Clinician Connect

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Nov 1, 2007 - The Pink Ribbon Day breakfast at the GMCT on 25 October. 2007 was a very pink affair. Thanks to Wendy Andrews' culi- nary skills, a fine ...
Clinician Connect

1 November, 2007

Guest Editorial by Jeffrey Braithwaite The underlying properties of networks The GMCT has been responsible for bringing together a series of clinical networks over several years in order to improve care for patients, but few participants have had the time to stop and think about the conceptual and empirical underpinnings of networks. What exactly are networks, what do we know about them, and how do they work? A surprising amount of academic knowledge has been assembled and is being applied to health care.1 Jeffrey Braithwaite Definitionally, a network is a collection of objects (agents, players, participants or members, collectively called nodes) linked to each other in some manner or another.2,3 Examples are the London Tube, the Internet, fad-makers in the fashion industry [and the fashionistas who wear the clothes they promote], the webs of influence of board members of large companies and of course, clinical staff who refer patients to and consult with each other on a regular basis about clinical care.

Random graph theory, the branch of mathematics on which network understanding is based, analyses the properties of networks into nodes and connecting links.4,5 It argues that when enough nodes are tied together a phase transition can be reached – that is, a critical point when the sum of the parts of the network becomes greater than the whole. The constituent elements interact rather than merely sum to a total. Not only that, but they self-organise.6 There is no clear centre in networks, and the features described here are universal amongst differing types of networks. Notwithstanding the similarities, networks can differ in terms of how loosely or tightly coupled [or joined up] they are, what the length of the path is between nodes, and what degree of clustering there is. Of the many fascinating features of networks that theorists are interested in, two are the small world problem and the search problem. A small world emerges when any two nodes can be connected regardless of the network’s complexity. Recognition that there can be short pathways through networks originated with a famous study conducted decades ago in which Stanley Milgram, a social psychologist, found that there were invariably few steps between connected nodes in a network.7 This has become known as ‘six degrees of separation’, and refers to the fact that no more than six steps are required, and usually fewer, to link disparate nodes. The search problem asks how different nodes find each other in a network.8 Theorists originally thought that people in a network need information about the network and others who comprise it more than anything else. Over and above other kinds of knowledge, network members require information about the geography of the network’s members [where are they?] or the occupational profile of them [who are they?] in order to find others. (Cont. P2.)

Cheryl Koenig with son Jonathan (l) at the launch of “The Courage to Care” at the Carers’ Picnic 18 October 2007 - see Brain Injury Rehabilitation report P4

In this Issue

Clinical Taskforce

Home Enteral Nutrition

Guest Editorial: Jeffrey Braithwaite

1

Severe Burn Injury Service

2

Aged Care

3

Bone Marrow Transplantation

4

Brain Injury Rehabilitation

4

Robert Bosi, Cheryl & Adeline Hodgkinson 6

Renal Services

8

Imaging: Nuclear Medicine Radiology

6

Respiratory Medicine

8

Spinal Cord Injury

8

Information & Communication Technology

6

Stroke Services

9

Transition Care

10

Urology

10

Comment “Deficiencies in Care”

11

Contact Us

11

Gastroenterology

7

Gynaecological Oncology

7

Consumer Participation

5

Neurosurgery

7

Cardiac Services

5

Ophthalmology

7

Diabetes

5

Orthopaedics

7

Page 1

Newsletter 1 November 2007

Guest Editorial (Cont.) Jeffrey Braithwaite is an organisational psychologist who is Director of the Centre for Clinical Governance Research and Professor in the School of Public Health and Community Medicine in the Faculty of Medicine at University of New South Wales. He has published extensively in the national and international literature on health policy and health systems reform. His research spans patient safety, Surprising amounts of information flow through networks. Rather networks, organisational culture and structure, and clinical leadership than relying on formal hierarchies or organisational arrangements, and management in the health system.

Increasingly, scholars of networks have been talking about ‘scalability’.6 The finding seems intuitive, perhaps even obvious that some nodes are more connected than others, ie. they are hubs, whereas many other nodes have fewer connections.

network members can exchange information fast and cheaply, learn from each other and contribute to knowledge by flying under References 1. Braithwaite J, Runciman WB, Merry A. Towards safer, better management’s radar.9 This of course can be a double-edged healthcare: harnessing the natural properties of complex sword. Like Goldilocks and the three bears, things have to be just right for optimal networks. Too much structure and demands made on the network, and it becomes overly constrained. Too few members or connections between them and relationships do not develop and information fails to flow.3,10 Networks that are just right can display robustness, and serve to accelerate information sharing and improve relationships amongst members. But networks can also, unnervingly, be quite fragile, and can fall apart if excessively controlled or they become gridlocked. How does your GMCT network stack up? Is it tightly or loosely coupled, or just right? Are the small worlds effective, such that information transmits readily between members? Is it too constrained, or not sufficiently organised? And what about you? Are you a hub, or a relative isolate? Depending on your answer to these questions, a network theorist could have a remarkably good attempt at figuring out how efficient and robust your network is.

sociotechnical systems. Quality and Safety in Health Care. In press. 2. Strogatz S. Exploring complex networks. Nature. 2001;410:268-276. 3. Watts DJ. Six degrees: the science of a connected age. New York: WW Norton, 2004. 4. Erdös P, Rényi A. On random graphs. Publicationes Mathematicae. 1959;6:290-297. 5. Erdös P, Rényi A. On the evolution of random graphs. Publications of the Mathematical Institute of the Hungarian Academy of Sciences. 1960;5:17-61. 6. Barabási A-L, Albert R. Emergence of scaling in random networks. Science. 1999;286(5439):509-516. 7. Milgram S. The small world problem. Psychology Today. 1967;1 (1):60-67. 8. Dodds P, Muhamad R, Watts D. An experimental study of search in global social networks. Science. 2003;301(5634):827-829. 9. Bryan LL, Matson E, Weiss LM. Harnessing the power of informal employee networks. The McKinsey Quarterly. 2007;4:1-10. 10. Buchanan M. Nexus: small worlds and the groundbreaking science of networks. New York: WW Norton, 2003.

