august 2012 - australian private hospitals association · august 2012 policy patter quality ......
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THE OFFICIAL MAGAZINE OF THE
AUSTRALIAN PRIVATE HOSPITALS
ASSOCIATIONAugust 2012
POLICY PATTERQUALITY IN FOCUS LEGAL MATTERSPHARMACYFOCUS
Private hospital Private hospital infrastructure
TRAINING TOMORROW’S WORKFORCE WORKFORCE The San is building a
new education centre
SURGICAL GUIDANCEGUIDANCEGreater accuracy
in cataract surgery
PAPERLESS LEARNING
Creating a flexible learning environment
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Material in Private Hospital is protected under the Commonwealth Copyright Act 1968. No material may be
reproduced in part or in whole without the written consent from the copyright holders (APHA).
Private Hospital welcomes submissions and a diversity of opinion on hospital-related issues and will publish views
that are not necessarily the policy of the APHA. All material must be relevant, cogent, submitted to APHA
and accompanied by a stamped self-addressed envelope, or submitted electronically by emailing
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Neither APHA, Globe Publishing or their servants and agents accept liability, including liability for negligence,
arising from the information contained in Private Hospital.
Private Hospital is published six times a year (February, April, June, August, October and December)
as a joint undertaking between the Australian Private Hospitals Association Ltd (ACN 008 623 809) and
Globe Publishing (ACN 116 377 354).
APHA Office: Level 3, 11 National Circuit, Barton ACT 2600
Postal Address: PO Box 7426, Canberra BC ACT 2610
Phone: (02) 6273 9000 Fax: (02) 6273 7000Email: [email protected]
Website: apha.org.auGlobe Publishing: Suite 3.15, 22-36 Mountain Street,
Ultimo NSW 2007 Postal Address: PO Box 57, Glebe NSW 2037Phone: (02) 8218 3400 Fax: (02) 8218 3488
Website: globepublishing.com.auAdvertising Enquiries: Adam Cosgrove
Phone: (02) 8218 3412Email: [email protected]
THE OFFICIAL MAGAZINE OF THE
AUSTRALIAN PRIVATE HOSPITALS
ASSOCIATIONAugust 2012
POLICY PATTER QUALITY IN FOCUS LEGAL MATTERSPHARMACYFOCUS
Private hospital Private hospital infrastructure
TRAINING TOMORROW’S WORKFORCE WORKFORCE The San is building a
new education centre
SURGICAL GUIDANCEGUIDANCEGreater accuracy
in cataract surgery
PAPERLESS LEARNING
Creating a flexible learning environment
Platinum Associate MembersOrion Health
Gold Associate Members3M HealthcareActive Partners in Health SolutionsAvant Insurance LimitedB. Braun Australia Pty LtdBMDi TUTA Healthcare Pty LtdCcentric Group Pty LtdCoregas Pty LtdGlobal-Mark Pty LtdHealth Industry PlanHolman Webb LawyersHPS PharmaciesJohnson & Johnson MedicalKnight Frank AustraliaLeighton Contractors Pty LtdMedline International Two Australia Pty LtdMedtronic Australasia Pty LtdNexa Group Pty LtdUnique Care Pty LtdVirginia Rigoni Consulting Pty Ltd
Associate MembersAdvanced Computer Software Supplies Pty Ltd Australian Health Services AllianceBard Australia Pty LtdDepartment of Veterans’ A¢ airsGE Healthcare AustraliaH Polesy & Co Pty LtdHealthcare Management Advisors Pty LtdHerring Health and ManagementServices Pty LtdHome NursesMeditech Australia Pty LtdMerrill Lynch AustraliaMetrofi re Pty LtdNoarlunga Health ServicesNursing AustraliaQueensland X-RayRegal Health ServicesSiemens HealthcareSunway Medical Centre BerhadSuters Architects Pty LtdSuva Private HospitalTransport Accident CommissionWillow Pharmaceuticals Pty Ltd
Diamond Sponsor:
Major Sponsors:
Australian Private Hospitals AssociationChief Executive Offi cer: Michael Ro¢ Director, Policy & Research: Lucy Cheetham Director, Communications & Marketing & Editor: Lisa RamshawCommunications Offi cer: Rebecca Angove
APHA National CouncilSteve Atkins Healthe Care Australia Henry Barclay Cura Day Hospitals GroupMichael Coglin Healthscope Robert Cooke HealthscopeAlan Cooper Friendly Society Private HospitalAnne Crouch Eye-Tech Day SurgeriesAndrew Currie Healthscope Philip Currie Sydney Adventist HospitalRobert Cusack St Vincent’s Private HospitalRay Fairweather St Andrew’s Toowoomba HospitalChristine Gee Toowong Private HospitalAlan Kinkade Epworth HealthCareMoira Munro Perth ClinicCraig McNally Ramsay Health CareKathy Nagle Western HospitalAmanda Quealy Hobart ClinicChris Rex Ramsay Health CareRichard Royle UnitingCare HealthGeoff Sam Healthe Care AustraliaDaniel Sims Ramsay Health CareDr Mark Stephens Chesterville Day HospitalDenise Thomas Metropolitan Rehabilitation HospitalGeorge Toemoe PHA NSWStephen Walker St Andrew’s Hospital
Australian Private Hospitals Association
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18 Educating for the future The San is building a new
education centre
22 World-leading cardiac imaging system
Now at St Andrew’s War Memorial Hospital
25 The Gosford Heart Centre opens
Providing new services for the Central Coast
26 Improving cataract surgery
At Hunter Valley Private Hospital
29 Cairns ready for action State-of-the-art theatre
redevelopment to open
30 Plan for a stronger Epworth HealthCare
Expanding rehabilitation services across Victoria
32 Growth for Healthscope hospitals
Queensland hospitals undergo significant growth
35 Advanced cardiac services for Bundaberg
The Friendly Society Private Hospital expands
38 Prompt cardiac diagnosis
The Avenue Hospital opens new diagnostic services
41 Paperless learning gets high marks
Training is easier at Macquarie University Hospital
45 Sunshine Coast University Hospital
On track for completion in late 2013
46 The hospital of the future Building Australia’s first
digital hospital
48 Partnership to improve Hunter cancer care
Lake Macquarie Private Hospital and GenesisCare
06 Editor’s Letter With Lisa Ramshaw
08 President’s Report With Chris Rex
10 As I See It With Michael Roff
12 News From APHA and beyond
56 Policy Patter With Lucy Cheetham
58 Quality in Focus With Christine Gee
60 Pharmacy Focus With Michael Ryan
62 Legal Matters With Alison Choy Flannigan
65 Since the Last Issue
67 Valuing Private Hospitals
70 On The Ground With Phil Currie
2218August 2012
51 Into the Crystal Cave Greenslopes ED’s extreme
experience
54 A novel solution for lymphoedema
Using liposuction to help breast cancer patients
Also in this issue
In focus: Infrastructure Regulars
Contents
41
5135
P.S. Have you checked out
our Facebook page lately?
We love to see your hospital
posts on our page. Check
it out at facebook.com/
valuingprivatehospitals.
6 August 2012
Editor’s Letter
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Chr
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INFRASTRUCTURE is the backbone upon which our health system is built. Without new infrastructure and facilities, Australia will not be prepared for the infl ux of patients
predicted as the baby boomers get older and more reliant on health care.
Private hospitals are rising to this challenge and this issue of Private Hospital highlights just some of the important projects around the country that are in development, fully completed or are currently somewhere in between.
Our lead story on the new education centre at the Sydney Adventist Hospital showcases an innovative approach to not just the shortfall of infrastructure but also the shortfall of medical professionals predicted that Australia will need by 2025. Read about the Sydney Adventist’s collaborative approach to provide a unique training facility on page 18.
Many people in Australia still do not understand that private hospitals treat complex cases and perform serious major
surgery. But as you leaf through the pages of this edition, one thing stands out clearly: private hospitals are investing in the infrastructure for cardiac services across the country. With stories from Bundaberg, Gosford, Brisbane and Melbourne, private hospitals are leading the way in cardiac services.
All of us at APHA enjoy showcasing the new and innovative programs in our private hospitals in Australia through the publication of this magazine and we hope you enjoy reading it. A lot of e¢ ort goes into the production of this magazine but everything does not always turn out right. The article on a ‘Multi-Modal approach to Complex Pain’ on pages 21-23 of the June edition of Private Hospital is a case in point. This article was written by two doctors at Masada Private Hospital. The ‘Neuromodulation’ part of the article was authored by Dr Paul Verrills and the ‘Partnering with ADAPT’ portion was authored by Dr Richard Sullivan. We apologise for erroneously attributing the entire article to Dr Paul Verrills.
Editor’s Letter
Building for the future
Private hospitals are preparing for an increase in demand for services
Our October edition will focus on Mental Health as private hospitals around the country come together to mark Mental Health Week from 7-13 October 2012. If you have an idea for an article for this edition, please get in touch with me at the APHA Secretariat.
Lisa [email protected]: @priv8hospitals
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8 August 2012
President’s Report with Chris Rex
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Cli¢
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The first national efficient price has been set at $4,808 per National Weighted Activity Unit
IN JUNE, the Independent Hospital Pricing Authority (IHPA) released its first “national e®cient price”, which provides the basis for calculating 884 categories of hospital procedures
and services. The price of a hip replacement is set at $21,239 and the price of complex cardiovascular surgery is $50,052.
This formula will be notionally applied for the first two years, from 1 July 2012, before the Commonwealth uses it to set the state’s share of Federal hospital funding.
It is hoped that this newly established price drives improved e®ciencies in Australia’s public hospitals - giving hospitals the incentive to treat more patients, more e®ciently.
It will be interesting to see how this activity-based funding system for public hospitals develops and whether it does actually lead to improvements in the value of public investment in hospital care in Australia.
One of the principles of the pricing arrangement is that there is “public-private neutrality” ie ABF pricing should not disrupt current incentives for a person to elect to be treated as a private or a public patient in a public hospital.
There are currently some financial incentives for public hospitals to treat private patients in preference to public patients, with various schemes currently existing within public hospitals around the country to encourage this practice, particularly in New South Wales and Victoria. APHA believes that these arrangements do not represent public-private neutrality.
APHA’s position has been, and remains, that in most conceivable circumstances, private patients should be treated in private hospitals. Public hospitals should focus on treating public patients and not divert their resources into attracting private patients to shore up their revenue.
At this stage we believe that the new ABF pricing regime lessens the incentive for public hospitals to treat private patients for revenue raising purposes because the Federal Government will provide funding minus any other funding (eg health insurance funds) received for the episode of care. It is expected that in later years funding will also be dependent on several performance measures like reducing waiting lists.
APHA is currently in discussion with both IHPA and the National Hospital Performance Authority in terms of the data collection systems and performance measures they are establishing. It is critical that private hospitals are involved in this process in the event that the performance regimes established by these bodies impacts the private sector in any way. To date, APHA has been appreciative of the manner the IHPA has gone about consulting with the private sector and we hope that the Board will see fit to support the continuation of data collection in a manner which respects industry concerns (surrounding publication and identification) and promotes maximum participation by private hospitals and day surgeries.
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Australia: Becton Dickinson Pty Ltd, 4 Research Park Drive, Macquarie University Research Park, North Ryde, NSW 2113. Toll free telephone: 1800 656 100.
BD PosiFlushTM SP meets the standards of the ACSQH National Recommendations for User Applied Labelling of Injectable Medicines, Fluids and Lines (2010)1 now mandated in NSW2, SA3 and WA4
1. Australian Commission on Safety and Quality in Healthcare, National Recommendations for User-applied Labelling of Injectable Medicines, Fluids and Lines, August 2010. http://www.safetyandquality.gov.au Accessed February 10 2012.
2. New South Wales Government. NSW Health Policy Directive Document Number PD2012_007. http://www.health.nsw.gov.au Accessed March 20, 2012.
3. Government of South Australia. SA Health Objective File Number: eA507858. http://www.sahealth.sa.gov.au Accessed March 20, 2012.
4. Government of Western Australia Department of Health Operational Directive OD 0350/11. http://www.health.wa.gov.au Accessed February 10, 2012.
BD, BD Logo and all other trademarks are the property of Becton, Dickinson and Company. © BD 2012. AMED230 INKI 13751 05/12
As I See It with Michael Roff
10 August 2012
Financing growth
efficiently
THIS issue of Private Hospital focuses on infrastructure and there is no doubt the private hospital sector continues to make a significant
and growing contribution to health infrastructure within Australia.
The figures speak for themselves. In the five years to 2009/10, private hospitals invested more than $3 billion in gross capital expenditure. The annual contribution grew from around $332 million in 2004/05 to $738 million in 2009/10.
Of course, the sector has been growing over this period, but it is not just the quantum of the contribution that has been steadily increasing. Since 2004/05, capital expenditure as a proportion of revenue has grown from 6 percent to 7.5 percent. Given the number of significant hospital developments and redevelopments that are underway (some of which are featured in this issue) it is likely we will see accelerated growth in these figures when the ABS updates them.
This growing investment is necessary to ensure Australians continue to have fast
access to hospital services into the future, especially when we know that demand for these services will increase as our population continues to age.
Over the same period, there has also been a significant level of capital expenditure in the public sector. State governments love to deliver more beds and new hospitals (although closing old hospitals can be problematic), but the real question is how e®ciently are they delivering this infrastructure?
Anecdotally, we know that where new hospitals are being developed, private sector operators are able to do so at a cost in the range of $500,000 to $700,000 per bed. On the other hand, new public hospital developments come in at a cost of around $2 million per bed for an identical end product.
In its 2009 report into public and private hospitals, the Productivity Commission compared the User Cost of Capital (UCC) in both sectors. The UCC is the opportunity cost of funds tied up in the capital used to deliver services. That is, the return that could be generated if the funds tied up in capital used to provide hospital services were employed in their next best use.
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Private hospitals show far greater financial discipline than those in the public sector
Guess what? They found the UCC per separation in public hospitals was $279, compared to just $100 in private hospitals. There was some di®culty in making these calculations, particularly given NSW Health told the Commission: “nobody really knows exactly how much capital is currently used by the public hospitals.”
Does any of this really matter as long as we are getting the health infrastructure we need? It does if you consider the case of the new 274-bed Royal Children’s Hospital in Melbourne, built at a cost of $1 billion (or around $3.6 million per bed!). Despite having 3,000 kids on the waiting list for treatment and sta¢ available to treat them, 45 beds in the new hospital remain unused as the state government cannot a¢ord to fund the recurrent running costs at this level.
So although state bureaucracies do not regard capital as “real money” (a State Treasury head has told me so), there are real costs to the community for the wasteful spending that characterises public hospital developments.
Perhaps it’s time they tried to harness some of the expertise and financial discipline from the private hospitals sector?
Ordering Information: For more information please contact your local representative or Customer Service on 1300 732 001.
