New Royal Adelaide Hospital check up: Six months on
SIX months after the opening of the new Royal Adelaide Hospital, we take a look at its successes and failures, and sort through the facts and fictions surrounding the $2.3 billion facility.
SA News
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PATIENTS admitted to the $2.3 billion, 800-bed Royal Adelaide Hospital regularly face waiting times of 24 hours or more after being treated in the Emergency Department.
A daily check by The Advertiser of SA Health data over the past fortnight has found at least 15 cases of patients who were waiting more than 24 hours for a bed.
While the new hospital has 700 overnight beds and 100 day beds, not all have been commissioned — it is understood to be less than the old RAH which was operating on around 680 overnight beds.
Doctors were advised when the hospital opened six months ago on September 5 there would be an average of 609 staffed overnight beds. In an interview with The Advertiser prior to the opening officials said they hoped to work from a base of 660 beds, but they can ‘flex up’ to deal with demand.
A check of SA Health data every day for the past fortnight between 9am-10.30am shows a gridlock in the ED as people are treated and admitted — then have to wait extended periods for a ward bed.
A typical morning — 9am on February 21 — showed there were 30 people waiting for a ward bed including two waiting more than 24 hours and 11 waiting 12-24 hours.
That bed block contributed to an average 155 minute wait for people arriving at the ED to be seen that morning.
The data shows there were regularly people waiting longer than 24 hours for a ward bed — for example on the morning of February 19 there were six, and on February 20 there were three.
The SA Salaried Medical Officers Association previously warned the decision not to open all beds means patients “will be at a high risk of bad outcomes.”
SA Health did not answer a query on current bed numbers, however, Jenny Richter, CEO of the Central Adelaide Local Health Network said work was being done to deal with initial problems and there was much to be proud of since it opened
“Over the past few months, South Australians have embraced their new, state-of-the-art Royal Adelaide Hospital, and I want to thank all our hardworking clinicians, volunteers and staff for their commitment to providing world class care,” she said.
“Our first six months have not been without challenge, but I am proud of the way any issues that arose have been swiftly responded to. As home to cutting edge technologies and groundbreaking research, our patients have access to the latest treatments and highest quality care.”
Nothing but praise
John Foster, 62, from the Yorke Peninsula has nothing but praise for the RAH after having a triple bypass on Monday.
“I cannot fault the staff, and the rooms here are just great,” he said.
“The place is light and airy, the decor and aesthetics are good — it might be new and the workers might still be finding their feet but I think it is great, and am pretty happy to have had the operation done here.”
Six month check up
SIX months after the $2.3 billion Royal Adelaide Hospital opened hopes that it would ‘fix’ the health system are yet to be realised.
It is the arguably the best hospital in the land but it is struggling with demand.
Its Emergency Department, with 65 cubicles compared to 59 at the old RAH, is regularly at or close to capacity, sometimes with an average waiting time of two hours or more at times to be seen — although any patients triaged as Category One (most urgent) are treated immediately.
Hopes that streamlined arrival including some ambulance patients bypassing the ED altogether, would ease pressure are still being worked on.
There is also ‘bed block’ where patients get stuck in the ED after treatment, taking up space that could be used for new arrivals.
Regular checks by The Advertiser of SA Health data over the past fortnight shows patients routinely stuck in the ED waiting for ward beds.
These are not short delays — every day for the past fortnight there have been people waiting 12-to-24 hours for beds and there also regularly have been people waiting more than 24 hours.
Those who end up in wards enjoy spacious single rooms with large ensuites, views, fresh air, natural light, courtyards, a day bed for a carer and an entertainment console that can be used to order meals, in a hospital with impressive ‘green’ credentials as well as cutting edge medical equipment.
A host of ‘teething problem’ accompanied the opening which officials say are being sorted out although workers at the facility continue to find fault.
Under the terms of the 35 year contract with consortium Celsus, taxpayers are paying around $1 million a day for the finance, construction, management and non-clinical services at the hospital such as cleaning and security.
