfer Stress, Setting the Scene for Transfer and Relationships. Parent 

stressors, the quality of the pre-transfer and transition preparation, communication of information in a positive manner, and a 

show of support and trust for the SCN were factors that influenced parents’ acceptance to the transfer. This was hindered if 

HPs were unaware of the environment they were preparing parents for, or if they worked within systems under pressure. This 

affected the timely preparation for transfer and the reception of parents at the SCN. 

Conclusion 

The knowledge gained from this research will enable HPs to review current practices and processes related to down-transfer. 

Ten recommendations are offered to support parents for the down-transfer. 

36 



THE TRANSFER OF INFANTS FROM TERTIARY NICus TO COMMUNITY SCNS: 

THE PerCEPTIONS AND OPinions OF HEALTH Professionals’ ON ParenTS’ 

Transfer EXPERIENCES 


Ramudu L 1 , McDonald S 2 , Thomas S 3 . 

1 


2 

La Trobe University/Mercy Hospital for Women 

3 

Monash University 

Background 

Health professionals (HPs) have always acknowledged that the down-transfer of infants from a Neonatal Unit (NICU) to a 

Special Care Nursery (SCN) is a difficult period for parents. This study will enable all HPs to be cognisant of the individual 

needs of families in all aspects of the down-transfer process. 

Aim 

The aim of this study was to explore the views of health professionals (HPs) at the NICUs and SCNs, and to gain an insight 

into their perspectives of parents’ experiences. 

Methodology 

A descriptive exploratory qualitative method was utilised in this study. An Interview Schedule was used to elicit the opinions of 

80 HPs through focus groups at six study sites. The common themes were analysed and categorised using directed content 

analysis. 

Results 

The four main themes categorised were Causes of Transfer Stress, Setting the Scene for Transfer and Relationships. Parent 

stressors, the quality of the pre-transfer and transition preparation, communication of information in a positive manner, and a 

show of support and trust for the SCN were factors that influenced parents’ acceptance to the transfer. This was hindered if 

HPs were unaware of the environment they were preparing parents for, or if they worked within systems under pressure. This 

affected the timely preparation for transfer and the reception of parents at the SCN. 

Conclusion 

The knowledge gained from this research will enable HPs to review current practices and processes related to down-transfer. 

Ten recommendations are offered to support parents for the down-transfer. 

37


PROMOTinG CUE BASED FEEDING PRACTICE ThrouGH The IMPLEMENTATION 

of A Cue BASED FEEDinG CHART 

Naughton C & O’Callaghan A. 

Background 

Accurate feeding documentation in Special Care Nursery is essential to intervention and discharge planning. The current 

Special Care Nursery Feed Chart (IP 720) records feeding progress through the comparison of volumes taken orally over 

successive days. This information is subjective. There is no scale or agreed terminology used to classify or rate feeds. 

Finally, discharge based on the information in the current feed chart is a clinical risk due to the omission of information 

regarding the quality of the feeding and the caregiver strategies required. 

Aim 

To profile the limitations of the Special Care Nursery Feed Chart (IP 720). This information will be used to revise the chart with 

the goal to identify and include an objective feeding rating scale 3 . 

Methodology 

A documentation audit was conducted with the IP720. Audit criteria were developed in line with developmental care 

recommendations 4 and cue based feeding 1 . Ten preterm infants born less than 32 weeks GA with birth weights less than 

2000g were selected. 162 feeds were audited. The audit spanned the entire admission. 

Results 

The quality of feeds was only evident in 45.5% of the audits. Comments were subjective descriptions such as “sucked fairly”. 

Feeding cues were documented in 0.02% cases. Of the 162 feeds audited 0% included caregiver strategies. 

Conclusion 

Results identified the current feeding chart omits information regarding quality of feeding, feeding cues, and caregiver 

strategies. Description of feeding quality is subjective and lacks clinical evaluation. Intervention and discharge planning based 

on information in the current feed chart is a clinical risk. 

38 



IMPlemenTATION OF THE ARC GuiDeline 13 FOR NEWBORNS AT THE NORTHERN 

HOSPITal 

Ramudu L 1 , Milonas A 1 , Keenan R1, Castillo G 2 . 


