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Anaesthetic services are provided by a multidisciplinary anaesthetic and anaesthetic-assistant workforce with a range of skills in providing procedural and operative anaesthesia. Anaesthetics may be delivered by anaesthetic senior medical practitioner or appropriately credentialed registered general medical practitioners in health centre settings through to large tertiary referral hospitals.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

No Level 1 service currently described.

Service Description

A Level 2 service generally provides analgesia/minimal sedation performed by a registered medical practitioner credentialed to provide anaesthetic services.

Service Requirements

Formal network linkages with specialist anaesthetist for consultation

Registered medical practitioner or GP to provide analgesia/minimal sedation

Some anaesthetic drug supplies on imprest

Workforce Requirements

Workforce staffing IAW PS9 PS09 Guidelines on Sedation and/or Analgesia for Diagnostic and Interventional Medical, Dental or Surgical Procedures, Australian and New Zealand College of Anaesthetists.

Registered medical practitioner or GP credentialed to provide anaesthetic services.

Access to specialist anaesthetist for consultation

Service Description

A level 3 service provides low to medium-risk local anaesthetics, neuraxial block and regional block for low to medium anaesthetic risk patients undergoing Surgical Complexity I (SCI) and Surgical Complexity II (SCII) procedures.

Low to medium-risk general anaesthetics are provided to patients (ASA 1-3) undergoing Surgical Complexity III (SCIII) procedures (refer to General Surgical role delineation framework).

Service Requirements

As for Level 2 plus:

At least one operating/procedure room with separate on-site , dedicated recovery area/room for post-operative care

Access to Level 4 or above Intensive Care Unit (ICU) (may be off-site)

On-site emergency service able to stabilise and transfer patients that experience deterioration

Elective anaesthetic services are generally provided during business hours for regularly scheduled lists

On-site medication

Workforce Requirements

As for Level 2 plus:

At least one operating/procedure room with separate on-site , dedicated recovery area/room for post-operative care

Service Description

A Level 4 service provides all Level 3 services plus general anaesthetics on moderate to high anaesthetic risk patients (ASA1-4) undergoing SCIII to Surgical Complexity IV (SCIV) procedures. Anaesthesia is administered by a specialist anaesthetist.

Service Requirements

As for Level 3 plus:

24 hour access to perioperative services where emergency services are provided

Broad range of day and general surgery and some specialty surgery

More than one theatre

High-dependency or ICU (24 hour ventilation capability) on-site

On-site pathology, diagnostic and medical services

Workforce Requirements

As for Level 3 plus:

Specialist anaesthetists on-site

Specialist anaesthetists on-call 24 hours

Anaesthetics registrar on-call 24 hours

Service Description

A Level 5 service provides services at Level 4 plus surgery is performed on low to high anaesthetic risk patients (ASA 1-4) undergoing Surgical Complexity V (SCV) procedures. Generally, a combination of procedures with a moderate to high level of complexity and risk are performed, and management of some patients with comorbidities and risk of intra- and post-operative complications occurs. Anaesthesia is administered by a specialist anaesthetist with support from anaesthetic registrars.

Service Requirements

As for Level 4 plus:

Provides emergency anaesthetic services

Network referral role

Has an active research role

On-site cardiac medicine, cardiac care unit

Workforce Requirements

As for Level 4 plus:

Specialist anaesthetist on 24 hour roster for low, moderate and high risk patients

Service Description

A Level 6 service manages the highest level of anaesthetic risk in a range of specialties in conjunction with the most complex surgical and medical presentations that have a high level of complexity or risk to patients with an extensive range of comorbidities requiring specialist staff.

Service Requirements

As for Level 5 plus:

Procedural/operative anaesthesia performed on patients with high potential for intra- and post-operative complications

Sub-specialty paediatric, cardiothoracic, neurosurgical, obstetric and trauma/retrieval anaesthetists

Credentialed paediatric and cardiac sub-specialty anaesthetists

Workforce Requirements

As for Level 5 plus:

Anaesthetic registrar on-site 24 hours

Broad range of surgical sub-specialties services on-site and available at close proximity 24 hours

An Intensive Care Unit (ICU) is a specially staffed and equipped, separate, self-contained section of a hospital for the management of patients with potentially life threatening conditions, and/or potentially reversible organ failures. An ICU provides clinical expertise, facilities and equipment for the support of patients and their families, utilising skills of specialist medical, nursing and allied health staff who are specifically trained in the multidisciplinary management of critically ill patients.

