AWH's commitment to service improvements continued throughout 2020-21, despite the ongoing challenges of the COVID-19 Pandemic. In many departments, ongoing improvements were made to staff workflows, practices and training, with the goal of improving patient care and outcomes. Four examples of this are included below, and demonstrate AWH's ongoing initiatives to enhance clinical practice and patient care.

Enhanced Medical Training Opportunities

Author: Hannah Mahoney

Albury Wodonga Health plays a pivotal role in training of junior doctors who will all go on to become medical specialists of various disciplines. Education and training of our junior doctors is very important to growing our own locally trained medical workforce. As such, we have worked on numerous improvements for junior doctors in 2021.

Improving our education programs for hospital medical officers 

These doctors are in their second to third year of training after completion of medical school and require a broad education program to prepare them for specialty training positions. In 2021 year we ran a new and interactive workshop with a broad range of topics designed to enhance their clinical and professional skills. The program was well received by those who attended and has been positively rated in various channels of formal feedback. The program was later adapted to an online format to continue to deliver this education safely within the COVID-19 environment.

Quote from feedback: “I felt this type of education was supportive and showed that Albury Wodonga Health is committed to teaching and advancing the skills of hospital medical officers in the service”.

Supporting junior doctors in gaining enhanced qualifications 

In 2021 year we have implemented a scholarship program for junior doctors to encourage completion of tertiary study whilst employed at AWH. The scholarship supports recipients in enhancing their capability and increasing their confidence with various responsibilities required as they progress through specialty training and is specifically targeted to doctors with a demonstrated commitment to the Albury Wodonga region.

Developing formal physician training pathway 

In 2021 AWH introduced a 3-year Basic Physician Training pathway to encourage and support junior doctors to gain access to high quality clinical and educational opportunities at accredited training sites, in both regional and metropolitan settings.

This inaugural training pathway between Albury Wodonga Health, Royal Melbourne Hospital and Western Health supports a 3-year Basic Physician Training pathway starting at AWH, followed by a second year at Western Health or Royal Melbourne, and then a final year at AWH.

During the three years junior doctors and trainees are supported by experienced medical professionals in a culture of improvement. These senior clinical staff provide accessible and proactive learning opportunities with hands-on clinical experiences. We reinforce day-to-day support, along with protected education, making AWH the perfect place for a career in Medicine.

This pathway approach also supports junior doctors interested in working in a regional area in the longer-term, supporting AWH’s aim to have access to more services closer to home for the cross-border community.

Partnered Pharmacist Medication Charting

Authors: Joshua Anderson, Medication Safety Pharmacist and Leo Mason, Director of Pharmacy

The Challenge

Medication-related harm, if it was a ‘disease’, would be a National Health Priority Area.

  • This harm results in 250,000 hospital admissions and costs $1.4Bn annually
  • There a 400,000 additional presentations to emergency departments likely to be due to medication-related problems.
  • 50% of this harm is preventable!

The Project

In 2017 an Australian study led by Alfred Health demonstrated a new way of writing Patient’s medication charts that significantly reduced medication errors and associated harms. This Alfred model is called Partnered Pharmacist Medication Charting and resulted in medication error reduction from 19.2 percent to 0.5 percent and a reduction in patient length of stay from 6.5 days to 5.8 days.

The Method

When a patient comes into the Emergency Department a Pharmacist takes a Patient’s best possible medication history, then discusses this with the treating Doctor. Together they formulate and document the Patient’s medication plan, deciding which medication to stop, start or hold. Once the plan is agreed upon the Pharmacist writes the medication orders onto the medication chart and the Doctor signs off on the orders. The Pharmacist then discusses this plan with the treating Nurse, letting them know of any urgent medications or ones that have already been given. Putting Pharmacists the hospital's medication experts directly with the Doctors and Nurses looking after our Patients.

The Results

This year AWH with 12 other healthcare partners participated in a repeat study of this model in rural and regional hospitals. Over 1300 charts were included in this study which showed similar reductions to those seen previously in the Alfred study from 2017. Making our Patients safer by reducing medication errors from 66.7 percent to 9.5 percent and reducing the amount of time they need to stay in hospital from 4.8 days to 3.7 days.

The Impact

The complete details of the study are about to be published by Alfred Health. But this study was so successful that this model of care has been adopted in both Albury and Wodonga emergency departments. Getting patients to the wards faster with all of their medications charted, which is safer for sending and receiving teams and most importantly our patients. Keeping our Patients safer through better teamwork!

