Fundus photography in ED: Saving sight, lives and time

This world-first project integrated Non-Mydriatic Camera (NMC) fundus photography into a regional Emergency Department (ED) and examined changes to patient management.  An NMC can reveal signs of life-threatening and blinding diseases much better than the current Direct Ophthalmoscope (DO).

It involved a prospective study of 150 ED patients with headache, vision disturbance, severe hypertension or neurological change, for whom a portable NMC was implemented after routine care with DO. A collaborative telemedicine photograph review was reported by the Ophthalmology team.

The program found urgent fundus pathology was present in 16 per cent of patients and NMC photographs changed patient management in 40 per cent of cases, improving ED efficiency and delivering better patient outcomes. It demonstrates the value of collaborative fundus imaging for the safety of patients presenting to ED.

 In Vivo Imaging – Safer, Better Patient Experience

This project combines in-vivo imaging with breath-hold technology to provide real-time tumour visualisation, allowing for more accurate radiotherapy treatment. The use of these technologies in combination is a first for the Southern Hemisphere and second in the world.

Patients attending for liver stereotactic radiotherapy are preferentially treated in a breath-hold state to minimise tumour motion. We implemented and combined a unique set of technologies to ensure patients spend less time on the treatment bed, while providing improved time critical in-vivo imaging of the treatment area.

The breath-hold technique delivered in conjunction with in-vivo imaging has been successfully implemented at the Mid North Coast Cancer Institute. The combination of these technologies reduces both the number of times the patient is required to hold their breath, and the total time spent on the treatment bed.

In combining these technologies, patients receive the best possible standard of care.

Award Recipient: Reducing Surgical Site Infection in Breast Surgery Patients 

A Multidisciplinary Breast Surgery Focus group was formed in 2018 with the overall aim of reducing Surgical Site Infections (SSI) and improving patient outcomes for those receiving breast surgery at Coffs Harbour Health Campus.

The focus group developed a Surgical Site Infections Prevention Bundle (SSIPB) by implementing pre-operative chlorhexidine body wash, 70 per cent alcohol/two per cent chlorhexidine intra-operative skin preparation, specialised post-operative wound dressings and education for the patient.

SSI rates before SSIPB intervention were 14.7 per cent and fell to six per cent after SSIPB implementation (Risk Reduction 8.64 per cent). During this period the readmission rates also reduced from 20 per cent to 8.4 per cent (Risk Reduction 11.57 per cent) and unplanned return to theatre from six per cent to 1.2 per cent (Risk Reduction 5.46 per cent).

A one-year evaluation post implementation of SSIPB showed improvements in NSQIP SSI, readmission and unplanned return to theatre rates. The implementation of SSIPB and evaluation of patient outcome in other surgical procedures in the hospital has been recommended.