160913 Technical Suite - Consultation Paper - Public · PDF file · 2016-09-206.7 Proposed Nursing Governance Structure 14 ... Consultation Paper – Technical Suite in the new RAH

Issued: September 2016

Consultation

Paper

new RAH Technical Suite Model of Care

Surgical Directorate

Central Adelaide Local Health Network

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TABLE OF CONTENTS

TABLE OF CONTENTS 2

1. INTRODUCTION 3

2. PURPOSE 3

3. DEFINITIONS 4

4. CURRENT MODEL 4

5. RATIONALE FOR CHANGE 4

6. FUTURE MODEL 5

6.1 Physical design 6

6.2 Perioperative Bays 7

6.3 Overnight Stay Ward 7

6.4 Workflow Principles 8

6.5 Patient Journey 9

6.5.1 Patient Flows through the Technical Suite 10

6.5.2 Admission 11

6.5.3 Transfers 11

6.5.4 Discharge 12

6.6 New RAH Administration Services 12

6.7 Proposed Nursing Governance Structure 14

6.8 Non-Clinical Support Services – Patient Support Services Assistant 15

6.9 Benefits of the future model 15

6.10 Implementation of the future model 15

6.11 Related change processes 16

6.12 Implications for not undertaking the change 16

7. FEEDBACK 16

8. REFERENCES 17

9. APPENDIX 17

Consultation Paper – Technical Suite in the new RAH

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1. Introduction The Central Adelaide Local Health Network (Central Adelaide LHN) is one of five Local Health Networks (“LHNs”) in South Australia. The population of the Central Adelaide LHN is estimated to represent 27% of the total State’s population. According to the recent Department of Planning and Local Government projections, the population is likely to increase to approximately 471,000 by 2016, to 488,000 in 2021 and 503,000 in 2026.

The Central Adelaide LHN brings together four hospitals: Royal Adelaide Hospital (“RAH”), The Queen Elizabeth Hospital (“TQEH”), Hampstead Rehabilitation Centre and St Margaret’s Rehabilitation Hospital, and a significant number of Mental Health (including Glenside Campus) and Primary Health Care Services. Central Adelaide LHN also governs a number of state-wide services including SA Dental, BreastScreen SA, DonateLife SA and Prison Health Care Services.

The Central Adelaide LHN is committed to delivering the highest quality health care possible and taking active steps to continuously review and improve its services.

Since the release of South Australia’s Health Care Plan 2007-2016 (“SA Health Care Plan”), it has been widely acknowledged by the Central Adelaide LHN that we would need to change some key aspects of our day-to-day business and service delivery to ensure that we can continue to provide services to our community into the future. Increasing pressures that Central Adelaide LHN is faced with as part of the public health system include:

> an ageing population with growing health care needs

> rises in chronic disease

> pressure to ensure we have enough clinicians and support staff to deliver services effectively

> delivering sustainable services with a limited health budget resource.

The Central Adelaide LHN is committed to achieving the vision set out in the SA Health Care Plan and in particular ensuring that we provide the best services possible to patients and that we find innovative ways of achieving this. Given the pressures we are facing and the need to make sure we can continue to provide services to the community, we have no choice but to change.

To this end, and consistent with the vision articulated in the SA Health Care Plan, Central Adelaide LHN has embarked on a journey to change its approach to health care and the way it delivers health care services into the future.

2. Purpose The purpose of this paper is to describe the clinical and administrative workflows based on the Models of Care within the Technical Suite in the new Royal Adelaide Hospital (“new RAH”).

This document describes the processes that will streamline the patient journey with quick access to appropriate services.

This paper follows the consultation process regarding the Technical Suite Operational Governance Framework issued in October 2015, with feedback distributed in December 2015. This paper includes further detail about changes to the nursing and administrative structures for the Technical Suite in the new RAH.


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3. Definitions Technical Suite

The Technical Suite Service supports the integration of all operating rooms, interventional and procedural rooms and associated support areas incorporating reception, patient admission, care and discharge within perioperative bays.

The Technical Suite governance pathway includes management oversight and responsibilities for the Central Sterile Services Department (“CSSD”) and scope cleaning.

Overnight Stay Ward

24 bed ward that is comprised of open plan pre and post-operative bays and includes three (3) rooms for those patients requiring transmission based precautions.