Amino Acids, Glucose, Soya Oil, Medium-chain Triglycerides, Olive Oil, Fish Oil
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The only 3-chamber bag with fi sh oil registered in Australia1
PM 2012.193/FR3750
SmofKabiven® is a registered trademark of Fresenius Kabi . References: 1. Australian Government Department of Health and Ageing Therapeutic Goods Administration. ARTG Medicines.Retrieved 30 April 2012 from www.ebs.tga.gov.au
SMOFKABIVEN® MINIMUM PRODUCT INFORMATION: Smof Kabiven consists of a three chamber bag system. Each bag contains the following different volumes depending on the four pack sizes. SmofKabiven 986mL/ 1477mL/ 1970mL/ 2463mL (per 1000mL). Amino acid solution with electrolytes: 500mL/ 750mL/ 1000mL/ 1250mL (508mL); Glucose: 298mL/ 446mL/ 595mL/ 744mL (302mL); Lipid emulsion: 188mL/ 281mL/ 375mL/ 469mL (190mL). This corresponds to the following total compositions: Active ingredients: Alanine: 7.0g/ 10.5g/ 14.0g/ 17.5g (7.1g); Arginine: 6.0g/ 9.0g/ 12.0g/ 15.0g (6.1g); Glycine: 5.5g/ 8.2g/ 11.0g/ 13.8g (5.6g); Histidine: 1.5g/ 2.2g/ 3.0g/ 3.7g (1.5g); Isoleucine: 2.5g/ 3.8g/ 5.0g/ 6.2g (2.5g); Leucine: 3.7g/ 5.6g/ 7.4g/ 9.4g (3.8g); Lysine (as acetate): 3.3g/ 5.0g/ 6.6g/ 8.4g (3.4g); Methionine: 2.2g/ 3.2g/ 4.3g/ 5.4g (2.2g); Phenylalanine: 2.6g/ 3.8g/ 5.1g/ 6.4g (2.6g); Proline: 5.6g/ 8.4g/ 11.2g/ 14.0g (5.7g); Serine: 3.2g/ 4.9g/ 6.5g/ 8.1g (3.3g); Taurine: 0.50g/ 0.75g/ 1.0g/ 1.2g (0.5g); Threonine: 2.2g/ 3.3g/ 4.4g/ 5.4g (2.2g); Tryptophan: 1.0g/ 1.5g/ 2.0g/ 2.5g (1.0g); Tyrosine: 0.20g/ 0.30g/ 0.40g/ 0.49g (0.20g); Valine: 3.1g/ 4.6g/ 6.2g/ 7.6g (3.1g); Glucose (as monohydrate): 125g/ 187g/ 250g/ 313g (127g); Soya oil: 11.3g/ 16.9g/ 22.5g/ 28.1g (11.4g); Medium chain triglycerides: 11.3g/ 16.9g/ 22.5g/ 28.1g (11.4g); Olive oil: 9.4g/ 14.1g/ 18.8g/ 23.4g (9.5g); Fish oil: 5.6g/ 8.4g/ 11.3g/ 14.0g (5.7g); Corresponding to: Amino acids: 50g/ 75g/ 100g/ 125g (51g); Nitrogen: 8g/ 12g/ 16g/ 20g (8g); Lipids: 38g/ 56g/ 75g/ 94g (38g); Carbohydrates – Glucose (anhydrous): 125g/ 187g/ 250g/ 313g (127g); Energy: - total (approx.) 1100kcal (4600kJ) / 1600kcal (6700kJ) / 2200kcal (9200kJ) / 2700kcal (11300kJ); - non protein (approx.): 900kcal (3800kJ) / 1300kcal (5400kJ) / 1800kcal (7500kJ) / 2200kcal (9200kJ); Electrolytes in SmofKabiven: Calcium chloride (as dihydrate): 0.28g/ 0.42g/ 0.56g/ 0.69g (0.28g); Sodium glycerophosphate (as hydrate): 2.1g/ 3.1g/ 4.2g/ 5.2g (2.1g); Magnesium sulfate (as heptahydrate): 0.60g/ 0.90g/ 1.2g/ 1.5g (0.61g); Potassium chloride: 2.2g/ 3.4g/ 4.5g/ 5.7g (2.3g); Sodium acetate (as trihydrate): 1.7g/ 2.6g/ 3.4g/ 4.2g (1.7g); Zinc sulfate (as heptahydrate): 0.0065g/ 0.0097g/ 0.013g/ 0.016g (0.0066g); Corresponding to: Electrolytes: sodium: 40mmol/ 60mmol/ 80mmol/ 100mmol (41mmol); potassium: 30mmol/ 45mmol/ 60mmol/ 74mmol (30mmol); magnesium: 5.0mmol/ 7.5mmol/ 10mmol/ 12mmol (5.1mmol); calcium: 2.5mmol/ 3.8mmol/ 5.0mmol/ 6.2mmol (2.5mmol); phosphate (contribution from both the lipid emulsion and the amino acid solution): 12mmol/ 19mmol/ 25mmol/ 31mmol (13mmol); zinc: 0.04mmol/ 0.06mmol/ 0.08mmol/ 0.1mmol (0.04mmol); sulfate: 5.0mmol/ 7.5mmol/ 10mmol/ 13mmol (5.1mmol); chloride: 35mmol/ 52mmol/ 70mmol/ 89mmol (36mmol); acetate: 104mmol/ 157mmol/ 209mmol/ 261mmol (106mmol). Osmolality: approx. 1800mOsm/kg water. Osmolarity: approx. 1500mOsm/L. pH (after mixing): approx. 5.6. Excipients: Glycerol, Egg lecithin, dl-α-Tocopherol, Sodium hydroxide, Sodium oleate, Acetic acid – glacial, Hydrochloric acid, Water for Injections. INDICATIONS: Parenteral nutrition for adult patients when oral or enteral nutrition is impossible, insuffi cient or contraindicated. CONTRAINDICATIONS: Hypersensitivity to fi sh-, egg-, soya- or peanut protein or corn (maize) and corn products or to any of the active substances or excipients, severe hyperlipidaemia, severe liver insuffi ciency, severe blood coagulation disorders, congenital errors of amino acid metabolism, severe renal insuffi ciency without access to hemofi ltration or dialysis, acute shock, uncontrolled hyperglycaemia, pathologically elevated serum levels of any of the included electrolytes; general contraindications to infusion therapy: acute pulmonary oedema, hyperhydration, and decompensated cardiac insuffi ciency; haemophagocytotic syndrome, unstable conditions (e.g. severe post-traumatic conditions, uncompensated diabetes mellitus, acute myocardial infarction, stroke, embolism, metabolic acidosis, severe sepsis, hypotonic dehydration and hyperosmolar coma). PRECAUTIONS: Monitor triglyceride levels to prevent overdose, which may lead to fat overload syndrome. Give with caution in conditions of impaired lipid metabolism which may occur in patients with renal failure, diabetes mellitus, pancreatitis, impaired liver function, hypothyroidism and sepsis. The medicinal product contains soya oil, fi sh oil, egg phospholipids and corn (maize) and corn products which may rarely cause allergic reactions. Cross allergic reaction has been observed between soya-bean and peanut. Disturbances of electrolyte and fl uid balance should be corrected before starting the infusion. Give with caution to patients with a tendency towards electrolyte retention. In patients with renal insuffi ciency, the phosphate and potassium intake should be carefully controlled to prevent hyperphosphataemia and hyperkalaemia. Parenteral nutrition should be given with caution in lactic acidosis, insuffi cient cellular oxygen supply and increased serum osmolarity. Stop infusion immediately at any sign of anaphylactic reaction. In malnourished patients, slow initiation of parenteral nutrition is recommended as it may precipitate fl uid shifts resulting in pulmonary oedema and congestive heart failure, and decrease in serum potassium, phosphate, magnesium and water soluble vitamins. SmofKabiven is not to be given simultaneously with blood in the same infusion set due to risk of pseudo-agglutination. Monitor laboratory tests regularly including: serum glucose, electrolytes and osmolarity, fl uid balance, acid-base status and liver enzymes. Blood cell count and coagulation should be monitored when fat is given for a longer period. Special clinical monitoring is required at the beginning of any intravenous infusion. The fat content of SmofKabiven may interfere with certain laboratory measurements (e.g. bilirubin, lactate dehydrogenase, oxygen saturation, haemoglobin) if blood is sampled before fat has been adequately cleared from the bloodstream. PREGNANCY AND LACTATION: There are no adequate and well controlled studies in pregnant women, therefore the safety is not known. It is not known whether SmofKabiven can enter maternal milk, therefore it should only be used during lactation if clearly needed. ADVERSE REACTIONS: Slight increase in body temperature, chills, dizziness, headache, lack of appetite, nausea, vomiting, elevated plasma levels of liver enzymes, tachycardia, dyspnoea, hypotension, hypertension, hypersensitivity reactions (e.g. anaphylaxis, skin rash, urticaria, fl ush), heat or cold sensation, paleness, cyanosis, pain in the neck, back, bones, chest and loins. DOSAGE AND ADMINISTRATION: The patient’s ability to eliminate fat and metabolise nitrogen and glucose and the nutritional requirements should govern the dosage and infusion rate. The dose should be individualised with regard to the patient’s clinical condition and body weight (bw). SEE FULL PRODUCT INFORMATION FOR MORE INFORMATION. Dosage: The dosage range of 13mL-31mL/kg bw/day covers the need of the majority of patients. Obese patients should be dosed based on estimated ideal body weight. The recommended maximum daily dose is 35mL/kg bw/day. SmofKabiven is not recommended for use in children. Infusion rate: The infusion rate should not exceed 2.0mL/kg bw/h (corresponding to 0.25g glucose, 0.10g amino acids and 0.08g fat/kg bw/h). The recommended infusion period is 14-24 hours. Method of and duration of administration: Intravenous infusion into a central vein. The contents of the three separate chambers have to be mixed before use. SmofKabiven should be used within 24 hours of preparation. STORAGE CONDITIONS: Store below 25oC. Do not freeze. Store in overpouch. Based on TGA Approved Product Information 20 January 2012.
PLEASE REVIEW FULL PRODUCT INFORMATION BEFORE PRESCRIBING. The full disclosure Product Information is available on request from Fresenius Kabi Australia Pty Limited.
PBS Information: This product is not listed on the PBS.
APHA News
12 August 2012
RAMSAY Health Care has launched a myspecialist app enabling users to search quickly and easily through a database of over 5000 specialists accredited in Ramsay hospitals throughout Australia.
Users can search for specialists across a wide range of specialties including orthopaedics, cardiology, psychiatry and obstetrics or pinpoint the exact type of specialist they are after in a range of subspecialty categories or special interest areas.
The myspecialist app uses location-based technology that allows a user to fi nd the specialist closest to their current location or to the location of choice. It also links to the online profi le of the specialist if one is available on the hospital website. The app can also assist users to locate Ramsay Health Care hospitals, fi nd out more about the company or register for updates from the Ramsay Twitter account.
With hospitals in the UK, France and Indonesia as well as Australia, Ramsay Health Care intends that the app will have international applicability and a version is currently under development in the UK.
For general practitioners (GPs), in addition to the myspecialist search facility, the app has a special feature that enables a GP to search for upcoming GP education activities in nearby locations. Ramsay Health Care facilities run over 200 RACGP approved educational events for GPs across the country each year. GPs using the app can read about the event and register their interest in attending all within a matter of seconds.
At this stage, the myspecialist app is only available to iPhone 4 (and above) and iPad users. A version suitable for android phones is currently under development.
RamsayHealth Care’s myspecialist app
ONE in ten mothers of children aged 24 months or less have been diagnosed with perinatal depression, according to a report released by the Australian Institute of Health and Welfare (AIHW).
The report, Perinatal depression: data from the 2010 Australian National Infant Feeding Survey, shows that of an estimated 111,000 mothers diagnosed with depression, about 56,000 had perinatal depression (that is, the depression was diagnosed between the time they were pregnant until the child’s fi rst birthday).
“Certain population groups are more likely to experience perinatal depression,” said AIHW spokesperson Ann Hunt. “For example, almost 19 percent of mothers who smoked daily experienced perinatal depression, compared to about nine percent of those who didn’t smoke. And mothers living in the lowest income households were more likely to experience perinatal depression than those in the highest (14 percent compared to seven percent).”
Other groups more likely to experience perinatal depression included younger mothers under the age of 25, mothers who were overweight or obese, those who spoke English as their main language at home and mothers who had had an emergency caesarean section. The rate of perinatal depression also varied by location. For example, mothers living in major cities and remote/very remote areas reported slightly lower rates of perinatal depression than those from other geographical areas.
Perinatal depression was less commonly reported among mothers who had higher levels of education (bachelor degree or higher), were working at the time of the survey and primarily spoke a language other than English at home.
“Of those we know about who sought help, the majority received help from their general practitioner or support from family and friends,” Ms Hunt said.
One in ten mums diagnosed with perinatal depression
August 2012 13
MORE calls answered by NPS Medicines Line pharmacists relate to questions involving antidepressants than any other class of medicine.
To help people be medicinewise, NPS has launched a new online knowledge hub on depression and antidepressant medicines, which covers many of the questions asked via Medicines Line.
NPS clinical adviser Dr Philippa Binns says that depression is second only to high blood pressure as the most common chronic problem seen by Australian GPs, and two thirds of people seeing their doctor for depression are given a prescription for antidepressants.
“Depression a¢ ects a lot of people in our community, but there are e¢ ective treatments for the condition, including both medicine and non-medicine options,” says Dr Binns.
“The use of antidepressants is continuing to rise in Australia and calls to Medicines Line clearly show that people are being medicinewise by asking questions about what they are taking.”
People who called Medicines Line about antidepressants most often wanted to know:• The potential for interactions with other
medicines when they taking an
antidepressant, such as possible interactions with cough and cold preparations and complementary medicines
• What side e¢ ects they are likely to experience with antidepressants
• Whether problems they are experiencing may be related to their antidepressant medicines, and
• Safety information about using these medicines in pregnancy and breastfeeding.
“Responses to antidepressants are quite individual, so what works well for one person may not for another,” says Dr Binns.
“Under guidance from their health professional, some people will need to try more than one antidepressant in order to fi nd the one that suits them best.”
NPS also urges people not to stop taking an antidepressant without talking to their health professional.
“If you are experiencing side e¢ ects, talk to your doctor as a di¢ erent antidepressant may suit you better, or there may be other strategies to reduce the side e¢ ects,” says Dr Binns.
“When you do need to stop taking antidepressants, or change to another one,
consult your doctor about how to do this. With certain antidepressants, you may need to gradually reduce the dose to avoid unpleasant side e¢ ects. If this is the case, your doctor will work out a plan with you.”
The new NPS knowledge hub provides:• Tips on fi nding the right treatment for you
and what to do about side e¢ ects from an antidepressant
• An A-Z listing of di¢ erent antidepressant medicines with information about e¢ ectiveness, side e¢ ects, interactions, and who needs to take extra care with them (eg other medical conditions that increase the risk of side e¢ ects)
• Information on how to avoid side e¢ ects and symptoms when making changes, and
• An overview of cognitive behavioural therapy (CBT), an e¢ ective alternative to antidepressants for some people and a useful addition to antidepressant therapy for some others, as well as lifestyle changes and other supportive treatments that can be of benefi t.
