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Volume 12, Issue 2 – April 2018

Clinician Connect

Guest Editorial

Paediatrics at the Agency for Clinical Innovation
Matthew O'Meara, NSW Chief Paediatrician

Matthew O'MearaThere’d been something missing in the Agency for Clinical Innovation (ACI). It finally arrived last winter. It’s small, but growing, keen to learn and get involved, enthusiastic and optimistic. That sounds like a child ... and it is. It is the ACI Paediatric Network.

Prior to the establishment of the Paediatric Network in August 2017, there had been paediatric input in many of the Networks at the ACI. The Transition Care Network was set up to help improve the delivery of healthcare from paediatric to adult health services, however paediatrics was in a separate Pillar until 2015. Under NSW Kids and Families and the Ministry of Health, a paediatric healthcare team had worked on standardising care, engaging with clinicians and developing models of care.

Since August 2017, these roles have moved to the ACI Paediatric Network.

I think it’s been a great move. As well as being welcomed into the ACI, it feels that we can be more effective. The Paediatric Network can draw on the skills of the support teams like Health Economics and Evaluation, Redesign, Patient Experience and Integrated Care.

Only 20% of children attend tertiary paediatric emergency departments (EDs); most are seen in the EDs of hospitals that care for all ages. Only one third of children are admitted to tertiary children’s hospitals; most are admitted to children’s wards in hospitals that care for all ages. To influence care of children we need to engage with clinicians who care for children as well as adults, especially emergency clinicians, surgical staff, allied health clinicians and primary care clinicians. Being in the ACI, we can collaborate more easily with Networks that care for children as well as adults, including the Emergency Care Institute, Intensive Care NSW and the Surgical Services Taskforce.

A Paediatric Network executive group met for the first time last month. Members come from existing paediatric groups, including the NSW Children’s Healthcare Network, and the Metropolitan Paediatric and Regional Paediatric groups. A parent, general practitioner and ambulance staff member are also involved. The value of this broad membership offers not only different perspectives but helps to provide solutions to problems.

Initial focus areas for the Paediatric Network are:

  • improving care of patients with bronchiolitis
  • supporting an interstate paediatric improvement collaborative
  • developing online resources for clinicians, children and families.

For bronchiolitis, there will be a focus on reducing low value care from unnecessary x-rays, viral testing, bronchodilator treatment and oxygenation. We will be seeking paediatric and emergency clinicians to get involved in a reference group, and we plan to share our strategies with colleagues in other states through Children’s Healthcare Australasia.

The paediatric improvement collaborative is being formed between NSW, Queensland and Victoria to share resources and strategies that improve care. We aim to share one set of paediatric clinical guidelines, developed by the Royal Children’s Hospital, and improve guidelines with more regular updates and relevant local content, expanding the range of topics, providing the evidence for recommendations, increasing the amount of illustrations and videos, and improving the app version. The collaborative will also focus on strategies to help implement these shared guidelines.

The Paediatric Network will continue to work with colleagues in the Ministry and Clinical Excellence Commission with regular quality and safety meetings and an innovation forum planned for the end of the year.

The Paediatric Network offers the opportunity to work on strategies together and explore opportunities for interstate collaboration. And it’s extremely satisfying to see this new network thrive.

Chief Executive Comment

Dr Jean-Frédéric Levesque

Dr Jean-Frédéric Levesque

Babies are such a nice way to start people

From preconception to old age, health is a dynamic construction. Early on in life and childhood, as our genetic material busily establishes the basis of our entire existence, we are shaping our future physical and psychological health. This is why it’s important to ensure that comprehensive prenatal, pregnancy, post-natal, childhood and adolescent health services are available and accessible for everyone. Healthy children make healthy adults.

Whilst no period of life is more important than another and our healthcare system has to provide excellent care across the entire lifecycle, your formative years have the added importance of influencing what is to come. The scientific evidence around the profound impact of early life is compelling. For example, we now recognise that the health of children is connected to health outcomes in later life.

  • Childhood infections at a young age influence the prevalence of chronic heart diseases.
  • Developmental problems have repercussions at all later stages of life.
  • The development of diabetes or cancer is strongly determined by lifestyle and risk factors that take their roots in early life.

