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Part B (5)

Service Profile for Roma Hospital

Infrastructure Renewal Planning Project for Rural and Remote Areas

July 2010


Service Profile for Roma Hospital Paper 2, July 2010

“PRINTED COPIES ARE UNCONTROLLED”

Endorsed by IPPEC—does not represent Queensland Health policy at this time.

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Contents

1 Executive summary ........................................................................................................ 3 2 Service Profile for Roma Hospital ................................................................................. 5

2.1 Geographic profile ...............................................................................................................5 2.2 Demographic profile.............................................................................................................5

2.2.1 Catchment population ...........................................................................................5 2.2.2 Services in the secondary catchment....................................................................7

2.3 Roma Hospital .....................................................................................................................9 2.3.1 Hospital inpatient activity.....................................................................................10 2.3.2 Projected activity .................................................................................................12

2.4 Core services.....................................................................................................................14 2.4.1 Surgical and procedural ......................................................................................14 2.4.2 Maternity..............................................................................................................15

• Maternity beds/rooms ......................................................................................15 • Accommodation for families.............................................................................16 • Paediatrics.......................................................................................................16

2.4.3 Emergency Department ......................................................................................17 2.4.4 General medical ..................................................................................................18

• Non-admitted occasions of services ................................................................18 • Visiting services including specialists ..............................................................19 • Flying Specialist Services ................................................................................20 • Medical Specialist Outreach Assistance Program ...........................................20

2.4.5 Current support services .....................................................................................21 • Pathology.........................................................................................................21 • Medical imaging...............................................................................................21 • Pharmacy ........................................................................................................21 • Dental/oral health services ..............................................................................21

2.5 Primary health care and community health services .........................................................22 • Integrated mental health services....................................................................22 • Allied health services .......................................................................................23

3 Current and future bed requirements ......................................................................... 25 3.1 Summary of projected bed requirements...........................................................................25

• Other treatment spaces ...................................................................................25 4 References..................................................................................................................... 26 5 List of figures and tables ............................................................................................. 27





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1 Executive summary The Infrastructure Renewal Planning Project for Rural and Remote Areas has been identified by the Deputy Premier as a priority project aimed at providing a comprehensive and prioritised health infrastructure program for rural Queensland. The need to address health inequities and access to hospitals in remote areas has also been identified by the Commonwealth Government’s National Health and Hospital Network Agreement 2010.

This Service Profile for Roma Hospital is one of 12 profiles developed for each of the Queensland prioritised rural sites. The profile identifies the current level (draft CSCF v3 Level 3.0) and mix of clinical services provided at each site with a focus on the core services of surgical and procedural, maternity, Emergency Department and general medical. To improve the efficiency of current service delivery, infrastructure upgrades will be required for the Emergency Department, maternity services area and the Operating Theatre suite.

Table 1 details the current and projected bed requirements for Roma Hospital. The Queensland Health Executive is currently investigating opportunities to address priority infrastructure issues identified at Roma Hospital which are impacting the delivery of emergency and maternity services. Infrastructure improvement for these services would enable growing levels of emergency activity to be safely accommodated and provide an enhanced environment for women to access maternity care close to where they live.

As Roma Hospital does not have an Outpatient Department, a separate Outpatient Department is proposed to support the needs of a range of health services, including visiting specialists and primary medical services. Alternatively, sufficient consultation and/or treatment rooms could be created to accommodate these services in an area separate from the Emergency Department.

Roma Hospital currently has insufficient capacity for Stage 1 and Stage 2 recovery spaces to be located on the same floor as the Operating Theatres. Refurbishment and extension of the Operating Theatre suite would improve integration and use of workforce, and provide capacity for potential growth in surgical activity.

Rural hospitals rely on visiting clinicians to provide a range of specialist services. Dysfunctional layouts and insufficient treatment spaces make it difficult to attract specialists to the hospital to provide these services. Without the services provided by visiting specialists rural communities will continue to experience health inequities.

Rural hospitals typically have difficulty recruiting skilled staff, and the age and condition of the staff accommodation is a major barrier to attraction and retention of staff. If staff cannot be recruited and retained, patient access to safe and sustainable services will be compromised.





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Table 1: Summary of current and future bed requirements for Roma Hospital

Bed and treatment spaces Current number Number required by 2021/22

Overnight beds 37 18

Same day beds 0 7

Bed alternatives 8 +

4 chemotherapy chairs

10 +

6 chemotherapy chairs

Emergency Department treatment spaces

6 15

Multipurpose consultation rooms (for outpatients)

0 7 multipurpose +

3 maternity





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2 Service Profile for Roma Hospital

2.1 Geographic profile

The South West Health Service District (the District) in western Queensland is vast, covering an area of 319,800 square kilometres and encompasses the councils of Balonne, Bulloo, Murweh, Maranoa Regional, Quilpie and Paroo. Roma is a town in the north eastern part of the District.

Roma Hospital is a primary hub, providing support to all health services in the District. St George and Charleville Hospitals are the two secondary hub hospitals within the District. Other small hospitals in the District include Surat, Injune and Cunnamulla Hospitals. There are also multipurpose health services at Dirranbandi, Mungindi, Quilpie, Augathella and Mitchell and Primary Health Care Centres at Wallumbilla, Morven and Thargomindah.

According to the Australian Statistical and Geographical Categories, Roma town is classified as ‘outer regional’ with a remote area score of RA3.1 The rest of the South West Health Service District is categorised as ‘remote’ or ‘very remote’ with categories of RA4 and RA5. The District has areas which have significantly restricted accessibility of goods, services and opportunities for social interaction.1

2.2 Demographic profile

2.2.1 Catchment population

The primary catchment area for Roma Hospital includes the Statistical Local Areas of Roma Town (Table 2), Bendemere, Booringa, Bungil and Waroo which make up the Maranoa Regional Council (Local Government Area). This area also includes the towns of Injune, Mitchell, Wallumbilla and Surat (Figure 1).





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Figure 1: Estimated resident population by statistical local area, total persons South West Health Service District June 2008

The 2008 Estimated Resident population of the primary catchment was 13,189.

