Background Clinical registry participation is a measure of healthcare quality. Limited knowledge exists on Australian hospitals participation in clinical registries and whether this registry data informs quality improvement initiatives. Hence, our study aimed to; identify participation in clinical registries; determine if registry data inform quality improvement initiatives; identify registry participation enablers; and clinicians’ educational needs to improve use of registry data to drive practice change. Methods : A self-administered survey was distributed to staff coordinating registries in seven hospitals in New South Wales, Australia. Eligible registries were international, national and state-based clinical, condition/disease-specific and device/product registries. Results : Response rate was 70% (97/139). Sixty-two (64%) respondents contributed data to 46 eligible registries. Registry reports were most often received by nurses (61%) and infrequently by hospital executives (8.4%). Less than half used registry data ‘always’ or ‘often’ to influence practice improvement (48%) and care pathways (49%). Protected time for data collection (87%) and benchmarking (79%) were ‘very likely’ or ‘likely’ to promote continued participation. Over half ‘strongly agreed’ or ‘agreed’ that clinical practice improvement training (79%) and evidence-practice gap identification (77%) would optimise use of registry data. Conclusions : Registry data are generally only visible to local speciality units and not routinely used to inform quality improvement. Centralised on-going registry funding, accessible and transparent integrated information systems, combined with data informed improvement science education could be first steps to promote quality data-driven clinical improvement initiatives.

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Aims and objectives:To compare the effectiveness and safety of ultrasound-guided fascia iliaca block (FIB) insertion in patients with fractured neck of femur by trained emergency nurses with insertion by doctors. Background:The FIB is an effective and safe form of analgesia for patients with hip fracture presenting to the emergency department (ED). While it has traditionally been inserted by medical doctors, no evidence exists comparing the effectiveness and safety of FIB insertion by nurses compared with doctors.Design: A prospective cohort study. Methods:The study was conducted in an Australian metropolitan ED. Patients admitted to the ED with suspected or confirmed fractured neck of femur had a FIB inserted under ultrasound guidance by either a trained emergency nurse or doctor. A retrospective medical record audit was undertaken of consecutive ED patients presenting between January 2013-December 2017. Reporting of this study followed the Strengthening the Reporting of Observational Studies in Epidemiology guidelines for cohort studies.Results: Of the 472 patients eligible for a FIB, 322 (68%) had one inserted. A majority were inserted by doctors (n = 207, 64.3%) with 22.4% (n = 72) by nurses and in 13.3%(n = 43) of patients the clinician was not documented. There were no differences between the nurse-inserted and doctor-inserted groups for mean pain scores 1 hr post-FIBinsertion;clinicallysignificantreduction(≥30%)inpainscore1hrpost-FIB insertion; pain score 4 hr post-FIB insertion; delirium incidence; opioid use post-FIB insertion; or time to FIB insertion. No adverse events were identified in either group. Conclusion:Insertion of FIBs by trained emergency nurses is as effective and safe as insertion by doctors in patients with fractured neck of femur in the ED. Senior 750 patients identified as admitted via ED with a fractured neck of femur based on Australian National Diagnosis Related Group 166 patients excluded: Transfer from another hospital directly to the ward or rehabilitation unit: 67 No fracture (incorrect coding): 57 Fracture diagnosed on CT or bone scan post discharge from ED: 22 Fall in hospital causing fracture: 11 Major trauma with multiple injuries: 9 584 patients assessed for FIB eligibility 112 patients excluded: Contraindications to FIBs including Anticoagulant medication: 74 Did not consent to FIB: 22 Medical record missing: 16 472 patients eligible for FIB 150 patients did not receive FIB 322 patients received FIB 72 nurseinserted FIBs 207 doctorinserted FIBs 43 clinician unknown