Output 1.1 Acute Services
The Canberra Hospital provides 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, that contains 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 NHRA
- meeting the increasing demand for elective surgery in the Territory and reducing the number of people waiting longer than the recommended standard waiting times
- strategies to meet performance targets for the emergency department, elective and emergency surgery, and
- continuing to increase the capacity of acute care services within the ACT and surrounding region.
ACT Public Hospitals-increasing the capacity of the ACT's public health services
More beds to manage increasing demand for hospital services
The Australian Institute of Health and Welfare (AIHW) reported that in 2012-13 ACT public hospitals provided an average of 986 beds.
Source: Australian Hospital Statistics , AIHW, 2001-2002 to 2012-13 publications
The ACT Government funded a further 44 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 at Calvary Public Hospital
- 5 new beds in the Centenary Hospital for Women and Children.
This represents an extra 360 beds since 2001-02.
The ACT Government continues its commitment to increasing bed capacity in the public hospital system to meet growing demand for care and to reduce bed occupancy to optimum levels.
The ACT Government has appropriated funding for another 31 inpatient beds in 2014-15, including:
- 16 general inpatient beds at Canberra Hospital
- 15 general inpatient beds at Calvary Public Hospital
- 6 bed-equivalents for Hospital in the Home (HITH) program.
In 2013-14, ACT's public hospitals provided 280,939 overnight hospital bed days of care, a 1 per cent increase on 277,993 in 2012-13. The Australian Hospital Statistics Report for 2012-13 issued by the AIHW in April 2014 showed that the ACT had achieved the national average in providing public hospital bed availability for the fourth time in the almost 22 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.
The ACT public hospitals overnight average bed occupancy rate for 2013-14 was 90 per cent. This is a 2 per cent improvement when compared to the 92 per cent reported for the same period last year. The long-term target is to maintain bed occupancy levels for best patient outcomes and to achieve maximum efficiency. However, with increasing pressure on ACT public hospitals each year, the ACT target for this indicator in 2013-14 was revised to 90 per cent. This recognises a more realistic target in the transition period while the necessary infrastructure and process improvements take effect, which will allow ACT public hospitals to achieve the 85 per cent in coming years. The additional 44 beds funded in the 2013-14 budget have assisted in reducing bed occupancy rates over this financial year. The additional 31 beds funded in the 2014-15 budget should reduce bed occupancy rates towards the 85 per cent target.
Over recent years, there have been significant increases in the demand for non-admitted outpatient services. In response to this growth, resources have been committed to improve the function and processes of Outpatient Services.
In 2013-14, ACT public hospitals provided 563,666 outpatient non-admitted occasions of service, a 7 per cent increase when compared to the 527,892 occasions of services reported in 2012-13. Outpatient services for 2012-13 and 2013-14 now encompass all non-admitted activity, including activity provided off-campus in the community health spectrum.
This change in counting methodology, which was driven by the implementation and adoption of activity-based funding under the National Health Reform Agreement (NHRA), means comparisons of outpatients/non-admitted data can no longer be made with previous years.
A total of 4,999 babies were born at ACT public hospitals in 2013-14. This is a 4 per cent increase on the 4857 reported for 2012-13 and the highest amount of births ever recorded for a single year. The result of 4,999 births in 2013-14 also represents a 70 per cent growth (over 2000 additional births) in the number of ACT public hospital births since 2001-02.
In 2013-14 the number of births by caesarean section was 29 per cent of all births. This is a 1 per cent increase on 28 per cent reported for 2012-13.
Caesarean rates have been steadily rising since 2001, both in the ACT and nationally. The ACT rate of 29 per cent in 2013-14 was lower than most recent national figures published by the AIHW for 2012-13. ACT public hospitals continue to have a low caesarean rate compared to benchmarking hospitals. ACT public hospitals are moving towards further implementation of the 'continuity of maternity model of care', which has proven improved clinical outcomes for women-including a reduced rate of caesareans.
The ACT Government 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 there. In March 2014, a Community Midwifery Program (CMP) at Calvary Public Hospital was established to further enhance obstetric services there.
Operations in ACT public hospitals
Over the past four years, the number of surgical operations performed at ACT public hospitals has risen by 6 per cent, from 17,991 in 2010-11 to 18,998 in 2013-14. Around 30 per cent of the emergency and elective surgical operations are performed on people from New South Wales.
Access to elective surgery
ACT public hospitals provided 11,780 elective surgery procedures in 2013-14. This result is now the highest number of elective surgery procedures performed ever in a single year for the ACT. This is also the fourth consecutive year that ACT Health has performed more than 11,000 elective surgery procedures.
This was achieved in part by utilising the private sector, 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 224 patients had elective surgery in the private sector. In 2013-14, 323 patients accessed elective surgery at private hospitals, which makes a total of 1084 patients since this initiative was first established.
In addition to the work contracted with the private sector, the ACT Government and Southern New South Wales Local Health District have utilised Queanbeyan Hospital to provide elective surgery. In 2013-14, 41 patients accessed elective surgery at Queanbeyan Hospital, covering urological and gynaecological procedures.