Table 2: South West Health Service District, and associated population

SLA for South West HSD 2006^ 2008 2011 2016 2021

Balonne 5,629 4,852 5,691 5,772 5,925

Bendemere 979 1,021 973 969 969

Booringa 1,819 1,848 1,792 1,766 1,741

Bulloo 456 377 455 451 453

Bungil 1,964 2,195 1,963 1,960 1,968

Murweh 5,027 4,838 5,016 4,989 4,969

Paroo 2,144 1,962 2,131 2,099 2,075

Quilpie 1,046 1,021 1,015 1,007 998

Roma (T) 6,835 7,041 6,944 7,014 7,118

Waroo 1,051 1,084 1,052 1,057 1,056

Total 26,950 26,239 27,032 27,084 27,272

Source: Queensland Health Admitted Patient Data Collection, May 2010

Figure 2 details the population projections for Roma by age. In the period 2006 to 2011, the highest percentage increase in population is predicted to be in the age groups 25–29 and 60–64 years. In the period 2011 to 2016 the highest percentage increase is projected to be in the age groups 30–34 and 65–69 years. By 2016, there is a notable population decrease predicted in the age groups 5–9 and 35–49 years.

Hospitals Multipurpose Health Centres Outpatient Clinics

Charleville to Roma 3 hrs

Roma to St George 2 hrs 20 min

2 hrs

20 min

3 hrs

MaranoaMaranoaMaranoaMaranoaMaranoaMaranoaMaranoaMaranoaMaranoa

13,14513,14513,14513,14513,14513,14513,14513,14513,145

BalonneBalonneBalonneBalonneBalonneBalonneBalonneBalonneBalonne

492749274927492749274927492749274927

QuilpieQuilpieQuilpieQuilpieQuilpieQuilpieQuilpieQuilpieQuilpie

104910491049104910491049104910491049

BullooBullooBullooBullooBullooBullooBullooBullooBulloo

394394394394394394394394394

ParooParooParooParooParooParooParooParooParoo

206320632063206320632063206320632063

Morven Morven Morven Morven Morven Morven Morven Morven Morven

Outpatients Outpatients Outpatients Outpatients Outpatients Outpatients Outpatients Outpatients Outpatients

ClinicClinicClinicClinicClinicClinicClinicClinicClinic

MitchellMitchellMitchellMitchellMitchellMitchellMitchellMitchellMitchell

InjuneInjuneInjuneInjuneInjuneInjuneInjuneInjuneInjune

RomaRomaRomaRomaRomaRomaRomaRomaRoma

SuratSuratSuratSuratSuratSuratSuratSuratSurat

WallumbillaWallumbillaWallumbillaWallumbillaWallumbillaWallumbillaWallumbillaWallumbillaWallumbilla

Mungindi Mungindi Mungindi Mungindi Mungindi Mungindi Mungindi Mungindi Mungindi

Health Health Health Health Health Health Health Health Health

ServiceServiceServiceServiceServiceServiceServiceServiceService

Dirranbandi Dirranbandi Dirranbandi Dirranbandi Dirranbandi Dirranbandi Dirranbandi Dirranbandi Dirranbandi

Health ServiceHealth ServiceHealth ServiceHealth ServiceHealth ServiceHealth ServiceHealth ServiceHealth ServiceHealth Service

Bollon Bush Bollon Bush Bollon Bush Bollon Bush Bollon Bush Bollon Bush Bollon Bush Bollon Bush Bollon Bush

Nursing ServiceNursing ServiceNursing ServiceNursing ServiceNursing ServiceNursing ServiceNursing ServiceNursing ServiceNursing ServiceCunnamullaCunnamullaCunnamullaCunnamullaCunnamullaCunnamullaCunnamullaCunnamullaCunnamullaThargomindahThargomindahThargomindahThargomindahThargomindahThargomindahThargomindahThargomindahThargomindah

QuilpieQuilpieQuilpieQuilpieQuilpieQuilpieQuilpieQuilpieQuilpie

CharlevilleCharlevilleCharlevilleCharlevilleCharlevilleCharlevilleCharlevilleCharlevilleCharleville

AugathellaAugathellaAugathellaAugathellaAugathellaAugathellaAugathellaAugathellaAugathella

MurwehMurwehMurwehMurwehMurwehMurwehMurwehMurwehMurweh

486348634863486348634863486348634863

St GeorgeSt GeorgeSt GeorgeSt GeorgeSt GeorgeSt GeorgeSt GeorgeSt GeorgeSt George





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Figure 2: Population projections for Roma town

Roma Population Projections

0

100

200

300

400

500

600

700

0-4

5-9

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-7

9

80-8

4

85+

Age Groups

Num

ber

of P

eople

(M

& F

)

2006

2011

2016

The secondary catchment for Roma Hospital is the whole of the District and includes the Statistical Local Areas of Balonne, Bendemere, Booringa, Bulloo, Bungil, Murweh, Paroo, Quilpie, Roma and Waroo. The secondary catchment also includes Charleville with a total 2008 population of 3466 and St George with a total population of 2528.

The 2008 Estimated Resident Population of the secondary catchment was 26,150. It is expected that the population change in the District will be nominal for the years 2011–2016 (2% or 468 people) and 2016–2021 (2% or 670 people). However the population for the Maranoa Regional Council (Local Government Area) is expected to increase by 10 per cent for the period 2006–2021. This increase is largely due to proposed and actual resource investment, including mining. As a result the 15–34 years age group has the largest projected increase by 2016 with the 85+ year age group having the next largest increase. By 2026 the population of the secondary catchment is projected to be about 27,272 persons.

The Roma Hospital also provides health services to visitors to the District and some residents of the Darling Downs–West Moreton Health Service District.

In 2007 there was an estimated 3.9 per cent of the District population who identified as Aboriginal and Torres Strait Islander. This is a relatively young population, with 38.6 per cent (1212 people) aged 0–14 years. Only 17.6 per cent (461 people) were aged over 45 years, of which 3.9 per cent (122 people) were aged over 65 years.

2.2.2 Services in the secondary catchment

In 2008/09 the majority of inpatient activity in the District (secondary catchment) was provided at the three hub services. The combined level of self sufficiency provided by these hubs was:

• 76 per cent for adult overnight separations

• 81 per cent for adult same day separations





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• 70 per cent for children’s overnight separations

• 69 per cent for children’s same day separations.

