NSW Health WSLHD Safety & Quality Account 2020-21

Our Hospitals

Goldilocks Project, Neonatal Intensive Care, Westmead Hospital Premature babies can get very cold (hypothermia) soon after birth as they do not have enough energy stores to maintain their body temperature. Hypothermia (body temperature < 36.5 degrees) in premature babies is associated with higher risk of complications such as poor feeding, risk of infection and even death. At Westmead Hospital’s neonatal intensive care unit, it was identified that > 50% premature babies born between 32+0 weeks and 35+6 weeks were hypothermic upon admission. This can lead to instability after birth, low blood sugar levels, poor feeding and need for other treatments such as IV antibiotics. To prevent preterm babies developing hypothermia, the Goldilocks Project implemented the following strategies: • Women admitted with a at risk of having preterm birth are identified early • Prior to delivery of the baby, medical staff and midwife attending the delivery ensure availability of necessary equipment. This anticipatory planning maximises the chances of keeping the baby warm • After birth, the medical staff and midwife attending the birth, follow a standard clinical pathway to ensure the baby is kept warm, including trouble shooting if the baby is getting cold • Mother-baby bonding is maximised in the birthing unit • Communication between Birth Unit and Neonatology Unit has improved to optimise patient care

Westmead maternity. Georgia Groves (mother), Jayden Groves (father) and their 12 hours old baby girl.

Osteoporosis Re-Fracture Prevention Service Leading Better Value Care Program, Department of Diabetes and Endocrinology, Westmead Hospital Osteoporotic fractures are common, painful and increase risk of death. However, once the fracture heals, very few patients receive the management necessary to prevent further fractures. The Westmead Osteoporosis Re-Fracture Prevention (ORP) program was established in 2019 with the central aim of “making the first fracture, the last fracture”. Over the last 18 months, the ORP program has screened 1000 fracture patients, diagnosing 66% of patients with osteoporosis and commencing 75% on fracture- preventing treatment. Through a partnership with the orthogeriatrics team, ORP program has treated > 100 patients with hip fracture, the most catastrophic osteoporotic fracture, improving their quality of life and significantly reducing their risk of another fracture. Previously, these patients would not have received such care, and would face a 50-60% risk of re-fracture within 5 years of initial fracture. The program has reduced morbidity for many of these patients, and a projected a reduction of 350 fracture re-presentations over the next 5 years.

Prior to the introduction of the project:

50% of babies were hypothermic on admission to the NICU

After introduction of the Goldilocks project:

on admission to NICU >90% of babies had a temperature over 36 degrees

67% had an admission temperature over 36.5 degrees

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