This is why I am excited to welcome the Paediatric Network to the Agency for Clinical Innovation. Even with the important work achieved in many Networks addressing the care of children and young people, we recognised there would be additional benefits to establishing a new, dedicated Network.

The ACI Paediatric Network will bring an integrated approach, focusing on tackling the priority issues that pertain to the provision of care to this age group. This will be the basis for stronger synergies to ensure that paediatric care and general healthcare settings can continue to innovate and respond to the needs of the entire population.

Working alongside other Networks (such as the Transition and Intellectual Disability Networks), and also more paradoxically alongside Networks focused on supporting older people at the other end of the age spectrum, the Paediatric Network will develop a portfolio of activities over the coming months.

The arrival of the Paediatric Network will serve as a catalyst for other Networks to broaden their focus or more closely align their work to the specific needs of children and young people. This may also be an important driver for stronger integration between preventive, early screening, acute and chronic care as well as cross-sectoral activities across the entire organisation.

An American humourist once said, ‘babies are such a nice way to start people’. I am full of hope that the arrival of the ACI’s Paediatric Network will anchor our desire to work across the life cycle and look at innovations that span healthcare to ensure we improve the health of our young people as an investment in our future.

Aged Health Network Update

Network Manager

Key Principles for Individual Patient Specials

The ACI Aged Care Network is currently seeking feedback on the draft Key Principles for Individual Patient Specials (IPS) in Hospital Toolkit.

The principles, developed with input from Nursing and Midwifery Office, Mental Health and Drug and Alcohol Office and LHD Directors of Nursing and Midwifery, aim to improve the experience and care of people who require one to one supervision or high levels of supervision during their admission to acute, sub-acute care or multipurpose services settings. These patients may be agitated, disorientated, confused and/or at risk of harming themselves and others.

Work on the key principles commenced in 2015 when the lack of information and resources was identified as a barrier in the delivery of specialised care for people requiring additional supervision in hospital. The working group undertook a literature review and gathered current evidence of practice across NSW. The key principles were circulated in 2016 with feedback incorporated.

A range of resources has now been developed to assist staff in the assessment and delivery of person centred care using the least restrictive practices possible. The Aged Health Network welcomes any feedback on the toolkit by 26 April 2018.

If you would like further information, please contact Kelli Flowers on 02 9464 4630 or

Acute Care Update

A/Clinical Associate Director, Acute Care for Children and Older People

Farewell and best wishes to Dan Comerford

Daniel Comerford joined ACI in July 2012 with a strong passion for improving both the patient and staff experience across NSW. He was instrumental in leading and delivering some major system-wide pieces of work, notably the statewide stroke and cardiac reperfusion, Quality in Stroke Care (QASC), a long term approach for caring for people who have received a blood or marrow transplant, a cystic fibrosis model of care, a reference guide for hepatitis C and investigating clinical variation in the acute care setting.

He was an inspiring manager for his team at ACI, which he led with authenticity and a great sense of humour. Dan also had a strong focus on the importance of personal reflection. Some of the phrases we already miss from him are, 'let’s stand this up', 'patient flow is everybody’s business' and 'focus'.

Dan is also missed from the ACI kitchen where you could often find him filling his Patient Flow mug with triple strength instant coffee. We wish Dan the best in taking up his new role at the Ministry of Health and we know that the system is in safe hands with his passion and commitment.

Brain Injury Rehabilitation Network Update

Vocational Intervention Program funding secured

The Brain Injury Rehabilitation Directorate is pleased that icare (Insurance and Care NSW) has awarded the ACI an additional three years of funding, to support the Vocational Intervention Program (VIP).

The VIP was piloted at six Brain Injury Rehabilitation Program (BIRP) sites in 2014-17. In partnership with three local vocational rehabilitation providers, 75 people participated in this employment initiative. The ACI provided project management, governance, research and clinical resources to support service delivery partners.

The additional funding allows the VIP to be upscaled and implemented statewide. The ACI will soon be conducting regional information sessions across NSW to promote the VIP and invite applications from suitable vocational rehabilitation providers to enter into partnership with the BIRP teams.