1 


2 

Quality, Safety & Risk Unit, The Northern Hospital 

Background 

In 2012, the Australian Resuscitation Council (ARC) was updated to reflect evidence based practice for the resuscitation of all 

newborns. 

Aim 

This poster will aim to depict the implementation in practice change within Northern Health specifically The Northern Hospital 

(TNH) site. 

Methodology 

The Quality Improvement Cycle was utilised in the implementation at several stages. This continuous quality improvement 

process consisted of Monitoring Activities, Assessment, Action and Evaluation. 

Results 

The Monitoring Activities process involved a phone survey conducted at eight maternity units to establish a working baseline 

of present practice. The survey allowed benchmarking to occur within TNH as well. The Assessment phase reviewed 

current neonatal resuscitation equipment and the accessibility of the equipment by specialised health teams. The Action 

stage involved the implementation phase of equipment upgrade and simplification in its existing locations. Purchase of 

recommended equipment occurred in conjunction with a standardised approach to all resuscitation equipment stock across 

Northern Health. Evaluation stage consisted of a repeat of the phone survey to ensure benchmarked consistent practice. 

Regular audits of neonatal resuscitation equipment have been undertaken since the Action phase. 

Conclusion 

Northern Health, TNH, has successfully implemented the ARC Guideline 13 for newly born infants to ensure and promote 

best practice. Whilst the physical nature of the existing clinical environments remain a challenge for all health teams, the 

consistent approach to practice, equipment access and its use has been improved to meet national standards. 

39


CRP VERSUS I/T RATIO IN SUSPECTED NEONATAL SEPsis 

De Silva M, Fan WQ. 

The Department of Paediatrics, Northern Hospital, Melbourne, Australia. 

Background: 

The management of neonatal sepsis is difficult because clinical presentations are non-specific, and laboratory testing lacks 

sensitivity and specificity. This retrospective study evaluates the use and effectiveness of C-reactive protein (CRP) and 

immature: total neutrophil ratio (I/T-ratio) as markers of the status of neonatal infection during antibiotic therapy. 

Methods: 

Retrospective patient data (n= 136) was collected on neonates of gestational age 33- 42 weeks admitted to The Northern 

Hospital special care nursery (SCN) for suspected neonatal sepsis treated with at least 2 days of IV antibiotics from 

September 2010 to August 2011. Data included: maternal risk factors, neonatal risk factors, clinical signs of neonatal infection 

and outcomes, CRP (measured via the turbidimetric method) and I/T-ratios (raised CRP >8.0mg/L; I/T-ratio > 0.2). The 

cohort was divided into clinically well and unwell subgroups. For paired data , CRP and I/T-ratio were compared statistically 

(well n=35, unwell n=80). Regression analysis was performed on CRP and I/T-ratio versus antibiotic duration (well n=42, 

unwell n=94). 

Results: 

More than 40% of all paired CRP and I/T-ratio data signaled opposite infection status. In the unwell group the paired data 

was significantly discordant (p


SAFETY AND EFFICACY OF INTRAVENOUS IRON PolymalTose IN 3rd TRIMESTER 

of PreGNANCY: THE NORTHERN HOSPITAL PersPECTIVE 

Dimoska N and Hayes L. 


Background 

Iron deficiency anaemia (IDA) is the most prevalent medical condition that complicates pregnancy and Hb levels


Health Service Evaluation 

ESTablishinG A MULTI-sourCE REVIEW ProCess FOR SENIOR MEDICAL STaff: 

THE NORTHERN HEALTH EXPerienCE. 

Health SERVICE EVALUAtion 

Corbett H, Lim WK, Pearson K. 

Background 

Appraisal formats that rely on the collection of feedback from peers, colleagues and co-workers have been reported in 

industry literature for over 20 years. The concept is variously known as multi-source or 360 0 feedback and has been used in 

areas including health care settings since the early 1990’s. 

Aim 

The aims of the initiative: improve performance support processes for senior medical staff; establish a multi-source review 

model that enhances the relationship between the organisation and staff; allow senior doctors to give and receive structured 

feedback, and gain insight into how others perceive their performance. 

