Objectives:
Hip fracture is associated with high morbidity and mortality, the rates of which can be improved by comprehensive hospital care. In a hospitalist consultant model, orthopedic surgeons play an active role in collaboration with hospitalists in preoperative medical evaluation and management. Meanwhile, in a hospitalist model, hospitalists have a comparatively more active role in patients’ care. We examined the impact of these hospitalist intervention methods on morbidity in patients with hip fractures.

Methods:
We conducted a retrospective cohort study of our patients who underwent surgery for hip fracture between April 2017 and March 2022. Hip fractures were managed conventionally in the orthopedic department, and then we launched a hospitalist consultant model in April 2019 and a family physician-led hospitalist model in April 2020. The primary outcome was the perioperative complication rate, comparing patients in each model. Secondary outcomes included the time to surgery, the length of stay, and in-hospital-mortality. Multivariate analysis was adjusted for age, gender, and any significant variables shown in univariate analysis.

Results:
Among 982 patients, 329, 224 and 429 patients were treated by the orthopedic department, within the hospitalist consultant model and within the hospitalist model, respectively. In adjusted analysis, time to surgery was shorter if managed within the hospitalist model (OR -0.259, 95%CI -0.502, -0.016), but there was no difference in length of stay, in complications or in-hospital mortality.

Conclusions:
A family physician-led hospitalist model might facilitate earlier surgery for hip fractures than by a conventional care model. Morbidity was not affected in our study, perhaps due to improved detection of complications.

1. Hip fractures were managed conventionally in the orthopedic department, and then we launched a family physician-led hospitalist model in April 2020.
2. Time to surgery was shorter if managed within the hospitalist model.
3. Morbidity was not affected in our study.

Patients complain for a variety of reasons. Avant has a wealth of information based on our claims data from our membership base of over 50% of Australian doctors. These insights have international relevance. With this information we can determine what patients complain about. In addition, we recently engaged in research to explore the reasons behind why patients complain. In today's increasingly complex healthcare landscape, it is crucial for doctors to understand why patients are complaining and to develop strategies to address the issues.

One common reason for patient complaints is a lack of communication. Patients may feel that they are not being listened to or that their concerns are not being taken seriously. This can lead to feelings of frustration and anger, which may in turn result in formal complaints. To address this issue, doctors need to prioritize open and effective communication with their patients, actively listening to their concerns, and working to address their needs and concerns in a timely manner.

Poor quality of care is another common reason for patient complaints. Patients who feel that their needs are not being met or that the care they receive is subpar may file formal complaints, leading to negative impacts on the reputation of the healthcare provider. To address this issue, healthcare providers need to prioritize high-quality care and ensure that their patients receive the care they need to achieve optimal health outcomes.

The implications of a patient complaint can be significant, damage to reputation, regulatory investigation and stress to name a few. In this session we explore the what and why of patient complaints as well as address ways to reduce the instance of complaints and the management of them when they occur.

1. To understand what patients, complain about
2. To explore the reasons why patients complain
3. To develop strategies to reduce the likelihood of a patient complaint

Australian general practices operate within RACGP's 184 page, 5th Standards.

Practices are assessed against these Standards on a three yearly Accreditation cycle via a visit of external assessors.
Success provides Accredited status.

The Standards include Modules, Standards, Criterions and a final layer of Indicators.
All 120+ Indicator tasks must be adhered to.

Accreditation preparation often commences a year before and is a significant and resource intensive task.

Concerns are often complexity of tasks, time pressures, focus constraints, information overload, inaccessibility of information, disinterest of those not involved and a lack of an overarching understanding.

Standards and Accreditation are often thought of as one.
An analogy of:
"Standards are like the rules of the road and the Accreditation is the day a police officer is sitting in your car" is accurate.
Much can change in general practice during the 1000 days between visits.

The 5th map [a map of the 5th Standards] is the mapping of all layers onto one page summarising the overall Standards visually and the specific content into concise seven or eight word descriptions in lieu of long sentences and paragraphs.