To view the new NPS knowledge hub on depression and antidepressants, visit www.nps.org.au/conditions/depression
Antidepressants top the list of frequently asked medicines questions
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APHA News
14 August 2012
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THE Heart Foundation’s risk classifi cation of emergency department patients with chest pain o¢ ers only fair prediction of myocardial infarction (heart attack), and this prediction is not su® cient to justify admission to coronary care for all patients classifi ed as high risk using these criteria.
This is the fi nding of a study by Professor Anne-Maree Kelly, from the Joseph Epstein Centre for Emergency Medicine Research at Western Health in Melbourne.
The study is published in the latest issue of Emergency Medicine Australasia, the journal of the Australasian College for Emergency Medicine.
“The evaluation of chest pain is a growing challenge for EDs, in particular ruling out acute coronary syndrome (ACS) and determining which patients can safely be discharged for further investigation and management in the community with a low risk of adverse cardiac events,” Professor Kelly said.
She studied almost 800 patients with chest pain who presented at a hospital emergency department, fi nding a high proportion of these patients were classifi ed as high risk by the Heart Foundation risk classifi cation criteria.
“If all patients classifi ed as high risk had been admitted to a ward environment for assessment, as recommended by the guidelines, there would have been a 21 percent increase in admission rate (161 patients) without any reduction in deaths, myocardial infarction during follow up, or arrhythmia.
“These data challenge the Heart Foundation classifi cation criteria and their associated recommendations as a useful tool for the ED chest pain patient group.”
With specifi city of approximately 50 percent, the recommendation for coronary care admission for all high-risk patients is hard to justify, she concluded.
Heart Foundation risk classifi cation of chest pain patients only a fair predictor of heart attack
More than one in four hospital admissions need surgery
MORE than a quarter of Australia’s 8.9 million hospitalisations in 2010–11 included a visit to an operating room for surgery, according to a new surgery snapshot released by the Australian Institute of Health and Welfare (AIHW).
The snapshot bulletin, Surgery in Australian Hospitals 2010–11, provides an overview of Australia’s 2.4 million annual hospitalisations for surgery, based on data fi rst published by the AIHW in April. Around 1 million surgery hospitalisations occurred in public hospitals and 1.4 million in private hospitals.
In the fi ve years to 2011, admissions involving surgery have been rising 2.4 percent a year in public hospitals and 4.1 percent a year in private hospitals. But in the last year, annual growth in surgery admissions in public hospitals has outstripped annual growth in private hospitals 2.7 percent to 2.1 percent.
“This probably refl ects a renewed emphasis by all levels of government to reduce elective surgery backlogs in public hospitals,” said AIHW spokesperson Alison Verhoeven.
Around 12 percent of surgery admissions were emergency admissions (requiring surgery within 24 hours). About 83 percent were elective admissions, with two-thirds of these occurring in private hospitals. A further four percent of surgery-related admissions were childbirth-related and one percent were for ‘other planned care’.
Compared with national rates, Indigenous Australians and people living in remote areas had higher rates of emergency surgery admissions and lower rates of elective surgery admissions. The most common reasons for emergency surgery admission were appendicitis, hip fractures and heart attacks, followed closely by leg fractures. For elective surgery admissions, the most common reasons were cataracts, skin cancers, knee disorders and procreative management (including IVF).
Just over 50 percent of surgery hospitalisations were same-day admissions. For overnight surgery admissions, the average length of stay was around four days in public hospitals and three days in private hospitals.
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APHA News
16 August 2012
IN JUNE, exceptional private hospitals were selected to showcase their innovative practices at the 9th annual Private Hospitals Association of Queensland Innovative Practice in the Private Sector conference.
Innovative Practice in the Private Sector is a one-day conference designed to showcase outcomes in the areas of clinical and non clinical operational innovations, strategic innovations and education and human resources management. The annual conference gives private hospitals throughout Australia the opportunity to submit abstracts to showcase and share innovations with industry colleagues. This year there were eight presentations in Clinical Innovations and six in Non-Clinical Innovations categories.
The Category Award Winners for Clinical Innovations were Nataliya Shkuratova from Epworth Rehabilitation Brighton (Vic) for the C.A.R.E. Multidisciplinary Falls Prevention Intervention Program, and Cheryl McWilliams and Susan Geyer from Mater Private Hospital Redland (Qld) for the Clinical Bedside Handover: Shift to Shift Every Shift.
The Category Award Winners for Non
Clinical Innovations were Anna Davey and Trish Thomas from John Flynn Private Hospital (Qld) for Management Transition: Future Proofi ng at John Flynn Private Hospital, and Diarmuid (DJ) Cronin from Greenslopes Private Hospital (Qld) for Volunteer Innovation at Greenslopes Private Hospital.
The overall winner was Nataliya Shkuratova from Epworth Rehabilitation Brighton (Vic) for the C.A.R.E. Multidisciplinary Falls Prevention Intervention Program.
“Innovation practice is evident throughout the private hospital sector and yet is often not publically recognised or rewarded,” Lucy Fisher, Executive Director from Private Hospitals Association of Queensland said.
“In addition to recognising outstanding innovation, the aim of this award program is to also provide a platform where these initiatives may be shared among industry colleagues. Well done to all the presenters and congratulations to the winners.”
The winners received prize money thanks to HESTA Super Fund who sponsored the event. For more on the winners and their innovative programs go to www.phaq.org
Top honours in innovative practice
AUSTRALIA’S premier online stroke education platform, e-Stroke Australia, has undergone a radical overhaul. Now owned by the Stroke Foundation, e-Stroke has been designed to deliver the most relevant educational training modules for stroke health professionals in an immediate and convenient platform.
e-Stroke provides critical, evidence-based, peer-reviewed educational training modules for health professionals new to the stroke discipline and the site has now been updated and enhanced by new and interactive training for nursing and allied health professionals.
Dr Erin Lalor, National Stroke Foundation chief executive o® cer said the free, online, e-Stroke training programs would provide ongoing professional development support to people working in the fi eld of stroke, particularly those who are new to stroke care or who are from rural areas where access to stroke specifi c education is limited. The new self-paced courses provide entertaining and interactive online learning to improve stroke education and outcomes.
“e-Stroke has now nearly doubled the number of free, evidence-based online learning courses on o¢ er,” she said.
In keeping with the fl exible nature of online learning, Dr Lalor said health professionals could create a personal profi le that allowed them to return to their online courses at any time after an interruption.
“We understand health professionals are busy and e-Stroke is designed to make professional development accessible and relevant.”
The online educational platform was fi rst developed by the Victorian Stroke Clinical Network in partnership with the Stroke Society of Australasia and developers Eye Media. In taking over management of the site the National Stroke Foundation aims to expand the site to provide a ‘one-stop shop’ for education and clinical resources for stroke clinicians.
To fi nd out more visit estroke.com.au
Stroke learning online gets easier
TO CELEBRATE the completion of a major redevelopment at Gri® th Rehabilitation Hospital, members of sta¢ and the local community were invited to enter a naming competition.
Three sta¢ members and two local residents were joint winners of the naming competition.
The winning names, Kingston, Heysen, Mawson and Hindmarsh, were given to the four wards at Gri® th Rehabilitation Hospital. The names were chosen to honour politician Sir Charles Kingston, renowned painter Sir Hans Heysen, Antarctic explorer Sir Douglas Mawson and fi rst South Australian Governor, Sir John Hindmarsh.
The redevelopment increased bed numbers at Healthscope’s Gri® th Rehabilitation Hospital to 64, with the addition of 10 private rooms. In addition to renovating the reception, hydrotherapy pool
change rooms and expanding the gym, the hospital was also given a facelift featuring a specially designed garden.
Belinda Singleton, Acting General Manager of Gri® th Rehabilitation Hospital, believes the garden will be uplifting for patients, their visitors and sta¢ .
“We’ve also added a new horticultural therapy called MyGarden to give patients an opportunity to participate in planting,” said Belinda.
Gri® th Rehabilitation Hospital has a long history in coastal Adelaide suburb Hove, where it was built as a family residence in 1914. The home was transformed into a 12-bed medical hospital in 1959 and expanded to 54 beds in 1984.
Mayor of Holdfast Bay, Dr Ken Rollond, o® cially re-launched the refurbished Gri® th Rehabilitation Hospital on 22 July 2012.
Griffith Rehabilitation Hospital naming comp
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A NEW education centre being built at Sydney Adventist Hospital (the San) aims to help redress the Australia-wide 109,000 nurse and 2,700 doctor
shortfall predicted by 2025.A collaborative project with the Federal
and NSW governments and private sector higher education, the $17 million Sydney Adventist Hospital Education Centre will provide unique side-by-side training of
student doctors, nurses and other health professionals. It is the fi rst building in a precinct that ultimately will provide easy access between hospital employment, residential accommodation and education opportunities.
Stage 1 of the centre currently under construction will be a purpose-built, three level 3500sqm facility providing two auditoriums, a library, student common room, administration areas, tutorial, clinical
skills, problem based learning and lecture rooms. It also features a simulation centre with operating theatre simulator, multi-purpose critical care area, anaesthetic bay, control, debrief and meeting rooms.
The centre will provide a unique training model of side-by-side clinical placements for medical, nursing, physiotherapy, pharmacy, radiography, occupational therapy, orthoptics, midwifery, dietetics and other allied health profession students.
In focus: Infrastructure
18 August 2012
Private sector Private sector Private sector Private sector Private sector Private sector Private sector Private sector Private sector helping national workforce issues
Sydney Adventist Hospital builds a new education centre
“It will increase health workforce educational outcomes and help the delivery of better quality care to patients Australia-wide,“ said Dr Leon Clark, Sydney Adventist Hospital Group Chief Executive O® cer.
“The SAH Education Centre recognises that a growing number of Australians are cared for in private hospitals and a growing number of clinicians are employed in the private sector. Private facilities have long been under-utilised for training.”
“One of the most exciting things about this project is that it is a partnership project between the private sector and the public sector,” said Dr Michael Spence, Vice-Chancellor and Principal of The University of Sydney.
Through the Clinical Training Funding Program of Health Workforce Australia (HWA), the Commonwealth is providing $11.83 million – including the largest HWA capital grant ($10 million) ever awarded to the private sector. Minister for Health, Tanya Plibersek applauded the collaborative initiative, saying: “Things don’t work, unless we work together.”
The NSW State Government is providing $10 million over two years from 2012/13 towards the costs of building the centre and the training by the San of medical interns as well as the provision of some health services.
“Clinical placement of health professionals has been limited by capacity issues in the public sector,” said Jillian Skinner, the NSW Minister for Health and Minister for Medical Research.
The centre will be home to the Sydney Adventist Hospital Clinical School of the University of Sydney (SAHCS)* and the Faculty of Nursing and Health of Avondale College. SAHCS was established in 2011 by Sydney Medical School of The University of Sydney in partnership with the San. The fi rst fully-fl edged private hospital clinical school in NSW, by 2016 SAHCS will graduate up to 40 doctors per year.
Avondale College of Higher Education’s School of Nursing is one of the oldest continuing nursing schools in Australia and was operated by the San from the early 1900s until 1982, when it joined Avondale. By 2016 it expects to graduate over 120 nurses a year.
“The funds provided by the Federal and
NSW governments gives us a unique opportunity to demonstrate what a major private hospital, a public university and a major private provider can contribute to the health workforce of NSW and Australia,” said Dr Roennfeldt, Avondale College President.
The new centre helps to meet the shortfall of public sector placements for students by providing increased clinical training day opportunities. By 2013 it will provide 6,589 clinical training days for medical students, 4,987 training days for nurses and 2,760 for allied health professionals. By 2016, with greater capacity and increased student enrolments it will be providing 21,420 medical student training days, 9,140 nursing student training days and 2,760 training days for allied health professionals.
The centre can provide education and training programs including undergraduate, post- graduate, registrar, fellowship and continuing professional education. But SAHCS medical student Isabelle Kapterian said the SAH Education Centre will provide more than theoretical knowledge.
“The theory of medicine can be learnt out
of a textbook – what the signs of a disease are, why it happens – but medicine is not a theoretical career. The art of communication underpins this profession and this is why, for us, a clinical school is of such signifi cance.”
Erin Raethel, nursing student at Avondale College thinks the centre site is Holy Ground.
“Training beside a range of health professions will develop respect for one another at the patient bedside, with the potential to mimic real life clinical relationships that will benefi t all students involved. This is necessary as all continuously collaborate during patient care. They are partners and they must be for patients to receive optimal and holistic care. During recent clinical training at the San I realised that no textbook could teach me the importance of investing time in our patients, not as clinical diagnoses but as people with genuine needs. I propose that this centre is Holy Ground. Great things will happen here, because our leadership believe in the importance of our professions.”
The centre will be built to implement cutting edge technology to maximise clinical
August 2012 19
➤
THIS CENTRE WILL PROVIDE A UNIQUE TRAINING MODEL OF
SIDE-BY-SIDE CLINICAL PLACEMENTS‘‘ ‘‘
L-R: Professor John Watson (Dean of SAHCS), Mr Mark Cormack (CEO Health Workforce Australia), Ms Mary Foley (Director General NSW Health), Dr Michael Spence (Vice
Chancellor of the University of Sydney), Dr Leon Clark (CEO Sydney Adventist Hospital Group) , Minister Tanya Plibersek (Federal Minister for Health), Minister Jillian Skinner
(State Minister for Health and Minister for Medical Research), Dr Ray Roennfeldt (President Avondale College) at the ground breaking in April.
In focus: Infrastructure
20 August 2012
training to graduate more competent and experienced health professionals. Plans anticipate state-of-the-art innovative and purpose-built furniture design and information and technology services that maximise learning, information sharing, inter-institution document access, inter-disciplinary teaching and simulation opportunities.
“This centre builds on our long history of training as a Registered Training Organisation, as a training ground for Stage 3 and Stage 4 medical undergraduates and our accreditation to provide Registrar training in 13 di¢erent medical specialties,” said Dr Clark.
“We appreciate the trust that has been placed in us for this collaborative partnership and we will honour it by ensuring the Education Centre helps all its students reach their full potential.”
The centre is scheduled to be completed by mid 2013. By the Corporate Communications team, Sydney Adventist Hospital
*The establishment of the Clinical School was supported by $1.75million in funding from the Commonwealth Department of Health and Ageing under the Increased Clinical Training Capacity Grant Scheme.
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In focus: Infrastructure
22 August 2012
world leaderworld leaderCardiac imaging system a
St Andrew’s War Memorial Hospital welcomes the Siemens Artis zee Biplane cardiac imaging system
22 August 2012
ST ANDREW’S War Memorial Hospital has successfully installed one of the most advanced cardiac imaging systems in the world, enabling
cardiologists at the electrophysiology laboratory to treat the most complex heart rhythm cases in Australia.
Queensland Cardiovascular Group specialists Dr John Hayes and Dr Wayne Sta¢ ord say they are delighted with the
successful installation of the Siemens Artis zee Biplane cardiac imaging system.
“We are now using the very latest technology incorporating world-leading X-ray tube and generator design with advanced biplane imaging capability,” said Dr Sta¢ ord, Director of St Andrew’s Cardiology.
The imaging system generates CT-like 3D images that are loaded into the anatomical mapping systems used when electrophysiology procedures are carried out.
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“We can generate 3D models of the heart and see electrical measurement all on one large screen. The biplane imaging system means we can view X-rays in two di¢ erent directions at the same time – this generates rich information and much more accurate imaging which improves the safety of procedures,” said Dr Sta¢ ord.
