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    2020 Quality Awards

    Each year, WSLHD hosts the Quality Awards as an opportunity to harness the creative and innovative ideas of staff, who are committed to making a difference to patient care and health outcomes. The benefits of the Quality Award projects extend to patients, carers and their families, as well as to staff and the community.

    This year, 52 quality improvement projects have been submitted. Please read more about the projects below.

     

     

    Project categories:

    Category 1: Transforming Patient Experience

    Patient Registration and Identification for New Emergency Department Triage

    TRANSFORMING PATIENT EXP - Patient registration ID for New ED Triage

    Westmead Hospital emergency department redesigned the patient registration process with reduced paperwork and a new ID wristband system. The simplified new system saved time for staff and saw the use of wristbands increase from 58% before the project to 98% by the end of the trial. The project reduced patient wait times and there were zero incidents of ID bands with incorrect patient information, zero medication incidents, and zero incidents or patients being taken to the wrong procedure.

    Healthy Eating Using Art Therapy


    TRANSFORMING PATIENT EXP - Healthy Art using Art Therapy


    Mental health patients often gain weight due to medication side-effects, poor diet, disordered eating patterns, low motivation and limited exercise. This three-week program involved dieticians delivering information during art classes and empowering consumers to develop their own diet plan. There was a noticeable downward weight gain trend for three of the five consumers who completed the program.

    Least Restrictive Care in Mental Health Units in the Age of the Smart Phone

    Personal electronic devices such as phones are part of everyday life for most people, but are usually confiscated upon admission to a mental health inpatient unit. This program aimed to give adolescent inpatients greater access to their devices with fewer restrictions in order to improve their recovery. Since January 2020, least restrictive practice has been achieved for 80% of young people on the ward with no increase in reported incidents related to phone use.

    Let’s Talk Sexual Health – It’s Important

    Lets talk sexual health

    Studies show that people with mental health problems are more vulnerable to sexual exploitation and high risk sexual behaviours, but staff are reluctant to discuss sexuality with consumers. Willow Unit at Cumberland Hospital aimed to establish a regular sexual safety program for consumers in a safe, empowering environment. The program had an 87% attendance rate, and 90% of attendees felt comfortable and reported increased understanding and confidence making decisions regarding their sexual health.

    My Paediatric Experience Matters

    Mount Druitt Hospital wanted to improve the hospital experience for their young patients but no parents or carers were completing the optional online survey. A new paper survey was created for the paediatric ward to capture the individual experience of each family. In nine weeks they had nine surveys completed, capturing many compliments for the staff, some feedback that led to changes, and greater understanding of how the COVID-19 pandemic was affecting families.

    Just Ask It

    TRANSFORMING PATIENT EXP - Just Ask It

    Historic institutionalised racism in hospitals has had a lasting impact on Aboriginal people, including increased distrust of the healthcare system. Auburn Hospital aimed to increase the identification of Aboriginal and Torres Strait Islander patients by creating a more culturally welcoming environment and training frontline staff to ‘ask the question’ about Aboriginal identification. The result was a 62% increase in the number of patients identifying as Aboriginal upon presentation to the emergency department.


    Category 2: Delivering Integrated Care

    Western Sydney Diabetes Virtual Care

    DELIVERING INTEGRATED CARE - WS Diabetes

    Approximately 12% of adults in Western Sydney have diabetes, which is managed in coordination with GPs and hospital-based specialists. COVID-19 forced Western Sydney Diabetes to rapidly pivot from face-to-face consultations to online care with four digital solutions set up within two weeks. The organisation conducted 1,607 occasions of service in February-May and now does 100% of consultations online.

    Growing Little Language Learners

    Growing Little Languge Learners - GLLL_Team_Photo_Quality_Awards

    Most children with poor speech and language development in vulnerable communities do not attend speech pathology, but they do attend childcare. This project involved 44 early childhood educators from Cumberland Council attending an eight-week professional development program led by WSLHD speech pathologists. The result was increased confidence and ability in five communication facilitation skills, creating a better communication learning environment within childcare centres.

