An exploratory study to examine the phenomenon and practice of ambulance ramping at hospitals within the Queensland Health Southern Districts and the Queensland Ambulance Service

Background: Ambulance Ramping, defined anecdotally as a practice where patients brought to emergency departments by ambulance experience delays to admission, has become more frequent in Australian emergency departments over the last few years. Previous research has shown a link between emergency department overcrowding, ambulance diversion and adverse outcomes for patients. However, there is very little research about Ambulance Ramping. The literature has no consistent definition of Ambulance Ramping, no description of how it is managed, and limited research on the effects it has on patient and service delivery outcomes...

Public realm and transport, international best practice case studies and opportunities for Brisbane

This report was prepared for Lat 27 Pty Ltd for the purpose of conducting a City Centre Public Realm and Active Transport Study for Urban Renewal Brisbane, Brisbane City Council. In this review, we highlight some key learnings and recommendations from innovative projects across the globe to inform public realm design and help facilitate active transport in subtropical Brisbane. Traditionally, Australian cities have been have been based on northern European models. This report is informed by the view that planners and urban designers must look beyond that paradigm to redefine and re-conceptualise our city in a different way, one that values our unique local identity and climate. In re-designing Brisbane’s public realm, therefore, design interventions and responses must celebrate our unique identity and outdoor lifestyle and address the subtropical climate's reality of life in warm humid summers and cool dry winters. The current period of rapid urban change, and the imperative to adapt to climate change, together offer an opportunity to prioritise and integrate design features that provide shade and shelter from sun and summer rain, open and permeable urban environments that facilitate cooling air movement, and connections to water and nature, so that the urban built form co-exists within an inviting, functional and memorable natural landscape. To inform this transformation, this review provides insight into international experiences and best practices. To date, although there is much practice-based knowledge, academic studies outlining learnings and recommendations from case studies (especially in a subtropical context) remain rare. Thus, a range of sources (industry reports, websites, journal articles and books) have been utilised.

Queen's Parks in Queensland

Queen's Park in Maryborough is one of many public gardens established in the nineteenth century in Queensland: in Brisbane, Ipswich, Toowoomba, Warwick, Rockhampton, Mackay, Townsville, Cairns and Cooktown. They were created primarily as places of horticultural experimentation, as well as for recreational purposes. They formed a local area network, with the Brisbane Botanic Garden and the Government Botanist, Walter Hill, at the centre – at least in the 1870s. From here, the links extended to other botanic gardens in Australia, and beyond Australia to the British colonial network managed through the Royal Botanic Gardens (RBG), Kew. It was an informal network, supplying a knowledge of basic economic botany that founded many tropical agricultural industries and also provided much-needed recreational, educational and inspirational opportunities for colonial newcomers and residents. The story of these parks, from the time when they were first set aside as public reserves by the government surveyors to the present day, is central to the history of urban planning in regional centres. This article provides a statewide overview together with a more in-depth examination of Maryborough's own historic Queen's Park.

Exposure to airborne fungi and bacteria in Brisbane houses after the 2011 flood

A series of flooding events occurred in Queensland, Australia during December 2010 and January 2011. The state’s capital city of Brisbane experienced major flooding in January 2011, when the Brisbane River broke its bank and inundated low lying areas.

Tangible cultural heritage and adaptive reuse: the Old Government House, Brisbane, Australia

The Old Government House, a former residence of the Queen’s representatives in Brisbane, Australia, symbolises British cultural heritage of Colonial Queensland. Located on the campus of the Queensland University of Technology, it is one of the oldest surviving examples of a stately residence in Queensland. Built in 1860s, the Old Government House was originally intended as a temporary residence for the first governor of the newly independent colony of Queensland. However, it remained the vice-regal residence until 1909, serving eleven succeeding governors. Nearly seven decades later, it became the first building in Queensland to be protected under heritage legislation. Thus its importance, as an excellent exemplar that demonstrates the significance of cultural heritage, was established. The Old Government House has survived 150 years of restoration work, refurbishments, and additions. Through these years, it has served the people of Queensland in a multitude of roles. This paper aims to investigate the survival of heritage listed buildings through their adaptive re-use. Its focus will be on the adaptive reuse of the Old Government House through its refurbishments and additions over a period of 150 years. Through a qualitative research process this paper will endeavour to establish the significance of restoration work on the Old Government house; the new opportunities that has opened up as a result of the restoration work; the continued maintenance and management of the building through adaptive re-use; the economic benefits of restoration work; and its contribution to the on-going interest in the preservation of the Tangible Cultural Heritage.

