February 2004 - Intensive Care & Coordination Monitoring Unit

INTENSIVE CARE CLINICAL IMPLEMENTATION GROUP
Minutes of the meeting held on Thursday 5 th February 2004
Present: Prof Malcolm Fisher (Co-chair), Ms Kate Needham (Co-Chair), Dr Craig Hore
(teleconference), Ms Linda Williams, Dr Martin Rowley, Dr Ron Manning, Mrs Robyn
Toohey (teleconference), Dr John Lambert, Ms Linda Williams, Mr Brett Abbenbroek,
Dr Gillian Bishop, Dr Imogen Mitchell (ACT)
Secretariat: Ms Lisa Chytra, Dr Steevie Chan
Apologies: Ms Denise Harris, Dr Phil Hungerford, Dr Paul McDonald, Dr Robert Herkes, Dr Neil
Kiloh, Dr Tony Burrell, Ms Lorna MacLellan, Dr Graham Reece, Ms Narelle Boyd, Dr
Tony O’Connell, Mr Martin Boyle.
Items and Actions Responsibility
Minutes of previous meeting
Minutes of the previous meeting were accepted.

Items and Actions Responsibility
Actions Arising
- Development of the Nurse Liaison concept and model (Kate
Needham)
Mary Chiarella has indicated her support for the principle.
It was suggested that this role be viewed at nurse practitioner level.
The nurse liaison concept may not be appropriate for smaller hospitals
(base hospitals and smaller metro sites). The model for larger sites
would entail management of sicker patients in the ward areas.
ACTION: Nurse Liaison document to be recirculated to ICIG and the
Chief Nursing Officer.
- Funding of ICU RNs to conferences – outcome of discussions with
the CNO (Kate Needham)
The feedback has been that there is money with the Area DONs for the
purpose of supporting nurses for education and conferences. There
are also nursing scholarships available through a number of agencies
which can be applied for.
ACTION: Letter from ICIG to Area CEOs re provision of funding
support for ICU nurses.
- Results of Influenza Pandemic Exercise (Tony Burrell)
Dr Burrell was not at the meeting to provide an update, Dr Steevie
Chan provided an update.
Dr Chan contacted Dr Alex Warner, the Report has not been finalised ,
once finalised and released it will be circulated to ICIG. Dr Warner has
indicated her willingness to present the findings to ICIG at a
subsequent meeting following release of the report.
System monitoring – Report – Ron Manning
Adult activity was slightly higher than for the same period last year but
otherwise it is on par. The increased workload has been due to increased
care requirements.
Area Health Services are transferring largely within their Area. Out of Area
transfers have generally been for appropriate reasons.
There have been some problems noted within IAHS such as inappropriate
admissions. It was noted that IAHS did receive additional funding to open
extra beds.
ACTION: Professor Fisher to contact Dr Grant Simmons at IAHS to
discuss issues.
Steevie Chan and Malcolm Fisher to try and attend the next meeting
of the Area Critical Care Committee.
There was a request for workload from rural Areas (by AHS) to be included
in the report provided. Dr Manning stressed that while this was possible,
the MRU data only records retrievals conducted by the Sydney based
retrieval services, therefore patient retrieval conducted by the regional
retrieval services may not be captured, so the data provided may not
provide a complete picture of patient movement statewide.
SARS Taskforce – update on final report
The Report was released in January 2004.
The SARS Hospitals recommended in the Report still need to be
designated. There will be a need to implement staff training at these
hospitals.
Generally the staffing ratio required for SARS patients is 3:1 which will
have implications for staffing in ICU.
The Chief Nursing Officer will be meeting with the Chief Nurses from the
Asia-Pacific Region to discuss nursing implications of SARS.
Following discussions it was recommended that all ICUs should be looking
at surge planning.
Kate Needham and Lisa
Chytra
Kate Needham
Malcolm Fisher
Steevie Chan, Malcolm
Fisher.