Clinical staff says lockers don’t work, there are problems with doors, carpark electronic signs don’t work, duress alarms are faulty — apparently $1 million a day doesn’t buy what it used to.
Among the tribulations and triumphs in the first six months are:
Blackout
Last month one seventh of the hospital was hit by a blackout when a back-up generator being tested ran out of fuel. When the power failed, two surgical procedures — a colonoscopy and a bile duct stone removal — were plunged into darkness but completed safely, three people were trapped in lifts, patients undergoing radiotherapy had their treatment halted, a dialysis patient’s treatment was paused, and a patient injected with radioactive dye for a PET scan was rushed to another building. Four inquiries are underway.
Acid spill
Fire crews were called to RAH last month after 80L of sulfuric acid spilt into a room at the hospital, when four large batteries ruptured. The batteries were in a power generator room when they leaked the corrosive acid about 7pm on January 15. The spill was contained to the room and one person who experienced minor exposure to the acid was decontaminated on-site.
Food
Unlikely to get a Michelin star anytime soon. While there have been complaints about the quality of the food, at least patients are now getting fed. Early on problems with the bedside console ordering system meant food arriving hours late, if at all. The issue appeared to be a technical hitch with any order slightly out of the ordinary, causing the order to be delayed or default to being a non-order. SA Health says they are working closely with catering contractor, Spotless, to implement strategies to improve the quality of meals. That includes engaging a quality assurance specialist and a food safety specialist to manage end to end food production standards, as well as increasing quality checks on the plating line to ensure meal accuracy. “We have also implemented a number of measures to improve the timeliness of meals and as a result, we have seen a significant improvement in the number of meals being delivered on time and to order,” they say. “We are constantly reviewing and auditing our processes in the kitchen and while we are getting positive feedback from some patients there are some areas we still need to improve on.”
Outpatients
The RAH started life with complaints from clinicians that the outpatients areas were not big enough. Patients arriving for some outpatients appointments now face being moved through multiple waiting areas. For example, they may get sent to one waiting area, then get a text message telling them to move to another waiting area. Then another text telling them to move to another waiting area, before finally being seen One patient who was ‘shuffled’ three times before being seen notes the signage was so poor she needed to ask directions for each move.
Opthamology
The promise that Modbury Hospital would house a statewide ophthalmology centre for excellence made then dumped in 2015 means the ophthalmology outpatients at the new RAH is seeing about half the patients as the old RAH. GPs tell The Advertiser they are not being sent information about patients — one sent a note to the department after three unsuccessful requests for information stating: “As I’m neither clairvoyant nor a mind reader, I’ve requested correspondence by fax since mid January and weeks later, am still none the wiser.” The patient in question had chemical burns to the eyes and the GP was extremely concerned for the person’s sight.
As The Advertiser revealed in February, the waiting list for an eye patient appointment at the RAH continues to blow out, with 299 people on the ophthalmology outpatient waiting list for five years or longer, including 13 on the list for more than a decade and one for almost 13 years, and the average wait time is now 548 days.
Parking
Nurses remain angry about the parking situation due to rosters which may start at 7am or finish at 9.30pm, making public transport difficult. They say shift workers are supposed to have priority for car parks but they have been threatened with being removed from the wait list if they complain. Early start staff say they have been arriving so early to get a street park they have been sleeping in their cars. Staff who have been told there ‘are no car parks available’ have sent The Advertiser photos of a section of the staff carpark showing it is empty, saying they have been unable to find why no-one is allowed to park there.
Signage
As the hospital is run by a private consortium, hospital staff cannot so much as put up a family photo on a wall let alone nail up a clear, obvious sign where needed.
Internet
The internet has been down multiple times, for extended periods, since the hospital opened.
EPAS
The electronic patient record system EPAS — overbudget and behind schedule — is only partially working. The RAH floors cannot support paper records so these have to be brought in from document storage depots at Beverely and Gepps Cross, at cost.