A High Dependency Unit (HDU) may be combined with an ICU or located separately. A HDU is a specifically staffed and equipped section of a hospital that provides a level of care intermediate between intensive care and general ward care. It may be located in a hospital with Level 4, 5 or 6 ICU’s or as a satellite unit supported by ICU in another hospital within a reasonable transport time, as long as transfer systems are available, safe and robust.

ICU’s / HDU’s provide high level acute, clinical support for the various specialist and subspecialist medical and surgical services practicing within a health service or hospital. In this sense, ICU provides a safety net for those patients undergoing major surgery, procedures and treatments, and for managing complications of these. ICU also supports those patients who present to the Emergency Department with severe acute reversible illness or injury, ICU care may also include end of life care and support for potential organ donation. Additionally, Intensive Care medical and nursing staff will provide a wide variety of outreach services to support patients on acute hospital medical and surgical wards.

A Close Observation Unit (COU) provides a higher level of monitoring and observation than standard ward base care, but it does not have the capability for invasive monitoring, or support from an aligned ICU.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

No Level 1 service currently described.

Service Description

A Level 2 service is a specifically staffed and equipped section of a hospital that provides a level of care intermediate between a HDU and that of standard ward base care. It provides close clinical and non-invasive vital sign monitoring of acutely ill medical or surgical patients within pre-defined clinical criteria, who do not meet criteria for urgent transfer to a higher level of care.

A COU cares for admitted patients who need observations or short term care that cannot be provided on a ward, where their condition is expected to improve such that they can be discharged within 24 hours. It may provide immediate resuscitation or lifesaving intervention under direct medical supervision, prior to urgent transfer to a higher level ICU.

Staff may be involved in local Rapid Response Systems.

Service Requirements

Dedicated COU

Close clinical observation with continuous cardiac ECG and pulse oximetry monitoring but no invasive pressure monitoring

Developed admissions and discharge policy and protocols

May provide nursing support for ward based emergency calls (MET Code Blue) as per developed policy and protocols

Established referral pathways with higher level ICU service, including defined transfer policy and access to telehealth support

Formal audit and review of activities and outcomes including need for urgent transfer, length of stay and morbidity/mortality

Active hospital based infection control policies

Clinical governance, management and leadership will be provided by an appointed part time Medical Director in conjunction with a Nurse Unit Manager (NUM)

Workforce Requirements

Medical Director with suitable experience and qualifications in an acute care specialty (ICU, ED, Anaesthesia)

Access to specialists from relevant disciplines to provide support and consultation as required

NUM with experience and post registration qualification in either intensive care, high dependency or emergency medicine nursing (or equivalent)

RNs with post registration experience in a critical care environment and minimum requirement of electrocardiography (ECG) interpretation and advanced life support (ALS) competence

A minimum nurse-patient ratio of 1:3 present in the unit

Educational program for nursing staff which may include links with higher level referral centres and tertiary education institutions

Access to technical support staff (e.g. biomedical engineers and scientific officers), as required

Access to clinical pharmacist, physiotherapist, pastoral care, social worker, dietician and any other allied health services

Support Service Requirements

Anaesthetics Imaging Pathology Pharmacy
3 2 2 2

Service Description

A HDU is a specifically staffed and equipped section of a hospital that provides a level of care intermediate between intensive care and general ward care. It may be located in a hospital with Level 4, 5 or 6 ICU service but physically separate, or as a satellite unit supported by ICU at a higher level ICU service within reasonable transport time

Patients may be admitted to the HDU from the ICU as a step-down prior to transfer to the ward, or directly from the ward, post-anaesthetic care unit (recovery) or ED or from nearby lower level health facilities, such as day surgical centres, or small rural hospitals (level 1-2).

