EXECUTIVE DIRECTOR,MEDICAL SERVICES
Tel: (03) 53204278
Fax: (03) 53204554
EXECUTIVE DIRECTOR MEDICAL SERVICES
OVERVIEW
FOR THE MEDICAL STAFF GROUP and for
CLINICAL DIVISIONS and HMOs
August 2010
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1.BUDGET AND WORKLOAD
As a result of reduced activity levels at the end of the 2009/2010 financial year, final activity at the end of the year was 100.8% of WIES allocation, resulting in all activity being fully funded. As a result Ballarat Health Services recorded a full year operating surplus of $47K, a remarkable result in a total budget of over $300M.
The net financial outcome at the year’s end after deducting depreciation and capital expenditure was a deficit of $6.5M.
The table below shows activity to the end of July 2010. Activity in the month was 102.58% of WIES allocation.
Ballarat Health Services Summary of Activity July 2010/11YTD 2010/11 / YTD 2009/10 / Change / % Change
WIES / 2,016 / 2,048 / -31 / -1.54%
Acute Separations / 3,016 / 2,881 / 135 / 4.69%
Acute Discharged Bed days / 7,090 / 6,740 / 350 / 5.19%
Discharged Births / 133 / 129 / 4 / 3.10%
Theatre Cases / 967 / 953 / 14 / 1.47%
Emergency Attendances / 4,273 / 3,537 / 736 / 20.81%
Outpatient VACS / 3,662 / 3,859 / -197 / -5.10%
Waiting List / 1,330 / 1,354 / -24 / -1.77%
The year-on-year changes reflect a continued increase in activity but areduction in funding. Continued pressure on the budget also arises from a higher than anticipated demand for cardiology services, new posts established in 2009/10, and the costs of operating the new short stay unit in ED (for which no funding stream has been provided). These pressures, together with a further productivity saving imposed by the Department of Health in the budget for 2010/2011,have resulted in a current deficit of approximately $4M in the BHS budget for the year 2010/2011. Further delays in finalising the budget have arisen because levels of Commonwealth funding will not be confirmed until the outcome of the Federal election is clear. Steps are being taken to address these issues, but one likely result is that new Registrar and HMO posts are unlikely to be approved for 2011 unless it can be shown that they willpay for themselves by reducing or eliminating overtime.
2.Medical Staff
JUNIOR MEDICAL STAFF:
Interns:
All 23 intern posts have been filled for 2011. Five additional posts were approved – 2 general medical, 2 general surgical and 1 ENT. These additional intern posts will reduce rostered overtime.
Hospital Medical Officers:
Four positions have been converted to a surgical residency stream for HMO2s. This will offer surgical training opportunities in the post graduate years between intern and registrar training posts. Each HMO will complete a rotation in Emergency Medicine, Intensive Care, Urology and Orthopaedics. An additional post will be funded through “Beyond Medical Education” under the Pre-vocational General Practice Placement Program,and interested HMOs will have the opportunity to undertake a rotation in a local Ballarat or Creswick general practice.
Registrars:
On Monday9 August twenty-two new registrars commenced rotations in Anaesthetics, General Surgery, Orthopaedics, ENT, Oncology, Gastroenterology, Cardiology, General Medicine, Sub-acute Medicine, Paediatrics and Obstetrics and Gynaecology. There was reduced theatre activity in the morning to allow new registrars to attend orientation which covered fire and emergency procedures, BOSSnet, clinical documentation and Medical Emergency Team [MET] protocols.
BHS has been shortlisted for funding under the Department of Health and Aging Specialist Training Program. This will support two existing advanced training posts in Gastroenterology and General Medicine and may allow establishment of two additional registrar posts in Paediatrics and ICU.
SENIOR MEDICAL STAFF:
Gastroenterology:
Dr Ian Hamilton retires at the end of October 2010 and I would like to take this opportunity to thank him on behalf of Ballarat Health Services for his leadership and major contribution to the Gastroenterology Service.
Dr Tim Elliott, who was to replace Dr Hamilton as Head of Gastroenterology and Endoscopy at the beginning of 2011, has withdrawn from the post. An active recruitment process is underway to recruit two full time gastroenterologists as soon as possible, one of whom will be Head of Gastroenterology and Endoscopy, as well as to expand the VMO component of the Gastroenterology Service. Until these initiatives bear fruit, there will be an unavoidable reduction in gastroenterology and endoscopy services at Ballarat Health Services.
