Medical training, 4-hour rule in emergency, endometriosis, aggression in nursing homes covered in latest AHHA-published research

Wednesday, December 5, 2018

Medical training, emergency department transit times, endometriosis and aggression in nursing homes are among the topics investigated in the latest edition of the Australian Healthcare and Hospitals Association’s peer-reviewed academic journal Australian Health Review (AHR).

Monitoring medical graduates

A University of Sydney research team led by Dr Christine Jorm suggests that:

  • In view of the recent suicides of three junior doctors and reports of workplace bullying, the time is ripe to ask medical graduates how they feel, and for the profession to take an objective look at work–life balance
  • In view of the cost of medical training to taxpayers and students, medical schools should monitor how their graduates are performing in the workplace.
  • In view of reported wide variations in clinical practice, unnecessary tests and procedures, and financial exploitation of some patients, action should be taken to research variations in practice, and measure and improve patient outcomes.

The authors suggest such improvements become ‘preventative measures’ that help future medical practitioners to have better wellbeing, attract fewer patient complaints, and consistently practise a high standard of evidence-based care.

The 4-hour rule in emergency

A research team from Princess Alexandra Hospital in Brisbane closely examined the ‘4-h rule’ in the UK and the National Emergency Access Target (NEAT) in Australia. These policies aim at most patients (95% in the UK, 80–85% in Australia) exiting emergency departments (EDs) within 4 hours of presentation.

Timeliness in ED care has improved in both countries. Evidence of improved patient outcomes is strong in terms of reduced mortality for selected serious illnesses—but is limited in terms of improvements for other conditions.

The authors argue that continually reducing times to the exclusion of other factors does not necessarily bring better outcomes—doctors need to guard against premature exiting of patients from ED who are at risk of subsequent deterioration. One study showed that as ED transit times decreased, the rate of unplanned return presentations increased.

Endometriosis—is it a chronic disease?

A Monash-University-led team examined whether endometriosis met accepted definitions of ‘chronic disease’. In Australia, such long term and complex conditions are managed within a chronic diseases framework that includes chronic disease management plans and team care arrangements.

The authors found that endometriosis should be classified as a chronic disease. It met 5 out of 6 characteristics of chronic disease. The sixth—a long period of onset—could not be proved. Some women present with symptoms in their teens while others experience them much later. Some show no symptoms but are diagnosed through laparoscopy.

Resident-to-resident aggression in nursing homes

A Melbourne research team led by Dr Briony Jain (Monash University) established that resident-to-resident aggression is common in nursing homes, affecting up to 1 in 5 residents, with potentially fatal consequences and serious implications for nursing home staff and administration. The problem is under-recognised and under-researched in Australia.

The authors conclude that the key to preventing and managing such aggression may lie in interpreting behaviour from the resident’s viewpoint. This could involve obtaining detailed life histories from residents to better understand and develop person-centred care plans for them.

The December 2018 issue of Australian Health Review is available online. Some articles are freely available through open access, while others need a subscription or can be purchased individually.

The Australian Healthcare and Hospitals Association is the national peak body for public and not-for-profit hospitals, Primary Health Networks, and community and primary healthcare services.

Media enquiries:  Prof. Sonĵ Hall , Acting Editor in Chief, Australian Health Review

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