Methodology 

A literature review was undertaken, leading practice was investigated and Northern Health organisational values were 

considered. A 21 question survey was developed that covers of three domains. The model consists of a paper-based 

“self assessment” plus a web-based 9 point Likert Scale survey, collecting responses from a minimum of 12 co-workers. 

Education sessions and supporting documentation were developed. 

Results 

Initial reservations regarding the appraisal process were overcome and the initiative was successfully implemented. Northern 

Health decided to commence the appraisal process with the most senior medical staff. The program has been rolled out 

to include senior medical staff across all areas. Barriers and enablers have been identified. Content of appraisals are 

confidential and will not be presented. 

Conclusion 

It is possible to introduce a 360 0 appraisal process for senior medical staff. Barriers to maintaining the program include low 

response rates from co-workers. 

43


EValuaTING THE OUTCOMES OF INTRODUCinG AN ADVANCED PRACTICinG 

PODIATRIST INTO AN ORTHOPAEDIC DEPARTMENT 

Bonanno D, Bennett V, Tan D, Gazarek J, Spring A, Bird A. 

Background 

In Australia the demand for foot surgery through public health services substantially outweighs capacity which results in long 

waiting times for orthopaedic appointments. In an attempt to manage this demand and provide a service to patients waiting 

for a surgical opinion, Northern Health (NH) has introduced a musculo-skeletal Advanced Practicing Podiatrist (APP) into 

orthopaedic clinics. The APP uses their existing clinical skills while maximising their scope of practice. 

Aim 

The aim of this project is to evaluate the outcomes of introducing an APP into an orthopaedic outpatient clinic at NH. 

Methodology 

Patients referred for a surgical consultation with a musculo-skeletal foot condition were triaged by an Orthopaedic Surgeon 

and APP to determine their appropriateness for surgical or non-surgical care. Patients considered likely to benefit from nonsurgical 

treatment were further assessed by the APP and a management plan established. Patients that responded positively 

were discharged; patients that didn’t respond remained on the orthopaedic waiting list; while patients requiring an urgent 

surgical consultation were escalated for surgical care. 

Results 

Of the 95 patients included in the project, 9% were immediately discharged from the waiting list, 18% were escalated for 

surgical care and 72% referred for non-surgical care. Preliminary results indicate 43% of participants have voluntarily removed 

themselves from the surgical wait list, however not all patients have completed their non-surgical management plan at the 

time of writing. 

Conclusion 

These findings are clinically relevant, as introducing an APP can be a cost effective, efficient and patient-centred approach to 

addressing the non-surgical demand of orthopaedic referrals. 

44 



EValuaTING THE IMPACT AN ‘IN-house’ ORTHOTICS SERVICE HAS HAD ON 

inPATIENT LENGTH OF STay AT THE NORTHERN HOSPITAL 


Morphet A, Spring A, Gazarek J. 

Background 

Historically, Orthotic services at Northern Health (NH) were provided by private companies/ contractors. Since the formation 

of the NH Orthotic department in 2009 there has been a large increase in demand for inpatient Orthotic services. 

Aim 

The aim of this service evaluation was to investigate the impact that the ‘In-House’ Orthotics service had on inpatient length 

of stay (LOS) for common referral conditions at The Northern Hospital (TNH), when compared to pre-2009 data. 

Methodology 

Diagnostic Related Group (DRG) codes for two conditions, toe amputations and tibial plateau fractures, were analysed to 

determine if Orthotics involvement impacted on LOS and bed-day cost savings. Data from a one-year period in 2010/11 was 

compared to the same patient groups in 2008. 

Results 

When Orthotics was not involved in patient management or care, LOS for these two conditions remained consistent across 

the compared time periods. Following the introduction of the NH in-house Orthotics service, the average LOS reduced by 4 

days for toe amputations and 1.3 days for tibial plateau fractures for patients when Orthotics was involved. 

The estimated total reduction in LOS for patients admitted with toe amputation is 80 days, and tibial plateau fracture is 330 

days, for patients requiring Orthotic intervention. 

