Patient Care Escalation Policy

Mr PEDERICK (Hammond) (11:49): I move:

That this house urges the state government and the Minister for Health to outline and implement a patient care escalation policy with the inclusion of a medical intervention phone number for families, carers, guardians, and patients, as an initiative to prevent misdiagnosis and future deaths.

I rise today with great honour as I introduce a motion holding the potential to save future lives, a motion which is close to the hearts of some here in this place today. It is with great privilege that I stand here as a member of parliament, and I hope that after my speech members on the other side will see the importance of the motion. I rise today to call on the state government and the Minister for Health to outline and implement a patient care escalation policy with the inclusion of a medical intervention phone number for family, carers, guardians and patients as an initiative to prevent misdiagnosis and future deaths.

Before sharing the story of little Leila, I need to acknowledge in the gallery Leila's parents, Edie and Ricky Harkin, as well as Edie's father, Hessel, who are here in support of this motion. I first learnt of the tragic circumstances surrounding the passing of Miss Leila Baartse-Harkin, upon meeting with her mother, Edie. I was extremely saddened to hear of the misdiagnosis and death of Leila on 1 October 2015, less than 48 hours after a playground accident at just nine years of age.

Leila was misdiagnosed by examining hospitals on several occasions and her final cause of death was a perforated bowel, an illness which I believe can be treated in numerous ways depending on its severity. Unfortunately, it was life taking in Leila's case. Edie, her husband, Ricky, family and all those affected by Leila's passing experienced a form of grief which no family should ever have to endure. No words can describe the loss of a parent or loved one, let alone a child.

When Edie met with me, she was so strong while sharing with me Leila's story and was persistent in the fact that she and Ricky do not want other families to go through the loss they live with every day. Edie and Ricky envision South Australia having a policy such as Ryan's Rule which is a patient care escalation system implemented in Queensland through the Queensland government.

Ryan Saunders tragically passed away at nearly three years old in a Queensland health facility in 2007, and his death was found to be 'in all likelihood preventable'. Upon the death of her young son, Ryan's mother did not want any person to be affected by the grief she feels daily, and I quote:

Ryan Saunders was nearly 3 years old when he tragically died in hospital. His death was found to be in all likelihood preventable. Staff did not know Ryan as well as his mum and dad knew him. When Ryan's parents were worried he was getting worse they didn't feel their concerns were acted upon in time. Ryan's Rule has been developed to provide patients of any age, families and carers with another way to get help.

Ryan's Rule was introduced into Queensland and, through my research, I do not believe it was legislated and instead was introduced as a policy. The Health Contact Centre and Health Support Queensland are in partnership with the health department's patient safety innovation unit, 13 HEALTH and Smart Services Queensland, to deliver Ryan's Rule throughout the state. It works on a three-step process:

1. Talk to a nurse or doctor about your concerns. If you are not satisfied with the response, you pursue step two.

2. Talk to the nurse who is in charge of the shift and if you feel as though your concerns are still present, you escalate the process to step three, the final step.

3. Phone 13 HEALTH (13 43 25 84) or ask a nurse and they can call on your behalf.

Upon phoning this medical intervention phone number, request a Ryan's Rule clinical review and you will be asked to provide the following information: the name of the hospital, the name of the patient, bed and ward number (if available and known) and your contact phone number. After this, a Ryan's Rule nurse or doctor will review the patient file and assist.

It is my understanding that Smart Services Queensland have 92 full-time equivalent staff who are the first to respond to a Ryan's Rule phone call. These staff are skilled and competency assessed, and this is done on a quarterly basis ensuring they are adequately trained to receive this form of correspondence. I think it is important to note that these staff are not employed solely to take Ryan's Rule calls as they are also responsible for answering other human service-related calls.

Ryan's Rule has been utilised heavily throughout Queensland since its commencement in December 2013. Recent data provided by the Queensland government suggested that one to two calls are made per day to Ryan's Rule across approximately 10,000 public acute submissions and feedback received has been positive. These statistics provide the house with an insight of the true significance of this service and show that it is not ignored by concerned patients, family members or carers.

I would like to share the story of a young mother who actioned Ryan's Rule after being turned away from a Queensland hospital eight times. Lili Curtis, the mother of 10-month old Arabella, visited Gold Coast University Hospital eight times over a period of 17 days. It is advised she was turned away every time as 'Arabella was apparently not sick enough to be there.' Lili acknowledged and followed her mother's instinct and made the decision to invoke Ryan's Rule. Arabella's diagnosis was referred to the head of paediatrics, who was called in to review the case notes. As a direct result, Arabella was diagnosed with a form of bronchitis and was treated with a long-term course of antibiotics. Through invoking Ryan's Rule, Lili was able to receive an adequate diagnosis for her daughter, and she was able to trust her gut instinct and provide her daughter with the care she needed.