St Andrew’s cardiologists have long been leaders in treatment of heart rhythm conditions which impact on the lives of tens of thousands of Australians each year.
“The new cardiac imaging system gives us the opportunity to treat even more complex cases than was previously possible. We continue to be positioned as Brisbane’s centre of expertise in this fi eld,” Dr Sta¢ ord said.
Dr Hayes said this new imaging platform enhanced the current 3D imaging and mapping technology that had been utilised at St Andrew’s for many years.
“We have been incorporating 3D models from CT scans, performed before patients enter the electrophysiology laboratory, into our cutting edge CARTO 3 and EnSite Velocity 3D electroanatomical mapping systems in the electrophysiology laboratory to help facilitate mapping and ablating the most complex cardiac arrhythmias.
“With this new technology we will be able to generate 3D models of the heart chambers in real time while the patient is still in the electrophysiology laboratory and incorporate them into our existing mapping systems.
“This technology will allow us to improve our
success rate at curing common arrhythmias that a¢ ect many people in our community, such as atrial fi brillation, while at the same time allowing us to help patients with rarer and potentially lethal arrhythmias as well.
“St Andrew’s has a reputation as a leading centre for cardiac arrhythmia management in Queensland. We look forward to continuing our leading position in research and management of cardiac arrhythmias.”
WE CAN GENERATE 3D MODELS OF THE HEART AND
SEE ELECTRICAL MEASUREMENT ALL ON ONE LARGE SCREEN
‘‘‘‘
Dr John Hayes and Cardiac Scientist Lisa Statham with the new Siemens Artis zee Biplane cardiac imaging system
August 2012 23
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August 2012 25
CENTRAL Coast residents requiring cardiac treatment now have greater access to diagnostic and interventional cardiac care services following
the opening of the Gosford Heart Centre in early June 2012. The cardiac service promises to enhance cardiac care on the Central Coast, Lower Hunter region and as far as Dubbo with state-of-the-art technology, newly constructed facilities and leading cardiologists.
Already acknowledged as a leading local health care provider, Gosford Private Hospital will deliver emergency response, interventional and diagnostic cardiac treatment to over 100 patients per month through the Heart Centre.
“Gosford Heart Centre is a new service with the simple aim of providing local cardiologists
with the best technology available to enhance the delivery of day-to-day patient care,” said Mr Steve Atkins, CEO of Healthe Care, who was part of the planning team and lead the e¢ ort to build the new service.
Gosford Heart Centre includes a cardiac catheterization laboratory, a cardiovascular procedure room, a dedicated six-bed private coronary unit and an eight-bed intensive care unit, which have been custom designed to e¢ ectively meet the needs of cardiac patients. The Heart Centre will also be supported by a chest pain referral service to provide patients and their GPs with direct access to cardiovascular specialists. This means that existing patients will have immediate access to emergency care and support.
“It’s a signifi cant milestone for our hospital and we strongly believe that Gosford Heart Centre will quickly become recognised as a
leading provider of cardiovascular medicine for the central coast,” said Ms Sue Rigney, CEO Gosford Private Hospital.
Cardiologist, Dr Brendan Gunalingam who is one of the specialists closely involved with the establishment of the service, undertook several procedures at the Heart Centre on its opening day.
“I’ve performed a number of procedures and am pleased with the level of planning and technology that has gone into establishing the service,” said Dr Gunalingam who runs a successful private practice in North Sydney and the Central Coast. “Everything ran smoothly and the sta¢ were attentive and responsive.”
Gosford Heart Centre is one of a number of new services that have been introduced over the last few years as part of the hospital’s multimillion redevelopment project.
Gosford Private Hospital launches new cardiac care services
In focus: Infrastructure
The GosfordThe GosfordThe GosfordThe GosfordThe GosfordThe GosfordHeart Centre opens
In focus: Infrastructure
26 August 2012
NSW-fi rst device ensures greater accuracy for the world’s most commonly performed surgery
Improving ImprovingImprovingcataract surgery Don’t have a hospital library?
Monash University Library, one of Australia’s leading research libraries, can provide you with a virtual library service. Get easy access to information delivered electronically, for an affordable monthly subscription.
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CATARACT surgery patients at Hunter Valley Private Hospital (HVPH) will be among the fi rst in Australia to benefi t from a new, state-of-the-art surgery
guidance device to ensure more accurate positioning of lenses.
HVPH is the fi rst hospital in NSW, and the second in the southern hemisphere, to use the $65,000 German-made SMI Surgical Guidance Solution, which only came on to the market globally last year. The machine takes a detailed photo of the eye. This image is then transferred to theatre with real-time eye tracking ensuring extremely accurate alignment of a lens.
Consultant surgeon Dr David Manning said the machine takes the guesswork out of a critical part of a cataract operation, which until now has been done by manual marking of the eye. After anaesthetic, and once a patient lies down, the eye can rotate, causing misalignment of the lens. Dr Manning said the device improves the accuracy and the stability of vision outcomes for patients.
“For every degree o¢ axis you are out with a toric lens, the lens lose three percent of its e¢ ect. So if you are out by just 10 degrees, one-third of the toric e¢ ect is lost,” Dr Manning said.
“We are seeing a change in lens technology and an increasing number of people are getting premium lenses. This device is particularly benefi cial for people requiring toric lenses to correct for astigmatism and for multifocal lenses.”
Dr Manning said everyone eventually gets
cataracts and they are the leading cause of vision loss among people aged 55 and over. Cataract surgery is the most performed procedure in the world. According to the World Health Organisation, more than 20 million cataract operations are performed globally every year, with 200,000 of those carried out in Australia and New Zealand.
HVPH has been o¢ ering cataract surgery to Hunter patients for more than 21 years. More than 1200 cataract operations are performed at the hospital each year.
HVPH CEO Lance Wheeldon said the hospital continues to invest in leading technology to ensure doctors and other
medical sta¢ can deliver the very best patient care. A $20 million upgrade of the hospital completed last year included two new integrated Stryker theatres featuring the latest in digital technology, including high defi nition cameras, high-defi nition fl at screen monitors and special LED surgical lighting, housed in special pendants suspended from the ceiling. The new theatres were also a fi rst for the region.
HVPH is a locally owned and independent hospital that specialises in a range of surgery and rehabilitation services. A team of more than 75 doctors and 230 sta¢ provide care to more than 11,000 people each year.
THE IMAGE IS TRANSFERRED TO THEATRE WITH REAL-TIME EYE
TRACKING ENSURING EXTREMELY ACCURATE ALIGNMENT OF A LENS
‘‘‘‘
Imag
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MI S
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August 2012 27
Don’t have a hospital library?
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This information from Health Industry Plan contains general advice only. It is not specifi c to your personal fi nancial situation, objectives or needs. Get the facts (including a Product Disclosure Statement) from www.hipsuper.com.au or talk to a fi nancial advisor before making any super decisions. The Trustee of HIP ABN 50 030 598 247 is Private Hospitals Superannuation Pty Ltd ABN 59 006 792 749, AFSL 247063.* This calculation is based on members aged between 16-36 at four units of cover, and only if members apply for an additional three units of cover within 60 days of joining the Fund. Insurance benefi t is reduced each subsequent year. Please refer to the HIP Insurance Booklet or PDS for full details. ** Subject to a maximum monthly benefi t of 75% of the member’s monthly income. Please refer to the HIP Insurance Booklet or PDS for full details.
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In focus: Infrastructure
August 2012 29
C AIRNS Private Hospital’s operating theatre redevelopment o® cially opens on 28 August and features a new stage one, two and three recovery unit,
sta¢ change room, dining room, day unit, endoscopy suite and pre-op admissions area as well as one complete operating theatre and one operating room shell.
The seven-stage project took 10 months to complete and will increase the number of operating suites to six operational theatres, with a seventh to be built-in and commissioned at a later stage. Steve Thompson, Operating Services Nurse Unit Manager, said the project occurred all within the walls of the existing hospital.
“We haven’t extended beyond the walls of the building,” Mr Thompson said. “Undertaking the
redevelopment without any alteration to theatre services and sta® ng was the biggest challenge for us and a huge achievement.
“The design of the theatre redevelopment has taken into account patient movement, the latest technology and sta¢ accessibility to optimise e® ciency and patient care. With this new operating theatre we will be able to o¢ er surgeons additional permanent theatre sessions to keep up with the demand. Using the sixth operating theatre to its full capacity will increase output by 20 percent.”
The theatre equipment is plugged into elevated consoles and the images from di¢ erent sources are displayed on the screens above, o¢ ering the surgeons accuracy, positioning and ultimately more control. The equipment is connected to overhead booms, which leaves the fl oor space
clear of electrical cords and equipment and reduces the need for manual handling of equipment in, out and around the room.
The seventh operating room will be built and commissioned when the hospital can meet the demands of the increase in patient throughput. Until then, the hospital’s new integrated suite will cater for endoscopic and a variety of specialities with the primary focus on arthroscopic and laparoscopic procedures.
“Completion of the redevelopment is exciting for the theatre sta¢ at Ramsay Cairns,” Mr Thompson said.
“We have a new operating room that will provide more e® cient patient fl ows and has the latest equipment and technology, which will bring Cairns Private Hospital in line with other major health facilities.” By Alexandra McLaren
Cairns Private Hospital’s state-of-the art theatre redevelopment features a new Stryker Integrated i-Suite
actionactionactionactionactionactionReady for
BUILDING is the current buzz word across Epworth, with a new teaching hospital planned for regional Geelong and both Epworth Richmond
and Epworth Rehabilitation Camberwell in the throes of major infrastructure projects. Epworth Rehabilitation Camberwell will be the fi rst of the three to be fully completed, scheduled for the middle of next year.
With the 2006 acquisition of Cedar Court
Rehabilitation Hospital in Camberwell, Epworth’s position as Victoria’s largest private provider of rehab services grew exponentially. It was purchased in collaboration with ING Healthcare Properties Trust, with Epworth acquiring full ownership in 2009.
Current specialties at the centre include the clinical management of in-patients and out-patients following acquired brain injury (ABI); hip and knee joint replacement;
multi-trauma; orthopaedic surgery; neurological events such as stroke; cardiac events and pain management issues.
In 2010, the City of Boroondara approved plans for a $35 million redevelopment that includes 68 new private patient rooms, as well as new consulting suites, therapy rooms and educational facilities added to the current centre. All up, the new facility will improve the site signifi cantly and bring the total number of beds to 146 for both
In focus: Infrastructure
30 August 2012
Master Plan Master Plan Master Plan Master Plan Master Plan Master Plan for a stronger
Epworth HealthCare
Epworth expands it’s rehabilitation services
Imag
es: a
rtis
t’s im
pres
sion
August 2012 31
rehabilitation and psychiatry patients. Psychiatry services will include in-patient and day-patient programs for both adults and adolescents, with specifi c needs around depression, anxiety disorders, eating disorders and mood disorders.
Moving into the area of mental health services has seen Epworth plan a ‘wellness precinct’ so that all patients will benefi t from other services available on the site. The co-location will enable psychiatrists to develop a new approach to patient care that incorporates improved exercise, dietary and healthy living activities alongside a specialist psychiatry service. The development incorporates an education and research centre to facilitate undergraduate and post-graduate training for medicine, nursing and allied health students and sta¢ .
Project managers Aurecon and architects Silver Thomas Hanley are overseeing progress of the works, in conjunction with builders Construction Engineering, to ensure that construction causes minimal disruption to the operations of the current rehabilitation facility, which is located within a busy suburban tra® c area.
Progress to date includes excavation of the basement levels and installation of pad
footings in preparation for pouring the ground slabs. The tower crane was commissioned following its recent installation and in spite of Melbourne’s winter weather stopping work on a few days, Construction Engineering helped sta¢ continue providing the very best in rehabilitation services to Epworth patients.
By July 2013, Epworth patients will not recognise their old hospital. A new gleaming entrance on Burke Road will open its doors. The total works include ancillary retail and support services as well as 98 extra car spaces, taking the capacity on site to 154.
As for the mother ship back at Epworth Richmond, Stage 1 of a four-stage redevelopment has recently uncovered the stunning new Porte Cochere, which has transformed the hospital’s façade to an imposing edifi ce and brightened a slice of busy Bridge Road at the same time. Everyone is enjoying the before and after comparisons.
As well as adding nearly 400 new car parking spaces on site, the major building project at Richmond will provide 23 new operating theatres, 430 new private rooms, new critical care and ICU beds and a new Emergency Department. But that is another story… By Colleen Coghlan
MOVING INTO MENTAL HEALTH SERVICES HAS SEEN EPWORTH
PLAN A ‘WELLNESS PRECINCT’ SO ALL PATIENTS WILL BENEFIT FROM
ALL AVAILABLE SERVICES
‘‘‘‘
In focus: Infrastructure
32 August 2012
Healthscope hospitals in Queensland have undergone signifi cant growth in 2012
Sunnybank Private HospitalIn March, Sunnybank Private Hospital o® cially opened a new integrated operating theatre, refurbished intensive care unit and recovery rooms.
“There was demand for another theatre to support surgical growth,” said Katrina Ryan, Sunnybank Private Hospital General Manager. “We’re putting ourselves on the map. With our new improved ICU, we’re well placed to provide higher acuity services to our patients.”
With the fi rst stage of the development project complete, there are now plans to refurbish the hospital’s maternity unit, with architects already working on designs.
QueenslandQueenslandQueenslandGrowth for
Healthscope hospitals in
Sunnybank Private Hospital Day Surgery Manager Cathy Ariotti
August 2012 33
Gold Coast Private HospitalHealthscope’s most anticipated new development for Queensland is the Gold Coast Private Hospital.
General Manager of Allamanda Private Hospital, David Harper is on the planning committee for the new private hospital, which will sit adjacent to the public Gold Coast University Hospital.
“We are now entering into the design development stage,” said David.
Designs include a Level 2 special care nursery with nine cots, 12-bed intensive care unit, 11 operating theatres, a hybrid theatre and cardiac catheterisation lab.
The Gold Coast Private Hospital will also have 180 medical and surgical beds, a six-bed paediatric unit, 25 maternity beds and five delivery suites.
“As part of a green strategy, we have partnered with Queensland Health to
purchase utility services, emergency power and chilled water,” said David.
With designs expected to be finalised this year, construction of the new hospital is anticipated to commence mid-2013.
Brisbane Private HospitalAt Brisbane Private Hospital, consultation between management and architects resulted in the decision to consolidate two smaller operating theatres into one. Since the new theatre opened in April, spinal and neurosurgery have increased and Brisbane Private Hospital became the first in the southern hemisphere to purchase a portable full body CT scanner. Known as BodyTom the portable CT allows theatre sta¢ to perform inter-operative and post-operative scans.
A fully integrated camera monitoring system was also installed, allowing visiting medical sta¢ to view live surgery and increasing the hospital’s teaching potential.
“The growth we’ve already seen will be supported by plans to refurbish patient accommodation,” said Mairi McNeill, General Manager.
Pine Rivers Private HospitalTo meet increasing demand for mental health services, Pine Rivers Private Hospital more than doubled in-patient beds to 79.
