Output 1.1 Acute Services

Output description

The Government provides public hospital services at Canberra Hospital and Calvary Public Hospital. These public hospitals provide a comprehensive range of acute care, including inpatient, outpatient, and emergency department services. The key strategic priority for acute services is to deliver timely access to effective and safe hospital care services.

This means focusing on:

  • implementing work arising from the National Health Reform Agreement which the Commonwealth Government has put into place through a number of national partnerships and agreements with the aim of improving services to the Australian community;
  • strategies to improve access to emergency services under the National Health Reform; meeting the increasing demand for elective surgery in the Territory and reduce the number of people waiting longer than recommended standard waiting times;
  • strategies to meet performance targets for the emergency department and elective and emergency surgery; and
  • continuing to increase the capacity of acute care services within the ACT and surrounding region.

Both Canberra Hospital and Calvary Public Hospital are part of the ACT Local Hospital Network. Section A9 reflects acute services delivered by the ACT Local Hospital Network.

Increasing the capacity of the ACT Public Health Services

More beds to manage increasing demand for hospital services

The Australian Institute of Health and Welfare (AIHW) reported that in 2011‑12, ACT public hospitals provided

an average of 939 beds. In 2012‑13, an additional 47 beds were introduced, providing an estimated capacity of 986 beds.

The ACT Government has proposed funding for another 39 inpatient beds in 2013‑14, including:

  • 16 general inpatient beds at Canberra Hospital
  • 15 general inpatient beds at Calvary Public Hospital
  • an 8-bed Rapid Assessment and Planning Unit to be established at Calvary Public Hospital.

This equates to an extra 355 beds since 2001–02.

In addition there has been a considerable expansion to the Hospital in the Home service, with the addition of 15 bed equivalents in 2012‑13.

ACT public hospitals

Bed capacity by year

 

 Bed capacity by year graph

* 2012‑13 and 2013‑14 figures provides estimated impact of Government investment in additional capacity.

Source: Australian Hospital Statistics, AIHW, 2012–02 to 2011–2012 publications.

The ACT Government continues its commitment to adding bed capacity to the public hospital system to meet growing demand for care and to reduce bed occupancy to optimum levels.

In 2012‑13, the ACT’s public hospitals provided 87,969 cost-weighted separations within Acute Care Services (which includes general hospital services and private hospital contracted patients but excludes hospital services provided by Mental Health ACT, the Capital Region Cancer Service and the Aged Care and Rehabilitation Service). This represents a 2 per cent increase in cost-weighted separations in 2012‑13 compared with 2011‑12.

ACT public hospitals

Inpatient Admitted Patient CWS

 

Inpatient admitted patient graph

(Round 14 National DRG 6.0X)

Source: Admitted patient care data set

In 2012‑13, ACT’s public hospitals provided over 277,988 overnight hospital bed days of care, 1 per cent up on the total of 274,851 in 2011‑12. The Australian Hospital Statistics Report for 2011‑12 issued by the AIHW in April 2013 showed that the ACT had achieved the national average in providing public hospital bed availability for the third time in the almost 21 years of reporting by the AIHW. ACT Health reached 2.6 public hospital beds per 1000 people—which is on par with the Australian national average.

ACT public hospitals

Available beds per 1,000 population ACT vs national

Available Beds Graph

The bed occupancy rate for overnight adult medical and surgical beds in 2012‑13 was 93 per cent. The Australian Government’s long-term target is to maintain bed occupancy levels at around 85 per cent, which is considered the best level for best patient outcomes and to achieve maximum efficiency. However, with increasing pressure on ACT public hospitals each year, the target for this indicator in 2013‑14 has been revised to 90 per cent. This will allow for the necessary infrastructure and process improvement to take effect which will make for more realistic transition for ACT public hospitals to achieve the 85 per cent in coming years.

The additional 39 beds funded in the 2013‑14 budget should assist in reducing bed occupancy rates towards the 90 per cent target.

ACT public hospitals

Bed occupancy rate

Bed occupancy graph

 

Outpatient Services redesign has been developed and implemented over the past two years, with the principal objectives being to review current business processes within the outpatient service and implement changes to improve efficiency, and to support access to services for consumers.

Over recent years, there have been significant increases in the demand for non-admitted outpatient services.

In 2012‑13, Outpatient Services experienced a 6 per cent growth in outpatient occasions of service compared with 2011‑12. However, since 2009–10, demand for these services has grown by 18 per cent at both Canberra and Calvary hospitals. In response to this growth, resources have been committed to improve the function and processes of Outpatient Services.

ACT public hospitals

Non-admitted occasions of service

 

Non-admitted occasions of service

Source: Outpatient dataset

Births

ACT public hospitals have accommodated record numbers of births in 2012‑13, with 4,854 births at Canberra and Calvary Hospitals, an 8 per cent increase on the 2011‑12 result. The result of 4,854 births in 2012‑13 also represents a 70 per cent growth (almost 2,000 additional births) in the number of ACT public hospital births since 2001–02.

ACT public hospitals

Births by year

 

Births by year graph

Source: Admitted patient care dataset

The number of births born by Caesarean section has reduced to 28 per cent of all births during 2012‑13, down from the 29 per cent reported in 2011‑12.

ACT public hospitals

 

Proportion of births graph

Proportion of births that required a caesarean procedure

 

Source: Admitted patient care dataset

However, Caesarean rates have been steadily rising since 2001— both in the ACT and nationally. The ACT rate of 26 per cent in 2010–11 was lower than most recent national figures published by the AIHW, for 2007–08. ACT public hospitals continue to have a low Caesarean rate compared to benchmarking hospitals. The main strategy is to move towards further implementation of the ‘continuity of maternity model of care’ which has proven improved clinical outcomes for woman—such as reduced rate of Caesareans.

The ACT Government has also provided an additional $2 million in 2010–11 and $1.5 million in 2011‑12 to enhance obstetric and gynaecological services and neonatal services. The Continuity at the Canberra Hospital (CatCH) Program began in 2011 as a second continuity-of-care model at the Canberra Hospital. In 2012‑13, a Community Midwifery Program (CMP) at Calvary Public Hospital will be established to further enhance obstetric services at Calvary.

Operations in ACT public hospitals

Over the past three years, the number of surgical operations performed at ACT Health public hospitals has jumped by 13 per cent, from 16,312 in 2009–10 to 18,469 in 2012‑13. Around 30 per cent of the emergency and elective surgical operations are performed on people from New South Wales.

ACT Public Hospitals

Total surgical operations performed (elective and emergency surgery)

 

Total surgical operations graph

Source: Admitted patient dataset

Access to elective surgery

ACT public hospitals provided 11,579 elective surgery procedures in 2012‑13. This is the highest number in a year of patients accessing elective surgery in the ACT. This is also the third consecutive year that ACT Health has provided for over 11,000 elective surgery procedures. The 2012‑13 result of 11,579 is an 18 per cent increase over the figure of 9,778 in 2009–10.

This achievement was aided through utilising the private sector, and was part of the strategy to maintain the high level of throughput for elective surgery in the ACT—particularly in the specialties of ear, nose and throat surgery, urology surgery and orthopaedic surgery.

In 2010–11, approximately 171 patients accessed elective surgery under these arrangements. An additional 366 people accessed elective surgery under this agreement in 2011‑12 and over 2012‑13 a further 191 patients had elective surgery which makes a total of 761 patients since this initiative was first established.

ACT Public Hospitals

Number of elective surgery operations performed

 

Elective surgery operations graph

Source: Elective surgery waiting list dataset

In addition to the work contracted by the private sector, the ACT Government and Southern New South Wales Local Health District have commenced utilisation of Queanbeyan Hospital to provide elective surgery capacity purchased by the ACT. In 2012‑13, a total of 69 patients accessed elective surgery at Queanbeyan Hospital, covering urological and gynaecological procedures.

As a result of the increased access to elective surgery, the number of people waiting to access elective surgery has reduced to 3,943 people on the waiting list at 30 June 2013. This is a 1 per cent reduction compared with the same period last year, and a 26 per cent decrease compared with 2009–10.

The increased access to elective surgery has also meant that the number of people waiting beyond the clinically recommended timeframes for their surgery has seen significant reductions, with a total of 705 patients waiting at

30 June 2013. This has resulted in a 21 per cent reduction in the number of overdue patients in just 12 months, and a 68 per cent reduction on the 2,220 reported for June 2010. While the result of 705 is pleasing, it is still too high.

ACT Health’s commitment to improving access to elective surgery will result in this number reducing in future reports.

The ACT Government will provide over $12 million over the next four years to meet the growing demand for surgical services in ACT public hospitals.

Number of people waiting against standard recommended waiting times by clinical urgency

ACT Public Hospitals

Reducing the number of patients waiting too long for elective surgery

Patients waiting for elective surgery graph

 

Source: ACT elective surgery published dataset June 2013

Median waiting time to surgery for ACT public hospitals

ACT Health reports the median waiting time to access elective surgery. This ensures that any improvement or deterioration in the way the directorate manages the elective surgery waiting list is evident, so it can adjust management to improve access as required. The result of 51 days reported for 2012‑13 is a vast improvement on the 77 days reported in 2010–11, which is evidence that this approach is paying off.

 

Urgency category 2009–10 2010–11 2011‑12 2012‑13
Category one 13 days 15 days 14 days 14 days
Category two 106 days 103 days 89 days 72 days
Category three 200 days 225 days 198 days 171 days
Median wait time all categories 73 days 77 days 64 days 51 days

 

Access to acute services

ACT Health is committed to improving waiting times in ACT Health emergency department (ED) services and is working towards meeting the National Emergency Access Targets (NEAT).

In 2012‑13, ACT Public Hospital EDs saw 118,969 presentations, an increase of 580 presentations, compared to 2011‑12, and an 18 per cent increase compared with the same period four years ago. Admissions to hospital via the ED have also grown, with 31,206 admissions reported for 2012‑13 compared to the 31,064 recorded in 2011‑12.

ACT Public Hospitals

All presentations to the Emergency Department

 

All presentations to ED graph

Source: Emergency Department published dataset June 2013

Waiting times for emergency treatment

ACT public hospital EDs did not meet national targets for timely access to emergency care in three of the five triage categories. Presentations within triage categories one and five are currently meeting national targets.