Jeffrey Braithwaite, PhD

Severe Burn Injury Service (Cont.)

Co-Chairs: John Harvey & Christine Parker



The effect of Myoglobin on kidney cells and oxidative stress has been studied and findings are ready to be published. Myoglobin has also been connected with kidney failure after severe burns and an investigation is underway to prove the possible connection.



Several projects are underway in the skin culturing and tissue engineering laboratory at Concord investigating human elastin, hollow fibre collagen and a biodegradable collagen/polymer scaffold for their potential to serve as the basis of a multilayered three-dimensional skin substitute.

• The Burn Units which form the NSW SBIS are constantly evaluating current practice and conducting research to ensure that the care their patients receive is best practice. All three NSW hospitals with burn units are aligned with the University of Sydney.

The factors produced by cultured skin cells are being identified and investigated to help understand the control mechanisms behind this technology. As part of these studies, a mouse model has been designed to look at the efficacy of these three-dimensional products in wound healing. In collaboration with the burns unit at The Children's Hospital at Westmead, the long-term survival of cultured skin cells is being investigated in a porcine model.

The NSW Severe Burn Injury Service (SBIS) submitted the burn patient Transfer Feedback process to the NSW 2007 Health Awards. The judges awarded this process special recognition as an important project. Anne Darton presented the project at the 2007 Health Expo and members of the SBIS attended the Halifax Ball.

Anne Darton and Christine Parker at the 2007 Halifax Ball

Research at Concord's Burn Unit encompasses laboratory based studies, clinical trials and epidemiology investigations. Several 2007 projects are awaiting publication. These include: • • A study investigating Dysphagia after severe burns. •

A project providing evidence on the need for and design of • escharotomies in severe burns.



A study describing the use of Acticoat in Toxic Epidermal Necrolysis (TENS) patients. (Acticoat, a modern silver dressing introduced at the Concord Unit several years ago is now widely used across Australia). •



Research into the incidence of heart dysfunction after severe burns. (Myocardial dysfunction after severe burn is a serious complication). This study is being considered for publication.



Basic science investigations into the use of patients own plasma, engineered into a gel for the delivery of cultured cells will be published later this year.

Clinical Taskforce

Page 2

Clinical studies designed to evaluate donor site dressings and the use of cultured cells for donor site healing. Two other phenomena in severe burns are under investigation: the incidence of heterotopic ossification and the development of Hyper-natraemia in burned patients. Both studies are designed to address rare but serious side-effects of large burn injuries. Infections are a major problem in burn patients and two studies investigating Biofilm and the mechanism of microbial invasion in burn wounds are underway. Outcomes after Tracheotomies in burned patients after long-term ventilation are being studied, as well as the incidence and outcomes of burn injuries from barbeques. (Cont. on P 3)

Newsletter 1 November 2007

Severe Burn Injury Service (cont.)

Co-Chairs: John Harvey & Christine Parker

The Children’s Hospital Burns Research Institute (CHBRI) was formed in 2003 as a collaborative enterprise between the Thanks to Peter Kennedy, the Concord Burn Unit has access hospital’s Burns Unit and the Kerry Packer Institute for Child to more than 20 years of data. The Unit is utilising this data to Health Research. The formation of the Institute has given staff of determine the incidence and outcomes of hot water scalds, all disciplines a focus around which to develop research ideas which are a major and avoidable health issue. both in the clinical setting, and in the laboratory.

Concord (cont.) •



The changing nature over time of burn wound appearance • after application of different dressing materials has always presented a challenge for burn professionals and a study is underway to describe and evaluate these occurrences.



Retrieval times for severely injured patients can be extremely long due to the sheer size of NSW and the transfer time from remote areas. The impact on treatment of such delays is being investigated.



In parallel, an evaluation of the available education in early burns treatment worldwide will give valuable data on how treatment before transfer could be improved through educa- • tional projects.

Royal North Shore Hospital with its affiliation with Sydney University and the Northern Clinical School has always encouraged research in a broad range of specialties, including burns. This year the Hospital has secured $5.25 million from NHMRC grants for more than 14 projects across many specialties. With the construction of the new research and education building, the prospects for future research and development are even more promising. Research at the Severe Burns Unit covers every aspect of the unit’s work. RNSH new Research & •

In collaboration with the Sutton Education Building Laboratory of arthritis, (one reason for the success of the hospital’s NHMRC application), two randomised control trials are presently underway into wound healing with the use of activated protein C on donor sites and burns. • A third randomised control trial is examining early discharges with lower limb burns and wounds with the use of topical negative therapy. • A protocol for trialing Penthrox analgesia for patients having dressings changed on the ward, is being undertaken. • A trial is underway with silicon and silver-based dressings for more difficult wounds in the dressing clinic. • RNSH staff are developing a proposal to conduct a multicentre trial evaluating management of blisters following a burn injury. It is encouraging to see additional resources being channeled towards research in the rapidly evolving field of burn care.



Current clinical projects include a prospective study to examine the timing of operative intervention on scar development. This study will include an evaluation of the use of the Laser Doppler in the assessment of the factors relating to burn scars.



A ten-year retrospective study has just been completed comparing the use of full-thickness and split-thickness skin grafts in hand burns in infants. The study will be presented at the Royal Australasian College of Surgeons meeting in Hong Kong in 2008.



A series of experiments conducted in the animal laboratory has demonstrated unequivocally that cold running water applied within three hours of a burn wound reduces the depth of the wound. This work provides important scientific validation for the current advice to the general public to use cold water as a first aid measure in burns.