    Tiny Tots Talking

    DELIVERING INTEGRATED CARE Tiny Tots Talking

    Children in Doonside are vulnerable on several developmental indices including significant delays in language and socio-emotional development. This project involved embedding a speech pathologist in two early childhood education and care centres for 12 months to improve the quality of early childhood educator practice through clinical intervention, professional development and mentoring. The result was an improvement in 14 out of 18 environmental measures within the care centres, and commitment from Blacktown City Council to fund the program for a further three centres in 2021.

    Co-designing Sustainable Partnerships at Auburn Hospital

    Codesigning suitable partnerships Auburn Hospital

    Auburn Hospital sought to hear honest and important insights from their culturally diverse community and hospital consumers. The plan was to create sustainable partnerships between staff, patients, carers, visitors, community leaders and volunteer consumer representatives. A wide range of 17 activities over a three-month period created deeper understanding and improved community insight, which has led to several initiatives to improve patient experience.

    Pathways to Community Living Initiative

    DELIVERING INTEGRATED CARE Pathways to Community Living

     

    This program supports people with severe and persistent mental illnesses who have had stays in hospital of 12 months or more. Clinicians work with the consumer and their family or carer to find the best option for community-based living. PCLI has facilitated a total of 110 transitions back to community living since it commenced in WSLHD in January 2016, equating to a combined length of stay of over 555 years discharged from mental health inpatient units.

    The Power of Partnerships

    Power of parnterships

    65% of people in Western Sydney are overweight or obese and demand for weight loss programs exceeds available services. This project referred all patients from the Blacktown Metabolic & Weight Loss Program to the NSW Health Get Healthy Service for 13 tailored health coaching calls. Patients enrolled in this cost-effective program trended toward greater weight loss and improvement in diabetes control.


    Category 3: Patient Safety First

    Enhanced Recovery After Surgery Protocol

    Patient Safety First - Enhanced Recovery After

    Westmead Hospital sought to reduce hospital length of stay and complication rates following elective colorectal surgery by 25% within 12 months. The team collected a database of 55 enhanced recovery after surgery protocols and met regularly to discuss issues, complications, readmissions and mortality. The result was a 25% reduction in length of stay and improved patient outcomes through a team-based electronic database approach to auditing, compliance and standardised care.

    Virtually Passing the Baton

    The chronic and complex nursing team found inconsistencies in service delivery as a result of gaps in the handover between weekday and weekend clinical nurse unit managers at five different sites. The team set up an online clinical handover meeting, saving time and $330 in travel costs per meeting. The result was improved continuity and service delivery including fewer missed services, fewer clinical errors, greater staff safety, lower use of casual staff and less product wastage.

    Treatment After Triage

    Growth in presentations to Auburn Hospital emergency department was leading to increased wait times, poorer patient experience and more people not waiting for treatment. The department introduced a new team comprised of an ED consultant, a junior medical officer and a nurse in the triage area during the busiest periods. The result was improved performance against all triage categories, leading to greater patient and staff satisfaction.

    Code Blue: Can’t find your way? Blue vests will save the day!

    Code Blue Cant find your way Blue Vests will

    Westmead’s Oral Health patient base has higher levels of medical complexity than the general population, leading to increased incidents of patient deterioration when advanced life support (ALS) is required from a team based in the main hospital. Oral Health staff started wearing high-visibility blue vests in set locations to provide directions to an ALS team responding to a medical emergency. The result was a 54-second improvement in emergency response times and a significant improvement in staff confidence.

    Five P’s Plus

    Falls, pressure injuries and aggression are top risks within Auburn Hospital’s temporary stay unit treating elderly patients, most of whom have dementia. Staff introduced a new proactive patient monitoring system that was made easy to remember with five p’s: pain, position, personal needs, proximity and plug-ins. The result was a reduction in falls, pressure injuries and incidents of aggression, and increased patient and carer satisfaction.

    Preventing the slippery slope of deteriorating patients

    When a patient enters the ‘red zone’ of deterioration they need a rapid response to prevent cardiac arrest, but only around 30% of red zone breaches at Auburn Hospital were being escalated properly within the clinical emergency response system (CERS). A staff survey determined the cause of the issue and education was used to empower nurses and midwives to escalate incidents in line with the CERS policy. The result was a 103% increase in red zone escalations and a 28% reduction in the cardiac arrest rate.

