APHA CONFERENCE March 2014 Richard Royle Executive Director - UnitingCare Health Dr Luis Prado Chief Medical Officer - UnitingCare Health and Director of Medical Services - The Wesley Hospital
The Wesley Hospital as the water continued to rise
The Wesley Hospital 524 overnight beds 2100 employees 300 onsite specialists in 3 medical centres Over 500 additional credentialed specialists 430 Volunteers
On a daily basis we Admit 145 new patients Care for 450-520 overnight and 70-100 same day patients Treat 70 Emergency Presentations Perform 90 operations Deliver 5 Babies Produce 1450 Meals
Last year we. Admitted 50,000 inpatients Treated 24,000 Emergencies Performed 33,000 Operations Delivered 1600 Babies Produced 530,000 Meals
Caring for you for Life Queensland s most comprehensive range of clinical services on one campus All specialties except Level 3 neonatology 17 Operating Theatres (21 by end 2014) 3 Cardiac Catheter Laboratories 19 Bed Intensive Care Unit Wesley Emergency Centre Bone Marrow Transplant Unit 14 Chair Renal Dialysis Service Full medical imaging service including PET, CT and MRI.
Legionella Timeline Patient 1 deceased 2/6/2013 Confirmed Diagnosis 1 st Patient 4/6/2013 Positive H 2 O results 5/6/2013 Confirmed Diagnosis 2 nd Patient 5/6/2013
Legionella Timeline Closed hospital to admissions 5/6/2013 East Wing reopened 19/6/2013 Moorlands Wing reopened 26/6/2013 Whole hospital reopened 2/7/2013
Patients 5/6/2013 Total of 450 inpatients Of these: 17 patients were in ICU 6 patient in the Bone Marrow Transplant Unit 22 patients in Dialysis 20 patients in Maternity
Legionella Legionnaires disease is an infection of the lungs (pneumonia) caused by bacteria of the Legionella family. The bacteria is commonly found in the environment, but infection usually only occurs in at risk people. It can be prevalent in air-conditioning and warm water systems.
Legionella Who is at risk? Legionnaires disease most often affects middle-aged and older people, particularly those who smoke or who have chronic lung disease. Also at increased risk are people whose immune systems are suppressed by medications or diseases such as cancer, kidney failure, diabetes or AIDS. Pregnant women with lung disorders or reduced immunity are also at risk. Well patients, children and babies are at very low risk
Key Immediate Challenges Over 100 very sick inpatients e.g complex cancers. Brisbane health system unable to cope with immediate additional volume in key specialties e.g. Renal Dialysis, Bone Marrow and complex cancers Needed to cleanse the water system with patients in beds Needed to clearly map a complex water system across the campus
Key Decisions Up Front Deal directly with the media up front open and honest, one spokesperson. Daily staff meetings to keep everyone fully briefed. Daily communications with the doctors. Regular communications with inpatients and their families. Contact all pending admissions. Decision-making team clearly enunciated.
Qld Regulatory Environment Prior to 2013 Queensland had no regulations or protocols relating to legionella testing in warm water systems. Legionella in warm water was simply not on the radar in Queensland hospitals.
Immediate Response Day 1 Established Incident Management Team. Staff / Patient / VMP communication commenced immediately. External Media Advisors including Social Media appointed. H20 supply bottled water Ceased all showering of patientsclosed the hospital in communication with the Chief Health Officer Set up call centres Contacted previous 1400 patients by telephone
Immediate Response Day 2 1 st Press Conference Media Releases commenced. Regular staff meetings Day 3 External Expert Review Board appointed. Expert to fix the problem sourced Day 3 and commenced Day 5.
Water Treatment East Wing - Scalding 6 & 7/6/2013 East Wing Disinfection 9 & 10/6/2013 Moorlands Wing Scalding 8 June & again on 13/6/2013 Moorlands Wing Disinfection 15 & 16/6/2013 Main Block Scalding 7 & 8/6/2013 Main Block Disinfection 21 & 22/6/2013
Main Challenges Leadership Staff meetings Confidence of staff Spokesperson for media Absence of key Executives on sick leave Maintaining composure
Main Challenges Decision-making to fix the problem Dealing with the media Presenting a calm and in control persona Exhaustion of core team members
Main Challenges Impact on other UnitingCare Health hospitals Testing regime Design of new facilities old infrastructure impact What is the rest of the industry doing Australia Internationally Consistency and equity across industry.
Impact on Staff Undertaking roles not normally part of their job Testing chlorine levels Water sampling Assisting with cleaning regime How long to resolve the problem Morale impact and ongoing communication Unions
Prolonged Crisis Challenges Internal Stakeholders Inpatients Staff Wesley and other UCH hospitals Volunteers Visiting Medical Practitioners Board of Management Maintaining the Incident management Team for four weeks.
Prolonged Crisis Challenges External Stakeholders Past / future patients Government regulators e.g public health Policy on-the-run Politicians Release of other hospital results Media
Prolonged Crisis Challenges External Stakeholders Cont. Health funds Unions General Practice Other hospital groups Hospital Insurers Other organisations e.g. water utilities.
Prolonged Crisis Challenges Patients and Families Legionella affected patients Existing inpatients.
Prolonged Crisis Challenges Fixing the problem Complex piping system Water treatment program created toxic water Cost of compliance and ongoing monitoring Anticipating unexpected consequences of water treatment Managing in an environment of uncertainty and changing rules
Media Summary MEDIA RELEASES 31 media releases issued from 5 June to 2 July. 8 formal press conferences from 5 June to 2 July. MEDIA REPORTS At least 1,800 print, TV, radio and online reports from June to early August. INTERNAL COMMUNICATIONS More than 10 separate emails, letters to staff groups (e.g. Wesley-specific, UnitingCare-wide). Several targeted letters to VMPs, GPs. Regular updates to intranet - news, photos, letters, etc.