Targets were not reached for triage category two, three or four presentations. While there has been growth in the number of presentations to the EDs, there has been a 12 per cent decrease in non-urgent category five presentations. This reflects a significant increase in higher acuity presentations and increasing pressure on

ED resources and can restrict the ability to see and treat lower acuity presentations in a timely manner.

 

Triage category 2012‑13 Target 2012‑13 Result
One (resuscitation – seen immediately) 100% 100%
Two (emergency – seen within 10 mins) 80% 74%
Three (urgent – seen within 30 mins) 75% 43%
Four (semi – urgent – seen within 60 mins) 70% 46%
Five (non-urgent – seen within 120 mins) 70% 79%
All presentations 70% 51%

 

ACT Health ED staff are currently reviewing their processes, and working with their colleagues throughout the hospitals, to find ways of eliminate barriers that delay quick access to services and improve patient flow through the EDs.

Recent initiatives implemented to improve timely access to emergency services include:

  • ‘front loading’—where patients can be assessed and treated by an ED doctor more rapidly
  • the expansion of the Canberra Hospital discharge lounge, which enables patients to leave the inpatient wards earlier, freeing up inpatient beds and allowing for increased access from the ED, and
  • the purchase of beds at Monash Goodwin Village for sub-acute patients with an extended length of stay in the acute setting.

The 2012‑13 budget provides for an additional $12.7 million over the next four years to meet the growing demand for emergency care, including:

  • an additional six treatment spaces at Calvary
  • capital works at Canberra Hospital to expand the ED by six beds and to change the physical layout of the ED
  • four cardiac assessment beds to provide rapid assessment for care for people who present to the ED with chest pain and associated cardiac issues
  • an additional 47 inpatient beds across both public hospitals, which will allow for improved access to inpatient beds for patients in the ED.

The ACT Government has also committed additional funding from 2013‑14 to provide for:

expansion of Canberra Hospital’s Emergency Medicine Unit

increasing the number of ED physicians at both Canberra Hospital and Calvary Public Hospital

the establishment of a Rapid Assessment Unit at Calvary Public Hospital

an additional 170 beds to the ACT public hospital system.

In March 2013, the ACT Government tabled its Emergency Access Plan for 2013–17, which detailed actions to be implemented over the next four years to improve waiting and treatment times within ACT Health public hospital EDs. The plan recognises that improvements to ED times must include changes to the way the whole hospital works and improved partnerships between hospitals and community services.

Australia’s first Walk-in-Centre

The Walk-in-Centre (WiC), located on the campus of the Canberra Hospital at Garran, provides free treatment for people with minor illnesses or injuries. The WiC has been funded by the ACT and Australian governments.

The WiC is designed to help people get fast, free, one-off treatment for minor illnesses and injuries. The people of Canberra are able to see a specialist nurse for advice, assessment and treatment for conditions such as cuts and bruises, minor infections, strains, sprains, skin complaints, and coughs and colds.

In 2011‑12 an independent evaluation report confirmed the WiC model to be a safe and effective means of providing primary health care services. The report also highlighted the improved access to free, extended hours primary health care services.

ACT Health currently operates one WiC located on the campus of the Canberra Hospital. In 2012, the ACT Government made an election commitment to double the current budget for the WiC and expand the nurse-led WiCs to the community location in Belconnen and Tuggeranong. It is proposed that the two WiCs be located within the new Community Health Centres at Belconnen and Tuggeranong.

Work on the WiC within the Tuggeranong Health Centre refurbishment will occur in 2014.

Walk-in Centre

Total Presentations to the WiC

 

 Total presentations WIC

Source: WiC published dataset

Presentations to the WiC increased by 10 per cent in 2012‑13 compared with 2011‑12. This increase reflects the value that the service provides to the community.

The WiC nurses treat a wide range of conditions, with no significant changes in the top 10 conditions treated since last year. The common cold remains the main reason for presentation to the WiC .

Walk-in Centre

Top 10 conditions treated at the WiC

 

Top 10 conditions graph

Note: URTI in above table is upper respiratory tract infection.

If necessary, people are redirected to more appropriate services, such as their GP or the ED. Of the 19,142 presentations in 2012‑13, a total of 13,665 had a completed treatment episode by the nurse. A total of 6 per cent of patients assessed were subsequently redirected to their GP (compared with 18 per cent two years ago) and 5 per cent were told to present to the Canberra Hospital ED (on par with 2011‑12).

Walk-in Centre

Patient redirections following assessment by nurse

WIC patient redirections

 

Source: WiC published dataset

Note: CALMS in above table reflects Canberra After-hours Locum Medical Service. ED-TCH in above table reflects Emergency Department and Canberra Hospital. GP in above table reflects general practitioner.

The WiC does not provide ongoing care for patients and will not treat people with chronic conditions or children less than two years of age. These patients should seek treatment and advice from their GP or the ED.

The WiC is not designed to provide the range of services that a GP can provide, including comprehensive medical management, referral to specialist services or general health checks. The nurses who work in the WiC have all completed additional training and the care they provide is guided by established protocols that have been endorsed by the appropriate clinical approvals processes. A visit report is sent to the patient’s general practitioner with consent.

People in the ACT community now have access to a wide range of primary health services including their GPs, EDs, community health services, pharmacists and the WiC.

The operation of the WiC was evaluated externally after its first year of operation. ACT Health is responding to aspects of the WiC review that will enhance its efficiency, such as staffing profile and hours of operation, as well as effectiveness of service delivery. Patient attendances have increased consistently since the WiC opened and consumer feedback remains positive.

National Partnership Agreement on Improving Public

Hospital Services

The Commonwealth will deliver an additional $67 million to the ACT under the National Partnership Agreement on Improving Public Hospital Services for ED, elective surgery and sub-acute services. This agreement commenced on 1 January 2012.

National Emergency Access Targets

The main objective of National Emergency Access Targets (NEAT) is that 90 per cent of all patients presenting to a public hospital ED will be admitted, transferred or discharged within four hours. The targets will be staged in increments over the next 4 years to achieve the final target of 90 per cent. The first target was to be achieved by December 2012, with the target set at 64 per cent.

In the 2012 calendar year (January 2012 to December 2012), ACT public hospitals reported 57 per cent of all patients had a length of stay less than four hours. This was 7 per cent below the target of 64 per cent. National reports on jurisdictional performance against NEAT targets showed that Western Australia was the only jurisdiction to meet their 2012 target.

In the calendar year to end June 2013 (January 2013 to June 2013), ACT public hospitals have seen some improvement in NEAT performance, with a result of 58 per cent, against a target for the end of 2013 of 65 per cent. ACT Health expects further improvements in the future with:

  • increased investment in infrastructure, including an additional 170 beds over the next four years
  • physical redesigns of ED.

At the same time, both public hospitals are undergoing continual redesign and process improvement initiatives to improve the way patients move into, through and out of the EDs.

National Elective Surgery Targets

There are three components to the National Elective Surgery Targets (NEST). These are aimed at ensuring timely access to surgery whilst reducing the number of patients waiting beyond clinically recommended timeframes. The final targets for all components of the NEST are to be met by December 2016; the first set of targets was to be achieved by December 2012.

In the 2012 calendar year (January 2012 to December 2012) ACT Health was successful in meeting all three components of the NEST. On 27 February 2013, the AIHW released its first annual report on jurisdictional performance against emergency access and elective surgery targets. The report shows that the ACT was the only jurisdiction to successfully meet all three components of the NEST.

Part 1 of the NEST refers to the proportion of patients who access their elective surgery procedure within clinically recommended timeframes. In the calendar year to June 2013 (January 2013 to June 2013), ACT public hospitals achieved the required targets for category one and three patients accessing their surgery on time. Category two patients did not meet the target reporting a result of 57 per cent of category two patients accessing surgery on time against a target of 66 per cent. Recent monthly results have seen an improvement, and work is ongoing to improve this result for future months.

Part 2A of the NEST is based on the requirement to reduce the average overdue waiting times for each category of patients so that there are no overdue patients by the conclusion of the agreement. In the calendar year to end June 2013 (January 2013 to June 2013), ACT public hospitals were on track to meet the required targets for urgency category one, two and three patients.

Part 2B of the NEST is related to the removal of the top 10 per cent of longest waiting patients on the elective surgery waiting list. The Australian Government has issued ACT Health with the 2013 cohort of long-wait patients to have their surgery in 2013. In the calendar year to end June 2013 (January 2013 to June 2013), ACT public hospitals removed 76 per cent of the longest waiting patients from the list established at 31 December 2012, and remained on track to meet the end of 2013 target.

Sub-acute care reform

The sub-acute component is aimed at improving patient health outcomes, functional capacity and quality of life by increasing access to sub-acute care services including rehabilitation, palliative care, sub-acute mental health and geriatric evaluation and management, and psycho-geriatric services in both hospitals and the community.

The ACT was required to build capacity for 11 sub-acute bed equivalents before 1 July 2012. Due to a lack of appropriate tender applications in relation to the ACT’s sub-acute projects, the ACT added 6.9 bed equivalents to the system at the end of June 2012.

However, to facilitate the process, ACT Health established a National Health Reform Steering Committee. This committee has worked on alternative models to attract additional service providers, as well as contingency plans in relation to this project. Over the 12 months of 2012‑13, the planning into growth for sub-acute care services has paid off. The ACT has now delivered over 22 sub-acute bed equivalents into the system, above the June 2013 target of 16 bed equivalents. There is no financial reward or penalty associated with this target.

Division of Critical Care

The Division of Critical Care was formed following the restructure of ACT Health in February 2011. The division is responsible for the delivery of acute and critical care and retrieval services. These are provided as inpatient and outpatient services at the Canberra Hospital, with a strong emphasis on accessible and timely care, delivered to a high standard of safety and quality. This is underpinned by the division’s commitments to research and training. The division includes the Retrieval Service (both road and air), Emergency Department (ED), Intensive Care Unit (ICU), Access Unit, Surgical Short Stay Unit, Medical Assessment and Planning Unit (MAPU), and Surgical Assessment and Planning Unit.