Educational and occupational outcomes amongst African men from refugee backgrounds living in urban and regional Southeast Queensland

Over the last ten years, approximately one third of refugee and humanitarian entrants to Australia have been adult men. To date, little research has been done on their health and settlement issues. Many of these men have come from the African continent. This paper reports on the educational and employment outcomes of a group of 173 recently arrived adult African men from refugee backgrounds who have settled in Southeast Queensland. Given the current government policy focus on regional resettlement, the paper compares key outcomes between the adult African men who settled in metropolitan Brisbane with those living in the Toowoomba-Gatton region. The study uses a peer interviewer model and a mixed method approach. Overall, we have found that African men who have settled in regional areas face significantly greater educational and occupational challenges than those who settled in the urban area. They report more negative experiences at educational institutions, are more likely to take jobs that are below their level of skills and qualifications, are more dissatisfied with their jobs, and report greater discrimination and difficulties while trying to secure adequate employment in Australia. A number of policy implications are discussed.

Associations between socioeconomic position, food insecurity and BMI

Introduction: Food insecurity is a social determinant of health and is defined as limited ability to access sufficient amounts of nutritionally adequate or safe food for a healthy and active life. Food insecurity is associated with poor health status and the exacerbation of other health inequalities. This study examined whether an association existed between 1) socioeconomic position (SEP) and food insecurity and 2) food insecurity and weight status. Methods: Data from the 1995 National Nutrition Survey was analysed. A random sample of households (n = 13 858) were asked about dietary habits and food choices. Information about gender, age, BMI, waist circumference, household income and whether the household had run out of money to purchase food in the previous 12 months was obtained and analysed using chi-square and logistic regression. Results: Income was significantly associated with food insecurity; households with lower income were at higher risk of food insecurity. Lower income males were nine times more likely to experience food insecurity and lower income females were three times more likely to experience food insecurity than their higher income counterparts. Food insecurity was significantly associated with body mass index (BMI) among women but not men. Women experiencing food insecurity were at higher risk of overweight/obesity according to BMI and waist circumference measures. Conclusion: Evidence suggests that low income households are at higher risk of food insecurity and women who are food insecure are at higher risk of being overweight or obese. Food insecurity may mediate the association between SEP and BMI.

Evaluation of implementation of a healthy food and drink supply strategy throughout the whole school environment in Queensland state schools, Australia

BACKGROUND/OBJECTIVES: This paper reports on the evaluation of the Smart Choices healthy food and drink supply strategy for Queensland schools (Smart Choices) implementation across the whole school environment in state government primary and secondary schools in Queensland, Australia. SUBJECTS/METHODS: Three concurrent surveys using different methods for each group of stakeholders that targeted all 1275 school Principals, all 1258 Parent and Citizens’ Associations (P&Cs) and a random sample of 526 tuckshop convenors throughout Queensland. Nine hundred and seventy-three Principals, 598 P&Cs and 513 tuckshop convenors participated with response rates of 78%, 48% and 98%, respectively. RESULTS: Nearly all Principals (97%), P&Cs (99%) and tuckshop convenors (97%) reported that their school tuckshop had implemented Smart Choices. The majority of Principals and P&Cs reported implementation, respectively, in: school breakfast programs (98 and 92%); vending machine stock (94 and 83%); vending machine advertising (85 and 84%); school events (87 and 88%); school sporting events (81 and 80%); sponsorship and advertising (93 and 84%); fundraising events (80 and 84%); and sporting clubs (73 and 75%). Implementation in curriculum activities, classroom rewards and class parties was reported, respectively, by 97%, 86% and 75% of Principals. Respondents also reported very high levels of understanding of Smart Choices and engagement of the school community. CONCLUSIONS: The results demonstrated that food supply interventions to promote nutrition across all domains of the school environment can be implemented successfully.

The governance of inter-organisational decision-making : understanding the impacts of informal networks on formal decision-making regimes in the Brisbane Airport region