Additions to elective surgery waiting list
The number of additions to the elective surgery waiting list continues to increase. In 2013-14, 119 more people were added to the elective surgery waiting list than in 2012-13. Urgency category 2 experienced the most growth, making up 42 per cent of the total number of additions in 2013-14. Despite the increase in demand for elective surgery, ACT public hospitals have ensured that patients can access elective surgery as quickly as possible, according to their urgency category.
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 latest AIHW report, titled Elective Surgery Waiting Times 2012-13, shows the ACT still has a high median waiting time. ACT Health has worked to reduce the number of overdue patients for the last few years. The result of 48 days reported for 2013-14 is a continued improvement on the 77 days reported in 2010-11 and 64 days reported in 2011-12.
|Median wait time||2010-11||2011-12||2012-13||2013-14|
|Medial wait time all categories||77||64||51||48|
Hospital-initiated postponements (HIP) measure how many patients have their elective surgery postponed. This performance indicator is very useful in measuring the efficiency and effectiveness of the ACT's elective surgery management. The most common reason for postponements occurring is lower acuity patients being substituted because another higher acuity patient is given priority. ACT Health aims to ensure that less than 8 per cent of patients' elective surgery is postponed. For 2013-14, ACT public hospitals achieved well below the target for this indicator, with a result of 6 per cent, which compares favourably with the 7 per cent reported for 2012-13.
ACT public hospitals have recorded a slight increase in the number of patients waiting longer than the recommended timeframe for their elective surgery procedure-726 patients at 30 June 2014. This is an increase of 14 patients when compared with the same period for last year. However, when comparing the 726 patients with the same period two years ago there has been a 19 per cent reduction in long-wait patients.
Source: ACT elective surgery published dataset June 2014
Access to emergency department services
ACT Health is committed to improving waiting times in our emergency department (EDs). In 2013-14, ACT public hospital EDs saw 125,890 presentations, a 6 per cent increase compared with the same period last year and the highest number of presentations ever recorded in a single year. In March 2014 there were 11,321 ED presentations, the highest number of ED presentations in a month on record.
Admissions to hospital via the ED have also grown, with 34,218 admissions (10 per cent growth) reported for 2013-14 compared to 31,206 recorded in 2012-13.
Waiting times for emergency treatment
Despite the increase in demand in ACT public hospital EDs, timeliness for patients to be seen continued to improve in 2013-14 compared to 2012-13, across all categories. National targets were met for triage category 1, 2 and 5 patients.
Overall timeliness also improved by 10 per cent compared to the 2012-13 result of 51 per cent.
Category 5 continued to exceed national benchmarks, with 86 per cent of this cohort seen on time. This is despite a significant increase in category 5 patient presentations during 2013-14. This improvement in performance for ACT EDs is very positive for ACT Health and shows that recent initiatives are starting to take effect. While more needs to be done, ACT public hospitals have made good progress in reducing waiting times in our EDs.
|Median wait time||2013-14
|Category 1 (resuscitation - seen immediately)||100%||100%|
|Category 2 (emergency - seen within 10 mins)||80%||83%|
|Category 3 (urgent - seen within 30 mins)||75%||50%|
|Category 4 (semi-urgent - seen within 60 mins)||70%||57%|
|Category 5 (non-urgent - seen within 120 mins)||70%||86%|
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
- expansion of the Canberra Hospital discharge lounge, enabling patients to leave the inpatient wards earlier, thereby freeing up inpatient beds and allowing increased access from the ED
- purchase of beds at Monash Goodwin Village for sub-acute patients with an extended length of stay in the acute setting.
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.
'Did not waits'
Despite the increase in demand on EDs in 2013-14, the number of presentations that did not wait to be treated has improved across all triage categories compared to 2012-13 and overall has reduced from 7 per cent to 5 per cent of presentations in the same period.
Emergency department presentations that did not wait
|Median wait time||2011-12||2012-13||2013-14||Target|
|Total all categories||7%||7%||5%||10%|
Australia's first Walk-in-Centre
Australia's first public, nurse-led Walk-in Centre (WiC) was opened in May 2010. Since then, the WiC has experienced 73,392 presentations to June 2014.
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.
Presentations to the WiC increased by 3 per cent in 2013-14 compared with 2012-13. 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 .
If necessary, people are redirected to more appropriate services, such as their GP or the ED. Of the 19,687 presentations in 2013-14, 14,234 had a completed treatment episode by the nurse. Seven per cent of patients assessed were redirected to their GP and 5 per cent were told to present to the Canberra Hospital ED.
Note: CALMS in above graph reflects Canberra After-hours Locum Medical Service. ED-TCH in above table reflects Canberra Hospital Emergency Department. 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 GP 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.
For the period of this report ACT Health operated one WiC located on the campus of the Canberra Hospital. In 2012, the ACT Government made a commitment to double the current budget for the WiC and expand the nurse-led WiCs to community locations in Belconnen and Tuggeranong.
The original WiC at Canberra Hospital closed in June 2014. A Tuggeranong WiC opened to the public on 26 June 2014, and a second WiC opened at Belconnen on 1 July 2014.
National Partnership Agreement on Improving Public Hospital Services
The National Health Reform Agreement-National Partnership Agreement on Improving Public Hospital Services was signed off by the Council of Australian Governments in July 2011. The objective of this agreement was to drive major improvements in public hospital service delivery and better health outcomes for Australians.
