Clinical Excellence Showcase Clinical Excellence Queensland

As always, we’ll see out the Showcase with The Great Debate. Known to entertain more than inform, this year’s debate asks whether Australia is the best place for clinicians to live and work.
Joining us this year is another stellar line up of some of Queensland’s best and brightest (and unusually, most are surgeons!)
Affirmative team (yes, Australia is the best place to live and work):

Dr Emilia Dauway, Director of Surgery at QEII Jubilee Hospital

Dr Bernie Whitfield, Director of ENT at Logan Hospital

Dr Rob Franz, Medical Director General Surgery at The Prince Charles Hospital.

Negative team (no, Australia is not the best place to live and work):

Associate Professor Robyn Littlewood, CEO Health and Wellbeing Queensland

Dr Diana Tam, Consultant Breast and Endocrine Surgeon

Associate Professor Cath McDougall, Chief Medical Officer for Queensland Health.

Chaired by the Deputy Director-General herself, Dr Helen Brown, this year’s Great Debate is sure to highlight the pros and pitfalls of our beautiful country!

Climate change is one of the most important challenges the world is facing currently. Climate change negatively impacts on health worldwide. To address climate change is our professional obligation.
SWAPNET has established an Environmental Accountability Working Group with the aim to engage clinicians, HHSs and facilities to promote change and to develop comprehensive resources to support improvement and to lead the way to encourage other networks to also take up the challenge.

Traditionally long-term antibiotic therapy for significant infections has been given intravenously (IV). Current evidence now supports the utilisation of highly bioavailable oral antibiotic (HBOA) therapy substituting for most of the IV course. This includes quinolones, sulphonamides, tetracyclines, macrolides, azoles, lincosamides, rifamycins and oxazolidinones classes of antibiotics.
HBOA therapy allows the patient to receive treatment in their own home, potentially return to work, removes the risk of long lines, and achieve therapeutic goals. However, treatment may be for several months and side effects may arise at any time; some potentially avoidable with early recognition.
We established a Complex outpatient antibiotic therapy (CoPAT) service that monitor’s patients on HBOA at home. This manages in a timely fashion any adverse outcomes to allow ongoing achievement of therapeutic goals, prevention of hospital admission and reduction of overall care costs. It also allows standardisation of the follow-up care provided.

Obesity places a significant burden on Australia’s healthcare system. Currently at The Princess Alexandra Hospital (PAH), local antimicrobial guidelines do not provide advice on dosing for obese patients. Instead, clinicians are directed to utilise standard dosing advice which has been developed and tested in non-obese patients, thus adopting a one-size-fits-all dosing mentality. The aim of this project was to determine the proportion of admitted patients at the Princess Alexandra Hospital receiving antimicrobial therapy, who are classed as obese (BMI >30kg/m2) as well as audit the current prescribing patterns of antimicrobial dosing in obese patients at the PA Hospital. As a result of the audit findings, it was clear there was a severe lack in dosing advice in this cohort of patients and that antimicrobial dosing most commonly followed standard dosing guidelines with no consideration for the patient's weight. Therefore, guidelines for the dosing of antimicrobial recommendations in obese patients were drafted and are currently awaiting publication.

Children’s Health Queensland Hospital and Health Services (CHQHHS) has empowered its workforce, young people, families and care partners to pursue innovative ways to minimise their environmental impact of our health care service. We have established an Environmental Stewardship Network, the ‘CHQ Green Team’, which has grown to over 200 active members who work together to meet the targets set out in the CHQHHS Environmental Sustainability Plan 2021-2024.
CHQ Green Team initiatives have resulted in emission reductions, improved energy efficiency and waste reduction at the Queensland Children’s Hospital (QCH) in South Brisbane.
This has established QCH as an international example for sustainable healthcare service delivery, both financially and environmentally.
CHQ Green Team initiatives support local businesses and circular economy jobs while also shifting current practices and improving Queensland’s environmental performance.
CHQ showcases sustainable leadership that has successfully diverted 491 tonnes of waste from landfill and generated and saved over $580 000 in 2021/22. Our sustainability success story can be shared and adopted across other Queensland Health Hospitals and Health care services.

Borderline Personality Disorder (BPD) is a complex and serious psychiatric condition with significant morbidity and mortality. It is often characterised by a severely and persistently impaired psychosocial functioning and a high risk for self-harm and suicide, resulting in the high consumption of healthcare resources.
Access to evidence-based interventions for Borderline Personality Disorder (BPD) is still highly limited in the current Australian health service system. Specialist mental health services are dominated by a generic case management model, with a lack of specific treatment modalities and staff struggling to provide psychologically focussed interventions. Similarly, non-government organisations (NGOs) report a lack of capacity, competence and confidence when working with consumers living with BPD.
Despite people with BPD commonly having multiple contacts with mental health services, an audit within Metro South Hospital and Health Service (MSHHS) found that access to evidence-based treatment for this group of patients was highly limited in the Brisbane South region. The need for all workers to be able to therapeutically respond to consumers needs, and better access to appropriate intervention intensities was required.
Using a stepped workforce capability framework the project aimed to increase the overall workforce capability to intervene effectively. In addition to develop higher level skillsets across NGO and public mental health and greater treatment access across the spectrum of care needs.
Outcomes were significant and have directly impacted the ability of staff to provide good care from thsoe with BPD and related disorders. Over 350 NGO and MSHHS frontline staff completed training to achieve a practice-informed level of DBT capability.
The project’s activities were highly valued in terms of content and presentation. Most participants reported greater use of and capability with Dialectical Behaviour Therapy (DBT)-informed practice and improved care coordination after training attendance.
The significant improvements in the self-efficacy of participants that were identified immediately following training attendance appear to have been maintained in the short term.
Almost 100 people attended advanced forms of training that will enable them to run DBT-informed groups, and in some cases provide individual comprehensive therapy. These individuals will serve as DBT leaders and champions who can support the maintenance of each service’s improved capability. There are new programs accessable to those with BPD in the region.