Airports and cities inevitably recognise the value that each brings the other; however, the separation in decision-making authority for what to build, where, when and how provides a conundrum for both parties. Airports often want a say in what is developed outside of the airport fence, and cities often want a say in what is developed inside the airport fence. Defining how much of a say airports and cities have in decisions beyond their jurisdictional control is likely to be a topic that continues so long as airports and cities maintain separate formal decision-making processes for what to build, where, when and how. However, the recent Green and White Papers for a new National Aviation Policy have made early inroads to formalising relationships between Australia’s major airports and their host cities. At present, no clear indication (within practice or literature) is evident to the appropriateness of different governance arrangements for decisions to develop in situations that bring together the opposing strategic interests of airports and cities; thus leaving decisions for infrastructure development as complex decision-making spaces that hold airport and city/regional interests at stake. The line of enquiry is motivated by a lack of empirical research on networked decision-making domains outside of the realm of institutional theorists (Agranoff & McGuire, 2001; Provan, Fish & Sydow, 2007). That is, governance literature has remained focused towards abstract conceptualisations of organisation, without focusing on the minutia of how organisation influences action in real-world applications. A recent study by Black (2008) has provided an initial foothold for governance researchers into networked decision-making domains. This study builds upon Black’s (2008) work by aiming to explore and understand the problem space of making decisions subjected to complex jurisdictional and relational interdependencies. That is, the research examines the formal and informal structures, relationships, and forums that operationalise debates and interactions between decision-making actors as they vie for influence over deciding what to build, where, when and how in airport-proximal development projects. The research mobilises a mixture of qualitative and quantitative methods to examine three embedded cases of airport-proximal development from a network governance perspective. Findings from the research provide a new understanding to the ways in which informal actor networks underpin and combine with formal decision-making networks to create new (or realigned) governance spaces that facilitate decision-making during complex phases of development planning. The research is timely, and responds well to Isett, Mergel, LeRoux, Mischen and Rethemeyer’s (2011) recent critique of limitations within current network governance literature, specifically to their noted absence of empirical studies that acknowledge and interrogate the simultaneity of formal and informal network structures within network governance arrangements (Isett et al., 2011, pp. 162-166). The combination of social network analysis (SNA) techniques and thematic enquiry has enabled findings to document and interpret the ways in which decision-making actors organise to overcome complex problems for planning infrastructure. An innovative approach to using association networks has been used to provide insights to the importance of the different ways actors interact with one another, thus providing a simple yet valuable addition to the increasingly popular discipline of SNA. The research also identifies when and how different types of networks (i.e. formal and informal) are able to overcome currently known limitations to network governance (see McGuire & Agranoff, 2011), thus adding depth to the emerging body of network governance literature surrounding limitations to network ways of working (i.e. Rhodes, 1997a; Keast & Brown, 2002; Rethemeyer & Hatmaker, 2008; McGuire & Agranoff, 2011). Contributions are made to practice via the provision of a timely understanding of how horizontal fora between airports and their regions are used, particularly in the context of how they reframe the governance of decision-making for airport-proximal infrastructure development. This new understanding will enable government and industry actors to better understand the structural impacts of governance arrangements before they design or adopt them, particularly for factors such as efficiency of information, oversight, and responsiveness to change.

Cost effectiveness of nutrition support in the prevention of pressure ulcer in hospitals

Background/objectives This study estimates the economic outcomes of a nutrition intervention to at-risk patients compared with standard care in the prevention of pressure ulcer. Subjects/methods Statistical models were developed to predict ‘cases of pressure ulcer avoided’, ‘number of bed days gained’ and ‘change to economic costs’ in public hospitals in 2002–2003 in Queensland, Australia. Input parameters were specified and appropriate probability distributions fitted for: number of discharges per annum; incidence rate for pressure ulcer; independent effect of pressure ulcer on length of stay; cost of a bed day; change in risk in developing a pressure ulcer associated with nutrition support; annual cost of the provision of a nutrition support intervention for at-risk patients. A total of 1000 random re-samples were made and the results expressed as output probability distributions. Results The model predicts a mean 2896 (s.d. 632) cases of pressure ulcer avoided; 12 397 (s.d. 4491) bed days released and corresponding mean economic cost saving of euros 2 869 526 (s.d. 2 078 715) with a nutrition support intervention, compared with standard care. Conclusion Nutrition intervention is predicted to be a cost-effective approach in the prevention of pressure ulcer in at-risk patients.

Productivity and time use during occupational therapy and nutrition/dietetics clinical education : a cohort study

Background: Currently in the Australian higher education sector higher productivity from allied health clinical education placements are a contested issue. This paper will report results of a study that investigated output changes associated with occupational therapy and nutrition/dietetics clinical education placements in Queensland, Australia. Supervisors’ and students’ time use during placements and how this changes for supervisors compared to when students are not present in the workplace is also presented. Methodology/Principal Findings: A cohort design was used with students from four Queensland universities, and their supervisors employed by Queensland Health. There was an increasing trend in the number of occasions of service delivered when the students were present, and a statistically significant increase in the daily mean length of occasions of service delivered during the placement compared to pre-placement levels. For project-based placements that were not directly involved in patient care, supervisors’ project activity time decreased during placements, with students undertaking considerably more time in project activities. Conclusions/Significance: A novel method for estimating productivity and time use changes during clinical education programs for allied health disciplines has been applied. During clinical education placements there was a net increase in outputs, suggesting supervisors engage in longer consultations with patients for the purpose of training students, while maintaining patient numbers. Other activities are reduced. This paper is the first time these data have been shown and form a good basis for future assessments of the economic impact of student placements for allied health disciplines.