The agreement aimed to facilitate improved access to public hospital services, including elective surgery and emergency department services, and sub-acute care. This agreement commenced on 1 January 2012.
A set of performance targets was included in the agreement to ensure timely access to services was a priority for all health sectors across the nation. These performance indicators are measured over the calendar year.
National Emergency Access Targets
The National Emergency Access Target (NEAT) measures the percentage of patients leaving the ED within four hours, whether for admission to hospital, referral to another hospital for treatment, or discharge. Commencing from 2012, this target is phased over four calendar years, with annual interim targets increasing to 90 per cent by 2015. The ACT 2013 target required that 65 per cent of all patients within the year who presented to an ED left the ED within four hours.
For 2013, NEAT performance across ACT public hospitals was 59 per cent.
|National Emergency Access Targets - ACT|
For the first six calendar months to June 2014, ACT public hospitals are reporting a NEAT result of 63 per cent. Calvary is currently at 69 per cent and Canberra Hospital 58 per cent.
ACT's NEAT performance does not compare well against other jurisdictions. This is largely due to the fact that the ACT has only two public hospitals, both of which are major centres; NSW, for example, which has 220 public hospitals, many of which are small regional facilities.
The most recent MyHospitals data, published December (Report: NHPA Hospital Performance: Time patients spent in emergency departments in 2012-13), indicates some major metropolitan hospitals in Sydney have similar results to those in the ACT. However, a number are performing at lower levels than the ACT. For the 2013 calendar year, the national peer group average performance was 60 per cent (major metropolitan hospital). ACT public hospitals are currently exceeding this figure, with a calendar year to June 2014 NEAT result of 63 per cent.
National Elective Surgery Targets
There are three components to the National Elective Surgery Targets (NEST), focusing on ensuring timely access to surgery and reducing the number of patients waiting beyond clinically recommended timeframes.
In the 2012 calendar year, ACT Health was successful in meeting all nine components of the NEST. On 30 April 2014, the AIHW released its annual report on jurisdictional performance against emergency access and elective surgery targets.
The report shows that the ACT was the only jurisdiction to meet all targets in each of the three components of the NEST.
The ACT public hospitals met eight of the nine NEST targets for 2013, missing the remaining target by 0.3 per cent.
Part 1 of the NEST refers to the proportion of patients who access their elective surgery procedure within clinically recommended timeframes.
For the 2013 calendar year, the ACT met the required targets for category 1 and 3 patients accessing their surgery on time. It did not meet the target for category 2 patients, reporting a result of 65.7 per cent accessing surgery on time, against a target of 66 per cent.
|Part 1 - % of patients treated within clinically recommended time|
|Target||Category 1||Target||Category 2||Target||Category 3|
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 calendar year 2013, ACT public hospitals met the required targets for urgency category 1, 2 and 3 patients.
|Part 2A - Average overdue days waitingCategory 1 Category 2 Category|
|Category 1||Category 2||Category 3|
|2013 calendar year result||0||107||73|
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 each year. The Australian Government issues ACT Health with the list of long-wait patients who are to have their surgery in that year. In the 2013 calendar year, ACT public hospitals removed all of the identified longest waiting patients from the 2013 list.
|Part 2B - Removal of top 10% longest waits|
|Category 1||Category 2||Category 3|
|2013 calendar year result||1||64||14|
Sub-acute care reform
The sub-acute component of the National Partnership Agreement on Improving Public Hospital Services aims to improve 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 psychogeriatric services in both hospitals and the community.
Over 2013-14, the planning for growth in sub-acute care services has paid off. The ACT has now delivered more than 25 sub-acute bed-equivalents into the system, above the June 2014 target of 21 bed-equivalents.
Division of Critical Care
The Division of Critical Care is responsible for the delivery of acute and critical care as well as 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 commitment 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, Surgical Assessment and Planning Unit (SAPU) and Medical Assessment and Planning Unit (MAPU).
The Canberra Hospital ED is a tertiary service and a trauma centre with a territory-wide and regional role. The service treats adults and children. The ED at Canberra Hospital strives to provide timely, accessible and appropriate health services to people with acute illness or injury. The service is required to manage large numbers of patients presenting with a broad range of conditions that must be dealt with on a priority basis. The National Emergency Access Targets require that, by 2015, 90 per cent of patients presenting to an ED will leave the department for admission to hospital, be transferred to another hospital or be discharged to go home within four hours. While achievement of this target is a whole-of-hospital responsibility, programs are being developed by the staff within the ED to ensure that improvement in this performance indicator continues.
The performance for 2013-14 has seen improvements in the majority of categories.
With the opening of the new Emergency Medical Unit within the ED in October 2013, the model of care changed to support the introduction of streaming within the ED. This allowed patients presenting to the ED for care to be directed to either Stream A (Acute) or Stream B (Ambulant), depending on the treatment required for their presenting condition. This has resulted in an upward trend in the number of patients seen and admitted, transferred or discharged from the ED within four hours.
The Division of Critical Care has worked closely with Project Venturi (Patient Flow Project) to improve the discharge planning process for patients who are admitted to MAPU and the Medical Short Stay Unit. The multidisciplinary team has worked collaboratively with the ED to expedite the assessment and management of patients with undifferentiated medical conditions. This work is a collaborative effort with the Division of Medicine, which is responsible for the clinical unit of General Medicine. All stakeholders are focused on ensuring optimal patient outcomes, maintaining quality and efficiency of care and ensuring the efficient use of resources.