4. Current Model

Currently there are various surgical, procedural, interventional and specialist imaging services (such as Radiology, Gastro-Intestinal Unit, Cardiovascular Investigation Unit) in multiple discrete locations and have differing:

> processes for the scheduling and admission of patients;

> governance structures;

> reporting processes; and

> ICT systems (such as hTrak, HealthTrack, Xcelera, ORMIS, WINCHART).

Current practices have developed over time and are based on historical segregation of services. For example the Gastrointestinal Unit currently manages patient “admissions” as outpatients. The current RAH site is the only SA Health site that manages this group of patients in this manner.

Pre-Admission, Admission, Service Delivery and Discharge has:

> Multiple systems for booking patients for procedures;

> Fragmented models of care that occur across multiple areas within the hospital;

> Separated stages with specialist admission points and service delivery; and

> Differing post-operative care and discharge areas.

5. Rationale for Change The implementation of a new operational model for the new RAH Technical Suite will be crucial to ensuring services, staff, systems and processes are delivered in an efficient, safe and effective manner. The move to the new RAH has provided the opportunity to develop a modern service model which will aim to make best use of new technologies and a unique design.

The Technical Suite Operational Governance Framework Consultation Paper, issued in October 2015, detailed the governance and accountability and the principles to guide the application of the framework. These principles included:

> A single overarching governance structure.

> An integrated workforce model.

> Centralised and single system for key processes.


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> Standardised approaches and process to ensure consistency in service delivery.

The Technical Suite within the new RAH will ensure the service it provides across Central Adelaide LHN and other LHN’s is compatible with strategic and operational directions e.g. utilisation and understanding of EPAS, iPharmacy, ICT interfaces.

All Technical Suite rooms within Central Adelaide LHN aim to:

> Maximise patient safety through the reduction in errors

> Improve operational and cost efficiencies

> Improve user and patient satisfaction

> Improve regulation and accreditation compliance

> Maximise the use of ICT technologies.

As such, the Technical Suite will work within an operational model that has not been implemented anywhere else in Australia. It will require the strategic integration and coordination of various specialties, disciplines, services, staffing models and supporting processes and systems.

By bringing together these different functions, the design allows for:

> maximum potential for flexible use on a day to day basis

> change of use or modalities

> change of technologies over time

> increasing convergence between surgery and complex interventional cardiology, radiology and neurological interventional work

> opportunity to increase efficiency of both Technical Suite and utilisation of staff across the new RAH Technical Suite floor.

6. Future Model The term “Technical Suite” has been introduced to reinforce SA Health’s approach to a flexible facility design. The new RAH Technical Suite is located on Level 4, co-located with the Intensive Care Unit (“ICU”) and CT imaging facilities. The Technical Suite design integrates all operating rooms, interventional rooms, complex imaging modality rooms, procedural rooms, holding and recovery areas, a centralised scope cleaning facility, storage spaces and support areas (for example, bookings and admission staff).

All procedural, interventional and surgical procedures requiring sedation or general anaesthesia will be undertaken within the Technical Suite, unless clinically contra-indicated.

There are defined and consistent patient flow processes for efficient admission, surgical intervention and recovery; incorporating acute medical, surgical units and inpatient specialties (see Appendices 1-2).

Entry points to the Technical Suite will include:

> Emergency Department;

> Helipad;

> Acute Assessment Unit;

> Inpatient Wing;

> Technical Suite Admission Desk e.g. patient admitted as Day Stay, Overnight Stay or Multi-Day Stay admission.


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6.1 Physical design

The new RAH design includes a total of 40 Technical Suite rooms with a minimum size of 65 square metres each have been designed with a generic and standardised configuration and layout, including case cart storage and scrub bays per room.

The area is designed to flow from left to right (as per above diagram) representing a move from ‘hot’ to ‘cold’ areas. The ‘hot’ area at the left is the 24/7 emergency area which will support the most complex services, whilst the ‘cold’ area at the right which will support the majority of elective surgical and procedural services.

There will be 3 categories of Technical Suite Rooms as follows:

> Category 1 : Laminar Flow/Hepa Filtered Operating Rooms (9 rooms) located in the western wing (all the rooms in Zone 1).

