NewsWelcome to the first edition of Transforming Health News for 2017.

This publication will keep you up-to-date on the progress of Transforming Health and provides further information about key milestones.

If you have any Transforming Health stories you would like to share or questions you would like answered, please email health.transforminghealth@sa.gov.au

The Jamie Larcombe CentreConstruction of the Jamie Larcombe Centre, a new $15 million Veterans’ Mental Health Precinct located at Glenside Health Service Campus, is well underway.

Builders moved on to the site in November 2016 and since then the site has been cleared, including demolition of two existing buildings, the gymnasium and store.Building pad preparation and compaction is complete and the car park, storm-water and some trenching for the new building has begun.

Premier Jay Weatherill and Minister for Mental Health and Substance Abuse, Leesa Vlahos M.P., visit the construction site.

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The Jamie Larcombe Centre will accommodate services currently provided at Ward 17 at the Repatriation General Hospital, when services are transitioned off the site in late 2017. The facility will be purpose-built and include a 24 bed inpatient unit and an ambulatory care service, incorporating treatment for Post-Traumatic Stress Disorder (PTSD).

A model of care for the Specialist Veterans Mental Health Services has also been finalised. The model of care outlines the services that will be provided at the Jamie Larcombe Centre and how these services will be delivered, in line with best-practice standards.

The model of care builds on the existing model for Ward 17, taking into consideration the wide range of services to be delivered at the Jamie Larcombe Centre.

Clinical Head of Ward 17 at the Repatriation General Hospital, Dr Taryn Cowain, said the model of care was designed to meet the current and future needs of Veterans.

“The model of care has been developed by a multidisciplinary workgroup, including consumers, clinicians, police and emergency services personnel and Veterans, and is based on evidence-based practice to ensure the services provided will meet the needs of the changing Veteran demographic,” Dr Cowain said.

“The Jamie Larcombe Centre will specialise in mental health care for the Veteran community and serving members, while also providing services to police and emergency service personnel who are referred for treatment of PTSD.

“Opportunities to offer tele-psychiatry services will also be explored, enabling Veterans from country areas to access psychiatry services closer to home.”

While patients admitted to the Jamie Larcombe Centre will have a mental health issue as their primary diagnosis, appropriate support will also be in place to ensure the medical and physical health needs of Veterans are met. A visiting physician will provide on-site services, including assessment, advice and referrals to specialty services off-site when required.

The centre will also link patients in to appropriate medical and outpatient services that are not available on-site to ensure patients have access to all of the services they need for effective treatment.

The model of care will be implemented when services move from the Repatriation General Hospital to the Jamie Larcombe Centre, following completion of the building in late 2017.

Work underway at the Jamie Larcombe Centre

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Sapper Jamie Larcombe killed in action in Afghanistan in 2011

Improvements at Noarlunga Hospital nearing completionMore than $12 million has been invested in Noarlunga Hospital under Transforming Health to build new facilities and improve surgical services for the South, ensuring the community can receive care closer to home.

Work on the new facilities is nearing completion, including a new Day Surgery Unit, two new operating theatres and larger recovery areas, which will enable the hospital to provide a greater range of operations and procedures.

Other upgrades at Noarlunga Hospital include dedicated spaces for children and families in the Emergency Department, aimed at making children feel more comfortable and a new, more spacious Renal Dialysis Unit.

See inside Noarlunga HospitalYou are invited to an Open Day showcasing the new facilities:

Saturday 13 May 2017 | 10am – 2pmNoarlunga Hospital, Alexander Kelly Drive, Noarlunga Centre

The Open Day will include:> Free sausage sizzle > Tours of the new facilities > Opportunity to see inside an ambulance.

New spaces for children in the Emergency Department

Launched in January 2017, the DTT aims to minimise secondary patient transfers and support the management of patient flow through the hospital system.

SA Ambulance Service’s Intensive Care Paramedic Sarah Adamson said the DTT would create a streamlined approach to care.

“The DTT will benefit patients by allowing the paramedics, who have a great deal of expertise in knowing what’s wrong with the patient, to take them to the right hospital,” Sarah said.

“Different hospitals have different levels of expertise and availability for patients, beds and types of medical conditions.

“And despite the fact it might be further away geographically from their home address, it’s actually going to advantage the patient for the care that they need.”