The implementation of the Medihotel in February 2014 enhances care for consumers who travel from remote or rural areas. Eight beds in hotel accommodation on the hospital campus allow consumers to be supported in their transition from the acute setting to community-based care. Family members or carers can also support consumers during their stay.
This service promotes the continuity of care for consumers and enables the Canberra Hospital to optimise access and patient flow by ensuring that rural and remote consumers who require sub-acute care but who no longer require continued hospital admissions can maintain access to necessary treatment.
The extension of the Discharge Lounge operating hours supports consumers who no longer require acute care, and who are awaiting either transport or social support, to have access to an area that is comfortable, secure and monitored by nursing staff. This ensures consumer safety and enhances patient flow across the campus.
The expansion of the ICU has provided an additional seven beds and a larger balcony area for long-term patients to utilise.
The additional capacity in ICU allows for patients requiring isolation or positioning more appropriate to their clinical needs.
Issues and challenges
The increasing number of presentations to the ED that require admission will continue to impact on the ability to meet demand in the ED. The multidisciplinary team continues to work on initiatives to enhance access as well as maintain quality and safety of care.
Percentage of admissions via ED with length of stay less than 4 hours 2013-14
Adequate intensive care coverage for a hospital that is both a major tertiary referral centre for the ACT as well as a teaching hospital has required the ICU to continue to expand in order to meet demand. This demand comes from both the emergency and trauma admissions and elective surgery.
The ACT Government and the Commonwealth Government have committed funds to establish a dedicated service for children in the Canberra Hospital ED (a paediatric stream). The project will refurbish an area within the ED to create a more suitable family-friendly waiting, triage and treatment area and will not be provided at the expense of existing adult treatment spaces. This service will streamline and better coordinate paediatric emergency and inpatient care. It will provide early identification of paediatric patients who are waiting for care and the streamlined transfer of those patients to the appropriate services in the Centenary Hospital for Women and Children.
The Division of Critical Care's ongoing work with Project Venturi, which is assessing patient flow across the hospital, will see the expansion of the improved discharge planning process across other areas of the hospital. The processes implemented within MAPU have identified key areas that negatively impact on discharge times. Project Venturi actively promotes a multidisciplinary approach to all of the project objectives.
Division of Medicine
The Division of Medicine provides adult medicine services to the Canberra community in inpatient, outpatient and outreach settings. An emphasis is placed on accessible, timely and integrated care, which is delivered to a high standard of safety and quality.
The Division of Medicine comprises:
- Renal services
- Academic Unit of Internal Medicine
- Sexual Health Centre
- Gastroenterology and Hepatology
- Diabetes Service
- Forensic and Medical Sexual Assault Services
- Infectious Diseases
- Inpatient ward services, ambulatory clinics and clinical measurement services across many specialties
- Pharmacy Services
- Respiratory and Sleep Services
The division has a strong commitment to teaching and research. Health students from several universities undertake practical placements within the division. Most of the division's senior medical staff hold academic appointments at the Australian National University Medical School, and there are many research programs in operation. Many members of the division's staff participate in the development of national professional guidelines and quality initiatives.
ACT Health is committed to consumer accessibility to the Diabetes Service and has established clinics at three community health centres and Canberra Hospital.
The next ACT Health Diabetes Service Plan is being drafted in consultation with consumer representatives and the aim is to have the new plan finalised this year.
Parkinson's Disease Service
The Chronic Care Program's Parkinson's Disease (CCP PD) Service provides education, clinical support and care coordination for frequent users of the acute care sector with Parkinson's disease, multiple systems atrophy, progressive supranuclear palsy and corticobasal degeneration.
The CCP PD Service began operation in 2012 under the Chronic Disease Management Unit. It completed one year of mature operations in 2013 and is currently in its second year.
An evaluation of this service was undertaken from April to June 2014 to review its operations, identify and document its achievements and make recommendations for its evolution and improvement.
The evaluation suggested that the CCP PD Service is associated with reduced hospitalisation rates and length of stay for people with Parkinson's in the ACT and surrounding region. The service is reported to be valued by those with Parkinson's and their carers.
The demand for acute stroke care in the ACT has been rapidly increasing. To account for the increased demand for services, the Division of Medicine has implemented the following:
- creation of a transient ischemic attack (TIA) clinic
- commencement of a cross-territory stroke service between the Canberra Hospital and Calvary Hospital. The Calvary Hospital Stroke Unit commenced operations on 28 April 2014 and has four acute beds and four sub-acute beds, as well as a dedicated Stroke Liaison Nurse.
Hospital in the Home
The Hospital in the Home (HITH) Program has developed a protocol, in conjunction 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 in HITH assisted with the increasingly complex and numerous medications being used both by patients in their homes and by those receiving treatment as day-only patients.
Obesity Management Service
The Obesity Management Service (OMS) commenced taking referrals in January 2014 and saw its first patients in February 2014. It is a referral-based service for adults with Class III obesity (BMI 40kg/m2 or more) to improve their health and wellbeing.