The maps are specifically hard copy, often on the practice kitchen wall, to be seen all day, everyday by everybody for opportunistic learning.

They encourage whole of practice understanding that the Standards are a cohesive and structured plan for practice and patient safety.

With the "What" now easily accessible, the "Why" can be understood and answered.
Managers who often felt they themselves were being Accredited can maintain oversight, delegate easier and spread knowledge across the practice with less effort.

The 5th map has a formal RACGP license for use of their copyrighted information and is in 600 Australian practices.

This large format always visible, mapping concept can certainly be applied beyond the Australian context.

1. Mapping and summarising complex information can be done to present the big picture.
2. "Low tech" can be as useful as the latest tech in the right context.
3. Accessibility to summarised information allows for opportunistic learning

A crucial tool for improving quality and patient safety (Q+PS) is to inform patient safety incidents (PSI) which may happen in any step of the patient’s journey in the health system to the reporting and learning systems (RLS). In-depth analysis of patient safety incidents reported by professionals from primary care practices (PCP) in the RLS is a key element in defining primary care risk map. The identification of contributing factors, particularly from incidents involving harm or adverse events (AE) will be useful to implement improvements in factors described in these maps.
Material and methods: The Camp de Tarragona health area has 26 PCP (26 PCP, 901 professionals, 326,000 inhabitants). We identified all AE from PC in the RLS, named SNISPCat , of the health region between 2013 and 2022. The contributing factors described in the analysis carried out by the RLS managers were analysed in depth identifying in each factor the issues which account for almost 80% of all.
Results: 1320 adverse events out of a total of 9,825 PSIs reported. The distribution of Professionals’ Factors were wrong application of regulations, distraction, lack of information. Regarding Patients’ Factors: negative attitude, complex patient, communication issues. Considering Environmental Factors: Equipment, infrastructures, environmental assessment and safety. Finally, Organizational Factors: lack of implementation of policies, protocols; team organization; overload of work. External Factors: services, systems; and policies and products technologies and infrastructure.
There were some patient mitigating factors: presentation of apologies, patient detected incident and requested help. Moreover, professionals mitigating factors were leadership and good supervision.
Conclusion: The in-depth analysis of adverse events in PC makes it possible to describe the primary care risk map in a dynamic way over time and throughout the patient's journey in the healthcare system

1. To know about Reporting and Learning Systems in primary care
2. To know about the main kind of patient safety incidents
3. To raise awareness on the analysis of patient safety incidents to improve healthcare quality and safety

Aim - To demonstrate the contribution of HealthPathways, a localised clinical management support tool to health system collaboration and describe the barriers and enablers for successful implementation.

Content - HealthPathways is an online platform designed to deliver localised clinical and referral content to clinicians at the point of care. The program has been implemented in all 31 Primary Health Networks across Australia, as well as in New Zealand and the UK. Findings from a combined process and outcome evaluation of a HealthPathways program will be presented. The evaluation used a mixed methods approach to assess program uptake, barriers and enablers, outcomes relating to general practitioner experience of care and collaboration across different levels of the local health system. HealthPathways was found to be a credible tool used to support clinical decision making. Spikes in usage correlated with key regional events including COVID-19 outbreaks and disasters, highlighting the value of the tool to meet the information needs of clinicians in novel scenarios that are rapidly changing. The program was found to have contributed to local models of care and health system changes, however limited high level integration into local health organisation planning and processes was identified as a key barrier to growth and effectiveness. The contribution of HealthPathways to collaboration in the health system was explored. At a micro-level, HealthPathways was suggested to add value through quality content provided about local models of care and best practice. At a meso-level the program was identified as an enabler of inter-organisational and interprofessional collaboration to facilitate strategic conversations addressing specific pain points in the health system. At a macro-level opportunities to leverage HealthPathways for wider system improvements were identified.

Goals - Attendees will be able to describe potential benefits of implementing a HealthPathways program and understand important barriers and enablers for successful implementation.

