Cheok T

Berman M

Delaney-Bindahneem, Richard

Jennings M P

Bray, Linda

Jaarsma, Ruurd

Poonnoose P M

Williams, Kanishka

Jayasekera N

2023-08-17

BACKGROUND: Indigenous Australians experience significant socioeconomic disadvantage and healthcare disparity compared to non-Indigenous Australians. A retrospective cohort study to describe the association between rates of self-discharge in Indigenous orthopaedic patients and the introduction of routine Aboriginal Liaison Officers (ALO) within the Orthopaedic multi-disciplinary team (MDT) was performed. METHODS: ALO were introduced within our routine Orthopaedic MDT on the 22(nd) of February 2021. Two patient cohorts were analysed, Group 1; patients admitted in the 9-months prior to inclusion of ALO, and Group 2; patients admitted within 9-months thereafter. The primary outcome of interest was the rate of self-discharge among Indigenous patients. Secondary outcomes of interest were the stage of treatment when patients self-discharged, recurrent self-discharge, risk factors for self-discharge and association between self-discharge and length of hospital stay. RESULTS: Introduction of ALO within routine Orthopaedic MDT was associated with a significant 37% reduced risk of self-discharge among Indigenous patients (p = 0·009), and significantly fewer self-discharges before their definitive surgical and medical treatment (p = 0·0024), or before completion of postoperative intravenous antibiotic treatment (p = 0·030). There was no significant change in the risk of recurrent self-discharge (p = 0·557). Risk factors for self-discharge were younger age; pensioners or unemployed; residents of Alice Springs Town-Camps or of communities within 51 to 100 km of Alice Springs; and those diagnosed with lacerations of the upper limb, but without tendon injury, wound and soft tissue infections or osteomyelitis. In Group 2, the odds of self-discharge decreased with increased length of hospital stay (p = 0·040). CONCLUSIONS: Routine inclusion of ALO within the Orthopaedic MDT reduced the risk of self-discharge in Indigenous patients. Those who self-discharged did so only after critical aspects of their care were met.

Department of Trauma and Orthopaedics, Alice Springs Hospital, 6, Gap Road, The Gap, Northern Territory, 0870, Australia. tim.cheok@flinders.edu.au.

Department of Orthopaedic Surgery, Palmerston North Hospital, 50, Ruahine Street, Roslyn, Palmerston North, 4414, New Zealand. tim.cheok@flinders.edu.au.

Department of Trauma and Orthopaedics, Alice Springs Hospital, 6, Gap Road, The Gap, Northern Territory, 0870, Australia.

Department of Orthopaedic Surgery, Monash Medical Centre, 246, Clayton Road, Clayton, Victoria, 3168, Australia.

Department of Plastics and Reconstructive Surgery, Bendigo Base Hospital, 100 Barnard Street, Bendigo, VIC, 3350, Australia.

Aboriginal Liaison Services, Alice Springs Hospital, 6, Gap Road, The Gap, Northern Territory, 0870, Australia.

Department of Orthopaedic Surgery, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia.

Department of Orthopaedic Surgery, Christian Medical College Hospital, IDA Scudder Road, Vellore, Tamil Nadu, 632004, India.

Department of Orthopaedic Surgery, Wairau Hospital, Hospital Road, Blenheim, 7201, New Zealand.

BMC Health Serv Res. 2023 Aug 17;23(1):874. doi: 10.1186/s12913-023-09921-7.

0000-0003-1215-9361

https://pubmed.ncbi.nlm.nih.gov/37592244/?otool=iaurydwlib

https://hdl.handle.net/10137/12521

23

Australia / epidemiology

Australian Aboriginal and Torres Strait Islander Peoples*

Health Services, Indigenous*

Hospitalization

Humans

Inpatients

Orthopedics / statistics & numerical data

Patient Care Team

Patient Discharge

Retrospective Studies

Patient Dropouts*

Closing the health gap in Central Australia: reduction in Indigenous Australian inpatient self-discharge rates following routine collaboration with Aboriginal Health Workers.

Journal Article

Publication