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.
Category 1: Transforming Patient Experience
Patient Registration and Identification for New Emergency Department 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
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
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
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 3: Patient Safety First
Enhanced Recovery After Surgery Protocol
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!
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
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
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 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
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
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
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
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 7: Innovation and Research
Gathering Place, Healing Spirits
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.
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
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
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
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
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.