nrah Medical Imaging staffing model- Nursing

nrah Medical Imaging staffing model- Nursing

nrah Staffing review In accordance with established business rules, SAMI through CALHN and the ANMF have commenced and invite discussion on safe staffing levels for the nrah distributed imaging service Recognised changes to current practice include: - Distributed imaging over 4 floors (Geography) - Technology changes including ADC, Imprest management, Tech Suite equipment processing and ordering (T-DOC) & EPAS

Design Principles- Distributed Imaging To provide purpose built facilities for dedicated patient services Designed to stream line patient journey with dedicated imaging departments Improve efficiency of service with increase in equipment and improved technology Distributed Store Imprest management with `Kanban management principles Automated Dispensing Cabinets (Pharmacy)

Ø The new RAH has a distributed imaging model, with 4 departments emergency, inpatient, outpatient and tech suite floor in geographically diverse locations. Ø This will have increased efficiencies from the overall patient management perspective, with reduced patient movements and reduced waiting times for all groups. Ø It forms the foundation to a number of the models of care for the new RAH. Ø The distributed imaging model will see efficiencies for the LHN in improved length of stay as current competing demands for equipment will be addressed.

Distributed Imaging model Imaging service over 4 floors of new RAH Level 2- Emergency Imaging 24/7 Level 2- Nuclear Medicine 0830-1700 Level 3- Outpatient Imaging/ Women s Health 0830-1700 Level 4- Interventional Suites (Tech Suites) 0830-1700 Level 5- Inpatient Imaging 0800-2000

Emergency Imaging Level 2 Immediate access for resuscitation and trauma Minimise delay due to close proximity to all Emergency Service areas Provide Emergency Clinicians with ready access to Radiologists for image interpretation and communication of results 24/7 onsite staffing for CT and General X-ray Principle of utilising skills onsite before a call out is instigated for all modalities Shift groups will operate from here afterhours and are proposed to increase in size

SUMMARY OF ANTICIPATED SERVICE PROVISION AT NEW RAH - Emergency EMERGENCY DEPARTMENT Level 2 Hours of Operation 24 hours a day, 7 days a week Bed Bays 4 Equipment CT 1 x Seimens (installed) 1 x Toshiba (installed) MRI 1.5 T Seimens (installed) US 1 Rad 2 OPG (Dental x-ray) 1 Resus 8

SUMMARY OF ANTICIPATED SERVICE PROVISION AT NEW RAH - Outpatients OUTPATIENTS Level 3 Hours of Operation 0830-1700 Mon-Fri 0830-1230 Sat (MRI only) Bed Bays 2 Equipment CT 1 x Seimens (installed) 1 x Seimens (to come, anticipated delay 4 weeks) MRI 3 T Seimens (installed) ** LICENSED 1.5 T Seimens (installed) ** PARTIALLY LICENCED US 3 general 1 Women s Imaging Rad 3 Mammography 1 (coming from RAH, anticipated delay 2 weeks)

SUMMARY OF ANTICIPATED SERVICE PROVISION AT NEW RAH Tech Suites HOT FLOOR Level 4 (includes technical suites) Hours of 0830-1700 Mon-Fri Operation Bed Bays 2 (Perioperative suites) Equipment CT 1 x Toshiba (installed) 1 x Toshiba (to come, anticipated delay 4 weeks) Angio 1 x bi-plane (installed) 1 x bi-plane (transfer, anticipate delay 4 weeks) 1 x single-plane Mobile 11 x image intensifier 1 x O-arm 9 x mobile (available across the hospital) Cardiology 5 labs

Inpatient Imaging Level 5 Provide streamlined and ready access for Inpatients to diagnostic imaging services Minimise delay in diagnosis or reviews and patient travelling Provide Inpatient Clinicians with ready access to Radiologists, located at Reporting Rooms within Inpatient Imaging, for image interpretation and communication of results. Staffed 7am till 8pm however access for inpatient examinations is 24/7 Where not detrimental to patient care, inpatients are able to be imaged in the emergency department after rostered hours.

SUMMARY OF ANTICIPATED SERVICE PROVISION AT Level 5 NEW RAH - Inpatients INPATIENTS Level 5 Hours of Operation 0700-2000 Mon-Fri After hours patients will go to ED Bed Bays 14 Equipment CT 1 x Seimens (installed) Space for another one if required MRI 3 T Seimens (installed) US 2 Rad 3 (2 coming from RAH, anticipated delay 2 weeks) OPG 1 (coming from RAH, anticipated delay 2 weeks) Flouroscopy 1

Nuclear Medicine 2.0 FTE Registered Nurse requirement PICC Service Current model maintained x1 PICC Nurse (Nurse Practitioner Candidate 1.0 FTE) Of note: Implementation of mobile PICC service to be considered post move

Directorate Structure Keirstie Bull Nursing Director Emergency and Diagnostic Services Critical Care Services Michael Consalvo Campus Operations Manager SA Medical Imaging Operations PICC CPC Nurse Unit Manager ANUM s, CN s RN s & EN s

Proposed Staffing Model Medical Imaging NUM PICC CPC ANUM s CN s 1.0 FTE (5 Days) 1.0 FTE (5 Days) 2.0 FTE (7 Days) As per Personal Reclassification RN:EN 55:45

Staffing review principles Review projected staffing FTE numbers for distributed imaging model against current FTE Assumption of increase in activity of 10-15% Recognise change in service provision through distributed model Recognise potential increase in services patient presentations, specifically outpatient services Increase in equipment- MRI and CT services Change in service hours of operation Change in practice for Technical suite services (ACORN standards)

Staffing review principles Computerised Tomography (CT)- staffing 1 nurse per scanner Technical Suites- 2 nurses per suite + 1 nurse transfer/float Patient Bays staffed at primarily level 5 hub Shift Coordinator + NUM MRI maintain status quo - no radiology nursing support required Interventional U/S support maintain status quo nursing support provided ad hoc

Proposed Nursing allocation Weekdays L2 ED/AAU/After Hours L3 OPD L4 Tech Suites L5 IPW Nuclear Medicine RN/EN ratio Early Total 2 3 6 4 2 13 4 17 Total Allocation X2 CT x2 CT x1 Women s Clinic X1 CT X4 interventional tech suites (staffing x2 suites) X1 Bed Bay/Fetch & Carry X1Fluro X2 CT X1 Bed bay Late 3 X2 CT only X1 Bed bay for non ED patients 4 As per above 4 3 7 Night Duty 1 X1 CT 1 1

Proposed Nursing allocation Weekends L2 ED/AAU/After Hours RN/EN ratio Total Early 3 X2 CT only X1 Bed bay for non ED patients 2 1 3 Late 3 X2 CT only X1 Bed bay for non ED patients 2 1 3 Night Duty 1 X1 CT 1 1