If it is determined that a patient needs to be transferred to another public hospital to receive the appropriate care, patients will not incur the cost for the transfer to another public hospital.

All SA Ambulance Service paramedics, career ambulance officers and volunteer officers are highly skilled and qualified, having undertaken extensive training and education, and are committed to providing the best care across South Australia, regardless of a patient’s location.

The DTT was developed in consultation with clinical specialists and Emergency Department staff from across the health system.

SA Ambulance Service’s Destination Triage ToolSA Ambulance Service has introduced a pre-hospital Destination Triage Tool (DTT) to assist paramedics in getting patients to the hospital best suited for their condition, more quickly or faster.

SA Ambulance Service is integral to the success of a high performing health system and that is why in South Australia we are building a responsive ambulance service for the future.

Our highly trained and skilled ambulance clinicians will make a decision about the best hospital to take you to for the care you need.

It is our job to get you the right care, first time, every time and to help us do that our major hospitals have dedicated teams of specialists ready to respond to serious emergencies like stroke or heart attacks.

So when you dial triple zero (000), our clinicians will assess your condition and commence treatment over the phone while the sickest patients will always be taken directly to the hospital that’s best suited to their needs.

It might not be the one that is closest but it will be the one that is most appropriate for the patient’s condition and with more skilled paramedics and ambulances on the road, we’ll be with you all the way.

SA Ambulance Service Chief Executive Officer,

Jason Killens

One morning I thought I could feel water dripping on me, and when I tried to put my arm around there, there was nothing there. The next minute, I went to stand up and I couldn’t. My wife walked in the door and was able to catch me when I went down.

When the ambulance arrived they thought I was having a stroke and they took me to hospital.

The paramedics told me that the Lyell McEwin Hospital would be the best hospital for me because they had the specialists there who could treat me. My closest hospital is Modbury Hospital, but we went straight to the Lyell McEwin Hospital where there is a dedicated on-site stroke team. I’m so thankful I was taken to the right hospital and received lifesaving treatment straight way.

You just have to trust in the paramedics and that they will take you to the right place and in my case that was the right thing to do. I’m really happy that they did otherwise I wouldn’t be sitting here.

PATIENT STORY: Hendrik

SA Ambulance Service paramedics.

Senior clinicians working the nightshiftLyell McEwin Hospital patients will receive better round-the-clock care thanks to an initiative that will see senior doctors and nurses working in the wards overnight.

Over the past few decades, there has been a growing tendency to put our most experienced night shift doctors closer to the ‘front line’ in the Emergency Department or on remote call from home.

This has made it increasingly difficult for our most junior ward doctors to access support from their more experienced colleagues overnight. However, in recent years, with an increased focus on patient-centred care, hospitals such as the Lyell McEwin are recognising the gap that has appeared and are working on ways to support overnight staff better again.

Therefore, according to Head of Anaesthesia Dr Simon Jenkins, the Lyell McEwin Hospital was an obvious choice by SA Health to trial an after-hours senior clinical cover initiative.

Dr Jenkins, who is chairing the implementation group for the pilot, said trialling a model of care for after-hours senior clinical cover was a natural progression.

“We’ve been going down this path for some time now,” Dr Jenkins said.

“The Department of Medicine at the Lyell McEwin has been working very hard on supporting its junior staff at night and has made some great progress. Our nurses have also gone down this path ahead of us and provide senior clinical support for the wards up until midnight or later. We hope that some of the resources provided by running this pilot will help them do even better.

“The Lyell McEwin Hospital has always been a place where we embrace change so it’s a fantastic site for testing new ways to do things.”

Some of the expected benefits of the pilot include improved communication between doctors and nurses, more readily available support for junior clinical staff overnight and, ultimately, better patient care.

“Patients won’t be waiting until morning for a decision to be made about their care,” Dr Jenkins said.

“We will be able to actively manage their problems as they arise. If treatment is progressed, rather than simply maintained overnight, patients will get better more quickly. This has the additional benefit of freeing up bed space within the hospital so that patients requiring admission are not held up.”

Introduction of an electronic clinical activity task board that chronicles a patient’s care in real time will enable senior clinicians to see what jobs each staff member is attending to, which assists in the allocation of work.

