Professor Leigh Kinsman

Professor Leigh Kinsman

Joint Chair, Professor of Evidence Based Nursing

School of Nursing and Midwifery

Career Summary

Biography

Professor Leigh Kinsman is a Registered Nurse with a PhD in Public Health. Leigh joined the School of Nursing and Midwifery in 2018 after building an extensive research track record in evidence-based nursing practice and rural health. Leigh was Professor of Healthcare Improvement at the University of Tasmania for four years after undertaking a number of leadership roles at the Monash University School of Rural Health. These key roles included Director of Research and Director, Centre of Research Excellence in Rural and Remote Primary Health Care. Professor Kinsman’s current role as Chair, Professor of Evidence Based Nursing, is a joint position with the Mid North Coast Local Health District based in Port Macquarie.

Professor Kinsman’s research program focuses on improving access to evidence based practice in rural settings, particularly via clinical pathways and enhanced research capacity in nurses and midwives.



Qualifications

  • Doctor of Philosophy, La Trobe University
  • Bachelor of Health Science (Nursing), La Trobe University
  • Master of Health Science, La Trobe University

Keywords

  • Clinical Pathways
  • health services research
  • knowledge translation
  • nursing
  • rural health

Fields of Research

Code Description Percentage
111003 Clinical Nursing: Secondary (Acute Care) 50
111002 Clinical Nursing: Primary (Preventative) 25
111799 Public Health and Health Services not elsewhere classified 25

Professional Experience

UON Appointment

Title Organisation / Department
Joint Chair, Professor of Evidence Based Nursing University of Newcastle
School of Nursing and Midwifery
Australia

Academic appointment

Dates Title Organisation / Department
7/11/2018 - 7/12/2018 Professor of Healthcare Improvement University of Tasmania
School of Nursing and Midwifery
Australia
7/02/2011 - 1/08/2014 Asociate Professor in Rural Health Monash University
School of Rural Health
Australia
7/11/2006 - 1/02/2011 Senior Research Fellow Monash University
School of Rural Health
Australia
7/11/1998 - 31/10/2006 Lecturer in Acute Nursing La Trobe University
School of Nursing and Midwifery
Australia

Professional appointment

Dates Title Organisation / Department
7/08/1984 - 1/11/1998 Registered Nurse Bendigo Health
Australia
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Publications

For publications that are currently unpublished or in-press, details are shown in italics.


Chapter (1 outputs)

Year Citation Altmetrics Link
1996 Rotter T, Kinsman L, Machotta A, Zhao F, van der Weijden T, Ronellenfitsch U, Scott SD, 'Clinical pathways for primary care: effects on professional practice, patient outcomes, and costs', Cochrane Database of Systematic Reviews, John Wiley & Sons, Ltd (1996)
DOI 10.1002/14651858.cd010706
Citations Scopus - 11
Co-authors Feili Zhao

Journal article (73 outputs)

Year Citation Altmetrics Link
2019 Mesman J, Walsh K, Kinsman L, Ford K, Bywaters D, 'Blending Video-Reflexive Ethnography With Solution-Focused Approach: A Strengths-Based Approach to Practice Improvement in Health Care', INTERNATIONAL JOURNAL OF QUALITATIVE METHODS, 18 (2019) [C1]
DOI 10.1177/1609406919875277
2019 Butler M, Schultz TJ, Halligan P, Sheridan A, Kinsman L, Rotter T, et al., 'Hospital nurse-staffing models and patient-and staff-related outcomes (Review)', Cochrane Database of Systematic Reviews, 2019 (2019) [C1]
DOI 10.1002/14651858.CD007019.pub3
Citations Scopus - 7
2019 Khanam MA, Kitsos A, Stankovich J, Kinsman L, Wimmer B, Castelino R, et al., 'Chronic kidney disease monitoring in Australian general practice', Australian journal of general practice, 48 132-137 (2019)

BACKGROUND AND OBJECTIVES: Kidney Health Australia recommends regular monitoring of patients with chronic kidney disease (CKD) to reduce progression and prevent complications such... [more]

BACKGROUND AND OBJECTIVES: Kidney Health Australia recommends regular monitoring of patients with chronic kidney disease (CKD) to reduce progression and prevent complications such as cardiovascular disease. The objective of this study was to examine how practice aligns with the recommendations in Kidney Health Australia's CKD guidelines. METHOD: Australian general practice data from¿the NPS MedicineWise MedicineInsight program (1 January 2013 - 1 June 2016) for 19,712 adults with laboratory evidence of stage 3 CKD were analysed. Complete monitoring in these individuals was defined as having at least one recorded assessment of blood pressure, urine albumin-to-creatinine ratio, estimated glomerular filtration rate and serum lipids over an 18-month period. RESULTS: Complete monitoring was performed for 25% of the cohort; 54.9% among patients with concomitant diabetes and 14.1% among patients without diabetes. Patients with diabetes, hypertension and a documented diagnosis of CKD were more likely to have complete monitoring. DISCUSSION: There is room for improvement in monitoring of patients with stage 3 CKD, particularly for albuminuria, which was monitored in fewer than 50% of these patients.

DOI 10.31128/AJGP-07-18-4630
2019 Rotter T, Plishka C, Lawal A, Harrison L, Sari N, Goodridge D, et al., 'What Is Lean Management in Health Care? Development of an Operational Definition for a Cochrane Systematic Review', Evaluation and the Health Professions, 42 366-390 (2019)

© The Author(s) 2018. Industrial improvement approaches such as Lean management are increasingly being adopted in health care. Synthesis is necessary to ensure these approaches ar... [more]

© The Author(s) 2018. Industrial improvement approaches such as Lean management are increasingly being adopted in health care. Synthesis is necessary to ensure these approaches are evidence based and requires operationalization of concepts to ensure all relevant studies are included. This article outlines the process utilized to develop an operational definition of Lean in health care. The literature search, screening, data extraction, and data synthesis processes followed the recommendations outlined by the Cochrane Collaboration. Development of the operational definition utilized the methods prescribed by Kinsman et al. and Wieland et al. This involved extracting characteristics of Lean, synthesizing similar components to establish an operational definition, applying this definition, and updating the definition to address shortcomings. We identified two defining characteristics of Lean health-care management: (1) Lean philosophy, consisting of Lean principles and continuous improvement, and (2) Lean activities, which include Lean assessment activities and Lean improvement activities. The resulting operational definition requires that an organization or subunit of an organization had integrated Lean philosophy into the organization¿s mandate, guidelines, or policies and utilized at least one Lean assessment activity or Lean improvement activity. This operational definition of Lean management in health care will act as an objective screening criterion for our systematic review. To our knowledge, this is the first evidence-based operational definition of Lean management in health care.

DOI 10.1177/0163278718756992
Citations Scopus - 4
2019 Lawal AK, Groot G, Goodridge D, Scott S, Kinsman L, 'Development of a program theory for clinical pathways in hospitals: Protocol for a realist review', Systematic Reviews, 8 (2019)

© 2019 The Author(s). Background: Despite the increased utilization of clinical pathways (CPWs) as a strategy to improve patient and system outcomes in hospitals, there remain ong... [more]

© 2019 The Author(s). Background: Despite the increased utilization of clinical pathways (CPWs) as a strategy to improve patient and system outcomes in hospitals, there remain ongoing challenges with their conceptualization, implementation, and evaluation. Theories that explain how CPWs work in hospitals are lacking, making it difficult to identify important factors for sustaining changes arising from CPWs implemented in hospitals. The objective of this realist review is to develop a program theory for CPWs in hospitals. Methods: This is a protocol for a realist review. The review will use a six-step iterative process to develop a program theory for CPWs in hospitals: (1) development of a preliminary program theory; (2) search strategy and literature search; (3) study selection and appraisal; (4) data extraction; (5) data analysis and synthesis; and (6) stakeholder engagement. In addition to searching the gray literature and contacting authors, we will search electronic databases such as MEDLINE, NHSEED, CINAHL EBSCO, HMIC, and PsycINFO. Studies will be included based on their ability to provide data that test some aspect of the program theory. Two independent reviewers will select, screen, and extract data related to the program theory from all relevant sources. A realist logic of analysis will be used to identify all context-mechanism-outcome heuristics that explains how CPWs implemented in hospitals translates to better health system outcomes. Discussion: Overall, the review aims to develop a program theory for CPWs in hospitals and to explore how, why, to what extent, and in what contexts does the implementation of CPWs in hospitals contribute to better health system outcomes. As a result, the review will provide a theoretical framework of how CPWs work in hospitals.

