Development and Evaluation of a Massive Open Online Course on Healthcare Redesign: A Novel Method for Engaging Healthcare Workers in Quality Improvement.

Healthcare workers are under increasing pressure to use limited resources more efficiently and improve patient outcomes. Healthcare redesign, a quality improvement methodology derived from the automotive industry, is a proven means of achieving these goals. Continuing Professional Development (CPD) opportunities for nurses seeking to build their capacity for healthcare redesign often come in the form of university courses, which can be costly and prohibitively time-consuming. We developed a Massive Open Online Course (MOOC) with a view to increasing the number of healthcare workers undertaking CPD in healthcare redesign and subsequently using these principles in their workplaces. The aim of the current study is to describe the development of our MOOC and its initial feedback from users. Materials and Methods: The theoretical and practical components of an existing postgraduate award course unit were made fit for purpose by being arranged into six weekly modules, before being transposed to an established learning management platform for MOOCs. Related quizzes, videos and interactive activities were then developed and included in each of these modules. Peer review of this content was completed by subject matter and teaching and learning experts prior to the MOOC being launched. Results: After running for nine months, 578 participants had enrolled in the MOOC, of whom 118 (20%) had followed through to completion. Participants were overwhelmingly from Australia (89%) and identified as female (78%). Preliminary feedback obtained from participants was positive, with 81% of respondents agreeing that they were satisfied with their experience, and 82% intending to apply their knowledge in practice. Conclusions: The MOOC has addressed a learning need by providing a brief and free form of education; learning from its development will help others seeking similar educational solutions. Initial feedback suggests the MOOC has been well-received and is likely to be translated into practice.

Delivering a work-integrated learning postgraduate course during COVID-19: Experiences, challenges and strategies.

COVID-19 has had a significant impact on teaching and learning in postgraduate education. In particular, work integrated learning, in health care settings, has been disrupted in many ways negatively impacting student learning. Our Clinical Redesign courses are designed to deliver work-integrated learning in partnership with healthcare organisations to deliver workplace projects in real time, which has been complicated by COVID-19. This reflection examines the challenges that arose in the healthcare redesign teaching and learning space during the COVID-19 pandemic. We explore the experiences of our work-integrated learning students using Johns' reflection model.1 Our students faced disruption to their education, workplaces and personal lives, and the experiences of our teaching team whose teaching philosophies were challenged. In response to the ongoing challenges, we developed strategies for supporting our students including the development of virtual projects for students who no longer had access to their workplaces or project appropriate resources.

Whiteboards and discharge traffic lights: visual management in acute care.

Flinders Medical Centre was experiencing issues with timely discharge and knowing the potential discharges and in-patient bed capacity for the next day. This case study describes the application of 'visual management' theory to discharge processes. The solutions developed were 'patient journey boards' and 'discharge traffic lights'. The implementation of these visual management systems has enabled the hospital to improve its discharge processes.

Electronic patient journey boards a vital piece of the puzzle in patient flow.

OBJECTIVE: Internationally, there is growing interest in the applicability of visual management in healthcare, although little is known about the extent of its effectiveness. In the past 5 years technical advances have permitted the integration of all relevant data into a singular display that can improve staff efficiency, accelerate decisions, streamline workflow processes and reduce oversights and errors in clinical practice. The aim of the case study is to describe the features and application of electronic patient journey boards (EPJBs) as an enabler to accelerate patient flow that has been demonstrated and evaluated in Queensland Health hospitals. METHODS: In 2012 and 2013 we collected ward-specific data that was sourced from the Queensland Hospital Admitted Patient Data Collection, determining the top 10 overnight diagnostic-related groups (DRGs) for each ward participating in the pilots. The Statistical Output Unit within Queensland Health then provided data and analysis on the ALOS for each of these DRGs for the period following an EPJB installation, along with the ALOS for the same DRGs for the corresponding period in the previous year. RESULTS: Patient length of stay reduced and display of estimated discharge dates improved with the introduction of EPJBs along with improved communication and information management resulting in time savings from 20 min per staff member per shift to 2.5h per ward a day. CONCLUSION: Queensland and South Australian Health systems have succeeded in 'making the hospital patient journey visible' through an innovative combination of information management and prominent display of key information related to patient care portrayed on large liquid crystal display (LCD) screens in hospital wards.