Priority
As revealed by The Advertiser in January, clinicians are being asked to comb through the records of more than 25,000 outpatients to assign them a “priority listing”, which assesses just how urgently they should be seen. An internal SA Health document obtained by The Advertiser showed there are 42,438 patients on the RAH waiting list, including people who have been waiting for an appointment since 2008 — but 25,017 do not have a clinical urgency category assigned to them.
Rescucitation bays
Surgeons continue to complain about lack of space in the eight resuscitation bays when emergency procedures requiring multiple staff are needed. SA Health says the bays meet national guidelines for size but the AMA and doctors’ union SASMOA say there are space problems when a dozen or more people are working together. Work also had to be done to fix the ceiling heights in some technical suites which were too low.
Legionella
Trace amounts of the legionella bacteria were found in 16 drinking taps out of 207 that were tested shortly after the hospital opened, forcing a temporary shut down of the drinking water system.
Technology
The 25 Automated Guided Vehicles (the Rahbots) have undertaken almost 100,000 missions to date — an average of 600 a day.
Pharmacy Robots have dispensed 159,275 items to inpatients and dispensed 58,400 items to outpatients and patients being discharged. SA Health says the RAH is home to one of the biggest Automated Pharmacy Distribution Systems in the nation, bringing South Australia to the forefront of automated medication technology. “The system includes more than 80 automated dispensing cabinets in patient wings to support the accurate and timely distribution of medicines. It is designed to reduce errors in the number of patients receiving the wrong drug or an incorrect dosage and, as you would expect with any new systems, adjustments have been made to ensure it operates efficiently to meet demand.”
Doors
There have been complaints about the doors with staff unable to gain access in some cases. SA Health says they are working on improvements, noting: “There are 4700 doors throughout the hospital and, as with any new building; there was some getting used to how the doors operate. Adjustments have been made in response to feedback from staff and patients to ensure the best movement around the hospital.”
Lack of water
SA Health says: “We have identified areas where water fountains can be installed in outpatient waiting areas and this process will begin shortly. In the meantime all kitchenettes in the outpatient areas are equipped with refrigerators for the storage of cold water that is provided to all patients as required. Bottled water is also available at the outpatient desks.”
BD Kiestra Automated Laboratory
SA Health marks this as a major achievement. The $4m automated bacteriology laboratory lab is the largest in the southern hemisphere. It has fully automated the processing of specimens, including blood urine and wound swabs. The system speeds up results by 40 per cent, with specimens that previously took 24 hours to process available in 14. The Kiestra’s high definition imaging allows some serious bacterial infections to be read from agar plates within three to four hours, rather than waiting up to 18 hours for results.
Clinical Trials Centre
The RAH now has a dedicated Clinical Trials Centre with its own shopfront to the eastern amphitheatre on L3. It is the first purpose-built space within a South Australian hospital where patients can take part in Clinical Trials as part of their ongoing treatment. Clinical trials involved the study of a new drug or device, giving patients access to cutting edge treatments before they are widely available. There are currently more than 500 clinical trials being conducted at the RAH for a wide range of illnesses.
Centre for Creative Health
The Centre for Creative Health, launched in November, is driving collaboration, innovation and research to develop best-practice arts, design, music and health programs to improve the quality and experience of healthcare for patients, families and staff at the Royal Adelaide Hospital, as well as the wider community. There are five gallery spaces throughout the hospital, featuring artwork from patients, staff and local artists. There is also a weekly rotation of events and exhibitions, including the ever popular piano in the main concourse.
Rahbots, myths and folklore
In such a big project urban myths soon abound. One was that a Rahbot had fallen down a liftshaft. This appears to have emanated from a radio talkback caller, who had been told about it by someone who had been told about it by someone else. Officials including SA Health chief executive Vickie Kaminski and then-Health Minister Jack Snelling duly investigated and dismissed it bluntly as rubbish. But such colourful tales tend to take on a life of their own — in the recent blackout it was suggested the Rahbots reverted to talking in their native German. There is also the persistent but unsubstantiated tale of surgeons calling for a medical ‘drain’ during an operation — and having a plumber turn up.
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