The service is medically led and the team includes a dietician, psychologist, physiotherapist, exercise physiologist and registered nurses. The OMS provides individual clinical care and groups for physical activity and health education. The service supports better clinical care for this patient group, community development, research and professional education. The OMS operates from the Belconnen Community Health Centre, which has specialist bariatric equipment and treatment facilities.
In 2013-14, the Chest Pain Evaluation Unit (CPEU) was established. This has seen a significant improvement in the management of patients presenting to the Emergency Department (ED) at the Canberra Hospital with chest pain-decreasing the time these patients spend in the ED.
The commencement in August 2014 of an additional cardiologist specialising in echocardiography will further enhance cardiology services.
Gastroenterology and Hepatology Unit
In 2013-14, refurbishment of the Gastroenterology and Hepatology Unit (GEHU) allowed for increased endoscopy and clinic capacity and reduced waiting time for patients.
In May the Endoscopic Ultrasound Service (EUS) commenced. The EUS is a medical procedure that combines with ultrasound to obtain images of the internal organs in the chest and abdomen. When combined with Doppler imaging, nearby blood vessels can also be evaluated. It allows for screening for pancreatic cancer, oesophageal and gastric cancer as well as benign tumours of the upper gastrointestinal tract.
In 2013-14 there was an increase of 9 per cent in total endoscopy procedures when compared to the 2012-13 financial year.
There were 12,473 outpatient clinic attendances in 2013-14, which is an increase of 20 per cent when compared to the same period in the 2013-14 financial year.
Issues and challenges
Gastroenterology and Hepatology Unit
The ACT Auditor-General conducted a performance audit on the outpatient services provided by the Gastroenterology and Hepatology Unit (GEHU) at the Canberra Hospital, which concluded in May 2014. The review of the unit and the recommendations fell into two categories: governance and operations.
As part of the audit, an independent expert was commissioned to review the GEHU consultant's triaging and outcomes of a selection of patients. This expert found that 'the triage category was appropriate in the vast majority of cases' and for those cases where outcomes could be assessed 'the patients were managed appropriately and in a timely manner'. While acknowledging the scope for improvement within the GEHU, ACT Health is reassured by the independent expert's assessment.
ACT Health believes that the work already undertaken, as well as the recommendations from the audit, will enable the GEHU to continue to improve and provide high-quality services to the ACT community.
The Division of Medicine will:
- relocate Northside Dialysis Unit from Calvary Hospital to the Belconnen Community Health Centre (BCHC), where an expanded service will be offered. The move offers a number of advantages to clients accessing the service, including easy access to co-located allied health services, including dieticians and podiatry, and longer opening hours, with plans to offer nocturnal dialysis in the future. Later in 2014, dialysis services will be provided at the newly refurbished Tuggeranong Community Health Centre.
- increase endoscopy procedures to support the National Bowel Cancer Screening Program (NBCSP). Renovations to the GEHU in 2013-14 will also facilitate this increase.
- refine the Acute General Medicine model, incorporating the Medical Assessment and Planning Unit
- build on work underway in relation to the GEHU Auditor-General's report and consider the learnings from this across the division
- implement the recommendations of the CHHS Administrative Services Review, including developing a model for administrative support to the division, with specific regard to ambulatory services
- continue to support the 'What Matters to You' Clinical Quality Improvement model, across the division
- progress more team-based models appropriate to care across the division
- facilitate more community-based services in the new community health centres in Gastroenterology, Liver and Renal Services, including the commencement of renal dialysis in the community settings in Belconnen and Tuggeranong
- participate in the rollout of Health Pathways, which will be developed in collaboration with the Medicare Local to articulate and publish pathways of care across the continuum, in collaboration with Canberra and regional general practitioners.
Division of Pathology
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.
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.
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.
Pathology works in close collaboration with many areas of ACT Health to provide access to accurate, timely results to assist in diagnosis, management and monitoring of patients.
In line with ACT Health objectives, Pathology supports Canberra Hospital, Calvary Hospital and the community in numerous ways, including with:
- infection control
- public health outbreaks (such as norovirus, measles, influenza, tuberculosis and meningococcal disease)
- the emergency department (priority testing for acute areas).
Pathology also performs testing for the ACT breast screening and cervical screening programs.
The tables below show the number of pathology requests received and the total number of tests performed.
The table below shows Australian Council on Healthcare Standards (ACHS) clinical indicators that demonstrate the timeliness of reporting of results for selected Canberra Hospital Emergency Department tests. The potassium result is below target due to issues with new instrumentation that delayed the numbering and separation of blood specimens when it was introduced at the beginning of the year.
|Potassium (% results in <60 mins)||76||82|
|Haemoglobin (% results in <40 mins)||87||88|
|Coagulation testing (% results in <40 mins)||52||51|
Investments in research to promote evidenced-based practice
Pathology is a scientific discipline with research as a cornerstone. The division is participating in more than 40 research projects. Many of its 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, both scientific and medical, continue to publish actively in peer-reviewed journals and participate in professional meetings and workshops both in Australia and overseas.
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.
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 the completion of mandatory information required for pathology testing, improve the legibility and thus accuracy of request information, and provide decision-making support information to the requesting doctor.
Pathology works closely with clinicians at Canberra Hospital to ensure accurate patient identification in specimen collection for pathology testing.