The expansion took place gradually over 12 months, and was completed in July.
“Pine Rivers Private Hospital had reached full capacity and often had a wait list,” said Queensland State Manager, Richard Lizzio.
“It was clear that more people needed the service in the northern corridor from Brisbane to the Sunshine Coast.”
With a growing number of people
seeking Transcranial Magnetic Stimulation (TMS) treatment for depression, a second machine was added as part of the redevelopment.
“Patients come from as far as Cairns and Co¢s Harbour because Pine Rivers Private Hospital is the only site o¢ering TMS in Queensland,” Richard said.
“There are now two TMS machines running continuously to keep up with demand for this e¢ective and non-invasive treatment.”
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August 2012 35
DELIVERING advanced cardiac services to the Bundaberg and Wide Bay community has reached another milestone. The
Friendly Society Private Hospital has been given approval to operate both the Intensive Care Unit and the Cardiac Catheterisation Laboratory; both constructed as part of the recent multi-million dollar development.
The Friendly Society Private Hospital’s Cardiac Investigations Unit will be the only private or public facility of this kind between the Sunshine Coast and Townsville. It is anticipated that the full commissioning of this unit will happen later this year and will bring a new range of medical specialties to the Friendlies and importantly patients in regional centres. Traditionally patients had a signifi cant delay in access to more invasive cardiac procedures due to remoteness and at times di® culty in transporting patients to tertiary centres based in Brisbane and the Sunshine Coast.
The new services provided will include
procedures such as angiographies, where dye is injected into the heart to see how it is working and if there are any blockages. Other procedures that will be undertaken in the Cardiac Investigations Unit include the insertion and revisions of cardiac pacemakers and defi brillators, trans-oesophageal echocardiograms and cardioversions.
The equipment itself is state-of-the-art and allows cardiologists to undertake advanced diagnostic procedures locally.
“By having the Cardiac Catheterization Theatre we will be able to determine a defi nitive diagnosis within 24 hours, which will have a major impact on the acute management of patients with acute coronary syndromes,” said Cardiologist, Dr Conradie from Bundaberg Cardiology.
“The theatre will also help attract other specialties, including vascular surgeons, which will further enhance the delivery of extensive cardiovascular care to the Wide Bay community. “As cardiologists we are looking forward in establishing the services as soon as possible and to play a part in
delivering fi rst-rate medicine and fast track access to cardiovascular care to all our patients in the community.”
The Friendly Society Private Hospital also received notifi cation of approval to operate an Intensive Care Unit (ICU). This will allow the hospital to establish four intensive care beds to complement the current Coronary Care Unit, which means that in the event that more complex medical and surgical conditions arise, the hospital will be well equipped to handle this locally. The intensive care services will be well supported with many nurses from the Coronary Care Unit updating their skills over the past 12 months in readiness for the soon-to-open ICU.
The ICU will also enable the comprehensive cardiac services to continue to expand with the soon-to-be-implemented cardiac investigations unit. These approvals certainly continue to propel Friendly Society Private Hospital along the path of being Bundaberg and the Wide Bay’s leading healthcare facility. By Creina Lister
Licences to operate an Intensive Care Unit and Cardiac Catheterisation Laboratory granted to the Friendly Society Private Hospital
for Bundabergfor Bundabergfor Bundaberg
In focus: Infrastructure
Advanced cardiac services
FRESENIUSKABI Caring for lifeCommitted to improving the quality of life of critically and chronically ill patients through innovative products and a focus on therapy and care.
When pharmacist Dr Eduard Fresenius took over the Fresenius family pharmacy in Frankfurt in
1912 he had big ideas. A skilled pharmacist, Dr Eduard Fresenius built a small laboratory and started experimenting, developing innovative products to meet the needs of his customers.
Yet even Dr Eduard Fresenius could not have imagined that the company he started would grow to become a world leader that it is today.
Fresenius Kabi’s oncology, anaesthesia and IV drugs are indispensible in the emergency, intensive care and surgical departments of thousands of hospitals worldwide. Its comprehensive portfolio of infusion solutions provides hospitals with
products for fluid substitution and blood volume replacement. Fresenius Kabi is also one of the few companies to offer both parenteral and enteral nutrition. This range of products ensures patients receive comprehensive nutrition to support their recovery.
All these products are supported by specialised medical devices that improve the convenience and safety of application for both medical professionals and their patients.
Innovation for total patient careDr Eduard Fresenius’ focus on developing products that make a difference in the lives of those who use them remains integral to Fresenius Kabi.
“If there’s one thing that has been a hallmark of Fresenius Kabi it is innovation,” says Peter Nolan, Fresenius Kabi’s Pharmaceutical Division Director.
“Our range of products, the containers they come in and the devices used for infusion and transfusion, as well as the ways Fresenius Kabi manufactures these products, are all highly innovative. It’s a big part of the Fresenius Kabi fabric.
“By developing such a wide range of products specifically for people who are critically ill, Fresenius Kabi aims to provide these vulnerable patients with access to state-of-the-art products in all areas of treatment; total patient care for the critically ill.
“We can provide a comprehensive portfolio of products and services for chronically or critically ill patients, including administration of the drugs through application technology” says Peter. “From the needles and lines connected through the port to the pump and the IV drugs, fluids or nutrition the patient requires during surgery or treatment. Furthermore our range also covers areas of transfusion technology, such as apheresis and autotransfusion.”
Fresenius Kabi is also researching a total cancer care concept, which aims to ensure patients receive the individualised nutritional support they need before, during and after treatment.
“Ideally we would like to see a nutritional profile developed for each cancer patient as soon as they are diagnosed, even before surgery or chemotherapy,” says Peter. “This
would allow us to determine what nutrition the patient requires during treatment or if they should be given particular supplements to take home after treatment.
“There is a lot of research that suggests if you provide nutritional support to patients during their cancer journey they manage their side effects better and ultimately recover more quickly.
“These types of programs have the potential to reduce the burden of health as they may shorten the length of hospital stays as well as lessen the number of infections and complications, all of which can decrease costs for hospitals.
“Really that’s our aim for everything we do: improve the quality of life of critically ill people by providing quality products and supporting the health professionals who treat them.
“The quality of the company’s products is essential in this aim and quality management is taken seriously. All the company’s employees are very aware that the products they produce are for very sick patients.
“I think our employees feel real pride in working for us because the products really can make a difference to people’s lives,” says Peter. “The staff are also very aware
that they have a responsibility to those patients. A great example is our oncology compounding. We produce around 200,000 individual patient-specific doses each year across our three compounding centres.
“Because our people are so integral to our success we are very committed to them. We invest quite heavily to ensure they enjoy coming to work each day and can grow with us.”
Fresenius Kabi in AustraliaThe company’s ability to provide its products in a timely manner and at a competitive price has been bolstered by a commitment to local manufacturing. To better service the Australian market, local operations were established in 2004.
Here, Fresenius Kabi is best known for its oncology compounding. The centres in Melbourne, Sydney and Brisbane service more than 180 hospitals nationally. The local centres mean the majority of orders are turned around in under 24 hours.
Fresenius Kabi has also recently invested in robotic automation to support its competence in oncology compounding. RIVA (Robotic Intravenous Administration) is considered the gold standard in compounding technology and has the
capacity to produce up to 45,000 units of chemotherapy drugs each year. RIVA uses automation technology to compound intravenous drug products for syringes and IV bags, resulting in a high level of accuracy and efficiency. The technology also reduces human operator exposure to cytotoxic drugs, creating a safer compounding environment. These are all important factors to both employees and patients in the healthcare system.
“We have TGA licensed facilities in Sydney, Melbourne and Brisbane and plan further geographic expansion as the business grows. Fresenius Kabi, through a subsidiary, holds a pharmacy license co-located at the Sydney facility, which allows us to provide clinical services at the same time as the compounded drugs. We are a one-stop-shop in that regard.
“We’d like to build on our foundations by developing an e-health portal where patients can go to find more information on the treatments they are receiving. We want to make the portal accessible and simple. It’s another way we can provide support to a patient during their journey.”
To achieve all this, and continue the company’s rapid growth, Fresenius Kabi has already committed to ongoing investments in its products, services and its people in locations right across Australia.
“We’re here to stay,” says Peter.
Fresenius Kabi aims to provide vulnerable patients with access to state-of-the-art products in all areas of treatment; total
patient care for the critically ill
Fresenius Kabi Australia Pty Ltd 964 Pacific Highway Pymble NSW 2073 Phone: 1300 732 001 Fax: 1300 304 384 www.fresenius-kabi.com.au
PM2012.187
In focus: Infrastructure
38 August 2012
diagnosisdiagnosisdiagnosisdiagnosisdiagnosisdiagnosisPrompt cardiac
The Avenue Hospital has opened its new cardiac diagnostic services
Cardiologist Dr Andris Ellims
August 2012 39
EARLIER this year, The Avenue Hospital in Melbourne opened its new Cardiac Diagnostic Services Department to complement its existing
Cardiac Catheter Laboratory.According to recent Australian Bureau of
Statistics data, coronary artery disease remains the leading cause of death in this country. In Western countries, an increasing prevalence of obesity and diabetes is contributing to higher risks of coronary artery disease. Unfortunately, coronary artery disease can remain silent for years until sudden disease progression occurs, resulting in an acute coronary syndrome, or ‘heart attack’.
The Avenue Hospital’s new cardiac diagnostic service has already earned a reputation for rapid accessibility for patients and prompt reporting turnaround for referrers. Augmenting the tertiary cardiac treatment services provided at the hospital, the cardiac diagnostic service provides a dedicated, comprehensive service to meet the needs of patients, general practitioners and physicians.
Dr Andris Ellims, a cardiologist at The Avenue Hospital, specialises in the non-invasive assessment of coronary artery disease.
“It is important that our community is aware of the warning symptoms of coronary artery disease, particularly newly-recognised chest pain or shortness of breath, and seek medical assistance promptly should they occur,” he said.
The new cardiac diagnostic services at The Avenue Hospital provides a full range of non-invasive tests from 12-lead ECG and exercise stress tests, through to Stress Echocardiograms and Dobutamine Stress Echocardiograms. Consultation with a Consultant Cardiologist is also available.
Perhaps the easiest and most dynamic test for detecting coronary artery disease is the Stress Echocardiogram. Stress Echocardiography uses a treadmill and the Bruce Exercise Protocol (through increasing treadmill speed and inclination) to increase heart rate and contractility. Prior to, and immediately after exercise, an ultrasound
transducer is placed on the chest wall in a number of imaging positions (windows) to evaluate heart function. Pre and post images are then compared to determine whether myocardial wall contractility has increased appropriately with exercise.
If a region of the heart is slow to, or doesn’t, contract, this is suggestive of a coronary artery obstruction due to a build up of cholesterol laden plaque. With detection, a patient can then be managed with medications or referred to the Cardiac Catheter Laboratory for coronary angiography where stenotic or ‘narrowed’ plaque can be identifi ed and, if necessary, opened by ballooning (angioplasty) and coronary stenting.
Another useful non-invasive cardiac imaging test for diagnosing coronary artery
disease and assessing heart structure and function is Transthoracic Echocardiography (TTE). In this procedure, a selection of ultrasound views are employed to evaluate cardiac chamber size, heart valves and the great vessels. Doppler ultrasound can interrogate blood fl ow and myocardial tissue velocities. Ultrasound images are displayed on an ultrasound machine, stored digitally and are available for review later.
If you are an adult with high blood pressure, elevated cholesterol, diabetes, a family history of heart disease and/or a current or ex-smoker, see your doctor today about the consideration of non-invasive testing for coronary artery disease. By the Cardiac Diagnostic Services team, The Avenue Hospital
IT IS IMPORTANT THAT OUR COMMUNITY IS AWARE OF THE
WARNING SYMPTOMS OF CORONARY ARTERY DISEASE
‘‘‘‘
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August 2012 41
New e-learning modules at Macquarie University Hospital
have engaged staff and made training requirements easier
In focus: Infrastructure
August 2012 41
MACQUARIE University Hospital’s Learning and Development Department has developed a new web-based e-learning
system for sta¢ , which has proven to be highly successful. The fl exible system is designed to accommodate the varying shift patterns of work – including those of external contractors – as well as the diversity of aptitude, literacy and professional di¢ erences among sta¢ .
At their convenience, sta¢ can login to the system via any internet access point, including on android and tablet devices. Sta¢ then complete modules that are relevant to them by the required due date. Some modules, such as ‘emergency procedures’ and ‘manual handling’, are compulsory for all new employees. Other modules are tailored for particular segments of sta¢ . Nurses, for example, complete modules like ‘basic life support’ and ‘safe medication administration’.
Paperless learninglearninggets high marks
➤
In focus: Infrastructure
42 August 2012
“Being a digital and a paperless organisation, we opted for the most advanced systems that we could,” explained Lyn Saul, who led the initiative. “We selected a system called Moodle and partnered with Access Macquarie, an education-based IT department at Macquarie University, to implement it.”
Lyn and Senior Nurse Educator Marcella Grech completed a sta¢ needs analysis to determine the diversity of educational needs across the organisation. By using this consultative approach, the team planned the di¢ erent modules.
“E-learning packages are usually generic,” said Lyn. “But we wanted something
engaging so we took photos of sta¢ doing their work and used these in the modules. It was important that the materials refl ected the look and feel of Macquarie University Hospital and the value of each individual’s role in maintaining our high standards.”
The team opted for an e-book-style interface rather than a traditional power point look because it is user-friendly and more comprehensive. Modules can be updated to integrate new information. Each page also has an interactive activity, with the system making good use of audio-visual tools.
“From a data analysis point of view, it’s been fantastic,” said Lyn. “We can measure if anyone is having di® culties and where we
may need to mobilise extra resources. This allows us to assist sta¢ individually or to tailor-make training for discrete areas.
“The data is easily retrievable and goes straight to an individual sta¢ member’s compliance fi le. Their profi le pages show them their results with a graph of their performance, so it’s all transparent.
“Sta¢ love it! Within a month of launching our ‘emergency procedures’ module, we had 90 percent compliance. This has dramatically streamlined access to mandatory training because we’ve created a user-friendly system and a positive learning environment.”
THIS HAS STREAMLINED
ACCESS TO TRAINING
BECAUSE WE’VE CREATED
A USER-FRIENDLY SYSTEM
AND A POSITIVE
LEARNING ENVIRONMENT‘‘
‘‘
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August 2012 45
THE NEW private hospital at Kawana on the Sunshine Coast University Hospital site is starting to take shape and is now one third of the way through
its building schedule. When it opens in late 2013, the new $150 million private hospital will provide a signifi cant range and volume of services to public patients through a service purchase agreement with Queensland Health.
Akalan Project Director David Du¢ y said despite two metres of rainfall this year, construction was on track with ground slabs completed in May and the level one suspended slabs due to be completed by mid June. Construction company John Holland said 100,000 man-hours have been completed by workers on site so far.
The next stages are the commencement of internal trades and the erection of the structural steel roof.
Ramsay’s Queensland State Manager Lloyd Hill said Ramsay Health Care was very happy with the progress of the development.
“Planning for fi tting out of the operating theatres and the intensive care unit are now well underway and we are pleased to report that these facilities will be equipped with the latest technology,” said Mr Hill.