    Keeping clozapine patients safe during COVID-19

    PATIENT SAFETY FIRST - Keeping clozapine patients safe during COVID-19 pandemic Team Photo

    The COVID-19 pandemic has been a challenging time for all mental health patients, particularly those who are on clozapine for treatment-resistant schizophrenia. Blacktown Clozapine clinic used an innovative combination of telehealth, partnering with primary care, and on-site dispensing and home delivery of clozapine to keep patients safe and manage their anxiety. All 160 patients remained mentally stable with no hospital admissions or relapses due to COVID-related stress or anxiety, and mental health clinicians formed better partnerships with primary care providers.

    Improving access to care for pregnant women

    PATIENT SAFETY FIRST - Improving access to care for pregnant women - WHC - Image of Team

    Pregnant women should have their first antenatal appointment within 12 weeks but at Blacktown Hospital the average first contact was occurring at 23 weeks, with a four-week waiting list for GP referrals. The Women’s Health Clinic analysed all their reports and introduced new work practices to streamline the process, and also found more clinical space for outreach midwifery care in the community. Results have included earlier contact with women from culturally and linguistically diverse backgrounds, higher engagement with Indigenous women, and improved outcomes for mothers and babies.


    Category 4: Keeping People Healthy

    Western Sydney Diabetes prevention alliance

    WS Diabetes prevention alliance

    People living in Western Sydney have twice the risk of developing diabetes as those in the eastern suburbs due to factors including food availability, cooking skills, physical activity and reliance on car transport. Health alone can’t fix this, which is why Western Sydney Diabetes has engaged leaders at all levels of government, universities, non-government organisations and the private sector to work together to change the environment. This Alliance now incorporates 130 organisations and has the potential to provide a $700 million benefit through 13 key interventions in Western Sydney over the a 14-year period.

    COVID Streetfighters

    Homeless people are a vulnerable population at increased risk of both COVID-19 and influenza, with lower access to primary and preventative health care. The Youth Health team established a flu vaccine outreach service that also presented the opportunity to screen for COVID-19 symptoms and share important health information. The results by June included more than 500 people vaccinated, more than 1500 people screened for COVID-19 and 69 symptomatic people tested, and more than 150 communications delivered.

    Breastmilk Any Way

    Breast Milk Anyway Team Photo

    Breastmilk has many benefits for babies, and so Westmead Hospital’s Women & Newborn Health division set the target that 100% of women who intended to breastfeed would be exclusively breast milk feeding on discharge – including expressing and cup feeding. The team surveyed staff and patients, then implemented changes including staff education and increased encouragement of skin-to-skin contact. The pre- and post-surveys revealed a significant increase in staff use of policies and procedures, and deceased conflicting advice given to patients.

    Health Workers Need Care Too

    Cervical screening is reducing cancer for women in Australia but many health workers say they struggle to find the time to get tested. The Westmead Hospital Women’s Health Clinic set up a convenient and accessible pop-up ‘wellness clinic’ for female employees to access care while at work. The clinic ran twice as long as intended due to demand and 81% of attendees were overdue for a cervical screen, with 21% requiring follow-up intervention – potentially saving lives.

    Youth Voices: Building Adolescent Leadership

    youth voices 01

    The Prevention Education and Research Unit partnered with GWS Giants to provide leadership training Year 10 students in Western Sydney, with the aim of the students implementing actions within their schools that promote healthy eating and physical activity. So far 200 students from 11 schools have produced projects including more equipment for school gyms, installation of water bubblers, redesigned girls’ PE uniforms, a table-tennis tournament, healthy snack stalls and reusable water bottles for every student. The students also built their leadership skills, communication, teamwork, decision making and health literacy.

    Quitting for Two

    KEEPING PEOPLE HEALTHY - Quitting for 2

    Women at Blacktown Hospital are twice as likely to smoke and half as likely to quit during pregnancy than women at Westmead or Auburn hospitals, causing immediate and long-term harm to themselves and their child. Blacktown Hospital Women’s Health Clinic supported women to quit smoking by making referrals to Quitline standard, pooling free support options, introducing a new carbon monoxide test to demonstrate the harms of smoking, and teaching midwives how to conduct brief interventions and referrals. The results included a significant rise in Quitline referrals, the quit rate rising from 12% to 30%, and reduced instances of low birthweight for women who quit while pregnant.