The unit is undertaking a collaborative double-blind study with the burns units at Concord and Royal North Shore Hospitals to validate the use of Cultured Epithelial Autograft (CEA) (spray on skin) in acute burn wounds. This is the first time that such a study has been undertaken in Australia since CEAs have been used in the clinical setting.



A study is being developed in the laboratory as an adjunct to the clinical trial, on the rate of engraftment and persistence of CEA in a burn wound, in a porcine model.

Apart from the NHMRC grant, all research at the CHBRI is made possible by the generosity of donors. In particular, continuing support from the NSW Fire Brigades is much appreciated. Contact: Anne Darton, Network Manager. Ph: (02) 9926 5641 Email: [email protected]

Aged Care

Chair: Richard Lindley

The newly reconstituted network has held productive meetings and defined key issues to be pursued including: workforce, rehabilitation and behavioural disturbance (delirium). The network will contribute to the pending service developments for the acutely ill aged.

It is pleasing that Advanced Trainee positions for Geriatrics are fully subscribed. This will have a positive effect on recruitment and service provision in the not too distant future.

Richard Lindley has participated in meetings with physicians involved in this planning process. Discussions have been influenced by programs already in place in several metropolitan settings which have helped to alleviate some pressures. Clinical Taskforce

The Burns Wound Healing Laboratory is investigating the role of macrophage surface receptors (Integrins) in both stimulating the accumulation of macrophages within the burns wound and maintaining their presence. A prolongation of these macrophages is one of the factors which affects the development of burns scars. Rachel Murray who heads the Laboratory, is the NHMRC RD Wright Fellow. She has recently been awarded an NHMRC grant for 2008. Research related to burns scars is also being undertaken by Andrew Holland who is investigating the role of the Fibrocyte in the development of scarring.

Page 3

Contact: Kylie Fraser, Project Manager. Ph: (02) 9887 5567, Email: [email protected]

Newsletter 1 November 2007

Bone Marrow Transplantation

Co-Chairs: Peter Shaw & Vicki Antonenas

The BMT Network staff participated in the Annual Haematology Society of Australia and New Zealand Conference (see photos on r.) which was held on the Gold Coast on 14-17 October 2007. More than 900 delegates attended, some from across the globe although most were from Australia and New Zealand. The presentations covered medical, nursing, scientific and pathology disciplines. The conference was an excellent demonstration of delegates’ commitment to this important area of clinical medicine. Our Network Clinical Nurse Consultant David Collins presented his research into BMT patients with Central Venous Lines and infection risks; Annette Trickett, BMT Quality Manager, presented a research study on validating CD34 Fresh and Cryopreserved cells. These presentations were very well received. The conference ended with a dinner at Sea World, which featured visits to the sharks and polar bears, rides on “the Flume” where those who braved it ended up quite wet, and “the corkscrew”, where some ended up quite sick! The Network Manager and CNC demonstrated their strong constitutions by braving this ride three times! With lots of dancing and general frivolity, it was a Contact: Jill Morrow, BMT Network Manager. great way to finish a very insightful and intensive conference! Ph: (02) 8382 4625 Email: [email protected]

Brain Injury Rehabilitation

Chair: Adeline Hodgkinson

The Courage to Care

Lifetime Care and Support Scheme (LTCS)

The much anticipated launch of Cheryl Koenig’s new book, The Courage to Care was performed by the Hon. Bruce Baird, MP (Federal Member for Cook) on 18 October 2007 during a Carers Picnic in the grounds of Hazelhurst Regional Gallery hosted by the Sutherland Shire Carer Support Service (SSCSS). Our thanks to Mary Bills and her organising committee for the spectacular day. About 100 people attended the picnic. There was significant interest in Cheryl’s book from the many carers who attended. Opportunities to share stories and create new friendships weren’t missed.

The Scheme provides treatment, rehabilitation and attendant care services to people severely injured in motor accidents in NSW, regardless of who was at fault in the accident. People with a brain injury represent some 90% of the Scheme’s clientele. Personnel from the BIRD and Program are therefore collaborating with the Authority through the LTCS Implementation Committee which met for the first time on 26 September 2007. The Committee agreed to: • Identify and address issues to support the successful implementation of the LTCS for people with brain injury in NSW •

The Courage to Care is the second book by Cheryl published by the Brain Injury Rehabilitation Directorate (BIRD)/GMCT. A con- • sumer member of the BIRD, Cheryl shares her own and others’ stories about caring for someone with a brain injury in the book. Scott Trevelyan, Diana Blazevic and John Fenwick who contrib• uted to the book also attended the launch. At twelve years of age, Cheryl and husband Rob’s elder son, • Jonathan sustained a severe brain injury. He was given little chance of survival. Ten years on from that pedestrian accident Cheryl is elated by her son’s recovery and proud of the role she has played as his carer. She hopes the book will help other carers in this important role. To order your copy of the book, contact Helen Badge on Ph: (02) 9828 6235 or Email: [email protected] or visit the website: http://www.health.nsw.gov.au/birp/birdreports.html

Support NSW BIRP clinicians and managers to adopt changes practices as required by the Scheme. Ensure consistent state wide feedback to influence Lifetime Care and Support Scheme policies, procedures, such as providing feedback on guidelines Monitor the impact of LTCS on statewide BIRP services and how they are managing the extra demand. Membership includes: Suzanne Lulham (LTCS); Neil Mackinnon (LTCS); Denis Ginnivan (Albury BIRS); Lacey Healey (Dubbo BIRS); Adeline Hodgkinson (BIRD); Marion Fischer (SCH Randwick); Helen Badge (BIRD); Robert Bosi [Committee Chair] (BIRD). The next meeting will be held on 20 November 2007. Contact: Robert Bosi, Network Manager. Ph: (02) 9828 6133 Email: [email protected]

