CLINICAL RECONFIGURATION STAGE 3 March 2017
Welcome to Country We would like to Acknowledge that the land we meet on today is the traditional lands for the Kaurna people and that we respect their spiritual relationship with their Country. We also acknowledge the Kaurna people as the traditional custodians of the Adelaide region and that their cultural and heritage beliefs are still as important to the living Kaurna people today. 2
Introduction > Consultation has been taking place about the SALHN Clinical Reconfiguration Service Plans throughout 2016 and early 2017. The SALHN Clinical Reconfiguration is occurring in three stages across Flinders Medical Centre (FMC), Noarlunga Hospital (NH) and Repatriation General Hospital (RGH), supported by a capital works program. > The SALHN Clinical Reconfiguration Service Plans Versions 2.0 and 2.1 included detailed information about the proposed Stages 1 and 2 of the reconfiguration of in-patient overnight services across SALHN. > Feedback received from the Service Plans 2.0 and 2.1 has been considered and changes have been incorporated into the revised Service Plan Version 3.1. The Service Plan Version 3.1 includes information about Stage 3 of the proposed reconfiguration of services across SALHN. 3
Length of stay reduction strategies LOS strategy Long stay patient strategy Timely ACAT assessments Standardisation of care for planned surgery Outcomes Improving internal processes for accessing tests, procedures or aged care assessments, and facilitating timely discharge has reduced length of stay (LOS) for many patients with a LOS of greater than 14 days. In November 2015, there were more than 100 patients at FMC with a LOS >14 days. This has reduced to about 70. In 2014/15, average waiting time for an ACAT assessment was more than 8 days at FMC, 8 days at RGH and 5.5 at Noarlunga. LOS for patients awaiting assessment to return home or to residential facilities has reduced significantly with assessments now completed within 2 days, with an average wait time of 1.5days (excluding weekends/public holidays). The clinical reconfiguration program has identified opportunities to increase the number of patients that can be admitted on the day of surgery and/or admitted for day surgery. The provision of clinically appropriate day surgery will reduce the demand on inpatient beds. 4
Length of stay reduction strategies LOS strategy Hip and Knee Arthroplasty Same Day and Extended Day Surgery Care Awaiting Placement Service (CAPS) Enhancing Patient Journey Projects Outcomes The establishment of a multidisciplinary pathway that supports patient discharge home or to rehabilitation within three days of elective hip and knee arthroplasty. The establishment of processes to support compliance with SA Health Same Day and Extended Day Surgery Policy Directives. Increase in CAPS beds in the community for patients awaiting residential aged care placement. The development, piloting and implementation of consistent processes for managing the patient journey across the care continuum to enhance quality care and reduce LOS for clinical units. 5
Length of stay reduction strategies LOS strategy SALHN Older Persons Service (previously known as the Frailty Pathway) Outcomes Prevent avoidable emergency department (ED) presentations and hospitalisation. Provide alternatives to hospitalisation and maximise care provided in the community. Minimise the risk for older people who require hospitalisation. MCAG Rehabilitation Service project recommendati ons Expansion of ambulatory (Rehabilitation in the Home and Day Rehabilitation) services Dedicated tele-rehabilitation equipment and staff State-wide pathways for rehabilitation including fractured hips, stroke, amputee, reconditioning, brain injury and spinal cord injuries 6
Clinical Reconfiguration Stage 3 Changes from SALHN Clinical Reconfiguration Service Plan Version 2.1, November 2016 to Version 3.1, March 2017 include: > The development of a Cardiovascular Hub on the 6 th floor at FMC incorporating stroke/neurology, cardiology, cardiothoracic surgery and vascular specialties. > Alternative location proposed for urology patients currently located at RGH, as part of RGH decommissioning. > Alternate location proposed for 1 of the GEM units currently at RGH, relocating from RGH to FMC as part of RGH decommissioning. > Relocation of ward 5A (Vascular) to ward 6C within FMC 7
