NSLHD News May 03


Main story Short blurb Kolling Institute researchers instrumental in Australian first guidelines

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Research aiding osteoarthritis care Page 5

NSLHDs’ initiatives for a Greener Future Page 4


Message from the chief executive Adjunct Professor Anthony M. Schembri AM

Dear colleagues, As we celebrate Administrative

and for staff who work in category A roles, working with vulnerable patients, they need to ensure they comply with NSW Health’s vaccination requirements. You can find more information about the 2024 vaccination program on the intranet. I would like to thank everyone who has already received their vaccine for playing a role in keeping our patients, colleagues and community members safe this winter. The district is currently seeking feedback on the draft version of the NSLHD Clinical Services Plan 2024-2029, which can be viewed via the following link: https://bit.ly/ draft-CSP-NSLHD. The Clinical Services Plan is a strategic document that outlines the priorities and service direction for the district over the next five years. It focuses specifically on the issues that affect the health of our catchment population and the delivery of our health services. It has been in development throughout 2023-2024 in collaboration with clinical networks, service directors, hospital and LHD executives, and service partners. Anyone is welcome to provide feedback and you can do so by visiting this link: https:// bit.ly/CSP-feedback. Warm regards, Adjunct Professor Anthony M. Schembri AM Chief Executive Northern Sydney Local Health District

Professionals Day (3 May) I would like to take the opportunity to recognise and thank all of our wonderful administrative staff from across our district. Our administrative staff work very hard and provide a huge amount of support to our departments, executive teams and the staff members they assist. They play a large role in helping our district deliver high quality care to our patients and community and are very much appreciated. I was pleased to attend the launch this week of the new NORTH Foundation fundraising campaign which aims to raise more than $55 million for clinical trials across the district. The three-year campaign is aimed at expanding our trial capacity, and positioning us as a national and international hub of clinical trial excellence. The campaign follows the $20 million donation from Kay Van Norton Poche and her husband Greg for a cancer clinical trials centre, and will significantly strengthen our clinical trial activity across all health disciplines. The NORTH Foundation has also launched the annual end of financial year tax appeal. If you or someone you know is interested in helping to raise funds via a tax-deductible donation, please visit https://bit.ly/4aOJZFk. As we move into winter, the 2024 influenza vaccination program has started for all healthcare workers across the district. It is important for everyone to consider receiving the annual influenza vaccination,



Jerry Yu, Michelle Shiach-Wise, Dr Pearl Wang, Thelma De Lisser Howarth, Mark Zacka at the Human Experience Week presentation

NSLHD’s Virtual Care Revolution Northern Sydney Local Health District Virtual Care and Hospital in the Home Service is helping hundreds of patients avoid emergency departments by providing expert clinical assessment and medical care closer to home. The ED Alternative Referral Pathway established at NSLHD in 2022 has proven to be successful in improving patients’ experience and easing the burden on busy emergency departments.

critical patients.” Patients who dial Triple Zero, who are not suffering an emergency episode, meet a strict criteria and live within the NSLHD catchment area, can be referred to the NSLHD Virtual Care Service (virtual hospital) by NSW Ambulance. They can be triaged by paramedics either over the phone or at the scene. If their condition is determined to be non-life-threatening, they are directly connected to a team of doctors and nurses. Jerry said depending on the patient’s condition, a paramedic may have already started treatment such as providing IV antibiotics, prior to a nurse attending who will go directly to the person’s home. As part of NSLHD ED Alternative Services, many patients are treated through the Virtual Care and Hospital in the Home Service which provides care by a team of medical, nursing and allied health staff, and follow up with the patients through telehealth. “Our aim is to build a single front door to acute and urgent care services for patients who can call through and depending on the acuity of their condition, can receive care virtually, or be referred to one of clinics, and not need to go through emergency departments,” Jerry said. NSW Health celebrated Human Experience Week (29 April to 3 May) which recognises the opportunities where staff can make a positive impact to the lives of everyone who comes in contact with NSW Health.

Since April 2022, over 300 patients have avoided a trip to an emergency department and received treatment at their home or have been treated by a team of medical and nursing staff through video consultations from the virtual hospital. Its success was celebrated at the recent NSLHD Elevating Human Experience Forum, where patients gave their first-hand accounts of using the service. NSLHD Virtual Care and Hospital in the Home Service General Manager Chenyao (Jerry) Yu said the ED Alternative Pathway was a great example of how our health system is putting patients first and finding new ways to care for people. “The ED Alternative Pathway saves a person a trip to the emergency department, and they can receive care straight away,” he said. “Patients who have used the pathway like it because they receive the care in the comfort of their own homes, and this frees up our clinicians in ED to treat the really urgent and



NSLHD’s Initiatives for a Greener Future Northern Sydney Local Health District (NSLHD) is making significant strides in promoting environmental sustainability and reducing its carbon footprint through the implementation of energy efficiency initiatives. Spearheading these efforts is Anna Jamison, Sustainability Projects Manager at NSLHD.

from all across the district to achieve a shared goal is truly rewarding,” NSLHD aims to increase on-site solar production by an additional 2.3 MWp by 2035 and improve energy efficiency of buildings to progress towards a 30 per cent reduction in energy consumption by 2030. This includes our LED upgrades, electrification of assets and phase out of high GWP refrigerants - a focus in the new Planetary Health Framework. “These targets underscore our district’s commitment to environmental sustainability and leadership in promoting energy efficiency within the healthcare sector,” she said.