Typical patients in HDU have single organ system dysfunction or are assessed to be at a high risk of developing acute complications. An HDU should have sufficient resources and immediate access to appropriately skilled medical staffing for the immediate resuscitation and management of deterioration in critically ill patients. Equipment should be available to manage short term life-threatening emergencies, e.g. the need for mechanical ventilation.

Service Requirements

As for Level 2 plus:

Operationally linked to a higher level ICU which should be closest by distance and transport time

Routine monitoring and support of stable patients including ECG, oximetry, and short term invasive measurement of blood pressure with pre-defined acceptable parameters that trigger escalation pathways

Protocols and Guidelines supported by nurse educator to allow invasive monitoring and the safe use of low dose vasoactive therapies.

All patients admitted to the HDU for more than 24 hours are referred to an attending Intensive Care Specialist for input towards care management

Access to either Anaesthetic, Emergency Medicine, or Intensive Care Specialist attendance within 15 minutes for acute medical emergencies

Access to theatre recovery or the Department of Emergency Medicine for short term ventilation and stabilisation whilst awaiting retrieval services

Access to pharmacy, pathology, operating theatres and imaging services

Structure and Equipment needs should adhere to College of Intensive Care Medicine (CICM) IC-13 recommendations

Equipment Officer support from the affiliated CICM

Workforce Requirements

As for Level 2 plus:

Medical director who is either a Fellow of the College of Intensive Care Medicine (FCICM) or has another relevant Specialist Qualification and suitable recent experience in modern intensive care practice

Access to Intensive Care Specialist to ensure patient safety and appropriateness of admission

Registered medical practitioner or GP with appropriate ALS and airway experience

Nurse Unit Manager with post registration qualification in intensive care

RNs with post registration qualification in intensive care or high dependency nursing and have ECG interpretation and ALS competence

A minimum nurse-patient ratio of 1:2.25 or 1:3 (24 hours) (Nursing Hours per Patient Day (NHPPD) HDU model (standalone)

Support Service Requirements

Anaesthetics Imaging Pathology Pharmacy
3 3 3 3

Service Description

A Level 4 service provides a self-contained critical care area with easy access to the ED and operating theatres within the facility.

A Level 4 service has the capability of providing immediate resuscitation and short-term cardiorespiratory support for critically ill patients. It must be capable of providing mechanical ventilation and simple invasive cardiovascular monitoring for a period of at least several hours.

Service Requirements

Separate and self-contained facility in the hospital capable of providing basic, multisystem life support, usually for up to 36 hours

Provides mechanical ventilation and simple invasive cardiovascular monitoring

Admission and discharge protocols for all beds to be determined by the Medical Director

Established referral relationship with a Level 5 or Level 6 ICU including defined transfer policies and access to telemedicine support

Formal audit and review of activities and outcomes through participation in the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation database activities

24 hour access to on-call pharmacy, pathology, operating theatres and medical imaging services

All patients admitted to a Level 4 Unit must be referred to the Consultant Specialist taking responsibility for the Unit at the time of admission (with the exception of Coronary Care Patients)

Active hospital based infection control unit and policies

Workforce Requirements

Medical Director with a full-time commitment to the operation of the unit and who is a Fellow of the CICM

Sufficient registered specialists from relevant disciplines on-call 24 hours, with rostering and call arrangements determined by the Medical Director

In addition to the attending Specialist, at least one on-site registered medical practitioner with appropriate level of experience, airway and ALS skills, rostered for the unit and immediately available at all times to attend the unit

A nurse in charge of the unit who has a post registration qualification in intensive care

All nursing staff in the unit responsible for direct patient care being RNs with the majority of all nurses having a post registration qualification in intensive care

All nurses working in unit must have ECG interpretation, ventilation, invasive line management, and ALS competence at a minimum

A minimum of two RNs present in the unit at all times when there is a patient present in the unit, and this number should be maintained irrespective of Rapid Response Team involvement

Educational programs for both medical and nursing staff which may include links with level 5 or 6 referral centres and tertiary education institutions

Access to a dedicated unit nursing educator

An orientation program for new staff

A minimum nurse–patient ratio of 1:1 for ventilated and similarly critically ill patients, as per accepted clinical standards for ICUs

A minimum 1:2 nursing ratio for high dependency patients

Access to technical support staff (e.g. biomedical engineers and scientific officers), as required

Appropriate access to specialist pharmacist, physiotherapist, social worker, dietician, pastoral care and any other allied health services

Support Service Requirements

Anaesthetics Imaging Pathology Pharmacy
4 4 4 4

Service Description

A Level 5 ICU provides services at Level 4 plus it has the capability of providing a high standard of general intensive care including more complex, extended, multisystem life support.

