Section A - Policy
9. Effectiveness & Safety
9.1 Maternity Services
The Maternity Services Enhancement Strategy began in 1998 with the aims of: increasing antenatal and postnatal care provision; improving maternity services for women with special needs; promoting maternity that reflects best available evidence on effectiveness; and improving provision and quality of information on care options for women using maternity services. The budget for 1999-2000, the second year of the Maternity Services Enhancement Strategy, is $16.4 million. $14.3 million will be allocated to networks and hospitals to implement Maternity Services Enhancement Plans. The remaining funds will be used to provide targeted services to women with special needs; improve birthing services for Aboriginal and Torres Strait Islanders; develop evidence based consumer information; and fund initiatives designed to encourage system wide adoption of practices and care pathways that are known to improve the effectiveness of care in pregnancy and childbirth. For details on the Maternity Services Strategy refer to appendix 5.
During 1999-2000 the Department will support the acute sector in efforts to improve the availability and quality of information on diseases or conditions and options for treatment and care. Initially the Department has tendered a review of consumer information in six health areas. The review will assess the extent to which the available information is based on evidence, and its relevance to consumers. This project will be completed in late 1999 and will also produce a guide for the development and review of consumer information.
As part of its commitments under the Australian Health Care Agreement, the Department will ensure that the public patients' hospital charter is updated and made available to patients and the public.
The Better Health Channel, launched in May 1999, is a 100 page web site providing reliable, easy-to-read health information on a wide range of subjects, and complete on-line versions of the Guide to Your Local Health Service, distributed as a booklet to every Victorian household in late 1998. Hospital waiting areas will be provided with dedicated internet facilities, allowing patients and visitors to explore the Better Health Channel, which will progressively provide a wealth of information on good health, illness, care options, and available services.
9.3.1 Evidence based practice
In 1998-99, $1.5 million was made available through the Quality Improvement Program for programs or projects that promote the practical use of research evidence of the effectiveness of health care. The twenty six projects and programs funded can be clustered into six key areas:
- Disease management, particular asthma and diabetes;
- Improving emergency medicine;
- Hospital-based risk reduction activities;
- Clinical practice change;
- Improving the effectiveness and efficiency of clinical practice in high volume DRGs; and
- Improving continuity of care through the development of critical care pathways for high volume DRGs in rural services.
This funding also provided support to the Centre for Clinical Effectiveness in the Southern Health Care Network and the Clinical Epidemiology and Health Service Evaluation Unit at North Western Health. These centres provide research, advice and assistance to support the uptake of evidence based practice in hospital settings. Information about the funded projects and programs is available through the Acute Health web site.
Workshops will be run throughout 1999-2000 to promote the sharing of skills, experiences and results of the projects and programs funded through the Quality Improvement Program. Limited funding will be available in 1999-2000 to support initiatives which build on the 1998-99 quality improvement funding.
9.3.2 Clinical Risk Management
Clinical risk management (CRM) is the prevention, monitoring, early identification and management of clinical incidents. Clinical incidents are unexpected and unplanned events in relation to patient care which may result in patient harm, with or without legal liability. Four CRM pilot projects have been funded in hospitals since 1997. These projects are developing and testing new models of CRM for hospitals. The evaluation of the projects will begin in mid 1999 and focus on the value of various methods for collecting and analysing clinical incident information and for preventing identified incidents.
Infection control is an integral part of the day-to-day operation of any hospital and it is the responsibility of Networks and hospitals to ensure that hospital management support and allocate appropriate resources for effective prevention, monitoring and control of infection within their facility. Infection control processes, policies and resources were audited in all Victorian acute public hospitals in 1997-98. In October 1998, in response to audit recommendations, Networks and hospitals submitted costed infection monitoring and control plans to the Department with a strategy for implementation to maintain appropriate standards and practices. Targeted funding totalling $13.6 million has been distributed to assist hospitals implement infection control plans.
$0.5 million will be allocated in 1999-2000 to improve infection monitoring and control in Victorian hospitals and will be used primarily to:
- Implement a standardised infection control surveillance system; and
- Provide some supplementary funding to help networks and hospitals develop systems to enable them to achieve best practice in infection control.
In 2000, the Department will refine the infection control survey tool used by the audit and re-survey all Victorian hospitals to assess performance against best practice recommendations arising from the audit report.