Australian health review : a publication of the Australian Hospital Association
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This paper presents the conceptual framework, activities and outcomes of the Allied Health BONE (Best Orthopaedic New Enterprise) Team, an early discharge incentive at the Gold Coast Hospital. The clinical team of a physiotherapist, occupational therapist and social worker provided services within an interdisciplinary model of care with the aim of reducing the length of stay of acute adult orthopaedic patients. The team provided intervention in the community, the accident and emergency department, pre-admission clinic and orthopaedic wards to patients with hip and knee replacements, back pain and upper femoral fractures. This paper reports data from the first six months of the project, demonstrating success in improving the continuity of care provided to orthopaedic patients and reducing the length of stay in target groups by 24%.
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The optimal way of delivering specialist services to rural and remote Australia, and particularly to remote Aboriginal and Torres Strait Islander communities, is a matter of keen debate at present, and is being considered by the Australian Medical Workforce Advisory Committee. This paper contributes to that debate by considering one specialist medical group, namely adult physicians, and discusses both their role and optimal number in the Top End of the Northern Territory, in light of the general workforce literature and recent changes to the organisation of physician services in the Northern Territory. Models of specialist service delivery need to be explicit, and organisational methods transparent, if the service is to be equitable, flexible and accountable to primary care practitioners.
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This study explores the association between selected socioeconomic characteristics of emergency patients with waiting times in emergency departments and walk-outs (those who did not wait for treatment) in South Western Sydney Area Health Service hospital emergency departments. Bivariate and multivariate analyses indicated that waiting times to see a doctor and walk-out rates varied by age, sex, country of birth, insurance status, socioeconomic status, severity of patient illness and day of arrival. Patients who were female, from a non-English-speaking background, self-referred, uninsured and those from lower socioeconomic status showed significantly longer waiting times than others. ⋯ This applied across socioeconomic categories. These findings indicate that prolonged waiting times for triage, which occur at the busiest periods, may be one of the main indicators for patients leaving emergency departments without treatment. The study also demonstrates variability in waiting times, which could possibly be partly addressed by more standardised triage policies, but may be influenced by other non-clinical factors, which require further investigation.