Launch l-r, Cheryl Koenig, Bruce Baird, Adeline Hodgkinson, Kate Needham, Cheryl, Robert Bosi, Jacob Joseph-Nance, Diana Blazevic Clinical Taskforce

Page 4

Newsletter 1 November 2007

Consumer Participation

Chair: Peter Castaldi

Consumer and Carer Forum 17 October 2007 l-r: Grahame Colditz, Helen Griffiths, Elaine Buggy, Anne Darton, Rob Koenig, Kate Needham, Cheryl Koenig, Jono Koenig, Noelene Burt, Betty Johnson

The final meeting of the Consumer Forum for 2007 was held on 17 October 2007 with four Carer Support personnel from Area Health Services attending. Each Area Health Service has been invited to nominate Carer Support personnel to participate in the GMCT Networks. Anne Darton provided a stimulating presentation on the Severe Burn Injury Service and highlighted the value of prompt first aid to minimise the long-term damage from burns. The consumer work plan was reviewed and some additional goals were included. Recruitment is underway for consumer participants to join the following Networks: Urology, Gastroenterology, Transition Care and Spinal Cord Injury.

The launch of Cheryl Koenig’s second book, “The Courage to Care” (see report on P 4, Photos P 1) prompted considerable media interest. Cheryl was interviewed by Glenn Wheeler for his Sunday 2UE radio program and by The St George and Sutherland Leader and the Bankstown Torch newspapers. Congratulations to Cheryl for her terrific achievement. The book is for sale through the Brain Injury Rehabilitation Directorate. Congratulations to Margo Gill who has been selected to join the NSW Primary Health Care Research Capacity Building Program. Contact: Lynne Gillard, Consumer Participation Manager. Ph: (02) 9887 5680, Email: [email protected]

Cardiac Services

Co-Chairs: Peter Fletcher & Karen Lintern

The Cardiac Nurses Education Program

Community Education Program - “Life...Live it Save it”

The Nurses Education Program has begun and the feedback has been very positive. Clinicians are participating from sites such as Port Macquarie, Tweed Heads and Coffs Harbour. The last presentation for the year will take place on 21 November 2007 at 3pm and will be given by Virginia Booth, CNC at Royal Prince Alfred. The topic is Acute Coronary Syndrome Review of Guidelines and Clinical Pathways. Please contact the Network Manager for details on how to participate in the program (see contact details opp.).

Clinicians working in the community may be interested in the Retiree Community Education Program developed by the NSW Ambulance Service, (see further details in section below ). Contact: Bridie Carr, Network Manager. Ph: (02) 9887 5946, Email: [email protected]

Diabetes

Interim Chairs: David Chipps

The GMCT is working toward the establishment of a Diabetes Network in NSW, as mentioned in the October Newsletter. The inaugural meeting will be held on 7 November 2007, at the Northern Sydney Education Centre, Macquarie Hospital, from 6-8 pm. At this meeting Endocrinologist/Diabetes Physicians, Nurses and Allied Health Workers will consider the scope of activities to be undertaken and appropriate Terms of Reference to establish the network. If you are interested in attending the inaugural meeting, please download the registration form and fax back to GMCT from: http:// www.health.nsw.gov.au/gmct/diabetes/pdf/diabetes_flyer.pdf

Please pass the information about our inaugural meeting on 7 November 2007 to any colleagues who may be interested in joining the Diabetes network Contact: Jan Peirce, Network Manager. Ph: (02) 8877 5173, Email: [email protected]

Congratulations to Trish McDougall The Retiree Community Education Program is a self-learning information kit for community groups developed by the Ambulance Service of New South Wales. It is free, takes only one hour and has no exams! If a community group you know of would like to update its members’ medical emergency knowledge, please contact Shelley Conasch on Ph: (02) 9320 7795, Email: [email protected] See: http://www.ambulance.nsw.gov.au/community_info/ Clinical Taskforce

Trish is Executive Manager of the NSW Institute of Trauma and Injury Management. She has been awarded the prestigious 2008 Society of Trauma Nurses Leadership Award. The award will be presented to Trish at the Society of Trauma Nurses annual conference in New Orleans in April 2008. Congratulations from all at the GMCT.

Page 5

Newsletter 1 November 2007

Home Enteral Nutrition

Co-Chairs: Peter Talbot & Janet Bell

Dubbo HEN Workshop

NSW HEN Register

HEN held a workshop at the NSW Rural Allied Health Conference on 17 October 2007 in Dubbo. Irena Martincich (Nutrition Support CNC, St George Hospital), Janet Bell (HEN Co-Chair) and Glen Pang (HEN Network Manager) presented an update of GMCT HEN projects, HEN resources, the NSW HEN Register and practical sessions on feeding tube and stoma care, medications and troubleshooting.

The NSW HEN Register has commenced. The HEN Register will collect data on the number of HEN patients, indications for nutrition support, length of time on HEN and prescribing patterns. Please speak to the HEN Network Manager regarding how you can participate. Registration Forms and instructions are on the GMCT website: http:// www.health.nsw.gov.au/gmct

Presenters: l-r Janet Bell, Irena Martincich, Glen Pang

HEN My Health Record GMCT HEN has distributed over 500 HEN "My Health Records" since September 2007. Have you got yours? Please contact the HEN Network Manager for extra copies. These resources can also be downloaded from the GMCT website. ESPEN Guidelines

HEN equipment for demonstration

The European Society of Parenteral and Enteral Nutrition (ESPEN) have published guidelines on adult enteral nutrition. These guidelines cover topics including: Patient management, ethical and legal aspects of enteral nutrition and specific guidelines to intensive care, surgery, oncology, gastroenterology, pancreatic and liver disease, HIV, gerontology and others. The ESPEN guidelines are available form http://www.espen.org/ Education/guidelines.htm Contact: Glen Pang, Network Manager. Ph: (02) 8877 5165, Email: [email protected]

Dubbo HEN Workshop participants

Imaging -Nuclear Medicine Imaging -Radiology

Chair: Richard Waugh, Deputy: Derek

Co-Chairs: Barry Elison & Liz Bailey

A meeting was held on 2 October 2007 between the Co-Chairs and Nuclear Medicine physicians about the differing views on the Cyclotron facility proposed to ensure a reliable supply of less common radioisotopes for use in PET/CT and research.