DOI 10.1186/s13643-019-1046-0
2019 Dwyer M, Rehman S, Ottavi T, Stankovich J, Gall S, Peterson G, et al., 'Urban-rural differences in the care and outcomes of acute stroke patients: Systematic review', Journal of the Neurological Sciences, 397 63-74 (2019) [C1]

© 2018 Elsevier B.V. Objective: To describe literature pertaining to urban-rural differences in both the quality of care and outcomes of acute stroke patients. Methods: We systema... [more]

© 2018 Elsevier B.V. Objective: To describe literature pertaining to urban-rural differences in both the quality of care and outcomes of acute stroke patients. Methods: We systematically searched CINAHL, PubMed, ProQuest Dissertations & Theses, and Scopus for published and unpublished literature until 9th December 2017. Studies were included if they compared the acute care provided to, or outcomes of, patients hospitalised for stroke in urban versus rural settings. Abstract, full-text review, and data extraction were conducted in duplicate. Findings are presented in the form of narrative syntheses. Results: A total of 28 studies were included in the review (16 on care, 12 on outcomes). With few exceptions, studies addressing the provision of care suggested that rural patients have less access to most aspects of acute stroke care. Studies reporting urban-rural differences in patient outcomes were inconsistent in their findings, however, few of these studies were primarily focused on the issue of urban-rural disparities. Overall, study findings did not appear to differ in line with study quality ratings, stroke subtypes included, or how inter-facility patient transfers were accounted for. Conclusions: There is convincing, albeit not unanimous, evidence to suggest that stroke patients in rural areas receive less acute care than their urban counterparts. Despite this, the available data and methodology have largely not been used to study urban-rural differences in patient outcomes. PROSPERO registration information: URL: https://www.crd.york.ac.uk/prospero. Unique identifier: CRD42017073262.

DOI 10.1016/j.jns.2018.12.021
2018 Chan A, Kinsman L, Elmer S, Khanam M, 'An integrative review: Adherence barriers to a low-salt diet in culturally diverse heart failure adults', Australian Journal of Advanced Nursing, 36 37-47 (2018) [C1]
Citations Scopus - 1
2018 Chung C, Cooper SJ, Cant RP, Connell C, McKay A, Kinsman L, et al., 'The educational impact of web-based and face-to-face patient deterioration simulation programs: An interventional trial', Nurse Education Today, 64 93-98 (2018)

© 2018 Elsevier Ltd Background: There are international concerns relating to the management of patient deterioration. The ¿failure to rescue¿ literature identifies that nursing st... [more]

© 2018 Elsevier Ltd Background: There are international concerns relating to the management of patient deterioration. The ¿failure to rescue¿ literature identifies that nursing staff miss cues of deterioration and often fail to call for assistance. Simulation-based educational approaches may improve nurses¿ recognition and management of patient deterioration. Objectives: To investigate the educational impact of the First2Act web-based (WB) and face-to-face (F2F) simulation programs. Design & Setting: A mixed methods interventional cohort trial with nursing staff from four Australian hospitals. Participants: Nursing staff working in four public and private hospital medical wards in the State of Victoria. Methods: In 2016, ward nursing staff (n = 74) from a public and private hospital completed three F2F laboratory-based team simulations with a patient actor in teams of three. 56 nursing staff from another public and private hospital individually completed a three-scenario WB simulation program (First2ActWeb) [A 91% participation rate]. Validated tools were used to measure knowledge (multi-choice questionnaire), competence (check-list of actions) and confidence (self-rated) before and after the intervention. Results: Both WB and F2F participants¿ knowledge, competence and confidence increased significantly after training (p =0.001). Skill performance for the WB group increased significantly from 61% to 74% (p = 0.05) and correlated significantly with post-test knowledge (p = 0.014). No change was seen in the F2F groups¿ performance scores. Course evaluations were positive with median ratings of 4/5 (WB) and 5/5 (F2F). The F2F program received significantly more positive evaluations than the WB program (p < 0.05), particularly with regard to quality of feedback. Conclusion: WB and F2F simulation are effective education strategies with both programs demonstrating positive learning outcomes. WB programs increase ease of access to training whilst F2F enable the development of tactile hands on skills and teamwork. A combined blended learning education strategy is recommended to enhance competence and patient safety.

DOI 10.1016/j.nedt.2018.01.037
2018 Morley C, Stankovich J, Peterson G, Kinsman L, 'Planning for the future: Emergency department presentation patterns in Tasmania, Australia', International Emergency Nursing, 38 34-40 (2018)

© 2017 The Authors Background: Emergency department crowding and associated adverse outcomes are major issues in health care systems worldwide. The Australian government has highl... [more]

© 2017 The Authors Background: Emergency department crowding and associated adverse outcomes are major issues in health care systems worldwide. The Australian government has highlighted the need to analyse emergency presentations to inform system redesign. Objective: To describe the profile of emergency department presentations by Tasmanian residents to emergency departments over four years, and examine regional variations. Method: A retrospective analysis of emergency department data for Tasmania's public hospitals over four financial years, 2010¿11 to 2013¿14, was undertaken. Descriptive statistics were used to identify patterns in Tasmanian state-wide emergency presentations, as well as disparities between Tasmania's three regions (South, North and North-West). Regression analysis was undertaken to test if changes were significant. Results: State-wide presentations increased by 3.4% (139,352¿144,130) over the four years. Regional variations included an increase in presentations of 16% in the South, 5.1% in the North and a decrease of 3.9% in the North-West. Per capita presentations were consistently lowest in the South and highest in the North-West. The South recorded a significant increase in per capita presentations of those aged 75 and over (p = 0.001), increasing at a rate of 12.5 per 1000 residents per annum (95% CI 5.8¿19.2). Conclusion: There is regional variation in emergency demand and utilisation in Tasmania. The results indicate that recent increases are predominantly occurring in the South, including in the elderly, and the reasons for this warrant further investigation.

DOI 10.1016/j.ienj.2017.09.001
Citations Scopus - 3
2018 Siddiqui N, Dwyer M, Stankovich J, Peterson G, Greenfield D, Si L, Kinsman L, 'Hospital length of stay variation and comorbidity of mental illness: A retrospective study of five common chronic medical conditions', BMC Health Services Research, 18 (2018)

© 2018 The Author(s). Background: With the increasing burden of mental illness globally, it is becoming common for hospitalised patients with chronic medical conditions to have a ... [more]

© 2018 The Author(s). Background: With the increasing burden of mental illness globally, it is becoming common for hospitalised patients with chronic medical conditions to have a comorbidity of mental illness. This combination could prolong length of stay (LOS) of this patient cohort. We conducted an investigation in Tasmania, Australian hospitals to characterise this cohort and assess if co-morbidity of mental illness is a distinguishing factor that generates LOS variation across different chronic medical conditions. Methods: The retrospective study analysed 16,898 admissions of patients with a primary diagnosis of one of five chronic medical conditions: lung or colorectal cancer, chronic obstructive pulmonary disease (COPD), type II diabetes, ischaemic heart disease (IHD) and stroke. Data were from July 2010 to June 2015, across four hospitals that collectively cover 95% of public hospital admissions in Tasmania, Australia. Descriptive statistics were used to compare characteristics of patients between the scenarios of with and without co-morbidity of mental illness. We used negative binomial regression models to assess whether co-morbidity of mental illness, along with its sub-types, after adjustment for potential confounding variables, associated with LOS variation in patients of each medical condition. Based on the adjusted LOS variation, we estimated differences in bed days' use between patients with and without comorbidity of mental illness. Results: Patients with co-morbidity of mental illness were significantly younger in comparison to patients without mental illness. With each medical condition, patients with comorbidity of mental illness had incurred higher bed days' use than for those without mental illness. In cancer and stroke cohorts, co-morbidity of mental illness unfavourably affected the LOS variation by as high as 97% (CI: 49.9%-159%) and 109% (78%-146%), respectively. Though mental and behavioural disorders due to psychoactive substances was a dominant sub-type of mental illness across the medical conditions, it contributed significant unfavourable LOS variation only in the stroke patients i.e. 36.3% (CI: 16.2%-59.9%). Conclusions: Mental illness consistently produced unfavourable LOS variation. Upskilling of healthcare teams and greater reporting and analysis of LOS variation for this patient cohort, and the sub-cohorts within it, are necessary to provide improved medical care and achieve system efficiencies.

