Queensland to review commissioning of Lady Cilento Children's

Queensland has launched an independent review into the building and operational commissioning processes of Lady Cilento Children's Hospital (LCCH) following concerns the opening of the hospital late last year was rushed.

A clinical review into the opening of the $1.5 billion hospital released last month by Children's Health Queensland (CHQ) found numerous problems with the outsourced cleaning and porterage services as well as confusion over medical records and information systems.

A lack of rubbish bins, hand cleansers and equipment not being set up were some of the biggest complaints from staff, while families complained about poor standards of cleanliness and a non-functioning cafe.

Queensland Health Minister Cameron Dick said the new review would focus on identifying lessons for future major projects. “This government will be commissioning another major hospital on the Sunshine Coast in this term of parliament so it is important that the lessons from this experience can be learned,” Mr Dick said.

CHQ's clinical report on the hospital, which was opened on November 29 and brought together staff and patients from the former Royal Children's Hospital (RCH) and Mater Children's Hospital (MCH), concluded that there was an “unparalleled level of complexity and risk” in the opening, but no serious adverse events causing long-term harm occurred on the day of the move or during the first two weeks of its operation.

However, the clinical review team – NSW chief paediatrician Les White, Cheryl McCullagh from the Sydney Children’s Hospitals Network, paediatric emergency doctor at the Children’s Hospital at Westmead, Sarah Dalton, and Jane Miller, executive director of strategy and organisational improvement at the Royal Children’s Hospital Melbourne – found there were problems with some services from private contractor Medirest.

“Examples provided included doors being left open in the mental health unit, delays in the transfer of patients to the operating theatre, wards or imaging services, and delays in cleaning beds for patients requiring admission,” the report found.

Some of the organisational problems encountered included differences in roles at the new hospital compared to the previous two, with some staff receiving written confirmation that they had been successfully appointed only on the day before opening.

Services at the Royal Children’s and the Mater needed to continue until the Lady Cilento was operational, which led to problems with staff being unable to be released for training in IT and in the new systems and processes they would need to use on the opening of the LCCH.

There were also serious problems such as a lack of experience running a switchboard. “Neither the RCH nor MCH had previously been responsible for managing their switchboard service; this service had been managed and provided by the Royal Brisbane and Women’s Hospital (RBWH) and the Mater Health Services (MHS) respectively,” the report found.

Staff were unfamiliar with the online system so it was difficult for them to use it quickly and many of the destination numbers were incorrect, and local departments did not understand how their phones were set up or should work.

In addition to combining different cultures, the two previous hospitals had different medical records systems, with RCH using a basic Cerner system, known in Queensland as the integrated electronic medical record (ieMR), and MCH using a scanned medical record. There was also confusion over the different outpatient booking systems.

“MCH records and other patient information such as outpatient appointments needed to be transferred to the Queensland Health systems used to support the integration of patient care into one site,” the report found. “This included the systems for recording and viewing medical records and clinical investigation results, the scheduling of outpatient appointments and communication to families.

“Scanning of MCH records commenced well before transition however, the process had not been completed and technical challenges migrating the outpatient data required the use of resource intensive manual processes (using multiple versions of data in spreadsheets which were manually transcribed) to transfer patient appointment information.”

While most families that made a submission to the clinical review team praised the staff and understood they were working under pressure, some noted the additional confusion caused by unfamiliar computer systems and communications. There were also issues regarding the transfer of information to the child's GP.

The report found much to be positive about, including a well-ordinated move day, staff willing to go above and beyond to avert clinical risks and manage poor patient experiences, and “excellent support from ICT and security was worthy of special mention by many groups”.

However, it found that 27 per cent of reports related to equipment. “Most of the equipment was either new to staff, not located where expected, or not set up for use on opening day. Many staff reported difficulties with the set-up of outpatients and that nothing was really ready for them to see patients, for example computers and workstations not were set up, and basic assessment equipment needed to be sourced on the first day.

“ICT support was considered very good by all, but the systems themselves were often described as highly challenging by staff. Computer access was reported to be an issue for all staff and it was noted that for staff new to Queensland Health, including those from MCH, there were a large number of new systems which required multiple log-ins.

“Some staff reported difficulties with finding their way around the integrated electronic medical record; this led to some information not being found, or being found after lengthy searches. They noted causes related to poor preparation for users, particularly MCH staff, who were not easily able to be freed up to attend training.

“Equipment set-up again was reported to create problems in many areas. Although there was very good circulated and printed information to all employees for accessing records, not all staff seemed to be aware of support resources, and some did not call for help when they could not find a record.

“In addition some had received information about charges to be applied to record requests at the MCH which led to further reluctance to seek records.”

The report found that the integration of outpatient department scheduling was disrupted due to the late transfer of information from Mater Health Services and there was a need to manually transcribe data from old systems to new. “The resolution of these issues was not clear to staff and seemed to be of continuing concern,” the report found.

“The new patient self-help and check-in systems were not consistently working adding to stress for administrative staff as queuing became an issue and waiting rooms filled.”

The report also found that there were ongoing challenges with information systems, including those associated with access to and the interface between systems. “It is noted these primarily relate to the age and functionality of statewide systems in use,” the report found.

“There is a continued lack of confidence in the referral management process and outpatient scheduling system as well as concerns over the inability of information systems to support contemporary clinical care models.

“Examples include a lack of video storage capability within the picture archiving and communication system (PACS), inability to access the RBWH PACS and inability to remotely monitor electroencephalograms (EEGs).”

Clinicians also reported a lack of confidence that the information held in electronic medical records was complete or that patient information is always available.

“A number of factors contributing to this remain unresolved including a continued lack of familiarity with using the ieMR, the inability to read all correspondence contained in a scanned MCH record due to a black banner appearing over parts of letters and the time delays in retrieving paper records for those which have not been scanned.”

The independent review will be led by the CEO of Australian Commission on Safety and Quality in Health Care, Debora Picone, along with Council on the Ageing CEO Mark Tucker-Evans and Ernst & Young's David Roberts.

Posted in Australian eHealth

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