Achievements

  • ED nursing introduced a Mentor Matrix in 2012 to ensure that all nursing staff have support for feedback, goal setting and recognition of achievements. Since its implementation, there has been 100% per cent compliance with learning and achievement plans.
  • The Medical Education Team collaborated in a cross-border learning initiative to develop and introduce an education website ( www.canberraemergency.com.au ). This is available to all ED nursing, medical and allied health staff and has quickly become an excellent communication and education tool.
  • ED Nursing Education Team arranged for Queanbeyan Emergency Staff to attend triage and resuscitation training workshops at Canberra Hospital.
  • In September 2012, four additional ED treatment spaces were created. These are used to treat ambulatory patients with non-complex problems. The additional beds support the capacity requirements for the ED to provide quality, safe care and assist with meeting activity targets.
  • The Optimal Capacity Escalation Plan was introduced to manage the unpredictable nature of the ED clinical volume and acuity through the implementation of efficient changes in bed management processes to maintain patient safety, including the forecasting of clinical workloads to assist in predicting future requirements for inpatient beds.
  • A targeted education plan saw a significant improvement in the compliance rate with police blood

testing requirements.

  • The ED, in conjunction with Rehabilitation, Aged and Community Care, ran a Delirium Project to screen all patients older than 85 years presenting to the ED. The project achieved a greater understanding of the treatment of patients with a delirium diagnosis within an extremely busy ED and has improved the working relationship between the two departments.
  • In November 2012, an additional two high-dependency beds were commissioned in the Intensive Care Unit. These have increased available capacity to 24 beds, expanding the ability of the Intensive Care Unit to optimally accept and treat 12 intensive care and eight high-dependency patients at any given time.
  • A territory-wide approach to clinical leadership training for nursing and medical staff, with multiple leadership training opportunities, was implemented.
  • A cascading mentorship structure was implemented in ICU to ensure all nursing staff participate in regular performance and feedback discussions, goal setting and recognition of achievements.
  • The Medical Emergency Team (MET), in collaboration with the Deteriorating Patient Team, won the Quality Award for Care and Response Escalation (CARE) for patient safety and was a national finalist in the National Lead Clinicians Group Awards for Excellence in Innovative Implementation of Clinical Guidelines in 2013.
  • A Volunteer Program was successfully introduced into the ICU waiting room to improve communication, support for families and orientation to the environment.
  • On completion of her PhD, the Clinical Director of the ICU, Associate Professor Imogen Mitchell, received a Harkness Scholarship for Health and Policy Practice at Johns Hopkins Hospital in the United States.
  • Associate Professor Frank Van Haren was appointed State Medical Director, DonateLife.
  • Ms Jenny Rochow, ICU Nurse Unit Manager, received the Defence Reserves Support Council Employer

Support Award.

  • The relocation of the Discharge Lounge to level 2 of Building 1 has provided additional capacity, improved access to support services such as Pharmacy and made pick-up easier for relatives and transport services.
  • The Access Unit received an Australia Day Team Achievement Award for the commitment and ability of staff to strive for excellence in service delivery in our health service system.

Issues and challenges

  • While the National Emergency Access Targets remain a challenge, senior ED staff continue to develop initiatives directed at internal departmental issues, with a view to achieving triage targets for all categories and streamlining the discharge pathway.
  • ED and ICU continue to experience challenges associated with the increasing numbers of unplanned admissions after hours.
  • MET is working with the Staff Development Unit to implement a more comprehensive advanced life support training program to meet the learning needs of multiple tiers of staff and provide opportunities to meet the demands of concurrent MET calls.

Future directions

  • The Division of Critical Care is working collaboratively with all hospital divisions to develop an ACT Health Winter Bed Strategy for the safety and isolation of patients during the flu season.
  • The Division of Critical Care is working collaboratively with the Division of Women, Youth and Children to develop the Paediatric Short Stay Unit to enable paediatric patients to be admitted more quickly.
  • Six new beds opened in the Medical Assessment and Planning Unit (MAPU) in September 2012 have been allocated to provide capacity for the Medical Short Stay Ward (MSS). This initiative is directed at expediting the flow of patients with an undifferentiated medical condition from the ED to an inpatient area for further assessment and management, leading to improved patient care and safety, and efficiencies of service.
  • The Division of Critical Care is working collaboratively with the Division of Medicine to develop the MSS model and undertaking ongoing work to provide timely admission for patients.
  • The ACT Government has committed funds to establish a dedicated Paediatric Stream for children in the Canberra Hospital ED to provide an overall increase in treatment spaces.
  • A large Infection Control Quality Improvement Project in collaboration with the Infection Control Team is under way to reduce rates of infection in the ICU. A monthly scorecard, hand hygiene audits, environmental improvements and a comprehensive education strategy form part of the project to improve patient outcomes by reducing the transmission of infections between patients.
  • An eight-bedroom MediHostel at the Canberra Hospital is on track to become operational in 2013. The MediHostel will provide high-quality, non-ward, hotel-style accommodation with nursing supervision to eligible consumers prior to or following their episode of acute care.
  • In 2013, the Access Unit has expanded operational hours to provide seven-day cover, until 11 pm. The extended hours have enhanced service delivery, continuity, coordination and monitoring through a centralised point of contact for all patient flow activity.
  • The Access Unit After-Hours Hospital Management Service was the beneficiary of a 2013 Practice Development Scholarship Award, which will provide resources for a review of its services. It is envisaged that the review will identify opportunities aimed at making resource efficiencies and implementing quality improvement initiatives.
  • The University of Technology Sydney has engaged in a partnership project with ACT Health Ward 7B to undertake a study titled ‘Effective clinical handover communication: improving patient safety, experiences and outcomes’. This innovative study project is due for completion in 2014 and aims to improve the safety of clinical handover practices, thereby reducing the number of adverse events.

Division of Medicine

The Division of Medicine provides a wide range of adult medicine services to the Canberra community in inpatient, outpatient and outreach settings. It also provides chronic disease management, infection control and pharmacy services. A strong emphasis is placed on accessible, timely and integrated care delivered to a high standard of safety and quality.

The division has a strong commitment to teaching and research. Health students from several universities do practical placements within the division. Most of our senior medical staff also hold academic appointments in the Australian National University Medical School, and there are many active research programs in operation. Many members of the division also participate in the development of national professional guidelines and quality initiatives.

Many units of the division work actively with community groups, other services and the private sector to improve the care of patients across the whole health system. Consumer representatives play a crucial role on our internal advisory committees.

In the coming year, the division’s services will expand to include more inpatient beds and an increase in Hospital in the Home provision. We will continue to develop innovative ways to provide the care that people need and ensure our patients have access to leading edge medical treatment. Over the next year, an emphasis will be placed on the care of acute medical admissions to Canberra Hospital and Health Services, including models of prevention of admission and the streamlining of discharge to appropriate services in the community with the further development of the Acute General Medicine Service.

Achievements

Endocrinology and Diabetes services

In 2012‑13, the ACT Health Diabetes Service made progress in restructuring and expanding its service to meet existing needs and the expected growth in service requirements due to increasing diabetes prevalence. The restructure was directed at improving the quality and efficiency of care to children, youth, pregnant women and adults in the ambulatory and acute care settings. The restructure included the following:

  • establishing the ACT Health Diabetes Service Clinical Advisory to provide strategic direction and clinical governance
  • establishing clinical teams in each of the service areas
  • increasing the focus and development of clinical services to adolescents and young adults with diabetes
  • addressing deficiencies in service levels for people with diabetes on the north side of the ACT.

The expansion of the ACT Health Diabetes Service involved the recruitment of three new part-time endocrinologists and a part-time social worker. At the Canberra Hospital, the Diabetes Service was enhanced by the opening of two new specialist medical consulting rooms and a second podiatry room.

A northside ACT Diabetes Service Working Group (including consumer representation) was established to inform the development of an enhanced collaborative approach to diabetes prevention and care across all health care sectors for the community living on the north side of the ACT.

The ACT Health Diabetes Service commenced clinical services at the Gungahlin Community Health Centre in November 2012. Services for women are being strengthened on the northside with the establishment of a new clinic for women with gestational diabetes.

The ACT Health Diabetes Service increased its support to the Winnunga Aboriginal Health Service with the establishment of an endocrinologist clinic at Winnunga to support the existing nursing, nutrition and podiatry diabetes service.

A Service Funding Agreement was established with the ACT Medicare Local for the Diabetes Link Project to improve the collaborative links between the primary care sector and the ACT Health Diabetes Service and foster a best practice care approach for all people with diabetes in the ACT. A project coordinator for the Diabetes Link Project was identified and will commence in mid-2013.

Cardiology Services

Procurement is underway for the purchase of a replacement state-of-the-art cardiac catheter laboratory. In addition, approval has been granted to purchase two echocardiography machines and the tender process is currently underway. The first stage of the integrated IT system has just been rolled out. This stage will provide an improved archiving process and ultimately a more secure reporting of echocardiography and better access to echocardiography results. This is the first step in a major upgrade. The recruitment process for a cardiologist specialising in echocardiography is underway to support this growing service. This is a key position that will assist with the upgrade of Canberra Hospital’s echocardiography services.

The Cardiology Department commenced the Chest Pain Evaluation Unit in April 2013. A large portion of patients attending the Emergency Department (ED) present with chest pain. Patients that are identified as requiring access to the Cardiac Catheter Laboratory for intervention are processed directly to the Cardiac Catheter Laboratory (CCL); however, those not requiring the CCL are transferred out of the ED in a more timely way. This process will allow for concentrated management and facilitation of investigation of these patients and therefore decrease times in ED.

Renal Services

The Renal Electronic Medical Record project is now operational and its use has steadily increased in all areas of the service. This project has improved renal service delivery by reducing duplication of data entry and improving communication between geographical sites and integration with other Health Directorate applications. Having a holistic view of patient data across the Renal Service allows for quality improvement in patient outcomes and will assist in further clinical research. The Renal Electronic Medical Record was launched in 2012 and has been rolled out to all dialysis units in the ACT and southern New South Wales.