1.Attendees will be able to identify potential benefits from implementing a localised clinical management support tool (HealthPathways)
2. Attendees will be able to describe how development and implementation of HealthPathways can contribute to collaboration between different elements of the health system at the micro, meso and macro level
3. Attendees will understand the importance of high level, strategic integration of programs into health organisations for their optimal functioning

Referral waiting time in the healthcare system is an indicator of service delivery and patient satisfaction. It is the time from referral by a primary care provider to the first actual consultation with a specialist. Many of the studies on referral waiting time were conducted in developed countries like Canada and Australia and from a specialist's perspective. It is poorly understood in developing countries like the Philippines. Therefore, there is a need to understand the referral waiting time from a primary care provider’s perspective particularly in the outpatient setting.

The aim of the research is to describe the sociodemographic and clinical factors associated with length of referral waiting time in a tertiary government hospital in a developing country.

A cross-sectional retrospective chart review of patient records from 2015 to 2019 was conducted. A total of 366 charts were reviewed. Many of the patients referred to other specialty clinics were middle-aged adults and females. Median wait times for medical and surgical specialties were 11 (IQR: 0-29) and 18 (IQR: 6-35) days, respectively (p=0.003). Nutrition, rehabilitative medicine, and family health unit received the most number of referrals among non-surgical fields. Ophthalmology, otorhinolaryngology, and general surgery received the highest number of referrals among the surgical fields. Referral waiting times were longest for cardiology (median: 125, IQR: 91-275 days) and shortest for nutrition (median: 0, IQR: 0-6 days).

Waiting times from a primary care clinic to a specialty clinic at a tertiary government hospital vary based on urgency, specialty clinic, purpose of referral, presence of co-morbidities, and chronicity of condition. Clinical factors found to be significantly associated with referral waiting time include urgency, type of clinic, and purpose of referral. Overall, waiting times to see a specialist were within acceptable limits, with only one clinic with a longer median waiting time of 125 days.

1. Sociodemographic and clinical characteristics of Family Medicine patients referred to other specialty clinics
2. Length of referral waiting time of patients across specialties
3. Sociodemographic and clinical factors associated with length of referral waiting time

Background: Australia is amongst OECD countries with the highest proportion of primary health care (PHC) funding as fee-for-service payments. There is however no agreement on what constitutes high-quality PHC to guide alternative funding models. The Quality Equity and Systems Transformation in Primary Health Care (QUEST PHC) project developed a suite of 79 indicators and corresponding 128 measures of high-quality general practice to address this gap.
Aim: To establish consensus with general practice and primary health networks (PHNs) on the QUEST PHC tool for the Australian general practice context.
Methods: An online Delphi survey was conducted with general practitioners, practice staff and PHN staff. Threshold for consensus was set at 70% agreement in both relevance and feasibility. Participants were also asked to comment on implementation of the tool. Ratings were statistically analysed; whole and sub-group analyses were performed. Qualitative responses were thematically analysed.
Results: All measures reached consensus. Nineteen measures, although reached consensus, were more commonly rated as ‘somewhat feasible’ rather than ‘feasible’. Eight of these were common to all subgroups (practice staff, PHN staff, clinician practice staff, and non-clinician practice staff); six of which were related to patient-reported measures. All agreements between subgroups were statistically significant. Thematic analysis elicited four themes: (1) Use of QUEST PHC indicators and measures; (2) Barriers to using quality indicators and measures; (3) Barriers to using quality indicators and measures; (4) Suggestions on implementation of the QUEST PHC. Although participants feel that the QUEST PHC tool is relevant and feasible, there were numerous challenges in collecting additional data including accessibility of appropriate assessment tools, patient compliance, time constraint and requirement of technological skills.
Implications: Findings will inform the further development and implementation of the QUEST PHC tool that would enable future primary health care reforms in Australia.

1. An understanding of the importance of measuring high-quality care in general practice.
2. The considerations required when implementing quality indicators and measures in general practice.
3. The potential application of the QUEST PHC tool in quality improvement and inform PHC funding reforms.