Meeting the Food Needs of Queensland’s Culturally and Linguistically Diverse (CALD) Aged Population: A Review of the Literature

This report summarises research undertaken by Queensland University of Technology, Brisbane, in partnership with Diversicare, on ‘Meeting the cultural food needs of Queensland’s Culturally and Linguistically Diverse (CALD) aged’. An earlier literature review[6] summarised the state of the evidence in relation to Australia’s CALD aged population and their less than optimal usage of Home and Community Care services (HACC), in particular, food services. This report builds on the information presented in the literature review aiming to explore the current provision of food services to CALD clients and the barriers and enablers to this service provision in Queensland.

Evaluation of "Eat Well Queensland"

Eat Well Queensland 2002-2012: Smart Eating for a Healthier State (EWQ) was developed by the Queensland Public Health Forum in 2002 as a 10-year strategy to improve the health of Queenslanders through better food and nutrition. This study aimed to evaluate the implementation of EWQ and identify future strategic action required. Queensland Health funded a mid-point review of EWQ in 2008, to identify achievements, gaps, barriers and emerging issues associated with EWQ. 31 key stakeholders were interviewed, 83 stakeholders responded to an online survey, 150 stakeholders attended a state-wide practitioner workshop and 209 EWQ-related project reports were assessed.

Emergency Health Services (EHS) : demand and service delivery models. [Monograph 2 : Queensland EHS users’ profile]

Emergency health is a critical component of Australia’s health system and one which is increasingly congested from growing demand and blocked access to inpatient beds. The Emergency Health Services Queensland (EHSQ) study aims to identify the factors driving increased demand for emergency health and to evaluate strategies which may safely reduce the future demand growth. This monograph addresses the characteristics of users of emergency health services with an aim to identify those that appear to contribute to demand growth. This study utilises data on patients treated by Emergency Departments (ED) and Queensland Ambulance Service (QAS) across Queensland. ED data was derived from the Emergency Department Information System (EDIS) for the period 2001-02 through to 2010-11. Ambulance data was extracted from the QAS’ Ambulance Information Management System (AIMS) and electronic Ambulance Report Form (eARF) for the period 2001-02 through to 2009-10. Due to discrepancies and comparability issues for ED data, this monograph compares data from the 2003-04 time period with 2010-11 data for 21 of the reporting EDs. Also a snapshot of users for the 2010-11 financial year for 31 reporting EDs is used to describe the characteristics of users and to compare those characteristics with population demographics. For QAS data, the 2002-03 and 2009-10 time periods were selected for detailed analyses to identify trends. • Demand for emergency health care services is increasing, representing both increased population and increased relative utilisation. Per capita demand for ED attention has increased by 2% per annum over the last decade and for ambulance attention by 3.7% per annum. • The growth in ED demand is prominent in more urgent triage categories with actual decline in less urgent patients. An estimated 55% of patients attend hospital EDs outside of normal working hours. There is no evidence that patients presenting out of hours are significantly different to those presenting within working hours; they have similar triage assessments and outcomes. • Patients suffering from injuries and poisoning comprise 28% of the ED workload (an increase of 65% in the study period), whilst declines of 32% in cardiovascular and circulatory conditions, and musculoskeletal problems have been observed. • 25.6% of patients attending EDs are admitted to hospital. 19% of admitted patients and 7% of patients who die in the ED are triage category 4 or 5 on arrival. • The average age of ED patients is 35.6 years. Demand has grown in all age groups and amongst both men and women. Men have higher utilisation rates for ED in all age groups. The only group where the growth rate in women has exceeded men is in the 20-29 age group; this growth is particularly in the injury and poisoning categories. • Considerable attention has been paid publicly to ED performance criteria. It is worth noting that 50% of all patients were treated within 33 minutes of arrival. • Patients from lower socioeconomic areas appear to have higher utilisation rates and the utilisation rate for indigenous people appears to exceed those of European and other backgrounds. The utilisation rates for immigrant people is generally less than that of Australian born however it has not been possible to eliminate the confounding impact of different age and socioeconomic profiles. • Demand for ambulance service is also increasing at a rate that exceeds population growth. Utilisation rates have increased by an average of 5% per annum in Queensland compared to 3.6% nationally, and the utilisation rate in Queensland is 27% higher than the national average. • The growth in ambulance utilisation has also been amongst the more urgent categories of dispatch and utilisation rates are higher in rural and regional areas than in the metropolitan area. The demand for ambulance increases with age but the growth in demand for ambulance service has been more prominent in younger age groups. These findings contribute significantly to an understanding of the growth in demand for emergency health. It shows that the growth is amongst patients in genuine need of emergency healthcare and public rhetoric that the congestion of emergency health services is due to inappropriate attendees is unable to be substantiated. The consistency of the growth in demand over the last decade reflects not only the changing demographics of the Australian population but also the changes in health status, standards of acute health care and other social factors. The growth is also amongst patients with acute injury and poisoning which is inconsistent with rates of chronic disease as a fundamental driver. We have also interviewed patients in regard to their decision making choices for acute health care and the factors that influence these decisions and this will be the subject of a third Monograph and publications.