Clinical Reconfiguration Stage 3 Benefits of proposed changes > The cardiovascular hub will enable a critical mass of complementary clinical skills and supports within a geographically defined area. > The cardiovascular hub will prepare the clinical spaces within SALHN for the inpatient wards and units transitioning from RGH between July and November 2017. > It will also strengthen the clinical infrastructure which may be required to assist the Royal Adelaide Hospital (RAH) transition to the new RAH. 8
Clinical Reconfiguration Stage 3 Benefits of proposed changes > Specifically the creation of a cardiovascular hub will: increase cardiac monitoring and telemetry capacity at FMC by 14 beds co-locate medical, nursing and allied health teams within areas and hubs of clinical specialty. provide telemetry and cardiac monitoring capacity to the stroke unit support improved patient care and clinical facilities 9
Clinical Reconfiguration Stage 3 Benefits of proposed changes > Co-location of Urology and Renal patients at FMC proposed for Ward 6G (Renal/Medicine). Supports complementary skillsets and expertise within urology/renal specialties Current haematology/oncology outlier patients in FMC will be accommodated within additional beds being built in the FMC Haematology/Oncology Ward (5G) This expands existing Haematology/Oncology bed capacity within a dedicated home ward. > It is proposed the relocation of a GEM unit from RGH will be to Ward 5A (previously proposed 6C). 5A has close access to gym facilities to assist in the care and management of GEM patients. 10
Proposed Timelines & Process FMC 6B ACE patients to relocate primarily to ward 4A (additional beds) There will be approximately 2-3 months capital works required to cardio-protect the unit and install telemetry and Monitoring in 6B in preparation for the relocation of Cardiothoracic Surgery from ward 6D to 6B. Cardiothoracic Surgery relocates to ward 6B following works for cardiac protection and installation of cardiac monitoring facilities. 16 Acute Stroke/Neurology beds relocate from 6C to 6D resulting in cardiology and stroke being co-located. 4 longer stay restorative stroke/neuro beds will relocate to FMC ward 6A (Respiratory/Dermatology/Infectious Diseases) as required. April 2017 June 2017 June 2017 11
Proposed Timelines & Process Vascular/General surgery beds on 5A will relocate to ward 6C. 5G (Haematology/Oncology) additional capacity available June 17 to support relocation of Haematology / Oncology patients within medical wards June 2017 June 17 Capacity available in 5A/6G to support RGH decommissioning 12
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Transition of staff > The initial service moves are proposed to take place on an interim as a service basis, where applicable, to facilitate capital works to support the longer term proposed configuration of services across SALHN. > SALHN will continue to work through the Nursing EOI responses to consider the longer term placement of in-scope Nursing employees over the next few months. > The Allied Health EOI outcomes are being finalised and staff will be notified shortly of the results of the selection and placement process. 16
Transition of staff > An EOI for in-scope Administrative employees will commence shortly and further information will be provided prior to the process commencing. > Consultation is taking place with Hotel Services Representatives and United Voice about an EOI for RGH Hotel Services staff. More information about this will be provided in the coming weeks. > Appropriate HR processes will be undertaken to facilitate the longer term transition of staff with the areas previously out of scope and not included in the Nursing EOI conducted in November/ December 2016, this includes FMC Wards 6D and 6G. 17
Consultation > Unions will be consulting with their members about the SALHN Clinical Reconfiguration Service Plan Version 3.1, March 2017. > Feedback or questions can be forwarded via email to: Health.SALHNTransformingHealth@sa.gov.au by COB Friday 24 March. > For more information or if you have questions, contact your Divisional Co-Directors, Directors of Nursing, Allied Health Directors or your Line Manager. > More information about the SALHN Clinical Reconfiguration can be accessed on the SALHN intranet 18
Employee Assistance Program > Employee Assistance Program services are available for staff during the consultation and implementation process. > Visit the SALHN intranet for more details: > http://intra.sahs.sa.gov.au/sahs/staff_matters/eap/jsp 19
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