University of Sydney Business School

Transfer of medication information from intensive care units (ICUs) to general wards is error prone. Additional challenges emerge in hospitals where a different electronic medical record (eMR) is used in ICU and wards. Digital transfer systems, that support information transfer between different eMRs, could minimise errors, but limited research has evaluated these. We aimed to 1) determine the impact of eTOC, a medication transfer system, on medication errors and potential patient harms that occur during ICU-to-ward transfers, 2) to determine frequency of eTOC use post-implementation, and 3) explore how eTOC is used and viewed by clinicians.

A mixed methods approach was used at one metropolitan and one regional hospital in NSW, Australia. Part 1 comprised a pragmatic pre-post chart-review study (n = 200 patient transfers) and Part 2 used a qualitative approach, including usability testing (n = 4) and semi-structured interviews with clinicians (n = 11).

Implementation of the eTOC system did not significantly reduce the number of transfers containing an error (51 % vs 46 %, pre-post). Although the use of eTOC more than halved the odds of a medication error occurring (OR: 0.44, 95 %CI: 0.27-0.71), the system was inconsistently used. Interviews and usability testing revealed that barriers related both to system design/configuration and to the context of use and organisation (e.g., time pressure) impacted uptake of eTOC.

There is significant potential for technology to support transfer of medication information from ICU to the ward and improve safety if technology is designed well and aligns with how work is done in practice.

Bleeding events are common during the provision of Venoarterial ECMO (VA ECMO). Previous observational has suggested that these bleeding events are associated with an increased risk of in-hospital mortality however data on long term mortality and functional outcomes are lacking.

This multi-centre prospective observational study included patients enrolled in the EXCEL registry from February 2019 until June 2023. We collected baseline demographics, and details of ECMO support. The primary outcome was a composite of death or new disability (defined as an increase of ≥10%. in the world health organization disability assessment schedule score) at 180 days after ECMO initiation. We used multivariable logistic and quantile regression adjusted for illness severity and patient characteristics and diagnosis to assess the association of bleeding with death and new disability and other functional and clinical outcomes.

The final study cohort included 704 participants, median [interquartile range IQR] age 54.5 [42 to 64] years and 259 (36.8 %) were female. Bleeding complications occurred in 312 (44.3 %) participants and 154 (22.3 %) had major bleeding. Patients with bleeding complications were more often receiving VA ECMO for peri-operative support [112 (36.4 %) vs (73 (19.3 %), p < 0.001). Patients who experienced bleeding complications were at significantly increased risk of the primary outcome at 6 months risk difference (RD) 8.95 % (95 % CI: 1.62 to 16.14). However, this finding was due to a significantly increased risk of new disability- adjusted RD 18.04 % (95 % CI: 6.22 to 29.55) rather than an increased risk of mortality in patients with bleeding compared to no bleeding [adjusted RD 5.71 % (95 % CI: -1.55 to 13.01)]. Patients with bleeding complications were also associated with an increased use of healthcare resources such as ICU length of stay and renal replacement therapy.

Bleeding increased the rate of death and disability at 6-months, but this was driven by increased disability rather mortality. Bleeding complications were associated with an increased use of healthcare resources. Prospective studies to address modifiable risk factors for bleeding complications are warranted.

Digital health technologies in aged care show promise for improving care quality and efficiency, yet implementation failure rates remain high. Understanding factors influencing successful adoption is critical for healthcare organisations.

To systematically review and synthesise the literature on health care professionals' experiences with adopting and implementing digital health solutions in Australian aged care settings, and to develop an evidence-based conceptual framework to guide future implementation strategies.

A scoping review was conducted, searching multiple databases from 2000 to 2025 including PubMed, Web of Science, and Scopus. Studies examining digital health technology implementation in aged care were included. Data extraction focused on implementation factors, user experiences, and outcomes. A conceptual framework was developed through thematic synthesis.

48 studies were included, representing diverse technologies across residential, community, and home care settings. Five key implementation domains emerged: user-related factors (digital literacy, attitudes, training), organisational factors (leadership support, workflow integration, resources), technological factors (usability, interoperability, support), contextual factors (regulatory environment, geography, care setting), and implementation processes (stakeholder engagement, change management, ongoing support). User experience analysis revealed five critical areas: efficiency, quality/safety, satisfaction/adaptation, communication/collaboration, and technical challenges. Implementation success was found to depend on establishing continuous learning environments rather than relying on discrete training events. Geographic disparities were evident, with rural facilities facing additional infrastructure challenges.

Successful digital health implementation requires simultaneous attention to user, organisational, technological, and contextual factors. The framework emphasises development of a continuous learning environment with comprehensive training, leadership support, workflow compatibility, and sustained technical assistance. Future implementations should prioritise user-centred design, continuous stakeholder engagement, and recognition of contextual variations, particularly geographic disparities.