IT on the sidelines as SA proposes reshape of hospital system
The South Australian government is proposing a fundamental revamp of its hospital system, establishing super-sites for major emergencies, specialist centres for stroke and more integration of rehabilitation services.
Despite a number of large investments over the years in electronic medical records, diagnostic imaging and a new pathology system, using IT to support the proposed changes barely rates a mention in the government's Delivering Transforming Health proposals paper (pdf).
The proposals paper follows a discussion paper released in October last year and a summit held with hundreds of clinicians the following month. The paper includes 282 clinical standards of care developed by three ministerial clinical advisory committees involving the different professions, including doctors, nurses and midwives, and allied health professionals and scientists.
Health Minister Jack Snelling said the Transforming Health proposal was a recognition that there are pockets of excellence in SA but the system did not deliver consistent quality outcomes across all services and sites. He also cited cuts to promises of long-term funding to the states in last year's federal budget.
Mr Snelling said many of the 282 standards can be achieved without reconfiguring the system, “but around 50 cannot be achieved with the way our hospital system is currently set up,” he said.
“We have a responsibility to change our system so that these standards can be met because they are about improving quality and consistency of care across our system so that people receive better health care and have better health outcomes.”
Four of the standards relate to eHealth and health IT, including:
- Consumers have a right to information, data and reporting that is relevant to them. All information and test results should be shared with patients and they should be advised of all options for treatment and treatment setting
- Electronic systems should be used to track care pathways and collect information about key milestones to support audit, research and quality activities
- Information should follow the patient through the care continuum. For example, through the Personally Controlled Electronic Health Record
- Technology should be used to its maximum extent to provide more effective care when appropriate. For example, shared electronic health records, telehealth, phone or SMS follow-up, and SMS-based appointment reminders. Telehealth should be made use of to support patient assessment if distance is a potential issue.
The paper proposes that there be new super-sites for major emergencies, with the new Royal Adelaide Hospital (new RAH) becoming the major multi-trauma hospital for the state. New RAH, Flinders Medical Centre (FMC) and Lyell McEwin Hospital will all be super-sites for major emergencies and will be equipped for 24/7 access to specialists, theatres and allied health.
The emergency departments at Queen Elizabeth and Modbury will remain open to local needs but they will no longer deal with life-threatening emergencies, and Noarlunga Hospital's emergency model will transfer to a new walk-in emergency clinic dealing with urgent needs such as gastroenteritis, ear infections, bronchitis, cuts or other minor injuries.
The realignment of emergency services – and potentially longer travelling times for patients – will necessitate a revamp of the ambulance service. Mr Snelling said the plan is to hire 72 more paramedics and support staff, deploy 12 more ambulances and look at how the skills of extended care paramedics can be maximised.
Two new ‘hub-and-spoke’ ambulance stations are proposed to be built, with one located in the northern suburbs of Adelaide and one in the west, to ensure paramedics are located in the right place to get to patients quickly.
“The proposals explore options for building two new ‘hub’ stations which will help to house the new crews,” Mr Snelling said.
“The hub-and-spoke model will involve building a main ambulance station, with another ‘spoke’ location for crews to return to within the region that allows them to respond quickly to patients in the community.”
The paper argues that the new RAH, FMC and Lyell McEwin will be able to deal with a broader range of major emergencies because they will be able to have senior medical staff on site 24 hours a day, seven days a week, with coverage from the full range of medical specialties, including cardiac interventional cardiology laboratories, trauma surgery and 24-hour diagnostics and imaging services.
“Even if all the specialist equipment needed for all major emergencies was installed at every hospital, there would not be enough specialist staff available or enough complex care patients to keep their skills at an optimal level,” the paper says.
“Our existing emergency departments do not all do the same scope of care and cannot provide full 24/7 care. Differentiating the care that will be available at each hospital means that we can provide full treatment for major traumas at every hour of the day, as well as treating people with urgent but less serious health problems more quickly.”
State-wide services and elective surgery
There is also a major emphasis on stroke services, with a hyper-acute stroke unit to be built at the new RAH involving staff on site 24 hours a day. Dedicated stroke units will also remain at Lyell McEwin and FMC to provide in-hours emergency stroke services for local residents.