In 2024, NSLHD has achieved remarkable progress in harnessing clean, renewable power, with key statistics highlighting the district’s commitment to sustainability. Currently, NSLHD boasts a combined solar photovoltaic (PV) system size of 1.3 MWp, and the combined solar production from January to April 2024 amounted to 457.43 MWh. Looking ahead, NSLHD has ambitious plans to further enhance its energy efficiency initiatives through upcoming projects. These include the installation of solar PV at Dalwood Child and Family Health Centre to be completed by the end of June 2024, planning for solar expansion at Mona Vale Hospital and the continuation of district LED lighting upgrades in the next financial year. “Since 2020, the district has been at the forefront of harnessing clean, renewable power at multiple sites, aiming to reduce reliance on grid electricity as a significant source of greenhouse gas emissions. Solar PV systems have been successfully installed at various NSLHD sites, including Hornsby Ku- ring-gai, Royal North Shore, and Mona Vale hospitals, Manly Adolescent and Young Adult Hospice and Brookvale Community Health Centre,” said Anna. In 2023 alone, the combined solar production at these sites exceeded 1.3 GWh, resulting in cost savings of over $250,000 and a carbon saving of 1,027,000 kg CO2 for the year. “Implementing strategies to promote both environmental and financial sustainability within the organisation is one of my favourite aspects of my role. Working alongside staff

Anna Jamison


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Dr Leo Pan conducting a scan northern-sydney-local-health-district



Dr Jillian Eyles

Research helping the community tap into the best osteoarthritis care While a large share of the community

to traditional referral pathways. “There is an urgent need to reduce the use of treatments that are not recommended such as unnecessary surgical procedures, and we will be working with surgeons to gain a better understanding around the existing pathways,” As part of this grant, Jillian will also be looking at new ways to educate and train the health workforce to deliver best-evidence care, and will be working to improve the uptake of programs which offer best- evidence models of care. This will involve phasing-out low-value osteoarthritis treatments. “A large amount of research has made considerable progress in recent years, and its crucial that this new advice and understanding of the joint disease is broadly incorporated into both the hospital and community settings,” she said. “Over eight per cent of Australians lives with osteoarthritis, so it’s important everyone has good access to the best available advice and treatment.”

experiences osteoarthritis, many people are not receiving the latest, evidenced-based care leaving them with poorer and more painful outcomes. Health and government bodies are working to address the shortfall, investing resources to increase awareness of high-value care. As part of this national approach, Kolling Institute researcher and physiotherapist Dr Jillian Eyles has received a prestigious $660,000 NHMRC investigator grant to promote best-practice osteoarthritis care. Dr Eyles said experts know that the first-line approach for osteoarthritis involves non- surgical treatments based on education, self- management, exercise and weight control. “This approach works well for many people and is consistently recommended by the clinical guidelines, and yet 64 per cent of people with osteoarthritis are not offered these treatments,” she said. “We can see there are many barriers to delivering the best care from a lack of knowledge and skills of health professionals



Digital technology to support those with long-standing pain Researchers based at the Kolling Institute have

“We are now enrolling participants in a randomised control trial to test if the intervention leads to a greater reduction of their opioid dose.” You can join the study from anywhere in Australia where you have access to a phone network and the internet. If you would like to participate go to https:// www.support4pain.org/

launched a clinical trial using digital health technology to help those with chronic pain reduce their use of opioids. Chief investigator and leading pain specialist at Royal North Shore Hospital Professor Paul Glare said many people with chronic pain were using opioid medications long-term, but research showed that in many cases, these medications are doing more harm than good. “We know that reducing the use of opioids not only minimises harm, but also leads to improvements in pain and quality of life,” he said. Paul said many people who have been on long term opioids for pain find reducing their dose a daunting prospect, and unfortunately, many of them don’t have much social support either. As part of the clinical trial, participants will watch a video about pain and opioids and receive text messages, while their opioid medication dose is reduced under the supervision of the prescribing doctor. “The aim of this study is to see if we can provide more support via their mobile phone to make tapering easier,” he said. “The clinical trial follows a pilot study which showed that patients’ confidence to reduce their reliance on opioids improved when they received text messages. “It also found their pain reduced, and their mood and functioning was better.