A renal network covering the ACT and Southern New South Wales Local Health District was established. Under this agreement, the Renal Service is providing governance to all dialysis centres in the Southern New South Wales Local Health District, including those in Queanbeyan, Goulburn, Moruya and Bega. The Renal Service is providing outreach clinics to Goulburn, Moruya, Batemans Bay, Bega and Cooma and overseeing quality assurance across the area.

A further achievement for renal services in 2012‑13 was the completion of the self-care training facility at Gaunt Place and the Weston Self-Care Unit, established for those patients who are unable to dialyse at home.

Chronic Disease Management

Chronic Disease Management (CDM) is a multidisciplinary team within the Division of Medicine of Canberra Hospital and Health Services. CDM focuses on improving the management of patients with chronic disease, particularly chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), Parkinson’s Disease and obesity.

Achievements for 2012‑13 include the following:

Due to increased service demand, a new approach to managing patients in the Care Coordination Service was implemented, leading to significantly increased productivity.

The Chronic Disease Management Register (CDMR) was used to support research projects and generate multiple patient identification reports. In collaboration with the ACT Medicare Local, a pilot study was developed to test joint care planning between the Chronic Care Program of the CDMU and the primary health care sector.

There was an increased uptake of advanced care planning (ACP) in the Chronic Care Program, with around half of case coordination patients having an ACP by June 2013.

Neurology services

The number of admissions to the Stroke Unit continues to rise each year, but this year the rise was offset by the creation of a Transient Ischaemic Attack (TIA) clinic, which allowed appropriate urgent neurology patients to be seen on an outpatient basis.

In addition to the TIA clinics, there was an expansion of capacity to meet demand for neurology outpatients, with increased registrar input into clinics.

With the appointment of a third neurophysiology technician, the waiting time for an electro-encephalogram (EEG) was reduced in the past year, from eight months to less than a month.

Clinical Forensic Medical Services

Clinical Forensic Medical Services (CFMS) is the overarching service combining two services, Forensic and Medical Sexual Assault Care (FAMSAC), funded under ACT Health, and Clinical Forensics ACT (CFACT), funded under a tendered contractual arrangement between ACT Health and the Australian Federal Police (AFP).

CFMS continued to expand CFACT services, meeting increased demand in response to AFP requirements. This included: the successful introduction of a seven-day-a-week nursing service to triage and attend consultations within scope of practice; increased medical expert reporting requirements for the ACT Coroner’s Office; and complex reporting to police requesting medical information and toxicology reports in relation to driving under the influence. Adding to this was a recently signed agreement with New South Wales allowing CFMS to provide medical forensic services to the New South Wales Police in the Monaro Local Area Command.

FAMSAC continued to provide care to victims of sexual assault in the ACT and surrounding New South Wales. FAMSAC also offers a service for injury documentation for victims of domestic violence. CFMS nursing staff commenced a service in 2013 to provide a weekly clinic within the drug and alcohol service for the purpose of blood-borne virus screening.

Pharmacy Services

A key indicator for pharmacy is the waiting time for discharge prescription processing. In 2012‑13 the average wait time from receipt of the medication order to distribution of the medication order was less than 45 minutes. A significant recognition in allied health was attributed to the Pharmacy Department. Jessica Parker was the recipient of the 2012 Allied Health Award for Excellence and won the 2012 Allied Health Professional of the Year award.

Closed System Transfer Devices (CSTD) were fully implemented in chemotherapy production, enhancing safety for staff in the pharmacy and on the wards.

A number of medication safety initiatives and continuous quality improvement activities were undertaken, including:

  • The Australian Commission on Safety and Quality in Healthcare recommended a pilot of a venous thromboembolism (VTE) prophylaxis section in the National Inpatient Medication Chart (NIMC). This pilot provided strong support for the inclusion of a VTE prophylaxis section in the NIMC, a major enhancement to patient safety.
  • A drug library was introduced to the new B. Braun Smart Infusion Pumps, which ensures that all intravenous drugs are administered in the safest possible manner.
  • The Director of the Pharmacy Department was the joint clinical lead for the Medication Safety Standard of the National Safety and Quality Health Service Standards and oversaw work to meet national standards for medication safety.
  • The Pharmacy Department of the Canberra Hospital participated in a national pharmaceutical spending benchmarking exercise. Despite being a small jurisdiction, the ACT has excellent purchasing processes, ensuring that resources are maximised.

Gastroenterology and hepatology

The Gastroenterology and Hepatology Unit at Canberra Hospital provides services to patients in the ACT and surrounding region in all areas of gastrointestinal diseases, with particular focus on inflammatory bowel diseases, gastrointestinal cancer, chronic hepatitis, chronic liver disease and gastrointestinal endoscopy. The unit has well-developed multidisciplinary teams, including consultant medical staff, senior registrars and nursing staff with special expertise.

In 2012‑13, the unit commissioned a third endoscopy room and commissioned new technology, the Transient Elastography (FibroScan), to assist in the detection and staging of liver disease and to reduce reliance on liver biopsies. In 2012‑13, additional medical, nursing and administrative staff were appointed on receipt of budget enhancement for the unit.

In 2012‑13, staff of the unit performed 4,832 endoscopy procedures (elective and acute), the highest number of endoscopies ever recorded and an increase of 9.4 per cent from last year. There were 7,040 outpatient attendances, an increase of 9.8 per cent over 2011‑12. The unit provided many other services, including inpatient care and day-only admissions. It also provided services and information sessions in the community and at the Alexander Maconochie Centre.

Hospital in the Home

In 2012‑13, funding for Hospital in the Home (HITH) was increased. This was used to recruit nursing staff,

including a nurse dedicated to identifying and assessing potential referrals in a timely manner. New arrangements were put in place whereby GPs can directly contact the HITH Registrar about a patient they are seeing in their rooms before sending them into HITH for assessment for admission, without patients needing to attend the Emergency Department.

Respiratory and Sleep Service

The Respiratory and Sleep Service is available to patients in the ACT and surrounding areas of New South Wales, with an occasional referral from Victoria. It provides care in all areas of respiratory and sleep medicine—and in particular supports the Tuberculosis Service of the ACT and surrounding New South Wales—including asthma, COPD (chronic obstructive pulmonary disease), interstitial lung disease and cystic fibrosis.

The Respiratory and Sleep Service supports the management of lung cancer and in particular has special weekly urgent clinics set aside. In addition, the service conducts joint meetings with thoracic surgeons, medical staff and radiation oncologists to facilitate the management of lung cancers. These meetings are held weekly.

The services provided have increased over the past few years and will continue to do so, particularly in relation to consultations for both inpatients, outpatients and bronchoscopies.

General/Acute Medicine

Work commenced in 2011‑12 to develop a model for a general/acute medicine service as part of a redesign exercise. Funding in 2012‑13 was utilised to implement an acute general medicine model with the advent of

the Medical Short Stay (MSS) Unit. This service facilitates early identification and management of patients who

are identified as requiring admission to medicine beds in the hospital from the Emergency Department. It is staffed by nursing and medical staff to better manage patients with multiple complex conditions who present to the hospital for care.

Issues and challenges

Issues and challenges for the Division of Medicine include:

  • further integrating services across the Territory, such as the Stroke Unit, Renal Services and Cardiology Services, including Chronic Disease Management
  • meeting patient demand for endoscopy
  • facilitating prevention of hospital admission and promoting seamless discharge.

Future directions

Endocrinology and Diabetes services

Services will be represented on the northside with the opening of the Belconnen Community Health Centre in 2013. The Diabetes Service will be further enhanced on the northside with the establishment of a new Vision Screening Program.

In 2013‑14, programs to enhance engagement between ACT Health Diabetes Service and primary care services will be developed with assistance from the ACT Medicare Local, and improved referral patterns, joint professional education and staff development programs will be established.

The ACT Health Diabetes Service has established collaboration with ACT health units involved in the care of patients with acute diabetes-related foot complications. A multidisciplinary high-risk foot collaboration clinic will commence in July 2013 at the Canberra Hospital.

ACT Health is working towards the establishment of a Public Obesity Management Service and is improving clinical data collection in relation to weight and height. In 2013‑14, this service will work closely with general practitioners and community organisations, as well as other specialist services that care for these people. These hospital-based services include Diabetes, Cardiology, Respiratory and Chronic Care programs.

Neurology services

The development of a Stroke Network, inclusive of a Stroke Unit, planned for Calvary Health Care will greatly contribute to the management of these patients across the Territory.

Pharmacy

The Pharmacy Business Plan for 2013‑14 aims to build on past successes and address upcoming challenges—namely:

to improve clinical pharmacy services, such as the establishment of specialised pharmacist positions, the creation of a ward-based technician service and an increase in the number of clinical pharmacists

to provide further education for the pharmacy workforce, such as TAFE certificate training for technicians and the internal People Manager Program for all senior staff.

Gastroenterology and Hepatology

Waiting lists for both endoscopy and outpatient services continue to grow but have been addressed by the recruitment of additional medical, nursing and administrative staff and effective leave management for medical staff. The planned refurbishment of the unit will also enable more patients to be seen in 2013‑14. The unit plans to commence endoscopic ultrasound to enhance the diagnosis and treatment of gastrointestinal cancer.

Hospital in the Home

HITH is working on the development of a protocol with the Chronic Care Program for the respiratory service to identify patients in the community who are acutely deteriorating and who may benefit from a pre-emptive stay in HITH, potentially avoiding an admission to hospital. In the second half of 2013, the introduction of a dedicated pharmacist to HITH will assist with the increasingly complex and numerous medications being utilised both by patients in their homes and by those receiving treatment as day-only patients.

General/Acute Medicine

The training program for General Medicine was accredited by the Royal Australasian College of Physicians, and

a team of registrars, including an Admitting Registrar for Medicine (ARM), was recruited to support this service. The service will enhance services already provided by the Medical Assessment and Planning Unit (MAPU).

A multispecialty consultant team will be further developed in 2013‑14 to better manage this cohort of patients and facilitate education of physician trainees in General Medicine and subspecialties.

Division of Pathology

The Division of Pathology provides specialist pathology services to the medical practitioners of the ACT and surrounding region. This includes pathology testing while patients are in hospital and when they return to their homes.

Services are provided in the acute setting at Canberra and Calvary hospitals and the National Capital Private Hospital and in the community through collection centres across the ACT. A home collection service for patients who are frail or unwell and who cannot attend these collection centres is also provided.

