Reloca'ng  a  neurosurgical  service:    It’s  not  brain  surgery    

Arna  Chauncey  Nursing  Director  –  Periopera've  and  Procedural  Services  Mater  Health  Services  

Jus'ne  Jones  Periopera've  Manager  Mater  Private  Hospital  

Presenta1on  Outline    •  History  

•  Vision  

•  Planning  

•  Implementa'on  

•  Lessons  learned  

•  A  li5le  fun  

In  1954,  the  Mater  formed  Queensland’s  first  neurosurgery  department  with  Dr  Peter  Landy  as  physician  and  Dr  Geoff  Toakley  as  surgeon  

Neurosciences  Service  Vision  

•  The  Journey  

•  Cri'cal  Success  Factors  

•  Periopera've  Unit    –  Dedicated  Welcome  Lounge  

–  3  dedicated  theatres  –  Access  to  ICU    –  Access  to  ED  

–  Access  to  Imaging  services.    

The  Vision  

•  Inpa'ent  Units  –  Centralised  service  –  Coloca'on  of  public  and  private  pa'ents  –  Observa'on  area  –  Stroke  unit  –  Epilepsy  monitoring  (in  the  future)  

The  Vision  

Next  Steps…….  Where?  

•  Our  Mission  •  Why  Me??  •  Scope  •  How  to  achieve  the  goal?  

The  Beginning  

•  Understanding  service  demand  •  Predicted  ac'vity  •  Stakeholder  engagement  •  Rela'onships  and  access  to  other  departments  

and  services  •  Floor  plans  •  Workforce  planning  •  Planning  challenges  

Planning  

 

Brisbane  Metro  North

Brisbane  Metro  South

Darling  Downs  West  Moreton

Sunshine  Coast  Wide  Bay

Central  Qld Other

MPH             Neurology 15% 62% 4% 6% 5% 8%

Neurosurgery 17% 35% 11% 10% 13% 14% Non-­‐Acute  RehabilitaQon   29% 59% 3% 2% 1% 6%

MPH  Total 25% 56% 4% 4% 4% 7%               MAH             Neurology 7% 84% 1% 6% 0% 3% Neurosurgery 15% 77% 1% 3% 0% 4% Non-­‐Acute  RehabilitaQon   5% 83% 3% 7% 0% 3%

MAH  Total 7% 83% 1% 5% 0% 3%

Who  will  the  Neuroscience  Centre  Service?  

*Percentage  separa1ons  by  place  of  residence  and  hospital  for  the  five  key  Districts  2012/13    

Current  Private  Neurosurgery  Ac'vity  

No.  of  Mins  FY  2012/2013   No.  of  Mins  May  2013  /  May  2014   No.  of  Mins  FY  2013  /  2014  

59213**   35483   28868  

Current  &  Predicted  Ac1vity  

•  Cranial  Procedures  –  Shunts  –  Tumours  –  Haematoma's  –  Aneurysms  

•  Pituitary  procedures  •  Carpel  Tunnel  

Specific  Neurosurgery  Ac1vi1es  

•  Spinal  Procedures  –  Discectomy  –  Laminectomy  –  Disc  Arthroplasty  –  Fusion  

•  Neuroscience  Stakeholder  Mee'ng  

•  Mul'disciplinary  

•  Internal  and  External  stakeholders  

 

Engagement  of  Key  Stakeholders  

•  Neurosurgical    theatres  integrated  with  current  theatres  

•  Medical  and  Surgical  pa'ents  separated  

•  No  Public  Adult  Neurosurgery  performed  

•  Public  and  Private  neurology  services  by  different  hospital  on  same  campus  

•  30  bed  Private  Surgical  Ward  

•  Private  stroke  pa'ents  nursed  throughout  MPH  

•  Alloca'on  of  beds  for  stroke  pa'ents    

•  General  Neurology  services  

•  Limited  space  available  for  VMO  consul'ng  rooms  

Current  State  

•  Preadmission  

•  Outpa'ent  clinics  

•  Welcome  Lounge  

•  Opera'ng  theatres  

•  CSSD  

•  ICU  

•  Inpa'ent  Unit  

•  Tes'ng  &  Diagnos'c  (Radiology  and  Pathology)  

Rela1onships  with  other  services  

OT  19  

OT  20  

PACU  

OT  18  

ICU  

Neurosurgery  Welcome  Lounge  

Neurosurgery  Opera-ng  Theatres  

Workforce  

Planning  Challenges  

•  Neuroscience  Theatres  –  Different  management,  same  floor  –  Pa'ent  Flow  –  Periopera've  Resources  •  Material  •  Human  

–  Space  availability  –  VMO  Theatre  alloca'ons  

 

Planning  Challenges  (cont)  

•  Moving  Goal  Posts  –  The  Stroke  Unit  –  Epilepsy  Services    

•  “Must  have”  mentality  •  Staff  Educa'on  and  Upskilling  •  Flow-­‐on  effects  of  change    

 

•  Crystal  Ball  Predic'ons  –  Case  Numbers  –  Case  Types  –  Separa'ons  (Public  &  Private)  –  Neurosurgery  consulta'ons  (Public)  

Planning  Challenges  (cont)  

•  Unresolved  planning  issues  •  Staff  integra'on  •  Pa'ent  flows  •  Radiology  •  CSSD  •  Food  services  •  Rela'onships  with  other  services  and  departments  

–  CSSD  –  ICU  

•  Capability  /  understanding  impera'ves  –           MHB  Opera'ng  Theatres  

Implementa1on  

•  Engagement  +++++  •  Mee'ngs  ++++  •  The  dreaded  scope  creep  and  budget  constraints  •  Being  the  meat  in  the  sandwich  •  Pa'ent  flows  •  Food  •  Car  parking    •  Internal  poli'cs  +  external  poli'cs    •  On  again  off  again  ICU  

Implementa1on  (cont)  

•  Shared  PACU  and  segregated  staffing  •  Shared  S8  Cupboard  and  miscounts  •  Pa'ent  flow  •  Staffing  for  paediatric  services  •  Food    •  Car  parking  •  Staffing    •  Last  minute  changes  •  PACU  •  Radiology  

Post  Implementa1on  Challenges  

•  Time  is  your  enemy  –  never  enough  of  it  •  Adaptability  •  Leverage  your  rela'onships  •  Ask  for  help  •  The  smallest  things  caused  the  biggest  issues  

(tours,  food,  parking,  radiology,  lockers)  •  Complexi'es  of  funding  models  (public  and  

private)  

Lessons  learned  

It’s  not  brain  surgery….  

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