Obstetrics & Gynaecology:
Dr Torben Iversen commenced as a Full-time Staff Obstetrician & Gynaecologist on Monday, 9 August, 2010.
Orthopaedics:
Mr Milos Kolarik commenced as a VMO in Orthopaedics on Monday 2 August, 2010. Mr John Dillon has been appointed a Full-time Staff Specialist in Orthopaedics at BHS and will commence in January 2011.
Cardiology:
Dr Rodney Reddy commenced as an additional VMO in Cardiology on Monday, 23 August 2010.
3.CLINICAL ISSUES
(i)VTE Prophylaxis
The BHS VTE Prophylaxis Guidelines have now been finalized and will shortly be circulated.
(ii)Infection Control
The Hand Hygiene compliance benchmark has been further raised by VICNISS to 65%. At the last audit overall compliance at BHS was just below this benchmark with 64.5%, although the performance of medical staff was considerablyworse. It is important that medical staff should set an example in this area and I would again urge all medical staff to observe the hand hygieneprotocols which have been re-circulated. Audits of compliance will continue.
(iii) Antibiotic Prophylaxis
Updated BHS guidelines for prophylactic antibiotic administration in patients undergoing endoscopic and surgical procedures have been finalized and will shortly be available in laminated format in Theatres and the Endoscopy Unit.
4. FACILITIES DEVELOPMENT
Construction of the refurbished Adult Acute Psychiatric Unit has been completed, and the unit was opened officiallyby the Minister for Aged Care on August 24th.
The Emergency Department Redevelopment and Short Stay Unit Project involves the redevelopment of the Emergency Department both within its current boundary and extending into the main foyer off Mair Street.The Short Stay Unit isexpected to be completein August 2010; the Emergency Department Entrance and Triage area should open in August 2010; and the Emergency Department Fast Track Rooms commenced development in July with completionanticipated in October 2010.
The Special Care Nursery and Maternity Outpatients Project requires the relocation of maternity outpatients to a temporary location in the undercroft to allow for the relocation of the Special Care Nursery (12 cots) to level 5 of the West Wing. The target date for completion of construction of Maternity Outpatients is 31 May, 2011 with completion of the Special Care Nursery scheduled for 23 February, 2012.
The new Cardiac Catheterisation Laboratory and support spaces will be adjacent to the existing day procedure unit, built partly over an existing concrete slab and the new CT Scanner Room. The unit will comprise one fully equipped Catheter Laboratory plus one shell for future expansion and 6 day beds. The project timeline for completion of the Catheter Laboratory is June 2011. BHS has finalised the tender for specialist angiography equipment.
On 7 April, 2010 the Federal and State Health Ministers announced funding of $42M and $13M respectively for the Ballarat Regional Integrated Cancer Centre.The development of the BRICC will include an Administration component to decant hospital administrative staff from Yuille House. The funding supports an integrated service including 4 radiotherapy bunkers (2 fitted with linear accelerators, and 2 spare), simulation, ortho voltage, transit holding area (10 spaces), 16 day oncology chairs, offices, reception, waiting area and stores on the Drummond Street car park site.BHS has sought the addition of two floors to ensure all administration can be relocated and to provide for future cancer service expansion. To support this BHS has committed $1M to the overall construction cost.Schematic design commenced in February, 2010 and has been approved by BHS and the Department of Health.
Construction of the second CT scanner was completed in mid August, 2010, and the Spect CT scanner should be installed, commissioned and available for use on Monday 30 August, 2010.
A feasibility study has commenced to develop a business case for a multi deck car park on the BaseHospital site. Urban Enterprise has been engaged to undertake the work.
The State Health Minister has announced a feasibility study to be undertaken by Air Ambulance Victoria into the possible provision of a helipad for the BaseHospital. This study is currently underway.
5. ACHS PERIODIC REVIEW
The ACHS accreditation periodic review will take place from Monday 4th to Wednesday 6th October. A team of three surveyors, with a medical team leader, will be reviewing BHS. Your co-operation in this process is greatly appreciated. Please be aware that the surveyors will attend a number of routine meetings during those days. I would appreciate it if all medical staff could ensure they wear their nametags. Please contact my office as soon as possible if you do not possess one so that we can rectify the situation.
Philip Reasbeck
A/Executive Director, Medical Services
26 August 2010
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EDMS Overview August 2010