Metro North Hospital & Health Service

Biofabrication techniques represent a promising avenue for the production of small diameter vascular grafts. However, while current tissue-engineered vascular grafts (TEVGs) fulfil certain functional requirements of native blood vessels, most exhibit very poor mechanical compliance, directly reducing patency in vivo. Here, highly compliant TEVGs were cultured in a dynamic pulsatile bioreactor which ensured enhanced compliance, using biomimetic melt electrowritten (MEW) tubular scaffolds as substrates for tissue growth. Through 6-week in vitro culture, we investigated differences in extracellular matrix (ECM) production and mechanical performance of TEVGs cultured with placental mesenchymal stem cells (MSCs) and smooth muscle cells (SMCs) in static and dynamic conditions. Pulsatile stimulation successfully maintained the high compliance (12.4 ± 0.8 % per 100 mmHg) of our biomimetic scaffolds, substantially greater than existing small diameter grafts. Dynamic TEVGs demonstrated physiologically relevant burst pressure (1125 ± 212 mmHg) and suture pull-out force (3.0 ± 0.4 N), while also accumulating greater ECM components than static TEVGs. To assess off-the-shelf suitability, grafts were decellularized and lyophilised to produce d-TEVGs, which exhibited negligible loss of mechanics or ECM integrity. Finally, rehydrated d-TEVGs were seeded with endothelial cells in vitro, with an intimal endothelial lining forming after 7 days. These findings demonstrate the production of TEVGs with specifically engineered mechanical compliance which has been maintained by dynamic in vitro culture, supporting continued work toward biofabrication of the next generation of vascular grafts.

Digital interventions are increasingly used in outpatient diabetes care to address growing healthcare demands and workforce limitations. This study investigates the functionalities of digital solutions and their impact on Quadruple Aim outcomes: enhancing population health, improving patient experience, supporting clinician well-being, and reducing healthcare costs.

We followed Joanna Briggs Institute guidelines, searching PubMed, Embase, Cochrane, Scopus, and Web of Science (January 2019-February 2024). Included studies reported digital diabetes interventions with outcomes directly relevant to the Quadruple Aim. Each intervention was mapped to a digital solution horizon: Horizon 1 involves foundational digital workflows; Horizon 2 leverages real-time data to create analytics; Horizon 3 encompasses transformative uses, such as predictive analytics.

We identified 4,397 articles with 56 meeting the inclusion criteria. Interventions included telehealth (n = 15), mobile health (mHealth) (n = 20), combined telehealth and mHealth (n = 14), robotics (n = 1), electronic medical records (n = 1), and artificial intelligence (n = 5). Most interventions (n = 51) were categorised as Horizon 1, with 10 adopting Horizon 2, 5 using Horizon 3, and 10 spanning multiple horizons. Regarding Quadruple Aim outcomes, 44 studies addressed population health (41 positive), 31 targeted patient experience (29 positive), 4 focused on clinician well-being (3 positive), and 6 on cost reduction (4 positive).

Digital solutions have demonstrated measurable benefits, particularly in population health and patient experience. Most interventions remain at Horizon 1. Advancing these digital solutions to Horizon 2 and 3 is essential for system-wide transformation. Future research should include cost efficiency and clinician experience alongside evaluations of population health and patient experience.

This study aimed to identify the primary barriers to timely ICU admissions from the ED and to assess their impact on patient care.

Between March and June 2023, we conducted a qualitative exploratory study involving direct observations of six ICU admission processes and interviewed fourteen healthcare professionals, including intensivists, ICU and ED nurses, ED consultants, and bed managers. We employed semi-structured interviews and direct observation to analyse the adult ICU admission process, with a specific focus on delays and communication challenges between the ED and ICU.

The analysis revealed several key factors contributing to delays in ICU admissions: (1) ICU capacity constraints, particularly due to bed blocking and staffing shortages during high-acuity periods; (2) administrative delays stemming from pending diagnostic and procedural requirements; and (3) communication breakdowns between the ED and ICU teams, characterised by unclear decision-making protocols.

The study highlighted the multifaceted nature of ICU admission delays, which are influenced by limited capacity, staffing challenges, administrative bottlenecks, and communication failures. Clinicians perceived those delays in ICU admissions affected care quality, linking them to negative outcomes such as patient deterioration, prolonged recovery, higher mortality risk, and longer ICU stays. These delays significantly affect the quality of care for critically ill patients and were associated with poorer health outcomes.

To improve the timeliness of ICU admissions from the ED, it is essential to address several key issues: streamlining administrative processes, enhancing interdepartmental communication, and optimising ICU capacity and staffing levels. Hospitals should invest in systems for better bed management, improve coordination between ED and ICU teams, and minimise delays in diagnostic and procedural tasks. By overcoming these barriers, healthcare systems can improve ICU admission efficiency, enhance patient outcomes, and optimise resource utilisation.