“The clinical activity task board should reduce the regular interruptions coming from pagers, because medical staff will be able to see at a glance where they are needed on the wards,” Dr Jenkins said.

“And the leadership team will be able to see when staff need them and can step in to help them out.”

The clinical activity task board was introduced in February and recruiting for the senior clinician positions is expected to be completed during March.

“This pilot is expected to result in faster and more positive outcomes for patients,” Dr Jenkins said.

The Lyell McEwin Hospital has always been a place where we embrace change so it’s a fantastic site for testing new ways to do things.

Increase in STROKE CAREMore specialist stroke services will be available for South Australians as a result of the new statewide model of care for stroke.

Expanded specialist stroke care across the metropolitan area have seen a 24/7 on-site reperfusion stroke unit at the Royal Adelaide Hospital and expanded on-site coverage after hours at Flinders Medical Centre and Lyell McEwin Hospital.

The new model of care was developed by an expert working group, led by stroke specialists from across the state. The expert group has investigated how to improve stroke services across the state to ensure consistency across hospitals, following a review in October 2014 that showed dramatic variations in death rates from stroke depending on the time or day of admission.

Head of Stroke at Lyell McEwin and Royal Adelaide hospitals Tim Kleinig said the risk of death or disability from stroke is reduced the faster treatment occurs.

“Most strokes occur due to a blood clot preventing blood flow in the brain. In selected cases this clot can be removed by reperfusion therapy, either by medication, or by a clot removal device. The faster this treatment starts, the less brain damage occurs, reducing the risk of death or disability,” Assoc Prof. Kleinig said.

Stroke units will operate out of the Royal Adelaide Hospital, Lyell McEwin Hospital and Flinders Medical Centre 24 hours a day, fully equipped with speciality technology and experienced specialist teams who see a minimum number of patients to maintain and improve their highly specialist skills.

Under the new model of care, stroke reperfusion services, including on-site stroke teams, will be expanded to be available 24/7 at the Royal Adelaide Hospital and from 8am to 8pm seven days a week at the Lyell McEwin Hospital and Flinders Medical Centre.

A support service for country thrombolysis will be extended to be supported by all stroke unit hospitals during the day and overnight by the Royal Adelaide Hospital.

SA Ambulance Service has also developed clear pathways to ensure stroke patients are taken directly to a stroke unit hospital where possible.

In August 2015, inpatient stroke services from The Queen Elizabeth Hospital were merged with the Royal Adelaide Hospital as the first step towards implementing the new stroke model of care.

With these expanded hours for stroke reperfusion services we will ensure more people than ever before get the care they need, as soon as they need it.

A second cardiac catheter lab now treating patients at Lyell McEwin HospitalLyell McEwin Hospital’s new cardiac catheter lab recently began treating North and North east residents with heart and other conditions. The hospital’s second cardiac catheter lab gives residents increased access to cardiology and interventional radiology services closer to home.

Some of the heart procedures carried out include internal measurement of the heart’s electrical activity to diagnose and treat abnormal heart rhythms, pacemaker and defibrillator insertions and insertion of stents to unblock arteries to the heart that cause heart attacks.

Dr Sharmarlar Rajendren, Interventional Cardiologist at Lyell McEwin Hospital said having two cardiac catheter labs would provide equal care to all patients irrespective of where they live.

“The ability to now divide these workloads and to serve the increasing workload, not just from Modbury Hospital, but the surrounding rural areas, will facilitate the efficiency of procedures and reduce the waiting time for patients,” Dr Rajendren said.

The new lab will result in a 30 per cent increase in the number of procedures involving interventional radiology.

The multi-purpose lab can also investigate and treat parts of the body other than the heart. It can be used for other radiological interventions, such as catheter insertions for medication administration, organ biopsy and non-cardiology vascular imaging.

Since 2002, $314 million has been invested in the Lyell McEwin Hospital over a continuous three stage redevelopment.

The new cardiac catheter lab at Lyell McEwin Hospital

One of the main problems with our health system at the moment is that almost half of the patients that should be treated at Lyell McEwin Hospital or Modbury Hospital are being transferred across town to the Royal Adelaide Hospital, Flinders Medical Centre or The Queen Elizabeth Hospital for their elective surgery and acute medical care.