Analysis of collected samples is undertaken at the two laboratories in the ACT. The main laboratory is located at the Canberra Hospital and a branch laboratory is located at Calvary Hospital.

Pathology is a medical specialty looking at disease processes and their cause. Body tissue, blood and other bodily fluids are analysed to assist medical practitioners to identify the cause and severity of disease, and to monitor treatment. The Division of Pathology is made up of a range of clinical specialities: Anatomical Pathology, Chemical Pathology, Haematology, Cytogenetics, Immunology, Microbiology and Molecular Pathology. All areas are accredited with the National Association of Testing Authorities and the Royal College of Pathologists of Australasia.

Pathology is a demand-driven service that plays a critical role in more than 70 per cent of clinical diagnoses and many of the decisions around optimal treatment for patients. Due to the critical role of pathology testing in diagnosis and treatment, the objective and direction for pathology are intimately tied to the objectives and priorities of ACT Health’s Corporate Plan.

Achievements

Quality system

ACT Pathology undergoes three-yearly accreditation inspections by the National Association of Testing Authorities (NATA) and Royal College of Pathologists of Australasia (RCPA). The last accreditation assessment in 2012 saw an overall accreditation achievement at a high level. A large number of ACT pathology specialist and scientific staff have been invited to become NATA assessors and regularly inspect other laboratories in Australia and overseas.

The microbiology laboratory participates in a range of surveillance programs, including the Australian Group on Antimicrobial Resistance (AGAR) and the World Health Organization (WHO) influenza surveillance group, contributing to important epidemiological information locally and internationally. ACT Pathology is also a member of the Public Health Laboratory Network.

Social inclusion

Pathology testing now includes Aboriginal identification when this information has been provided. This data is then available to feed through to health databases such as the Pap smear register, notifiable diseases and cancer cases, and should enable better health policy planning.

Collaboration and performance

Pathology works in close collaboration with many areas of the Health Directorate to provide access to timely results, facilitate decision making and assist them to achieve their outputs.

While the number of requests for pathology from Canberra Hospital has slightly decreased overall, there has been an increase in the number of tests per request, resulting in a 2.6 per cent increase in tests.

 

Location Number of requests
2011‑12
Number of requests
2012‑13
% increase
in requests
Canberra Hospital 352,519 350,048 –0.7%
Calvary Hospital 94,951 100,411 5.8%

 

New technology

The Cytogenetic Department has implemented microarray analysis as the first line of investigation for the detection of chromosomal rearrangements in constitutional and products of conception referrals. This technology offers a higher level of resolution, improves the scope of detection of chromosome anomalies and replaces conventional karyotyping of chromosomes. The introduction of this service to ACT Pathology has contributed to patient care in genetic services.

Changes in technology

  • New slide stainer: The Anatomical Pathology Department has introduced a new processor for the staining of tissue samples. This processor has a number of features that improve safety and quality. This includes decreased handling and use of dangerous chemicals by staff, and individual processing of samples to eliminate cross-contamination.
  • Front-end automation: A PVT automated front-end processor was installed this year. This system improves processing and storage of patient samples received in the laboratory. It decreases the amount of manual handling of samples staff are required to do, as well as reducing pre-analytical errors and the incidence of repetitive strain type injury. It will benefit both patients (with improved quality) and staff (with improved work safe practice) and release staff to concentrate on more complex scientific duties.

E-health

Pathology embraces electronic delivery of pathology results for better management of patient care and the provision of continuity of services. Pathology results are currently:

  • included in the discharge summary
  • delivered to the ICU and renal department systems to support patient care and other databases in clinical areas
  • delivered electronically to medical practitioners in the community.

Education

  • Pathology holds Royal College of Pathologists of Australasia accreditation for medical postgraduate pathology training in all the major specialisations of pathology.
  • Pathology is working in collaboration with the University of Canberra, Australian National University and Canberra Institute of Technology to continue to develop and support the various scientific and technical courses required in medical laboratory science. This includes both undergraduate and postgraduate courses.

A number of ACT Pathology scientific staff prepare and provide lectures for these courses. In addition, students are supported in the pathology laboratories while undertaking their professional practice requirements. This initiative is already providing new graduates who are being introduced into the workforce in Canberra

  • The scientific staff from cytogenetics contributed to the development of the University of Canberra course that is now the only postgraduate cytogenetic course to be offered in Australia.
  • ACT Pathology continues to support staff continuing education through attendance at external conferences of national associations, including the Australian Association of Clinical Biochemists (AACB), Australian Institute of Medical Scientists and various industry workshops.

Investments in research

  • Pathology is a scientific discipline with research as a cornerstone. Many of the pathologists and scientists are actively involved in their own research or work collaboratively with others. This demonstrates the important role of research in teaching, and Pathology’s increasing link and contribution to the Australian National University Medical School. Members of the division (scientific and medical) continue to publish actively in peer-reviewed journals and participate in professional meetings and workshops both in Australia and overseas.
  • ACT Pathology has been instrumental in a study to determine reference intervals for a healthy Australian population. This study, Aussie Normals, has been supported by the diagnostic industry through the availability of consumables. ACT Pathology scientific and clinical staff, in supporting this initiative, have been involved in pursuing harmonised reference intervals in clinical chemistry. This has resulted in a national workshop in 2012 and a satellite conference in association with the AACB national meeting. Publication of the findings will be presented later in 2013.
  • The ACT Haematology Research Tissue Bank archives tissue samples from patients with haematological and related disorders. Set up in 2007, it has proven to be an important resource to support laboratory research and has enabled the department to apply for competitive grants.

Issues and challenges

The major challenge for the Division of Pathology in the future is dealing with increasing demand by clinicians and patients for more rapid, specific and high-tech testing for patient management, particularly in the molecular fields of cancer gene analysis and bacterial sequencing, in combination with maintaining a skilled workforce operating 24 hours a day. The future will see a significant increase in technology, including both automation and new technologies, that will require a workforce that is well informed and able to adapt to changes in laboratory practice. Therefore, it is imperative to maintain links with universities and other national bodies to foster a dynamic group of pathologists and scientists who form the critical link between clinical medicine and laboratory practice.

Another challenge for the Division of Pathology is managing demand on staff and resources. Community collection centres have been a major contributor to this increasing demand over recent years. To manage this increase in demand, two of Pathology’s collection centres have been closed. This has enabled resources to be redirected and assist in responding to demand on public pathology services with the available workforce and resources. ACT Pathology’s core business is the delivery of inpatient pathology services to Canberra and Calvary hospitals.

Future directions

Increased range of services

At the request of ACT Health staff specialists, the Molecular Pathology Department is in the process of implementing mutation marker assays to assist in the selection of suitable treatment modalities for cancer patients. This diagnostic service is likely to be offered later in 2013. The laboratory offers an already expanded respiratory pathogen testing service and is looking to expand this repertoire of testing in the future.

Research that promotes evidence-based practice

Pathology supports much of the clinical research being carried out in the public hospital system in the ACT by undertaking the assays directly or preparing special samples for forwarding to research institutes in other states. This activity is in addition to work initiated within various departments across pathology, which is often of a collaborative nature with the Australian National University and University of Canberra. ACT Pathology is currently supporting and contributing to in excess of 40 research projects, and it will continue to support such projects in the future.

Improve patient safety and quality of care

Pathology is working collaboratively with Health IT to introduce Computerised Physician Order Entry (CPOE). CPOE is an electronic ward ordering system that will improve completion of mandatory information required for pathology testing, improve legibility and thus accuracy of request information and provide decision-making support information to the requesting doctor. Having this up-front information for requesting doctors is expected to lead to more efficient ordering of pathology tests. In conjunction with the CPOE, a pathology collection system providing positive patient identification (PPID) for the collection of blood samples will be introduced. The introduction of both CPOE and PPID is expected to reduce pre-analytical errors that occur before the sample is presented to the laboratory for analysis. This will significantly improve patient safety. The process is necessarily long and intensive and we look forward to implementation in 2014.

Division of Surgery and Oral Health

The Division of Surgery and Oral Health is responsible for delivering inpatient and outpatient surgical and medical imaging services and prevention and treatment dental health programs for children, targeted youth and adults of the ACT community and surrounding region. The aim of surgical services is to provide timely access to elective and emergency surgery, with a focus on quality patient-centred care, supported by evidence-based practice. The division includes the Surgical Bookings and Pre-Admission Clinic, Anaesthesia, the Pain Management Unit, Operating Theatres, the Post-Anaesthetic Care Unit, the Day Surgery Unit, the Admissions/Extended Day Surgery Unit, Medical Imaging, various specialty surgical ward areas, the Outpatient Department (medical and nursing only), the Shock Trauma Service, the Trauma Orthopaedic Research Unit and the Dental Health Program.

