Supporting Australia's new veterans.

BACKGROUND: The recent period of instability and conflict in parts of the world has exposed a new generation of Australian service members to conflict and its associated traumas. OBJECTIVE: The aim of this article is to assist general practitioners (GPs) in engaging with younger veterans who have served in the Australian Defence Force (ADF) since 1990 and acquired health problems as a result of this service. It provides abbreviated advice on the resources available from the Department of Veterans' Affairs (DVA), particularly for mental health problems, and how to efficiently access DVA-funded services for newer veterans. DISCUSSION: Early detection of and attention to health problems (especially mental ill health) arising from military service, particularly from conflict or peacekeeping missions, has been found to improve veterans' health, their functioning and family happiness. GPs are ideally situated to arrange and coordinate this care.

Understanding insurance - the GP's professional and ethical responsibilities.

BACKGROUND: General practitioners will often consult with patients in situations where professional skill is required to support a decision regarding insurance. OBJECTIVE: The aim of this article is to assist doctors' understanding of the basis of insurance and risk, in order to support their own practice in this important area. DISCUSSION: This article provides information about insurance and the professional skills required to assist in decisions made by insurance companies (for which, commercial factors predominate), and/or by patients (in whom, social and emotional factors may be more important). A quality improvement activity is provided for those interested in making changes to their practice.

A strategy for real time improvement (RTI) in communication during the H1N1 emergency response.

OBJECTIVE: To develop and implement a strategy that would enable the Emergency Operations Centre (EOC) to assess the effectiveness of communication strategies and guide real time improvements within the life cycle of the emergency. DESIGN, SETTING AND PARTICIPANTS: An anonymous internet-based questionnaire featuring multiple choice and open text questions was administered to stakeholders of the EOC of a regional tertiary hospital. MAIN OUTCOME MEASURES: The outcomes were perceptions of sufficiency and relative usefulness of various sources of information on Pandemic (H1N1) 2009, including differences between local, state-wide and authoritative worldwide information sources. RESULTS: A total of 328 responses were received over two rounds of questionnaires. Email communication from the Health Incident Controller (HIC) was the most useful source of information (74% found it very useful, compared with authoritative international websites at 21% (Centers of Disease Control) and 29% (World Health Organization)). A total of 94% felt this strategy contributed to improvements. Free text responses also helped the EOC and HIC to tailor communication methods, style, content and tone during the response. CONCLUSIONS: Real time improvement is a useful strategy for implementing change to practice during the life cycle of the current emergency and has broader applicability than Pandemic (H1N1) 2009. Local stakeholders demand local content for their information feed and messages from a trusted local leader are the most superior forms of communication.

The challenge of long waiting lists: how we implemented a GP referral system for non-urgent specialist' appointments at an Australian public hospital.

OUR PROBLEM: The length of wait lists to access specialist clinics in the public system is problematic for Queensland Health, general practitioners and patients. To address this issue at The Townsville Hospital, the GP Liaison Officer, GPs and hospital staff including specialists, collaborated to develop a process to review patients waiting longer than two years. GPs frequently send referrals to public hospital specialist clinics. Once received, referrals are triaged to Category A, B or C depending on clinical criteria resulting in appointment timeframes of 30, 90 or 365 days for each category, respectively. However, hospitals often fail to meet these targets, creating a long wait list. These wait listed patients are only likely to be seen if their condition deteriorates and an updated referral upgrades them to Category A. PROCESS TO ADDRESS THE PROBLEM: A letter sent to long wait patients offered two options 1) take no action if the appointment was no longer required or 2) visit their GP to update their referral on a clinic specific template if they felt the referral was still required. Local GPs were advised of the trial and provided education on the new template and minimum data required for specialist referrals. WHAT HAPPENED: In 2008, 872 letters were sent to long wait orthopaedic patients and 101 responded. All respondents were seen at specially arranged clinics. Of these, 16 patients required procedures and the others were discharged. In 2009 the process was conducted in the specialties of orthopaedics, ENT, neurosurgery, urology, and general surgery. Via this new process 6885 patients have been contacted, 633 patients have been seen by public hospital specialists at specially arranged clinics and 197 have required a procedure. LEARNINGS: Since the start of this process in 2008, the wait time to access a specialist appointment has reduced from eight to two years. The process described here is achievable across a range of specialties, deliverable within the routine of the referral centre and identifies the small number of people on the long wait list in need of a procedure.