[VIS] Royal Adelaide Hospital Rebuild

[Howie]

So we should do a few more patch ups, waste some more money and then do the inevitable rebuild anyway? And if it was true, that the building didn't matter, then let's do health care out of an empty paddock, because hey the only thing that matters is the staffing and equipment.

Way to take things out of context man. But if you want me to entertain the idea that there is no replacement for brand new facilities.. what does your brother think about the new ER that has been built at the RAH since he works there?

[Benski81]

So we should do a few more patch ups, waste some more money and then do the inevitable rebuild anyway? And if it was true, that the building didn't matter, then let's do health care out of an empty paddock, because hey the only thing that matters is the staffing and equipment.

Way to take things out of context man. But if you want me to entertain the idea that there is no replacement for brand new facilities.. what does your brother think about the new ER that has been built at the RAH since he works there?

Not intential Howie, and I haven't asked him but if you want I can certainly do that and post to let you know?

[Howie]

Please do as I was just down at ER about 2 minutes ago, and it looked perfectly good to me.

[Benski81]

Will do, but for now as you know a hospital is more than just an ER and the question is whether or not rebuild a new hospital or to work with what's already there.

So I don't disagree with you, the ER probably is fantastic nay state of the art but as you can appreciate we are talking about the entire hosptial being over due for an upgrade. We can't retain the hospital because they've built a new ER now can we?

And Howie, no offence was intended.

[Howie]

Sure it's more than just an ER.. but it's also a new Intensive Care Unit, Burns Unit and Renal Dialysis Unit. What's left to upgrade? Perhaps a new residential wing. Doesn't seem to make sense to me, that we'd throw away hundreds of millions of dollars already spent and also pry the RAH away from the IMVS, and the universities and plonk it on the other side of North Terrace. I mean come on, you don't need to be Dr Tim Cooper to realise this just doesn't make any sense.

p.s. no offence taken Benski.

[peas_and_corn]

With the rebuild, will I still need to go up a few floors, down a corridor and then down a flight of stairs to get to some of the wings?

[Professor]

The new hospital looks increasingly likely now that the Adelaide oval rebuild will take the heat off the need for a new stadium in the railyards. And the medical research centre will start soon right alongside the new RAH. Adelaide is big enough to spread the research and medical precinct and Uni SA City West is right across the road. Should be a good set of construction and capacity building projects that will breath new life into the city. Hopefully the Adelaide oval rebuild is not a ploy to get us through the next election and then - hey - we have just discovered a budget "black hole" and will defer the plans for 500 years etc etc

[Benski81]

Sure it's more than just an ER.. but it's also a new Intensive Care Unit, Burns Unit and Renal Dialysis Unit. What's left to upgrade? Perhaps a new residential wing. Doesn't seem to make sense to me, that we'd throw away hundreds of millions of dollars already spent and also pry the RAH away from the IMVS, and the universities and plonk it on the other side of North Terrace. I mean come on, you don't need to be Dr Tim Cooper to realise this just doesn't make any sense.

p.s. no offence taken Benski.

Hey Howie, I hope you've been well. As promised I caught up with my bro at one of the family functions we all love. I asked him firstly about the ER and then about the hospital in general. I can't remember all that he said, partially because I'm not a nurse and therefore couldn't relate but also because he said too much for me to remember. But from what I can remember here's an essay:

On the ER, he said that when it was built it was actually done so without consulation of a lot of the staff that use it and for that reason it's actually poorly designed. He also said that it's too small and they've already run out of room in there and there's no more room to expand it which is also creating problems. He elaborated by saying that they expect a 40% increase on current patient levels coming through the ER by 2012 (i think he said) and the ER just wouldn't cope with this and doesn't have the space to expand. Apparently they,ve also actually rigged it up with a bluetooth system that they can't use for some reason to do with things I don't understand but this was done to accommodate a new patient file sharing system they want to put into place across all SA hospitals but can't implement in the current RAH because of the buildings limitations. Over my head.

On the hospital in general he said from a nurses point of view it's just poorly designed and laid out. He was saying that in Canada and America new technologies and building designs are being used which they want to adopt here in SA that are somehow far superior (I don't understand so can't comment) and they can't achieve that by doing a refurbishment. He mentioned also that the current wards where you can have 9 or 10 patients sharing the ward wasn't condusive to treatment, privacy or healing of the patient and what the government wants to do is copy what they do in Canada and have a separate room for every patient as this is better for care. Also apparently the nurses stations are too small and it's making it difficult for them to do their work properly and he said they struggle to find space to sit down and complete the patient paperwork in these stations and again there's no room for cost effective expansion.