Achievements

  • Capital funding was received for the purchase and installation of two new CT scanners. The first, a state-of-the-art CT scanner, became operational on 3 July 2013. The second, a medium-range CT scanner, is expected to be operational by the end of August 2013.
  • Medical Imaging implemented neuro-interventional services—in particular, coiling of intracranial aneurysms—which provide access for patients who have previously had to travel interstate for these services.
  • In the past 12 months, there has been increasing interest from international radiologists in spending time at Canberra Hospital to further develop skills and training. These positions are sponsored by their individual governments.
  • The appointment of a Nuclear Medicine Fellow assisted with the development of a career path and future teaching opportunities.
  • Dr Robert Allen received an Interventional Radiology Society of Australia Gold Medal Award in recognition of his contribution to interventional radiology. Dr Allen is the third person to be awarded this honour.
  • Mr Chris McLaren became an Honorary Life Member of the Australian and New Zealand Society of Nuclear Medicine in 2012. Mr McLaren is only the second nuclear medicine scientist to be granted this honour.
  • In 2012‑13, the federal government provided $345.9 million over three years to reduce public dental waiting lists across Australia. The ACT was the first jurisdiction to sign the National Partnership Agreement (NPA) in January 2013 and was allocated $5.5 million over three years. The funding has increased workforce capacity and increased utilisation of the private sector to reduce public dental waiting lists. At 30 April 2013, the Dental Health Program (DHP) met baseline NPA activity targets, attracting an additional $300,000 of NPA funding on 1 June 2013. This brings total NPA funding for 2012‑13 to $954,000.
  • At 30 June 2013, there were 1,659 people waiting for non-urgent restorative dental services, compared to 2,310 clients on the waiting list at 30 June 2012. At 30 June 2013, 2,447 clients were removed from the restorative waiting list, compared to 1,856 at 30 June 2012. This is an increase of 591 clients being removed in 12 months.
  • One dental clinic in Civic was refurbished, and an additional clinic in Civic was constructed. A student tutorial room and orthopantomograph (OPG) x-ray machine, to increase the number of dentistry students, were completed.
  • Vision-Impaired Persons Hospital Kits were introduced across the hospital in September 2012 for use by people who are blind or have low vision, as well as their families and carers. The kit provides information on a range of resources that enable patients to maintain a high level of independence and assist hospital staff to have a greater understanding of the needs of people who are blind or have low vision. The kit includes resources for use in hospital, such as signage to increase awareness of patients’ needs, checklists to ensure patients are prepared and orientated to the ward environment, signed guide techniques for staff or carers and information about low vision services in the ACT.
  • Mr Daniel Wood, Acting Assistant Director of Nursing, Wards, was awarded an ACT Health Australia Day Award.
  • Two college ophthalmology trainees were re-accredited in September 2012 for three years.
  • Dr Rohan Essex is coordinating a national research project on retinal surgery outcomes based in Canberra.
  • The Pain Management Unit won the ACT Quality in Healthcare Award in 2012 for ‘Access and Efficiency—Improving Customer Access to Multidisciplinary Pain Management Services’ and the ACT Government Health Better Practice Award in 2013 for ‘Improving Consumer Access to Multidisciplinary Pain Management Interventions’.
  • The ACT Trauma Committee was formed to promote integration and coordination of the trauma system. Key representatives from Canberra Hospital and from hospitals in our region are members.
  • Monthly Trauma Grand Rounds were established to improve the health outcomes of trauma patients by providing trauma education and training that are locally accessible.
  • The Shock Trauma Service made a formal commitment to the Australian Trauma Quality Improvement Program. The aim of the program is to collaborate in improving care of seriously injured patients through sharing information, making joint efforts in trauma quality improvement projects and developing a ‘next generation’ national clinical quality registry for trauma.
  • Ms Rebekah Ogilvie, Trauma Coordinator, was recognised this year for her research in major traumatic injury in young people when she was awarded the inaugural Skellern PhD Scholarship.
  • A new Director of the Pain Management Unit commenced in April 2013.

Issues and challenges

  • Demand for services increased but the division was able to respond with additional activity—for example:
  • In 2012‑13, there were 6,464 elective surgery procedures undertaken, compared with 6,317 in 2011‑12, which has exceeded the annual target of 6,300.
  • The Dental Health Program removed 3,098 clients from the central list for treatment in 2012‑13, compared with 1,727 in 2011‑12.
  • The decanting of the Tuggeranong Dental Clinic to the Phillip Dental Clinic to allow for the refurbishment of the Tuggeranong Health Centre presented a number of challenges, including:
  • scheduling and relocation of staff and equipment to enable the continuation of service delivery to child and youth clients
  • negotiations with the Phillip Health Centre for additional office space to administer the National Child Oral Health Survey
  • good communication to allay staff concerns and anxiety about the relocation

– a multi-pronged client communication strategy to inform clients of the changes to service delivery and access.

Future directions

The installation of new CT scanners provides opportunities to offer new developments in diagnostic options.

Medical Imaging has received funding to acquire a range of new, state-of-the-art equipment, including ultrasound machines, a gamma camera and a biplane angiography suite.

The ACT Government has committed $1.6 million from 2013‑14 over four years to fund a mobile dental van to provide dental care to residential aged care facilities, special schools, and pregnant and parenting students attending the Canberra College Cares Program. The operations of the mobile dental van are in the early planning stages.

The newly built Belconnen Health Centre will open in November 2013 with 11 dental chairs—an additional six chairs compared with the old Belconnen Health Centre. The newly refurbished Tuggeranong Health Centre will open in the first half of 2014 with five dental chairs.

The DHP continues to collaborate with allied health professionals to introduce orthodontic treatment for clients with cleft palate. Clinical training is occurring between the Canberra Hospital Cleft Palate Clinic and the DHP, and a mentorship has been established with a senior orthodontist at the Sydney Cleft Palate Clinic. Clients are being treated for general dental interventions, with full orthodontics expected to commence for clients referred by the Canberra Hospital Cleft Palate Clinic later in 2013.

An upgrade to the dental electronic client information system, including digital radiography, will be completed in October 2013.

Formalisation of cross-border networking arrangements as part of the 2013 New South Wales Trauma Services Review will strengthen data linkage with New South Wales referral facilities and facilitate repatriation for ongoing care, which will link in with rehabilitation services available closer to home.

Division of Women, Youth and Children

The Division of Women, Youth and Children provides a broad range of primary, secondary and tertiary health care services. The provision of services is based on a family-centred, multidisciplinary approach to care in partnership with the consumer and other service providers. Services are provided at the Canberra Hospital, in community health centres and in community-based settings, including clients’ homes, schools, and child and family centres. Some services are provided within other agency facilities.

The Division of Women, Youth and Children service comprises:

  • maternity services, including the Continuity at the Canberra Hospital (CatCH) Program and the Canberra Midwifery Program (CMP)
  • women’s health, including screening, gynaecology and programs targeting violence against women
  • neonatology, including the Neonatal Intensive Care Unit, Special Care Nursery, specialist clinics, newborn hearing screening and ACT Newborn Retrieval Service
  • paediatrics, including inpatient care, specialist clinics, community paediatricians and genetics
  • Maternal and Child Health (MACH), including a universal home visit following birth, support for breastfeeding and parenting, immunisation and referral
  • services that support children and their families with complex care needs:

– Maternal and Child Health (MACH) Parenting Enhancement Program

– Asthma Nurse Educator Service

– Caring for Kids Program (care in the home for children with complex needs)

– Child at Risk Health Unit (care for children affected by violence and abuse)

– Integrated Multi-agencies for Parents and Children Together, which coordinates care for woman with complex care needs who are pregnant and/or have young children

– child protection training for clinicians

  • school-based nursing services, including immunisation, kindergarten health checks, school youth health checks and special school nurses
  • nurse audiometry, providing hearing assessments to children and adults.

Achievements

Centenary Hospital for Women and Children

The new Centenary Hospital for Women and Children is one of the Health Infrastructure Program’s major new facilities and features state-of-the-art equipment and infrastructure. The project includes the major refurbishment of the existing maternity building. The move into the Centenary Hospital for Women and Children took place in August 2012 and presented significant challenges, including:

relocation of babies in the NICU and Special Care Nursery and women in the Maternity Unit

communication with staff, which was of utmost importance to alleviate any concerns regarding the relocation

a multi-pronged client communication strategy to inform clients of the changes to service delivery and access.

Community health programs

Community health programs provide services under a primary health care framework for children, families and women in the community. Programs and services are delivered to individuals or groups across a variety of settings in health centres, child and family centres, schools and clients’ homes.

In 2012‑13, there was increased demand for services and a need to develop new models for service delivery to try to address this demand. Extensive work was also done to prepare for the moves to the new or refurbished community health centres.

ACT Breastfeeding Strategic Framework

The ACT Breastfeeding Strategic Framework 2010–2015 was launched on 10 November 2010. Its aim is to increase the number of infants being exclusively breastfed from birth to six months and to encourage ongoing breastfeeding with complementary foods until at least 12 months of age, in line with National Health and Medical Research Council recommendations. Implementation of the framework continues, with a focus on priority groups and consistency with the national breastfeeding strategic framework.

Key initiatives include the development of resources for priority and mainstream groups, health professional education, a whole-of-government approach to the ‘Breastfeeding-Friendly Workplace’ and enhanced breastfeeding data collection. A dedicated project officer led the implementation until June 2013. The development and implementation of the Breastfeeding Strategic Framework was funded by the ACT Population Health Division’s Healthy Future budget and is a joint initiative of the Health Improvement Branch and the Women Youth and Children community health programs.

The implementation of the framework has been guided since its inception by the Breastfeeding Initiative Steering Committee. Implementation will now be coordinated through the Division of Women, Youth and Children and Policy and Government relations. The Division of Women, Youth and Children will manage the service delivery side of breastfeeding, including:

  • exploration of the current service delivery model for breastfeeding
  • ongoing education of health professionals and support for resource development
  • the embedding of breastfeeding and the strategy into the core business of ACT Health by establishing a subcommittee
  • ongoing Breastfeeding-Friendly Workplace re-accreditation for ACT Health
  • the development of an ACT Health policy on the preparation of formula
  • the embedding of breastfeeding into all relevant health and government policies and frameworks during the development process.

Women’s Health Service

The Women’s Health Service (WHS) has continued to implement an interprofessional primary health care (ACCESS) model for disadvantaged women who experience significant barriers to health service access. The counsellors, women’s health nurses, nurse practitioner and staff specialist work collaboratively to provide comprehensive care to the priority population groups. The women’s health nurses have maintained their expanded outreach to better target vulnerable groups. An evaluation framework for the ACCESS model has been developed by researchers from the Australian Primary Health Care Research Institute.

To support health professionals working with women who have been subjected to interpersonal violence, a training package for general practitioners has been developed and delivered in conjunction with Medicare Local, and presentations on trauma-informed care have been developed and delivered to other health professionals.

School Youth Health Nurse Program

The School Youth Health Nurse Program aims to promote positive health outcomes for young people and their families through the delivery of accessible, acceptable, appropriate and culturally respectful primary health care services in the school setting. It also provides the opportunity for young people, their parents and members of the school community to access a health professional in the school setting. This can be for matters relating to health or wellbeing and includes acting as a curriculum resource for staff. The external evaluation was completed in 2012 and, based on the positive results, the program was extended in 2013.

Immunisation

From 2013, the Human Papillomavirus (HPV) vaccination program, which has been offered to girls in Year 7, is being offered to boys. The School Health Team is offering the vaccination to Year 7 boys, with a two-year catch-up component for boys in year 9. The HPV virus can cause genital warts and a range of cancers, including cervical, penile and anal cancer.