Conclusion 

The formation of an in-house Orthotics Service has not only provided more time-efficient treatment, but decreased average 

LOS in the studied patient groups. This has a positive impact on patient flow and cost-savings to NH. 

45


EFFECTS OF HOSPITAL ACQuireD CONDITIONS ON LENGTH OF STay FOR 

DiabeTIC PATIENTS 

Cromarty J, Parikh S, Lim WK, Jackson TJ. 

Background 

Inpatients with diabetes are known to have longer lengths of stay (LOS) when hospitalized. Understanding differences in 

the rates and patterns of hospital acquired conditions between diabetes and similarly-complex patient sub-populations may 

reveal preventative measures to improve patient welfare and minimise length of stay. 

Aim 

To evaluate the rate of hospital acquired conditions amongst diabetic and non-diabetic patients, to characterise differences in 

the type of complications these patients are most at risk of developing, and any effects on length of stay. 

Methodology 

47615 admission episodes from The Northern Hospital database (1 July 2011 to 30 June 2012) were reviewed in this 

study. These episodes were divided into four groups: 1) patients with no recorded diabetes (n=45299), 2) patients with a 

diagnosis of diabetes without end-organ complications (n=356), 3) patients with a diagnosis of diabetes with end-organ 

complications (n=1775), and 4) a subset of Group 1 non-diabetic patients with a Charlson co-morbidity score ≥1 (n=9255). 

Hospital acquired conditions were defined using the Classification of Hospital Acquired Diagnoses (CHADx). Linear 

regression was used to analyse the impact of group membership and the number of CHADx, on length of stay. 

Results 

Almost 30% of all admissions of diabetic patients with end-organ complications had at least one hospital acquired condition, 

compared to only 13% for all non-diabetic patients and 17.6% for the subgroup of non-diabetic patients with a Charlson comorbidity 

score ≥1. While the types of hospital-acquired conditions in diabetic patients with end-organ complications were 

similar to their non-diabetic counterparts, their rates were consistently higher than the rates of similarly complex non-diabetic 

patients. The younger non-diabetes and diabetes with no end-organ complications groups had intermediate rates of these 

conditions. Linear regression demonstrated that diabetes patients with end-organ damage stay longer than other patients, 

and that each complication in a diabetes episode has a larger effect on LOS. 

Conclusion 

We demonstrate that increased infection rates and delayed wound healing are not the only conditions leading to excess 

length of stay. These findings may provide a foundation for future clinical and cost-effectiveness studies of preventative 

practices for this high-risk patient population 

46 



INNOVATIVE PODIATRY STUDenT PlaCemenTS AT NORTHERN HEALTH 


Grollo A, Morphet A, Gazarek J. 

Background 

Tertiary institution processes have recently changed with student enrolments increasing, placing new demands on 

placements within the healthcare setting. In response to changing university curriculum and in line with Victorian Department 

of Health, Clinical Placement Networks and Health Workforce Australia, Northern Health (NH) Podiatry department identified 

a unique opportunity in provision of clinical placement education. NH developed an innovative approach to the management 

and delivery of podiatry student clinical placements to ultimately increase capacity. 

Aim 

To ensure provision of high quality, evidence based and safe student clinical education whilst supporting clinicians and 

students. 

Methodology 

To address increasing placement demands and a decrease in students being graduate-ready when on placement; NH 

created a Podiatry Clinical Educator (CE) position. This role involved a gap analysis and facilitation of developments 

including: augmenting 2:1 model of supervision; integrating simulation into traditional clinical education; evidence based 

tutorials and support provision to podiatrists and students. Pre and post introduction of the CE position qualitative data was 

collated via surveys. 

Results 

Evaluation findings of student (N = 8) and podiatrist (N = 9) perspectives in areas including confidence, communication, 

support, supervision and placement experience show high podiatrist and student satisfaction. 

Conclusion 

The addition of a Podiatry CE position and great team communication; strategies implemented allow consistent provision of 

high quality, evidence based student clinical placements, where students develop skills whilst working in a well supported 

clinical environment. 