He also said that they've had meetings recently in which they were told that they want to centralise health care in SA. That means that all acute care would be transferred to the new RAH, Lyell Mac in Elizabeth and one more hospital down south. Modbury and the QEH would be outpatients only and that the staffing levels would therefore be significantly reduced. I'm guessing this is a large reason for the new hospital, to facilitate this as this would not be possible on the existing site. On the note of the IMVS he said that they are on the hospital grounds and would simply transfer to the new site, and as far as the university goes he raised a fair point and said walk for five minutes (fair call).

That's all I can remember, he finished off by saying let's face it for every reason you can find to build the hospital there's probably a reason to do the refurbishment. He wasn't claiming he's an expert but in his opinion as someone who works there he would like to see the new hospital built. Actually that reminds me he did say that the RAH already has a lot overseas doctors wanting to come work here but the current hospital is a bit of a joke and he feels that with a new world class hospital it will attract even more overseas health care professionals here who will want to work and critically stay and practice or to do research etc and that this brings with it obvious finanical/economic benefits beyond just pure healthcare.

anyway that was way too long, enjoy.

[Howie]

Thanks Benski. Comprehensive list and some valid points there. As he says though, for every reason there is to build new there probably is a good reason to rebuild also. For instance, the floor i'm currently in was originally a nurses ward, it has gone through several refurbishments over it's lifetime to become a joint data storage and computer facility. These buildings are open and walls can be removed to accommodate change. Btw, the new RAH/Marj won't be any bigger than a refurbished RAH (or even the current RAH as is), so if floorspace is an issue now it will continue to be an issue with the Marj.

As for the new patient file system, assuming he's talking about open clinical records systems, there is no reason why it cannot be implemented here. You could deploy these technologies over bluetooth, wifi, 3g, workstation you name it. I don't see this as being a problem with the building, but lack of resourcing to get the job done. And once again, this problem isn't unique to the RAH, open clinical record systems in Australia is the holy grail, getting there has been a long process spanning two decades and we're still no where close to where we need to be. A new building won't help, but some funding might.

[Aidan]

So now the big question is: can a hospital rebuild on the existing site solve the problems of the ER quickly enough?

[Howie]

So now the big question is: can a hospital rebuild on the existing site solve the problems of the ER quickly enough?

Not sure if that will be deciding factor. Whatever space issues there are current with the ER will remain with the new Marj.

However one would argue hospitals are just walls with movable configurations for most departments.. so they get reconfigured all the time.

ER would have plenty of options in a rebuild. A succondment of the loading bays directly north of ER and extension of ER facilities. Or when units move from the floors ER could be expanded vertically.. taking floors 3, 4, 5. Or perhaps even moving into a new ground floor ER unit in the proposed North Terrace building. They've got plenty of options.. and they could still operate while this is taking place.

[Wayno]

hi howie, what's the lowdown on Golden Staf problems at the RAH? is it an idiosyncratic problem inherent to the current RAH building only? or a generic hospital problem that would soon exist in a railyards RAH too?

Many people seem to see this as the crux of the rebuild or relocate issue.

[Howie]

hi howie, what's the lowdown on Golden Staf problems at the RAH? is it an idiosyncratic problem inherent to the current RAH building only? or a generic hospital problem that would soon exist in a railyards RAH too?

Nail on the head Wayno. Argument is that infections are between the walls and not in them. So really any problems that exist in the RAH/Modbury/QEH/etc will still be there in a new building.

[skyliner]

Same problem in Brisbane hospitals as well - exacerbated by interaction of staff, ambulances, patients and equipment taking the problem with them. V hard to contain it seems.Cleanliness and cleaning a big issaue.

SA - STATE ON THE MOVE

[stumpjumper]

I have been trying to find any sort of document called something like "Comparison of Hospital Options".

As usual, there isn't one as far as I can tell. So how did the government reach the decision to build a new hospital on some free land that happened to pop up?

I really object to projects, instead of being a rational response to a need and properly compared to alternatives, being either porkbarrelling or the outcomes most desired by interested parties, whether they're politicians or developers.

I'd like to see all proposals costing over say $10 million of public money subject to scrutiny by a neutral panel of some sort.