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Northern Territory Department of Health Library Services Historical Collection
DL HIST 362. 1109 94295
REP1982
REPORT ON GOVE DISTRICT
HOSPITAL
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1i11l1~1!REPORT ON GOVE DISTRICT HOSPITAL
This report was prepared after a visit to Nhulunbuy on l to 3 June 1982, at the request of the Secretary for Health. ·
The Report is written on the assumption that all involved with the running of Gove District Hospital accept that there are problems. The recommendations are aimed at providing a plan of corrective action for the next 3 to 6 months. Fmther review will then be required.
INITIAL IMPRESSIONS
These are worth recording as I believe many in Gove have got themselves into a state where they can no longer see the obvious.
1. There is a destructive relationship between the Regional Office and the Hospital.
2. The disruptive and destructive effect of the Medical Superintendent on his staff is as great as their lack of insight. into it.
3. Everybody in the Hospital works under the misapprehension that the
reduction in the Hospital (a closed ward) is temporary and that one day they will blink and the Hospital will return to its previous bedstate and staffing.
HOW MANY BEDS?
The question I had some difficulty in determining was how many beds the Matron and Medical Superintendent thought they had at present. Though they and others talked about 40 beds a physical count of beds revealed that there were in fact only 34 physical beds in the ward!
There are many factors that determine how many beds are used in a Hospital in Gove other than the population served. These factors will have undergone many changes without deliberate decision over the years. This will have happened with changing staff. Admissions, Transfers and Discharges Policy is an area that the Regional Director, The Medical Superintendent Gove District Hospital, Dr P Fuller, and peripherally the Medical Superintendent Darwin Hospital should discuss.
I studied bed occupancies and lengths of stay for January/February /March and April from 1980 - 1982. I considered three specialisations in the provisions of beds;
adults, children and obstetrics. (Appendix l & 2). It can be seen that 36 beds is what should be authorised under the Department's 85% average bed occupancy policy.
The downward trend in the average length of stay is both remarkable and pleasing, but I would venture to suggest, cannot be much further reduced without a
corresponding rise in early readmissions.
The most disturbing aspect of these statistics is that nobody else is aware of them.
The Hospital has monitored the Total occupancy but has done no analysis on the performance and problems arising from it. Neither has the Hospital Management Board, the Regional Office nor Central Office. All of these parties receive copies of the monthly statistics collected and collated at some considerable effort and expense. A degree in statistics is not required to get useful information. from these figures.
Recommendations
,.
1.
2.
An authorised bed number should be set at least 36, not more than 40.
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This number will require one ward only to be used.
CENTRAL LIBRARY 1 8 A U G 1998
TEAR1TO'AY HEALTH SERVICES l
3.
4.
5.
A comprehensive plan including staffing and any building alterations should proceed once the number of authorised beds is determined.
The Hospital staff and Hospital Management Board must regularly review the utilisation in the Hospital and recognise any change· trends.
The Regional Director or his delegate, the Medical Superintendent, and Dr P Fuller, must develop a definite admissions, transfers and discharges policy.
Though it will need to be quite flexible, it would be worth stating the policy in writing to the benefit of all parties.
ADMISSIONS
Though he had done it unpleasantly at times, and not always in the best interest of patient care, by insisting that he be consulted on all admissions, Dr Irwin had set up an admission policy. The essential part of his policy that should be retained is that no decision to evacuate a patient for admission should be made without up to date knowledge of the bed occupancy and patient dependancy loading at Gove District Hospital.
Recommendation
1. The Hospital must have an admission officer each day (normally the Senior Medical Officer on duty).
2. The admission officer must have a clear idea of the ability of the hospital to absorb any additional patient load.
3. AMS, Dr Fuller or other Medical Officer must contact the Admission Medical Officer before any decision to admit a patient is made.
TRANSFERS Recommendation
Transfers in must be organised with the Admissions Officer just as admissions are.
DISCHARGES
A tight discharge policy will be necessary. In the N. T. patients, their families and the Community regard the Hospital as a Hotel to some extent (even Hotels have a tight discharge policy). A patient may need to be discharged early in the morning even though they do not regard it as convenient, if they are medically fit for discharge and the bed is required.