47


ADVANCinG AHA’S CliniCAL PRACTICE IN SPeeCH PATHOLOGY: THE 

DEVELOPMENT OF AN AHA SPeeCH PATHOLOGY TRAINING PACKAGE. 

Beer E, Gochian T & Thomson E. 

Background 

The role of the Allied Health Assistant (AHA) is an emerging one and there are significant opportunities to expand the roles 

of AHA’s in health organisations (Department of Health 2010). The staff of the Speech Pathology Department at an outer 

metropolitan public health service are committed to expanding AHA’s clinical skills and knowledge in the area of Speech 

Pathology. AHA’s make a valuable contribution to patient care and with training and skill development for extended roles 

provides an opportunity to enhance this. 

Aim 

• To ensure a structured and consistent training program for AHA’s developing and maintaining skills in the areas of speech 

pathology 

• To update the training package in line with the best available evidence base 

Methodology 

AHA’s working within the SP department were invited to participate. Participants were asked to rate their knowledge and 

confidence pre-training and post training in core clinical areas of speech pathology: communication disorders, swallowing 

disorders, meal reviews, videofluoroscopy (VFSS) preparation, working with interpreters, hearing, oral hygiene and Alternative 

and Augmentative Communication devices on a 5-point Likert Scale (Very poor (1) – Very good (5). 

Results 

The median pre-training rating was 4 (good) for both confidence and knowledge in the core clinical areas of swallowing and 

communication; and 3 (average) for working with interpreters, meal review, hearing, oral hygiene and VFSS. On completion of 

the training, the median ratings for confidence and knowledge rose to 4 (good) to 5 (very good) in all the core clinical areas. 

Conclusion 

The Speech Pathology AHA Training Program was effective in providing AHA’s with the knowledge, skills and confidence 

necessary for performing speech pathology tasks directed by the treating speech pathologist. 

48 



EMERGENCY DEParTMENT FREQUENT PRESENTERS: MULTIDISCIPlinary 

MANAGemenT Plans IMProVE PATIENT Care AND REDUCE EMERGenCY 

DEParTMENT PRESENTATions. 


Dunn NL, Hutchinson A and The Northern Hospital Emergency Department Frequent Presenter Committee. 

Background 

Patients with frequent Emergency Department presentations have been identified as a high risk cohort. The Northern Hospital 

Emergency Department frequent presenter committee was established to identify and improve the care of such patients 

through the development of multidisciplinary management plans. 

Aim 

• To improve the care of Emergency Department Frequent presenters by engaging individuals in appropriate health services 

as part of developing multidisciplinary management plans. 

• To reduce Emergency Department presentations six months following initiation of an multidisciplinary management plan. 

Methodology 

Eighty three patients at Northern Hospital identified as ‘Emergency Department Frequent Presenters’ were reviewed from 

March 2011 to March 2013. Fifty eight patients were included in the data analysis where a six month follow up occurred. 

Percentage calculations were used to profile frequent presenter patients and interventions. A paired T test was used 

to determine the mean difference in Emergency Department presentations six months after initiation of an Emergency 

Department management plan. 

Results 

The main reasons for ED presentations were medical and a large proportion had a hospital alert for a serious risk to 

themselves or staff, for example; self harm. Various interventions occurred including; liaising with general practitioners, 

medical specialists, case managers or community health services. Overall, Emergency Department presentations were 

significantly reduced from a mean of 9.85 / person / year to 5.57 / person / year in the six months following implantation of a 

multidisciplinary management plan. 

Conclusion 

Multidisciplinary management plans improve patient care and reduce Emergency Department Presentations for patients 

considered ‘Emergency Department Frequent Presenters’. Future research investigating cost effectiveness would be 

beneficial. 

49


Prime : IMProVING THE Journey TO HIP AND KNEE JoinT ARTHOPlasTY FOR 

THE ELDerly WITH CO-morbiDITIES AND HIGher RISK OF COMPliCATIONS. 

Leahy E 1,2, Hill K 3,5, Sunderland Y 1 , Kennett P 1 , Breheny T 1 , Tu A 1 , Smith R 1,2, Lim K 1,4 . 