The first Competency developed by the Radiology Nursing Managers Committee has been distributed. Entitled “Learning Package for Infection Control & Aseptic Technique for Nurses in the Medical Imaging Department”, it will provide a uniform tool for nurses to be assessed as competent in all relevant aspects of infection control to enhance the safety of patients and clinicians.

A really good story at last! The Commonwealth Government announced $3.5m funding for a PET/CT scanner at Royal North Shore Hospital. Congratulations to all those at RNSH who have Contact: Annie Hutton, Network Manager. persisted with this quest on behalf of patients in Northern Sydney. Ph: (02) 9887 5541, Email: [email protected] Contact: Annie Hutton, Network Manager (see details opp.)

Information & Communication Technology Tips Preparation for Electronic Medical Record – Training Over 84,000 clinicians will be using the applications in the eMR as the rollout progresses over the next three years. Making staff comfortable with using the new system is a priority. The challenge of providing training in a limited time is recognised and a number of tactics are being considered. At a state level, a considerable amount of work has taken place to create learning and development resources to assist staff as the health system moves towards the Electronic Medical Record. The tools have been developed through a series of workshops that were held with staff from hospitals in NSW and include: Clinical Taskforce



A web based training tool



Paper based materials to support face to face training sessions



Suggested practice scenarios for staff to do while in training which will help staff understand how the new system fits into their work practices.

Development of learning resources at state level means that each AHS will have a starter pack of tools and resources that can then be customised to fit local requirements. For further information please contact your local Area Health Service eMR team. Contact: Wendy Andrews IM&T Manager. Ph: (02) 9887 5617 Email: [email protected] or, Bruce Czerniec GMCT Data Manager. Ph: (02) 9887 5809 Email: [email protected]

Page 6

Newsletter 1 November 2007

Gastroenterology Services

Co-Chairs: Brian Jones & Ellie McCann

Michael Grimm, the NSW Specialty Convenor for Gastroenterology has forwarded a report on the centralised selection of advanced training gastroenterology registrars, to Heads of Departments of NSW Training Hospitals inviting feedback by 9 November 2007. A survey has been issued to all gastroenterology advanced training registrar applicants inviting feedback on this year’s process. Feedback from trainee applicants (whether successful or unsuccessful) is essential in helping to guide necessary changes to future years processes. Completed surveys should be returned in confidence to the Network Manager by 16 November 2007 (see contact details below). The Colonoscopy Study Implementation Committee will meet on 13 November 2007. Items to be discussed include a proposal to establish a NSW endoscopy information system, similar to that underway in Queensland, and revised clinical priority category advice on elective colonoscopy procedures.

(NBCSP) launched in 2006 and participation of a wider proportion of the NSW population. In the lead up to the Federal Election the Co-Chairs have written to the relevant Colleges and Societies to flag the urgent need for the Federal Government to appropriately fund States and Territories to ensure that public hospitals can cope with the expected increased demand on endoscopy, pathology and cancer treatment services brought about by the NBCSP and to assist with the implementation of much needed endoscopy information systems. One of the issues considered at the Executive meeting in October 2007 was errors in the PBS online application process for Infliximab for the treatment of Crohn’s Disease, listed on the PBS on 1 October 2007. The Co-Chairs have written to the Pharmaceutical Benefits Advisory Committee Chair and Secretariat to flag the committee’s concerns. Contact: Maeve Eikli, Network Manager. Ph: (02) 9887 5602, Mobile: 040 777 6189, Email: [email protected]

There is likely to be an exponential growth in demand for endoscopy procedures with the expansion of the Federal Government’s National Bowel Cancer Screening Program

Gynaecological Oncology

Co-Chairs: Kath Nattress & Chris Dalrymple

The Gynaecological Oncology (GO) Palliative Care Guideline is progressing very well with a wealth of talent and knowledge in the Advisory Group. The weekend retreat held in mid September resolved many issues. All team members attending thought it a valuable way to reach consensus.

The last residential retreat at Nundle in September for GO patients run by the Psychosocial Support Committee was again a great success. Participants commented, ’it provided space to process what has happened since being thrown into the cancer basket' and 'it has been an inspiration and a help, an important part in my recovery’. The next retreat will be held mid-November 2007 in the Blue Mountains.

Due to a staff change at the Royal Hospital for Women, Don Marsden will rejoin the Committee and Sue Valmadre will be leaving. Russell Hogg, a Gynaecological Oncologist at Westmead will Contact: Annie Hutton, Network Manager. now take over as Chair of the Guideline Review Committee. Ph: (02) 9887 5541, Email: [email protected]

Neurosurgery

Co-Chairs: Michael Besser & Violeta Sutherland

The final meeting for 2007 will be held on 12 December 2007 at the Northern Sydney Education Centre. Refreshments at 6:30pm and the meeting will commence at 7pm. The nominees for the Medical Co-Chair’s position will be announced.

Contact: Lyn Farthing, Neurosurgery Network Manager. Ph: (02) 8877 516, Mob: 0438 551 357, Email: [email protected]

Ophthalmology

Chair: Peter McCluskey, Deputy: Michael Braham

Eye Emergency Manual (EEM) Phase 3 The Eye Emergency Project has commenced with multidisciplinary teams engaged from Belmont, John Hunter, Maitland, Manly, Mona Vale, Singleton, Tamworth and Wollongong Hospitals. Team members are committed and enthusiastic participants in the project which aims to improve the diagnosis and management of people who present to Emergency Departments (ED) with eye problems. Applying ‘Clinical Practice Improvement’ (CPI) methodology, the project teams are identifying how they can better manage eye emergencies. The CPI model is designed not only to improve management in the short-term, but also to be sustainable.