DOI 10.1186/s12913-018-3316-2
Citations Scopus - 2
2018 Unwin M, Crisp E, Rigby S, Kinsman L, 'Investigating the referral of patients with non-urgent conditions to a regional Australian emergency department: A study protocol', BMC Health Services Research, 18 (2018)

© 2018 The Author(s). Background: Australia&apos;s only island state, Tasmania, experiences one of the nation&apos;s highest incidences of non-urgent emergency department (ED) pre... [more]

© 2018 The Author(s). Background: Australia's only island state, Tasmania, experiences one of the nation's highest incidences of non-urgent emergency department (ED) presentations in a healthcare system regularly faced with service demands that exceed resource availability. Service-demand mismatches are acknowledged to contribute to ED crowding which in turn, has been documented to have a correlation with poorer patient outcomes. Crowding within EDs is complex, non-urgent presentations alone are not the primary cause, but have been reported to be a contributing factor. In 2015-16 Tasmania recorded over 153,000 ED attendances, 55% of these fell into the two least urgent triage categories. Recent research in the State's North established that 29% of non-urgent presentations were referred, formally or informally, from primary healthcare providers and that, for many patients (39%), the ED was not their first choice of service provider. This study aims to identify the service needs of patients referred to a regional Australian ED and subsequently triaged as non-urgent. Method: In order to achieve this aim, three objectives have been identified. The first two objectives use an explanatory sequential mixed-method approach while the third objective will incorporate an implementation science approach. These three objectives are: first, a retrospective analysis of seven years of routinely collected hospital data to identify trends in referral of patients with non-urgent conditions; second, focus group interviews with patients and primary care providers to further understand perceived need and service requirements of those referred to the ED, and third, translation of findings into local health service recommendations. Discussion: Identification of the needs of patients referred to the ED with non-urgent conditions will inform future service planning aiming to facilitate access to the right service at the right time and in the right place.

DOI 10.1186/s12913-018-3411-4
2018 Morley C, Unwin M, Peterson GM, Stankovich J, Kinsman L, 'Emergency department crowding: A systematic review of causes, consequences and solutions', PLoS ONE, 13 (2018)

© 2018 Morley et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and repr... [more]

© 2018 Morley et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Emergency department crowding is a major global healthcare issue. There is much debate as to the causes of the phenomenon, leading to difficulties in developing successful, targeted solutions. Aim The aim of this systematic review was to critically analyse and summarise the findings of peer-reviewed research studies investigating the causes and consequences of, and solutions to, emergency department crowding. Method The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A structured search of four databases (Medline, CINAHL, EMBASE and Web of Science) was undertaken to identify peer-reviewed research publications aimed at investigating the causes or consequences of, or solutions to, emergency department crowding, published between January 2000 and June 2018. Two reviewers used validated critical appraisal tools to independently assess the quality of the studies. The study protocol was registered with the International prospective register of systematic reviews (PROSPERO 2017: CRD42017073439). Results From 4,131 identified studies and 162 full text reviews, 102 studies met the inclusion criteria. The majority were retrospective cohort studies, with the greatest proportion (51%) trialling or modelling potential solutions to emergency department crowding. Fourteen studies examined causes and 40 investigated consequences. Two studies looked at both causes and consequences, and two investigated causes and solutions. Conclusions The negative consequences of ED crowding are well established, including poorer patient outcomes and the inability of staff to adhere to guideline-recommended treatment. This review identified a mismatch between causes and solutions. The majority of identified causes related to the number and type of people attending ED and timely discharge from ED, while reported solutions focused on efficient patient flow within the ED. Solutions aimed at the introduction of whole-of-system initiatives to meet timed patient disposition targets, as well as extended hours of primary care, demonstrated promising outcomes. While the review identified increased presentations by the elderly with complex and chronic conditions as an emerging and widespread driver of crowding, more research is required to isolate the precise local factors leading to ED crowding, with system-wide solutions tailored to address identified causes.

DOI 10.1371/journal.pone.0203316
Citations Scopus - 16
2017 Callaghan A, Kinsman L, Cooper S, Radomski N, 'The factors that influence junior doctors capacity to recognise, respond and manage patient deterioration in an acute ward setting: An integrative review', Australian Critical Care, 30 197-209 (2017)

© 2016 Australian College of Critical Care Nurses Ltd Objectives Junior doctors are frequently the first doctor to be called by a nurse to review patients whose clinical status ha... [more]

© 2016 Australian College of Critical Care Nurses Ltd Objectives Junior doctors are frequently the first doctor to be called by a nurse to review patients whose clinical status has declined in hospital wards, yet little is known about how well prepared they are to deal with this situation. This paper aims to identify the factors that influence junior doctors¿ early recognition and management of patient deterioration in an acute ward settings. Method Integrative review methodology was used to allow for the inclusion of broad research designs, summarising current knowledge from existing research and identify gaps in the literature. Quantitative, qualitative and mixed method studies were included. An electronic database search including PubMed, Medline and Scopus was performed. Research articles, exploring junior doctors¿ skills specific to critically ill, or deteriorating patients, technical and non-technical skills and failure to rescue were included. Findings Thirty-three articles were included, of which eighteen were quantitative, six qualitative and nine mixed methods The majority of the studies, eighteen out of thirty-three, were from the United Kingdom. The evidence showed that the capacity for junior doctors to effectively deal with patient deterioration was influenced by: educational models that incorporated non-technical skills; the integration of high quality clinical simulation into education; and the level and type of supervision in the clinical environment. Conclusion The factors that influence junior doctors¿ capacity to recognise, respond and manage patient deterioration in an acute ward settings are complex. This review indicates that there is substantial room for improvement in junior doctors¿ capacity to deal with patient deterioration. Evidence suggests preparation of junior doctors in the recognition and management of the deteriorating patient is influenced by effective simulation education and clinical experiential exposure over time. More accessible supervision for junior doctors in acute wards is recommended to avert error and delays in the appropriate escalation of care in the deteriorating patient.

DOI 10.1016/j.aucc.2016.09.004
Citations Scopus - 4
2017 Sari N, Rotter T, Goodridge D, Harrison L, Kinsman L, 'An economic analysis of a system wide Lean approach: Cost estimations for the implementation of Lean in the Saskatchewan healthcare system for 2012-2014', BMC Health Services Research, 17 (2017)

© 2017 The Author(s). Background: The costs of investing in health care reform initiatives to improve quality and safety have been underreported and are often underestimated. This... [more]

© 2017 The Author(s). Background: The costs of investing in health care reform initiatives to improve quality and safety have been underreported and are often underestimated. This paper reports direct and indirect cost estimates for the initial phase of the province-wide implementation of Lean activities in Saskatchewan, Canada. Methods: In order to obtain detailed information about each type of Lean event, as well as the total number of corresponding Lean events, we used the Provincial Kaizen Promotion Office (PKPO) Kaizen database. While the indirect cost of Lean implementation has been estimated using the corresponding wage rate for the event participants, the direct cost has been estimated using the fees paid to the consultant and other relevant expenses. Results: The total cost for implementation of Lean over two years (2012-2014), including consultants and new hires, ranged from $44 million CAD to $49.6 million CAD, depending upon the assumptions used. Consultant costs accounted for close to 50% of the total. The estimated cost of Lean events alone ranged from $16 million CAD to $19.5 million CAD, with Rapid Process Improvement Workshops requiring the highest input of resources. Conclusions: Recognizing the substantial financial and human investments required to undertake reforms designed to improve quality and contain cost, policy makers must carefully consider whether and how these efforts result in the desired transformations. Evaluation of the outcomes of these investments must be part of the accountability framework, even prior to implementation.