> Category 2 : Operating rooms, Interventional Rooms located along the southern aspect of the facility in the 2 centre wings (all rooms in Zones 2 and 3).

> Category 3: Procedural Rooms (6 Rooms) located in the eastern most wing (Zone 5). There will be two Burns capable Technical Suite rooms (TS 23 and 24) located within the Technical Suite, with an adjacent tissue processing room.

All surgical, procedural and interventional services work (ie. Cardiac, Vascular, Neurology and Radiology) requiring anaesthesia, potential for anaesthesia or sedation, requiring monitoring will be undertaken on Level 4. The exception to this is High and Low Dosage Rate brachytherapy procedures which will be undertaken in Radiation Oncology on Level 2.

All Technical Suite rooms will be provided with radiation shielding to allow the use of mobile imaging equipment. Each Technical Suite will have its own dedicated mechanical and electrical system which can be isolated without compromising other Technical Suite rooms.

Negative Pressure rooms have been provided in the perioperative bays, 2 (two) Procedural Rooms and 2 (two) further Technical Suite rooms are able to be changed to Negative pressure (if required).

The Technical Suite will have key relationships to the Emergency Department on Level 2, CSSD on Level 5 and the Helipad.

Elective surgery team


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Technical Suite room 33 and the adjacent storage space have the ability to support a future Hybrid Technical Suite room at up to 130 square metres, including a Control Room.

6.2 Perioperative Bays

3 Physical Care Zones:

1. ‘Hot-Zone’ emergency/complex inpatients. 2. Interventional Radiology/General Surgery, Interventional Cardiology. 3. General Surgery and Procedural such as gastroenterology, dermatology,

bronchoscopy, haematology, etc. Assumptions:

The complex nature of scheduled elective surgery (and resulting time required for the surgery) and the unpredictability of emergency surgery being undertaken in the ‘hot zone’ (emergency zone) will result in a predictably slower patient journey through Zone 1 when compared to the other Zones. Patients within this zone will flow more consistently to ICU and Cardiothoracic units post-operatively.

Perioperative Bay 1 supports the 24 hour model of emergency care of the Technical Suite rooms in Zone 1 and will be staffed accordingly.

6.3 Overnight Stay Ward

The new RAH has an area designated Overnight Stay Ward. There will be no change from the model in the current RAH.

Definition – High volume high patient turnover.

Patients must be medically managed by the admitting Medical Team.

Rules for admission:

> Patient should be discharged after a short stay e.g. overnight (<23 hours).

> Patient should have small / short turnaround surgery such as appendicectomy, small fractures, abscesses, etc.

> Patient may be deemed an emergency but with a low acuity.

> Surgery time is certain e.g. required and confirmed to occur within four (4) hours. Cases unlikely to occur within this time frame will be admitted to the inpatient wards.

> Non-avoidable admission.

> Requires additional care overnight (post-operatively).

The Overnight Stay Ward will be:

> Monday afternoon to Saturday morning; and

> A reduced occupancy (to be determined) Saturday morning to Monday morning.

Isolation Rooms:

Patients requiring isolation due to a specific condition such as tuberculosis can be cared for in this area with purpose built facilities.

Discharge:

Nurse Led Discharge is will be undertaken against agreed criteria.


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6.4 Workflow Principles

ADMISSION PATHWAY

PLANNED DIRECT ACCESS*

UNPLANNED PLANNED

BOOKING PROCESS

Unplanned procedures will be booked into ORMIS by the Medical Officer, with subsequent communication with relevant stakeholders (i.e. nursing and anaesthetic leads). Should the proposed 24/7 administration support be provided (refer section 6.6) this process will be reviewed, with the aim to consolidate bookings into a centralised area and managed by the Technical Suite administrative staff to ensure accuracy and standardised booking processes.

Elective Admissions All elective admissions will be booked through an integrated administrative model, using standardised systems (i.e. ORMIS, EPAS) and processes (i.e. in conjunction with the Medical Officer – refer appendix 1). These will comply with predefined business rules aligned to national and state-wide performance indicators (where required), college guidelines and local requirements.