Eye education for ED clinicians has been highlighted by the teams as a priority for the project and an education schedule has been drawn up with the first of the education sessions held at Singleton Hospital on 31 October 2007. Meanwhile, site visits by the Project Officer have commenced, to offer assistance and support with the project. The first site visit was to Maitland on 16 October 2007 with subsequent visits to Singleton, Manly, Mona Vale and Wollongong. Visits to the remaining sites -Tamworth, Belmont and John Hunter, are planned for November.

Contact: Carmel Smith, Project Manager. The project teams held their first teleconference 10 October 2007 Statewide Ophthalmology Service. Ph: (02) 9887 5705, and most teams were represented. The next teleconference will Email: [email protected] be held on 7 November 2007.

Orthopaedics Orthopaedic clinicians will meet in the near future to discuss the establishment of an Orthopaedic Network with a particular focus on models of care. Clinicians interested in participating should Clinical Taskforce

Interim Chair: Peter Castaldi contact the Network Manager. Contact: Bridie Carr, Network Manager. Ph: (02) 9887 5946, Email: [email protected] Page 7

Newsletter 1 November 2007

Renal Services

Chair: Jeremy Chapman

Renal Physicians Group About 50 physicians met at the Intercontinental Hotel on 20 September 2007 to hear Dr David Rankin, Senior Medical Adviser from the Dept of Health & Ageing speak about the new provider number, with respect to Nephrology - billing and provider number issues for public and private practice. There was lively discussion. The main presentation was followed by a Clinical Case Presentation: “A case of unexplained recurrent acute renal failure”, provided by Tim Furlong, Director, Renal Unit, St Vincent’s Hospital. Renal Services Network Models of Care Project

Renal Nurses attending Models of Care Project meeting 19 September 2007

Thirty-four renal nurses attended the final of four Workshops for the Models of Care Project led by Prof Mary Chiarella (see photos opp.). Prof Cliff Hughes from the Clinical Excellence Commission presented illustrations from Australian history demonstrating leadership for change and supervised a workshop in assessing sustainability. The sixteen teams have grown in knowledge and capability over the course of the 12-month project, and all teams presented their progress at the September Workshop. The teams plan to present their outcomes at a Nursing Forum to be held in Sydney in February 2008.

l-r: Cliff Hughes, Fidye Westgarth, Mary Chiarella

The next Renal Physicians' Group meeting will be held on 29 November 2007. Contact: Fidye Westgarth, Network Manager. Ph: (02) 9362 5792, Email: [email protected]

Respiratory

Co-Chairs: David McKenzie & Jenny Alison

Rural respiratory issues: an invitation to join the GMCT Respiratory Network’s Rural Working Group

rehabilitation, airways education, cystic fibrosis, and sleep disorders.

Following the NSW Health Council’s (Menadue) review of the NSW healthcare system in March 2000 two clinical planning taskforces, the Greater Metropolitan Clinical Taskforce and the Rural Health Priority Taskforce, were created to address issues concerning the delivery of clinical services in NSW.

Future priorities include the development of medical guidelines for non-invasive ventilation, and the creation of a centralised information management system to facilitate data collection. Collaboration with clinicians in rural and regional NSW was discussed in preliminary Network meetings and at the Network’s inaugural clinicians’ forum in May 2006. The Network is now in a position to convene a Rural Respiratory Working Group.

Since then the GMCT has established more than twenty clinical networks, including the relatively new Respiratory Network. Commencing in mid-2006, the Respiratory Network has developed into a clinical advisory body to NSW Health in the fields of respiratory medicine and sleep disorders.

To this end we warmly invite interested clinicians from rural NSW to join the GMCT Respiratory Network. Metropolitan clinicians are encouraged to forward this invitation/newsletter to rural colleagues. Expressions of interest should be directed to the Network Manager (see contact details below).

Early achievements include the development of guidelines, in collaboration with NSW Health, for the provision of oxygen and other respiratory equipment, and the development of an innovative proposal to improve respiratory services for patients with respiratory infections. Current activities include the development of proposals on smoking cessation, pulmonary

Contact: Nick Wilcox, Respiratory Network Manager. Mob: 0438 241 033, Ph: (02) 8877 5112 Email: [email protected]

Spinal Cord Injury

Co-Chairs: James Middleton & Jenni Johnson

The State Spinal Cord Injury Service (SSCIS) has had significant assistance from the GMCT Information and Communication Technology (ICT) personnel recently. The application of on-line learning modules is being progressed through the Seating Professional Development project. Links to these modules have now been added to the SSCIS website so they are readily available to clinicians. The first two (of 12 planned) modules have been completed. The initial aim is to develop a sustainable model for providing education for generalist clinicians about seating issues for Spinal Cord Injury clients. When this phase is completed in the next few months, the education needs of specialist spinal clinicians will be determined. Video technology will be incorporated into the modules enabling practical components to be visually explored. Bruce Czerniec’s experience with on-line learning has Clinical Taskforce

informed some of the planning of other SSCIS services where education is a key component. The Spinal Outreach Service is currently recruiting an Education Officer to help develop its resources for on-line use. ICT personnel have also been assisting the Spinal Outreach Service to design and establish a new database which will enable monitoring and analysis of the new Rural Spinal Cord Injury Service. Much has been achieved in a very short time and we are hoping that we can commence populating the database within the next month. Contact: Jenni Johnson, Acting Manager SSCIS. Ph: (02) 9808 9666, Email: [email protected]

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Newsletter 1 November 2007

Stroke Services NSW

Co-Chairs: Catherine Storey & Sue Day

In the last edition we detailed a number of events held in NSW to celebrate Stroke Awareness Week (17-21 September 2007). The following table outlines some further events held. Location Central Coast Shopping Centre Displays – Erina, Woy Woy and Lakehaven

The XVII European Stroke Conference will be held in Nice, France on 13-16 May 2008.

