The implementation of interprofessional education: a scoping review.

INTRODUCTION: Implementation of interprofessional education (IPE) is recognised as challenging, and well-designed programs can have differing levels of success depending on implementation quality. The aim of this review was to summarise the evidence for implementation of IPE, and identify challenges and key lessons to guide faculty in IPE implementation. METHODS: Five stage scoping review of methodological characteristics, implementation components, challenges and key lessons in primary studies in IPE. Thematic analysis using a framework of micro (teaching), meso (institutional), and macro (systemic) level education factors was used to synthesise challenges and key lessons. RESULTS: Twenty-seven primary studies were included in this review. Studies were predominantly descriptive in design and implementation components inconsistently reported. IPE was mostly integrated into curricula, optional, involved group learning, and used combinations of interactive and didactic approaches. Micro level implementation factors (socialisation issues, learning context, and faculty development), meso level implementation factors (leadership and resources, administrative processes), and macro level implementation factors (education system, government policies, social and cultural values) were extrapolated. Sustainability was identified as an additional factor in IPE implementation. CONCLUSION: Lack of complete detailed reporting limits evidence of IPE implementation, however, this review highlighted challenges and yielded key lessons to guide faculty in the implementation of IPE.

COVID-19 in a complex obstetric patient with cystic fibrosis.

We report the first case of COVID-19 in a pregnant patient with cystic fibrosis. We describe the diagnosis, clinical course and management of the patient and their family with regards to clinical, social and infection control measures around delivery. This case highlights the importance of the cooperation of multidisciplinary teams to achieve good clinical outcomes in complex patients with COVID-19.

Chronic kidney disease in pregnancy: Maternal and fetal outcomes and progression of kidney disease.

BACKGROUND: There is a paucity of Australian data regarding renal disease in pregnancy. We undertook a retrospective cohort study at a tertiary institution to examine the impact of renal disease on pregnancy outcomes and the effect of pregnancy on disease progression. METHODS: A total of 55 pregnancies of patients with renal disease admitted from 2003 to 2010 to the Royal Brisbane and Women's Hospital were analysed. Pre-conception variables, fetal/delivery and maternal outcomes were analysed in this group and in a control group of women with normal kidney function pre-pregnancy. RESULTS: Of the 55 pregnancies, 71% experienced pre-term delivery, 38% had intra-uterine growth restriction and 62% required caesarean section. Of all, 60% of neonates required neonatal intensive care unit (NICU) admission and six perinatal deaths occurred. Of all, 67% of women suffered preeclampsia, 47% anaemia and 3 patients required dialysis in pregnancy. Postpartum deterioration of renal function occurred in patients with pre-conception chronic kidney disease stage 3-5. CONCLUSIONS: Chronic kidney disease of all stages is a risk factor for adverse pregnancy outcomes. In a tertiary institution however, there is a high rate of successful pregnancy (84%).

Quality of transitions in older medical patients with frequent readmissions: opportunities for improvement.

BACKGROUND: Medical patients with a recent previous hospitalisation are at very high risk of subsequent readmission. Evidence suggests that improving key transition processes may reduce hospital readmissions. This study describes quality of transition processes in frequently admitted medical patients, to inform system improvements for this high risk group. METHODS: Retrospective records review of consecutive medical inpatients aged 50 years or older in a major metropolitan teaching hospital in Australia with a recent (within 6 months) prior hospitalisation. Information was sought on 4 key processes: discharge summary completed and sent within 2 weeks; discharge medication reconciliation; patient/carer discharge education; and timely scheduling of outpatient review with the treating team. Readmission rates were obtained from a state-wide admissions database. RESULTS: Discharge processes for 209 live discharges in 164 patients were reviewed. Although timely discharge summary completion (81%) and discharge medication reconciliation by a pharmacist (81%) were high, there were major gaps in patient education (33%) and in timely outpatient review (12%). Outpatient systems appear poorly organised to support high quality transitions. Readmission rates were high (23% at 30 days and 58% at 180 days). Individual discharge quality processes did not predict readmissions. DISCUSSION: Gaps in transitional care of frequently attending medical patients provide potential targets for improvement. In particular, opportunities for better patient/carer education and timely, structured outpatient review may inform design of improved transitions for this high risk group, to be tested in prospective controlled trials.