Division of Surgery, Oral Health and Imaging
The Division of Surgery, Oral Health and Imaging is responsible for delivering inpatient and outpatient surgical services, and prevention and treatment dental health programs targeting youth and adults of the ACT community and surrounding region. The aim is 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 speciality surgical ward areas, outpatients departments (medical and nursing only), the Shock Trauma Service, the Trauma Orthopaedic Research Unit and the Dental Health Program.
The ACT Government has made an ongoing commitment to support the National Elective Surgery Access Targets (NEST) and maintain services for the trauma and emergency patients who require access to surgery.
In 2013-14, the number of patients provided with access to elective surgery was 6364, which was above the target of 6300.
Performance against the NEST continued to improve, with 100 per cent of category 1 patients being provided with access to surgery within 30 days. Work is ongoing to improve access for patients in clinical urgency categories 2 and 3.
As well as contributing to the Territory's reduction in the elective surgery waiting list, the Canberra Hospital conducted more than 6300 emergency and trauma surgical procedures in 2013-14, reflecting growth of 3.2 per cent over the 6100 in the previous year.
In the ACT Budget Papers 2013-14, strategic indicator number 2 for Canberra Hospital and the division was to ensure that there was no waiting time to access emergency dental health services for eligible residents of the ACT. This performance target was set to ensure that 100 per cent of eligible clients received treatment within 24 hours of contact with the service. The ACT Dental Health Program (DHP) met this target throughout 2013-14.
The division supports the Canberra Hospital in improving the health and wellbeing of the ACT population through initiatives that focus on early intervention. With the assistance of the DHP, the division has continued to achieve the mean waiting time target for clients on the dental services waiting list, set at 12 months in accountability indicator 1.1d. The Dental Health Program improved on this target, with a mean waiting time of 3½ months at the end of June 2014. In June 2013, the mean waiting time was 11 months.
The division is also required to monitor achievement against accountability indicator 1.1h, which states that 100 per cent of category 1 elective surgery patients should receive their surgery within 30 days of registration on the waiting list. The Canberra Hospital has continued to meet this target, with 100 per cent of these patients having their procedure within the clinically indicated timeframe.
In 2012-13, the federal government provided additional funding to reduce the public dental waiting list in the ACT. This funding supported a three-year program and involved the DHP entering into a National Partnership Agreement to meet a number of key performance indicators. The DHP continues to achieve 100 per cent compliance for the number of emergency patients receiving treatment within 24 hours and has made significant improvements on the median waiting time for treatment, which has been reduced from 11 months in June 2013 to three months in June 2014.
In the 2011-12 federal budget, the Volunteer Dental and Oral Health Therapist Graduate Year Program was announced to fund new graduates in both the public and private dental sector. Funding was provided for program development, dental graduate and pro rata mentor salaries, incentive payments for dental graduates completing the program and additional infrastructure to support placements. The program will support 50 full-time dental graduate placements per year from 2013 and 50 full-time oral health therapists from 2014. The DHP has also been approved to host one dentist and one oral health therapist who commenced in early 2014.
During 2013, the DHP participated in the National Child Oral Health Survey (NCOHS), conducted in collaboration with the Australian Research Centre for Population Oral Health (ARCPOH) and state and territory public dental services. The survey was undertaken to identify more effective dental service models for children and adolescents by evaluating oral health outcomes. The DHP team (which consisted of dental therapists and dental assistants) was responsible for the administration and field work, in which more than 2200 children across 30 primary schools in the ACT were seen.
Internal service delivery was maintained while the survey was being undertaken, and the ACT was the first jurisdiction to meet its response quota. ARCPOH is using the ACT as the benchmark for other jurisdictions undertaking the survey.
Issues and challenges
The elective surgery waiting list at the Canberra Hospital continues to grow, with an increase of 2.5 per cent in 2013-14. There were 8389 additions to the waiting list in the year to June, compared to 8187 in 2012-13. The high demand for elective surgery, coupled with increased trauma and emergency cases, is placing pressure on the Division of Surgery, Oral Health and Imaging.
Timely access to Outpatient Services within the division continues to be closely monitored. Strategies are being developed with Cancer, Ambulatory and Community Health Support to ensure access to reporting that will provide greater visibility in regard to waiting times and service delivery levels. This will enable effective strategies to be developed that will ensure timely access to surgical outpatient clinics.
The division will work with other ACT services to finalise and implement the Surgical Services Plan 2014-2017. Under this plan, recommendations will be made to create more efficiencies in the management of the territory's elective surgery waiting lists. The plan has three areas of focus: the effective management of trauma and emergency surgery, the establishment of a single waiting list for the ACT, and the need for improvements and efficiencies in public hospital operating theatres to optimise access for trauma and elective surgery.
Some of the major benefits of this plan will be:
- better outcomes for patients through the streamlining of access to elective surgical services
- reduced pressure on Canberra Hospital operating theatres and inpatient beds
- improved utilisation of high-cost assets and improved efficiency in surgical services.
In early 2014, the ACT Government was provided with Commonwealth funding to increase access to dental health services for eligible ACT residents. A mobile dental clinic will be purchased to provide dental care to residential aged care facilities. Under the current system, the elderly in nursing homes receive only basic dental examinations and basic denture services and are not always able to access the complete range of dental care services, including fillings and extractions, because of their medical conditions or lack of mobility. This new service will be able to deliver the same quality of dental care to the elderly in nursing homes as would be available to any other eligible member of the community.