1 

Northern Health, 2 La Trobe University, 3 National Ageing Research Institute, 4 The University of Melbourne, 5Curtin University 

Aim 

To evaluate whether patients attending a new multidisciplinary “PRoactive Intervention and Medical assessment in Elderly 

elective surgical patients” (PRIME) service prior to knee or hip arthroplasty have an improved pre and post-operative journey. 

Methodology 

The design was a cohort study with matched historical controls. The intervention group consisted of 30 patients (mean age 

74.13) with significant co-morbidities who attended PRIME prior to a hip or knee joint arthroplasty. The historical control group 

consisted of 60 patients matched for procedure, gender and age. Patients from the intervention group had assessments and 

interventions performed and co-ordinated by a geriatrician, dietitian, nurse and physiotherapist. 

Results: Baseline comparisons between groups indicate that patients were well matched for age, surgery and gender. The 

PRIME intervention group had a significantly greater co-morbidity (p = 0.046). Post-operatively, there were no differences 

between groups in readmissions within 28 days, (p = 1) length of stay (p = 0.54) or number of complications (p > 0.05). The 

PRIME intervention group had a shorter time between notice of admission and surgery (p = 0.000, mean difference= 81.85 

days, 95% CI 37.55 to 126.15). 

Conclusion 

Preliminary evidence indicates that elderly patients with a high co-morbidity index who attend PRIME clinic prior to joint 

arthroplasty have similar post-operative outcomes to age, gender and surgery matched patients who have a lower comorbidity 

index. The PRIME service appears to be effective in reducing time to surgery. 



Northern Health Guideline for the Offloading Management of 

Plantar Neuropathic Foot Ulcers: Development and Evaluation 


Harper K, Steel A, Spring A, Gazarek J. 

Background 

The treatment and prevention of plantar neuropathic foot ulceration (PNFU) involves a holistic approach which addresses 

factors affecting healing and ulcer recurrence. Integral to this is the adequate reduction of plantar pressures with appropriate 

offloading modalities. A guideline was developed to direct the offloading interventions for Northern Health (NH) Podiatrists 

and Orthotists and its use was evaluated. 

Aim 

The aim of the project was to develop an evidence based guideline to direct the offloading management of PNFUs for NH 

Podiatrists and Orthotists. 

Methodology 

A literature review was completed to assess the evidence base on selection and use of offloading devices for the treatment 

and prevention of PNFUs. Knowledge of the experienced clinicians was also incorporated to address important patient 

factors with offloading treatments. The guideline was launched with education workshops to ensure effective implementation 

of best practice offloading. A file audit of NH patients with PNFUs was conducted evaluating the use of offloading devices 

prior to the implementation of the guideline, and repeated 3 months 

post implementation. A survey was conducted to evaluate clinician knowledge and use of appropriate offloading interventions 

before and after the guideline was introduced. 

Results 

The literature review found that devices that reduce foot plantar pressures, control ankle joint range of motion and are 

irremovable; are the most effective in achieving optimal ulcer healing outcomes. The guideline incorporated this with clinician 

expertise to direct the short, medium and long term goals of offloading. After implementation of the guideline, there was a 

trend toward a more co-ordinated transitional approach with an increased use of higher level and more appropriate devices in 

line with best practice, an improvement in clinicians’ knowledge and use of appropriate offloading devices for PNFU. 

Conclusion 

The Offloading Guideline for Plantar Neuropathic Foot Ulceration facilitates evidence based practice to guide the selection of 

offloading devices for NH Podiatry and Orthotics patients. 

51


Orthopaedics 

ORTHOPAEDICS 

DisTAL RADIAL FRACTURES IN ChilDren: RISK FACTors FOR 

REDISPlaCEMENT FOLLOWING CloseD REDUCTion 

Asadollahi, S and Hau RC 

Background 

Distal radial fractures represent one of the most common fractures in children; the majority are treated by closed reduction 

and cast application. Redisplacement after manipulation can occur resulting in potential poor outcome. 

Aim 

The aim of the study was to evaluate a range of possible risk factors contributing to loss of reduction in children undergoing 

closed reduction of distal radial fracture. We also reviewed the cohort of cases treated with Kirschner wires for associated 

complications. 