In 2008/09 the District was self sufficient in a few of the special Enhanced Service Related Groups (ESRGs) including ophthalmology and other urological procedures, with outflow primarily going to Metro South Health Service District and some to Metro North Health Service District (Attachment B).

The District has significant outflows of patients for maternity services (deliveries) and renal dialysis (haemodialysis for adults) to the Darling Downs–West Moreton Health Service District.

For children there were significant outflows for qualified neonates and injuries, with the outflows going to Metro North, Metro South, and Darling Downs–West Moreton Health Service Districts.





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2.3 Roma Hospital

Roma Hospital provides a range of surgical and procedural, maternity, general medical and Emergency Department inpatient and ambulatory care services, including:

• accident and emergency

• maternity

• specialist outpatients

• medical imaging

• pharmacy

• general medical

• general surgical

• palliative care

• chemotherapy

• paediatric

• dental surgery

• day surgery

• obstetrics and gynaecology

• ophthalmology

• urology.

The basis for identifying gaps in service capability against the core service profile is to secure and consolidate services provided at Roma Hospital, the primary hub service in the District. This may involve the enhancement of existing service roles and staffing levels to support its role in the District.

The current level of service capability at Roma Hospital is outlined in Table 3. Gaps are also identified against this level of service in Table 3. Services provided should align with the draft CSCF v3.0 Level 3 or lower.

Providing the minimum suite of core services aims to ensure the provision of surgical and procedural, maternity, Emergency Department and general medical services at Roma Hospital.

Table 3: Draft CSCF v3.0 service gap analysis

Core services

Draft CSCF v3.0 Level Current services

Current CSCF Level Gaps

Emergency services 3 Emergency services 3

Medical services 3 Medical services 3

Surgical services 3 Surgical services 3

Peri-operative services 3 Peri-operative Services

3

Anaesthetics services 3 Anaesthetics services

3

Maternity services 3 Maternity services 3

Neonatal services 3 Neonatal services 3

Mental health Services 2 Mental health services

2

Rehabilitation services 3 Rehabilitation services

3

Palliative care services 2 Palliative care services

2

Pathology services 3 Pathology services 3





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Core services

Draft CSCF v3.0 Level Current services

Current CSCF Level Gaps

Medical imaging services

3 Medical imaging services

3 ultrasonographer– only a weekly to fortnightly visiting service with two full days on the weekend

Pharmacy services 3 Pharmacy services 3

Source: Queensland Health, February 2010

2.3.1 Hospital inpatient activity

The Hospital has an annual average occupancy rate of 30.8 per cent for all age overnight services. Patients from the District account for 85.6 per cent of beddays and 9.9 per cent of patients are from Central Queensland and Darling Downs–West Moreton Districts combined.

Table 4: All age activity at Roma Hospital by separations and district of residence

District of residence Separations %* Beddays

South West 1621 85.6 4832

Darling Downs–West Moreton 140 7.4 171

Central Queensland 48 2.5 68

Not Stated 20 1.1 41

Sunshine Coast–Wide Bay 18 1.0 29

Metro South 15 0.8 30

Metro North 7 0.4 19

Central West 6 0.3 20

Gold Coast 6 0.3 16

Mackay 4 0.2 6

Townsville 4 0.2 4

Mt Isa 3 0.2 3

Cairns and Hinterland 1 0.1 1

Torres Strait–Northern Peninsula 1 0.1 1

Total 1894 100 5241

Source: Queensland Health Admitted Patient Data Collection, April 2010

*Rounded to nearest 0.1 per cent

The acute ward at the Roma Hospital is a 30 bed unit that provides care for acute/medical conditions, paediatrics, some limited high acuity care, aged and respite care, mental health, and some rehabilitation for post-operative patients within the parameters of draft CSCF v3.0 Level 3 services. There are an additional seven beds in a separate maternity ward giving Roma Hospital a total of 37 beds.

Table 5 and Table 6 summarise the inpatient activity and average occupancy for Roma Hospital and top 10 adult Service Related Groups (SRGs) respectively over the last five years. During this period separations did not change, while beddays decreased by just below 10 per cent.





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Table 5: Top 10 adult Service Related Groups including same day separations and overnight separations with beddays at Roma Hospital, 2008/09

Same day Separations Overnight Separations Beddays

Chemotherapy and Radiotherapy 130 Obstetrics 156 434

Diagnostic GI Endoscopy 121 Cardiology 135 355

Non subspecialty medicine 62 Non-subspecialty Surgery 123 344

Ophthalmology 59 Respiratory Medicine 104 415

Urology 52 Non-subspecialty Medicine 88 415

Plastic and Reconstructive Surgery 44 Neurology 65 182

Gynaecology 36 Orthopaedics 49 243

Neurology 31 Urology 47 114

Orthopaedics 31 Gastroenterology 42 130

Cardiology 27 Immunology and Infections 35 127


For the year 2008/09, same-day activity endoscopies, ophthalmology and urology made up the majority of the separations, although ophthalmology separations decreased from the previous year. Chemotherapy has increased significantly (83 per cent) between 2006/07 and 2008/08, due to regular visits of an oncologist from Toowoomba.

Table 6: Five year trend of adult same day activity at Roma Hospital, in decreasing order for 2008/09

Same day separations 2004/05 2005/06 2006/07 2007/08 2008/09 % Change Over 5 Years

Chemotherapy and Radiotherapy 71 65 38 90 130

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Diagnostic GI Endoscopy 87 103 88 98 121 41

Non-subspecialty Medicine 19 53 43 28 62 44

Ophthalmology 68 51 84 76 59 -13

Urology 21 22 40 52 52 68

Plastic and Reconstructive Surgery 33 37 53 45 44

25

Gynaecology 41 37 47 40 36 12

Neurology 12 15 24 12 31 63

Orthopaedics 28 23 31 23 31 14

Cardiology 15 20 18 30 27 8






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For the five year period 2004/05–2009/10, the obstetric SRGs consistently had the highest number of separations and beddays at Roma Hospital. This is despite obstetric separations decreasing by 20 per cent during 2008/09 and 7.6 per cent over the last five years. Cardiology and neurology had increased by 11.5 and 18.2 per cent respectively for the same period, whereas gastroenterology decreased by 40 per cent.