    Category 5: Supporting Our Teams

    6S Lean Stores

    The Chronic and Complex Nursing team aimed to improve sustainability by reducing excessive stock, stock going out of date and inappropriate stock storage. To achieve this they utilised the 6S methodology: sort, set, shine, standardise, sustain and safety. The results include a cost saving of approximately $1000 per month across the community health centres, time savings for staff, and increased communication and collaboration between teams.

    Emergency COVID-19 Anaesthesia Response Team

    COVID-19 presented a distinct challenge to the perioperative team as staff were at risk of contracting the highly-infectious disease while performing aerosol-generating procedures. The Department of Anaesthesia created a 24/7 consultant-led intubation service for the purpose of safe practice in patients with suspected or confirmed COVID-19. Simulation exercises were performed with 120 anaesthetists and nurses in two weeks, and the team provided safe intubation to 29 patients with no transmission to staff.

    Digital Multidisciplinary Care for People Living With HIV

    Western Sydney Sexual Health Centre 300x90

    HIV is a highly-stigmatised, complex, chronic health condition that disproportionately affects marginalised people and requires ongoing care. Western Sydney Sexual Health Centre created a procedure for identifying and actively recalling patients at risk, ensuring people living with HIV receive the follow-up care they need and reducing the risk of transmission. The new process identified 29 people ‘lost to follow up’ and 25 ‘at risk’, flagging them for follow-up from the Centre.

    Workplace Wellness in the Time of COVID-19 and Beyond

    SUPPORTING OUR TEAMS - Workplace Wellness in the time of COVID

    In response to COVID-19 the People & Culture team needed to quickly redesign and sustain services to provide for our entire workforce’s needs around being informed, supported, focused and valued. Exceptional collaboration, flexibility and creative problem solving was needed as the department work with the unions and other internal and external partners. Some of the new initiatives and outcomes include Workplace Wellness mobile teams and centres, a call centre, a range of childcare services, and assistance with COVID staff clinics.

    Emergency Department Triage Education Series

    Supporting our Teams - Emergency Department Triage Edu

    Many nurses in Auburn Hospital emergency department completed triage training more than five years ago and needed to update their skills so patients were treated on time. The clinical nurse educators (CNEs) introduced a structured education program in collaboration with other CNEs across the district featuring different topics and presentations focused on patient safety. The triage audit showed an improved result from 81% to 93% within one quarter.

    COVID-19 Rapid Mental Health Response for Quarantined Travellers

    Supporting our teams - COVID-19 Rapid Mental Health Response for Quarantined Travellers

    In the context of the COVID-19 pandemic, people returning from overseas are required to be quarantined within hotel rooms for 14 days, which could be stressful and exacerbate mental health issues. Our mental health service worked closely with private health care providers and the State Health Emergency Operations Centre (SHEOC) to provide a 24-hour service and ensure that returned travellers remain safe and receive the expert mental health care that they require. The specialised team has provided rapid mental health assessment to 65 people experiencing severe mental health issues such as stress, anxiety, depression, suicidal thoughts, self-harm behaviour, homicidal thoughts and relapse of pre-existing psychiatric disorders.

    Better Outcomes for Obsessive-Compulsive and Related Disorders

    The project aims to provide early intervention for people with obsessive-compulsive and related disorders (OCRDs) by offering expert consultation to clinicians within the inpatient and community mental health service. The team triages all referrals within the week and aims to assess and discuss with referrers within a month. A review of the service indicates that patients are being seen within an average of 18.5 days from the time of referral, that there are high levels of satisfaction, and that ratings of symptom severity reduce significantly post-intervention.

    Collaboration, Culture and Care

    Greater demand for midwifery at home care in Blacktown was placing a strain on resources. The service was restructured to develop a streamlined, simplified and sustainable approach, and greater collaboration with Westmead Hospital. As a result staff are more productive, less stressed during their work day, and have reported greater job satisfaction and a more positive workplace culture.

    Midwives Making Health Matter

    42% of women in Western Sydney are overweight or obese during pregnancy, which increases the risk of complications. Blacktown Women’s Health Clinics aimed to refer more women to the Get Healthy in Pregnancy (GHiP) free telephone coaching service to help them choose a healthier lifestyle during pregnancy. As of April the clinics had referred 402 women to GHiP, beating their goal by 25%, by embedding the service into routine care.