Burn Injury Network Update


Updated burn injury guidelines

The NSW statewide Burn Injury Service has recently reviewed and updated guidelines for the management of people sustaining burn injuries.

The new editions, which are based on the latest evidence and consensus best practice, cover the early assessment and transfer of patients to the specialist burns units, the management of minor burn injuries and physiotherapy and occupational therapy for burn injuries.

See the ACI burn injury resources webpage for these guidelines, educational videos, burn prevention, first aid information and more.

Emergency Care Institute Update


Supporting quality, education and safety in smaller emergency departments

Following a successful six month trial in 2017, the ACI Emergency Care Institute (ECI) is continuing its Emergency Quality Education and Safety Teleconference (E-QuEST) initiative in 2018.

E-QuEST is targeted at smaller (level 1-3) emergency departments (EDs) throughout NSW. These EDs see 25% of all presentations in NSW, however individual clinicians are exposed less frequently to critically ill patients.

The E-QuEST program is developed and delivered by the ECI advanced trainees. It consists of a one hour videoconference based on real cases which had challenging features or resulted in adverse outcomes. Attendees are encouraged to analyse, discuss and reflect on these cases, and consider implications for local practice. E-QuEST also contains an education component supported by relevant evidence based guidelines and policies. There is an opportunity to share quality improvement initiatives that could be trialled at other locations.

The initiative supports rural EDs in achieving recommended standards outlined by the Australian College of Rural and Remote Medicine, the Australasian College for Emergency Medicine and the College of Emergency Nursing Australasia.

Over the six month trial period, E-QuEST had increasing uptake, with 29 sites attending the November session. All survey respondents reported that they would recommend E-QuEST to their colleagues.

For more information please contact Brendon Zeman, ECI Manager, on or visit the E-QuEST webpage.

Intellectual Disability Network Update

Network Manager

Research into intellectual disability

In 2013 and 2016 the Intellectual Disability Network conducted a survey in NSW to identify research gaps, understand barriers and enablers to research, and build and maintain a catalogue of current research.

This February, network members met to share current research and partnerships. Some emerging themes from their current research were population health, communication and attitudes. The Intellectual Disability Network seeks to address these areas of need through its Essentials resource and supporting tools.

Network member Dr Seeta Durvasula is the lead clinician working with the Northern Sydney Intellectual Disability Health Team. Her research into predictors of frailty show evidence of frailty in people with intellectual disability at a younger age than in the general population. Although frailty research typically focuses on older age, her research aims to predict where health supports and interventions can keep young people with indicators of frailty, healthy and out of hospital.

Dr Seeta Durvasula, Tracey Szanto, Namira Williams and Bronwyn Newman at the Research and Development half day forumDr Seeta Durvasula, Tracey Szanto, Namira Williams and Bronwyn Newman at the Research and Development half day forum.

National Women’s Health Summit 2018

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) hosted the National Women’s Health Summit, held 2 March in Sydney.

Women’s health is affected by the social and political environment, which can have a major influence on their health outcomes. The Summit provided an opportunity to highlight disparities in health outcomes and discuss potential initiatives to improve women’s health. Guest speakers for the day included state and federal ministers.

On average, Australian women experience good health throughout their lifespan. However, there are a number of population groups, such as women with disability, which have significantly poorer health outcomes than the general population.

During the Summit, Intellectual Disability Network Manager Tracey Szanto met with key stakeholders about disability-related topics. The disability stream recommended actions to improve access to health information for issues such as managing menstruation, contraception, sexually transmitted diseases and sexual assault.

RANZCOG hopes to use the Summit’s Priorities Document to shape future policies with regard to women’s health.

The National Women’s Health Summit -  Disability StreamThe National Women’s Health Summit - Disability Stream. Photo: RANZCOG.

Musculoskeletal Network Update

Network Manager

Musculoskeletal Network Forum 2018

The Musculoskeletal Network’s Annual Forum was held on 22 February 2018 at the Kolling Institute, Royal North Shore Hospital. This event brought together more than 120 attendees with an interest in advancing musculoskeletal health in NSW. This included doctors, nurses, allied health professionals, consumers contributing to the ACI work, managers, researchers, private health service providers and consumer organisations.