DOI 10.1186/s12913-017-2477-8
Citations Scopus - 3
2017 Rotter T, Plishka C, Hansia MR, Goodridge D, Penz E, Kinsman L, et al., 'The development, implementation and evaluation of clinical pathways for chronic obstructive pulmonary disease (COPD) in Saskatchewan: Protocol for an interrupted times series evaluation', BMC Health Services Research, 17 (2017)

© 2017 The Author(s). Background: Chronic obstructive pulmonary disease (COPD) has substantial economic and human costs; it is expected to be the third leading cause of death worl... [more]

© 2017 The Author(s). Background: Chronic obstructive pulmonary disease (COPD) has substantial economic and human costs; it is expected to be the third leading cause of death worldwide by 2030. To minimize these costs high quality guidelines have been developed. However, guidelines alone rarely result in meaningful change. One method of integrating guidelines into practice is the use of clinical pathways (CPWs). CPWs bring available evidence to a range of healthcare professionals by detailing the essential steps in care and adapting guidelines to the local context. Methods/design: We are working with local stakeholders to develop CPWs for COPD with the aims of improving care while reducing utilization. The CPWs will employ several steps including: standardizing diagnostic training, unifying components of chronic disease care, coordinating education and reconditioning programs, and ensuring care uses best practices. Further, we have worked to identify evidence-informed implementation strategies which will be tailored to the local context. We will conduct a three-year research project using an interrupted time series (ITS) design in the form of a multiple baseline approach with control groups. The CPW will be implemented in two health regions (experimental groups) and two health regions will act as controls (control groups). The experimental and control groups will each contain an urban and rural health region. Primary outcomes for the study will be quality of care operationalized using hospital readmission rates and emergency department (ED) presentation rates. Secondary outcomes will be healthcare utilization and guideline adherence, operationalized using hospital admission rates, hospital length of stay and general practitioner (GP) visits. Results will be analyzed using segmented regression analysis. Discussion: Funding has been procured from multiple stakeholders. The project has been deemed exempt from ethics review as it is a quality improvement project. Intervention implementation is expected to begin in summer of 2017. This project is expected to improve quality of care and reduce healthcare utilization. In addition it will provide evidence on the effects of CPWs in both urban and rural settings. If the CPWs are found effective we will work with all stakeholders to implement similar CPWs in surrounding health regions. Trial registration: Clinicaltrials.gov (NCT03075709). Registered 8 March 2017.

DOI 10.1186/s12913-017-2750-x
Citations Scopus - 1
2017 Rotter T, Plishka CT, Adegboyega L, Fiander M, Harrison EL, Flynn R, et al., 'Lean management in health care: Effects on patient outcomes, professional practice, and healthcare systems', Cochrane Database of Systematic Reviews, 2017 (2017)

© 2017 The Cochrane Collaboration. Published by John Wiley &amp; Sons, Ltd. This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess eff... [more]

© 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess effects of Lean management in health care on patient, professional, and systems outcomes by addressing the following question. What are the effects of Lean management interventions in health care on patient outcomes, professional practice, and healthcare systems? What are the effects of Lean management interventions in health care on patient outcomes, professional practice, and healthcare systems? To answer the following questions in addressing secondary objectives: What are the effects of Lean management interventions in combination with other management systems (e.g. Six Sigma) on patient outcomes, professional practice, and healthcare systems (utilisation and access, adverse effects, cost)? Is the effectiveness of Lean interventions influenced by the setting (e.g. Emergency Department, Laboratory, Pharmacy) in which they are implemented? What are the effects of Lean management interventions in combination with other management systems (e.g. Six Sigma) on patient outcomes, professional practice, and healthcare systems (utilisation and access, adverse effects, cost)? Is the effectiveness of Lean interventions influenced by the setting (e.g. Emergency Department, Laboratory, Pharmacy) in which they are implemented?.

DOI 10.1002/14651858.CD012831
Citations Scopus - 4
2016 Plishka C, Rotter T, Kinsman L, Hansia MR, Lawal A, Goodridge D, et al., 'Effects of clinical pathways for chronic obstructive pulmonary disease (COPD) on patient, professional and systems outcomes: protocol for a systematic review', SYSTEMATIC REVIEWS, 5 (2016)
DOI 10.1186/s13643-016-0311-8
Citations Scopus - 3Web of Science - 2
2016 Allenby A, Kinsman L, Tham R, Symons J, Jones M, Campbell S, 'The quality of cardiovascular disease prevention in rural primary care', Australian Journal of Rural Health, 24 92-98 (2016)

© 2016 National Rural Health Alliance Inc. Objective: To measure the differences in the recording of risk factors and lifestyle advice between those at high risk of cardiovascular... [more]

© 2016 National Rural Health Alliance Inc. Objective: To measure the differences in the recording of risk factors and lifestyle advice between those at high risk of cardiovascular disease and those diagnosed with cardiovascular disease, and to identify the practice characteristics associated with such recording in rural primary care. Design: A cross-sectional observation study of 14 general practices. Medical records were audited to measure recording of risk factors and lifestyle advice for those at high risk of and those diagnosed with cardiovascular disease. Practice characteristics were collected, with logistic regression used to test for an association with the recording of risk factors. Setting: General practices in rural Australia. Participants: Each practice was asked to identify 20 patients; 10 at high risk and 10 diagnosed with cardiovascular disease. Main outcome measures: The recording of risk factors and lifestyle advice in patient records and practice characteristics. Results: 282 records were audited with 142 being high risk and 140 diagnosed with cardiovascular disease.Measures recorded significantly less in the high-risk group were: blood pressure (94% versus 99%; P=0.019); physical activity (24% versus 56%; P=0.000); dietary advice (32% versus 51%; P=0.001); and physical activity advice (34% versus 56%; P=0.000). Recording of risk factors was positively associated with practice involvement in quality improvement (P<0.001), continuing education (P<0.001), and greater percentage of general practitioners (P<0.05) and practice nurses (P<0.001). Conclusions: There is substantial room for enhanced cardiovascular disease prevention through rural primary care in Australia, particularly for high-risk patients. This study has demonstrated an association between practice factors (including targeted education, quality improvement activities and appropriate workforce) and improved preventive activities.

DOI 10.1111/ajr.12224
Citations Scopus - 4Web of Science - 4
2016 Kinsman L, Tham R, Symons J, Jones M, Campbell S, Allenby A, 'Prevention of cardiovascular disease in rural Australian primary care: An exploratory study of the perspectives of clinicians and high-risk men', Australian Journal of Primary Health, 22 510-516 (2016)

© La Trobe University 2015. Rural primary care services have the potential to play a major role in reducing the gap in cardiovascular disease (CVD) outcomes between rural and metr... [more]

© La Trobe University 2015. Rural primary care services have the potential to play a major role in reducing the gap in cardiovascular disease (CVD) outcomes between rural and metropolitan Australians, particularly in men at high risk of CVD. The aim of this study was to explore the self-reported behaviours and satisfaction with their general practice/practitioner of men at high risk of CVD, and attitudes of rural primary care clinicians regarding the role of primary care in CVD prevention. This observational research was addressed through survey questionnaires with rural men at high risk of CVD and semi-structured interviews with rural primary care clinicians. Fourteen rural primary care practices from towns with populations less than 25000 participated. One hundred and fifty-eight high-risk men completed the questionnaire. Their responses demonstrated poorly controlled risk factors despite a willingness to change. Alternatively, rural primary care clinicians (n=20) reported that patients were unlikely to change and that illness-based funding models inhibited cardiovascular preventive activities. Australians living in rural areas have worse CVD outcomes. In addition, there is a disparity in the assumptions of health providers and male patients at high risk of CVD in rural areas. This necessitates innovative rural primary care models that include a blended payment system that incentivises or funds preventive care alongside an emphasis on lifestyle advice, as well as an explicit strategy to influence clinician and patient behaviour to help address the disparity.

DOI 10.1071/PY15091
2016 Cooper SJ, Kinsman L, Chung C, Cant R, Boyle J, Bull L, et al., 'The impact of web-based and face-to-face simulation on patient deterioration and patient safety: protocol for a multi-site multi-method design', BMC HEALTH SERVICES RESEARCH, 16 (2016)
DOI 10.1186/s12913-016-1683-0
Citations Scopus - 4Web of Science - 3
2016 Lawal AK, Rotter T, Kinsman L, Machotta A, Ronellenfitsch U, Scott SD, et al., 'What is a clinical pathway? Refinement of an operational definition to identify clinical pathway studies for a Cochrane systematic review', BMC MEDICINE, 14 (2016)
DOI 10.1186/s12916-016-0580-z
Citations Scopus - 29Web of Science - 21
2016 Unwin M, Kinsman L, Rigby S, 'Why are we waiting? Patients' perspectives for accessing emergency department services with non-urgent complaints', INTERNATIONAL EMERGENCY NURSING, 29 3-8 (2016)
DOI 10.1016/j.ienj.2016.09.003
Citations Scopus - 16Web of Science - 14
2016 Chung C, Cooper S, Kinsman L, Evans L, Cahill A, 'RESEARCH: PATIENT DETERIORATION -- PATIENT SAFETY', Australian nursing &amp; midwifery journal, 24 41 (2016)

Inadequate management of deteriorating patients is of international concern. In order to tackle this issue there has been an increasing effort to upskill nursing and medical staff... [more]

Inadequate management of deteriorating patients is of international concern. In order to tackle this issue there has been an increasing effort to upskill nursing and medical staff (Australian Commission on Safety and Quality in Healthcare, 2012).