Maternal and Child Health nursing partnership with Canberra College

The Maternal and Child Health (MACH) nursing partnership with Canberra College (CCCares), where MACH services are delivered to pregnant young women and young parents who are continuing their education and bringing their child to this unique school setting, continues to grow and develop. Over 100 young parents are engaged with MACH services through this partnership, and an increased number of sessions have been provided by MACH services. A community paediatrician now provides a clinic once a month.

National Perinatal Depression Initiative

The Australian Government Department of Health and Ageing and ACT Health have a five-year agreement for the National Perinatal Depression Initiative (NPDI), from 2008 to 2013, to improve prevention and early detection of antenatal and postnatal depression and provide better support and treatment for expectant and new mothers who are experiencing depression or are at risk of developing depression. The initiative is making consistent progress aligned with the agreed milestones of the NPDI. Progress and improvements against all outputs in the implementation plan are on track, with no significant risks or issues emerging.

The NPDI project particularly focuses on:

  • routine and universal screening to identify women at risk of, or experiencing, perinatal depression (PND)
  • follow-up integrated care pathways for women
  • an education and training framework in perinatal mental health for multidisciplinary professionals
  • community awareness of the risk factors related to PND, anxiety and adjustment to parenting
  • improvement of data collection methods.

Health services to children and young people with complex health issues in all ACT Government schools

The Health Directorate and the Education and Training Directorate are working together on a project to develop a whole-of-government model addressing the provision of health services to children and young people with complex health issues in all ACT Government schools. A community consultation process was conducted in November 2012. A preferred model, named Healthcare Access At School (HAAS), was piloted in early 2013 with positive outcomes. Implementation will occur in 2013‑14.

Centre for Newborn Care

The new Neonatal Intensive Care Unit (NICU) was built to accommodate up to 34 patients. Since the move to the Centenary Hospital for Women and Children in August 2012, occupancy in the NICU has been at 91 per cent.

Neonatal Intensive Care Unit Webcam

In the 2008–09 Budget, ACT Health allocated $200,000 to develop and implement a video streaming service for parents of infants at the Centre for Newborn Care Neonatal Intensive Care Unit (NICU).

The NICUCAM website provides general information on the services provided by the Centre for Newborn Care and can be accessed by the public. From this site, parents can access the secure password-protected portal to view their own babies daily between 6.00 am and 10.00 am and between 6.00 pm and 10.00 pm, via a webcam installed above the baby’s cot in the Centre for Newborn Care.

Parents may provide the password and login to family members in Australia and overseas, which promotes bonding with the new baby.

A total of 10 babies can be on the webcam site at the same time, though to date six has been the maximum number. The website has received over 100,000 hits and has been accessed from 80 countries, as far afield as the United Kingdom, Canada, France, Italy, Hungary and India. In 2011, the program was awarded the national and, in 2012, the International Oceania–Pacific Project Management Award in the category Organisation/Change Management.

A technical design was developed to update the website and manage the cameras by NICUCAM staff. Solution went for tender and the successful company was offered the contract.

ACT Newborn Retrieval Service

The Newborn Retrieval Service, a satellite of the Newborn Emergency Transport Service (NETS) New South Wales, has been operational since 2008. Annually, 40 to 50 babies are retrieved from the ACT and New South Wales and taken as far as from Nowra to Canberra Hospital by the neonatal retrieval team, which consists of a neonatal nurse and medical officer. In addition, the service provides a timely, safe and coordinated transfer of babies to their local hospitals. The retrieval team (medical and nursing) is being trained in paediatric life support and provides a neonatal and infant (up to 10 months of age) medical emergency team at Canberra Hospital in the Centre for Newborn Care. The team also provides treatment and stabilisation of children up to the age of two years before transfer to Sydney to a Paediatric Intensive Care Unit.

An updated memorandum of understanding has been developed to increase service delivery to hospitals in New South Wales that are closer to Canberra than Sydney and to facilitate time-appropriate retrieval and back-transfer of convalescing neonates to improve patient flow.

Paediatric and Adolescent Health Services

The Paediatric Department, in addition to its general paediatrics duties, runs sub-speciality services in paediatric endocrinology, respiratory medicine and nephrology and conducts outreach clinics in Cooma and Pambula on a monthly basis. The department also strives to meet the needs of children requiring other sub-specialist services by hosting visiting specialists from Sydney in paediatric cardiology, gastroenterology, oncology and neurology. Paediatric research is conducted with involvement in vaccine and drug trials, as well as research on genetic renal disorders and endocrine and metabolism disorders in children. All paediatric staff specialists have an academic appointment and actively participate in Australian National University Medical School student teaching.

Outpatient waiting lists in paediatrics have been addressed by administrative improvements, the recruitment of two new paediatricians (1.8 full-time equivalent) and improved paediatric registrar participation in outpatient clinics. The work of the Chronic Care Coordinator nurse in the Outpatient Department has allowed for a cohesive, family- and child-centred approach for children with chronic disease.

The Paediatric Palliative Care Committee has improved palliative care services for children and their families through a collaborative, multidisciplinary and multi-agency approach. Improved links with Clare Holland House through a monthly interdisciplinary meeting and attendance at a conjoint meeting with New South Wales Paediatric Palliative Care Services ensure our paediatric palliative service aligns with current best practice.

The Paediatric Department has commenced strategic planning on improved resident and registrar training by developing a training program that will allow Australian National University graduates to undertake all but six months of their paediatric training in the ACT. Recognition is actively being sought from the Royal Australasian College of Physicians for local training in several paediatric sub-speciality rotations.

iPatCH (Paediatrics high dependency unit)

In the 2012‑13 Budget, funding was allocated for two additional iPatCH beds. These beds have been identified in Ward 4B and will be utilised to provide closer monitoring of patients and a higher level of nursing care for sick children. iPaTCH has accepted NETS transfer of nine acutely unwell children from surrounding hospitals in New South Wales and Canberra. iPaTCH beds are not restricted to patients of the Paediatric Department; all specialities may admit paediatric patients into iPatCH care under the guidance of a consultant paediatrician.

Maternity and gynaecology services

Maternity and gynaecology services at Centenary Hospital for Women and Children provide care to women and children in the ACT and surrounding regional area. There were 3,342 births in 2012‑13, compared to 2,974 in 2011‑12 and 2,769 in 2010–11. In the past six months, outpatient antenatal care occasions of service were 3,425 for medical officers and 3,848 for midwifery. Outpatient gynaecology services provided 1,795 occasions of service.

Issues and challenges

In recent years, there have been significant changes in the mix between private and public sector births, and the number of public sector births has increased significantly. Between 2006–07 and 2011‑12, there was only a 9 per cent increase in the total number of births in the ACT; this is less than 2 per cent a year. Over the same period, there was a 25 per cent increase in births in the public sector, while private hospitals experienced a 21 per cent reduction in birth rates over the same period.

Changes to the Medicare Safety Net have coincided with a significant decrease in private sector activity and a significant increase in public sector activity. This change was significant in 2010–11 and 2011‑12, as many of the private sector bookings were previously made at the time of the safety net changes. The change in pattern and downturn of private sector activity unfortunately occurred too late to enable any change in planning for the construction of the new hospital. The planning of the facility was based on the projections for increases in demand. The total number of ACT births is consistent with the projections that were made. However, the safety net changes were not known at the time and therefore the shift from private to public sector was unexpected.

The Centenary Hospital for Women and Children has experienced pressure in relation to occupancy. A review into maternity services has been commissioned to look at ways in which the territory can work collaboratively to meet this unprecedented demand. The purpose of the review is to examine and provide an assessment of the model of care in the new Centenary Hospital for Women and Children Maternity Unit. It will also look at the capacity of ACT maternity services to meet current and future demand, taking into account recent changes to service demand as well as the model of care. The review team was sought from Women’s Health Australasia (WHA), the peak body for hospitals and health services providing care to women and babies. The review team has conducted interviews with members of staff and consumers of the Centenary Hospital for Women and Children and will provide a report by September 2013. Strategies have been put in place to manage demand, such as:

  • the opening of four short-stay postnatal beds as a short-term measure to manage the overflow of patients
  • additional staff
  • increased capacity for the continuity of the midwifery program.

Future directions

Centenary Hospital for Women and Children

Maternity and gynaecology services at Centenary Hospital for Women and Children provide care to women and children in the ACT and surrounding regional areas. The Centenary Hospital for Women and Children, stage 2 will open at the end of October 2013. At the completion of stage 2, the inpatient and outpatient paediatric service will relocate to level 1. The Antenatal and Gynaecology Outpatient Service, the Maternity Unit and the Fetal Medicine Unit will occupy level 2. Two assessment rooms, five birth centre beds and the new birthing suite, which have 13 labour birth recovery beds, will occupy level 3.

Community Paediatric and Child Health Service: Child Development Service

In early 2012, a discussion paper titled ‘The Future of Community Paediatrics in the ACT Region—Beyond 2012’ was sent to the Director-General of ACT Health, Dr Peggy Brown. It was subsequently endorsed for further exploration and a working group to be formed. This paper has stimulated stakeholders across government departments and non-government organisations involved in the provision of child and youth services to work together to develop a collaborative model to improve child development services in the ACT. This work will be incorporated into the Paediatric Services Strategic Plan.

The aim of this collaborative and multidisciplinary work is to examine the potential to transform the present Community Paediatric and Child Health Service (CPCHS) into a best practice, evidence-based, multi-disciplinary child development centre for the ACT and surrounding region.

Personal Child Health Record

In alignment with the National Framework for Universal Child and Family Health Services, ACT Health is committed to the progression of a national Personal Child Health Record (PCHR). The logical first step is to come into alignment with the recently updated New South Wales PCHR in consultation with ACT clinicians and other professionals who work with children. This approach was approved by the ACT Child Youth Health Reference Group and the ACT Maternity Services Network Forum. The rationale for this includes:

  • extensive recent consumer consultation by New South Wales Health on their PCHR
  • ongoing trials of an electronic version of the New South Wales PCHR
  • consideration of those professionals, clinicians and families whose working and living arrangements straddle the ACT–New South Wales border
  • substantial cost savings from printing this format.