Methodology 

The prospective study included 135 displaced distal radial fractures. There were 48 girls (36%) and 87 boys (64%), with 

a mean age of 9.9 years (3-17 years). The risk factors for redisplacement evaluated included: age, gender, location of the 

fracture, preoperative fracture displacement, presence of ulna fracture, grade of surgeon, quality of reduction, quality of 

plaster, and residual post reduction displacement. 

Results 

Redisplacement occurred in 39 of 135 cases (28.8%). Initial complete displacement was the most important risk factor for 

loss of reduction (Odds ratio 6.94, p=0.001). Completely displaced fractures were 7 times more likely to redisplace than 

fractures with some bony contact or no translation. Achievement of anatomic reduction decreases the risk of redisplacement 

(Odds ratio 0.29, p=0.046). The complication rate from K-wire fixation was 46% (7 of 15 cases) with pin site infection being 

the most common. 

Conclusion 

Completely displaced distal radial fractures that cannot be anatomically reduced have a high risk of redisplacement after 

closed reduction. K-wire use in management of displaced distal radial fracture is associated with a high rate of complication. 

53

Orthopaedics 

SKIN Closure IN Primary TOTAL HIP ARTHROPlasTY AT THE 

NORThern HOSPITal 

Bewsher, S, Karagiannis, P, Sandhu, H and Hau RC 

Background 

A recent meta analysis suggested the risk of infection was four times greater using staples for skin closure in hip surgery 

compared to sub-cuticular sutures, but the rates of haemo-serous wound discharge was not statistically different 1. 

Aim 

The aim was to demonstrate that in THR, staples lead to not only an increase in infection rates, but also contributed to 

increased rates of wound ooze resulting in early dressing change and a high rate of temporary clexane cessation. 

Methods 

Retrospective audit of 188 consecutive primary THR recipients from a 3-year period (November 2009 to October 2012) was 

conducted. Data collected included: stapled or sutured closure, dressing change/reinforcement and temporary cessation of 

clexane. Adverse outcomes were defined as patients recieving oral Abx, or re-admission for IV antibiotics or washouts due to 

presumed wound infection. 

Results 

There were 188 primary THRs on 175 patients; 136 closed with staples and 52 with sutures. In the staples group, each 

patient had an average of 2.4 dressing changes until healed versus 0.9 for sutures (OR 5.6 (2.15-11.38) p

Orthopaedics 

ORTHOPAEDICS 

RETURNING TO DRIVING FOLLOWING LOWER LIMB SURGERY 

Hau RC and McLeod-Mills L 

Background 

Following an injury or surgery to a lower limb patients are keen to return to normal activities such as work, recreation and 

driving. Advice on returning to driving should be based on knowledge, clinical experience, functional assessment and 

radiological information. The challenge of advising a patient on when it is safe to return to driving may result in uncertainty 

with the patient returning too soon 1. A safe return to driving requires the patient to confidently apply appropriate brake force 

to stop the car in an emergency situation without hesitation. 

Eighteen studies have been published on return to driving following lower limb surgery in an attempt to provide guidelines 

for clinicians. Studies included ankle fracture, pre and post joint arthroplasty, ACL repair and knee arthroscopy. Most studies 

reported brake reaction time (BRT) and total braking time (TBT), few measured break pedal force (BPF) 1. 

Our study 

Ankle fractures are common in the adult population and often require surgical intervention. One study suggests that it takes 9 

weeks after an ankle has been operated on before it becomes mobile and agile enough to drive 2. 

Hypothesis 

The investigators hypothesize that patients will return to driving quicker if they are allowed to start mobilising their ankles 

sooner following surgery. 

Methodology 

Following two weeks in a half plaster patients will be randomised to: 

• weight bearing in plaster for 4 weeks 

• early mobilisation in a CAM walker for 4 weeks 

• non-weight bearing in plaster for 4 weeks (control) 

We plan to test driving reaction between three groups of patients at 6, 8, 10, 12 and 24 weeks post surgery. Data measured 

to achieve an emergency stop will include; BRT, TBT and BPF. 