It was frequently alleged at the Hospital that considerable delays were experienced in arranging transport home for patients to the "Bush". The Hospital had never monitored it, however AMS kept accurate figures even though nobody analysed them, nor were they published. Appendix 2 shows the performance in this area, which I consider good. If it was not good it would of course have caused consider- able embarrassment to the Hospital. This needs to be monitored closely and
perhaps AMS could publish similar figures monthly with cumulative totals to inform the Regional Director, the Medical Superintendent and the Hospital Management Board.
Recommendation
1. A tight discharge policy is required and should be published for the informa- tion of all parties.
2. Repatriation performance should be reviewed re~ularly by publishing a monthly review of repatriation delays.
3. The monthly review should be sent to the Management Board, the Medical Superintendent and the Regional Director.
WARD ORGANIS,L\ TION
The first impression in walking into the ward is that it is very disorganised. It is not, but it took a while to work out why this impression of disorganisation is so strong.
The working part of the ward is very compressed and cluttered with a large amount of equipment that was not in use during my visit and obviously, though required, is only required infrequently.
The Delivery Suite, Nursery and Formula Room is nearly 25% of the available patient space in the ward. There is also what I will call a "2 bed room" with the more specialised medical equipment in it ("ICU") which is only occasionally used but is mostly saved for special patients. This is gross waste considering the relative congestion in the rest of the patient areas.
A planning group with majority local participation needs to decongest and declutter the ward.
I believe this congestion and cluttering relate to point 3 in my Initial Impressions.
Correction of this is the most pressing problem for the Hospital from the public confidence point of view and the staff morale point of view.
Any detailed analysis necessary before definite planning recommendations was beyond my 3 day visit. However I gained some impressions and they may be useful.
1. The Medical Superintendent must be replaced as soon as possible as orderly planning will not be possible with Dr Irwin. ·
2. The Regional Office/Hospital problem must be resolved.
3. Once a Medical Superintendent is appointed he should head up a small planning group.
4. 4 single rooms in the staff quarters or perhaps better the closed ward should be opened as a Hostel for Boarder mothers, patients awaiting repatriation, self sufficient patients awaiting discharge etc. If done correctly
accommodation here may be supported by IPT AAS to defray expenses.
Temporary partitions and locks could "protect" the rest of the ward.
5. The equipment not in use must be removed to storage to declutter the ward immediately. It may be necessary to build new or alter current storage spaces.
6. A good deal of effort must be put into increased useable patient areas and reduction of the low use areas.
7. The current delivery room is too large. It is only a 4 bed space with lights fixed in ceiling. This was done only in 1978. No other modifications were put in. A two bed space would be big enough. Perhaps the delivery room does not need to be in the ward but this was seen as desirable in 1977-78. There is a full delivery suite constructed in the top floor. Perhaps the ward should shift to the ground floor and the delivery room remain on the second floor and be staffed only for deliveries. Issues that need to be examined!.
8. A semi-enclosed paediatric unit within the ward is required to control noise, odour and patients with diarrhoea to one area. This would be the rr,ost expensive item although with its glass walls and some interconnecting doors installed the Nursery area of today has some distinct possibilities.
9. The concept of an ICU room should be dropped and when patients are coming (the admissions officer will know in advance of any admission) ~ a one or two bedded room cleared and only necessary equipment got out of storage.
Recommendations l.
2.
3.
High priority must be given to ward reorganisation in the interests of restor- ing Patient/Community confidence and staff morale.
The Medical Superintendent, when appointed, should head a planning group and bring about urgent local consultation with central input added to redevelop the ward to the uses required of it.
A staffing review should finally be completed in light of the pla111ning group's decisions.
MEDICAL STAFF
Two Medical Officers working full-time could cope with the inpatient and out- patient workload. They should not work harder than a l in 3 out of normal hours as this has proven too exhausting in the past. I should state here that I believe there must be a Senior Doctor appointed for all staff to identify as the Medical
Superintendent. He need not be full-time in the hospital but his presence and input must be significant. This is necessary in a Hospital that does not have Specialists.
1. A Medical Superintendent must be appointed as soon as possible.
2. Two full-time Hospital Medical Officers will need assistance with the out of hours roster.
NURSING STAFF
It was my impression that there were a lot of staff on duty during all shifts. There is no resource monitoring. I believe Darwin Hospital Nursing Administration staff could easily design a simple manual RMS for Gove District Hospital.
The Matron mentioned problems with midwife recruitment and training of theatre staff. I believe the resources of Darwin Hospital should be an·d are available to · assist. It is important that the Matrons of the two Hospitals communicate regular- ly to discuss these and similar problems.
