Southern Adelaide Local Health Network Rehab V Vita Square Operational Guideline Consultation Paper Version 2.2 January 2018
Purpose The purpose of this document is to provide an overview of operational guidelines for Rehab V (RV) post decommissioning of the Repatriation General Hospital (RGH). Rehab V is a 20-bed rehabilitation inpatient unit located in the Vita Building adjacent to the RGH site. Rehabilitation services previously onsite in RV relocated to the new Rehabilitation Building at Flinders Medical Centre (FMC) in November 2017 as part of the RGH service moves. Specifically, this document addresses: Governance Overview of the Model of care Key service support elements o Corporate o Clinical Escalation of Care Clinical Deterioration Staffing plan This is a pilot model with proposed commencement date of 13 February 2018 for an initial period of six to 12 months. The model will be reviewed throughout the course of the pilot period and amended as appropriate in consultation with key stakeholders. Governance The Southern Adelaide Local Health Network (SALHN) Rehab V 20 bed unit will be part of the existing SALHN Rehabilitation Service, currently a 55-bed inpatient service based at FMC incorporating ambulatory and outpatient rehabilitation services. The Rehabilitation service sits within the Division of Rehabilitation, Aged and Palliative Care (RAP). Existing divisional Operational and Clinical governance structures will support the Rehabilitation service. RAP sits within the broader SALHN Divisional Structure. Overview of the Model of care The current SALHN rehabilitation model of care provides an interdisciplinary team approach to enhance and restore an individual s function following a disabling injury, illness or surgical intervention; goal-orientated medical, therapy and nursing interventions to assist individuals to regain independence, confidence and participation in the community; and access to the service by a dedicated triage team led by rehabilitation nurse consultants and medical consultants. This Model of Care will be implemented in Rehab V. ** Detailed description of Rehabilitation Services Model of Care is available in the SA Health Statewide Rehabilitation Service Plan 2009-2017 All disciplines use evidence based practice guidelines for assessment and therapy such as National Stroke Foundation Clinical Guidelines for Stroke Rehabilitation and Recovery. The services are aligned to Australian Faculty of Rehabilitation Medicine (AFRM) standards.
Rehabilitation Inpatient Services The focus of rehabilitation inpatient services includes: Management of patients with high levels of disability Facilitated reduction in overall hospital length of stay through early identification and admission to rehabilitation and high quality team based care to optimise outcomes Improvement in overall patient outcomes through increased functional ability Key service and patient focused approaches include: Multidisciplinary team focused on goal directed, patient centred care with discharge planning commencing from time of admission Provision of a patient passport for patients to map their journey providing an individualised care plan for discharge Family meetings support decision making and discharge planning Multidisciplinary team goal setting, carer training and patient self-directed exercise Functional Independence Measure (FIM) scores completed within 72 hours of admission (reported to Australian Rehabilitation Outcomes Centre (AROC)) Length of Stay (LOS) and FIM are utilised at case conferences to allow discharge planning to remain within national targets FIM scores are reviewed for accuracy using a team based approach Admissions and discharges occur across seven days Consultant review of all new admissions Patient Selection for Rehab V The selection of rehabilitation patients to be located at Rehab V will be undertaken by the Rehabilitation Consultants in coordination with senior nursing staff. Selection criteria will include: Medical condition suitable to the environment < 65 years of age transitioning to disability support services, especially those with a chronic neurological condition Patients requiring slow stream rehabilitation Patients requiring complex multi D input to enable independence to facilitate discharge Patients who would benefit from goal - orientated, time limited and therapy focused care, in support of completing their restorative process and optimising their functional capacity Patients not considered appropriate for TCP or CAPs Bariatric clients service can support x1 bariatric client at any time Amputees requiring wound healing
Exclusion criteria for admission to Rehab V History of harm: either to self or to others Current Inpatient treatment order Patients requiring dialysis Key support services Corporate Support Services Hotel Services Hotel services in Rehab V will be provided under SALHN hotel services contracts, with the appropriate resourcing required to support services at the Rehab V site. Hotel Services include but are not limited to: Linen Stores Cleaning (clinical areas) Patient Services Assistant personnel (Portering) SALHN are working with ACH to finalise arrangements for the provision of food services. ICT services Current ICT services in Rehab V, including both physical assets and EPAS functionality will remain in Rehab V. Administrative Services Administrative services including Ward Clerk and Medical Administrative support will be provided through additional FTE. Environmental Services Environmental services will be provided through existing ground and waste maintenance arrangements for the Vita precinct. Emergency Response and Security Fixed and personal duress alarms will be configured to alert the Police Protective Services and SALHN Security when activated. External security patrols will be conducted at regular intervals and with increased visibility at shift change times when staff are accessing the car park In the event of an emergency such as fire or security breach/risk, the main response will to be to access emergency response services via 000, this is in line with SALHN processes and protocol for other offsite units. Clinical Support Services Pharmacy imprest and clinical pharmacy Pharmacy imprest services will be provided by SA Pharmacy through FMC Pharmacy Services with access to increased stock within the unit. Courier services will be utilised for discharge medications. Clinical pharmacy services will be provided via additional FTE.