“Currently, the stroke pathway is not enacted overnight because the required senior staff are not on site at the hospitals,” the paper says. “Patients who have strokes before 8am cannot access a service with full specialist teams, so their treatment is delayed. A 24/7 service will save lives.”
A single statewide cardiothoracic surgical service will be created, with FMC and the RAH both providing routine cardiac and thoracic surgical services but FMC handling complex cardiac surgery and RAH focusing on thoracic services.
“These two sites will work together in a single statewide service to ensure patients are treated in the right place to receive the most expert care,” the paper says.
“There is no scope in South Australia to have more than two sites for this surgery because we must ensure specialists and their teams can perform a high volume of procedures to continuously improve and maintain their skill levels.”
The plan also calls for a realignment of elective surgery, with Noarlunga taking on single-day surgeries, Queen Elizabeth becoming a speciality centre for multi-day elective surgery procedures for patients who have complicating factors such as diabetes or obesity, and the new RAH providing a dedicated speciality elective stream for highly complex elective surgery.
Elective non-surgical therapy that is required regularly and frequently, such as chemotherapy and dialysis, will be available at many sites across the state, so it is as close to home as safely possible.
The co-location of the Women’s and Children’s Hospital and the new RAH will be accelerated, with the Women’s and Children’s becoming a centre of excellence in complex maternity, neonatal and paediatric services but also able to access more easily the adult intensive care unit at RAH.
Modbury Hospital will become a speciality eye centre, including elective surgery and ophthalmology day procedures. The paper says this will enable the state's eye specialists to share knowledge and constantly improve their service.
Comprehensive rehabilitation services is a major focus of the paper. The plan is to develop new or upgraded rehabilitation facilities at FMC, Modbury, Lyell McEwin, new RAH and Queen Elizabeth, expand rehabilitation at home services and an expanded nurse-led recuperation centre.
A single statewide model of care for orthogeriatric services will also be developed, with orthogeriatric units and integrated ward gyms for acute rehabilitation centred on Queen Elizabeth, FMC and Lyell McEwin.
The services currently provided at the ageing Repatriation General Hospital, Hampstead Rehabilitation Centre and St Margaret’s Rehabilitation Hospital will be integrated to major hospitals.
In what is certain to be a controversial move, some services for veterans will move to a new Centre of Excellence for the treatment of post-traumatic stress disorder (PTSD). The government argues that while the Repat General provides excellent services at Ward 17, the facility is old and is unsuitable for a leading PTSD service.
While the plan is for the Repat General and St Margaret's to continue providing services, the fate of the Hampstead Rehabilitation Centre is yet to be determined.
Mental health and community care
For mental health, the plan is to allow for direct admission for acute patients into a mental health bed and avoid the emergency department. Mental health clinicians will be aligned with Local Health Network boundaries to better provide community and acute care.
A new psychogeriatric ward will be created at FMC, with a nurse-led recuperation centre built to care for older people who need secondary support or those waiting for a place in a nursing home. This is hoped to relieve the problem of elderly people who are ready to be discharged from hospital but are forced to take up a bed as there is inadequate support at home or lacking a place in residential aged care.
There will also be a focus on better co-ordination of care in out of hospital services. “Although GP care is not under the jurisdiction of the state health system, it is a key component of people’s healthcare,” the paper says. “We will continue to develop ways to work better with GPs for better patient outcomes.
“There are also better ways to use services that we already have in the state system, such as Healthcare@Home, Hospital@Home, extended care paramedics and nurse practitioners. These experts can liaise directly with hospital-based services, helping people avoid unnecessary hospital visits.”
The plan calls for a $252 million investment over four years to improve the state’s health infrastructure, including $154 million for FMC, $32 million for Modbury Hospital, $20 million for Queen Elizabeth Hospital, $15 million for Noarlunga Hospital and $15 million for the PTSD Centre for Excellence.
Mr Snelling said the funding for the capital investment proposals had come from the health capital reconfiguration fund announced in last year’s state budget.
He said this fund was as a result of $655 million in cuts to health by the federal government, which caused the state government to pause the roll-out of many of its planned health infrastructure improvements, including some IT projects.
The government emphasised that no decisions have been made as yet, and final decisions will be made by government only after feedback on the proposals.
Feedback is due by Friday, February 27.
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