Invited speakers included Megan White and Priya Gnanakumaran who presented their work at Concord Hospital concerning changing the culture of care of people in the orthopaedic ward. Their work focused on engaging the whole team to provide early and continuous patient mobilisation post-surgical procedures (that is not reliant on a physiotherapist to be present) and setting early and realistic rehabilitation goals with patients. The end results include:

  • more patients getting out of bed and moving around the ward early post-operation
  • patients reporting less boredom and loss of pre-admission physical function
  • reduced complications such as pressure injuries and venous thromboembolism
  • improved patient satisfaction
  • more people with fractures, hip and/or knee joint replacements being discharged to home rather than, for example, sub-acute rehabilitation.

Other speakers provided examples of their journey in implementing the musculoskeletal initiatives of Leading Better Value Care. Anne Poulton (Illawarra Shoalhaven LHD), Anna Butcher (Northern Sydney LHD) and Michelle Hilton (Murrumbidgee LHD) shared their local experiences from a management or project officer perspective.

The rest of the day’s program included free paper and poster presentations featuring efforts across various settings to implement or test elements of the musculoskeletal models of care.

Presentations are available to view on the Musculoskeletal Network Forum 2018 page of the ACI website.


The following awards were presented.

  • Lyn March Award Winner – Gustavo Machado and the team at Musculoskeletal Health and Sydney LHD, titled Development of an online data analytics dashboard to measure unwarranted clinical variation in the emergency department: The STARS Back Pain app
  • Lyn March Award Runner Up – Fiona Niddrie, Clinical Nurse Consultant, Rheumatology at John Hunter Hospital, and the paediatric, rheumatology and transition care teams at John Hunter Children’s Hospital and the John Hunter Hospital, titled Rheumatology transition: A coordinated approach
  • People’s Choice Award for Best Poster – Stephanie Mathieson and the team at Musculoskeletal Health, titled Is pregabalin effective in reducing leg pain associated with sciatica?

Anne Poulton, Project Manager, Leading Better Value Care presents on early experiences in implementing programs across the Illawarra Shoalhaven LHD. Photo: J Tragardh.

The ACI Musculoskeletal Network Co-Chairs and team. From left to right: Sarah Meikle, Lyn March, Julia Thompson, Jennifer Tragardh, Robyn Speerin, Matthew Jennings, Chris Needs, Ian Harris.

Patient Reported Measures (PRMs) Program

Manager, Health Outcomes

PRMs formative evaluation report

Patient Reported Measures evaluation report

We are pleased to share that the Patient Reported Measures Program Formative Evaluation Report is now available.

The purpose of the formative evaluation was to assess the short and intermediate term outcomes and identify the key barriers and enablers to program implementation, sustainability and scalability. The evaluation also reviewed the success of the capability building activities provided by the ACI Patient Reported Measures (PRMs) Program and assessed any intended or unintended program impacts.

Consumers and staff (clinicians, managers and administrators) from the proof of concept sites were invited to participate in the evaluation via a range of modes allowing people to participate. The evaluation included a patient and carer questionnaire, focus groups with patients and carers who have accessed the PRMs program, in-depth telephone interviews with key stakeholders and sites, a health service staff questionnaire, focus groups and a clinician and system review at each participating health service, and an analysis of the PRMs de-identified aggregated data set.

Key findings of the evaluation included:

  • the PRMs program had facilitated more patient centred and holistic care
  • care plans were altered as a result of receiving patient reported outcome measures (PROMs) data
  • PRMs data helped clinicians/services to improve patient centredness and be more responsive to patient needs
  • individual PROMs data promoted holistic care through uncovering preferences or unknown concerns that mattered to patients (for example mental health issues, mobility issues).

According to clinicians, this more holistic approach may, on occasion, have contributed to improved health outcomes through:

  • more appropriate initial care and support provision (for example triage tool)
  • guiding of ongoing care and support provision
  • uncovering of mental health and wellbeing issues
  • enabling patient engagement in care.