“The six theatres will have smart operating room technology that can bring patient critical information into the operating suite during a procedure. The hospital will also have a catheter laboratory for cardiac and vascular procedures.”
Mr Hill said the interest from doctors
locally and Australia-wide was strong. “We have had over 1,100 expressions of interest from people wanting to work at the facility. The majority of the interest is coming from the local community but we have had a lot of interest from interstate.
“We are also really happy with the interest from doctors to work at this hospital. Many of these doctors have expressed interest in purchasing suites in the on-site specialist centre and already we have had to expand our initial planning for this centre to cope with the high demand.”
In June the Queensland O® ce of Fair Trading advised that it has approved the name Sunshine Coast University Private Hospital. Ramsay applied for this name with support of the University of the Sunshine Coast.
Construction is on track for completion in late 2013
University Private Hospital on track
University Private Sunshine Coast
In focus: Infrastructure
In focus: Infrastructure
46 August 2012
Australia’s fi rst digital hospital will showcase the future of healthcare
futurefuturefuturefuturefuturefutureThe hospitalfuturefuturefuturefuturefuturefutureThe hospital
of the
AUSTRALIA’S fi rst fully-integrated digital hospital will be built at Hervey Bay on Queensland’s Fraser Coast by UnitingCare Health with the
support of Federal Government funding. The state-of-the-art ‘hospital of the future’ will be supported by the Health and Hospitals Fund (HHF), which will provide $47 million towards the estimated $87.5 million construction and e-health costs.
Scheduled to open in August 2014, the 96-bed hospital will not only provide vital medical and surgical services and an unparalleled model of patient care, but also will be the fi rst to showcase the future of healthcare. According to UnitingCare Health’s Executive Director, Mr Richard
Royle, this project will demonstrate how technology can transform the healthcare experience for patients and clinicians.
“UnitingCare Health has always been committed to providing fi rst-class treatment and care and consistently redevelops and refurbishes its facilities both in Brisbane, at The Wesley and St Andrew’s War Memorial Hospital, and in the regions at The Sunshine Coast Private Hospital as well as at St Stephen’s in Maryborough. But this project at Hervey Bay will be transformational,” said Mr Royle.
“The advanced wireless technologies will generate e® ciencies, improve safety and clinical outcomes and create higher levels of patient and clinician satisfaction.
“All medical records, X-ray and pathology results will be accessible by doctors and
nurses anywhere in the hospital, whether at the bedside or remotely on tablets, mobile phones, laptops or mobile computers on wheels, as well as at nurses’ stations. For the fi rst time, clinicians will have information at their fi ngertips which will enable faster and more e® cient decision making.”
The Acting Minister for Health, Mark Butler, said that through the $5 billion Health and Hospitals Fund the Gillard Government was giving Australians better access to hospital services, while at the same time helping to create jobs and strengthen local economies.
“Hervey Bay is one of the fastest growing local government areas in Australia,” said Mr Butler. “This hospital development will deliver world-class patient care, including through the latest in e-health technology.
August 2012 47
“St Stephen’s is an important local project that will deliver the benefi ts of the Federal Government’s Health Reform agenda and commitment to e-health initiatives.”
Leanne Tones, General Manager of St Stephen’s Hospital, said that the project was a unique opportunity to provide a fl agship hospital, not only for Hervey Bay, but for the whole of Australia.
“To be the fi rst to build a fully-integrated digital hospital in the nation is a privilege and an enormous responsibility,” Ms Tones said.
“We are putting together a prestigious e-health project team, sourced from the best available in Australia and complemented by leaders in the fi eld from the US, including Cerner, a major global provider of healthcare IT solutions.”
Jill O’Brien, Director of Nursing at St Stephen’s Hervey Bay, said that the digital system will mean all electronic medical records, nurse call system, phone systems and patient medical devices such as blood pressure machines and infusions pumps would be integrated.
“This will mean the development of an entirely new model of care with better accessibility to patient records and other information enabling improved sharing of information and results with patients and less time wasted trying to fi nd other sta¢ or equipment,” said Ms O’Brien.
“The digital capability of St Stephen’s Hospital Hervey Bay and the corresponding change and innovation in work practices is an exciting challenge for our clinicians.”
ALL MEDICAL RECORDS, X-RAY AND PATHOLOGY
RESULTS WILL BE ACCESSIBLE BY DOCTORS AND NURSES
ANYWHERE IN THE HOSPITAL
‘‘‘‘
Richard Royle, UnitingCare Health Executive Director
In focus: Infrastructure
48 August 2012
GenesisCare and Lake Macquarie Private Hospital partner to provide radiation oncology services
GENESISCARE and Lake Macquarie Private Hospital have combined in a partnership that will see essential radiation oncology
services provided at the Hospital and will improve overall care and access for cancer patients in the Hunter Valley.
In a fi rst for the region, Lake Macquarie Private Hospital will provide comprehensive, private cancer treatment services. This will be the fi rst and only private radiation oncology service in the Newcastle and Hunter
region. GenesisCare will deliver radiation oncology services to accompany the existing medical oncology, day chemotherapy and cancer surgery services o¢ ered by Lake Macquarie Private Hospital.
The benefi ts for those undergoing treatment for cancer in Newcastle, Lake Macquarie and the broader Hunter Region will be signifi cant.
“This announcement is the culmination of extensive consultation and planning between GenesisCare, Ramsay Health Care and local radiation and medical oncologists,”
A5 Private Hospital insert v4.indd 1 27/07/2012 4:14:35 PM
Improving Improving Improving Improving Improving Improving cancer carefor Hunter residents
August 2012 49
A5 Private Hospital insert v4.indd 1 27/07/2012 4:14:35 PM
said Mr John Pitsonis, Chief Executive O® cer of Lake Macquarie Private Hospital
The Radiation Oncology Unit at Lake Macquarie Private Hospital will form part of a comprehensive range of private cancer services and supplement the hospital’s existing range of specialist medical, diagnostic and surgical services.
“The provision of radiation oncology services compliments the existing range of cancer treatment services provided at Lake Macquarie Private Hospital as well as the comprehensive range of public cancer treatment services available within the Hunter New England Area Health Service,” said Mr Pitsonis.
Speaking on behalf of local radiation oncologists, Dr Anne Capp said: “The development of a new, private radiation oncology service will benefi t cancer patients in the Hunter region by increasing local capacity and o¢ ering patient choice”.
Dr Peter O’Brien added: “This much needed addition to radiation oncology services will provide the people of Newcastle with state-of-the-art cancer care and treatment as part of a new comprehensive service.
“The new centre will help relieve pressure on current radiotherapy services and most importantly, will reduce the enormous emotional burden for patients by improving access.”
Planning has commenced with the unit set to be open late 2013.
Managing Director of Genesis CancerCare, Mr Dan Collins, said: “As a result of the introduction of GenesisCare cancer services into Lake Macquarie Private Hospital, cancer patients in the Hunter region will benefi t from some of the most advanced Radiation Oncology treatment techniques, technology, clinical professionals and facilities available in Australia. We are pleased to be partnering alongside Ramsay in this initiative where the best of both organisations combines together for real patient benefi ts.”
THIS MUCH NEEDED ADDITION TO RADIATION ONCOLOGY SERVICES
WILL PROVIDE THE PEOPLE OF NEWCASTLE WITH STATE-OF-THE-ART
CANCER CARE AND TREATMENT
‘‘‘‘
We’re giving Rosie confi dence she can relax when she’s fi nished work.
Rosie. Nurse, pâtissier and member since 1988.
Find out more on how we’re helping Rosie at healthsuper.com.au/Rosie
Health Super is a division of the First State Superannuation Scheme ABN 53 226 460 365 of which FSS Trustee Corporation ABN 11 118 202 672 AFSL 293340 is the Trustee.
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August 2012 51
Into the
Extreme experiences
➤
AN UNEXPECTED call from a 60 Minutes producer found Greenslopes Private Hospital’s Dr David Rosengren, Director of
Emergency, o¢ on a spectacular journey to the centre of the earth, a magical place known as the Crystal Cave, deep in the deadly heart of a Mexican lead mine.
After two years of planning and negotiation, the 60 Minutes team received two weeks’ notice to mobilise a crew to the province of Chihuahua in central Mexico, where they would have only four days’ access to secure this amazing story.
As one of Australia’s leading emergency medicine specialists with a keen interest in
adventure medicine, Dr David Rosengren jumped at the opportunity to be part of this once in a lifetime experience. But this is not the fi rst time Dr Rosengren has travelled with the 60 Minutes crew having previously been at the centre of a story about potential causes of illness and recent deaths of trekkers on the Kokoda Track several years ago.
This time 60 Minutes was keen to have Dr Rosengren join the crew because of the unique environment and conditions they would encounter in the Crystal Cave.
In many caves and mines the temperature remains constant and cool, but the Naica mine gets hotter with depth because it lies above an intrusion of volcanic magma about a mile below the surface. Within the cave
Director of Emergency’s journey with 60 Minutes
Extreme experiences
52 August 2012
itself, the temperature leaps to in excess of 45 degrees Celcius with 100 percent humidity; an environment that is incompatible with human life.
For hundreds of thousand of years, groundwater saturated with calcium sulphate fi ltered through the many caves at Naica, warmed by heat from the magma below. As the magma cooled, water temperature inside the cave eventually stabilised and remained static at about 52 degrees Celcius. At this temperature minerals in the water began converting to selenite (a form of gypsum) and molecules of which were laid down like tiny bricks to form crystals. Inside the Cave of Crystals, conditions remained unchanged for thousands of years and the crystals steadily grew. Only around 1985, when miners using massive pumps lowered the water table and unknowingly drained the cave, did the growth of the crystals stop.
The limestone cavern and the world’s largest crystals were discovered in 2000 by two brothers drilling nearly a thousand feet below ground in the Naica mine, one of Mexico’s most productive, yielding tonnes of lead and silver each year.
“There have been very few people allowed
to enter the cave so I feel very privileged to be one of them,” said Dr Rosengren. “It is extraordinary – the walls and fl oor of the cave are covered in blocks and clusters of the crystal formations some of which span 11-12 metres and have a cross section of one-and-a-half metres. It is estimated that the oldest crystals would be in excess of 600,000 years old. Nothing on this scale has ever been seen before.
“The giant gypsum crystals are like frozen pillars of ice, similar to Superman’s Fortress of Solitude. The di¢ erence is that the Crystal Cave is far from frigid; in fact is quite the opposite and can be quite dangerous. The catch is that the extreme environment needed to produce such massive crystals is incompatible with human life.”
“The experience in the caves can best be described as excruciatingly hot, stunningly beautiful, and potentially deadly. It was my
job to make sure the crew stayed outside the danger zone. Even with ice suits and protective gear the heat and humidity were oppressive and each visit inside the cave lasted about 10 to 12 minutes before we had to get out to avoid our bodies overheating. The conditions were tough for the crew who had to do several trips to set up camera and sound gear before we could even begin to fi lm.”
The site remains part of a functioning mine and is locked to any access to protect the cave and the mine. Apart from the geologists and scientists who undertook extensive scientifi c survey in 2007-08 and stories covered by National Geographic in 2008 and BBC in 2010, the 60 Minutes crew, including Dr David Rosengren and British Geologist Dr Dougal Jerram, are among some of the select few that have been able to witness this extraordinary wonderland fi rst-hand.
THERE HAVE BEEN VERY FEW PEOPLE ALLOWED TO ENTER
THE CAVE SO I FEEL VERY PRIVILEGED TO BE ONE OF THEM
‘‘‘‘
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Treating lymphoedema
54 August 2012
Using liposuction to help breast cancer patients with lymphoedema
54 August 2012
August 2012 55
WHEN breast cancer patient Megan Southwell developed lymphoedema following surgery,
she put her hand up for a novel procedure that had just become available at Macquarie University Hospital.
Diagnosed with breast cancer at the age of 36, Megan Southwell underwent a lumpectomy and lymph node resection, followed by a course of chemotherapy and radiation treatment. After her second round of chemotherapy, she developed a small infection in her right arm, which eventually became moderate to severe lymphoedema complicated by infection. The fatty deposits in the lymphoedematous arm prevented recovery by usual massage and compression therapy.
Previously, with neither viable treatment nor cure available for lymphedema, patients would have had to simply endure the inconvenience of swollen limbs. But Megan found herself open to a novel solution being o¢ ered to breast cancer patients at Macquarie University Hospital. The solution involves applying a standard liposuction technique, usually used for removing fat from the stomach and thighs, to the removal of fat from the arm. It was pioneered by Swedish plastic and reconstructive surgeon Professor Hakan Brorson.
The application of liposuction for lymphoedema in breast cancer patients was brought to Australia by Dr Helen Mackie, a specialist providing lymphoedema management to breast care patients at Macquarie University Hospitals Cancer Care Institute.
In 2008, Dr Mackie – at Professor Brorson’s invitation – took a team from Australia to Malmo in Sweden to train in the full program, which includes the assessment,
surgery and important aftercare of the multidisciplinary program.
“Professor Brorson will not train a single person, only a team,” said Dr Mackie. “This is because it is the combination of elements of the team’s work that is innovative in his approach, as well as the selection of the patients who will most benefi t in improvement in their quality of life and physical function.
“At Macquarie University Hospital, the multidisciplinary approach is securely in place to enable success of the approach. The involvement of the research team and the international connection will add further value for lymphoedema su¢ erers in a condition that has largely been ignored for many years, but is causing a loss of survivor quality of life.”
To perform the procedure, a surgeon makes about ten small cuts in the arm. Because the fat in the arm is tougher than on the stomach and thigh, a sharper cannula is used and more sub-cutaneous fat is removed. A torniquet can be used – again, as this is possible with the arm – so less blood loss results.
Plastic and reconstructive surgeon Dr Thomas Lam, who performed the operation in collaboration with Scottish surgeon Dr Alex Munnoch, agrees with Dr Mackie that it is the integrated team approach that plays the pivotal role in the success of this approach for patients.
“The multidisciplinary team structure set up by Professor John Boyages in the Cancer Care Institute at Macquarie University
Hospital is precisely what is enabling, and will enable, new procedures to come to Australia,” commented Dr Lam.
“For many new procedures to be successful, they need follow-up and support. In Megan’s case, physiotherapy and occupational therapy after her surgery were paramount; without them the procedure would not have succeeded.
“While surgeons can train and perform
the procedures, they need the support of neurologists, rehabilitation specialists, radiographers, nurses and allied health workers. And this support needs to be close at hand and part of a well-established and integrated approach. At Macquarie University Hospital, we have this environment.”
The benefi ts to patients are not insignifi cant. Previously, a patient like Megan would su¢ er not only the inconvenience and discomfort of a hugely swollen arm, but also a sorely restricted quality of life. For her, the procedure was an opportunity that would be life-changing.
“The prospect of the procedure was exciting to me,” Megan said. “I gladly put my hand up when I heard about it. I found the teamwork at Macquarie University Hospital amazing; there was such a collaborative approach to my operation. The surgeons at the hospital are doing fi rst-time procedures in Australia; they are bringing new options to us.