ADMISSION POINTS

• Helipad (Medstar and RFDS) to Operating Room

• Ambulance (SAAS) transfer to interventional cardiology or radiology

• Emergency Department

• Inpatient units • ICU

Day of Surgery admission patients (i.e. Day Stay, Overnight Stay and Multi-Day Stay) will report to a central admission desk on Level 4 and then be transferred into an allocated Perioperative Bay for nursing and medical admission and preoperative preparation. Inpatient Unit transfers.

PROCEDURE ACCESS

There will be future capacity at the new RAH to provide dedicated emergency procedure space in Zone 1 including:

• 24 hour emergency surgery access

• 24 hour emergency interventional access

• 24 hour trauma access

• 12 hour ASU/PSE access

Clinical specialties will have sessions allocated to them based upon activity requirements and waiting list pressures. Sessions will be allocated on a 4.5 hour session time which are currently being implemented.

OPERATING ROOM MANAGEMENT INFORMATION

ORMIS is used to book emergency and elective surgery schedules; to track activity; document

Emergency cases are booked directly into the ORMIS. Emergency cases are prioritised

Administrative staff book patients into ORMIS based upon a waiting list category related to


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ADMISSION PATHWAY

PLANNED DIRECT ACCESS*

UNPLANNED PLANNED

SYSTEM (ORMIS)

surgical and nursing patient care and provide a reporting tool.

based upon a clinical category based upon each individual patient’s needs.

the patient’s clinical condition. The construction of Tech Suite lists are created in conjunction with senior clinical staff.

RECOVERY AND POST OPERATIVE CARE

There are 3 perioperative bay areas situated across the Technical Suite. The new model co-locates nursing and medical admission, preoperative preparation, postoperative care and discharge within the perioperative bay area.

Emergency patients will be managed in Perioperative Bay 1 in Zone 1, staffed over 24 hours.

Perioperative Bay 1 will manage patients from Zone 1. Perioperative Bays 2/3 will manage patients from Zone 2 & 3. Perioperative Bays 4/5 will manage the bulk of the Day Surgery activity in Zone 4 & 5.

OVERNIGHT STAY WARD (<23HR)

There are 24 beds within the Overnight Stay ward area co-located in the TS area.

There will be a fully functional Overnight Stay patient care setting available to support timely patient care and early discharge for identified procedures.

TRANSFER/ DISCHARGE

Discharge from Technical Suite. Use of Criteria Led Discharge will support timely patient movement through the system.

Transfer to ICU or Inpatient Units (supported by clinical handover). Discharge to home for emergency DSU cases.

DSU – discharge home; Multi-Day Stay – transfer to inpatient wings; and Overnight Stay – transfer to Overnight Stay Ward situated within the Perioperative Bay area.

*Direct access/admissions is a change to the current model of admissions via the Emergency Department.

6.5 Patient Journey

Patients and/or their carers will be involved in developing their treatment plan at the time of admission, including identification of an expected date of discharge. Any deviation and/or variation in the plan will be brought to the attention of the primary consultant. Appendices 1-2 show the high level workflows and processes for planned (elective) admission.

There will be alternative points for a patient to access acute health services and the Technical Suite at the new RAH such as direct admission or via the Emergency Department. These will be defined by protocols which are currently being developed in discussions with staff. Direct admissions will be subject to a separate consultation process.

As the unplanned (emergency) model of care is implemented (following the consultation process regarding the new RAH Emergency Department Model of Care) internal and external factors that will impact on the patient journey will be considered and addressed to improve patient flow from the Emergency Department.


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6.5.1 Patient Flows through the Technical Suite

The following image broadly describes the “Same-Day, Planned, Multi-Day Stay and Unplanned” patient journey through the Technical Suite.

The following image broadly describes the “Same-Day, Planned, Multi-Day Stay and Unplanned” patient journey through the Technical Suite Endoscopy and Procedure Rooms.

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The following image broadly describes the “Same-Day, Planned, Multi-Day Stay and Unplanned” patient journey through the Technical Suite Cardiac and Interventional Laboratories.

6.5.2 Admission

Planned (elective)

An admission that can be delayed for at least 24 hours and is referred from Outpatients / Private Rooms or through an inpatient stay. Patients are directed to the Admission Arrival area on Level 4 for ‘Day of Surgery Admissions’ (i.e. Day Stay, Overnight Stay, Multi-Day Stay) or will be directed straight to the ward, for ward admissions.

