Latest Australian research

Alan JJ, Laging B, Cameron P, Laging R, Boyd J, Porock D, et al.

Objective: To explore emergency hospitalisations from Victorian residential aged care facilities (RACFs).

Methods: Retrospective descriptive study of Victorian RACFs transfers to ED from 2015/16 to 2022/23.

Main outcome measures: (1) ED event rate per 100 RACF beds; (2) Number of ED events, day/time, triage category, reason, comorbidity profile, length of stay, death within 12 months of ED presentation and costs; (3) Relationship between resident characteristics and total ED events; (4) Number of inpatient events, comorbidity profile, length of stay, intensive care use, preventable hospitalisations, diagnosis-related group, deaths and costs.

Results: The rate of ED presentations from Victorian RACFs from 2015/16 to 2022/23 ranged from 77 to 91 ED events per 100 RACF beds. Associated costs for ED and inpatient stay were over $2.8B. An advance care directive or substitute decision maker was unavailable for 84% of ED events. Eighty-seven per cent of residents presenting to ED were admitted; 90% for medical DRGs. Sixteen per cent of inpatient stays were potentially preventable under the national definition.

Conclusion: Victorian RACF residents make substantial use of hospitals. This study highlights a significant gap in advance care planning (ACP), with causes potentially linked to inadequate planning, poor document quality or lack of accessibility. To enhance hospital-RACF interactions, it is essential to identify and address unmet palliative care needs at policy, planning, and practice levels, ensuring person-centred care for residents in their final years.

Bartley N, Rodriguez Grieve L, Kirsten L, Wilson C, Sajish B, Shaw J.

Abstract: This research explored current practices, gaps in services and resources, and identified barriers and facilitators to implementing a bereavement model of care in an Australian health setting. We conducted 34 interviews with staff/volunteers who provide bereavement care to explore their practice and perceptions of care delivery. Five themes were identified through thematic and framework analysis: 1. Conceptualisation of bereavement was setting dependent; 2. Formal versus informal delivery of care; 3. Current bereavement care, referral pathways, and evaluation; 4. Barriers and Facilitators to accessing and providing care; 5. An ideal bereavement model of care. This research highlighted gaps in services and suggests a disconnect between current practice and ideal bereavement care delivery. We present an evidence-based bereaved-centred model of care, that can be tailored to fit specific health context and settings. Identified barriers and facilitators to implementing this model of care should inform strategies that underpin implementation of the model.

Collins MP, Steele P, Hackenberger L, MacIsaac C, Presneill J.

Abstract: This study aimed to characterise specialist palliative care service involvement within the intensive care unit (ICU) and subsequently in post-ICU hospital wards, and compare current ICU referral practices with those suggested by an internationally utilised ICU palliative care referral tool. This was a retrospective cohort study, carried out at a large university-associated ICU in Melbourne, Australia, and was conducted on adult patients aged at least 18 years admitted to ICU between July 2019 and July 2023. The study included 11,449 ICU admission episodes relating to 10,171 patients. The overall ICU mortality for all patients was 9% in ICU with a further 4.3% post-ICU. Within non-survivors, specialist palliative care involvement was uncommon for patients who died in ICU (78/1035, 7.5%), but substantial (287/488, 59%) for those ICU patients who died on a hospital ward after ICU discharge. Compared with ICU patients who did not have an identified palliative care referral, ICU patients with palliative care input averaged longer ICU stays with shorter hospital stays post-ICU discharge. The referral tool showed low sensitivity (39%) when compared with observed current ICU palliative care referral practice. Clinical staff within the ICU provided the majority of palliative care for ICU patients, with a palliative care consultative service taking a proportionally much greater role in post-ICU hospital wards. The selected criteria appeared inadequate for use as an effective referral tool. Future research may explore the quality of palliative care provided by ICU staff and specialist palliative care staff, and the role of decision support tools, so as to provide optimal care for critically ill patients approaching the end of life.

Gillan PC, Parker C.

Abstract: Pressure injuries are a major problem in all health care settings. The incidence of pressure injuries at the end of life is as high as 58% in some facilities, and there is little consensus on how pressure injuries are managed at the end of life. A scoping review was conducted, to investigate what is known of the factors associated with the management of pressure injuries at the end of life. Literature was sourced from several databases. A total of 1760 potential sources were identified; after applying the Population Concept Context inclusion and exclusion criteria, 16 empirical research articles were sourced: 10 were quantitative, 5 were qualitative, and 1 was mixed methods. Studies were published between 2003 and 2021 and originated from Italy, the United States, Australia, Sweden, Brazil, Taiwan, Turkey, and Canada. Key interventions included regular second hourly turning, wound debridement, wound assessment, and application of various wound coverings. The most widely discussed management strategy, regular second hourly turning, proved controversial and inconsistent in practice. There were also inconsistencies with wound assessment, with practice not always following best evidence-based assessment guidelines. Research findings also highlighted issues with prognostication and identification of the end-of-life phase with no consistent tool applied to assist end-of-life pressure injury management decision-making.

Jahan S, Lindsay D, Diaz A, Li M, Griffiths K, Olver I, et al.

Purpose: Cancer significantly impacts First Nations Australians, with higher incidence and lower survival rates. However, understanding of end-of-life (EOL) service use and costs in this population is limited. We aimed to assess EOL healthcare utilisation and costs for First Nations cancer patients in Queensland, Australia.

Methods: Retrospective data from CancerCostMod, a linked administrative dataset of all cancer diagnoses in Queensland, were used. This dataset includes records from the Queensland Cancer Registry (QCR) from July 1, 2011, to June 30, 2015, linked to Queensland Health Admitted Patient Data Collection (QHAPDC), Emergency Department (ED) Information Systems, Medicare Benefits Schedule (MBS), and Pharmaceutical Benefits Scheme (PBS) data from July 2011 to June 30, 2018. All diagnosed cancer patients who had died during the study period (N = 467) were included. Health service usage and costs during the last 6 months of life were described and compared across care type, comorbidity status, age group, and residential remoteness using Mann-Whitney and Kruskal-Wallis tests.

Results: Individuals had at least one hospital episode (100%), ED visit (83%), MBS claim (96%), and PBS claim (96%). The median overall cost per person for hospital episodes was AUD$40,996, with higher costs for those receiving palliative care (AUD$43,521) and chemotherapy (AUD$50,437) compared to those who did not receive these services (palliative: AUD$34,208, chemotherapy: AUD$38,557). Having comorbidities and living in regional and remote areas were associated with higher hospital costs.

Conclusion: The study findings may guide the re-design and delivery of optimal and culturally appropriate EOL care for First Nations Australians diagnosed with cancer.