As part of AusHSI’s drive to build strong health services research capacity, we also support students undertaking postgraduate degrees. We currently support several PhD students via our competitively funded research grants and where our experienced researchers also act as formal supervisors for PhD students.
AusHSI PhD students come from a variety of backgrounds, with very few following the traditional route to higher degree research. Many have returned to research or study after working in industry or policy roles. As a result, AusHSI values the wealth of real-world knowledge and insights its students bring to the group.
Who am I?
Phil is Research Fellow at Deakin University’s Centre for Quality and Patient Safety Research – Alfred Health Partnership. Phil has over 25 years of nursing experience in a variety of health care settings. He is also the President Elect for the Australasian College for Infection Prevention and Control and on the NHMRC Infection Control Guidelines Advisory Committee. For over ten years Phil has been a member of the HAI Advisory Committee for the Australian Commission for Safety and Quality in Health Care. Currently he is on the editorial board of Infection, Disease and Health, and the Journal of Infection Prevention. In 2019 Phil will start his NHMRC Early Career fellowship.
PhD Research Project
Healthcare-associated infections (HAIs) are one of the most common complications for patients in hospitals, yet Australia remains one of the few OECD countries to lack a national surveillance program. The lack of current HAI data presents unreasonable challenges to those at a hospital, state and national level seeking evidence on which to base infection-prevention policy. It also severely limits local and national infection-prevention research initiatives. Importantly, it also raises doubt about patient safety and quality in infection prevention on a national scale.
Phil’s Ph.D. project examined the gaps in existing HAI surveillance activities across Australia and explored the characteristics of international surveillance programs to identify enablers and barriers to implementing similar schemes in Australia.
There is broad variation in existing HAI-surveillance practices across Australia, meaning any attempt to collate existing data for a national aggregate would be flawed. Despite the lack of a national program, there is strong support amongst key stakeholders for national coordinated surveillance activities. The research suggests having a centralised program with mandatory core elements – such as standardised basic risk adjustment, supported by training and regular competency assessment and public reporting – would result in high participation and acceptable data.
The project concluded that, to improve national patient safety and quality, Australia should develop and implement a national HAI-surveillance program.
Who am I?
Elaine is a Senior Research Fellow at Nanyang Technological University’s Lee Kong Chian School of Medicine in Singapore. She is a clinical pharmacist and health services researcher and a credentialed as an Advance Practice Pharmacist (Australia). Elaine is a Visiting Clinical Fellow with the School of Clinical Science, Queensland University of Technology; affiliated with Australian Centre for Health Services Innovation (AusHSI); and serves on the research grants committee of the National Translational Research Collaborative (SHPA, Australia).
PhD Research Project
Use of antimicrobial agents to treat and prevent infections is an essential component of medical care. Indeed, many advances in critical care medicine, surgery and transplantation would not be possible without the use of effective antimicrobials. While antimicrobials benefit the individual patient, the emergence of resistance has consequences to all of society. In 2014, the World Health Organization (WHO) urged all countries to work together to improve surveillance and to address the issue of antimicrobial resistance. An effective approach to improving antimicrobial use in hospitals may be achieved by an organised antimicrobial management program known as antimicrobial stewardship (AMS). The overarching goals of an AMS program are to optimise clinical outcomes while minimising the unintended consequences of antimicrobial use, including toxicity, the rise of opportunistic pathogens (such as Clostridium difficile), and the emergence of antimicrobial resistance AMS interventions have been reported to reduce antimicrobial consumption by 22–36% and lead to a cost reduction of US$200 000–900 000 per annum in some hospitals in the USA. Despite this, attracting adequate support for these activities has been reported as difficult, as AMS is competing for resources against many other healthcare initiatives. The implementation of Antimicrobial Stewardship (AMS) in Australian hospitals is mandatory, but the components of each program are heterogeneous. Whilst there are many combinations of strategies available for the development of an AMS program, it is unclear which are optimal.
Elaine’s PhD research was the first cost-effectiveness analysis of AMS interventions in Australia. The project aimed to synthesise existing literature on the cost effectiveness of AMS programs, assessing the cost and health outcomes, the economic evaluation methods used and the overall findings of this body of research, including important knowledge gaps in this area. The project evaluated the cost effectiveness of key AMS strategies – including the AMS team and the value of rapid diagnostics and Clinical Decision Support Systems (CDSS) – in the context of AMS interventions implemented at two metropolitan hospitals in Brisbane, Australia. It focused on how public hospitals in Queensland could overcome problems and improve outcomes for patients with serious infections.
The AMS interventions at both hospitals were cost-saving and resulted in modest positive net monetary value. Rapid pathogen identification provided value for money, but the impact of CDSS was less conclusive. The impact of labour costs in assembling an AMS team was also shown to have a major bearing on expenditure. The research has highlighted a need to routinely collect better data on longer-term mortality and adverse outcomes for patients on antimicrobial therapy. It supports these conclusions:
- clinical decision makers should carefully consider which components of an AMS intervention best suit their setting to maximise cost saving
- to better evaluate the true cost effectiveness of AMS, longitudinal patient outcome data needs to be more rigorously and routinely collected.
For more information on PhD opportunities at AusHSI, please email firstname.lastname@example.org