Unplanned (emergency)

An admission for care or treatment which, in the opinion of the treating clinician should occur within 24 hours. These patients are:

> usually admitted via the Emergency Department to inpatient wings prior to surgical intervention; or

> may be a direct admission into a peri-op bay or Overnight Stay Ward (as a first touch point) to a Technical Suite Room (or may go direct to the Technical Suite room as in a STEMI). Direct admissions will be subject to a separate consultation process.

This flow may include a return to the Technical Suite room from an ICU / inpatient area or through the delivery of patients for immediate intervention for example, via the Helipad.

6.5.3 Transfers

Intra-Hospital Transfer

Patients may require intra-hospital transfer post-surgery to specialised areas for example Technical Suite directly to ICU, Radiology CT rooms to Perioperative Bays or inpatient wings.

Patients undergoing procedures requiring sedation or general anaesthetic in areas external to the Technical Suite may be required to be transported to a Perioperative Bay. Specialist biomedical equipment is required to support the maintenance of the patient’s

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condition and safety during this transport phase.

Transfers to ICU

Transfer of patients to and from the Technical Suite (refer SSI-02572) outlines the specific requirements for the management of intubated or critically ill patients between ICU and the Technical Suite.

Clear communication between the two areas to coordinate the handover and specialist escort of these patients is required. Specialist biomedical equipment is required to support the maintenance of the patient’s condition and safety during this transport phase.

Inter-Hospital Transfer

All inter-hospital transfers will be managed in accordance with OWI-03194 Inter-Hospital Transfer, Direct Admissions, and Referral for Unplanned Admission by External Health Providers. Direct admissions will be subject to a separate consultation process.

6.5.4 Discharge

Discharge Planning from Day Surgery

Planning for discharge will start when booking the patient in for surgery, by confirming they have an escort, transport home and a responsible adult will be with them for 24 hours postoperatively (as per the Australian and New Zealand College of Anaesthetist guidelines).

Early planning provides staff with the best opportunity to address any risks to timely discharge (such as the need to arrange services to support the discharge) and helps to inform the patient and their family or carer of when they are likely to be discharged.

Criteria Led Discharge

Criteria Led Discharge (“CLD”) is when nurses discharge patients under medical direction, using defined criteria based on best practice principles to ensure a safe and timely discharge of patients. Effective and timely discharge using CLD supports patient flow and effective use of bed capacity.

A discharge letter (MR 14.6) is prepared by the Medical Officer just before the patient leaves the Technical Suite. Nurses then lead the CLD process, referring to the procedure and type of anaesthetic. If a problem arises with the patient, a Medical Officer review is initiated.

At discharge, the patient is provided with a discharge letter, discharge instructions (MR14.8) and a specific information sheet relevant to their procedure. These discharge instructions are signed and dated by the nurse giving the instructions as per legislative requirements.

6.6 New RAH Administration Services

The new RAH Administration Services consultation process described the key principles for administration services for the new RAH in order to provide a support service that demonstrates best practice and professionalism, while ensuring the effective support of new Models of Care and the efficient use of resources. Documents relating to the new RAH Administration Services consultation process can be found on the new RAH consultation intranet page.

The roles and core functions of the team that will have responsibility for delivering a range of front and back-of-house functions within the Technical Suite will be as follows:

> Elective Waiting List and Booking Management: Technical Suite Reception and Administration


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> ORMIS Management

> Technical Suite Admissions and Discharges

> Administrative Support.

When undertaking front-of-house functions, staff will be located in the admissions area on level 4 (four) of the new RAH. When undertaking back-of-house functions, staff will be located within the blue space area on level 4 (four) of the new RAH.

Currently some administration staff responsible for managing admissions, waiting list and bookings etc are embedded with sub-specialty units and located in multiple locations across the hospital. These units include Gastroenterology Interventional Unit (“GIU”), Cardiovascular Interventional Unit (“CVIU”), Interventional Radiology, Spinal and Cardiothoracic Surgery.