I don’t think that’s good enough for the North. We are expanding on the areas that we already have so we can provide a more complete service 24 hours a day, seven days a week.

We are adding additional services, such as dialysis and an additional angio suite.

We are expanding significantly on rehabilitation services at Modbury Hospital.

We are going to boost elective surgery at both the Lyell McEwin Hospital and Modbury Hospital, which will allow several thousand more operations every year.

When changes as part of Transforming Health are complete, patients in the North and North eastern suburbs will be able to receive their healthcare close to home and won’t need to travel to the other side of town for care.

Simon JenkinsHead of Anaesthesia, Lyell McEwin Hospital

Opinion: Why Transforming Health is needed in the North

I think we should be improving things here so our residents receive the same types of healthcare as residents in different areas of Adelaide. That’s what we are doing through Transforming Health.

Rehabilitation hub brings care closer in the NorthModbury Hospital’s rehabilitation hub will enable the hospital to double the number of rehabilitation patients seen each day from 20 to 40.

The facilities are part of the $32 million Transforming Health investment in the hospital, which has seen the opening of a new ward for patients treated in these facilities.

Divisional Director of Aged Care, Rehabilitation and Palliative Care, Dr John Maddison said, with the opening of the new facilities, Modbury Hospital was now the rehabilitation hub for the North and North eastern area.

“The rehabilitation hub will significantly ease the burden of travel faced by many residents whose only option now is to go to Hampstead or even further afield,” Dr Maddison said.

“For example, each year up to 60 of our North and North east amputee patients will be able to have their care at Modbury instead of elsewhere.”

The state-of-the-art rehabilitation centre has 18 treatment rooms, a gym, hydrotherapy pool, a laboratory for analysing patient mobility, prosthesis services and a kitchen where clients can re-learn and practice everyday tasks.

It brings together allied health specialists including occupational therapists, physiotherapists and speech therapists with medical and nursing staff, resulting in improved communication and collaborative work practices.

Dr Maddison said, until now, residents living North or North east of Adelaide had to travel significant distances to access some services, especially ongoing rehabilitation.

“Having rehabilitation services closer to home will significantly ease the travel burden felt by some locals,” he said.

“The centre allows clinicians to deliver greater, higher-quality care to North and North eastern residents. Patients can return home from hospital sooner because they can receive a comprehensive program of support at a local service.

“Greater access to services will maximise the recovery and independence of patients living in the local community. Both an elderly person recovering from a stroke or orthopaedic injury and a young adult with a neuro-muscular condition such as multiple sclerosis can receive the treatment they need in this new centre.

“Because our health professionals are co-located, patients can attend follow-up treatments over an extended period of time in one location.”

See inside Modbury Hospital’s new Rehabilitation CentreYou are invited to an open day showcasing the new Rehabilitation Centre at Modbury Hospital where you can see the new facilities and speak to health professionals about the improvements at the hospital.

Saturday 8 April 2017 | 10am – 2pmModbury Hospital Rehabilitation Centre, corner of Smart Road and Hatherleigh Ave, Modbury> Face painting> Free sausage sizzle> Tours and demonstrations

Modbury Hospital’s new hydrotherapy pool

Modbury Hospital’s new therapy sensory garden

Modbury Hospital’s new rehabilitation gym

Clinical Improvement Projects UpdateChronic Pain ServicesIn late 2016, a new statewide model of care for the management of chronic pain was finalised. The model of care is a result of extensive collaboration between the primary and acute health sectors, which will see people experiencing chronic pain directed to the right service for their condition, based on the severity of their pain.

The model of care will ensure chronic pain services are available in each Local Health Network, either through a dedicated chronic pain service, via telehealth or via outreach services. Care will be coordinated across the system with General Practitioners and Pain Management Specialists in hospitals working together to provide consistent care.

As a priority, planning will commence to implement chronic pain services in NALHN as well as CHSALHN where there are currently no discrete chronic pain tertiary services, and the state’s first paediatric pain service at the Women’s and Children’s Hospital.

Allied Health ServicesThe availability of allied health services for orthogeriatric (acute hip fractures in older people), stroke and rehabilitation patients currently varies depending on the hospital a patient attends and the type of allied health service they need.

