Repat General to lose most services as SA govt commits to plan

The South Australian government has committed to closing most services at Adelaide's Repatriation General Hospital but has given in to concerns over emergency departments by retaining emergency capability at Noarlunga Hospital.

The government released a new paper yesterday outlining an initial set of decisions following the Delivering Transforming Health proposals paper released in February. That paper built on a discussion paper released last October that included a strategy to implement 282 clinical standards of care in the state's acute care services.

The government argued that 50 of those standards could not be implemented without a realignment of infrastructure and services at several hospitals and an acknowledgement that SA does not have the workforce capacity to allow all of the major hospitals to offer a full suite of services.

The February proposals paper recommended that major emergencies be handled at Royal Adelaide, Flinders Medical Centre and Lyell McEwin, but a reduction in ED capability at Queen Elizabeth and Modbury, with Noarlunga's ED to transfer to a walk-in clinic for minor injuries.

This will proceed, but the plan for Noarlunga's walk-in clinic has changed to a “community emergency department” operating 24/7, but with very serious emergencies transferred to Flinders Medical Centre. Intensive neonatal services will also remain at FMC.

Despite community disquiet over the fate of the beloved Repat, Health Minister Jack Snelling has confirmed that surgical, rehabilitation and acute medical services would relocate, along with the palliative services provided by Daw House Hospice.

The government argued in the proposals paper that while the Repat General provided excellent services to veterans in Ward 17, the building was unsuitable for its plans to build a centre of excellence for the treatment of post-traumatic stress disorder (PTSD).

"The dedicated staff at the Repatriation General Hospital work hard every day to provide patients with the very best care," Mr Snelling said. "But the reality is the current facilities were constructed in the 1940s and the buildings belong to the last century. They can't provide the spaces and equipment and layout needed for modern medical treatments."

He also said Daw House would not be able to meet the required standards as a stand-alone unit when the acute medical, surgical and rehabilitation services relocate to other sites.

"We'll work with the community, clinicians and the industry to decide on the best location for the service, and ensure the high quality care it currently delivers is continued at the new location,” he said.

Orthotics and Prosthetics SA and the chapel, museum and remembrance garden will remain on the Repat site.

Concerns over EPAS

The South Australian branch of the Australian Medical Association (AMA SA) criticised the proposals for the clinical standards in a submission last month, saying it was not clear that they were achievable or would lead to improvements.

“They are largely aspirational principles rather than true standards, i.e. desirable goals, but difficult to measure objectively,” AMA(SA) said in its submission. “Measuring success or otherwise against the proposed ‘standards’ will be meaningless: if you cannot measure it, then it is not a standard.”

It also called for the general practice sector and community health resources, particularly aged care, to be involved, and criticised the lack of mention of the health needs of rural and remote SA.

It also opposed the closure of the Repat General, saying it could potentially cause an increase of about 20 or more patients a day presenting at FMC.

Instead, the organisation wants the Repat to becoming an ambulatory care centre of excellence. “With its flat terrain, multiple access points and recent investment for rehabilitation facilities as well as developed and coordinated ambulatory care medical services, it seems foolish to waste such a potential resource,” the submission says.

One major concern is medical records and the stalled roll-out of the EPAS system. The submission says that relocating and fragmenting clinical services will have “enormous logistical implications” for medical information transfer as patients attend multiple sites for treatment.

“Multi-site record systems will be chaotic and inefficient,” it says. “The inefficiency of the EPAS system is already concerning with non-congruent medical record processes occurring within the same hospital, let alone across different sites. This poses an increased risk of harm to patients.

“Also, patients transferred from EPAS sites to non-EPAS sites (private or public) have no information about their healthcare available leading to increased risk of harm. We know the limitations of any totally discordant medical records system. With the proposed reforms, problems are likely to be compounded until this is addressed.”

Other decisions confirmed in the new paper include:

  • More than $250 million in capital investments at the metropolitan hospitals
  • Establishing three dedicated elective surgery centres, with multi-day surgery provided at The Queen Elizabeth Hospital, day surgery at Noarlunga Hospital and eye surgery at Modbury Hospital
  • Day surgery will still be performed at all other metropolitan hospitals, including Modbury, Queen Elizabeth and Lyell McEwin hospitals and FMC
  • Improved theatre capacity and efficiency resulting in releasing hospital bed capacity of between 180 and 200 beds across metropolitan hospitals
  • 80 new dedicated nurse-led restorative care beds, releasing 80 acute beds for more acutely ill patients
  • Expanding care at home to ensure patients are able to receive care at home where appropriate, freeing up more acute beds
  • Investing $15 million in increasing ambulance services, including a major increase in ambulance officers and support staff and expanding the ambulance fleet by 12 vehicles
  • A 24/7 acute stroke unit at the new Royal Adelaide Hospital, and dedicated stroke units at the Lyell McEwin Hospital and Flinders Medical Centre to provide care seven days a week
  • Integrated rehabilitation services at major hospitals, relocated from Hampstead Rehabilitation Centre
  • Admitting more people needing mental health services directly to acute beds, bypassing emergency departments
  • Investigate bringing forward planning the new Women's and Children's Hospital, so it can be collocated with the new Royal Adelaide Hospital sooner.

Clinical ambassador Dorothy Keefe said the priority was now to safely increase access to acute beds and improve patient flow through the hospitals before the new measures are implemented.

Posted in Australian eHealth

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