Health services administration

One thing is clear: what is considered teaching is not agreed on

Shyan L L Goh

Consider all the evidence to ensure safe stewardship of PIVCs

Diana Egerton-Warburton · George Braitberg · Anthony Kambourakis

Current targets based on insufficient data create potential risks and pose implementation problems

Dev A S Kevat MPH, LLB(Hons), BMedSc(Hons) · Ashim K Sinha MB BS, MD, FRACP · Anna G McLean MB BS(Hons), FRACP

Steve Hambleton looks forward to closing the gap between what we know and what we do

Steven J Hambleton MB BS, FAMA

Brian Owler hits the ground running

Brian K Owler MB BS, PhD, FRACS

Judging when troponin testing is best done, in general practice and beyond

Derek P B Chew MB BS, MPH, FRACP · Louise Cullen MB BS, FACEM

Children in out-of-home placements have complex health needs

Klaus Martin Beckmann

Recommendations to reduce emergency presentations, hospitalisations and premature death from CHF

Karen Page RN, DN, BEd · Thomas H Marwick MB BS, PhD, MPH · Rebecca Lee BPharm, MPH · Robert Grenfell MB BS, MPH, FAFPHM · Walter P Abhayaratna FRACP, FACC, DrPH · Anu Aggarwal MB BS, FRACP, PhD · Tom G Briffa PhD · Jan Cameron PhD, MHSc(HealthProm · Patricia M Davidson RN, PhD · Andrea Driscoll PhD · Jacquie Garton-Smith MB BS, FRACGP · Debra J Gascard BN, MNP, NP · Annabel Hickey MMSc(ClinEpi), BApp(OT) · Dariusz Korczyk FRACP, FCSANZ · Julie-Anne Mitchell MPH, BA, RN · Rhonda Sanders RN, MNSt · Deborah Spicer MNg(NP), GradDip(CVNursing), BN · Simon Stewart PhD · Vicki Wade DipAppSci, BHS, MN

The pressures for continued health expenditure are beyond rational control

John B Best AO, MD BS, PhD, DSc(Hon)

Objectives: To understand the changes in the population incidence of inhospital cardiopulmonary arrest (IHCA) and mortality associated with the introduction of rapid response systems (RRSs). Design, setting and participants: Population-based study of 9 221 138 hospital admissions in 82 public acute hospitals in New South Wales, using data linked to a death registry, from 1 Jan 2002 to 31 Dec 2009. Main outcome measures: Changes in IHCA, IHCA-related mortality, hospital mortality and proportion of IHCA patients surviving to hospital discharge. Results: RRS uptake increased from 32% in 2002 to 74% in 2009. This increase was associated with a 52% decrease in IHCA rate, a 55% decrease in IHCA-related mortality rate, a 23% decrease in hospital mortality rate and a 15% increase in survival to discharge after an IHCA (all P < 0.01). The adjusted absolute reductions in IHCA-related mortality and hospital mortality were 1.49 (95% CI, 1.30–1.68) and 4.05 (95% CI, 3.17–4.76) patients per 1000 admissions, respectively. The decrease in IHCA incidence rate accounted for 95% of the reduction in IHCA-related mortality. In contrast, the increase in IHCA survival accounted for only 5% of the reduction in IHCA-related mortality. Conclusions: During nearly a decade, as RRSs were progressively introduced, there was a coincidental reduction in IHCA, IHCA-related deaths and hospital mortality and an increased survival to hospital discharge after an IHCA. Reduced IHCA incidence, rather than improved postcardiac arrest survival, was the main contributor to the reduction in IHCA mortality.

Jack Chen MB BS, PhD, MBA(Exec) · Lixin Ou MBA, MPH, PhD · Kenneth M Hillman MD, FRCA, FCICM · Arthas Flabouris MD, FCICM, FANZCA · Rinaldo Bellomo MD, FCICM, FRACP · Stephanie J Hollis BSc, MMedSc, PhD · Hassan Assareh PhD, MEng, MSc(Manag)

How can we ensure that medical workforce supply matches population health need?

Anthony Scott BA(Hons), MSc, PhD · Catherine M Joyce BA(Hons), MPsych, PhD

Increased use of eye protection is needed for children at risk

Swetha S Philip MS(Ophthalmol) · Annette K Hoskin BSc, MBA

Screening has proven benefits, and a nationally consistent approach is needed

on behalf of the Disorders of Sex Development Subcommittee, Australasian Paediatric Endocrine Group

Health care providers identify barriers to optimal antibiotic prescribing in nursing homes

Ching Jou Lim BPharm(Hons) · Megan W-L Kwong MB BS, BMedSci · Rhonda L Stuart MB BS, FRACP, PhD · Kirsty L Buising MPH, MD, FRACP · N Deborah Friedman FRACP, MD, MPH · Noleen J Bennett PhD, MPH · Allen C Cheng FRACP, MPH, PhD · Anton Y Peleg MB BS, PhD, FRACP · Caroline Marshall FRACP, PhD, GradDipClinEpi · David C M Kong BPharm, MPharm, PhD

Health professionals’ duty of care includes combating racism in society as well as in health care settings

Chelsea J Bond PhD, BAppHSc · Geoffrey K Spurling MB BS, MPH, RACGP · Deborah A Askew BAppSci, MHltSci, PhD