Professor Paul Glare

269 million people to experience neck pain by 2050 New research led by investigators from the Kolling Institute has identified a concerning global trend which will see the burden of neck pain dramatically increase over the next 30 years.

“Concerningly, the projections indicate a 32 per cent increase in cases between 2020 and 2050, bringing the total number of cases of neck pain to 269 million,” he said. “This will lead to a tremendous burden on health systems across the globe, as well as a significant individual toll. “We know that neck pain has a considerable economic, social and personal cost, and we would like to see more effective interventions introduced on a large scale. “Currently, there is no gold standard diagnostic test for neck pain, no known pathophysiology and no universally effective treatment for it. “We need to shine a light on the condition and drive new technology, new assessments and new management options that are economically viable, effective and broadly available. “We hope that following this historic research there will be a renewed commitment to improving our understanding of the different causes and risk factors for neck pain.”

The research analysed data from more than 200 countries and measured the prevalence of neck pain from 1990 to 2020. It found 203 million people now experience neck pain across the globe, a figure which has remained stable over the last 30 years and not improved. More women than men live with neck pain, while the condition primarily affects people between 45 years and 74 years. Investigators say the evidence suggests a range of factors from muscle strains, work or sports related events through to degenerative conditions like osteoarthritis, car accidents, or neurological issues are contributing to the painful condition. Lead author and Kolling Institute Academic Director Professor James Elliott said the data points to a sharp rise in expected cases due to a rapidly ageing global population.



Kolling Institute researchers instrumental in Australian first guidelines

and former Royal North Shore Hospital specialist Professor Michael Cousins AO has been remembered, following his passing recently. Michael was a trailblazer in anaesthesia and pain medicine, and a mentor to many on the RNSH campus. With a career spanning more than 50 years, Michael dedicated his life to helping others through pain management and better care. He changed the way that Australia managed pain believing that access to pain management was a fundamental human right. He instigated change not only in Australia, but on a global scale. Michael designed Australia’s National Pain Strategy, and was a founding member of peak Australian pain advisory bodies and academic faculties. In 1995, he was made a Member of the Order of Australia. Michael was instrumental in the establishment of RNSH’s Pain Clinic and the Kolling Institute’s Pain Management Research Institute (PMRI). This multidisciplinary centre is internationally regarded for its clinical care, teaching and research. In 1998, the institute was recognised as one of only eight national Centres of Clinical Excellence in hospital-based research, and in 2012, it was named the lead site for pain research in the state by the NSW Ministry of Health. Two researchers from the John Walsh Centre for Rehabilitation Research have developed the first clinical practice guidelines for physiotherapists to inform the care of people with life-changing spinal cord injuries. Physiotherapy is a key part of rehabilitation for people with a spinal cord injury, but until now, there has been no nationally consistent advice based on the best available evidence. The guidelines were driven by A/Professor Joanne Glinsky and Professor Lisa Harvey, who worked with a team of physiotherapists, researchers, and people with a spinal cord injury across Australia and New Zealand. Lisa said the recommendations provide up- to-date information on the most effective physiotherapy management. “Importantly, they are based on a rigorous evaluation of the available evidence, taking into account the opinions of clinical experts and people with a spinal cord injury,” she said. “We started the process by identifying over 100 clinical questions of importance to physiotherapists and those living with

Today, it continues to support the community, delivering world leading research and improvements in care. Current PMRI Director Professor Paul Glare said he first met Michael in the early 1990’s and worked alongside him in an academic capacity. “Little did I know at the time that I would replace him as Chair of Pain Medicine and be the beneficiary of the incredible academic legacy he left here in Northern Sydney,” he said. “His passing is an injury, and each question was ultimately answered by way of an evidenced-based recommendation or a consensus statement.” A/Professor Glinsky said we followed a very detailed and rigorous process with many meetings, discussions and reviews of the evidence. “It is this process that should give people confidence in the recommendations of the guidelines,” she said. Lisa added that the work was only possible with the initial financial support from icare in NSW, and the support from organisations throughout Australia including the Transport Accident Commission, the National Insurance Scheme Queensland and the Lifetime Support Authority. “Their support for this important piece of work was critical to our success. We are tremendously grateful they shared our vision to create these first Australian recommendations,” Lisa said. The guidelines can be viewed at www. SCIPTguide.org

VALE PROFESSOR MICHAEL COUSINS AO The remarkable life of pain medicine pioneer

very sad for all of us in the Michael J Cousins’ Pain Management Research Institute. “I would like to recognise his truly incredible efforts to lift standards of care and improve the management of pain across Australia and internationally.”

Professor Michael Cousins AO



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