Table 7: Five year trend of adult overnight activity for top 10 Service Related Groups at Roma Hospital 2008/09

Overnight separations 2004/05 2005/06 2006/07 2007/08 2008/09 % Change

Over 5 Years

Obstetrics 169 169 196 194 156 -7.6

Cardiology 121 103 129 131 135 11.5

Non-subspecialty Surgery 119 115 115 99 123 3.3

Respiratory Medicine 128 119 76 119 104 -19

Non-subspecialty Medicine 90 84 93 86 88 -2.2

Neurology 55 46 55 57 65 18.2

Orthopaedics 48 55 48 39 49 2.0

Urology 37 36 59 33 47 27

Gastroenterology 70 93 42 65 42 -40

Immunology and Infections 31 31 40 49 35 13


2.3.2 Projected activity

In rural hospitals beds are classified as multipurpose as they are not designated into specific bed type categories because in Level 3 services (draft CSCF v3.0) there are no specialist clinical units. When projecting overnight beds, bed type categories have been limited to multipurpose beds only.

The profile of projected activity in rural hospitals is not expected to change, however with improved infrastructure, including modernised layouts or refurbished buildings, service provision could be enhanced. Maternity, emergency services, surgical and outpatient services could continue to grow and provide more efficient services.

The bed types and treatment spaces set out in Tables 18 and 19 reflect the categories from the More Beds for Hospitals Strategy.2 It should be noted that many of the categories outlined in the More Beds for Hospitals Strategy2 are not applicable for rural hospitals. The projections have been calculated using aIM data and data templates developed by the Planning and Coordination Branch Statewide (Data) Team. The benchmarks and methodology used for calculating the projected bed categories are described in the Statewide Implications for Service Provision Section 4.

Roma Hospital currently has 37 multipurpose overnight beds and projections indicate that only 18 overnight beds will be required by 2021/22 (applying an 85% occupancy rate) or 22 overnight beds (applying a 70% occupancy rate).

Using the Victorian Normative Benchmarks, Roma Hospital currently has a major and minor theatre with insufficient Stage 1 recovery bays to meet benchmark requirements. An additional two recovery bays are required now, with no further increase required by 2021/22.





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There are currently eight Stage 2 recovery chairs which would need to increase to ten by 2021/22 with consideration for the volume of scheduled day surgery activity. If additional visiting specialist are persuaded to visit surgical services could increase. Roma Hospital also requires that there be an increase of two chemotherapy chairs to meet the activity demand generated by the weekly visits of an oncologist. The number of these chairs should not be double counted with same day bed numbers as these usually serve the same purpose in rural hospitals. Currently there are no same day beds but it is projected that seven will be required by 2021/22.

The number of Emergency Department treatment spaces will need to increase from six to 13 by 2021/22. These treatment spaces will need to include a mix of acute treatment trolley spaces (including a resuscitation cubicle), consultation rooms and specific treatment rooms (e.g. plaster procedure and isolation rooms). Additional multipurpose consultation rooms will be required for outpatient activity.

As there is currently no Outpatient Department at Roma Hospital, there are insufficient outpatient consultation rooms. Seven multipurpose outpatient consultation rooms and three maternity/ women’s health consultation rooms are required by 2021/22.

In 2008 there were 140 births at Roma Hospital, projected to increase to 160 births by 2021/22 if there is no change in the model of care (Table 8).

Table 8: Current and projected births for South West Health Service District 2007/08–2021/22

2007/08 2011/12 2016/17 2021/22

Total births for South West Health Service District as a district of residence

*461 463 503 525

Roma Hospital 140 150 156 160

St George Hospital 69 69 73 75

Charleville 40 40 40 40

Cunnamulla 6 6 6 6

*Live births by district of usual residence Queensland 2006–2008 source perinatal data collection Projections developed by Office of Economic and Statistical Research using Perinatal Data Collection





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2.4 Core services

Outlined below is a description of the four core services provided at Roma Hospital –surgical and procedural, maternity, Emergency Department and general medical.

2.4.1 Surgical and procedural

Roma Hospital provides surgical and procedural services at a draft CSCF v3.0 Level 3. Roma Hospital’s Operating Theatre is accessible 24 hours a day, seven days a week. Most surgery is done on a weekly and/or monthly basis by visiting specialists. The Flying Surgeon visits once a week, with other visiting services providing surgery on another day every week. Additional surgery done at Roma Hospital is managed by Hospital medical staff and local general practitioners on other days.

Multiple visiting specialists often arrive at the same time, as they travel together in the Flying Surgeon’s plane. They generally travel from Toowoomba and require sufficient consultation spaces and theatre time on the day of visiting. Currently the dysfunctional and aged layouts of the Operating Theatre and non-existent outpatient spaces exacerbate problems of capacity and inhibit the capability to provide services.

Infrastructure improvements are required as the Operating Suite currently does not have the built capacity to provide sufficient Stage 1 and Stage 2 recovery bays in the same place. There are eight Stage 2 recovery chairs and a bed in a separate building to the Operating Suite. When one of the ophthalmologists visits, the peak requirement is 14 recovery chairs. On these days it is necessary to use overnight beds to accommodate the additional cases.

Substantive theatre specialties are non-specialty surgery, ophthalmology, obstetrics and gynaecology, urology and dental (Table 9). Roma Hospital does not have an Intensive Care Unit and therefore cannot undertake complex surgery. Roma Hospital, like all rural hubs, has the capability to manage emergencies and higher acuity care while waiting transfer out to a higher level facility.

Table 9: Current top 10 adult surgical/procedural Service Related Groups at Roma Hospital for 2008/09


Diagnostic GI Endoscopy 121 Non-subspecialty Surgery 34 97

Ophthalmology 56 Urology 27 64

Plastic and Reconstructive Surgery 44 Diagnostic GI Endoscopy 20 83

Urology 40 Obstetrics 19 73

Gynaecology 29 Gynaecology 16 30

Orthopaedics 19 Upper GIT Surgery 13 22

Non-subspecialty Surgery 6 Ophthalmology 11 14

Colorectal Surgery 4 Plastic and Reconstructive Surgery 9 20

Breast Surgery 2 Colorectal Surgery 7 17

Ear, Nose and Throat 2 Ear, Nose and Throat 6 7






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During 2008/09, the highest number of surgical separations were endoscopies (same day activity), and non-subspecialty surgery (overnight activity). Although obstetrics had the highest number of separations, it had the fourth highest number of overnight surgical separations.

