Women’s and Children’s Hospital Paediatric Intensive Care Unit failings exposed in damning report

A shocking report has revealed the WCH intensive care unit is understaffed, overcrowded and obsolete, causing burnout among exhausted doctors and nurses. Read the findings here.

Sick children fighting for life in the Women’s and Children’s Hospital Paediatric Intensive Care Unit (PICU) are being left without a doctor on site, a devastating report exposing multiple failures in the system shows.

The Advertiser last night revealed the PICU this month lost its accreditation to teach young doctors intensive care medicine. The damning assessment which withdrew that accreditation found a system rife with chronic failures, ranging from staffing and equipment to bed spaces and confidential files being left in the open.

The sole positive aspect cited by the College of Intensive Care Medicine was the PICU’s “motivated but exhausted medical and nursing staff”.

The College of Intensive Care Medicine issued a damning verdict after examining the Women's and Children's Hospital Paediatric Intensive Care Unit.

The report found the junior medical staffing model is one registrar per shift.

“This single person is also required to attend outside ICU activities such as medical emergencies, difficult IV access in both the ward and emergency department as well as the review of obstetric patients at times,” it states.

“This means no doctor is immediately available in the ICU during these times, which breaches the college’s minimum standard for our intensive care units.

“The registrar job is so busy there is often no time to write medical notes that leave time for reflection and learning.

“Given the roster of only five people, this means leave is very difficult to access or not available. This leaves overtime as the only option to cover leave.”

Women’s and Children’s Hospital chief executive Lindsey Gough, centre flanked by Dr Todd Maddock and Dr Gavin Wheaton in 2020. Picture: Tricia Watkinson

It warned “the nursing staff are exhausted” as the unit consistently runs above capacity and relies on staff working on days off or coming in from leave, and says “unfortunately the long-term consequence of this approach is staff burnout and fatigue”.

It notes the system of having medical specialists on call is “onerous duty and not sustainable” as they are often required to attend after hours due to the nature of the work.

In a litany of other failures which led the college to conclude the unit cannot continue to be accredited for training “as it fall substantially short of expectations on several fronts”, it found:

THE physical environment is inadequate, a point identified in previous inspections, with clinical and non-clinical spaces not meeting standards;

BED spaces are small and many cannot accommodate the required ICU equipment or safely accommodate a parent;

STORAGE hazards with equipment blocking the corridor access, drugs being stored in accessible areas and some equipment needing ICU staff to run to the basement to collect it;

NO private space “for difficult or private conversations” with families, and the staffroom used as a family meeting room where the inspection found confidential staff files in open shelving;

BATHROOMS are inadequate, particularly the female staff facilities;

STAFF at all levels so busy with clinical work that “other non-clinical work such as teaching, research and quality assurance activities are regularly deferred or cancelled”.

THE DAMNING VERDICT

The report also criticised putting adult obstetric patients in the PICU which it labelled a “difficult and historic issue”, saying “while keeping families together is an admirable principle, children and adults should not be competing for the same scarce resources … when the current paediatric resources are stretched beyond capacity”.

WCH Alliance member Professor Warren Jones said warnings on these issues had been largely ignored for years.

“The public needs to know the board and executive were warned about these problems over a year ago,” he said.

Women’s and Children’s Health Network executive director medical services Dr Gavin Wheaton said hospital officials are working with the college on a plan to address the issues.

Health Minister Chris Picton has called for a report on progress towards meeting the college’s standards within two weeks.

Opposition health spokeswoman Ashton Hurn condemned lack of action leading to the situation.

“This report is so damning that it makes references to the ICU being understaffed and overcrowded and it also suggests sick children fighting for their lives are being left without a doctor in sight,” she said.

“There are serious concerns about little lives being put at risk because of the Malinauskas Labor Government’s failure to act.

“The reality is we know the Malinauskas Labor Government received a warning that the accreditation of the Paediatric ICU was at risk.

“I don’t believe it should have ever gotten to this situation.”

SA-BEST MLC Connie Bonaros called for an immediate independent inquiry, saying “the blame lies entirely at the feet of the hospital management and not at the hard-working, dedicated medical clinicians who dedicate their lives to our sick children.”

“Heads at the WCH must roll,” she said. “It is said a fish rots from the head down so the blame starts at the top.

“Senior management – and presumably the Board – have known about these accreditations failings for a significant period of time but here we are.

“The revelation that sick children fighting for life in the PICU are being left without a doctor on site borders on medical negligence.”

A new 394-bed Women’s and Children’s Hospital will be built on the Thebarton Police Barracks site in the CBD, near the RAH, will cost between $3bn to $3.2bn and is slated for completion in 2030-2031.