Citations Scopus - 1
2015 Ingham G, Morgan S, Kinsman L, Fry J, 'Are GP supervisors confident they can assess registrar competence and safety, and what methods do they use?', AUSTRALIAN FAMILY PHYSICIAN, 44 236-240 (2015)
Citations Scopus - 4Web of Science - 1
2015 Endacott R, Bogossian FF, Cooper SJ, Forbes H, Kain VJ, Young SC, Porter JF, 'Leadership and teamwork in medical emergencies: performance of nursing students and registered nurses in simulated patient scenarios', JOURNAL OF CLINICAL NURSING, 24 90-100 (2015)
DOI 10.1111/jocn.12611
Citations Web of Science - 18
2015 Morgan S, Ingham G, Kinsman L, Fry J, 'Clinical supervision using random case analysis in general practice training', Education for Primary Care, 26 40-46 (2015)
Citations Scopus - 5Web of Science - 5
2015 Cooper S, Cant R, Bogossian F, Kinsman L, Bucknall T, 'Patient Deterioration Education: Evaluation of Face-to-Face Simulation and e-Simulation Approaches', CLINICAL SIMULATION IN NURSING, 11 97-105 (2015)
DOI 10.1016/j.ecns.2014.10.010
Citations Scopus - 17Web of Science - 15
2014 Campbell AM, Brown J, Simon DR, Young S, Kinsman L, 'Leading the rebirth of the rural obstetrician', MEDICAL JOURNAL OF AUSTRALIA, 201 667-670 (2014)
DOI 10.5694/mja14.00278
Citations Scopus - 4Web of Science - 3
2014 Tham R, Buykx P, Kinsman L, Ward B, Humphreys JS, Asaid A, et al., 'Staff perceptions of primary healthcare service change: influences on staff satisfaction', AUSTRALIAN HEALTH REVIEW, 38 580-583 (2014)
DOI 10.1071/AH14015
Citations Scopus - 3Web of Science - 3
Co-authors Penny Buykx
2014 Bogossian F, Cooper S, Cant R, Beauchamp A, Porter J, Kain V, et al., 'Undergraduate nursing students' performance in recognising and responding to sudden patient deterioration in high psychological fidelity simulated environments: An Australian multi-centre study', NURSE EDUCATION TODAY, 34 691-696 (2014)
DOI 10.1016/j.nedt.2013.09.015
Citations Scopus - 61Web of Science - 57
2014 Ward BM, Buykx PF, Tham R, Kinsman L, Humphreys JS, 'Investing in longitudinal studies of primary healthcare: what can we learn about service performance, sustainability and quality?', RURAL AND REMOTE HEALTH, 14 (2014)
Citations Scopus - 2Web of Science - 3
Co-authors Penny Buykx
2014 Kinsman L, Rotter T, Stevenson K, Bath B, Goodridge D, Harrison L, et al., '"The largest Lean transformation in the world": the implementation and evaluation of lean in Saskatchewan healthcare', Healthcare quarterly (Toronto, Ont.), 17 29-32 (2014)

Copyright © 2014 Longwoods Publishing. The Saskatchewan Ministry of Health has committed to a multi-million dollar investment toward the implementation of Lean methodology across ... [more]

Copyright © 2014 Longwoods Publishing. The Saskatchewan Ministry of Health has committed to a multi-million dollar investment toward the implementation of Lean methodology across the province's healthcare system. Originating as a production line discipline (the Toyota Production System), Lean has evolved to encompass process improvements including inventory management, waste reduction and quality improvement techniques. With an initial focus on leadership, strategic alignment, training and the creation of a supportive infrastructure (Lean promotion offices), the goal in Saskatchewan is a whole health system transformation that produces "better health, better value, better care, and better teams." Given the scope and scale of the initiative and the commitment of resources, it is vital that a comprehensive, longitudinal evaluation plan be implemented to support ongoing decision-making and program design. The nature of the initiative also offers a unique opportunity to contribute to health quality improvement science by advancing our understanding of the implementation and evaluation of complex, large-scale healthcare interventions. The purpose of this article is to summarize the background to Lean in Saskatchewan and the proposed evaluation methods.

Citations Scopus - 10
2014 Rotter T, Machotta A, Kinsman L, Champion R, 'Evaluation of a clinical pathway for 'radical laparoscopic prostatectomy': An interrupted time series study', International Journal of Urological Nursing, 8 84-89 (2014)

The aim of this study was a rigorous evaluation of a clinical pathway (CP) in patients who underwent a radical laparoscopic prostatectomy (RLP). The study was performed at a Germa... [more]

The aim of this study was a rigorous evaluation of a clinical pathway (CP) in patients who underwent a radical laparoscopic prostatectomy (RLP). The study was performed at a German university hospital. The Department of Urology has considerable expertise and performs more than 200 RLP per year. The CP for 'RLP' was developed based on the best available evidence and introduced in July 2003. It was composed of six modules, and in each module standardized recommendations for clinical examination, therapy and outcome measurement were given. An interrupted time series design with multiple linear regression models was used to measure the effects of a CP for 'RLP' on length of hospital stay, and durations of operation and anaesthesia before and after implementation. ¿2 tests were used to compare the number of patients admitted to intensive care unit, the number requiring re-operation during admission, the number requiring transfusion(s) of blood products and 30-d readmission rates. A total of 254 patients were analysed. A significant reduction in operation time and admission to intensive care but also a significant increase of patients readmitted to the hospital after the implementation of a CP was observed. Inconclusive results always warrant careful exploration, and measures on CP uptake should always be used to evaluate the success or failure of the implementation strategy. © 2014 John Wiley & Sons Ltd.

DOI 10.1111/ijun.12036
Citations Scopus - 2
2014 Lawal AK, Rotter T, Kinsman L, Sari N, Harrison L, Jeffery C, et al., 'Lean management in health care: Definition, concepts, methodology and effects reported (systematic review protocol)', Systematic Reviews, 3 (2014)

© 2014 Lawal et al.; licensee BioMed Central Ltd. Background: Lean is a set of operating philosophies and methods that help create a maximum value for patients by reducing waste a... [more]

© 2014 Lawal et al.; licensee BioMed Central Ltd. Background: Lean is a set of operating philosophies and methods that help create a maximum value for patients by reducing waste and waits. It emphasizes the consideration of the customer's needs, employee involvement and continuous improvement. Research on the application and implementation of lean principles in health care has been limited. Methods: This is a protocol for a systematic review, following the Cochrane Effective Practice and Organisation of Care (EPOC) methodology. The review aims to document, catalogue and synthesize the existing literature on the effects of lean implementation in health care settings especially the potential effects on professional practice and health care outcomes. We have developed a Medline keyword search strategy, and this focused strategy will be translated into other databases. All search strategies will be provided in the review. The method proposed by the Cochrane EPOC group regarding randomized study designs, non-randomised controlled trials controlled before and after studies and interrupted time series will be followed. In addition, we will also include cohort, case-control studies, and relevant non-comparative publications such as case reports. We will categorize and analyse the review findings according to the study design employed, the study quality (low- versus high-quality studies) and the reported types of implementation in the primary studies. We will present the results of studies in a tabular form. Discussion: Overall, the systematic review aims to identify, assess and synthesize the evidence to underpin the implementation of lean activities in health care settings as defined in this protocol. As a result, the review will provide an evidence base for the effectiveness of lean and implementation methodologies reported in health care.