Activities

Publicity

Stroke Awareness Display and BP Screening and identification of risk factors. Presentations by local stroke recovery clubs

Central Coast Express, GP email, ABC Radio

Tumbi Umbi

Trivia Night

Prince of Wales Hospital

Stroke Awareness Display, BP Screening and identification of risk factors.

Hospital Newsletter

Stroke Seminar for older people and their carers

Local newspaper

Health Promotion and Health Check Picnic at Mt Annan Botanic Garden

Local newspaper, The Camden Advertiser

Stall in Hospital foyer included Stroke Awareness Display and BP Screening and identification of risk factors.

Local Newspaper

Newcastle – JHH Ward G2, Royal Newcastle Centre foyer.

FAST T-Shirts worn by stroke staff. Stroke Awareness Display

Hospital PR, Local Newspaper, “The Star”

RPAH & Concord Hospital – Burwood RSL

Community full day forum, “Creating Connections”

Local Newspaper

Royal North Shore Hospital – Foyer,

Display BP Screening, identification of risk factors.

N. Sydney Leagues Club Cammeray

Stroke Awareness Seminar, “Strides for Stroke”

Local Newspapers– North Shore Times, Manly Daily, Stroke Recovery Association

St Vincent’s foyer Bondi Junction Mall

Stroke Awareness Display, BP Screening and identification of risk factors.

Internal mail Flyers

Blacktown / Mt Druitt

Stroke Awareness Seminar, “Stamp out Stroke”

Internal hospital mail

War Memorial Hospital Camden/ Narellan Library

Liverpool Hospital

Mt Druitt Hospital Display

Blacktown Hospital Display

Triage’ project at the ACHS Annual Dinner and Award presentation night to be held on Thursday 22nd November. Congratulations to the Hunter Stroke Service and the Hunter New England Area Stroke Clinical Stream for winning this important award.

Stroke Society of Australasia ASM On 17 October 2007, 250 Australasian clinicians attended the Annual Scientific Meeting of the Stroke Society of Australasia. Mark Longworth chaired a breakfast session on “The Management of Stroke Patients in Rural Australia” and presented on the Rural Stroke Education Program that was coordinated by Melissa Gill, Rural Stroke Project Officer from the NSW Institute of Rural Clinical Services and Teaching and supported by Stroke Services NSW. On 21 November the final rural stroke education forum for 2007 will be conducted in Dubbo. You may still register, please contact Di Marsden on Ph: (02) 4939-2492, Email: [email protected] ACHS Award Chris Levi and Mark Parsons will accept the ACHS Quality Improvement Award 2007 (Health Care Performance Indicators category) on behalf of their team’s ‘Pre-Hospital Acute Stroke Clinical Taskforce

The Stroke Care Strategy for Victoria was announced on 16 September 2007. The strategy is designed to ensure that patients have better access to specialised stroke care. International Stroke Day was held on 9 October 2007 and the CEO of the National Stroke Foundation, Dr Erin Lalor, featured on a number of national news programs where she outlined priorities for stroke care in Australia. Cate Storey, Co-Chair of Stroke Services NSW stated that although NSW services compare favourably to other states, there is much more to be done to ensure equity of access for patients to organised stroke management. Contact: Mark Longworth, State Stroke Services Manager. Ph: (02) 8877 5106, Email: [email protected]. gov.au

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Newsletter 1 November 2007

Transition Care

Co-Chairs: Kate Steinbeck & Allison Kingsley

NSW Health Red Books

Diabetes Transition

The clinical inserts for the NSW Health ‘My Health Record’ red books, developed by the GMCT Home Enteral Nutrition Group are being promoted for use by the Transition Coordinators, as many young people with chronic illness have gastrostomies or peg tubes etc.

The draft NSW Healthcare Plan 2007-2011 for children and young people with diabetes which has been developed through the NSW Child Health Networks has been circulated widely for comment. GMCT contributed to the transition section. This month sees the launch of the brand new transition information kit for young people with type 1 diabetes called:

The concept of developing inserts for other chronic diseases is under consideration by the Transition team. Other avenues for providing young people with their medical information such as USB ports and wallet sized emergency cards are also being explored. The Northcott spina bifida card mentioned in the last newsletter is already in high demand. Contact Lynne Brodie (see contact details below).

“Stay Connected”.