Outcomes of establishing an acute assessment unit in the general medical service of a tertiary teaching hospital.

OBJECTIVE: To evaluate the impact of an acute assessment unit (AAU) on length of hospital stay (LOS), emergency department (ED) waiting times, direct discharge rate, unplanned readmission rate and all-cause hospital mortality of general medical patients. DESIGN AND SETTING: Retrospective comparison of data for general medical patients admitted to a tertiary teaching hospital in Adelaide, South Australia, before and after the establishment of an AAU (reference years, 2003 [before] and 2006 [after]). MAIN OUTCOME MEASURES: Mean LOS, ED waiting times and all-cause hospital mortality during calendar years 2003 (pre-establishment) and 2006 (post-establishment). RESULTS: Following the establishment of an AAU, the mean LOS shortened (from 6.8 days in 2003 to 5.7 days in 2006; P < 0.001) despite a 50.5% increase in the number of admissions (from 2652 to 3992). The number of admitted patients waiting in the ED more than 8 hours for a hospital bed decreased (from 28.7% to 17.9%; P < 0.001), as did the number waiting more than 12 hours (from 20.2% to 10.4%; P < 0.001). The rates of unplanned readmission within 7 and 28 days did not change. The all-cause hospital mortality for general medical admissions was 4.6% in 2003 v 3.7% in 2006 (P = 0.056). CONCLUSION: The establishment of an AAU within the general medical service coincided with decreases in both LOS and ED waiting times, despite a 50% increase in admissions. This structural reform in the process of acute medical care may have contributed to the improvement in these key health care performance indices without compromising the quality of patient care.

Misoprostol for second and third trimester termination of pregnancy: a review of practice at the Women's and Children's Hospital, Adelaide, Australia.

AIMS: To assess clinical outcomes for women undergoing induction of labour either for fetal anomaly or following intrauterine fetal death using intravaginal misoprostol. METHODS: Between January 1999 and December 2002, clinical outcomes for women who were admitted to the delivery suite of the Women's and Children's Hospital, South Australia, were prospectively collected and entered onto a database by the attending midwife. The effect of cumulative dose of misoprostol, indication for induction of labour, parity and gestational age were assessed. RESULTS: One hundred and ninety nine women were admitted during the study period. Women who required in excess of 800 microg of misoprostol were more likely to have side-effects (57/78 women dose > 800 microg misoprostol versus 71/121 women dose < or = 800 microg, RR 0.80 95% CI 0.66-0.98), in particular diarrhoea (12/78 women dose > 800 microg misoprostol versus 5/121 women dose < or = 800 microg, RR 0.27 95% CI 0.10-0.73) and elevated temperature (46/78 women dose > 800 microg misoprostol versus 36/121 women dose < or = 800 microg, RR 0.50 95% CI 0.36-0.70). Women with an intrauterine fetal death (IUFD) were less likely to require in excess of 800 microg of misoprostol to effect the termination (10/56 women IUFD versus 70/143 women fetal anomaly, RR 0.36 95% CI 0.20-0.66), had a shorter induction to birth interval (mean 13.2 h +/- 7.5 h, women IUFD versus 21.2 +/- 17.5 h, women fetal anomaly, WMD -8.02 95% CI -11.49 to -4.55) and were more likely to give birth within 24 h of the induction process commencing (48/56 women IUFD versus 106/143 women fetal anomaly, RR 1.16 95% CI 1.00-1.34). CONCLUSIONS: Side-effects increase with increasing dose of misoprostol. Induction following intrauterine fetal death is associated with a need for lower doses of misoprostol and a shorter induction to birth interval.