Sandra Brownlea , staff specialist in the emergency department at Royal Darwin Hospital in Australia, identified inequitable and culturally unsafe care for frequent emergency department attenders, particularly Aboriginal and Torres Strait Islander patients. Social complexity was often addressed through a biomedical lens, leaving patients exposed to stigma and systemic racism. In 2023, attendance at the International Forum on Quality and Safety in Healthcare in Melbourne provided a practical framework to address these challenges. Plenary sessions and case studies on co-design, consumer partnership, equity-focused service redesign, and workforce wellbeing demonstrated how frontline clinicians can implement context-specific interventions to improve outcomes and reduce avoidable emergency presentations. Building on these insights, Brownlea and colleagues secured Medical Research Future Fund support to pilot a culturally informed, patient- centred case support programme. Led by an Aboriginal health practitioner and grounded in co-designed care plans, early results were promising: emergency department attendance at Royal Darwin Hospital fell by 50%, 94%, and 84%; total admission bed days dropped from 27 to 9; and discharges against medical advice decreased from nine to one. Co-designing safer emergency care From international learning to local change
Attending the International Forum on Quality and Safety in Healthcare gave me insight into the value of co-design methodology and involving consumers, and also the value of workforce wellbeing and how all of those things can intersect and improve outcomes. Sandra Brownlea Staff specialist, emergency department, Royal Darwin Hospital, Australia
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