Through the Shock Trauma Service, the Canberra Hospital will partner with the NRMA ACT Road Safety Trust to conduct the Prevent Alcohol and Risk-Related Trauma in Youth (PARRTY) program across ACT schools. This program targets young people between the ages of 16 and 24, as this group has the highest rates of injury in the ACT. Research indicates that, between July 2007 and June 2012, 717 adolescents and young people were admitted to Canberra Hospital and Health Services suffering major life-threatening injuries. Under this program, students have the opportunity to spend a day in a hospital, talking with healthcare professionals and other staff who care for seriously injured patients. The students are able to experience some of the challenges that face mobility-impaired patients, through the use of equipment such as wheelchairs and leg braces. The final talk of the day is from an injury survivor who is living with permanent disability as a result of trauma. The speaker focuses on the choices that he or she has made in life and the impacts of those choices.
Division of Women, Youth and Children
The Division of Women, Youth and Children provides a broad range of primary, secondary and tertiary healthcare 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 comprises:
- maternity services, including the Continuity at the Canberra Hospital (CatCH) program, the Canberra Midwifery Program, the Maternity Assessment Unit, the Early Pregnancy Assessment Unit and the Fetal Medicine Unit
- women's health, including screening, gynaecology, programs targeting violence against women, and the Women's Health Service which prioritises women who experience barriers to accessing mainstream services
- neonatology, including the Neonatal Intensive Care Unit, Special Care Nursery, specialist clinics, newborn hearing screening and the ACT Newborn Retrieval Service
- paediatrics, including inpatient care, specialist clinics, community paediatricians
- genetics service
- Maternal and Child Health (MACH) nursing service, 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:
- 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
- Healthcare Access At Schools (HAAS) Program
- school-based nursing services, including immunisation, kindergarten health checks, school youth health checks and the HAAS Program
- nurse audiometry, providing hearing assessments to children and adults.
Centenary Hospital for Women and Children-Stage 2 opening
The Centenary Hospital for Women and Children (CHWC) brings services for women and children together under one roof. Services include paediatrics and specialised outpatient services, maternity, birthing and specialised outpatient services, gynaecology and foetal medicine, neonatal intensive care unit and special care nursery. It has set a benchmark within Australia for women's, paediatric and newborn care.
Stage 2 of the CHWC was officially opened on 11 December 2013 after completion of the refurbishments of the previous Maternity Building and following the opening of the George Gregan Foundation Playground on 14 November 2013 and the Ronald McDonald House on 16 November 2013.
Maternity Model of Care Review
An independent review team was commissioned through Women's Health Australasia (WHA) to review the ACT CHWC Maternity Model of Care. They were tasked to examine and provide an assessment of:
- the model of care in the new CHWC Maternity Unit
- capacity of ACT Maternity Services to meet current and future demand, including commitment to expand capacity on the north side.
The WHA report was provided to ACT Health with five recommendations. ACT Health agreed in full or in principle to all recommendations. The report and ACT Health's response to the report were disseminated for public consultation, which was completed in January 2014. During the consultation period, ACT Health received four feedback submissions and after review, did not amend its response to the report.
The Maternity Leadership group is overseeing the implementation of the recommendations. This group has representation from medical and midwifery staff, as well as representation from the People, Strategy and Services Branch.
The group is chaired by the Clinical Director of Obstetrics and Gynaecology and Assistant Director of Nursing and, Midwifery in Maternity. There is also consumer representation. An action plan is being developed by the Maternity Leadership group which will outline the service's plans to address the recommendations, over the next three to five years.
The Early Pregnancy Assessment Unit
The Early Pregnancy Assessment Unit (EPAU) commenced operation in October 2013 as a result of a review of the Gynaecology Assessment Service (GAS).
The EPAU has replaced the GAS and is a specialist-led service for women experiencing pain and/or bleeding in the first 20 weeks of pregnancy. This represents more than 80 per cent of all women who presented to the GAS. The EPAU model of care is based on the National Institute for Health and Care Excellence (NICE) Guidelines. The EPAU includes a midwifery role that assists with the coordination and provision of comprehensive evidence-based care to women at less than 20 weeks gestation who are experiencing early complications or pregnancy loss. The service is available from 8.30 am to 5.00 pm, Monday to Friday.
Expansion of the Continuity at the Canberra Hospital program
The expansion of the Continuity at the Canberra Hospital (CatCH) program provides a midwifery continuity model of care to all risk groups, for women who have planned to birth at the CHWC.
The CatCH program has been evaluated. The evaluation highlighted the fact that this model is effective for consumers of the service as well as the staff who operate within this model. The review encouraged continued expansion of the CatCH program and team, and confirmed that this is a safe and successful model of care.
Gungahlin Maternal and Child Health team
The Maternal and Child Health (MACH) nursing services and resources have been redistributed from two to three teams-Tuggeranong, Belconnen and the new Gungahlin team. This was in response to the increased number and changing distribution of families in the ACT with babies and young children. The restructure enables increased responsiveness and operational efficiency for this service.
Healthcare Access At School
In 2012 a project was undertaken by the Community Health Programs Unit of the Division of Women, Youth and Children in collaboration with the Disability Education section of the ACT Education and Training Directorate (ETD).
