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House of Assembly - Fifty-Third Parliament, First Session (53-1)
2014-11-20 Daily Xml
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Cardiothoracic Intensive Care Review

The Hon. J.J. SNELLING (Playford—Minister for Health, Minister for Mental Health and Substance Abuse, Minister for the Arts, Minister for Health Industries) (14:06): I seek leave to make a ministerial statement.

Leave granted.

The Hon. J.J. SNELLING: In 2012, Central Adelaide Local Health Network began working towards creating an integrated intensive care service that will provide intensive care to patients across the Royal Adelaide Hospital and The Queen Elizabeth Hospital. The new model includes the co-location of cardiothoracic and general intensive care patients in the same intensive care unit, and is the model that is intended for use at the new 60-bed ICU at the new Royal Adelaide Hospital.

Historically there has been a level of disagreement between cardiothoracic surgeons and intensivists over the management of patient care following cardiothoracic surgery at the Royal Adelaide Hospital, and until last year cardiothoracic patients were treated in a separate unit and not the general ICU. A review was commissioned that aimed to identify how the cardiothoracic ICU and general ICU could progress to an integrated service, and this review was completed in September 2013.

The team selected to carry out the review included well-respected peer experts from interstate including: Dr Richard Chard, a cardiac surgeon from Westmead Hospital in New South Wales; Professor Charlie Corke, an intensivist from Barwon Health in Victoria; Professor Geoff Dobb, an intensivist from the Royal Perth Hospital; Judy Currey, director of postgraduate studies (critical care nurse educator, researcher and clinician) from Deakin University in Melbourne; and Professor Paddy Phillips, chief medical officer at SA Health.

The review team made several recommendations to help with the integration of the two units as the care of post-operative cardiothoracic patients in intensive care moved from the stand-alone cardiothoracic unit to a hub within the RAH's general ICU.

In September 2014, the review team returned to assess the progress of their recommendations and provided a new report that includes 20 recommendations for improvement and has highlighted several matters that are of grave concern to me.

The reviewers found that the central matter of culture and behaviour remained a serious issue and that little progress had been made on the lack of teamwork between clinicians in the ICU and the cardiothoracic unit. Stunningly, the report highlights incidents of bullying, derogatory behaviour and a lack of respect for fellow professionals within and between clinical specialties, culminating in the reviewers concluding that 'some of the levels of dysfunction are unprecedented and present a real risk to patient care and staff wellbeing'.

Another behaviour uncovered by the reviewers was, 'a long running episode of bullying anonymous notes about certain members of nursing staff'. I find this kind of abuse of authority over the hardest working patient carers reprehensible. This sort of behaviour would not be tolerated in a schoolyard and I will not tolerate it in an intensive care unit.

The safety and wellbeing of our patients has to be at the centre of everything we do as a health service, and internal conflict and dysfunction within and between clinical teams should never be allowed to impact on the care that patients receive. To address the significant importance of patient safety, a new Head of Intensive Care for the Central Adelaide Local Health Network, Dr Gerry O'Callaghan, has been appointed, as has a new Head of Cardiothoracic Intensive Care, Dr Matt Hooper, but I am concerned there is still a long way to go.

The Central Adelaide Local Health Network is now focused on carrying out the remaining recommendations from the review team's report and fixing the problems that have been identified. The successful implementation of these recommendations needs leadership from the hospital's management team and the cooperation of clinical staff. They must all work together to deliver the best and safest outcomes for patients, setting aside whatever internecine disputes they have.

This process will be headed up by Dr O'Callaghan, Dr Hooper and the Nursing Co-Director of Critical Care, Dr Tina Jones. I place a great deal of trust in this team's skill, knowledge and experience, and I expect that they will put the appropriate measures in place to rectify this wholly unacceptable situation.

We have entered on the journey of transforming our health system. This means that we must change, and that includes moving on from the past and looking to the future. It means examining all aspects of our system from clinical practice and professional behaviour to where our clinicians provide services and the impacts of things like the way we employ our staff and private practice for doctors.

Under our health system some of this state's most highly paid public servants, our doctors, have access to patient practice entitlement which the public tolerate in return for better health outcomes. However, any doctor in any public hospital who engages in private practice needs to understand that matters of private practice cannot impact on the public health system lest that public trust be broken. Doctors have good access to private patients and it is important to ensure that any conflicts that arise from their work in the private sector, whether these issues are real or perceived, are managed appropriately.

I want to emphasise that the overwhelming majority of our doctors and nurses and other health professionals diligently work day in and day out to help us create a health system that makes best use of its resources, is adaptive to the latest medical knowledge and can cope with big changes such as the transition to the new Royal Adelaide Hospital so that patients receive the best possible care. For this, these doctors and nurses have my wholehearted thanks. To those few other clinicians, who are not doing the right thing, my message is plain: your behaviour is childish, unacceptable and potentially dangerous. It will not be tolerated and it must stop.

Ms CHAPMAN: Point of order, Mr Speaker: I ask that the minister table both the September 2013 report that he has referred to and the September 2014 report in this ministerial statement.

The Hon. J.J. SNELLING: I am more than happy. It was released on the Health intranet last year. I do not have a copy on me but I am more than happy to make that available. If the member for Schubert googles it, he might find it.

The SPEAKER: I was about to call on the member for Schubert.

Ms CHAPMAN: Point of order, Mr Speaker: there is a second report referred to in the ministerial report and that is—

The Hon. J.J. SNELLING: I just said I would bring it back.

The SPEAKER: Both reports.

The Hon. J.M. Rankine interjecting:

The SPEAKER: The Minister for Education is called to order.

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