Facebook Direct communication via Facebook Many people sought information from the hospital via Facebook - general enquiries and direct questions about their planned admission or treatment. Supporters also left a number of encouraging comments.
Facebook Content of Facebook posts The Wesley PR team distributed all media releases regarding legionella to relevant media, then posted these to the Wesley website and social media pages. Many media releases and alerts were positive news stories generated by the public relations (PR) team and were accompanied by photographs for the Facebook page. For example, a story was published on the first five babies born when the maternity unit reopened. It was encouraging to observe how well people responded to positive news content this story attracted 166 likes and positive comments such as: And they are cute babies also - all Wesley babies are cute though!
Wesley Website A dedicated Legionella update page was established and received a very high number of views 18,128 from 5 June to 3 July. This indicates how important it was to keep the Wesley website up to date, and how it kept stakeholders informed during this time. The strong reliance on the website also indicates the demographic profile of many Wesley patients who are 40 years or older and therefore less likely to use social media.
Twitter While the Wesley previously had a Twitter account, it had not been regularly updated. The PR team linked the Wesley s Twitter account and Facebook page so all Facebook posts appeared on Twitter automatically. The PR team used Twitter for: monitoring media reporting on the issue ensuring the Wesley s voice was heard in the Twitter conversation and correcting any misinformation that emerged.
Media conclusions The legionella issue at the Wesley received extensive coverage in the media Australia-wide and internationally. It was vital to communicate clearly and effectively to counter negative coverage. Using social and online media allowed the hospital to provide accurate information quickly and regularly, and to reach stakeholders directly.
Media conclusions The Wesley was able to directly allay patient, staff and community concerns and reinforce confidence in the hospital s response to the crisis. Through the transparency of social media and swift response to public enquiries, the Wesley was able to ensure: - accurate information was in the public domain - the hospital s voice was heard and - public confidence was maintained.
Brisbane Wesley Hospital on Lockdown For Possible Legionnaire's Disease Outbreak By Reissa Su June 6, 2013 9:36 AM EST A female patient is admitted to the Wesley Hospital due to legionnaire's disease. This is the second case of legionnaire's disease in Brisbane following the death of a 60-year-old woman last Sunday. Although a cancer patient, the elderly woman tested positive for legionnaire's disease. In a statement released today, Wesley Hospital said that the latest patient is confined in a different section of the hospital. The older woman stayed in a different hospital ward until her death. New hospital admissions were temporarily cancelled last night according to Executive Director Richard Royle of Uniting Care Health. The emergency department of Wesley Hospital will be the holding place of all emergency cases related to the disease. Royle said the decision was made for the safety of all patients. It is a necessary precaution until the source of contamination is clearly determined. The director also said the health department would not risk the lives of patients in the hospital without knowing more about the recent legionnaire's disease case. Hospital personnel distributed wash kits to patients since showering was not allowed at this time. The water supply of the hospital is being disinfected by engineers. Royle says every precautionary step mys be taken until the hospital hears from Queensland Health experts. An investigation will conducted today by agency environmental health experts.
Wesley Hospital Contacts Former Patients Amid Legionnaires' Disease Outbreak; Second Case Now In Intensive Care By Frances Samson June 6, 2013 11:50 AM EST Authorities at the Wesley Hospital in Brisbane have contacted around 1,400 former patients in the wake of rising concern over the latest outbreak of Legionnaires' disease. So far, the disease has claimed the life of one 60-year-old man who died in the hospital on Sunday, while another patient, a 46-year-old woman, is now being given intensive care at Wesley. No official finding has been released yet by hospital officials as to the cause of the disease, but they have discovered bacteria in the hot water system of the hospital's east wing. At present, the hospital is not admitting patients and has suspended medical procedures such as surgeries. The emergency room is likewise unavailable. and are advised not to take a shower. As a precautionary measure, patients have been handed washing kits Operators of the hospital expect difficulty in contacting all 1,400 patients who were admitted since May 25. "We are trying to get into contact with 1,400 former patients who have been in the hospital during the incubation period," said Richard Royce, executive director of United Care Health. He said that the incubation period may be between 2 and 10 days from the patient's inhalation of the bacteria until the full development of the illness. "We have taken a slightly longer period than that to be extra cautious."
Medical Impact Patients Doctors GP Local Community Clinical Services Impact Training impact.
Clinical Services Impact Acute Admissons Interruption of core business Moving the Wesley Emergency Centre Moving patients internally (including BMTU). Dialysis Services
Impact on Affected Patient and Families Risk of being lost in the emergency Open Disclosure Medico- legal implications Incident investigation and management
Clinical Incident Management Patient care Diagnosis Pathological investigation Clinical Guidelines Ongoing audit
Lessons Learnt 1. Close the hospital / Evacuate the hospital 2. Minimise core incident response team to key personnel 3. Fatigue Management for Incident Management Team 4. Handover between Incident Management Team members
Personal Reflections Leadership is critical Receiving advice vs action. Comments and talk vs decision-making. Importance of communication: Honesty Transparency Engagement Consistency
Personal Reflections Management of morale. Importance of culture. Importance of peer support. Importance of family support. Impact of being at the front line and under close scrutiny.
Two Weeks after Opening
Two Weeks after Opening