What Transforming Health means for Adelaide’s northern suburbs — Modbury and Lyell McEwin hospitals
WE explain the implications of the Transforming Health plan for residents of the northern suburbs of Adelaide.
WE explain the implications of the Transforming Health plan for residents of the northern suburbs of Adelaide.
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MODBURY HOSPITAL
Changes to Modbury Hospital have been among the most controversial in Transforming Health.
In February, 30 senior staff signed an open letter warning changes will put patients at increased risk. The clinical director of the emergency department resigned from the position in March citing the changes, and people needing emergency care have faced long delays due to changed protocols which have forced them to be transferred.
Modbury’s ED has been downgraded but remains open 24/7 for cases which do not require overnight admission — these people are now sent to major EDs such as Lyell McEwin.
Ambulances with such cases will bypass Modbury, and patients who arrive under their own means needing complex care requiring more than 23 hours in hospital will be stabilised and transferred by ambulance, at no cost to the patient.
The cost of ambulance transfer, dubbed the MoHo Express, will be picked up by taxpayers. Plans to have a major eye clinic at Modbury were abandoned after protests from consumer and clinician groups about difficulty of access for many patients.
Modbury Hospital will become the major rehabilitation and subacute services centre for the north and northeast.
It will be a centre for same-day surgery, carrying out an additional 1800 elective surgery procedures a year and treating an extra 3000 patients a year.
Gastroenterology outpatient services and elective endoscopies will commence, and a comprehensive “one-stop breast service” will give women access to a breast surgeon, radiologist and breast-care nurse at the one location for faster diagnosis and treatment.
Medical ward beds are being shifted to Lyell McEwin to make way for rehabilitation services, and the hospital loses orthopedics, general surgery, cardiology and non-acute medicine services.
A $32 million upgrade includes a new hydrotherapy pool and centre for expanded rehabilitation services, which will have 52 beds by the end of the year.
The $32 million upgrade compares with $27.8 million in works planned before Transforming Health changed the focus of the hospital to day surgery and rehabilitation.
SA Health notes 25 per cent of elective surgery cases are delayed or postponed, often because sudden emergency cases take priority with doctors and operating theatres.
The aim of winding down emergency care and increasing elective day surgery procedures is to dramatically cut the cancellation rates, increasing efficiency and reducing inconvenience and discomfort for patients.
Health officials also note that SA’s elective day surgery rate of 52 per cent of surgeries is low compared with other areas, such as the 75 per cent average recorded in the United Kingdom.
The focus on day surgery at Modbury aims to improve that figure, getting patients home faster rather than stuck in hospital.
The move to direct ED cases from Modbury and the QEH to the Lyell McEwin Hospital resulted in 19 of 23 LMH ED doctors signing an open letter in March saying they fear they will be overwhelmed, resulting in “potentially avoidable deaths”.
They wanted their warning on the record in the event of any coronial inquiry because their objection is “based on clearly foreseeable poorer patient outcomes and adverse events”.
LYELL MCEWIN HOSPITAL
As the flagship hospital in the northern suburbs, Lyell McEwin Hospital will handle all major trauma and life-threatening emergency cases from the region in its “super ED”, including many cases which previously would have gone to Modbury Hospital or The Queen Elizabeth Hospital.
ED services will be supported around the clock by senior doctors and nurses as well as diagnostic and imaging support for swift service.
The reforms have delivered a 24/7 orthopedic trauma service, and it gets a new cardiac catheter lab for cardiac emergencies, two new CAT scanners and an emergency stroke service, available 8am-8pm every day.
The orthopedic and stroke service in particular are part of the reforms’ aims of ensuring consistent high-quality health care for emergency cases.
Previously, patients turning up with orthopedic trauma on a Friday night had to wait on average 150 hours for surgery. Now, most such surgery is done within 24 hours.
Lyell McEwin will become the major northern hospital for elective multi-day surgery, allied health services for rehabilitation will be available seven days a week, and it will get a new gym facility.
It will increase the complexity and volume across the current range of surgical services, including vascular, urology and ear, nose and throat surgery. Day surgery and other procedures will continue to be available.
SA Health notes that patients get better outcomes when seen by a specialist who sees a “critical mass” of patients each year compared to just a few.
They also note about 55 per cent of patients in the north and northeast are seen in local hospitals, compared to 88 per cent in the south and central Adelaide — the reforms in the north aim to help people get the help they need in their local area.
Getting a leg-up on orthopedic care
Andrew Thornton, 20, of Fairview Park, is one of the early beneficiaries of Transforming Health changes which have upgraded orthopedic services at the Lyell McEwin Hospital from a weekday to a 24-hour, seven days a week service.
The plan to offer consistent high-quality care for orthopedic trauma cases now sees most such surgery done within 24 hours regardless of arrival time, compared to an average wait of up to 150 hours for patients who arrived on a Friday night.
Mr Thornton, studying telecommunications engineering at the University of Adelaide, suffered complex breaks to his lower right leg in a weekend water skiing mishap at Big Bend on the Murray River in February and was taken by ambulance to the Lyell McEwin Hospital after being stabilised and given pain relief.
He arrived at 7pm and after initial treatment it was decided he needed surgery, and he was operated on at 12pm.
“They were great, I was seen to pretty quickly and initially had a plaster put on but on further investigation the senior surgeon decided I needed surgery for compartment syndrome and I had the operation at midnight,” he said.
“I was very lucky — the idea of waiting until the next day or even longer for surgery was not great. They did a great job and I am back to full function, can walk and do everything, though I haven’t gone back water skiing just yet.”
Ambulance Service — a drive for EDs on wheels
Major changes to the SA Ambulance Service are a crucial aspect of Transforming Health. As “EDs on wheels”, ambulances take on an even more important role as hospital emergency services are realigned and some patients face longer transport rides.
Changes which will see EDs at Modbury, Noarlunga and The Queen Elizabeth Hospital deal with non-life threatening, less complex emergency cases mean ambulances with urgent trauma and medical cases will bypass these in favour of the “super EDs” at the Royal Adelaide Hospital, Lyell McEwin Hospital and Flinders Medical Centre.
A $16 million investment will see an extra 12 ambulances added to the fleet and metropolitan paramedic and support staff increased by about 72 full time equivalents. The services is also exploring options for new ambulance stations in the north and west.
In June a new $3.6 million ambulance station opened at Oakden and in September a $5.3 million station opened at Noarlunga and a station is planned for Seaford — but these were 2014 election promises which predated Transforming Health. The Noarlunga station houses 50 staff, 13 ambulances and five specialised vehicles.
This investment comes against a background of claims the service is already stretched to breaking point and is being propped up by officers working overtime.
SA Ambulance Employees Association state secretary Phil Palmer detailed recent situations including a vehicle accident where a single paramedic had to attend to three victims, and an occasion where there was only one available ambulance in the metropolitan area.
His evidence to the Parliamentary committee inquiring into Transforming Health also included the allegation that a person who died in an ambulance en route to a hospital from a sudden cardiac arrest may have survived if the ambulance had not been delayed due to lack of resources.
SAAS has investigated the claim and while there was a case of a person dying, they insist there was no delay in treatment which could have contributed to the death.
As things stand more than 4700 patient transfers are made each year between hospitals in South Australia, often because patients are not in the right hospital to treat their condition, resulting in delays to treatment and longer recovery times.
If anyone arrives at a hospital using their own transport and they need to be transferred to another site for the most appropriate care, the cost will be covered by the public health system.
Options will also be explored to train paramedics to manage and treat patients in their homes who would normally be transported to hospital for treatment, such as administering intravenous antibiotics and suture wounds.