It is proposed that from Day One at the new RAH these staff will be integrated with the Surgical Directorate elective surgery team; their line reporting transferred to the appropriate supervisor within the Surgical Directorate, and will also be located within the blue space and admissions area on level 4 (four) of the new RAH. It is recognised that these staff have expert knowledge of their units and will remain involved with their specialty unit. This model will also provide for continuity of service with improved leave cover for administrative staff.

As per the Technical Suite Operational Governance Framework Consultation Paper and the new RAH Administration Services Consultation Paper, the administrative processes and systems will be standardised to support a single:

> Elective admission waiting list using EPAS, MS Outlook, and wherever possible standardised admission forms – this is currently in place in all surgical units, and, in various forms, in some integrating areas, but will require consistency in all areas.

> Technical Suite schedule, booking and cancellation system using ORMIS Technical Suite Schedule – this is currently in place in all surgical units and the majority of integrating areas. This will be implemented in those areas who do not currently use it before the move to the new RAH.

> Patient booking communication process using EPAS – this should follow similar processes as currently performed in APMS.

> Patient admission and discharge process using EPAS – this should follow similar processes as currently performed in APMS.

All specialty services utilising the Technical Suite will be required to use these standardised processes and systems, regardless of where the administrative processes are undertaken.

It is intended that administration support will be provided to the Technical Suite 24 hours a day, 7 days a week. Prior to implementing this there will be consultation with affected staff and their representatives, as required.

For administrative staff, the information arising from this consultation process will also inform the development of specialised Technical Suite responsibilities and functions in the Standard Competency Based Role Descriptors currently being developed, and as outlined in the new RAH Administration Services consultation process. The new RAH Administration Services consultation process also discussed the Administration Professional Workforce Stream (“APWS”), the ‘Central Governance, Local Management’ administrative model for the new RAH and Principles of Professional Practice, which will also apply to Technical Suite administrative staff. Further information and / or consultation with affected staff and their representatives will be undertaken in relation to the implementation of the new RAH Administration Services consultation process as required.


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6.7 Proposed Nursing Governance Structure

As part of Technical Suite Operational Governance Framework Consultation process, it was clarified that there will be a change in title for the current Nursing Director (“ND”) - Operating Room Services position to the ND - Technical Suite. This position will continue to provide the organisational line reporting structure for nursing personnel working within the Technical Suite.

The ND - Technical Suite is a member of both the new RAH Technical Suite Operational Management Group and Central Adelaide LHN Technical Suite Governance Committee, as described in the Technical Suite Operational Governance Framework Consultation Paper, issued in October 2015.

The nursing organisational structure for the (current) Operating Room Services and the (proposed) new RAH Technical Suite are as illustrated in Appendices 3 and 4.

It is proposed that the current nursing roles reporting to the ND - Operating Room Services continue in the same manner (as per Appendix 3).

The proposed changes to operational reporting lines, to operate from Day One at the new RAH, are as a result of the co-location of positions from the integrating procedural areas are as follows (and as shown in red in Appendix 4):

> Transfer of line reporting for nursing personnel engaged in Thoracic Medicine (“TM”) procedural activity within Technical Suite Rooms to the role of Clinical Service Coordinator (“CSC”) Gastrointestinal Investigational (endoscopic) Technical Suite.

> Transfer of line reporting for current CSC Cardio Vascular Interventional (five (5) procedural rooms and including supervision of designated peri-operative bays) to the ND - Technical Suite.

> Transfer of Overnight Stay Ward and designated CSC from the Orthopaedic and Trauma Nursing Director to the ND - Technical Suite.

Proposed changes not shown in Appendix 4 are as follows:

> The day to day operational reporting for Burns Unit staff to CSC Technical Suite while rostered/working in the dedicated Technical Suite room.

> The day to day operational reporting for interventional Medical Imaging Procedural Activity nursing staff will be to CSC Technical Suite whilst rostered/working in the Technical Suite.

It is envisaged that co-ordination of activity will be undertaken by the CSCs in the East and West Perioperative Bays with the CSC of the Cardiovascular Investigation and the CSC of the Gastrointestinal Investigation and Thoracic Medicine.

The CSC in the Eastern Perioperative Bays will co-ordinate the higher volume ambulatory and overnight stay admissions (such as Gastrointestinal Investigation, General Gynaecology Oncology, ENT/Ophthalmology/Oral Maxillofacial). This CSC is currently the CSC of Day Surgery Unit/Day of Surgery Admission (DSU/DoSA).