2.4.2 Maternity

As the primary hub for maternity services in the District, Roma Hospital provides a booking-in clinic, antenatal clinic and classes, birthing and postnatal care. Postnatal follow up (after discharge) is currently done by telephone with some casual drop-in activity. Table 10 provides the maternity and gynaecology occasions of service at Roma Hospital. Maternity occasions of service have decreased slightly in 2008/09 after four years of increases. Gynaecology occasions of service have decreased by 41 per cent over the last five years.

Table 10: Maternity and gynaecology occasions of service at Roma Hospital 2004/05–2008/09

Clinics 2004/05 2005/06 2006/07 2007/08 2008/09 % Change Over 5 Years

Gynaecology 399 416 335 317 234 41

Maternity 1009 1249 1384 1477 1140 13


Roma, Charleville, St George and Cunnamulla Hospitals provide low risk maternity services with planned deliveries of ≥37 completed weeks gestation. There is some ability to manage unplanned deliveries of 35–37 weeks gestation, elective and emergency vaginal and assisted deliveries and selected low risk elective caesareans. The average length of stay after a vaginal delivery is 3.2 days, after a caesarean section is 4.7 days, for a postnatal stay (postnatal readmission) is 2.5 days and for an antenatal admission is 1.9 days.

Antenatal care and postnatal care is provided across the District under a network arrangement, with St George, Charleville, Cunnamulla and Roma Hospitals offering birthing services. Women often travel long distances for antenatal appointments, birthing, postnatal and child health services.

The Flying Obstetrician and Gynaecologist service is based in Roma and provides specialist services across the District and is also responsible for visiting other towns in Queensland. These services are provided both as an elective and emergency service.

Maternity beds/rooms

Maternity service provision is complicated by the configuration of the current infrastructure, which includes delivery suites, ward, and antenatal and gynaecology clinics. Trolleys cannot be manoeuvred into rooms resulting in unsafe situations for women and staff during routine and emergency care. In addition, there is no child-safe waiting area located in the maternity services area.

Currently there are no specific maternity consultation or appropriate gynaecological procedure rooms. When the Flying Obstetrician and Gynaecologist visit Roma Hospital most of the Emergency Department consultation rooms are used for the duration of the visit. There is no connection to maternity as there is no capacity in this area and there are no consultation rooms for the Women’s Health Nurse Clinics and Midwifery Clinics. There are also no antenatal or staff education spaces, and office space is inadequate to accommodate visiting specialists.





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Roma Hospital has recently been awarded funding from the Office of the Chief Nurse to develop a rural model of maternity care. This is to ensure the best use of midwives and the best care for women and families. This could provide the opportunity to develop maternity and women’s health services in one place.

Accommodation for families

Prior to their delivery, mothers and families may need to stay in Roma where accommodation may not be easily available or affordable. The only accommodation available at Roma Hospital for women awaiting delivery is the Red Cross rooms in a small building which is in poor condition and inadequate for that purpose.

Paediatrics

Paediatric inpatient services at Roma Hospital consist of low risk non-specialty paediatrics. There are several visiting paediatric services including mental health, the Flying Surgeon and specialist paediatricians. Table 11 shows same day and overnight paediatric activity. In both overnight and same day admissions, the highest numbers of paediatric separations were for non-subspecialty medicine and surgery.

Table 11: Top 10 paediatric Service Related Groups at Roma Hospital 2008/09


Endocrinology 24 Non-subspecialty Medicine 40 72

Non-subspecialty Medicine

16 Non-subspecialty Surgery 16 38

Dentistry 11 Respiratory Medicine 12 44

Non-subspecialty Surgery

6 Ear, Nose and Throat 11 14

Drug and Alcohol 5 Endocrinology 11 23

Neurology 4 Neurology 5 135

Neurosurgery 3 Neurosurgery 5 5

Plastic and Reconstructive Surgery

3 Orthopaedics 5 5

Ear, Nose and Throat 2 Gastroenterology 4 12

Gastroenterology 2 Immunology and Infections 4 6


Paediatric beds at Roma Hospital are located in a separate bay in the adult ward. Acute medical and surgical paediatric patients are managed there together with some long-stay patients.

There are also regular monthly bookings for paediatric respite care as there are nine severely disabled children in the community, one of whom is frequently admitted for long periods. Although only 2.5 paediatric beds are required based on annual activity, capacity must be allowed for long-stay and respite care as this is the only facility offering that service. Additional capacity must also be available for scheduled theatre days.

Over the years 2004/05 to 2008/09, overnight separations for paediatric activity decreased for most SRGs, except for endocrinology admissions (Table 12). Same day activity for paediatrics at Roma Hospital was very low.

The highest numbers of same-day admissions were for the SRGs endocrinology, non-subspecialty medicine and dentistry. The paediatric day surgery activity has generally remained unchanged over the last five years.





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Table 12: Five year trend paediatric overnight Service Related Group (SRG) separations at Roma Hospital in descending order for 2008/09

Overnight separations 2004/05 2005/06 2006/07 2007/08 2008/09 % Change Over 5 Years

Non-subspecialty Medicine 58 49 50 42 40 -31

Non-subspecialty Surgery 14 7 10 13 15 7.1

Respiratory Medicine 25 26 27 21 12 -52

Endocrinology 3 3 2 5 11 266

Ear, Nose and Throat (Surgery)

2 9 14 6 7 250

Neurology 2 4 4 1 5 150

Neurosurgery 5 5 7 2 5 0

Ear, Nose and Throat (Medicine)

- 1 - - 4 0

Gastroenterology 4 9 2 6 4 0

Immunology and Infections 5 10 9 5 4 -20


2.4.3 Emergency Department

Roma has a small emergency service, constrained by the available space and configuration of the current layout. This service is provided by staff at the hospital including nurses and general practitioners.