55

Orthopaedics 

EVALUATion of A PersPEX PosiTioninG DEVICE on POST OPERATIVE imaGING 

followinG TOTAL Knee rePLACemenT (TKR) 

McLeod-Mills L, Hammond N, Dunn S and Hau RC 

Background 

Post-operative imaging is important in the evaluation of the success of a total knee replacement (TKR). The Orthopaedic 

surgeon uses post-operative imaging to assess sizing and sagittal and coronal alignments of the prosthesis. Poor 

radiographic technique can hinder this evaluation and in some cases patients require additional imaging prior to discharge 

which has resource and cost implications. 

This is a combined Radiology and Orthopaedic quality assurance project. 

Aim 

The aim of this project is to evaluate the effect of a new positioning device on the quality of immediate post-operative 

imaging of patients who have undergone a TKR. 

Methodology 

In January 2012 the Radiology department introduced a new positioning device. The device allows radiographers to 

obtain required images without repositioning the patient between views and provides improved patient comfort. Improved 

positioning and patient comfort in combination with a simple marking technique allows radiographers to make small changes 

to correct rotation or tilt. 

Two senior radiographers reviewed the immediate post-operative examinations performed on patients who underwent TKR 

at The Northern Hospital between July 2011 and June 2012. The images were categorised as good, acceptable and requires 

re-imaging. 

Results 

A total of 69 examinations prior to the introduction of the new device and 46 examinations following the introduction were 

reviewed. Prior to the introduction of the device 74% (51) anterior-posterior (AP) images and 88% (60) lateral images were 

rated as good-acceptable. These results increased to 87% (40) for AP images and 96% (44) for lateral images following the 

introduction of the new device. 

Conclusion 

The introduction of the new positioning device has resulted in an overall improvement in the quality of the post-operative 

imaging following TKR. 


Orthopaedics 

ORTHOPAEDICS 

THEATre START Time AUDIT (ORThoPAEDIC uniT QUALITY PROJECT) 

Easton J, McLeod-Mills L and Hau RC 

Background 

Delays in the commencement of first cases in The Northern Hospital (TNH) Orthopaedic theatre lists have been noted. These 

delays can lead to the cancellation of cases requiring rescheduling or reduced access for opportunistic emergency cases, 

which have patient care and cost implications. 

Aim 

The aim of the theatre start time audit was to investigate start time of the first case on Orthopaedic lists and identify delays in 

the patient journey from arrival in Day Procedure Unit (DPU) to knife-to-skin time. 

Methodology 

Scheduled Orthopaedic lists from 21/11/11 to 16/12/11 were reviewed. A total of 30 lists out of a possible 66 (45%) were 

reviewed. The first case on each list was audited and a range of time points between patient arrival and operative start time 

were recorded. 

Results 

The earliest knife-to-skin time occurred 16 minutes after scheduled list start time, the latest was 70 minutes and on average 

the delay was 35 minutes. On average patients arrived in the anaesthetic bay 4 minutes prior to start time with an average 

of 40 minutes from this point to surgery commencing. The most efficient patient journey from the patient’s arrival in a DPU 

cubicle to knife-to-skin time was 30 minutes and the maximum journey measured was 160 minutes. 

Conclusion 

Delays in start time of the first cases in Orthopaedic lists were common. Routine recording of time points for the first case 

in a list and reasons for delay would allow planning and changes to systems and staffing in order to increase productivity of 

theatres. 

57


Broadmeadows Health Service 

35 Johnstone Street Broadmeadows Vic 3074 

T. (03) 8345 5000 F. (03) 8345 5655 

Bundoora Extended Care Centre 

1231 Plenty Road Bundoora Vic 3083 

T. (03) 9495 3100 F. (03) 9467 4365 

Craigieburn Health Service 

Craigieburn Road West Craigieburn Vic 3064 

T. (03) 8338 3000 F. (03) 8338 3110 

Panch Health Service 

300 Bell Street Preston Vic 3072 

T. (03) 9485 9000 F. (03) 9485 9010 

The Northern Hospital 

185 Cooper Street Epping Vic 3076 

T. (03) 8405 8000 F. (03) 8405 8524 

www.nh.org.au 

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