Many other states throughout Australia, and the world for that matter, have individual policies in this regard, which pose similar comparisons. However, South Australia has none sharing the same similarities and security processes as those in Ryan's Rule. As previously mentioned, policies much like Ryan's Rule also exist in the United States. This is known as the Josie King Foundation. The story that initiated the creation of this foundation is another case which is extremely saddening to read.

Josie King was just 18 months old when she passed away. In the days leading up to her death, Josie's mother, Sorrel King, can recall her screaming for water each time she saw it, and sucking profusely on a flannel when bathing. Sorrel thought this was concerning, but was instructed by medical staff not to let Josie drink. Upon putting Josie to bed, she noticed her eyes rolling into the back of her head. She was advised by a nurse on duty that this sometimes happened. Sorrel suggested speaking to another nurse, as she knew this was not a normal trait of Josie's. The second nurse reassured her also. However, unfortunately, two days later Josie King's life support was switched off, with her final cause of death being dehydration and a wrongly administered narcotic.

It is understood that 98,000 people in the United States die every year as a result of medical errors, making it the fourth leading cause of death in the US. Through the death of her young daughter, and those of some 98,000 people, Sorrel King initiated the inception of the Josie King Foundation, which endeavours to implement change and deter future deaths which may be caused by misdiagnosis. The foundation has created a program called Condition H, with the 'H' meaning Help, which is a helpline for families. This also works on a three-step method before ringing an independent phone number.

In relation to states within Australia, New South Wales has implemented a policy called REACH, which stands for 'Recognise, Engage, Act, Call and Help is on its way.' Similar to the processes in Ryan's Rule, parents, carers or family members are encouraged to firstly engage with a nurse or doctor to express their concern, and if those concerned are still not comfortable, the matter can be escalated by requesting a clinical review, which should occur within 30 minutes of its lodgement. If after these two steps, parents, family members or carers still believe that something is not right, an independent review or a rapid emergency response can be activated.

Within the Canberra Hospital there is a program titled Call and Respond Early (CARE). This also works on a three-step escalation process for those concerned about a patient's health or diagnosis, and the third step involves ringing a medical intervention phone number and speaking with a CARE nurse. In Victoria, the Let Me Know policy has been carried out through the Alfred Hospital, which again has a three-step process, with the inclusion of an independent phone call as the third step. I also note that other hospitals throughout Victoria also have their own individual patient care escalation processes, similar to this.

As has been heard, many states throughout Australia have implemented such a policy within their hospitals. Parents, family members and carers often know when something is wrong with their child or a loved one, and, if they have gone through all the appropriate processes and still feel as though there is an underlying issue, they deserve the opportunity to be heard and listened to.

The policy in South Australia would be titled Leila's Lifeline. It would have a step-by-step escalation process and, if any parent, caregiver, patient or family member felt as though the diagnosis was incorrect, there would be a phone number they could ring where an independent doctor could access the patient file and make a third-party determination. A petition on Change.org was created by Edie, which urges the Minister for Health and others to ensure future lives are protected by endorsing Leila's Lifeline in South Australia, and this petition has so far received 5,494 online signatures, mine being one.

I hope that those on the other side and the Minister for Health will see the benefits of introducing such a policy in South Australia, not only to honour the life of Leila Baartse-Harkin but all those who may have lost their life and did not have the opportunity to be provided with this potentially life-saving second chance. I have introduced this motion to fulfil the wishes of Leila's mother, father and family and also as a way of honouring Leila. From what I have gathered, she was a beautiful, strong girl, and I hope her name and memory can live on through the policy Leila's Lifeline. I commend the motion.

Ms COOK (Fisher) (12:00): I rise with pride on behalf of the government to support the motion. I have spoken in this place a number of times in relation to health care and have a degree of authority to do so based on 28 years working as a nurse across a number of healthcare sites. When I started nursing, clinicians did not actually seek the help of an acute medical team from the intensive care unit to assist with resuscitation and retrieval of a patient who had medically fallen off a cliff, so to speak, until the patient was in a state of cardiac or respiratory arrest. These calls were known as Dr Speedy or Dr Quick calls, and the teams were notified over the loudspeaker system. More often than not, even a patient arresting in the hospital resulted in a negative outcome. Calls were made infrequently and usually far too late.