The aim was to research national and international models of care that support the complex and/or invasive healthcare needs of students to enable them to attend school. This was undertaken in response to an increasing number of students with complex healthcare needs who attend mainstream ACT public schools, as well as increasing demands from parents for equitable access to an inclusive education for their children. As a result, the Healthcare Access At School (HAAS) Program was developed in partnership with the families, schools and the ETD.
The objective of HAAS is to support ACT public school students with complex or invasive healthcare needs to attend school. This can refer to care of tracheostomy, provision of nutrition and/or medication via gastrostomy, catheterisation and oxygen therapy during school hours.
The HAAS nurse role provides a link between parents and the school. Nurse-led care means a registered nurse delegates tasks, where appropriate, to a non-nursing or non-licensed school staff member. It is anticipated that most care will be provided by non-licensed school staff, as evidenced by models in other Australian jurisdictions and overseas. The nonnursing worker will be appropriately trained and will receive ongoing support from the HAAS registered nurse.
Benefits of the new model include:
- equitable access to health care for students in all ACT public schools
- individually tailored care plans developed in partnership with parents
- health needs being met with the appropriate level of care
- nurses working in specialist schools being more productive when working in HAAS across all public schools
- ongoing nurse support to schools, students and families
- a safe and sustainable model aligned with current national and international practice.
HAAS supports 20 students across eight schools to attend school. Early evaluation indicates that the program has been very successful, and a formal evaluation is planned for 2015.
Redesign of care for children with a chronic condition
Caring for Kids was a program that supported children with complex needs and their families to stay in the community and out of hospital with a range of short-term supports such as home visits, equipment, school support or overnight support. A review of the Caring for Kids program has resulted in a restructure. The services that are now offered are guided by the ACT Chronic Conditions Strategy and are based on evidence and benchmarked best practice. Feedback from consumers in the form of patient stories has contributed to the redesign.
Paediatrics Winter Strategy
Increased admission numbers and activity levels on the paediatric ward over the winter period have created a need to develop a Paediatrics Winter Strategy. Data for this period is being collated within the division, and staffing models are being assessed for the best level of staffing to cope with the predicted increased demand.
Privately Practising Eligible Midwives at the Centenary Hospital for Women and Children
ACT Health has commenced planning for the introduction of a model of patient care which will allow privately practising eligible midwives to admit their private patients to the CHWC for birthing services. The planning process includes consultation both internally with key stakeholders in the Division of Women, Youth and Children, including midwives, managers and medical practitioners, and externally with the Australian College of Midwives, consumers and privately practising midwives. It is anticipated that this work will be completed by 2015.
Child Development System of Care
The Child Development System of Care Steering Committee (CDSC-SC) first met in November 2013 to review the way child development services are provided across the ACT. The Director, Early Intervention and Prevention Services, Community Services Directorate (CSD), and the Executive Director, Women, Youth and Children Division, ACT Health, co-chair this committee. Membership includes representation from Early Intervention and Disability (ETD), Therapy ACT, Child and Adolescent Mental Health Services (CAMHS), Community Paediatrics, Women, Youth and Child Health Policy Unit, ACT Medicare Local, the Australian Research Alliance for Children and Youth (ARACY), Marymead and the Australian Association for Infant Mental Health Inc. (AAIMHI).
The committee has been expanded to incorporate work already underway in partnership with ACT Medicare Local. The Proposal to support an improved ACT child health and development service system engaged the Murdoch Childrenâ€™s Research Institute, through the Royal Children's Hospital Melbourne, to:
- undertake a detailed quantitative and qualitative analysis of issues
- identify the strengths and assets of the current service system
- explore and define action to promote healthy childhood development and wellbeing in the immediate, medium and long term explore and define whole-of-system improvements.
The first of two workshops was held in March 2014 and the second is planned for late 2014. There was a willingness across sectors to strengthen the service system, with a number of key best practice elements identified for consideration. The second workshop will explore the opportunities provided from the implementation of the National Disability Insurance Scheme (NDIS) and Human Service Blueprint and plans to map out a demonstration initiative that could be trialled, for example, in one geographic area.
Family-Integrated Care-Neonatal Intensive Care Unit/Special Care Nursery project
In some models of care in neonatal intensive care units (NICU), parents spend a significant amount of time at the hospital with their babies and are encouraged to take on many aspects of their baby's care, once their baby is stable. This model is called 'Family-Integrated Care'. The Family-Integrated Care model has been successfully introduced to a small group of patients at Mount Sinai Hospital in Toronto, Canada, and is now extended to more families in NICUs across Australia and New Zealand. To understand whether this model of care is better for parents and their babies, the NICU and Special Care Nursery (SCN) at the Canberra Hospital are participating in an international, randomised trial.
This study examines whether the Family-Integrated Care model improves the health and wellbeing of prematurely born babies. Parents and babies will be involved in this project from the time of enrolment until the babies are discharged from the hospital or reach 36 weeks gestational age. Parents will be given access to small-group learning sessions and some additional support, to make it easier for them to be present in the NICU for the required amount of time. There will be no change in the nurse-to-patient ratio. It is estimated that this study will commence at the end of July 2014 and will be completed after July 2015.