Closing the health gap in Central Australia: reduction in Indigenous Australian inpatient self-discharge rates following routine collaboration with Aboriginal Health Workers

Tim Cheok; Morgan Berman; Richard Delaney-Bindahneem; Matthew Phillip Jennings; Linda Bray; Ruurd Jaarsma; Pradeep Mathew Poonnoose; Kanishka Williams; Narlaka Jayasekera

doi:10.1186/s12913-023-09921-7

Closing the health gap in Central Australia: reduction in Indigenous Australian inpatient self-discharge rates following routine collaboration with Aboriginal Health Workers

BMC Health Serv Res. 2023 Aug 17;23(1):874. doi: 10.1186/s12913-023-09921-7.

Authors

Tim Cheok^{1

2}, Morgan Berman^{3

4}, Richard Delaney-Bindahneem³, Matthew Phillip Jennings^{3

5}, Linda Bray^{3

6}, Ruurd Jaarsma^{3

7}, Pradeep Mathew Poonnoose^{3

8}, Kanishka Williams³, Narlaka Jayasekera^{3

9}

Affiliations

¹ Department of Trauma and Orthopaedics, Alice Springs Hospital, 6, Gap Road, The Gap, Northern Territory, 0870, Australia. tim.cheok@flinders.edu.au.
² Department of Orthopaedic Surgery, Palmerston North Hospital, 50, Ruahine Street, Roslyn, Palmerston North, 4414, New Zealand. tim.cheok@flinders.edu.au.
³ Department of Trauma and Orthopaedics, Alice Springs Hospital, 6, Gap Road, The Gap, Northern Territory, 0870, Australia.
⁴ Department of Orthopaedic Surgery, Monash Medical Centre, 246, Clayton Road, Clayton, Victoria, 3168, Australia.
⁵ Department of Plastics and Reconstructive Surgery, Bendigo Base Hospital, 100 Barnard Street, Bendigo, VIC, 3350, Australia.
⁶ Aboriginal Liaison Services, Alice Springs Hospital, 6, Gap Road, The Gap, Northern Territory, 0870, Australia.
⁷ Department of Orthopaedic Surgery, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia.
⁸ Department of Orthopaedic Surgery, Christian Medical College Hospital, IDA Scudder Road, Vellore, Tamil Nadu, 632004, India.
⁹ Department of Orthopaedic Surgery, Wairau Hospital, Hospital Road, Blenheim, 7201, New Zealand.

Abstract

Background: Indigenous Australians experience significant socioeconomic disadvantage and healthcare disparity compared to non-Indigenous Australians. A retrospective cohort study to describe the association between rates of self-discharge in Indigenous orthopaedic patients and the introduction of routine Aboriginal Liaison Officers (ALO) within the Orthopaedic multi-disciplinary team (MDT) was performed.

Methods: ALO were introduced within our routine Orthopaedic MDT on the 22^nd of February 2021. Two patient cohorts were analysed, Group 1; patients admitted in the 9-months prior to inclusion of ALO, and Group 2; patients admitted within 9-months thereafter. The primary outcome of interest was the rate of self-discharge among Indigenous patients. Secondary outcomes of interest were the stage of treatment when patients self-discharged, recurrent self-discharge, risk factors for self-discharge and association between self-discharge and length of hospital stay.

Results: Introduction of ALO within routine Orthopaedic MDT was associated with a significant 37% reduced risk of self-discharge among Indigenous patients (p = 0·009), and significantly fewer self-discharges before their definitive surgical and medical treatment (p = 0·0024), or before completion of postoperative intravenous antibiotic treatment (p = 0·030). There was no significant change in the risk of recurrent self-discharge (p = 0·557). Risk factors for self-discharge were younger age; pensioners or unemployed; residents of Alice Springs Town-Camps or of communities within 51 to 100 km of Alice Springs; and those diagnosed with lacerations of the upper limb, but without tendon injury, wound and soft tissue infections or osteomyelitis. In Group 2, the odds of self-discharge decreased with increased length of hospital stay (p = 0·040).

Conclusions: Routine inclusion of ALO within the Orthopaedic MDT reduced the risk of self-discharge in Indigenous patients. Those who self-discharged did so only after critical aspects of their care were met.

Keywords: Indigenous health; Orthopaedics; Self-discharge; Surgery.

MeSH terms

Australia / epidemiology
Australian Aboriginal and Torres Strait Islander Peoples*
Health Services, Indigenous*
Hospitalization
Humans
Inpatients
Orthopedics / statistics & numerical data
Patient Care Team
Patient Discharge
Patient Dropouts*
Retrospective Studies