An expert working group has provided recommendations for delivering appropriate allied health services to these patients across the system. Some allied health services will be available five days a week and some services will be available across seven days, helping patients to recover faster and reducing the risk of deterioration by providing better access to the specialist care they need, seven days a week.

These recommendations will be implemented as part of the new orthogeriatric, stroke and rehabilitation models of care.

Transforming Health

UpdateBuilding on the significant improvements implemented in 2016, work will continue this year to redesign our public health system to ensure we are providing best care, first time, every time to all South Australians. This includes implementing new models of care, transferring services throughout our metropolitan hospitals to ensure people can access the care they need closer to home and a range of capital works to support these changes. We are already seeing good outcomes coming out of the changes we’ve implemented so far, such as reducing the average length of stay in our metropolitan hospitals, which means our patients are spending an average of seven hours less in our hospitals this year compared to last year. However there is still more work that needs to be done. Our hospitals have the largest number of beds per head in the nation and employ the largest workforce of full time doctors and nurses, according to the 2017 Report on Government Services report released in February. The report provides a snapshot of how each state’s health system compares to the rest of Australia and showed South Australia’s public hospitals led the nation with 2.9 beds per 1,000 people – 12 per cent higher than the national average.The report also highlighted areas we need to continue to improve, such as reducing Emergency Department waiting times. Although 100 per cent of triage one patients were seen within the national clinically appropriate timeframes, overall we recorded longer waiting times than the national averages. This data further reinforces the need to transform our health system and we are committed to making improvements by focussing on patient flow, service accessibility and efficiencies throughout our hospitals. I would like to thank all of our staff who have been involved in this journey so far. I look forward to working closely with you as we continue to modernise our health system in 2017.

Acting Deputy Chief Executive, Transforming Health

Lynne Cowan

New buildings progress at Flinders Medical Centre

Construction of the Older Persons’ Mental Health Unit at Flinders Medical Centre

Construction of the new car park at Flinders Medical Centre

Construction of the new car park and rehab building at Flinders Medical Centre

Construction of the new Older Persons’ Mental Health Unit at Flinders Medical Centre is taking shape with external work wrapping up and internal work beginning.

The roof of the new multi-level car park has been finished and installation of formwork is taking place.

The rehabilitation building is also on track with progressive completion of the curtain walls and façade. Internal partition walls and ceilings are being installed throughout the building.

Work is expected to be completed by late 2017.

Construction of the rehabilitation building at Flinders Medical Centre

For more information Visit: transforminghealth.sa.gov.au Email: health.transforminghealth@sa.gov.au

www.ausgoal.gov.au/creative-commons

© Department for Health and Ageing, Government of South Australia. All rights reserved. March 2017 FIS 17011.7

Public-I3-A2

Work has been progressing on a number of clinical improvement projects that are being undertaken to review and redesign health services to meet the Clinical Standards of Care.

The Chronic Pain, Stroke, Specialist Veterans Mental Health and Seven Day Allied Health models of care have all been finalised in the last few months, with planning for implementation currently underway.

In April, project initiation workshops will be held for two new projects: Trauma and Pre-operative Assessment for Elective Surgery. The Trauma Project aims to identify and develop a Clinical Governance Framework and a Statewide Trauma Model of Care to ensure that every South Australian who suffers major trauma is provided with the best care, first time, every time. The Pre-operative Assessment for Elective Surgery project will develop a consistent, standardised approach to pre-operative assessment and management of adult elective surgery across the State.

Clinicians are invited to both workshops:

TraumaDate: Wednesday, 12 April 2017

Time: 4.00pm – 6.00pm

Location: Adelaide Pavilion, corner of South Terrace and Peacock Roads, Adelaide

Pre-operative Assessment for Elective SurgeryDate: Tuesday, 4 April 2017

Time: 2.00pm – 4.30pm

Location: Adelaide Pavilion, corner of South Terrace and Peacock Roads, Adelaide

For more information about all of the clinical improvement projects underway as part of Transforming Health, visit the SA Health intranet.

Clinical Ambassador

UpdateProfessor Dorothy Keefe P.S.M. is the Clinical Ambassador for Transforming Health and the Chair of the Ministerial Clinical Advisory Group, which provides clinical leadership on the implementation of Transforming Health projects.