View the report

For enquires about the PRMs evaluation, please contact Michaela Lanning, PRMs Project Officer, at

Radiology and Nuclear Medicine Networks Update

Network Manager

Consumer factsheets now available

The Radiology and Nuclear Medicine Networks have released 28 consumer factsheets about common medical imaging tests and procedures, along with one nuclear medicine examinations clinician summary.

The factsheets were developed and reviewed by nuclear medicine practitioners, chief technologists, radiologists, radiographers, medical imaging nurses, consumers and medical writers. They provide easy to understand information about common imaging tests and procedures, how to prepare for them and where to go for more information.

Factsheets available

  • Angioplasty and stent insertion
  • Barium test
  • Biopsy guided by CT or ultrasound
  • CT scan
  • Drainage guided by CT or ultrasound
  • Hysterosalpingogram (HSG)
  • Injection guided by CT, ultrasound, or X-ray
  • Iodinated contrast (dye)
  • Medical Imaging tests for children
  • Magnetic resonance imaging (MRI)
  • Transrectal ultrasound scan
  • Ultrasound scan
  • Biliary (HIDA) scan
  • Bone mineral density test
  • Bone scan
  • Gallium scan
  • Gastric emptying study
  • Gated heart pool scan
  • Lung scan
  • Lymphoscintigraphy (sentinel lymph node scan)
  • MIBG scan
  • Myocardial perfusion scan
  • Nuclear Medicine Examinations (clinician summary)
  • Nuclear Medicine procedures Parathyroid scan
  • Nuclear Medicine therapy
  • Parathyroid scan
  • PET scan
  • Renal scan
  • White blood cell scan
  • To download the factsheets, visit the Radiology Resources and Nuclear Medicine resources pages of the ACI website.

    Thank you to everyone who has been involved in the development of these resources.

    State Spinal Cord Injury Service Network Update

    Manager, State Spinal Cord Injury Service

    New online Spinal Cord Injury Pressure Injury Toolkit

    A new toolkit has been developed in support of a recommendation from the Model of Care for Prevention and Integrated Management of Pressure Injuries in People with Spinal Cord Injury (SCI).

    The toolkit brings best practice information and resources to health professionals in NSW hospital and community settings who are working with adults who have SCI. This includes general practitioners and other medical practitioners, nurses, occupational therapists, rehabilitation engineers, physiotherapists, social workers, dietitians, psychologists, case managers and peer support workers.

    It is intended to support clinical decision-making, with an interdisciplinary, consumer focused approach to pressure injury assessment and management. Although the toolkit may be useful for people with other neurological conditions and children with SCI, additional resources are necessary to address the unique management needs of this group.

    The toolkit has been developed in support of the estimated 6500 individuals living in NSW with SCI and spina bifida, who have an 85% lifetime incidence of pressure injury. The impact on the individual, family and community is immense and can have long term physical and psychological consequences. Hospitalisations are complex, can be lengthy, and have a considerable impact on individuals and their families. During the period 2006-11 the average cost per year for these patients in NSW was just under $13 million.

    Prevention and early intervention are key to reducing the impact and cost of severe pressure injuries. It is hoped the toolkit will help build the capacity of the local workforce in the assessment and early intervention, reducing deterioration and the need for hospitalisation.

    The ACI acknowledges the invaluable contribution of many health professionals to produce this comprehensive resource. Their expertise and time is greatly appreciated and valued.

    View the toolkit

    Surgical Services Taskforce Update

    Clinical Associate Director, Surgery, Anaesthesia and Interventional Medicine

    Farewell and best wishes to Gavin Meredith

    It is with sadness that the Surgical Services Taskforce (SST) farewells manager Mr Gavin Meredith from the ACI. Gavin finished up in February 2018 after 11 years.

    Gavin’s consistent efforts and leadership resulted in substantial improvements to surgical services and care of surgical patients in NSW. In particular, the development and implementation of the Minimum Standards for the Management of Hip Fracture in the Older Person, the Operating Theatre Efficiency Guidelines, the introduction of the NSW pilot of the National Surgical Quality Improvement Program (NSQIP) and the many reviews of clinical services have supported LHDs and hospital surgical services to identify and drive quality improvement in healthcare delivery in their local areas.