DOI 10.1186/2046-4053-3-103
Citations Scopus - 39
2012 Rotter T, Kinsman L, James E, Machotta A, Willis J, Snow P, Kugler J, 'The Effects of Clinical Pathways on Professional Practice, Patient Outcomes, Length of Stay, and Hospital Costs: Cochrane Systematic Review and Meta-Analysis', EVALUATION & THE HEALTH PROFESSIONS, 35 3-27 (2012) [C3]
DOI 10.1177/0163278711407313
Citations Scopus - 64Web of Science - 58
Co-authors Erica James
2012 Buykx P, Humphreys J, Wakerman J, Perkins D, Lyle D, McGrail M, Kinsman L, 'Making evidence count': A framework to monitor the impact of health services research', AUSTRALIAN JOURNAL OF RURAL HEALTH, 20 51-58 (2012) [C1]
DOI 10.1111/j.1440-1584.2012.01256.x
Citations Scopus - 21Web of Science - 19
Co-authors Penny Buykx, David Perkins
2012 Rotter T, Kinsman L, James EL, Machotta A, Steyerberg EW, 'The quality of the evidence base for clinical pathway effectiveness: Room for improvement in the design of evaluation trials', BMC Medical Research Methodology, 12 80 (2012) [C1]
Citations Scopus - 12Web of Science - 9
Co-authors Erica James
2012 Endacott R, Scholes J, Cooper S, McConnell-Henry T, Porter J, Missen K, et al., 'Identifying patient deterioration: Using simulation and reflective interviewing to examine decision making skills in a rural hospital', INTERNATIONAL JOURNAL OF NURSING STUDIES, 49 710-717 (2012)
DOI 10.1016/j.ijnurstu.2011.11.018
Citations Scopus - 17Web of Science - 14
2012 Kinsman LD, Rotter T, Willis J, Snow PC, Buykx P, Humphreys JS, 'Do clinical pathways enhance access to evidence-based acute myocardial infarction treatment in rural emergency departments?', AUSTRALIAN JOURNAL OF RURAL HEALTH, 20 59-66 (2012)
DOI 10.1111/j.1440-1584.2012.01262.x
Citations Scopus - 15Web of Science - 17
Co-authors Penny Buykx
2012 Kinsman L, 'Making a difference: An appreciation of the career of Professor John Humphreys', AUSTRALIAN JOURNAL OF RURAL HEALTH, 20 173-174 (2012)
DOI 10.1111/j.1440-1584.2012.01292.x
2012 Kinsman L, Buykx P, Cant R, Champion R, Cooper S, Endacott R, et al., 'The FIRST2ACT simulation program improves nursing practice in a rural Australian hospital', AUSTRALIAN JOURNAL OF RURAL HEALTH, 20 270-274 (2012)
DOI 10.1111/j.1440-1584.2012.01296.x
Citations Scopus - 23Web of Science - 21
Co-authors Penny Buykx
2012 Buykx P, Missen K, Cooper S, Porter J, McConnell-Henry T, Cant R, et al., 'Emergency training boosts confidence.', Australian nursing journal (July 1993), 19 43 (2012)
Co-authors Penny Buykx
2012 Buykx P, Cooper S, Kinsman L, Endacott R, Scholes J, McConnell-Henry T, Cant R, 'Patient deterioration simulation experiences: Impact on teaching and learning', COLLEGIAN, 19 125-129 (2012)
DOI 10.1016/j.colegn.2012.03.011
Citations Scopus - 16Web of Science - 13
Co-authors Penny Buykx
2012 Scholes J, Endacott R, Biro M, Bulle B, Cooper S, Miles M, et al., 'Clinical decision-making: midwifery students' recognition of, and response to, post partum haemorrhage in the simulation environment', BMC PREGNANCY AND CHILDBIRTH, 12 (2012)
DOI 10.1186/1471-2393-12-19
Citations Scopus - 25Web of Science - 24
Co-authors Penny Buykx
2012 Buykx P, Humphreys JS, Tham R, Kinsman L, Wakerman J, Asaid A, Tuohey K, 'How do small rural primary health care services sustain themselves in a constantly changing health system environment?', BMC HEALTH SERVICES RESEARCH, 12 (2012)
DOI 10.1186/1472-6963-12-81
Citations Scopus - 14Web of Science - 16
Co-authors Penny Buykx
2012 Cooper S, Bulle B, Biro MA, Jones J, Miles M, Gilmour C, et al., 'Managing women with acute physiological deterioration: Student midwives performance in a simulated setting', WOMEN AND BIRTH, 25 E27-E36 (2012)
DOI 10.1016/j.wombi.2011.08.009
Citations Scopus - 16Web of Science - 15
Co-authors Penny Buykx
2012 Cooper S, Beauchamp A, Bogossian F, Bucknall T, Cant R, DeVries B, et al., 'Managing patient deterioration: A protocol for enhancing undergraduate nursing students' competence through web-based simulation and feedback techniques', BMC Nursing, 11 (2012)

Aims: To describe a funded proposal for the development of an on-line evidence based educational program for the management of deteriorating patients.Background: There are interna... [more]

Aims: To describe a funded proposal for the development of an on-line evidence based educational program for the management of deteriorating patients.Background: There are international concerns regarding the management of deteriorating patients with issues around the 'failure to rescue'. The primary response to these issues has been the development of medical emergency teams with little focus on the education of primary first responders.Design/Methods: A mixed methods triangulated convergent design.In this four phase proposal we plan to 1. examine nursing student team ability to manage deteriorating patients and based upon these findings 2. develop web based educational material, including interactive scenarios. This educational material will be tested and refined in the third Phase 3, prior to evaluation and dissemination in the final phase.Conclusion: This project aims to enhance knowledge development for the management of deteriorating patients through rigorous assessment of team performance and to produce a contemporary evidence-based online training program. © 2012 Cooper et al.; licensee BioMed Central Ltd.

DOI 10.1186/1472-6955-11-18
Citations Scopus - 18
2011 Rotter T, Kinsman L, James EL, Machotta A, Willis J, Snow P, Kugler J, 'Have we drawn the wrong conclusions about the value of care pathways?: Is a Cochrane review appropriate?: Response to the commentary article published by Kris Vanhaecht et al', Evaluation & the Health Professions, 1-4 (2011) [C3]
DOI 10.1177/0163278711409209
Citations Scopus - 1Web of Science - 1
Co-authors Erica James
2011 Buykx P, Kinsman L, Cooper S, McConnell-Henry T, Cant R, Endacott R, Scholes J, 'FIRST(2)ACT: Educating nurses to identify patient deterioration - A theory-based model for best practice simulation education', NURSE EDUCATION TODAY, 31 687-693 (2011)
DOI 10.1016/j.nedt.2011.03.006
Citations Scopus - 53Web of Science - 45
Co-authors Penny Buykx
2011 Cooper S, Buykx P, McConnell-Henry T, Kinsman L, McDermott S, 'Simulation: can it eliminate failure to rescue?', Nursing times, 107 18-20 (2011)

Evidence shows the management of deteriorating patients needs to be improved, particularly in midwifery care. In a series of three simulation-based studies in Australia we examine... [more]

Evidence shows the management of deteriorating patients needs to be improved, particularly in midwifery care. In a series of three simulation-based studies in Australia we examined qualified nurses', student nurses' and midwives' ability to manage patient deterioration. Nurses' knowledge levels were acceptable but their skill performance was low and there was a gap between the theory and practice they had experienced. In these high-pressure situations, demographic factors (including educational level) had no impact on their performance, which suggests they need repetitive "high-stakes" simulation, improved feedback mechanisms and enhanced educational processes.

Citations Scopus - 12
Co-authors Penny Buykx
2011 Tham R, Humphreys JS, Kinsman L, Buykx P, Asaid A, Tuohey K, 'Study protocol: Evaluating the impact of a rural Australian primary health care service on rural health', BMC HEALTH SERVICES RESEARCH, 11 (2011)
DOI 10.1186/1472-6963-11-52
Citations Scopus - 8Web of Science - 10
Co-authors Penny Buykx
2011 Martin M, Champion R, Kinsman L, Masman K, 'Mapping patient flow in a regional Australian emergency department: A model driven approach', INTERNATIONAL EMERGENCY NURSING, 19 75-85 (2011)
DOI 10.1016/j.ienj.2010.03.003
Citations Scopus - 28Web of Science - 21
2011 Cooper S, McConnell-Henry T, Cant R, Porter J, Missen K, Kinsman L, et al., 'Managing deteriorating patients: Registered nurses' performance in a simulated setting', Open Nursing Journal, 5 120-126 (2011)

Aim: To examine, in a simulated environment, rural nurses&apos; ability to assess and manage patient deterioration using measures of knowledge, situation awareness and skill perfo... [more]

Aim: To examine, in a simulated environment, rural nurses' ability to assess and manage patient deterioration using measures of knowledge, situation awareness and skill performance. Background: Nurses' ability to manage deterioration and 'failure to rescue' are of significant concern with questions over knowledge and clinical skills. Simulated emergencies may help to identify and develop core skills. Methods: An exploratory quantitative performance review. Thirty five nurses from a single ward completed a knowledge questionnaire and two video recorded simulated scenarios in a rural hospital setting. Patient actors simulated deteriorating patients with an Acute Myocardial Infarction (AMI) and Chronic Obstructive Pulmonary Disease (COPD) as the primary diagnosis. How aware individuals were of the situation (levels of situation awareness) were measured at the end of each scenario. Results: Knowledge of deterioration management varied considerably (range: 27%-91%) with a mean score of 67%. Average situation awareness scores and skill scores across the two scenarios (AMI and COPD) were low (50%) with many important observations and actions missed. Participants did identify that 'patients' were deteriorating but as each patient deteriorated staff performance declined with a reduction in all observational records and actions. In many cases, performance decrements appeared to be related to high anxiety levels. Participants tended to focus on single signs and symptoms and failed to use a systematic approach to patient assessment. Conclusion: Knowledge and skills were generally low in this rural hospital sample with notable performance decrements as patients acutely declined. Educational models that incorporate high fidelity simulation and feedback techniques are likely to have a significant positive impact on performance. © Cooper et al.; Licensee Bentham Open.