    Category 6: A Safe and Healthy Workplace

    Contain the Contagion! A Clinical Mission to Eradicate Transmission

    Community health nurses visit patients at home, which presented a transmission risk during COVID-19. Integrated & Community Health quickly created a video outlining the correct process including pre-visit screening, use of personal protective equipment (PPE), hand hygiene, and cleaning or disposal of equipment. 93% of nurses reported increased feelings of safety, support and ability and 95% reported improved knowledge of PPE use in a community setting.

    Sliding Doors

    A Safe and Healthy Workplace_WMD_Sliding Doors – Improving Safety Team P

    Westmead Centre for Oral Health is 40 years old and the building has remained relatively unchanged in that time. After an incident involving a child running into the clinic area, staff noted issues including patients entering the clinic without an appointment and a lack of privacy. A secure sliding door was installed between the clinical area and the patient waiting room, after which 78% of staff reported feeling safer and 91% agreed it was it was a positive change.

    Where Art Thou, Meds?

    Where there art thou meds Auburn-Hospital

    Accessing the main pharmacy after-hours at Auburn Hospital requires assistance from a security guard, and the on-call pharmacist is often needed when medication is hard to locate, leading to additional workload and delays for patients. The pharmacy department set about optimising use of the after-hours drug room and the MedLocator app; a live database that replaces ward hard copies. Over two years the project saw significant reduction in items taken from the main pharmacy and total time taken to locate medications, providing benefits for staff and patients.


    Category 7: Innovation and Research

    Gathering Place, Healing Spirits

    WMD_Gathering Place Healing Spirits Team Photo

    Due to historic racism and current health inequalities, work was needed to make Westmead Health Precinct a safe, welcoming and connected healing space for Aboriginal and Torres Strait Islander people. The project team engaged in extensive community consultation to design a space as part of the Westmead Redevelopment set to open in 2021. The Gathering Place meets the cultural need to remain connected to country and provides an area for smoking ceremonies, sorry business and other cultural events. It also features Aboriginal art integrated into the garden and indoor room to ensure the spaces are culturally safe and welcoming.

    Digital Innovation Gets Integrated Clinically

    Treatment planning and provision of oral health care involves extensive and expensive laboratory work which can be simplified via digitisation and use of in-house milling systems. The project delivered multiple work stations for planning, printing, milling and post-processing of different dental products for enhanced patient care, improved patient education and enhanced staff enjoyment. As part of the learning phase they were also able to trial printing individual customised N95 mask frames, aiding our District’s response to the COVID-19 pandemic.

    PPE Predict

    PPE Predict

    COVID-19 created unprecedented need for personal protective equipment (PPE) in hospitals around the world to keep staff safe while treating patients. The project team utilised mathematical predictive modelling to not only keep track of stock, but also predict need based on the type of patients in the hospital – known as the ‘burn rate’. The model is being used to inform PPE requirements as the District returns to full clinical services, and has the potential to be applied at a state level.

    Check Me, Check My Baby

    Check me check my baby

    Pregnant women requiring specialist care at Auburn Hospital were being seen in different clinics, leading to occasions of service not being recorded. The hospital introduced a new Auburn Maternity Assessment Clinic to consolidate services, increase efficiency and relieve pressure on the birth unit. In six months it has provided 969 occasions of service, with ongoing staff and patient surveys showing improved satisfaction and improvements in all areas of concern.

    Dispensing With Paper: Australian-first Implementation of e-Discharge Scripts

    The average discharge medication processing time at Blacktown Hospital was 105 minutes, delaying patients leaving due to two main causes: no notification for prescriptions being generated, and manual transportation of prescriptions to the pharmacy. The pharmacy developed an Australian-first tool to enable automated, instantaneous notification and transmission of discharge prescriptions within the electronic medical records system. The result saw discharge processing time fall to 76 minutes within six weeks of implementation.

    Artificial Intelligence a ‘Trigger’ for Patient Safety

    Artificial Intelligence a Trigger for Patient Safety

    Electronic medical records allow for integration of new tools to detect or even predict adverse events, delivering improvements in patient safety. This two-phase study showed an electronic risk trigger monitoring (RTM) tool improved identification of adverse events and real-time intervention, contributing to earlier management and prevented patient deterioration. This was the first proof-of-concept project in NSW utilising an RTM tool, and also helped identify gaps which led to other quality improvement projects in the District.