Recommendation
l. A Resource Monitoring system should be designed and implemented in the Hospital.
2. Greater communication with Darwin Hosital should be initiated wi.th the resources of Darwin Hospital available to Gove, made.
SUMMARY OF RECOMMENDATIONS How many beds
1. An authorised bed number should be set at least 36, not more than 40.
2. This number will require one ward only to be used.
3. A comprehensive plan including staffing and any building alterations should proceed once the number of authorised beds is determined.
4. The Hospital staff and Hospital Management Board must regularly review the utilisation in the Hospital and recognise any change trends.
Admissions
1. The Hospital must have an admission officer each day (normally the Senior Medical Officer on duty).
2. The admission officer must have a clear idea of the ability of the hospital to absorb any additional patient load. "'
3. AMS, Dr Fuller or other Medical Officer must contact the Admission Medical Officer before any decision to admit a patient is made.
Discharges l.
2.
3.
A tight discharge policy is required and should be published for the informa- tion of all parties.
Repatriation performance should be reviewed regularly by publistiing a monthly review of repatriation delays.
The monthly review should be sent to the Management Board, the Medical Superintendent and the Regional Director.
Ward Organisation
l. High priority must be given to ward reorganisation in the interests of restoring Patient/Community confidence and staff morale.
2. The Medical Superintendent, when appointed, should head a planning group and bring about urgent local consultation with central input added to redevelop the ward to the uses required of it.
3. A staffing review should finally be completed in light of the planning group's decisions.
Medical Staff
l. A Medical Superintendent must be appointed as soon as possible.
2. Two full-time Hospital Medical Officers will need assistance with the out of hours roster.
Nursing Sta ff
1. A Resource Monitoring system should be designed and implemented in the Hospital.
2. Greater communication with Darwin Hospital should be initiated with the resources of Darwin Hospital available to Gove, made.
Appendix I
Occupied Bed Days
' "
Aboriginal Non-Aboriginal Average
adult child adult child length of stay
Jan 82 494 218 167 9
Feb 82 504 313 129 17
Mar 82 436 297 130 10
April 82 411 242 190 55
Ab.
=
6.81J-A 1982 1845 1070 616 91 Non-Ab
=
3.09Jan 81 376 157 215 19
Feb 81 537 232 238 24
Mar 81 465 280 307 47
April 81 561 223 267 44
Ab. = 8.07
J-A 1981 1939 892 1027 134 Non-Ab = 4.28
Jan 80 579 352 206 33
Feb 80 526 225 169 76
Mar 80 580 196 167 46
April 80 486 322 272 54
Ab. = 9.12
J-A 1980 2171 1095 814 209 Non-Ab = 4.11
/JI
Appendix 2
Average Bed Occueanc~
·,
Obstetrics Children Total • No beds
if Total
=85% average
1982 J 8.32 9.2 28.64 33.7
F 11. 54 11.0 34.39 ·40.5
M 7.26 9.0 28.16 33.1
A 4.23 9.6 29.93 35.2
1982 Av. 7.8 9.7 30.28 35.6
1981 J 10.26 6.4 24.77 29.l
F ll.61 .9. 6 36.82 43.3
M 7.35 9.2 35.50 41. 7
A 14.20 9.2 36.50 42.9
- -
1982 Av. 10. 9 8.7 33.39 39.3
1980 J 9.52 11.3 37.74 44.4
F 11. 35 10.3 34.34 40.4
M 10.42 9.6 31.87 37.5
A 10.04 11.0 36.58 43.0
- -
1980 Av. 10. 3 10. 5 35.13 41.3
Appendix 3
Repatriations
AMS/Travel Clerk keep a log of all repatriation requests. The date of each request is recorded and the eventual date of repatriation. This allowed me to.calculate delays and know which destinations these delays were associated with.
I looked at all repatriations from l January to 31 May simply from delay and destination point of view.
Of 205 patients 165 were repatriated on the day of request or the next day.
Destinations
No of days Outstations Groote Numbulwar Elcho L.Evella Ramingining delay
2 0 7 2 4 2
3 1 3 0 l
4 1 1 1
5 0 1
6 1
3pt = 13 day llpt=27day 4pt=l3day 4pt=8day 3pt=7day 2pt=5day
Groote/Numbulwar and Milingimbi/Ramingining patients remain problems. At least patients from outstations can usually wait with family at Yirrkala.
,,.
l l
Milingimbi
3 3 2
8pt=23day