DOI 10.2174/18744346011050100120
Citations Scopus - 39
2010 Kinsman L, Rotter T, James EL, Snow P, Willis J, 'What is a clinical pathway? Development of a definition to inform the debate', BMC Medicine, 8 1-3 (2010) [C1]
DOI 10.1186/1741-7015-8-31
Citations Scopus - 176Web of Science - 147
Co-authors Erica James
2010 Cooper S, Cant R, Porter J, Sellick K, Somers G, Kinsman L, Nestel D, 'Rating medical emergency teamwork performance: Development of the Team Emergency Assessment Measure (TEAM)', RESUSCITATION, 81 446-452 (2010)
DOI 10.1016/j.resuscitation.2009.11.027
Citations Scopus - 137Web of Science - 132
2010 Endacott R, Scholes J, Buykx P, Cooper S, Kinsman L, McConnell-Henry T, 'Final-year nursing students' ability to assess, detect and act on clinical cues of deterioration in a simulated environment', JOURNAL OF ADVANCED NURSING, 66 2722-2731 (2010)
DOI 10.1111/j.1365-2648.2010.05417.x
Citations Scopus - 42Web of Science - 39
Co-authors Penny Buykx
2010 Cooper S, Kinsman L, Buykx P, McConnell-Henry T, Endacott R, Scholes J, 'Managing the deteriorating patient in a simulated environment: nursing students' knowledge, skill and situation awareness', JOURNAL OF CLINICAL NURSING, 19 2309-2318 (2010)
DOI 10.1111/j.1365-2702.2009.03164.x
Citations Scopus - 92Web of Science - 87
Co-authors Penny Buykx
2010 Tham R, Humphreys J, Kinsman L, Buykx P, Asaid A, Tuohey K, Riley K, 'Evaluating the impact of sustainable comprehensive primary health care on rural health', AUSTRALIAN JOURNAL OF RURAL HEALTH, 18 166-172 (2010)
DOI 10.1111/j.1440-1584.2010.01145.x
Citations Scopus - 16Web of Science - 15
Co-authors Penny Buykx
2010 Rotter T, Kinsman L, James EL, Machotta A, Gothe H, Willis J, et al., 'Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs', Cochrane Database of Systematic Reviews, 1-163 (2010) [C1]
DOI 10.1002/14651858.CD006632.pub2
Citations Scopus - 267Web of Science - 282
Co-authors Erica James
2009 Rotter T, Kinsman L, James E, Machotta A, Gothe H, Kugler J, 'The experience of conducting a cochrane systematic review of the impact of clinical pathways on professional practice, patient outcomes, length of stay and hospital costs', International Journal of Care Pathways, 13 62-66 (2009) [C1]

Despite the high prevalence of clinical pathways (CPWs), the results from published studies are inconsistent and contradictory. The plethora of study designs, settings and lack of... [more]

Despite the high prevalence of clinical pathways (CPWs), the results from published studies are inconsistent and contradictory. The plethora of study designs, settings and lack of an agreed definition of a CPW make the relevance of individual studies difficult to apply to clinical settings. It was timely to catalogue and analyse the existing evidence base for CPWs via a rigorous systematic review. Systematic reviews and meta-analyses provide a high level of evidence for the effectiveness of interventions and are commonly employed reviewing strategies for addressing scientific questions in health-related research. This method is especially useful when research results are known to be inconsistent. Instead of conducting another primary evaluation, a detailed review is needed that reflects a summation of available research. This paper reports and discusses methodological and technical issues of a systematic review of the effectiveness of CPWs in hospitals, based on our experience with the Cochrane Effective Practice and Organisation of Care Group.

DOI 10.1258/jicp.2009.009009
Citations Scopus - 2
Co-authors Erica James
2009 Kinsman LD, Redfern J, Briffa TG, 'Invasive management and late clinical outcomes in contemporary Australian management of acute coronary syndromes: observations from the ACACIA registry', MEDICAL JOURNAL OF AUSTRALIA, 190 162-162 (2009)
DOI 10.5694/j.1326-5377.2009.tb02324.x
2009 Briffa TG, Kinsman L, Maiorana AJ, Zecchin R, Redfern J, Davidson PM, et al., 'An integrated and coordinated approach to preventing recurrent coronary heart disease events in Australia Policy statement from the Australian Cardiovascular Health and Rehabilitation Association', MEDICAL JOURNAL OF AUSTRALIA, 190 683-686 (2009)
DOI 10.5694/j.1326-5377.2009.tb02636.x
Citations Scopus - 44Web of Science - 44
2009 Wakerman J, Humphreys JS, Wells R, Kuipers P, Jones JA, Entwistle P, Kinsman L, 'Features of effective primary health care models in rural and remote Australia: a case-study analysis', MEDICAL JOURNAL OF AUSTRALIA, 191 88-91 (2009)
DOI 10.5694/j.1326-5377.2009.tb02700.x
Citations Scopus - 35Web of Science - 39
2009 Humphreys JS, Kuipers P, Wakerman J, Wells R, Jones JA, Kinsman LD, 'How far can systematic reviews inform policy development for "wicked" rural health service problems?', AUSTRALIAN HEALTH REVIEW, 33 592-600 (2009)
DOI 10.1071/AH090592
Citations Scopus - 9Web of Science - 8
2009 Kinsman LD, Buykx P, Humphreys JS, Snow PC, Willis J, 'A cluster randomised trial to assess the impact of clinical pathways on AMI management in rural Australian emergency departments', BMC HEALTH SERVICES RESEARCH, 9 (2009)
DOI 10.1186/1472-6963-9-83
Citations Scopus - 6Web of Science - 6
Co-authors Penny Buykx
2008 Spencer P, Kinsman L, Fuzzard K, 'A critical care nurse's guide to intra abdominal hypertension and abdominal compartment syndrome', Australian Critical Care, 21 18-28 (2008)

Abdominal compartment syndrome (ACS) is a life-threatening syndrome that is increasing in incidence amongst critically ill patients. A 2005 survey of critical care nurses revealed... [more]

Abdominal compartment syndrome (ACS) is a life-threatening syndrome that is increasing in incidence amongst critically ill patients. A 2005 survey of critical care nurses revealed that there were recognised knowledge deficits of ACS amongst surveyed nurses. The purpose of this review is to inform critical care nurses about ACS and its antecedent, intra abdominal hypertension (IAH). Detection techniques, causes, clinical manifestations and pathophysiology of IAH and ACS will be outlined and medical and nursing management will be reviewed. The incidence of ACS is reported to be up to 35% in the intensive care population with reduced survival when compared to other intensive care patients. Physiological changes that occur with ACS include compromise to the cardiovascular, respiratory, renal and neurological systems and development of metabolic acidosis. Management may incorporate percutaneous drainage of ascitic fluid, use of muscle relaxants, prone positioning and surgical intervention to open, decompress and gradually close the abdomen. Throughout this care the critical care nurse should ensure accurate monitoring of organ function, assessment for recurrence of ACS as well as the amount and type of drainage, appropriate wound management and provision of physical and psychosocial support of the patient. These aspects of care have the potential to impact significantly on patient outcome. Crown Copyright © 2007.