In the period 2004/05 to 2008/09 there has been a 34 per cent increase in emergency presentations from 5029 to 7619. At the same time there has only been a two per cent increase in population.

The majority of activity comprised of Category 4 and Category 5 presentations (518–782 presentations per month). Much of this increase in activity has been in Category 5 presentations, with little change in the numbers of Category 1, 2 and 3 presentations, which totalled nine per cent of presentations. For Category 1, there were between zero to four presentations per month (Table 13).

Table 13: Percentage of Emergency Department presentations admitted/transferred at Roma Hospital 2004/05–2008/09

2004/05 2005/06 2006/07 2007/08 2008/09 % Change Over 5 Years

Number of Presentations 5029 6070 6476 7386 7619 34

% of admitted transferred 20 17 15 14 14 -6

% of triage Category 1, 2 and 3 15 13 9 9 9 -4

% of triage Category 4 and 5 60 66 73 74 74 14

Source: Queensland Hospital Admitted Patient Data Collection, April 2010

Roma’s Emergency Department has a lack of both space and appropriate consultation rooms. Most of the consultation rooms are used for outpatient appointments, resulting in an inadequate number of consult rooms for emergency use. When specialists are visiting they often take over multiple rooms and hallways as waiting areas.





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There is no triage room and desk for initial assessment and continual observation of the waiting room. There is no central observation desk for health professionals to view patients who are ill in the acute treatment spaces. Additionally, there is no security to prevent the Emergency Department being used as a public thoroughfare.

2.4.4 General medical

General medical services at Roma Hospital are routinely provided by nursing, medical (general practitioner and senior medical officers) and allied health staff. In addition, there are visiting medical specialists who provide services on a regular basis, including a cardiologist (stress testing), renal physician and oncologist.

Chemotherapy is administered on a weekly basis to approximately six patients, with only four at any given time due to limitations with staff and chairs. This is done in conjunction with an oncologist who visits from Toowoomba (on the same day as the Flying Surgeon).

As previously mentioned, renal dialysis is one of the major outflows from the District. There is a self-care renal chair set up at Roma Hospital which is currently not in use due to lack of demand. This may be utilised by a patient from November/December 2010 (or earlier).

Over the years 2004/05–2008/09, utilisation of beds for non-acute activity increased at Roma Hospital with total beddays increasing by 55 per cent. The average length of stay in 2004/05 was nine days and 16.4 days in 2008/09. The total number of separations (same day and overnight) for non-acute care did not change much over the five year period, although the split of same day and overnight separations did (Table 14). As mentioned, in the paediatric section there are nine disabled children who require regular respite care for varying periods of time.

Table 14: Five year trend for non-acute activity at Roma Hospital 2004/05–2008/09

Non-acute 2004/05 2005/06 2006/07 2007/08 2008/09

Separations

Same day 2 2 0 0 13

Overnight 36 32 20 30 17

Beddays

Overnight 339 382 487 514 491


Non-admitted occasions of services

Outpatient services at Roma Hospital provide a range of non-admitted services. These include general practice clinics (provided by medical officers or visiting general practitioners), minor operations clinic, fracture clinic, pre- admission/anaesthetic clinic, ophthalmology clinic, dressing/wound management clinic, Rural Isolated Practice Endorsed Registered Nurse scheme, occasions of service and telehealth clinics. There is also a range of allied health services provided at the Hospital.

Specialty or subspecialty services at Roma Hospital are provided as a visiting service. These services include:

• ophthalmology

• physician

• oncologist





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• paediatrician

• radiologist

• plastic and reconstructive surgery

• ear, nose and throat

• orthopaedic

• cardiac (including stress testing)

• surgical

• gynaecology and obstetrics.

Visiting specialists, who utilise the facility on a weekly or monthly basis, are required to share limited consultation space within the designated emergency areas.

Outpatient occasions of services decreased over the last five years, although selected groups such as allied health, cardiology and ophthalmology services increased in activity.

In 2008 there was a total of 24,154 occasions of services, a decrease from 28,590 in 2005/06. The highest number was for emergency presentations. The second highest number was for allied health occasions of service, totalling 4592.

Visiting services including specialists

Visiting services include day surgery, palliative care/chemotherapy and renal. Visiting surgeons provide day surgery services two days per week, and conduct a pre-admission clinic, post-discharge follow up and pre-work up prior to admission. All visiting specialists require consultation rooms, waiting areas and staffing to manage the outpatient activity generated by visiting services.

The Flying Surgeon visits weekly and completes a mixed paediatric and adult list, some of which is same-day and some overnight. There is a growing list of visiting specialists, most of who visit monthly and complete a varied number of cases. One of the ophthalmologists will usually do a case list of 14 cataracts while the other will do a list of eight.

Overflow from day surgery currently needs to use overnight beds in the ward when there are insufficient post operative chairs available.

Visiting specialists and services deliver acute and non-acute care and patient education (other than medical specialists) include:

• child health nurse

• cancer care coordinator

• palliative care nurse

• women’s health nurse

• Diabetic educator

• mental health practitioner

• Aboriginal and Torres Strait Islander health workers

• diabetes educator

• Alcohol, Tobacco and Other Drugs Services workers deliver acute and non-acute care and patient education.

The following private medical specialists visit Roma Hospital:





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• two paediatricians

• two ophthalmologists (day only list)

• ear, nose and throat specialist (does not operate)

• reconstructive and aesthetic surgeon, plastic surgeon (day only list)

• urologist (day only and overnight surgery)

• endocrinologist

• sonographer

• renal specialist

• trauma (orthopaedic) specialist.

Flying Specialist Services

Two Flying Specialists are based in Roma. Although there is sufficient Operating Theatre time for both the surgeons, there are insufficient consultation rooms available for their use when they visit. The Flying Obstetrician requires a consultation room, a procedure room and an office and often uses all four of the Emergency Department consultation rooms when present, disrupting Emergency Services on a regular basis.

It is suggested that a group of consultation rooms be available in the maternity service area and be used for maternity, gynaecology and women’s health activity. The second delivery suite could then be used as an antenatal assessment and gynaecological procedure room if fitted out correctly.

