BackgroundReducing patient length of stay is a high priority for health service providers. Preliminary information suggests additional Saturday rehabilitation services could reduce the time a patient stays in hospital by three days. This large trial will examine if providing additional physiotherapy and occupational therapy services on a Saturday reduces health care costs, and improves the health of hospital inpatients receiving rehabilitation compared to the usual Monday to Friday service. We will also investigate the cost effectiveness and patient outcomes of such a service.Methods/DesignA randomised controlled trial will evaluate the effect of providing additional physiotherapy and occupational therapy for rehabilitation. Seven hundred and twelve patients receiving inpatient rehabilitation at two metropolitan sites will be randomly allocated to the intervention group or control group. The control group will receive usual care physiotherapy and occupational therapy from Monday to Friday while the intervention group will receive the same amount of rehabilitation as the control group Monday to Friday plus a full physiotherapy and occupational therapy service on Saturday. The primary outcomes will be patient length of stay, quality of life (EuroQol questionnaire), the Functional Independence Measure (FIM), and health utilization and cost data. Secondary outcomes will assess clinical outcomes relevant to the goals of therapy: the 10 metre walk test, the timed up and go test, the Personal Care Participation Assessment and Resource Tool (PC PART), and the modified motor assessment scale. Blinded assessors will assess outcomes at admission and discharge, and follow up data on quality of life, function and health care costs will be collected at 6 and 12 months after discharge. Between group differences will be analysed with analysis of covariance using baseline measures as the covariate. A health economic analysis will be carried out alongside the randomised controlled trial.DiscussionThis paper outlines the study protocol for the first fully powered randomised controlled trial incorporating a health economic analysis to establish if additional Saturday allied health services for rehabilitation inpatients reduces length of stay without compromising discharge outcomes. If successful, this trial will have substantial health benefits for the patients and for organizations delivering rehabilitation services.Clinical trial registration numberAustralian and New Zealand Clinical Trials Registry ACTRN12609000973213

No abstract

Private health insurance (PHI) is an important part of the Australian health system. During the introduction of the recent PHI reforms it was argued that, without the reforms, the public hospital system would undoubtedly collapse under the increased demand for public health services. The increase in PHI coverage might also have been expected to result in an increase in the revenue earned by public hospitals as a result of treating privately insured patients. However, the decline in numbers of privately insured patients using their PHI in public hospitals has continued, with adverse impacts on public hospital budgets in some states. This article addresses the complex interactions between various policy instruments and their impact on public hospitals, and reports the results of a study conducted at the Austin & Repatriation Medical Centre (A&RMC) which examined the reasons for privately insured patients electing not to use their insurance in public hospitals, and methods by which they might be overcome.

(CPR) recommend pulse checks of less than 10 seconds. We assessed the effect of video review-based educational feedback on pulse check duration with and without point-of-care ultrasound (POCUS). Methods: Cameras recorded cases of CPR in the emergency department (ED). Investigators reviewed resuscitation videos for ultrasound use during pulse check, pulse check duration, and compression-fraction ratio. Investigators reviewed health records for patient outcomes. Providers received written feedback regarding pulse check duration and compression-fraction ratio. Researchers reviewed selected videos in multidisciplinary grand round presentations, with research team members facilitating discussion. These presentations highlighted strategies that include the following: limit on pulse check duration; emphasis on compressions; and use of "record, then review" method for pulse checks with POCUS. The primary endpoint was pulse check duration with and without POCUS. Results: Over 19 months, investigators reviewed 70 resuscitations with a total of 325 pulse checks. The mean pulse check duration was 11.5 ± 8.8 seconds (n = 224) and 13.8 ± 8.6 seconds (n = 101) without and with POCUS, respectively. POCUS pulse checks were significantly longer than those without POCUS (P = 0.001). Mean pulse check duration per three-month block decreased statistically significantly from study onset to the final study period (from 17.2 to 10 seconds [P<0.0001]) overall; decreased from 16.6 to 10.5 seconds (P<0.0001) without POCUS; and with POCUS from 19.8 to 9.88 seconds (P<0.0001) with POCUS. Pulse check times decreased significantly over the study period of educational interventions. The strongest effect size was found in POCUS pulse check duration (P =-0.3640, P = 0.002). Conclusion: Consistent with previous studies, POCUS prolonged pulse checks. Educational interventions were associated with significantly decreased overall pulse-check duration, with an enhanced effect on pulse checks involving POCUS. Performance feedback and video review-based education can improve CPR by increasing chest compression-fraction ratio.

ObjectiveIn 2018 the Australian Commission on Quality and Safety in Health Care released a new consumer driven Australian Hospital Patient Experience Question set. The objective was to explore the acceptability, adoption, appropriateness, feasibility, fidelity, penetration, resources and sustainability of implementing the AHPEQS, and to review which questions correlated with overall rating of care. MethodsThirty-six Australian private hospitals participated in the AHPEQS implementation over an 18-month period. ResultsResponses were analysed for 86 180 patient experience surveys. Positive patient experiences (Question 12) correlated most highly with Question 2 (My individual needs were met; correlation coefficient (CC) 0.45, P &lt; 0.001), Question 4 (I felt cared for; CC 0.45, P &lt; 0.001) and Question 9 (When I was in the hospital, I felt confident in the safety of my treatment and care; CC 0.44, P &lt; 0.001). Day procedure patients rated their experience higher than overnight patients. Uptake was rapid across the 36 hospitals, with minimal resources and demonstrable acceptability, adoption, appropriateness, feasibility, fidelity, penetration and sustainability. ConclusionUtilising a consumer-driven survey highlighting treatment and care, assisted in enhancing staff engagement and continuous improvement in patient experience in acute, day procedure and rehabilitation hospitals. What is known about the topic?Patient experience in hospital is associated with healthcare quality, safety and outcomes. What does this paper add?From a consumer perspective, feeling cared for, having needs met and confidence in the safety of care, correlated with a positive patient experience. What are the implications for practitioners?Investing staff time and health service resources into a consumer-driven patient experience survey tool, which highlighted treatment and care, assisted in enhancing staff engagement and continuous improvement in patient experience in acute, day procedure and rehabilitation hospitals.