As new figures reveal soaring demand expected at Ballarat Base Hospital's emergency department over the coming decades, the first breakdown of what is expected in its new ED has been revealed in Grampians Health's new Clinical Services Plan.
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Within 20 years the number of ED presentations is expected to jump more than 50 per cent, from 66,000 last financial year to almost 100,000 in 2041-42 with the number of urgent category two patients who should be seen within 10 minutes to more than double from 9995 to more than 21,400, and category three patients also set to surge.
The hospital's new emergency department, being built as part of the hospital's $541.6 million redevelopment due for completion in 2027, will have a capacity almost two thirds bigger than the current ED.
According to the plan, the new ED will have 68 points of care including more triage, three extra ambulance triage bays, six resuscitation bays, a pediatric unit of six beds, a sexual assault unit, and five points of care for a new mental health, alcohol and other drug crisis hub which will later be expanded to 12, compared to the current ED's 42 points of care comprising 30 cubicles and 12 short stay beds.
Separate waiting areas for adults and children will also be created.
The emerging issues for ED and (urgent care) services across Grampians Health relate to increasing demand with the ageing population, together with the increased complexity and acuity of presentations, including an increase in presentation of an older cohort that need specialist geriatric input as well as the growing presentations that involve psychosocial and mental health issues related to home environments, carer issues, family violence, sexual assault, amongst other factors
- Grampians Health Clinical Services Plan
Consultations revealed that there was a shortage of registrars and hospital medical officers in Ballarat's ED.
"There is also a shortage of nursing staff in senior roles due to an exodus of senior nurses during the pandemic," the plan states.
It also identified limited physical space, inefficient patient flow to ward areas, workforce issues managing existing patients within the ED; and difficulties discharging patients from wards and othe rparts of the hospital as having a significant impact on the ED.
"The emerging issues for ED and (urgent care) services across Grampians Health relate to increasing demand with the ageing population, together with the increased complexity and acuity of presentations, including an increase in presentation of an older cohort that need specialist geriatric input as well as the growing presentations that involve psychosocial and mental health issues related to home environments, carer issues, family violence, sexual assault, amongst other factors," the plan states.
COVID's impact on the health care system have further compounded existing issues.
There were more than 65 consultations carried out to create the Clinical Services Plan and its more than 200 recommendations, which Grampians Health chief executive Dale Fraser describes as "essentially a stocktake on the health of our community" and services.
One of plan's recommendations would see Ballarat developed as a genuine seven-day hospital, extending the normal business hours of operation and staffing of departments, imaging and other services across seven days rather than five, improving the ability to move patients through on weekends.
Further expansion to the hospital in the home program, a discharge coordination hub for complex patients and an acute care of the elderly (ACE) program are also proposed along with separate ICU and coronary care units with expanded capability and capacity.
Key to most expansion is the ability to retain and attract staff, with critical shortages in nurses, junior doctors and some specialties including cardiology and neurology where workforce pressures are high.
Grampians Health currently has a cardiology workforce of 3.01 full time equivalent staff, all at Ballarat, where at least three more full time staff are needed to also support other Grampians Health campuses.
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"There is escalating demand for cardiology services at Ballarat. There has been strong service utilisation growth and yet wait times for cardiology outpatient clinics are now increasing beyond reasonable levels, limiting the timeliness of access for patients," the plan states.
"For after-hours coverage there is a reliance by generalist registrars covering clinical cardiology wards. This increases the likelihood for after-hours call-outs from the cardiologist workforce, contributing to already high workforce pressures for this group."
It is also noted that Ballarat does not have a stroke nurse coordinator, and no designated stroke registrar after hours, instead relying on the Victorian Stroke Telemedicine (VST) program for after-hours stroke coverage.
Grampians Health also released its Strategic Plan, following approvals from Victorian health minister Mary-Anne Thomas, outlining its commitment to improving equality and access to healthcare for all regional communities across its service region.
"The communities we serve are at the centre of everything we're doing, and the Strategic Plan has been developed in consultation with local communities, our workforce and key stakeholders. The Strategic Plan shows our dedication to providing safe and sustainable healthcare that is tailored to our community's needs now and into the future," said Grampians Health board chair Bill Brown.
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