“I was back on my cross-trainer within a week and, for the fi rst time in four years, I could wear a coat,” said Megan with a smile.
PREVIOUSLY, A PATIENT LIKE MEGAN WOULD SUFFER A SORELY
RESTRICTED QUALITY OF LIFE ‘‘ ‘‘
A novel solution for A novel solutionfor lymphoedema
56 August 2012
Policy Patter with Barbara CarneyPolicy Patter with Lucy Cheetham
Future in partnerships?
The focus of public and private sector partnerships is shifting
towards service provision
THE excitement surrounding the announcement of several major Public Private Partnerships (PPPs) and Privately Financed Projects (PFPs) in recent
months, including the New Royal Adelaide Hospital in South Australia, contrasting with continuing tensions surrounding the Royal North Shore Hospital in Sydney, might well prompt deeper thinking on the future of public and private sector partnerships.
National Public Private Partnership Policy and Guidelines endorsed by the Council of Australian Governments (COAG) in November 2008 recognise the role of PPPs in providing not only infrastructure but also services (although most of the emphasis to date has been on built infrastructure). Several recent reports highlight that new approaches are emerging in Australia and internationally that see a greater emphasis on service provision and the importance of fl exibility in ensuring that these partnerships deliver value.
Katie Wood, Arup’s Australasia Healthcare leader, has recently highlighted the importance of understanding the need for long-term fl exibility when planning and contracting for hospital infrastructure.1
Two other papers both look to the UK for inspiration. In a paper from the Centre for Independent Studies, Dr Jeremy Sammut argues that PFPs in NSW must be widened
in scope to include not only building projects but the full range of clinical, accommodation and related services. However, if they are to work, Dr Sammut argues they must be grounded in management accountability. Local Health Districts must have autonomy and responsibility for their own budgets and PFP arrangements must allow for the introduction of fl exible workplace practices including the right to hire and fi re clinical sta¢ .2
Gary Sturgess cites several examples in the UK of new hybrid business models and supply chains through which public, private and not-for-profi t providers provide contracted services on behalf of government. Some models challenge traditional public and private sector defi nitions.3
In Australia too, collaboration between public and private sectors is taking an ever increasing variety of forms. Not all infrastructure development projects are on the mammoth scale of the New Royal Adelaide Hospital or the Royal Children’s Hospital in Melbourne. The 2012/13 Commonwealth Budget provides for $475 million to support 76 rural and regional health infrastructure projects including 10 involving private hospitals. Not all partnerships are infrastructure focused as there are also private wards in public hospitals and private hospitals providing public hospital services.
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COAG funding commitments to improve access to elective surgery and sub-acute care squarely focus attention on areas where the private sector is clearly placed to deliver. In future years, direct resourcing implications will fl ow from the performance of the states. As states and territories continue to look for ways to manage their fi scal environment and as approaches to activity based funding mature, will we see increased emphasis on competitive tendering? And on what terms?
While there are some salutary instances of failure in the past, it is perhaps too early to tell whether the right lessons have been learnt.
APHA is keen to ensure that policy at state and Commonwealth level is well informed not only by international practice but also by Australian industry experience.
I would like to close my fi rst column by thanking those of you who have been so welcoming since I joined APHA in June and especially Michael Ro¢ , CEO and Dr Barbara Carney, my predecessor.
Gow-Gates understands the specific issues facing Private Hospitals and Day Surgery Clinics. Our experienced team is here to assist with your Property, Liability, Medical Malpractice, Workers Compensation and all other insurance related issues. Make
contact with our team today to see how we can improve your program and reduce your risk related costs.
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Protecting Health Care Providers for over 25 years
For more information please contact Gow-Gates on:Phone: (02) 8267 9999 Email: [email protected] Website: gowgates.com.au
Health Care Industry Insurance
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I look forward to hearing from many more of you in coming weeks as I work to enable APHA to bring your day-to-day issues to the attention of governments to e¢ ect practical change. Please feel free to contact me at [email protected].
References1. Katie Wood, Health / PPP hospitals must
give value for money, 12 April 2012. http://thoughts.arup.com/post/details/182/ppp-hospitals-must-give-value-for-money
2. David Gadiel and Jeremy Sammut, How the NSW Coalition Should Govern Health: Strategies for Microeconomic Reform, CIS Policy Monograph 128, The Centre for Independent Studies, June 2012. http://www.cis.org.au/images/stories/policy-monographs/pm-128.pdf
3. Gary Sturgess, Diversity and Contestability in the Public Service Economy, NSW Business Chamber, June 2012. http://www.nswbusinesschamber.com.au/News-Media/Latest-News/Diversity-and-contestability-report-highlights-sev
Gow-Gates understands the specific issues facing Private Hospitals and Day Surgery Clinics. Our experienced team is here to assist with your Property, Liability, Medical Malpractice, Workers Compensation and all other insurance related issues. Make
contact with our team today to see how we can improve your program and reduce your risk related costs.
Gow Gates Insurance Brokers Pty Ltd ABN 12 000 837 785 AFSL 245432
Protecting Health Care Providers for over 25 years
For more information please contact Gow-Gates on:Phone: (02) 8267 9999 Email: [email protected] Website: gowgates.com.au
Health Care Industry Insurance
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58 August 2012
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Quality in Focus with Christine Gee
IN KEEPING with the theme of this edition of Private Hospital, health infrastructure, I have enlisted the help of Nick Wilcox, Senior Project O®cer, Clinical Registries, Australian
Commission Safety and Quality in Health Care to give insight and overview into the development of national arrangements for clinical quality registries.
A recent study1 of 13 disease registries in five countries indicates that clinical quality registries improve health outcomes, often at lower cost. The study suggests that, if the US had a hip replacement registry comparable to that in Sweden, the US would avoid $2 billion of an expected $24 billion in total costs for these interventions in 2015.
The US and UK have a broad range of clinical quality registries and more than 70 registries have been developed in Sweden. Over 20 of these registries have greater than 85 percent patient coverage and the conditions or interventions they monitor represent approximately 25 percent of total national healthcare spending.
In Australia, however, we can only monitor the degree to which health care benefits the patient and how closely that care aligns with the best available evidence for a small number of conditions and interventions. We have limited capacity to measure and compare:• the appropriateness of Australian health care
for specific interventions and conditions• the e¢ectiveness of interventions for patients.
The paucity of data on the quality of healthcare interventions may come as a surprise to consumers of health care. It mystifies many who work in health as the healthcare sector is at the forefront of
developments in medical technologies.National and international experience
shows that clinical quality registries work and are cost-e¢ective. In November 2010, Health Ministers endorsed the Commission’s Strategic and Operating Principles for Clinical Quality Registries2 as the basis for a national approach to the development of registries.
Historically, the drive to measure patient outcomes and adherence to recommended care has come from clinicians and clinical groups. In their ‘spare time’ clinicians have lead e¢orts to build and populate their locally developed data collection systems by gathering and entering information on the patient’s condition, what was done in terms of medical or surgical interventions and the results of those interventions. The process, carried out with varying degrees of success, often involves busy clinicians entering data close to the point of care.
Sometimes hospital units, or small groups of hospitals, have developed common databases. In many instances these systems have the ability to provide clinicians and hospitals with the capacity to track improvements in local outcomes over time. The outcomes of clinical teams can be compared within a particular hospital or across hospital groups. However, often the units that have the capacity to create such systems are the least likely to fall below a clinical standard or outcome benchmark.
The ability to track outcome improvements does not necessarily provide an indication of the acceptability of those outcomes against minimum standards, and the goal of achieving comparisons across national peer groups remains unfulfilled. E¢orts to address such comparisons are
plagued by data and systems incompatibility and a complicated legislative environment.
Some clinical groups in Australia have developed standardised data sets and sophisticated database systems - clinical quality registries - enabling routine monitoring and measures of health care e¢ectiveness for jurisdictions, providers, funders, clinical colleges and researchers. This information facilitates comparison with peers and against benchmarks and the identification of significant variance in health care quality. Ultimately, the information is used by clinicians and clinical groups to inform improvements in healthcare quality, safety and value.
Australia has at least 28 identified clinical registries which continuously collect patient-level data across numerous healthcare sites. Many can be classified as clinical quality registries because the primary purpose of the collection is to inform quality assurance or quality improvement activities. However, in 2009 only a handful of registries, including those monitoring the management of hip and knee joint replacements, end-stage renal failure and intensive care, had acceptably high levels of participation. While other high-quality Australian registries exist,
Clinical quality registries
Developing national arrangements for clinical quality registries
Quality in Focus with Christine Gee
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August 2012 59
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many lack adequate levels of coverage. A registry with low participation rates su¢ ers from ‘selection bias’; the resulting data is insu® ciently representative of the eligible population, thereby having little credibility to provide quality assurance or inform improvements in healthcare quality.
Australian developmentsThe principal barriers to the development of clinical quality registries in Australia are: • Data entry (collection) of source data• Poor interoperability between clinical
information systems• Technical systems development and support• ‘Data governance’ burdens and constraints
(restrictions on the disclosure, collection, and use of patient-level data) and
• Funding.
The Australian Commission on Safety and Quality in Health Care is working to address the fi rst four of these barriers.
In November 2010, Health Ministers endorsed the Commission’s Strategic and Operating Principles for Clinical Quality
Registries2 as the basis for a national approach to the development of registries. Additionally, Ministers accepted that the Commission will draft national arrangements for clinical quality registries including: 1. The drafting of costed infrastructure
options for the establishment of secure data hosting and operational services for a limited number of high priority clinical quality registries, and
2. The development of health information (or ‘data governance’) arrangements.
In 2011 the Commission, in collaboration with the National E-Health Transition Authority, developed costed infrastructure options for clinical quality registries. In June 2012 the Commission published a suite of technical resources3 to guide the development of registries including Business and Technical Requirements, Infrastructure and Technical Standards, Logical Architecture and Design, and a Security Certifi cation Framework.
The Commission, working with expert advisory groups including jurisdictional representatives and sta¢ from established
registries, is working to identify national data governance arrangements under which patient level data may be routinely disclosed, collected and analysed. This will support the monitoring and reporting of the appropriateness and e¢ ectiveness of specifi c healthcare interventions and conditions.
This work, along with costed infrastructure options, will be presented to the Australian Health Ministers’ Advisory Council in early 2013.
I welcome your feedback on this column and on any matters relating to quality and safety and the Australian Commission on Safety and Quality in Health Care. I can be contacted via the APHA Secretariat, [email protected]
References1. Larsson S et al Health A� airs Jan 20122. www.safetyandquality.gov.au/our-work/information-strategy/clinical-quality-registries/strategic-operating-principles-for-clinical-quality-registries3. www.safetyandquality.gov.au/our-work/information-strategy/clinical-quality-registries/technical-resources
Nursing and Allied Health Scholarship and Support Scheme (NAHSSS) is funded by the Australian Government.
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Opens 23 Ju ly 2012 Closes 14 Sept 2012
60 August 2012
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Pharmacy Focus with Michael Ryan
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THE ten National Safety and Quality Health Service (NSQHS) Standards have been developed by the Australian Commission on Safety and
Quality in Health Care (ACSQHC). They are designed to provide a quality assurance mechanism that tests whether relevant systems are in place to ensure minimum standards of safety and quality are met and a quality improvement mechanism that allows health services to realise aspirational or developmental goals.
The intention of the Medication Safety Standard is to ensure competent clinicians safely prescribe, dispense and administer appropriate medicines to informed patients and carers. The ACSQHC has produced a draft guide:• To help hospitals meet the requirements
of the National Safety and Quality Health Service (NSQHS) standards
• Which provides examples of evidence a hospital can use to demonstrate how it is meeting the NSQHS Standards and
• Which provides additional information and resources and to support the implementation of the NSQHS Standards.
It is important to note that the standards were designed by the ACSQHC to be applicable across all healthcare settings and to all categories of patients within those settings. The ACHS will be reviewing compliance with these standards from 1 January 2013.
The five major criteria to achieve the standard for medication safety are:• Governance and systems• Documentation of patient information• Medication management processes• Continuity of medication management and• Communicating with patients and carers.
The standard describes 15 ways for the criteria to be achieved and 37 actions required to do this. These 37 actions can be categorised into one or more of the following types of checking or reviewing:• That certain things are in place (eg policies
and procedures, a governance structure etc)• That regular assessment or monitoring is
occurring (eg medication incidents are regularly monitored)
• That action is being taken (eg to reduce the risk of medication incidents)
• That certain things are documented (eg a medication history)
• That certain things are reported (eg ADRs are reported to the hospital and to the Therapeutic Goods Administration and
• That audits where appropriate are conducted to provide evidence that the criteria are being met and the required activity is taking place (eg that a medication management plan is available in each patient’s clinical record).
Obvious questions that arise in relation to audits (for which to date no guidance has been provided by the Commission) are:• How is the sample to be created and • What is the number of individual
clinical records that need to be audited in order to provide a statistically appropriate level of confidence (eg to a 90 percent or 95 percent level) that the sample does not vary by more than 10 percent from the whole of the hospital’s patient population.
The sampling method and size of the sample are critical to providing this level of confidence and to allow the audit to be conducted again with the confidence that
Medication safety
Like most serious undertakings, Standard 4 (medication safety) raises
as many questions as it answers
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August 2012 61
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the results of longitudinal audits can be compared and changes accurately identifi ed.
To date the Commission has also not provided a tool that will facilitate accurate and fast data collection and tabulation. It is possible to create such a tool, using MS Excel, which allows data from multiple sources within the individual clinical record to be noted in a way that make this onerous task much easier.
The examples that the ACSQHC uses in the (draft) guide provides a good idea as to what activities are deemed to provide evidence of meeting the various criteria.
What we need to knowTo be compliant with Standard 4 by 1 January 2013, hospitals and health services will need to decide:• Which of the medication-related processes,
records, documentation and audits best demonstrate the hospital’s compliance with the criterion listed in Standard 4
• Which aspects of medication management will need to be audited to
demonstrate compliance• Which sampling method should be
employed (eg random sampling of the individual clinical record for every patient discharged over a one month period using a consecutively numbered discharge patient approach)
• What should the size of the sample be in order to provide confi dence that the sample varies from the total population by less than 10 percent
• Which tool(s) will enable data to be collected and collated accurately and quickly
• When and who will collect, collate and report the audit work and
• When the audit will be repeated in order to demonstrate progress towards meeting the requirements of the Standards.
Although there are many important decisions to be made and a lot of work to be completed to demonstrate compliance, the e¢ ort will be worth it for what it will reveal of a hospital’s systems and practices in ensuring medication safety.
Michael Ryan, Director, PharmConsult PharmConsult is Australasia’s leading hospital pharmacy consultancy advising hospitals on the operational, fi nancial, professional, service, risk and legislative issues associated with hospital pharmacy services. www.pharmconsult.com.au
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62 August 2012
Legal Matters with Alison Choy Flannigan
THE development and redevelopment of hospitals raise particular contracting issues. In the June 2011 edition of Private Hospital, I described how
hospital infrastructure projects can be unique. In this article, I will discuss a case involving a private hospital project that illustrates some of the principles and pitfalls in infrastructure contracting: Macquarie International Health Clinic Pty Ltd v Sydney South West Area Health Service [2010] NSWCA 268. That case involved a number of issues, however, we will focus on one specifi c issue in this article: the meaning of an obligation to act in “utmost good faith”.
