Emergency overhaul for Mount Gambier Hospital after review sparks major concerns

Country Health SA will invest $536,000 into a major overhaul of Mount Gambier Hospital's emergency department following an extensive review into the regional South Australian hospital.

The review, conducted in late 2016, was in response to concerns surrounding patient safety and inadequate emergency department staffing levels raised by hospital staff and the public.

Australia's former Chief Medical Officer, Professor Chris Baggoley, and Critical Care Nursing Director, Mr Andrew McGill led the review, the findings of which were released on Wednesday and communicated to staff.

The review cites reliance on locum employees, the experience level of staff and a lack of medical leadership as key issues facing the facilities emergency department.

Among the 22 recommendations were to appoint a new emergency department director, to review and restructure recruitment processes for junior registered medical officers (RMOs) and the introduction of an electronic patient tracking system in the emergency department.

Country Health SA Chief Executive Officer Maree Geraghty said Country Health SA had accepted the review's 22 recommendations and was in the process of working through the timeframes for their implementation.

"Implementing all of the recommendations will take some time, but as each one is completed it will strengthen the high quality of services we provide to the local community," Ms Geraghty said.

The review also recommended the appointment of additional staff, including a triage nurse, emergency department nurse educator, two medical registrars and a paediatric registrar.

Despite the report finding the performance of the emergency department has been declining since 2013, Ms Geraghty believes the department still meets high performance standards.

"We're really not far off at all. I think Mount Gambier continues to nearly meet all of key performance measures in terms of the delivery of care.

"I think the senior team is now working very closely together, both from a senior management team and the senior clinicians in the emergency department.

Former emergency department Director Dr Trevor Burchall, who left the role after the review, told reviewers he found it 'increasingly difficult to provide clinical leadership' and was concerned he was unable to find time to teach within the emergency department, particularly during the last year.

More patients through emergency department

Patient flow through the emergency department, which was overhauled as part of a $27 million redevelopment in 2014, also came under the microscope.

Reviewers observed no clear bed management procedure was in place to support the 24-7 flow of patients and said the absence of an electronic patient tracking system 'significantly impacts work flow and patient care'.

Also recommended was a review into admission procedures into the emergency department in relation to rising numbers presenting to the emergency department.

The number of people seeking treatment at the hospital's emergency department had increased by more than 22 per cent since 2012-13, with nearly 20,000 people presenting to the department in 2015-16.

Response to recommendations mixed

The Australian Nursing and Midwifery Federation (ANMF) called Country Health SA's response 'grossly inadequate', saying the timeline of implementation was vague and uncertain for staff.

"We are deeply concerned by the response of CHSA when they say things such as that they will give further consideration to nurse practitioner staffing in six months’ time, given that this issue has been the source of contention for several years," ANMF Director of Operations and Strategy, Rob Bonner said.

"The time for action, as acknowledged by the reviewers in their recommendations, is now."

Mr Bonner said the union had not been advised of the recommendations in advance of their release and staff at the facility were only informed of the review conclusions on Wednesday.

Nursing staff interviewed by the reviewers reported a number of issues, saying patient assessment was suffering, they could not access regular in-house education and triage nurses should be additional to base staffing levels.

Mr Bonner said the union would be seeking further assurances and specific detail on the recommended measures and would meet with members at the hospital in coming weeks.

"We need to work through how we support the staff through that change process at the hospital," Mr Bonner said.

Local MP Troy Bell welcomes funding

Member for Mount Gambier Troy Bell said he was initially concerned about the review being independent, but both reviewers had come highly recommended.

"It's really not an independent review when someone from the department does the review," he said.

"The correct term, I would say, is a departmental review."

Mr Bell said the increase in funding for staffing levels was welcome news.

"To me, it validates the raising of these concerns and that clearly, there have been issues regarding understaffing and supervision, which is what people on the front line were coming into my office and telling me."

He said it was too early to tell whether the recommendations would address all the concerns raised, and said he would like to address 'bottlenecks' at the emergency department.

"It is reported to me the amount of people who go to the emergency department because it is a free service that are better suited going to see their local GP."

"There are free services without going to the emergency department."