The CSC in the Western Perioperative Bays will co-ordinate lower volume, but more complex, admissions (currently this is the CSC Post Anaesthetic Recovery Unit (PARU)). These include cardio-thoracic, neuro-surgical, orthopaedic, spinal, plastic, the majority of emergency procedural activity including Burns and neuro and vascular interventional.

Cardiovascular Investigation procedural activity will be co-ordinated centrally via the CSC, Cardiovascular Investigation across the continuum from admission via procedural rooms to post procedural care.

Anaesthetic support is proposed to be co-ordinated across the East and West ends by two separate CSCs as per CSCs for Perioperative bays. There is currently one CSC, Anaesthetics, and it is therefore proposed that there will be one additional CSC, Anaesthetics under the proposed new structure for the new RAH (as shown in green in


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Appendix 4).

6.8 Non-Clinical Support Services – Patient Support Ser vices Assistant

A new role of Patient Support Services Assistant (PSSA) will be introduced in the new RAH. The PSSA role will be an employee of Spotless and an integral part of the clinical team where they are regularly allocated.

PSSAs allocated within the Technical Suite will work under the direction of clinical staff. PSSAs will be provided with a handheld device to enable them to have regular contact with the Technical Suite flow coordinator (clinical staff) who will have the latest information relating to the status of each Technical Suite room. Clinical staff will allocate the PSSAs specific tasks along with routine tasks to be completed during the day. The Technical Suite PSSA will generally perform patient transfers within the Technical Suite area.

The dedicated Orderly service will generally perform the tasks outside of these restricted areas, in particular tasks relating to the movement of patients and FFE between the inpatient areas and the Technical Suite and any other (non-restricted) areas in the Technical Suite.

6.9 Benefits of the future model

As outlined in the consultation process regarding the Technical Suite Governance Framework, all staff working within the new RAH Technical Suite service area will work under a single overarching governance structure and will abide by consistent policies and procedures that govern the new RAH Technical Suite.

An integrated workforce model will be adopted to support the safe and effective delivery of peri-operative, intra-operative and post-operative care for all patients. This will require core staffing to be supported by specialist staffing (such as anaesthetists, surgeons, technicians) in the agreed clinical areas to ensure an integrated service delivery to patients.

The proposed Model of Care for the integrated services within the Technical Suite will provide the following benefits:

> Improved patient care and staff collaboration through co–locating surgery and complex interventional cardiology, radiology and neurological interventional work.

> Increased efficiencies for staff and patients through the use of a single standardised system for booking and waiting list management.

> Improved patient admission process through single admission point for elective surgery.

> Demonstrable efficiencies for both staff and patients in the admission, service delivery and discharge processes.

> Opportunities to improve patient flow and care.

6.10 Implementation of the future model

The training and education plan for the up-skilling of clinical and administrative staff is currently being developed. This model will be enhanced by specialised clinical training (simulation and skills laboratory) areas which supplement current clinical area training. The impact to the current Technical Suite Clinical Training Program is under review, with changes to delivery expected.

In addition to the above:


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> All Organisation Wide Instructions (“OWIs”) and Site Specific Instructions (“SSIs”) that are under review will ensure standardised processes and language.

> Clinical and administration staff have been engaged to review all processes and documentation to standardise where possible. Discussions with staff within integrated areas are continuing and changes will occur prior to the move to the new RAH.

> EPAS has been involved in all flow mapping workshops to assist in aligning discussions on standardisation of documents with the potential for electronic replacements.

> ICT systems have been reviewed and all clinical groups will be aligned to use ORMIS for scheduling of cases. ORMIS will be introduced to some areas that are not using any electronic system before the move.

6.11 Related change processes

The CSSD model will introduce new processes and management systems which have a major impact on the service delivery of the Technical Suite model, and therefore the staff involved in this phase. The CSSD model will be the subject of a separate consultation process.

The implementation of outcomes of the new RAH Administration Services consultation process (as referred to in section 6.6) is intended to support the operational processes within the Technical Suite by aligning functions and competencies.