FactsOn 18 September 1989 the parties signed Heads of Agreement for the development by Macquarie of a 200-bed private hospital and a car park on the campus of Royal Prince Alfred Hospital (RPAH).
After negotiations to proceed with a smaller hospital, the parties signed various agreements.
Under some of these documents, the parties were obliged to act with utmost good faith in the performance of their respective duties, in the exercise of their powers and in their respective dealings with one another.
An important aspect of the project was the co-location of RPAH and the proposed private hospital, requiring a physical link between RPAH and the private hospital.
In mid 1994, the Sydney South West Area
Health Service (SSWAHS) appointed consultants to undertake an asset strategic plan. A draft of the plan did not indicate any proximity or linkages to the proposed private hospital. On or about March 1996 Mayne Nickless trading as Health Care of Australia (HCoA) began developing a project for a Sydney University Private Hospital (SUPH) on a site adjoining RPAH.
A dispute arose as to whether or not Macquarie complied with the contractual timetable, and by 15 September 1999 SSWAHS served on Macquarie notices of default under the Lease and the Construction Deed and took possession of the land.
Utmost good faithThe court held that the promise of utmost good faith must be construed having regard to the terms of the contract and the circumstances known to the parties in which it was entered into. “A contractual obligation of good faith embraces no less than three related notions:• an obligation on the parties to co-operate
in achieving the contractual obligations;• compliance with honest standards of
conduct; and• compliance with standards of conduct that
are reasonable having regard to the interests of the parties.”1
A contractual obligation of good faith does not require a party to act in the interests of
Hospital infrastructure
projectsContracting issues:
the principles and pitfalls
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the other party or to subordinate its own legitimate interest to the interests of the other party; although it does require it to have due regard to the legitimate interests of both parties.2
The Court held that the obligation of utmost good faith required SSWAHS to inform Macquarie of SSWAH’s planning process concerning the fl ow of persons between the hospitals or the creation of the campus concept and to at least enable Macquarie to take account of it in the design and construction of the works as contemplated under the Heads of Agreement. It also extended to enabling Macquarie the opportunity to persuade SSWAHS to take a di¢ erent course and/or withdraw from the project and seek SSWAH’s consent.
Further, in contracts such as these in a context such as this one, the obligation of good faith necessarily requires a degree of cooperation between the parties in a reasonable way in the furtherance of their contractual obligations.
The court held that it is relevant to consider dealings of the parties prior to the signing of the HOA, as bearing on circumstances known to parties which
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advice
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could be relevant to the construction of the obligation. Where SSWAHS’s planning process would make a substantial di¢ erence to what Macquarie could reasonably expect concerning the fl ow of persons or the creation of the campus concept, Macquarie was required to be informed. SSWAHS was required to disclose that planning processes were under way, indicating that Macquarie could no longer reasonably expect that there would be substantial RPAH facilities in the proposed location.
It was a breach of the obligation of utmost good faith for SSWAHS to give any support to the establishment of a private hospital which would make Macquarie’s private hospital non-viable. It was common ground that there could not be two viable private hospitals in the immediate vicinity of RPAH.
However, Macquarie failed to prove that that a signifi cantly di¢ erent result would have been achieved if there had not been a breach by SSWAHS and did not prove that it was ready, willing and able to substantially perform the Heads of Agreement so it’s claim for reliance damages was defeated.
CommentaryNot every hospital project will be a hospital co-location project. However, hospitals are typically co-located with other businesses, including medical consulting suites, pathology and diagnostic imaging businesses, gift shops, cafes and pharmacies.
When entering into contractual negotiations care needs to be taken in using legal terms such as “utmost good faith” and “good faith” as these terms can impose signifi cant obligations on the parties which are not otherwise expressly stated. These obligations may a¢ ect the redevelopment of a hospital site. Before embarking on hospital redevelopments it is important to undertake due diligence on existing contractual obligations to ensure that the new development does not cause an issue and that issues are appropriately planned for and resolved without recourse to litigation.
References1. Macquarie International Health Clinic Pty Limited v Sydney South West Area Health Service [2010] NSWCA 268; please also refer
to other references referred to in the case.2. Macquarie International Health Clinic Pty Limited v Sydney South West Area Health Service [2010] NSWCA 268; Overlook v Foxtel [2002] NSWSC 17 referred to.
Alison Choy FlanniganPartner, Health, aged care & life sciencesHolman Webb, Lawyersalison.choyfl [email protected]
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August 2012 65
Since the Last Issue
Raising your concerns
AT THE beginning of June, APHA met with senior o®cials and Board members of the National Health Performance Authority
(NHPA). The NHPA was established in October 2011 and its role is to monitor and report on the comparable performance of Local Hospital Networks, public and private hospitals, and primary healthcare organisations.
The NHPA recently released a Performance and Accountability Framework, which can be accessed at www.tinyurl.com/cwod6tt
Discussions with NHPA focussed on developing a mechanism and framework for the private hospitals sector to provide input and assistance to NHPA in relation to: • developing a reporting framework for
private hospitals (this will not be the same framework that will apply to public hospitals);
• identifying appropriate indicators to be reported by private hospitals;
• ensuring NHPA processes do not impose any additional burden on private hospitals;
• rationalisation of existing reporting requirements.
NHPA has sought APHA input on its draft data plan and has asked to present to APHA’s Safety & Quality Taskforce.
APHA submission on classification of MBS item 42738 APHA has made a submission to the Department of Health and Ageing in support of the current Type B classification of 42738 (for Intra-vitreal injection) based on clinical and safety reasons. This recognises that the procedure of intra-vitreal injection is appropriate to be performed as hospital treatment regardless of anaesthetic type, medical condition or any other special circumstance as required under Type C.
To read our submission, please go to: www.apha.org.au/advocacy/submissions
Meeting with ACSQHCOn 28 June, Michael Roff, APHA CEO and Christine Gee, APHA Chair of Council, met with Debora Picone, CEO and Mike Wallace, COO of the Australian Commission for Safety and Quality in Health Care (ACSQHC).
APHA raised concerns about progress towards the implementation of the National Accreditation regime, due to commence on 1 January 2013, and the lack of clear communications from the Commission, which was causing some confusion within the sector.
Ms Picone assured APHA that all details would be finalised shortly and undertook to send a clear communiqué to private hospitals following the next meeting of the Board
of ACSQHC in early August. This would specify the requirements for organisations in the transition to the new regime and provide details of all information and advice available from the ACSQHC. The Commission is currently establishing an advice line for use by hospitals and will also provide assistance and support in the field.
APHA Council 2012/2013 electionsMembers are advised that as this is an election year for APHA Council positions, APHA will shortly be commencing the election process by calling for nominations. Following the successful trial of the online Council election in the “For profit small independent” electorate last year, APHA will utilise a web-based tool to call for nominations and if required to hold ballots to fill all Council positions.
The process will commence on Monday 13 August 2012 when chief representatives of eligible members will receive an email inviting them to follow a link to nominate for a position on the APHA Council. Nominations will close on 27 August. If a ballot is required in any of the electorates the ballots will be issued electronically on 31 August.
To confirm who is listed as the chief representative of your organisation, or if you have any queries in relation to this, please contact [email protected]
AHMAC recognises role of private sector in internshipsThe Australian Health Ministers’ Advisory Council (AHMAC) met on July 19 to consider the latest information regarding any potential shortfall of internships for international fee paying students of Australian medical schools in 2013. APHA has been advised that measures to increase intern capacity will include: • considering additional capacity in new
settings such as the private and non-government sector;
• ensuring that accreditation for any new places is fast tracked; and
• identifying any additional capacity for intern rotations and places.
APHA is liaising with HWA and other stakeholders in addressing this challenge, keen to ensure that strategies agreed by AHMAC are implemented smoothly and with effective consultation with the private sector.
APHA has met with the National Health Performance Authority and the Australian
Commission for Safety and Quality in Health Care to ensure private hospitals are heard.
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August 2012 67
Valuing Australia’sPrivate Hospitals
AUSTRALIA’S private hospitals sector is set to test just how much Australians really know about some of the nation’s most prevalent mental disorders
with the launch of its large-scale campaign: ‘What do you know… about mental illness?’.
Targeting depression, anxiety, substance abuse and eating disorders, Australia’s private mental health hospitals will, over the next three months, strive to better educate Australians on the lesser-known symptoms for these mental disorders and the innovative programs available in private hospitals to treat them.
Launching an interactive series of ‘What do you know...’ quizzes both online and within hospitals, APHA is also aiming to dispel negative stereotypes and common misconceptions associated with mental illness and get the Australian public more actively involved in and talking about the disease.
“While public discussion about mental illness in Australia has certainly improved over the years, we still have a long way to go before we can say that we’ve fully erased negative stigmas,” said Michael Ro¢, CEO of APHA. “Education plays a key part in this and our campaign will look to actively engage the public in a way that will drive home the facts.”
With almost half of Australians experiencing mental illness at some point in their lives, most people will know someone who is a¢ected and Mr Ro¢ stresses how important it is for the public to have a comprehensive understanding of the most common types of mental illness.
“The fact is that 45.5 percent of Australians experience mental illness at some point in their lifetime,” he said. “But exactly what classifies as a disorder, how to recognise the signs and how to ensure that your health insurance will cover you and your family if you need it is not as clear. Not knowing these crucial facts contributes to why people tend to su¢er with mental illness in silence and why it’s so important that we address this issue.”
Through pocket-sized cards and Facebook quizzes, to an enlightening YouTube video, the eyes of Australians will now be opened by APHA to the range of di¢erent symptoms and treatments available for mental illness.
“There’s a common belief that hospitals only provide medical treatment for mental illness,” said Mr Ro¢, “but some of the most successful private hospital programmes are actually holistic and focus on the bigger picture and improving a patient’s lifestyle. This campaign is about ensuring more people get the help they need and so can better enjoy their life.”
The APHA’s ‘What do you know… about mental illness?’ has been devised to culminate in activities during this year’s Mental Health Week which will run from October 7 to 13. For more information on the campaign or to find out how your hospital can get involved, please contact the APHA Secretariat.
WHAT DOYOU KNOWABOUT BEING COVERED FOR MENTAL ILLNESS?
Test your knowledge about mental illness at facebook.com/valuingprivatehospitals
Mental Health Week 7-13 October 2012
There is only a two month waiting period for psychiatric hospital cover on private health insurance policies. Check that your policy includes coverage for psychiatric services.
AUSTRALIA’S PRIVATE HOSPITALS
Private hospitals unite to ask Australians what they really know about mental illness
WHAT DOYOU KNOWABOUT ANXIETY?
AUSTRALIA’S PRIVATE HOSPITALS
1 in 5 Australians will suffer from some form of anxiety disorder at some point in their livesTest your knowledge about anxiety disorders at facebook.com/valuingprivatehospitals
Mental Health Week 7-13 October 2012
Valuing Private Hospitals
68 August 2012
News from our advertisers
Industry updateIndustry updateIndustry updateNews from the healthcare and hospital industry
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August 2012 69
News from the healthcare and hospital industry
Furthering your career is something that’s nice to think about, but the realities of life can make it almost impossible.
The University of Tasmania’s MBA in Health Management tries to ease the pressures of work, family and travel commitment with a simple solution – you decide when to study.
Their distance MBA in health management, delivered online, gives students the business administration skills of MBA, but a with a focus on the health sector.
“The flexibility was very important,” said Dr Adam Mackie, Senior Registar of Obstetrics and Gynecology at RPA Women and Babies Hospital in Sydney, regarding the University of Tasmania’s MBA in Health Management.
“The main advantage of a distance MBA is the flexibility to study when you can, and to balance the demands of your role, your family and your study.”
“It means that you can study when you want – or when your life allows.
To find out more, call the University of Tasmania on 1300 363 864, or go online to utas.edu.au/business
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70 August 2012
On The Ground
Phil CurrieWhere do you work, what is your role and how long have you been there?I am the General Manager/Deputy Chief Executive Officer of Sydney Adventist Hospital Group (the San). I started here 25 years ago as a Registered Nurse, working for seven years in the Intensive Care environment. I have a Master’s Degree in Nursing and have completed a Post Graduate Certificate in Change Management. I was appointed General Manager in April 2011.
I am also Treasurer of the Private Hospitals Association of New South Wales, an Australian Private Hospitals Association Councillor and Treasurer of the APHA Board.
The San has recently begun a multi million dollar redevelopment. What is your role in the redevelopment? I oversee Master Planning of the Sydney Adventist Hospital site and the redevelopment expansion. That growth
will take place in stages. Stage 1 of the redevelopment will include a 25,000sqm expansion and cost over $181 million.
The decision to redevelop was made in response to increasing occupancy pressures, and 2010 projections that indicated we could expect an almost 70 percent increase in demand for our services between then and 2026. The North West corridor of Sydney has an increasing, and an increasingly ageing, population who want, and are able, to choose private health care.
We have grown from a 60-bed Sanitarium in 1903, to an over 500-bed hospital (358 licensed overnight), just one of three facilities that form the Sydney Adventist Hospital Group.
Our Redevelopment tagline is Building for the Future, Caring for our Community which recognises that if we are to continue to satisfy our mission of ‘Christianity in Action - Caring for our community’ then we must continue to grow our facilities.
How has the San managed the upgrade, from the beginning stages to its current state? What have been the biggest challenges? We recognised that among the biggest challenges of undertaking a development of this size over several years was to maintain current operational viability: maintaining the ability for our 2400 strong staff to continue to provide services to the over 220,000 patients we treat each year, maintaining good quality care and minimising the inconvenience that changes to site access, traffic, parking and a major building works program could cause if not managed well.
A Redevelopment Executive Steering Committee has been established, reporting to the Executive Committee, that manages all hospital day to day operations. Similarly, a Project Working Group Committee and regular meeting of individual user
groups ensures input, consultation and communication about what is happening. Operational, occupational health and safety, human resources, medical liaison, business development, fundraising and communication issues are all regularly assessed and actioned. We held a breaking ground ceremony in June last year and are well underway and on target.
How will the San benefit from the upgrade of the Hospital?The upgrade enables us to meet current and future demand, increase the diversity and quality of our services and complement local public healthcare facilities. Stage 1 includes:• An expansion of our Clinical Services
Building providing up to 200 additional beds and 12 new operating theatres
• A new entry and arrivals building• A purpose built Integrated Cancer Centre
providing one central point of entry for cancer patients to screening, diagnostic, treatment, and counselling services, and
• A multi-deck and other car-parks - increasing spots by almost 600 resulting in total on-site parking for almost 1900 cars.
At the same time as this redevelopment a new Education Centre is also being built on site, partly funded by Health Workforce Australia (see page 18 for details).
When do you expect completion?Stage 1 of the Redevelopment will be finished in 2014 - within approximately a year of celebrating the 110th anniversary of the San commencing as a place of health and healing. It will be a tribute to all the dedicated, passionate and committed people who have worked at the San since then and will honour their altruism, their skills and their vision. We are genuinely excited about sharing the benefits with our community.
General Manager/Deputy Chief Executive Officer of Sydney Adventist Hospital Group
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