Clinical Safety & Quality Unit

Author: Sally Squire, Executive Director, Nursing & Midwifery

In June 2021, the Australian Centre for Health Care Governance was commissioned by AWH to carry out a review of the safety and quality functions and structure at AWH. This review was focussed on the need to align the current Clinical Governance Unit and other clinical safety functions with the new organisational structure, and move to a more contemporary model focused on improvement, innovation, safety and quality. The unit also needed to be restructured to accommodate current and future growth within AWH and to reflect the need for increased capacity to deliver patient safety and person-centred care.

The consultant, Fiona Webster, spent several weeks consulting with key stakeholders at AWH including the Board, Executive, Co-directors, and the staff employed in the Clinical Governance Unit. Contemporary, best-practice quality and safety models were used as a benchmark, as well as discussions with two organisations of a similar size and service scope.

A number of key themes arose during the consultation process particularly:

  • A strong commitment to clinical governance but a lack of systematic processes or overly burdensome processes;
  • Recognition of the central role of clinical directors in driving service excellence but a lack of resources, difficulty accessing data to support and drive improvement, and a need to develop organisational capability in improvement science.

The Clinical Governance Unit's resourcing and structure were also highlighted as in need of improvement, as well as the need to make the name of the unit more descriptive to support understanding of the role of the unit and the language of improvement.

The recommendations of the review have formulated the AWH Quality Plan for 2021-22. One important outcome to date has been the decision to formally change the Clinical Governance Unit to the Clinical Safety and Quality Unit (CSQU), as a first step towards reimagining the department responsible for safety, quality and improvement at AWH. We hope to bring you more information about the changes to this unit in our next Quality Account.

The Safer Baby Collaborative

Author: Julie Wright, Director of Midwifery & Nursing, Women's and Children's Services

Until mid-2019 Victoria’s stillbirth rate was 6.2 per 1000 births with little change in this rate for 20 years. Awareness of risk factors for stillbirth was low and research suggested many were avoidable. Safer Care Victoria (SCV) in partnership with the Institute for Healthcare Improvement (IHI) worked to lead a breakthrough series collaborative to reduce Victoria’s stillbirth rate. Albury Wodonga Health were proud to be participants in the project and introduced a range of strategies in line with the five key aspects of care to support the aims of the project by better informing women, increasing awareness of risk factors and how to avoid them and focusing on increased monitoring and assessment of women during pregnancy where appropriate.

AWH Maternity Unit was one of 15 Victorian health services that completed both phases of the Safer Baby Collaborative state wide project that sought to reduce the rate of avoidable stillbirths by 30 per cent in participating maternity services across Victoria. Commencing in June 2019 the collaborative progressed in two phases with phase one running until July 2020 and phase two running from July 2020 to April 2021.

The collaborative focused on five key aspects of care:

  • Increasing public awareness of the importance of fetal movements;
  • Diagnosis and management of fetal growth restriction;
  • Improving rates of smoking cessation in pregnancy;
  • Raising awareness of safe maternal sleep positions;
  • Promoting appropriate timing of birth and mitigating unintended consequences or harm.

Albury Wodonga Health Maternity Unit's commitment to the Safer Baby Collaborative was both challenging and amazing, as staff sought to deliver improved outcomes and experience for women and their babies in these extraordinary times (including bushfires in the region and the ongoing COVID-19 pandemic).

The Outcome

Not only did the health services collectively prevent 20 stillbirths across Victoria, they achieved even more:

  • Increased smoking cessation rates of women during pregnancy by 200 percent from an average rate of 11 percent to 33 percent.
  • Decreased the stillbirth rate by 21 percent from an average rate of 0.24 percent to 0.19 percent.
  • Increased the days between stillbirths by 131 percent, from an average of 3.5 days to 8.1 days, including periods of 47 days and 32 days without a stillbirth occurring at any of the reporting sites.

AWH was amongst the top three maternity services in the state for improving detection & management of Fetal Growth Restriction (FGR).

The successful work undertaken endures and AWH Midwives and Obstetric Doctors continue in their commitment to ensure safe outcomes for mothers and babies and to continue to reduce the rate of avoidable stillbirths.

The Safer Baby Collaborative work was supported strongly by the Maternity Unit Midwife Unit Manager Anna Van Uden and Clinical Nurse Specialist Jane Lloyd who together led the Maternity Unit team to roll out and embed the initiatives. Sarah McFarlane the Consumer Representative provided valuable input from the consumer perspective.

Safer Baby Collaborative

Partnered Pharmacist program