6.12 Implications for not undertaking the change

Failure to undertake this change will result in an inability to deliver a safe and effective service across the Technical Suite in the new RAH. It will not be possible to safely book patients, schedule sessions, admit and discharge patients and provide a safe service across a disparate range of staff and units operating within the Technical Suite, without an integrated and standardised workforce and processes.

7. Feedback The proposals outlined in this paper have resulted from engagement with staff through various forums, including existing staff meetings and special reference groups.

This proposal provides more detail in relation to the proposed Model of Care for the Technical Suite, and further detail about the nursing and administrative structures. There are still details that need to be determined and your feedback, suggestions and questions will assist in further refining the model. The model will undergo continuous improvement and staff will continue to be engaged in further iterations, up to and beyond the opening of the new RAH.

Feedback can be provided via survey monkey https://www.surveymonkey.com/r/TechSuiteMoC or in writing to Workforce Workstream, new RAH Program, Level 8, Emergency Block, Royal Adelaide Hospital, Adelaide, SA 5000.

Feedback is due by 17 October 2016.

In particular we are seeking responses to the following questions:

1. Do you have any feedback in relation to the new RAH Technical Suite Model of Care?

2. Do you have any specific feedback in relation to the Workflow Principles and Patient Journey?


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3. Do you have any specific feedback in relation to the Nursing Governance Structure for the new RAH Technical Suite?

4. Do you have any specific feedback in relation to the integration of Administration Services for the new RAH Technical Suite?

5. What else would you like to know about the new RAH Technical Suite Model of Care at the new RAH?

8. References Model of Care for Major Hospitals – SA Health

South Australia’s Health Care Plan 2007 – 2016

Consultation Paper – new RAH Technical Suite Operational Governance Framework

9. Appendix Appendix 1 – Planned (Elective) Work Flow and Processes: Pre Arrive, Arrive and

Service Delivery,

Appendix 2 – Planned (Elective) Departure (Transfer/Discharge) Work Flow and Processes

Appendix 3 – Current RAH Operating Room and TQEH Peri-Operative Services Structure (Nursing)

Appendix 4 – New RAH Technical Suite and TQEH Peri-Operative Services Structure (Nursing)


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APPENDIX 2 – PLANNED (ELECTIVE) DEPARTURE (TRANSFER OR DISCHARGE) WORKFLOW AND PROCESSES (HIGH LEVEL)

Bla

ck B

ox P

ool

Poo

l6

Dis

cha

rgin

g N

urse

Adm

inO

utpa

tient

Sup

port

Ser

vice

s

Discharge / Transfer Patient

«BusinessProcess»4.1.2 Transfer Patient to Wing/ ICU/ Coronary Care

«BusinessProcess»4.1.2 Transfer Patient to Wing/ ICU/ Coronary Care

«BusinessProcess»4.1.3 Discharge Patient

(returns home)

«BusinessProcess»4.1.3 Discharge Patient

(returns home)

Patient no longer requiringservices of a Recovery unit and

can be discharged fromPerioperative Space

«BusinessProcess»4.1.4 Return Medical

Records

«BusinessProcess»4.1.4 Return Medical

Records

4.1.6 Collate andsend reports to

referring doctors

At what point does the Patient to Morgue process vary?

Need to consider coroners report process

«BusinessProcess»4.1.1 Perform Down

Transfer

«BusinessProcess»4.1.1 Perform Down

Transfer

4.1.7 Perform FollowUp Tasks

4.1.5 CompleteStatistical Reporting

Data Entry

Forms::MR 58.0 Restraint/Seclusion Notification Form –

Acute Serv ices

(from Forms)

Process exception flowdocumentation

Forms::MR 60.20 Acknowledgment

of Medical Recommendations

A

(from Forms)

Transfer Patient (toMortuary)

Patient Deceased

Patient to go home

«trace»

Patient Transferred toother Hospital Site

Patientto Pod

or Wing

«trace»


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APPENDIX 3 – CURRENT RAH OPERATING ROOM AND TQEH PE RI-OPERATIVE SERVICES STRUCTURE (NURSING)


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APPENDIX 4 – PROPOSED NEW RAH TECHNICAL SUITE AND T QEH PERI-OPERATIVE SERVICES STRUCTURE (NURSING) (Note: changes to reporting lines are in red – these are not new positions; new positions are in green )