Acute-care settings have come a huge distance in a relatively short time. Not only do we have a MET (medical emergency team) that undertakes regular and specialist training in supporting medical emergencies, the ward staff are also well versed in the recognition of warning signs. There are well-defined criteria and a clearly documented and universally accepted policy that see many more MET calls than ever before that have a much better outcome because rarely are they for a patient in full cardiac arrest. They are made because people just do not feel right about the patient.

Health systems have come a long way, and it is important that in this place there is an understanding of this constant nature of change, improvement and delivery of evidence-based practice. Clinicians always set out to do the right thing by their patient. They construct appropriate care pathways, and they deliver the best possible care. As stated, serious adverse events such as unexpected death and cardiac arrest are often preceded by observable physiological and clinical abnormalities. We know that early identification of deterioration may improve outcomes and lessen the intervention required to stabilise patients whose condition deteriorates in hospital.

There is evidence that the warning signs of clinical deterioration are not always identified or acted on appropriately although, according to patient incident data on clinical deterioration from across all of our LHNs (local health networks) that exist statewide in South Australia, the incident numbers in 2015 and 2016, thankfully, have reduced by about 3 per cent, which is significant, across all health networks. The organisational and workforce factors that contribute to a failure to recognise and respond to a deteriorating patient are complex and overlapping, and we need to understand those also. These include, but are not limited to:

not monitoring physiological observations consistently or not understanding observed changes in physiological observations;

lack of knowledge of signs and symptoms that could signal deterioration;

lack of formal systems for responding to deterioration;

lack of skills to manage patients who are deteriorating; and

failure to communicate clinical concerns, including in handover situations.

Systems to recognise deterioration early and respond to it appropriately need to deal with all of these factors and need to apply across an entire healthcare facility. The 'National consensus statement: essential elements for recognising and responding to clinical deterioration' was developed by the Australian Commission on Safety and Quality in Health Care and has been endorsed by Australian health ministers as the national approach for recognising and responding to clinical deterioration in acute-care facilities in Australia. It provides a consistent national framework to support clinical, organisational and strategic efforts to improve recognition and response systems.

This standard builds on the national consensus statement to drive implementation in acute care facilities. This standard applies to all patients in acute healthcare facilities, including adults, adolescents, children and babies, and to all types of patients, including medical, surgical, maternity and mental health patients. Acute healthcare facilities range from large tertiary referral centres to small district and community hospitals.

The 'Recognising and responding to clinical deterioration' policy directive has been implemented across SA Health. The policy is underpinned by the criteria established in the National Health Safety and Quality Health Service, standard 9, 'Recognising and responding to clinical deterioration in acute health care'. Under this policy, three local health networks have started to implement escalation of care processes that can be initiated by patients, families and carers, while two are finalising plans for the process.

An SA Health working group has been established under the 'Recognising and responding to the deteriorating patient program' to develop an SA Health model for consumer-initiated escalation of care. The model will support SA Health sites to further embed consistent statewide processes that are best practice and in line with current research. This will save lives. SA Health is collaborating with the Faculty of Medicine, Nursing and Health Sciences at Flinders University, which has conducted an extensive research program into the best ways to promote and publicise patient escalation of care to members of the public, and also to ensure that responses to worried patients and families are activated effectively by caregiving staff.

With that, I would like to commend the hardworking nursing, midwifery, medical, allied health, research, administration and ancillary staff working across all of our local health networks, and thank them for the wonderful outcomes that they do achieve for our loved ones in their care. There are experiences, however, that inform their work daily and stay with them for life.

Private members' motions such as this often arise from conversations and genuinely powerful stories of pain and loss in our communities. I acknowledge the presence in the gallery today of a family who has experienced this deep pain and loss. The loss of a child is the biggest thing that you can experience in your life, and I wish that family well as they move forward; we are there for you. The government supports the motion before the house by the member for Hammond in acknowledgment that any piece of work with the aim of preventing death and improving the journey of our loved ones, as patients, within our health service is worthy of support.

Mr PEDERICK (Hammond) (12:07): I really do appreciate the government's support for this motion, and the kind words by the member for Fisher. It is great that this has been moved through the house so efficiently. We see many things that can take a lot of negotiation, but I am pleased—absolutely ecstatic, in fact—that the government have gone onside to support this motion.

It is my wish, moving ahead, that this is rolled out in clinics, hospitals and other health facilities throughout South Australia in a very expedited manner so that we can get the health care for our friends, our children, our parents and our loved ones, and get the right health outcomes for our state. I am really pleased for the Baartse-Harkin family that we have this consensus here today, and I commend the motion.

Motion carried.