DOI 10.1016/j.aucc.2007.10.005
Citations Scopus - 8
2008 Kinsman L, Champion R, Lee G, Martin M, Masman K, May E, et al., 'Assessing the impact of streaming in a regional emergency department', EMERGENCY MEDICINE AUSTRALASIA, 20 221-227 (2008)
DOI 10.1111/j.1742-6723.2008.01077.x
Citations Scopus - 15Web of Science - 14
2007 Champion R, Kinsman LD, Lee GA, Masman KA, May EA, Mills TM, et al., 'Forecasting emergency department presentations', AUSTRALIAN HEALTH REVIEW, 31 83-90 (2007)
DOI 10.1071/AH070083
Citations Scopus - 51Web of Science - 47
2007 Kinsman L, Tori K, Endacott R, Sharp M, 'Guideline implementation fails to improve thrombolytic administration', Accident and Emergency Nursing, 15 27-33 (2007)

Background: International randomised controlled trials conducted over the last two decades have consistently demonstrated improved mortality and morbidity resulting from thromboly... [more]

Background: International randomised controlled trials conducted over the last two decades have consistently demonstrated improved mortality and morbidity resulting from thrombolytic therapy for patients with acute myocardial infarction (AMI). Subsequently, evidence-based guidelines have been designed and implemented to optimize thrombolytic delivery. The effect of evidence-based clinical guidelines on clinical practice is heavily influenced by strategies used to develop, disseminate and implement those guidelines. Aims: This study evaluated the impact of a collaborative, multifaceted implementation strategy for AMI management guidelines on thrombolytic usage in the Loddon Mallee Region, Victoria, Australia. Intervention: The multi-faceted implementation strategy included an inter-disciplinary team representing all treating venues contributing to the content of the "Guidelines for the Early Management of Acute Myocardial Infarction" followed by education sessions that coincided with the dissemination of the guidelines. Methods: A retrospective medical records audit 12 weeks before and 12 weeks after the intervention was used to evaluate the impact on proportion of those patients eligible and receiving a thrombolytic and door-to-needle time. Variables of treating venue, age, gender, type of AMI, and type of transport to hospital were also measured to determine their impact on results. Results and conclusions: A retrospective audit of 170 medical records found that the intervention appeared to have had no impact on the proportion of patients eligible and receiving a thrombolytic (74.2% vs. 62.5%: p = 0.275), and door-to-needle time (67.7 min vs. 60.5 min: p = 0.759). Venue specific influences produced a variety of patterns in thrombolytic delivery that require further exploration. This suggests that a single solution approach across multiple venues will have limited impact. © 2006 Elsevier Ltd. All rights reserved.

DOI 10.1016/j.aaen.2006.11.004
Citations Scopus - 10
2007 Price M, Fitzgerald L, Kinsman L, 'Quality improvement: The divergent views of managers and clinicians', Journal of Nursing Management, 15 43-50 (2007)

Aim: The aim of this study was to identify and explore nurse managers&apos; and clinical nurses&apos; perceptions of quality improvement as related to their practice. Background: ... [more]

Aim: The aim of this study was to identify and explore nurse managers' and clinical nurses' perceptions of quality improvement as related to their practice. Background: The quality improvement process has become an integral component of health care service delivery. The pivotal role that nurse managers and clinical nurses play in the success of quality improvement initiatives is consistently reported throughout the literature. Published evidence has primarily focused on nurses' perceptions of 'quality' and the importance of the nurse's role. However, the literature fails to provide evidence that nurse managers and clinical nurses agree with this. Method: Research was conducted at one large regional hospital in Australia in the year 2000 and used a descriptive qualitative research methodology. Data were collected using semistructured interviews with six nurse managers and six clinical nurses on two consecutive occasions and analysed using constant comparative analysis. Results: Nurse managers' and clinical nurses' understanding of the concept of quality improvement and how it applies to the practice of nursing differed. Each group identified that quality improvement can be beneficial to nursing practice, but blamed each other for potential benefits not being realized. Both nurse managers and clinical nurses offered similar solutions with varied emphasis on how quality improvement could improve nursing practice and patient outcomes. Conclusion: The quality improvement process requires review. Nurse managers and clinical nurses offered divergent views of the identified deficiencies in the way quality improvement is implemented that reduce its clinical impact. Integral to the success of any quality improvement process is the inclusion of views of both nurse managers and clinical nurses. © 2007 Blackwell Publishing Ltd.

DOI 10.1111/j.1365-2934.2006.00664.x
Citations Scopus - 22
2004 Kinsman L, James EL, Ham J, 'An interdisciplinary, evidence-based process of clinical pathway implementation increases pathway usage', Professional Case Management, 9 184-196 (2004) [C2]
Citations Scopus - 12
Co-authors Erica James
2004 Kinsman L, 'Clinical pathway compliance and quality improvement.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), 18 33-35 (2004)

BACKGROUND: Clinical pathways have been developed to guide evidence-based practice in health care. The documented use of a clinical pathway by clinicians can be measured by chart ... [more]

BACKGROUND: Clinical pathways have been developed to guide evidence-based practice in health care. The documented use of a clinical pathway by clinicians can be measured by chart audit and used effectively as part of the quality improvement process. The application of a rigorous process of collecting data for quality improvement adds further evidence to the quality improvement process. This article describes a chart audit methodology developed and implemented to measure documented compliance with a myocardial infarction clinical pathway used in an acute hospital. CONCLUSION: The results informed a quality improvement process where documented use of the clinical pathway increased from 23 per cent to 58 per cent (p = 0.000). The chart audit methodology described was a key component in this successful quality improvement initiative.

Citations Scopus - 14
2001 Kinsman L, James EL, 'Evidence- based pathways need evidence -based implementation', Lippincott''s Case Management, 6(5) 208-219 (2001) [C1]
Citations Scopus - 6
Co-authors Erica James
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Review (1 outputs)

Year Citation Altmetrics Link
2007 Rotter T, Koch R, Kugler J, Gothe H, Kinsman L, James EL, 'Clinical pathways: Effects on professional practice, patient outcomes, length of stay and hospital costs. (Protocol)', Cochrane Database of Systematic Reviews (2007) [D1]
Citations Scopus - 95
Co-authors Erica James
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Research Supervision

Number of supervisions

Completed1
Current4

Highlighted Supervision

Commenced Level of Study Research Title Program Supervisor Type
2019 PhD Perceptions and Knowledge of a Low-Salt Diet for Preventing Hypertension Among Chinese Populations in Australia PhD (Nursing), Faculty of Health and Medicine, The University of Newcastle Principal Supervisor
2018 PhD Preventability of Hospital Readmission of COPD Patients and the Impact of Under-utilisation of Pulmonary Rehabilitation and Drug Therapy
Chidi is combining a comprehensive review of the international literature with Tasmanian hospital data and patient interviews to understand and reduce readmissions for people with COPD.
Nursing, University of Tasmania Co-Supervisor
2016 PhD Primary Health Care to Emergency, Right Service, Right Time, Right Place
<span style="font-face:Times New Roman;font-size:medium;"></span><p style="margin:0cm 0cm 8pt;"><span style="font-face:Calibri;font-size:medium;">Maria is using a sequential explanatory, mixed methods approach to understand why people with non-urgent problems attend the emergency department. The primary focus is on young adults from disadvantaged circumstances.</span></p><span style="font-face:Times New Roman;font-size:medium;"></span>
Nursing, University of Tasmania Co-Supervisor
2015 PhD Emergency Department Presentations in Tasmania, Australia: A sequential explanatory investigation
Claire used a sequential, explanatory mixed methods approcah to undertsand drivers of emergency deparytment demand in Tasmania.
Nursing, University of Tasmania Principal Supervisor

Current Supervision

Commenced Level of Study Research Title Program Supervisor Type
2017 Professional Doctorate Australian Wound Assessment, Information and Management System Study
<span style="font-face:Times New Roman;font-size:medium;"></span><p style="margin:0cm 0cm 8pt;"><span style="font-face:Calibri;font-size:medium;">Juliet plans to develop and test tools to calculate wound prevalence rates as a step towards standardising wound management and improving patient outcomes.</span></p><span style="font-face:Times New Roman;font-size:medium;"></span>
Nursing, University of Tasmania Principal Supervisor

Past Supervision

Year Level of Study Research Title Program Supervisor Type
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News

Local expertise on display at health showcase

September 20, 2018

The University of Newcastle (UON) is proud to present the Port Macquarie Health Showcase this Friday, an event bringing together the local healthcare community and leading experts in the fields of health and medicine.

Professor Leigh Kinsman

Position

Joint Chair, Professor of Evidence Based Nursing
School of Nursing and Midwifery
Faculty of Health and Medicine

Contact Details

Email leigh.kinsman@newcastle.edu.au
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