    In addition to his stewardship of the SST and its many initiatives, Gavin was a constant team member, enthusiastically training a new generation of change agents through the Accelerating Implementation Methodology, participating as part of the feedback team for the Centre for Healthcare Redesign, facilitating workshops and supporting integration of new technology to the ACI. His good humour, sound counsel and unflagging passion for improvement and innovation in the NSW Health system will be missed.

    On behalf of the ACI and the SST, we wish Gavin all the best for this next chapter in his health career.

    Transition Care Network Update

    Network Manager

    New Youth Health and Wellbeing Assessment Guideline

    A new resource, Youth Health and Wellbeing Assessment Guideline (GL2018_003), has been produced to encourage and support health workers to undertake a Youth Health and Wellbeing Assessment (known as HEEADSSS)*, to assess and respond to the health and wellbeing needs of young people aged 12-24 years presenting to NSW Health services.

    Published in February, the guideline was developed collaboratively with the statewide paediatric clinical nurse consultants group and clinicians specialising in adolescents. The guideline website features additional resources, such as assessment charts and contact lists, to support the implementation of the guidelines.

    *Home environment, Education and employment, Eating, peer-related Activities, Drugs, Sexuality, Suicide/depression, and Safety from injury and violence

    Northern news

    Fiona Niddrie

    The Adolescent and Young Adult with Rheumatic Disease (AYARD) clinic at John Hunter Hospital has recently celebrated its first birthday.

    Based in the adult ambulatory care setting, AYARD is a dedicated clinic for young people aged 13 years and older. It is supported by both paediatric and adult clinicians, including Angie Myles, ACI Transition Care Coordinator for the Northern area.

    A formal transition pathway and resources have been developed by Rheumatology Clinical Nurse Consultant Fiona Niddrie, and the model of care was presented at the ACI Musculoskeletal Network Forum in February.

    South Eastern Area – Randwick transition clinic

    A new transition clinic for young people aged 14-30 will commence shortly in the Centre for Adolescent and Young Adult Health, Bright Alliance Building, Randwick.

    The clinic, led by Dr Liz Thompson, is for young people accessing rehabilitation and disability medicine. It is an initiative of Prince of Wales Hospital and Sydney Children’s Hospital Randwick.

    For more details, contact the ACI Transition Care Coordinator, Silvana Techera on

    Western News

    Establishment of Youth Council

    The ACI Transition Care Network Co-Chair Mae Rafraf has joined a newly established steering committee for the Western Sydney LHD Youth Council.

    The council is comprised of 14 members aged 18-25 and the first meeting was held in February. Its mission is to ensure that young people in Western Sydney have better health outcomes. Priorities include improving health literacy, tackling abuse of alcohol and other drugs, and focusing on mental health and wellbeing.

    Western Sydney LHD Youth Council. Front row left to right: Mae Rafraf, Gianina Raymundo, Lauren Moujalli, Jessica Lam, Shannen Twine, Jo-Anne Pogorelsky. Back row left to right: Thomas Clark, Alison Shiner, Claudia Reed, Karisma Ram, Monique Van Acquoy, Silvana Techera, Sarah Siu. Absent: Fatimah Al Gharbawi, Bonnie Dorise, Stephanie D’Souza, Brent Nolland. Photo: M Rafraf.

    Youth Health Forum on aggression and violence

    For the past 10 years, the ACI Transition Network has supported the Youth Health Forum. The ACI was pleased to support this year’s Forum, All fired up: Aggression and violence in young people.

    Held at The Children’s Hospital at Westmead on 7 March, the Forum was attended by 170 people and streamed online at more than 15 rural and regional sites.

    Presenters included Ken Nathan, Founder and Director of Interventions Plus, co-creator of RAGE, a six-week anger management course for adolescents, and Gerard Veltre, Artistic Director of Phunktional, a not-for-profit company that uses the arts to reduce risk factors and promote respectful relationships.

    The key message was to remember that anger is a secondary feeling. Participants were encouraged to try to take a step back and discover the primary emotion, such as fear or sadness, that they may be avoiding.