The Stay Connected kit includes valuable information and resources to help young people ‘stay connected’ with the health service as they move from Collection of ambulatory data the paediatric to adult The focus for the Transition Network Coordinators this month is setting. It has been develcollecting ambulatory data for the workforce project. The main conditions being targeted are diabetes and other endocrine disor- oped by a specially asders, spina bifida, gastroenterology conditions and cerebral palsy. sembled reference committee with representaOther conditions we are tracking include metabolic genetics and tives from Diabetes Ausneuromuscular disorders, immunology / haemophilia and related tralia, Australian Diabetes disorders and Epidermolysis Bullosa. We are investigating what Service, Australian Diabetes Educators Association, Australasian paediatric, adult and young peoples’ clinics exist, how often they Paediatric Endocrine Group, Type 1 Diabetes Network, young are held, how they are staffed, how many young people attend people with diabetes and with financial support from Eli Lilly Ausand any service gaps. To date information on 66 clinics in NSW tralia, along with input from numerous healthcare professionals has been provided. Our sincere thanks to all the clinicians who across Australia. have contributed. Results and recommendations will be published towards the end of the project in July 2008. The transition kit (shown above r) which is packaged in a compact and eye catching case, features copies of Stay Connected - a Bathurst Forum unique and interactive CD-Rom for young people with type 1 diaOn Friday 19 betes, an accompanying CD-Rom for healthcare professionals, zOctober 2007, cards for young people and a copy of the ‘Get Your Stuff Tothe Network gether’ DVD from Diabetes Australia. The kits will be distributed Manager and to diabetes centres across the country in the coming weeks and Transition Cothe information will also be available online later in 2007 at http:// ordinators www.stayconnected.com.au. attended a Transition FoThe kit has also included some of the information developed by rum in Bathurst the GMCT transition team, giving healthcare professionals and organized by young people from across Australia access to our own transition local materials. For more information on the kit, email: transitionalcarePaediatrician, [email protected] Bathurst Forum participants Tim McCrossin. Contact: Lynne Brodie, Network Manager. Ph: (02) 9887 5578, The forum was well attended with Health, DADHC, the DepartEmail: [email protected] ment of Education and Training, parents and carers represented. A brainstorming session identified many local transition issues to be pursued, perhaps at a second forum early in 2008.

Urology

Co-Chairs: Andrew Brooks & Janette Williams

The project on management of upper-tract stone disease is nearing completion. The results are already very interesting. The catheterization trial has been submitted to the Hunter New England Human Ethics Research Committee and if approved, patient recruitment is expected to commence early in 2008.

The GMCT’s James Macneil will be running the ‘GMCT – Mo Network’. To sponsor James or to join the ‘Mo Network’, contact James at: [email protected] For more information on Movember, visit: http:// www.movember.com.au

Movember

Artist’s impression of Contact: Kylie Fraser, Network Manager. Movember (the month formerly known as NovemProf Castaldi Ph: (02) 9887 5567, ber) will be celebrated by the growing of moustaches (Mos) for mens health. Movember’s benefici- at the end of Movember Email: [email protected] ary partners are the Prostate Cancer Foundation of Australia and beyond blue—the national depression initiative.

Clinical Taskforce

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Newsletter 1 November 2007

Comment on “Deficiencies in Care”

Chief Executive: Peter Castaldi

Those of us working in health have been taken aback and alerted by revelations in the media recently about deficiencies in care. Most clinicians are committed to providing their patients with the best care. We feel a sense of loyalty to the system and value the collegial support and learning environment that it provides. Whatever our individual roles, these events should make us pause and reflect. What then is the appropriate response? Is it resignation, indignation or innovation? In the day-to-day clinical environment care processes that are potentially or actually defective need to be identified. Organisational systems that ignore, fail to stop or to correct defective practices need to be overhauled.

Peter Castaldi

There are many institutional obstacles to navigate every day. We also have a tendency to institutional isolation, to the detriment of shared practices and agreed outcomes. There is however, a wealth of talent, generosity and mutual agreement about the ultimate goal - the best result from clinical care. When we examine models of care in the acute medicine domain we find examples of innovation arising spontaneously from the need to solve the problems of acute illness and clinical demand. The clinical redesign process has provided significant leadership to encourage the re-evaluation of care from the perspective of the patient and to renew clinicians’ sense of pride, value and achievement. These aims are not new. Many of the solutions being developed are not complex or rule-bound but are in fact, simple and achievable. There is a good record in acute surgery over the last few years resulting from a reorganisation of the chain of responsibility. Similar approaches by physicians in the acute medicine domain have been introduced in some hospitals and are the subject of active consideration in others. Unless we solve problems internally, utilising the commitment and good will of our clinicians, external criticism will be warranted. It seems that we stand poised to make real advances to ease the pressure on Emergency Departments and to develop bridges across institutional barriers. These will be the rewards for all clinicians who are part of the solution! Peter Castaldi, Chief Executive GMCT. Email: [email protected] In the Pink The Pink Ribbon Day breakfast at the GMCT on 25 October 2007 was a very pink affair. Thanks to Wendy Andrews’ culinary skills, a fine breakfast was had by all and $222 was raised to support breast cancer research.

۞ Announcing a new website: 'Clinicians Speak Out' http://www.cliniciansspeakout.org

If you have contact with patients in the Australian healthcare system then we want to hear from you.

Are you a registered nurse, physiotherapist, ambulance officer, occupational therapist, podiatrist, radiographer, doctor, orderly, social worker, speech therapist, dentist, midwife, ward clerk, pharmacist, pathology collector, hospital or community volunteer, psychologist, hospital administrator, optometrist, enrolled nurse, dental hygienist, paramedic, sonographer, pacemaker technician, hospital scientist, clinicial educator, patient advocate, ECG technician, nutritionist, orthoptist, clown doctor, practice manager, massage therapist, music therapist, dental nurse, diversional therapist, patient assistant, aged care worker, acupuncturist? The list goes on...

The Hospital Reform Group (HRG) has established a new website 'Clinicians Speak Out' and we invite you to visit the site and tell us what you think. Give us your ideas about how to improve the health system for all Australians: patients, carers and clinicians. Guidelines for comment are available on the site. Further information about the HRG is also provided. Clinicians must speak out if we are to move ahead towards better health for all Australians. Kerry Goulston - Founding Member HRG, Gastroenterologist Clare Skinner - Founding Member HRG, Emergency Registrar

۞ Announcing a new website listing health conferences - visit: http://www.econference.com.au/Category/healthcare/

Contact Us / Feedback “Clinician Connect “ is available on the GMCT website at: http://www.health.nsw.gov.au/gmct/news/newsletters.html

Clinical Taskforce

We appreciate hearing your views – please contact the Editor. Lynne Gillard, Editor/Designer, “Clinician Connect.” Ph: (02) 9887 5680, Email: [email protected] Page 11

Newsletter 1 November 2007