Items and Actions Responsibility
ICU Coordination and Monitoring Unit Report (ICCMU) – Tony Burrell
The web-site ‘ICU Connect’ is set-up and is working well to date with
discussions on a range of clinical management issues occurring. There
was some discussion about the accessibility of the web-site to nursing staff
after-hours. It was agreed that this should be investigated by ICCMU.
Work is still occurring on the quality indicators.
The development of combined protocols is proving more difficult than
originally thought. The NSW Institute of Trauma and Injury Management
(ITIM) are currently undertaking the development of trauma clinical
guidelines. It was suggested that ICCMU should contact ITIM and discuss.
Critical Care Resources & AHS Profiles – Draft Paper
ICCMU have requested that individual sites check the data contained in the
report for accuracy and provide feedback to Dr Tony Burrell
ACTION: Check of figures contained in report against local data –
report any variations to ICCMU
Medical FTE
Held over from last meeting.
A health workforce requirements survey was sent to all AHSs in January.
ACTION: Distribute copy of survey to ICIG members
Reports
Nursing
Issues covered in Actions Arising.
Paediatric
Nil
Rural
MNCAHS – Due to budget overrun no elective surgery will be undertaken
for the remainder of the financial year. This may have implications for
increased workload for the Sydney Units.
The ICU Plan is currently being undertaken – this predicts an increase to
10 bed ICU/HDU and 10 bed CCU over the next 10 years
Requested an extension for submission of the planning survey – it was
agreed that a 2 week extension be granted.
MWAHS – The IC Services Plan is not reflective of current care.
There was extensive discussion about the ICU funding model which has
been released in particular the impact on individual ICUs. The funding
allocation to ICU in MWAHS is not reflective of the amounts indicated in the
funding model.
ACTION: John Lambert to follow up concerns regarding the level of
funding by writing to the MWAHS CEO, copy the letter to Steevie
Chan.
Data/IT
ISIS web progressing as adult and neonatal.
All members
Steevie Chan / Lisa
Chytra
John Lambert

Items and Actions Responsibility
Other Business not covered by agenda items
Media
The recent impact of media focus on hospitals in particular staff morale
was briefly discussed. Malcolm will discuss this with Barry O’Farrell when
he meets with him.
Special Purpose Accounts
There was discussion about access to and the use of special purpose
accounts, according to Department of Health Policy.
ACTION: Provide information regarding the difference between Trust
Funds and Special Purpose Accounts.
Number of ICUs
Concerns were raised regarding increasing difficulties for smaller
metropolitan units to provide adequate medical coverage. It was agreed
that ICIG should prepare a business case which evaluates coverage and
other clinical issues across the system and the recommended actions.
ACTION: Malcolm Fisher to review available data (from ICCMU),
discuss service provision and the future configuration of ICU services
with Tony O’Connell.
ICU Services at Goulburn and Bega Hospitals
A letter was tabled at the meeting from Southern Area Health Service in
response to the SAHS Site visit report. The current provision of services at
Goulburn Hospital was briefly discussed, with further discussion to be held
at next meeting when SAHS representative present.
It was suggested that the HDU should remain at Goulburn Hospital with
ICU patients transferred to either Prince of Wales or Canberra Hospitals.
ACTION: Narelle Boyd to be requested to provide an update on status
of Goulburn ICU at the next meeting.
Connecting Critical Care Telemedicine Research Applications
Phase 1 of this project is focusing on radiological imaging. There are a
number of rural sites participating but there are difficulties finding tertiary
centres to participate. The Rural Areas involved at present are: Macquarie,
Mid West and New England. Ideally the tertiary centres will be found which
conform with the current functional networks.
The project officers will be seeking advice from ICIG regarding tertiary sites
interested in participating in the project.
Next meeting
Wednesday, 11 March 2004, 2:30 – 4:30pm
Wallamutta Conference Rom, Level 4
NSW Department of Health
Steevie Chan
Malcolm Fisher
Lisa Chytra