The number of Aboriginal people from remote locations admitted to Flinders Medical Centre (FMC) has grown steadily over the past decade. However, significant gaps in the patient care provided for this group have resulted in a high incidence of patient ‘no shows’ and cancelled surgery due to poor patient preparation. This research aimed to provide advice on enhancing clinical and cultural aspects of the trajectory of care by documenting the experiences and perspectives of a group of Aboriginal cardiac patients admitted to FMC. The research looked at the entirety of patients’ journeys from their homelands to FMC and then the return journey to their homelands. The research particularly considered surgical consenting processes, Aboriginal peoples’ understanding of their heart conditions and surgery-related issues including their cardiac medications, as well as the nature of interpersonal skills and delivery of culturally safe care by nurses and doctors throughout their stay in Adelaide.
The key finding from this project is that effective intercultural communication and liaison between primary and tertiary settings improves remote area patient access to care and outcomes by ensuring psychological preparation for surgery and post-operative recovery, as well as medication management and dental fitness for surgery, informed consent, and the transferring and sharing of knowledge. Outcomes delivered so far include:
- A permanent remote clinical/cultural nursing liaison service has been established within the FMC’s clinical unit, which has delivered improved intercultural communication and liaison between primary and tertiary settings, reduced ‘no shows’, improved care, and better outcomes for patients.
- Reduced travel costs and the incidence of unnecessary travel for Aboriginal cardiac patients and their carers.
- Improved efficiencies and cost savings at the hospital site.
- Strong support from the Australian Nurses Federation, which has called for a wider national application of the remote area nurse liaison model to ‘close the gap’ in Indigenous health outcomes across a variety of chronic conditions, in consultation with Indigenous communities.
- Proposed improvements to the States’ Patient Assistance Transfer Schemes (PATS), which resulted from a submission by the Project Leader to a 2007 Commonwealth Senate Inquiry into PATS.
Researchers used an action research approach, incorporating both a literature review and a series of case studies on Aboriginal cardiac patients admitted to FMC over a six-month period. The patients were interviewed and the audio recordings used to analyse patients’ experiences. In early 2007 a pilot Remote Area Liaison Nurse position (currently FTE .4) was trialled at FMC and established that a nurse-led clinical/cultural model of care resulted in improved patient care, coordination, communication and management of cultural diversity.
Lawrence, M. with Dodd, Z., Mohor, S., Dunn, S., de Crespigny, C., Power, C. & MacKean, L. 2009, Improving the Patient Journey: Achieving Positive Outcomes for Remote Aboriginal Cardiac Patients PDF [1.4MB], CRCAH, Darwin.
- Monica Lawrence 2007, Submission to Inquiry into the operation and effectiveness of Patient Assisted Travel Schemes (PATS) PDF [90KB] plus Attachment 1 PDF [134KB] and Attachment 2 PDF [37KB]
- Aboriginal Patient Journey Mapping Tools
- Improving the Patient Journey Policy Brief PDF [959KB]
- The cardiac patient journey for Aboriginal and Torres Straqit Islander people timeline brochure PDF [479KB]
- Media Release 15 June 2009 PDF [88KB]
- NSW Nurses Association media release: Nurses Applaud Positive Indigenous Health Initiatives On Close The Gap Day (14 April 2008)
- Story in CRC for Aboriginal Health 2007–2008 Annual Report PDF [3.0MB], pp. 24–5.