The Flying Surgeon also uses consultation rooms in the Emergency Department as do the other surgeons and specialists when they visit. The Flying services include:

• Flying Surgeon who provides weekly outpatients and theatre visits.

• Flying Obstetrician and Gynaecologist who visits monthly for theatre, and twice monthly for day consultations.

Medical Specialist Outreach Assistance Program

Where there is a demonstrated need in rural and remote areas, the Medical Specialist Outreach Assistance Program provides a range of Commonwealth-funded visiting services. The program funds services to the District, as shown in Table 15.

Table 15: Medical Specialist Outreach Assistance Program services provided to the South West Health Service District

Type of service Locations serviced Source

General paediatrics services Roma, Charleville, St George, Cunnamulla, Quilpie

Provided by Mater Children’s Hospital

General paediatrics Roma, St George, Charleville, Cunnamulla, Quilpie.

Gold Coast private specialists

Pyschiatric telepaediatrics Roma, Charleville, St George Provided by Mater Children’s Hospital

Child and adolescent psychiatry

Roma, Charleville, St George Provided by Mater Children’s Hospital

Physician oncologist Roma, St George From Toowoomba

Physician cardiologist (including cardiac stress testing)

Roma Provided by Princess Alexandra Hospital





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2.4.5 Current support services

Pathology

Roma has a pathology service that includes a laboratory situated at the rear of the Hospital. A scientist is available to provide pathology tests five days a week, with a 24 hour on call service available. Any specimens that cannot be tested at this laboratory are transported to higher level of service.

Medical imaging

Roma has a medical imaging service provided on the Hospital campus five days a week, with a 24 hour on-call service. There is also a private medical imaging service in town which includes a Computerised Tomography (CT) scanner used by Queensland Health. It is only available during business hours (9am-5pm) and patients requiring an urgent CT scan after hours must be transferred out to a higher level service.

Ultrasonography is provided in a room in the Emergency Department. This visiting service generally is available two full days on some weekends.

Table 16 indicates there were 2374 occasions of service in 2008/09 for medical imaging services, which is a significant decrease over the years 2004/05 to 2008/09 (6169 to 2374 occasions of service). This decrease in activity is due in part to the private service in town. However when the private service is used there is a delay of one to two weeks with reporting of films.

Table 16: Medical imaging and pharmacy Occasions of Service, Roma Hospital 2004/05–2008/09

Services 2004/05 2005/06 2006/07 2007/08 2008/09 % Change Over 5 Years

Medical Imaging 6169 6252 4104 2511 2374 -61%

Pharmacy 1910 1348 1313 1292 2018 10%


Pharmacy

Pharmacy services are provided on site during standard working hours and are accessible to the nursing supervisor after hours. The pharmacist holds a District-wide position and is assisted by a graduate pharmacist. There are also several private pharmacies in Roma. In 2008/09, there were 2018 occasions of pharmacy service, showing little change over the period 2004/05 to 2008/09 (Table 16).

Dental/oral health services

Dental/oral health services are currently provided in the Hospital. There is very little waiting area for dental patients and their presence impacts on the Emergency Department waiting area. It has been proposed that dental services will move to the old Westhaven with allied health services when it is renovated.





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2.5 Primary health care and community health services

One of the major challenges of health services in the catchment is to effectively implement evidence-based interventions aimed at addressing preventable disease. The growth in the population, the travel required to access health services and the need to provide services to sparsely populated regions has created a need to reconsider current models of care and look for alternative service delivery models.

Implementation of alternative models of care such as Hospital in the Home, Hospital in the Nursing Home, integrated models of care across primary health care and acute services and nurse practitioner led clinics may achieve some efficiency in service delivery.

A key strategy in achieving these efficiencies will be expanding community-based resources for targeting, identifying and managing key chronic diseases and common conditions of ageing in collaboration with other local agencies.

Future community-based service requirements have been broadly considered in the context of the catchment and opportunities for enhancing community-based services. Detailed consideration of future community health services and capacity requirements will occur if the preliminary evaluation progresses to a Business Case.

There is an Aboriginal and Torres Strait Islander health service, non-government community services in addition to acute and community services. Population Health services are located in Roma.

A number of Community Health Services are provided through the Primary Health Care Unit. These include:

• child and family health

• early intervention specialist

• mental health

• oral health

• school dental services

• audiometry service

• Aboriginal and Torres Strait Islander health services

• community aged care packages

• aged care assessment

• home and community care services domestic assistance, social support, nursing care, personal care, centre based care, meals, respites care, home maintenance.

• Child Protection Liaison Officer

• Community Health Nurse

• School Based Youth Health Nurse

• Mobile Women’s Health Nurse

• Palliative Care Coordinator

• Continence Promotion Officer

• Community Health Nurses assistance with discharge planning for the facility.

• Breast Care Nurse assistance with inpatient and outpatient care of clients within the community

• Palliative Care Nurse assistance with inpatient and outpatient care of clients within the community.

Integrated mental health services

The South West Health Service District Mental Health Services are made up of:

• Roma Mental Health Service

• St George Mental Health Service

• Charleville Mental Health Service.





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These three services provide outreach to the following centres: Injune, Surat, Mitchell, Wallumbilla, Mungindi, Bollon, Dirranbandi, Cunnamulla, Yowah, Quilpie, Eulo, Wyandra, Morven, Augathella, Eromanga and Thargomindah.

The Community Mental Health Teams provide services in adult and child and youth, with expansion into older persons’ mental health in 2009. The Child and Youth Mental Health Services has three positions across the District, currently staffed by clinicians of social work and nursing backgrounds.

The Adult Mental Health Service has five clinical positions to support the District, currently staffed from a variety of multi-disciplinary backgrounds including nursing, social work and occupational therapy.

The District has also secured the additional positions of District Mental Health Manager, Mental Health Nurse Educator, Service Integration Coordinator and 0.5 full time equivalent psychiatrist, who commenced in late 2008/early 2009.

The Adult Mental Health Services offer a case management model of service, where an individual plan is developed to meet the needs of the individual, this includes:

• assessment and ongoing treatment/therapy

• providing education/resources to clients, service providers and the community

• crisis intervention to people with mental health problems

• relapse prevention

• shared care with general practitioners

• consultation and support for carers/families

• medical support from our visiting psychiatrist

• referral to other agencies when necessary.