    Video Interpreting Pilot Project

    Video Interpreting Pilot

    Health Care Interpreter Services (HCIS) helps staff communicate with patients and families across three health districts, which led to significant travel costs and challenges providing timely access. The service was an early adopter of the telehealth platform myVirtualCare, providing interpreter services via video rather than in person or over the phone. The service is now provided 99% remotely, which has led to greater access, no unmet appointments, $36,000 saved over a three-month period, and reduced risk for staff exposure to COVID-19.

    Pregnancy and Pexip in the Time of COVID-19

    Pregnancy and PEXIP in the time of COVID-19

    Face-to-face breastfeeding, childbirth and parenting education sessions were cancelled due to COVID-19, leaving women with minimal options to prepare before giving birth. Blacktown Hospital Women’s Health clinics developed online sessions using Pexip video conferencing with resources that were accessible for culturally and linguistically diverse women. To date more than 100 women have attended the breastfeeding session and 25 couples have attended the childbirth and parenting sessions, providing very positive feedback and also connecting with other parents.


    Category 8: Education and Training

    Febrile Neutropenia Management

    Febrile neutropenia is a common complication in patients undergoing cancer treatment, when fever can lead to a more severe infection, but many new nurses on the Westmead Hospital haematology ward were unaware of the management guidelines. The department introduced education and training as well as a written flow chart on the ward to increase understanding of the correct procedure. 96% of nurses increased their knowledge over a two-month period and 80% retained that knowledge when quizzed again after a month.

    Teach One; Save One

    Teach One  Save One

    In 2019 it was identified that Auburn Hospital paediatric and midwifery staff were struggling to meet training needs in order to recognise and respond to deteriorating patients. The project team collaborated with tertiary institutions and District paediatrics services to develop a unique, flexible program to reskill staff in key courses. By December 2019, 89% of staff were trained in DETECT Junior and 98% in FONT Maternity/Neonatal. Post training, the clinical emergency response calls doubled, reflecting appropriate escalation of deteriorating patients.

    Newborn Education and Skills Training

    Staff surveys revealed Auburn Hospital nurses and midwives wanted more education on core newborn care skills, and further opportunities to learn and practice specialised newborn care skills. A workshop was developed and run in collaboration with Westmead Hospital NICU, utilising case scenarios and simulation-based education to rehearse specific clinical skills and challenges to better consolidate learning. Participants reported an increase in confidence, knowledge and skills, and better understanding of equipment and procedures.

    Linking Mind and Body in Blacktown Mental Health Services

    Linking mind and body mental-health

    Patients with severe mental illness have significantly higher rates of morbidity and mortality, but Blacktown mental health clinicians indicated the lacked the knowledge and confidence to respond to medical deterioration, putting their patients at risk. The project team developed an experiential educational package to provide training in scenarios in physical deterioration that are known to occur in mental health settings. Clinician knowledge in responding to medical deterioration rose from 68% to 81%, confidence in responding rose from 43% to 76%, and 96% said they would recommend the Sim Lab training to others.

    Short but Sweet

    Diabetes is prevalent both in and out of hospital, and a basic understanding of its management is a key part of a doctor’s training. To complement junior doctor education, Blacktown and Mount Druitt hospitals introduced a novel two-week structured clinical placement with the Diabetes Service, working with diabetes educators, dietitians, podiatrists and medical staff in both inpatient and outpatient settings. 100% of participants would recommend the rotation to other colleagues and 90% were interested in undertaking some clinical research in diabetes.

    Flipping COVID Facedown

    Education and Training - Flipping COVID

    International evidence from treating COVID-19 showed benefits to prone positioning – lying patients facedown – but physiotherapy staff at Blacktown and Mount Druitt hospitals did not feel confident performing this uncommon and difficult procedure in intensive care. The project team ran a 30-minute education session followed by a 60-minute training session, teaching staff about the pathophysiology of COVID-19 and giving them the immediate opportunity to apply their new skills. 90% of therapists reported feeling more confident and 100% said they were more likely to assist with prone lying procedures in ICU.







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