Rural hospital bed management practices during influenza season.

INTRODUCTION: Rural health services face greater challenges in managing infectious patients due to lack of specialty beds and longer lengths of stay. The pressures of seasonal influxes of influenza patients with a heavy burden of chronic disease and an ageing population result in an increased demand for hospital beds. During these peak periods it is common for rural hospitals to experience bed block. The result is that patients may be placed into any available bed or ward at the time, increasing the need for transfer and the risk of spreading hospital-acquired respiratory illnesses to other patients and staff across the hospital. This further exacerbates bed block, with patients then requiring more specialised treatment and longer lengths of stay. This places additional strain on already existing workforce shortages and limited resources that must accommodate higher-than-normal patient loads. The objective of this study was to examine rural hospital bed management practices with a focus on the transfer of patients who are actively diagnosed with influenza (either on admission or during their stay in hospital) and to investigate the association of increased bed movement with the rate of nosocomial transmission and staff workload. METHODS: The rates of patients admitted to a rural hospital in New South Wales, Australia, during the yearly peak influenza season (July to September) during 2016-2019 with either community-acquired or hospital-acquired influenza were examined using an infection control surveillance program. Bed management practices related to these inpatients were audited to examine their contribution towards nosocomial transmissions and staff workload during these periods. RESULTS: A total of 229 patients presented to this hospital with an influenza diagnosis over the study period and generated 175 bed transfers. Forty percent of community-acquired and 70% of hospital-acquired influenza inpatients experienced one or more intrahospital bed transfers during their active infection period. Half of all bed transfers involved patients being transferred to another ward (interward) and the other half consisted of those transferred within the same ward (intraward). These transfers impacted staff workload, requiring a total of 245 extra hours from nursing and cleaning staff to facilitate - time not included when allocating staff at the start of each shift. CONCLUSION: Findings from this study indicate that there is no active strategy for influenza containment during high-occupancy periods for this rural facility. This resulted in multiple bed transfers occurring during the active phase of influenza infection. This then led to an exacerbation of bed block and thus further inappropriate placement of newly admitted patients. The development of an optimal bed management plan for future surges of influenza and other highly infectious respiratory illnesses is essential to reduce nosocomial infection and staff workload, especially given the limited resources available in rural areas compared to metropolitan centres.

Reducing falls through the implementation of a multicomponent intervention on a rural mixed rehabilitation ward.

PROBLEM: There is an absence of literature to guide staff in how falls can be reduced in a diverse patient population on a mixed acute/subacute rehabilitation unit, especially one with daily fluctuations in acuity that occurs due to frequent changes in its acute/rehabilitation patient ratio. DESIGN: Pre-intervention and post-intervention audits. SETTING: The Rehabilitation Unit at Tamworth Rural Referral Hospital in Tamworth, NSW. KEY MEASURES FOR IMPROVEMENT: Improvement in the number of falls and repeat fallers. STRATEGIES FOR CHANGE: A multicomponent intervention involving: (a) in-service education sessions for nursing staff about falls risk-increasing drugs, (b) patient and family education regarding falls risks and prevention strategies, (c) improving documentation of incident reports by using a set template, (d) ensuring that the correct patient mobility status information is handed over between nursing shifts and physiotherapists providing timely and regular updates, (e) the introduction of the 'traffic light mobility system' and (f) enhancing the use of existing falls prevention strategies. EFFECTS OF CHANGE: The total falls reduced in number from 36 falls to 19 with a decrease in the number of repeat fallers from 8 to 4. There was also increased compliance with existing falls risk tools and improved documentation of each falls incident which provided insight into activities and times with higher falls risk. LESSONS LEARNT: A multicomponent approach remained effective even when applied to a mixed acute/subacute rehabilitation ward setting.

Predictive value of the Royal Melbourne Hospital Falls Risk Assessment Tool (RMH FRAT) for post-stroke patients.

Falls after stroke are common and carry a significant disease burden. Several scores aim to identify patients who are at risk of falls to implement primary prevention therapy. The aim of this study was to determine the validity of the commonly used Falls Risk Assessment Tool (FRAT) developed at the Royal Melbourne Hospital (RMH) in 1995 for predicting falls after a stroke. The RMH FRAT was administered within 2 weeks after discharge post-stroke. Occurrence of falls was recorded at 3 and 6 months post-stroke in 202 and 152 patients, respectively. In our study 90% of patients were placed in the RMH FRAT high risk or medium risk group. In these two groups the RMH FRAT did not provide sufficient predictive value.

Depression, financial problems and other reasons for suspending medical studies, and requested support services: findings from a qualitative study.

OBJECTIVES: This study aimed to qualitatively explore medical students' reasons for suspending, or thinking of suspending, their studies and the types of support services they request. METHOD: Data were collected through an anonymous online survey. Medical students' responses to open-ended questions were analyzed thematically. RESULTS: Responses were received from 475 students. Financial problems, doubts as to whether medicine was the right vocation, and depression were the most commonly reported themes. Students endorsed a wide range of other pressures and concerns, barriers to obtaining assistance, and also suggested solutions and services to address their concerns. CONCLUSIONS: Medical students' financial concerns and potential depressive symptoms should be addressed by university and faculty support services. Government financial support mechanisms for students should also be reviewed. Students' suggestions of the types of services and their location must be borne in mind when allocating resources.