Allied health services

Allied health services are provided both as inpatient and ambulatory care services. They are provided from the Hospital in the main building, and will be moving to the old Westhaven building when it is renovated.

Allied health services include the provision of a range of services including:

• physiotherapy

• speech pathology

• occupational therapy

• podiatry

• oral health

• social work

• dietician

• cardiac services.

All these services deliver acute and non-acute care to patients including education services. They also provide outreach services to the outlying facilities including Mitchell, Injune, Surat and Wallumbilla.





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Allied health Occasions of Service are shown in Table 17. Over the years 2004/05 to 2008/09 total allied health services Occasions of Service increased by over 156 per cent with 3397 in 2008/09 compared to 1329 in 2004/05. The largest increase in allied health Occasions of Service was for social work services. This may mean that either workforce recruitment was a problem or there was unmet need in the community for social work services.

Table 17: Allied health Occasions of Service at Roma Hospital 2004/05–2008/09

Services 2004/05 2005/06 2006/07 2007/08 2008/09 % Change Over 5 Years

Nutrition - 171 371 391 293 71

Occupational Therapy 349 242 479 361 700 101

Other Allied Health 86 - - - - -

Physiotherapy 763 875 977 1516 1589 108

Social Work 131 722 466 494 815 522

Total 1329 2010 2293 2762 3397 156






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3 Current and future bed requirements

3.1 Summary of projected bed requirements

Table 18 and Table 19 present a high-level summary of the projected bed and other treatment space requirements for the Roma Hospital to 2021.

Table 18: Current and projected bed requirements for Roma Hospital

Current numbers

Projections using 85% occupancy rates

Projections using 70% occupancy rates

Beds/Alternatives 2010 2011 2016 2021 2011 2016 2021

Overnight Beds

Total multipurpose overnight beds

37 17.2 17.5 18 20.3 21 21.4

Same day beds/bed alternatives

Same day beds 0 5 6 7

Stage 2 recovery chairs 8 10 10 10

Chemotherapy chairs 4 6 6 6

Renal dialysis chairs (in centre)

1 1 1 1

Other medical (inc. Discharge Lounge)

0 0 0 0

Total same day beds/ bed alternatives

13 22 23 24

Other treatment spaces

Projected requirements for recovery spaces, delivery suites, outpatient clinic rooms and Emergency Department spaces currently exceed the current built capacity at Roma Hospital.

Table 19: Current and projected other treatment space requirements for Roma Hospital

2010 2011 2016 2021

Operating Theatres 2 2 2 2

Procedure rooms 1 in ED 1 in ED 1 in ED 1 in ED

Recovery spaces 2 4 4 4

Delivery Suites 2 2 2 2

Outpatient clinic rooms 0 6 +

3 maternity

7 +

3 maternity

7 +

3 maternity

ED treatment spaces 6 8 13 15

X-ray rooms, ultrasound, plain film x-ray

1 x-ray

1 ultrasound

1 x-ray

1 ultrasound

1 x-ray

1 ultrasound

1 x-ray

1 ultrasound

CT scanner 0 CT scanner to be considered for Hospital site





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4 References

1 Australian Bureau of Statistics. Australian Statistical and Geographical Categories. Australian Standard Geographical Classification (ASGC) 2009 (cat. no. 1216.0); Australian Standard Geographical Classification (ASGC) - Electronic Structures 2009 (cat. no. 1216.0.15.001) and Australian Standard Geographical Classification (ASGC) Correspondences 2009 (cat. no. 1216.0.15.002); 2009.

2 Queensland Government. More Beds for Hospitals Strategy. Queensland Health; 2006.

3 Australasian Health Infrastructure Alliance and University of New South Wales. Australasian Health Facilities Guidelines Revision v.3.0. Centre for Health Assets Australasia; 2009.





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5 List of figures and tables

Table 1: Summary of current and future bed requirements for Roma Hospital .................. 4 Figure 1: Estimated resident population by statistical local area, total persons

South West Health Service District June 2008 ..................................................... 6 Table 2: South West Health Service District, and associated population ........................... 6 Figure 2: Population projections for Roma town .................................................................. 7 Table 3: Draft CSCF v3.0 service gap analysis .................................................................. 9 Table 4: All age activity at Roma Hospital by separations and district of

residence............................................................................................................. 10 Table 5: Top 10 adult Service Related Groups including same day separations

and overnight separations with beddays at Roma Hospital, 2008/09................. 11 Table 6: Five year trend of adult same day activity at Roma Hospital, in

decreasing order for 2008/09.............................................................................. 11 Table 7: Five year trend of adult overnight activity for top 10 Service Related

Groups at Roma Hospital 2008/09...................................................................... 12 Table 8: Current and projected births for South West Health Service District

2007/08–2021/22 ................................................................................................ 13 Table 9: Current top 10 adult surgical/procedural Service Related Groups at

Roma Hospital for 2008/09 ................................................................................. 14 Table 10: Maternity and gynaecology occasions of service at Roma Hospital

2004/05–2008/09 ................................................................................................ 15 Table 11: Top 10 paediatric Service Related Groups at Roma Hospital 2008/09 .............. 16 Table 12: Five year trend paediatric overnight Service Related Group (SRG)

separations at Roma Hospital in descending order for 2008/09......................... 17 Table 13: Percentage of Emergency Department presentations

admitted/transferred at Roma Hospital 2004/05–2008/09 .................................. 17 Table 14: Five year trend for non-acute activity at Roma Hospital 2004/05–

2008/09 ............................................................................................................... 18 Table 15: Medical Specialist Outreach Assistance Program services provided to

the South West Health Service District ............................................................... 20 Table 16: Medical imaging and pharmacy Occasions of Service, Roma Hospital

2004/05–2008/09 ................................................................................................ 21 Table 17: Allied health Occasions of Service at Roma Hospital 2004/05–2008/09............ 24 Table 18: Current and projected bed requirements for Roma Hospital .............................. 25 Table 19: Current and projected other treatment space requirements for

Roma Hospital..................................................................................................... 25

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