Medical Imaging In hours medical imaging services will remain on site through Repat Radiology and will enable non urgent services for the patients in Rehab V. After hours medical imaging services will be provided by FMC, as clinically indicated, this will involve up-transfer transport processes. SA Pathology SA Pathology courier services will be available for specimen collection. Point of care testing device to be considered for investigations as required. Escalation of Care Clinical Deterioration Medical Emergency Response 24/7 000 call will be activated SA Ambulance Service (SAAS) to attend The SALHN medical emergency response criteria will be used to escalate to a 000 call. Medical review required 24/7 non medical emergency response criteria Senior medical staff will be available 24/7. Medical reviews will be undertaken as requested either in person or by phone for consults. All Doctors on call and rostered to work in Rehab V will have remote EPAS access capability. The following is a guide but not limited to Contact the Rehab V consultant / delegate for all medical reviews Contact the Rehab V consultant / delegate for all patient falls Contact the Rehab V consultant / delegate for clarification/discussion on patient orders and treatment plans Elective up transfers will be coordinated by the Rehabilitation Consultant as a direct admission to FMC. The FMC Central Flow Coordinator will assist in the coordination and the acceptance to a bed/clinical unit following consultant to consultant agreement. Nursing advice after hours - non medical emergency criteria The SALHN After-Hours Clinical Nurse Consultant (located at FMC) will be available to provide remote clinical care coordination advice or support after hours. Escalation of operational/site issues and concerns Monday to Friday during usual business hours escalation of any operational issues will be via existing Divisional escalation processes. In line with current SALHN process, afterhours any issues will be escalated to Executive On Call via the FMC Hospital Coordinator. Access to rehabilitation facilities gym/hydrotherapy Fully equipped gym facilities are available within Rehab V. Hydrotherapy facilities are available within the ACH complex (collocated with Rehab V) and also in the Rehabilitation and Palliative Care building at FMC.
Proposed Staffing Plan Summary Discipline Allied Health 9.6 Nursing (includes Nurse Unit Manager, triage nurse and senior clinical practice consultant) 23.6 Medical (TMO& Consultant) 1.6 Administration 1.5 Portering / PSA support services 1.5 TOTAL FTE 37.8 FTE Clinical Staff Allied Health The proposed allied health staffing model will include the following disciplines; Physiotherapy, Occupational Therapy, Social Work, Psychology, Speech Pathology, Dietetics, Pharmacy, Exercise Physiology and Allied Health Assistant support. Position Classification FTE Physiotherapist AHP303 1.0 Physiotherapist AHP105 1.0 Social Work AHP303 1.0 Navigator ASO303 0.4 Occupational Therapist / Physiotherapist AHP303 1.0 Occupational Therapist AHP105 0.4 Dietician AHP105 0.2 Exercise Physiologist AHP105 0.4 Music Therapist AHP105 0.5 Allied Health Assistant OPS203 1.6 Speech Pathologist AHP205 0.4 Pharmacist AHP303 0.5 Psychologist AHP303 0.8 Physiotherapist (weekend) AHP205 0.2 Allied Health Assistant (weekend) OPS203 0.2 Nursing It is proposed that Rehab V will have a full time dedicated Nurse Unit Manager - NUM (Level 3 Registered Nurse (RN)) and an Associate Nurse Unit Manager (Level 2 RN) with additional senior clinical nursing roles (RN3/4) to support referral pathways and specialist clinical nursing care. Core nursing staff will include a skill mix of both registered and enrolled nurses (ENs) with rehabilitation skills and experience. A minimum of two Registered Nurses and overall minimum of three nurses per shift will apply regardless of occupancy. Staffing will be in accordance with agreed Nursing Hours per Patient Day and in line with Appendix 2 of the Nursing and Midwifery (SA Public Sector) Enterprise Agreement (2016) and associated Business Rules.
Position Classification FTE Nurse Unit Manager RN3 1.0 Associate Nurse Unit Manager RN2A 1.0 Registered Nurse/Enrolled Nurse RN2C/RN1/EN 20.0 Nurse Consultant (Triage) RN3 0.6 Nurse Practitioner/Nurse Practitioner Candidate RN3/4 1.0 Medical Medical staffing will include Rehabilitation Consultant and Trainee Medical Officers Position Classification FTE Trainee Medical Officer MD0107 1.00 Consultant MD029G 0.60 Other roles Other proposed roles within the unit include; Medical Administrative Support Officer, Ward Clerk and Patient Service Assistant Position Classification FTE Ward Clerk ASO203 1.0 Medical Administration ASO403 0.5 Portering/ PSA support WHA202 1.5 services
Access to Professional Development All Rehab V staff will have access to SALHN professional development opportunities, consistent with usual processes. Staff will be able to access the moodle from Rehab V and there will be a local education and training calendar to provide professional development onsite. Management of unplanned leave To ensure consistency in the communication and management of absences created through unplanned leave, the following corporate instructions will be utilised. All nursing absences will be managed according to the SAHLN Work Instruction Personal Carers Leave for Nurses and Midwives. Unplanned leave will be managed through FMC Hospital Coordinator as per other FMC wards/units. Part-time staff currently working in RAP Division will be given the opportunity to work additional hours to cover unplanned absences in RV and staff from the Central Staffing Unit (casual and permanent pool) will be given the option to express interest in working in RV to also cover unplanned leave. PSA absences will be managed according to the SAHLN Hotel Services Procedure for Advising Management of Unplanned Leave Trainee Medical Officer absences will be managed according to the SAHLN procedure Unplanned Leave (Personal Leave) Interns & Trainee Medical Officers. Consultant cover will be managed through Division Rehabilitation, Aged Care and Palliative Care. Allied Health absences will be covered using Allied Health in the Division Rehabilitation, Aged Care processes.