Approval to adopt the New South Wales PCHR style and format has been given by New South Wales Health and the Executive Director of New South Wales Kids and Families. A working group will make minor local amendments and then seek final endorsement by the ACT Child Youth Health Reference Group and New South Wales Health.

Chronic Kids

The paediatric service is looking at the development and implementation of a chronic care strategy. This would aim to improve the service delivered to children and their families through a more integrated and comprehensive approach to chronic care management. The strategy would be based on the principles outlined in the ACT Chronic Conditions Strategy and the National Chronic Disease Strategy.

Paediatric Services Strategic Plan

The future direction for the Paediatric Department is to continue to strive to improve paediatric outpatient services and waiting times for families, to improve inpatient services and to ensure the timely and seamless discharge of children when hospital care is no longer required. The service is working to improve the flow of children through the Emergency Department to the ward and is undertaking a trial of a paediatric observation unit (Short Stay Ward) for children who require a longer period of observation for acute treatment prior to a decision to admit or discharge being made. The service is planning to develop an acute paediatric review clinic, which will give ACT general practitioners the ability to obtain an immediate paediatric review of a child they have concerns about who does not require presentation to the Emergency Department. Such a model will assist greatly in meeting the National Emergency Access Target (NEAT), reduce the burden on the Emergency Department and improve liaison with ACT general practitioners.

Calvary Health Care ACT

Calvary Hospital provides public health and hospital services in the ACT. These services include Emergency Medicine, Critical Care, Medical Care, Elective and Emergency Surgery, Day Surgery, Aged Care and Rehabilitation, Mental Health, and Inpatient and Community Specialist Palliative Care services from Clare Holland House (the ACT Hospice).

Calvary Hospital is operated by Calvary Health Care ACT (CHC ACT), a subsidiary of Little Company of Mary Health Care. CHC ACT has operated Calvary Hospital since its inception in 1979.

Funding for the operation of the public component of Calvary Hospital is provided by the Territory. The enduring arrangements between Calvary Health Care ACT and the Territory are described in the Calvary Network Agreement.

Each year the Territory and Calvary Health Care ACT negotiate required activity levels and funding arrangements. These are formalised in the annual Performance Plan, against which Calvary regularly reports its service to the local community and other people in need of public health and hospital services.

Achievements in the reporting period

  • Achieving impressive results from the Australian Council on Health Care Standards accreditation survey of Calvary Health Care ACT against the recently introduced EquipNational criteria, which include the National Quality and Health Standards. Calvary Hospital is the first public health facility in the ACT to be reviewed and to receive unqualified accreditation against EquipNational requirements.
  • Delivering record levels of service in all clinical areas and outpatient occasions of service.
  • Redesigning Community Palliative Care Services provided from Clare Holland House. The Community Specialist Palliative Care Pathway provides patients with faster and more equitable access to palliative care services, with all patients being assessed and reviewed through a triage process and then being involved in choosing their preferred palliative care treatment program.
  • Introducing the Palcare patient management system to enable greater involvement and improved coordination of primary care providers in their patients’ palliative care treatment.
  • Embedding the Calvary Patient Access Improvement Program, which is constructed around robust processes and cooperation between clinical areas, to provide improved patient access and flow and to achieve efficiency in elective and emergency admissions and surgery.
  • Continuing to build the partnerships and processes associated with the networking of health and hospital services in the Territory.
  • Increasing the number of people who received elective surgery procedures and reduced surgery waiting times.
  • Completing the refurbishment of the Calvary Hospital Emergency Department, which has created additional treatment spaces and facilitated the streaming of patients into ‘likely to be admitted’ and ‘see and treat’ streams.
  • Expanding Aboriginal and Torres Strait Islander liaison services through the appointment of a second Liaison Officer; these officers have direct contact with Indigenous patients and families and actively participate in Aboriginal and Torres Strait Islander networks in and around the ACT.
  • Strengthening links between Clare Holland House and the Aboriginal and Torres Strait Islander communities to ensure Indigenous people have access to culturally sensitive and appropriate palliative and end-of-life care.
  • Continuing the program of implementing technology which is shared with other health and hospital services in the Territory. Notable achievements in this area include: the roll-out of the ACT Patient Administration System (ACTPAS), creating a single electronic patient record across the Territory; the expansion of free wi-fi in many areas of Calvary for business and personal use; and the introduction of the MetaVision Clinical Information System in the Calvary Critical Care Unit.
  • Improving the level of governance of clinical and administrative systems through the continuous review and refinement of the Calvary Hospital Committee Structure.
  • Establishing the Australian Catholic University Clinical School on the Bruce campus, enriching clinical experience and practical learning opportunities for ACU students of nursing, midwifery and allied health.
  • Enhancing the Graduate Program for Nursing, Midwifery and Allied Health staff, and building the importance of this program as a core element of the recruitment and retention strategies documented in the draft Calvary workforce plan.
  • Advancing negotiations with the Territory on the planning and development of expanded services and new facilities on the Calvary Bruce campus.
  • Refining the Calvary Health Care ACT Strategic Planning Framework, comprising a 15-Year Strategic Vision,

a 5-Year Strategic Plan and the 2013‑14 Local Services Plan.

  • Expanding and formalising patient and consumer participation in the design, development, review and refinement of Calvary’s services. The role of patients and consumers will be formalised in a Consumer and Carer Participation Strategy that will be completed in the third quarter of 2013.
  • Actively contributing to the broader public health and hospital networks and partnerships in the ACT, with particular attention to the Local Hospital Network and the ACT Medicare Local.
  • Creating the Calvary Health@Home Unit, comprising an expanded Hospital in the Home program and an innovative Calvary Medical Outreach Service. A pilot of the Outreach Service will commence in the fourth quarter of 2013.
  • Implementing, in partnership with Carers ACT, the Carers at Calvary program, which introduces the assistance and support available to carers early in the patient journey, and facilitates the creation of carer services and support for the timely and safe discharge of patients to their preferred residential arrangement.
  • Expanding the process for patient feedback, including the introduction of bedside patient experience surveys and follow-up phone calls to patients discharged after treatment for serious health ailments.
  • Commencing the design of Calvary Hospital’s Midwife-Led Model of Care, including an extensive public consultation process around the model and service. Design work has also been advanced for the creation of a birth centre at Calvary Hospital.
  • Initiating the development process for expanded car-parking capacity at the Calvary Bruce campus.
  • Enriching the Calvary community and the Calvary patient experience through the expanded and innovative engagement and deployment of the Calvary Volunteers Group.
  • Refining the Calvary Refugee Mentoring program and offering participants more individualised work placements to assist with their settlement, assimilation and contribution to their new community.
  • Continuing to collaborate with the Calvary Community Advisory Council.
  • Improving staff engagement. In the most recent staff satisfaction survey, 63 per cent of respondents said they believed Calvary was ‘a truly great place to work’.

Issues and analysis

The clear and transparent arrangements that now exist between Calvary and the Territory under the Calvary Network Agreement continued to provide a platform for open and productive clinical and administrative relationships that address contemporary circumstances and allow for collaborative future planning and development. This is of particular importance, as the Territory is committed to the expansion of public health and hospital services in North Canberra in close proximity to the major population growth areas of Gungahlin and Molonglo.

Calvary’s levels of activity in the reporting period corresponded with the projected health needs of an ageing and growing population, in the context of improving services and developing new treatments. Calvary has made consistent progress in this area. Improved patient flow processes enable better forecasting of service levels;

24-hour coverage of emergency surgical services ensures earlier appropriate treatment for emergency presentations; enhanced discharge procedures featuring multidisciplinary collaboration are reducing patient length of stay; tracking of inpatient progress occurs in all medical and surgical wards, with the production of daily patient status reports; and the use of clinical pathways is being expanded from surgical patients to include many more medical patients.

The provision of services in non-acute settings is also being expanded at Calvary. More patients are receiving the later stages of their treatment and follow-up care in the Outpatient Clinic environment; the Calvary Hospital in the Home program has been expanded and a trial of direct external referrals to the service is under way; and a medical outreach service will commence shortly. In addition, a new ward area has been created specifically for patients transitioning from acute care to nursing home accommodation.

The Calvary Medical Inpatient Wards have been reconfigured to create standard patient numbers and common staffing levels. This process ensures equitable accommodation for patients across the various wards and enhances patient and staff safety by reducing the risk of transmission of infections and other illness through improved patient isolation options.

Engagement with patients and consumers at Calvary is growing as a result of their greater formal involvement and representation on clinical and non-clinical committees. In addition, consumers are engaged to comment on and contribute to any information being produced for patients and families.

Development and design work for expanded car-parking capacity at Calvary Hospital, which is expected to assist with peak demand, has commenced.

Future directions

  • Calvary Health Care ACT has identified a number of areas of focus for the short, medium and long term. These include:
  • increasing the capability of our workforce and growing the engagement of the workforce in the development and delivery of services—a workforce plan will be published to describe the strategies to achieve this
  • ensuring our conduct and service strongly represent our values of hospitality, healing, stewardship and respect
  • striving to be more consistent in the provision of high-quality care, distinguished by patient engagement
  • advancing our attention to patient safety with an even stronger focus on areas of preventable harm, including infection control, skin integrity and pressure ulcers, falls prevention, medication safety, the handling of blood products, nutrition, and pre-procedure consent and preparation
  • enhancing our patient and family feedback processes to ensure our patients’ experiences assist us to improve our service
  • introducing new services and service expansion, as negotiated with the Territory and described in the Calvary Performance Plan
  • continuing to explore ways care can be provided earlier, more rapidly and in the most appropriate setting
  • exploring ways that technology can improve our services and working collaboratively with the Territory in the use of shared technology
  • continuing the enhancement of budgetary and reporting processes to underpin our financial sustainability
  • considering the environmental impact and whole-of-life costs in our procurement processes
  • publishing and implementing the Calvary Health Care ACT Reconciliation Action Plan
  • ensuring that we support and assist the vulnerable and needy in our community, and ensuring that they have access to our services.
  • Our future directions are documented in the Calvary Health Care ACT Local Services Plan for 2013‑14.