A Level 5 service provides mechanical ventilation, renal replacement therapy, invasive cardiovascular monitoring for extended periods. A Level 5 ICU with suitably trained clinical and support staff and resources, may be capable of providing more advanced respiratory and cardiovascular support using ECMO. However this is not essential to the minimum provisions for a Level 5 ICU service.

Service Requirements

As for Level 4 plus:

Accredited CICM training program

Regional referral role

Adequate capacity, equipment resources, and medical and nurse staffing to support the required elective caseload, emergency surgical referrals and any medical procedural services provided on-site, locally or in affiliated regional centres. This will ultimately depend on the nature and level of other services delivered in the region and should be addressed and adjusted in line with other service structures

Access to urgent echocardiography services 24/7, by either trained Intensive Care Specialists, Cardiologists or Cardiac sonographers

Specialised bariatric lifting equipment integrated into bed spaces

Nearby inpatient rehabilitation services for post-critical illness recovery and support

Adequate staffing and resources to provide any ward-based support service or outreach programs and deteriorating patient quality assurance (National Safety and Quality Health Service (NSQHS) Standard 9)

Active research program including research nurse and data collection

Adequate clerical and administrative support, as per CICM guidelines

Systems for the facilitation and support of organ donation

Workforce Requirements

As for Level 4 plus:

Minimum 50% of all nursing staff to have post registration qualification in ICU

Each nursing shift requires a designated Clinical Nursing Co-ordinator and ACCESS nurses. The number of ACCESS nurses required per shift will vary depending on percentage of qualified staff. E.g. Units with 50-75% qualified ICU nurses require one ACCESS nurse for every 6 patient’s. (Australian College of Critical Care Nurses (ACCCN) ICU staffing position statement, 2003)

Capacity and staffing models adequate to cope with surges in demand for unexpected peaks in emergency referrals, both from within the institution and from referring regional centres

Allied health support, including dedicated, specialised ICU physiotherapists. Recommend 1.0 FTE Senior Physiotherapist per 7 ICU beds OR 1.0 FTE Senior per 5 HDU beds

A dedicated ICU Specialist Pharmacist. Other pharmacy services including compounding, sterile room services, TDM, clinical drug guidelines and protocols

Equipment officer

Support Service Requirements

Anaesthetics Imaging Pathology Pharmacy
stand alone ICU 5 5 5

Service Description

A Level 6 service provides services at Level 5 plus it is the highest level referral unit for intensive care patients and is capable of providing comprehensive critical care, including complex and multisystem life support for an indefinite period, and support for complex Level 6 activity.

A Level 6 ICU should contain and be supported by services that provide patient care at a level which delivers appropriate clinical services for all types of illness/injury, other than those which the State does not support such as acute transplantation medicine. As such a Level 6 ICU should not require transfer of acute patients to other ICUs except for times of significant bed pressure. However, elective transfer of patients to other ICUs within the State should be supported where services exist to support the patient, and the transfer facilitates better proximity to the patient’s family.

Service Requirements

As for Level 5 plus:

Sub-specialty Cardiothoracic and/or Neurosurgical throughput and support

Appropriate systems for support of Tertiary Trauma and/or Major Burns centre patients

Hyperbaric chamber available at short notice

Participates in the trauma team for the hospital

Formal research program

Statewide and interstate referral role

Capacity for extended advanced respiratory and cardiovascular support using ECMO

Workforce Requirements

As for Level 5 plus:

Fellow of CICM qualified ICU Consultant specialists on-call 24 hours

ICU registrar on-site and exclusively rostered to the Unit 24 hours

Support Service Requirements

Anaesthetics Imaging Pathology Pharmacy
stand alone ICU 6 6 6

Medical Imaging encompasses a spectrum of both conventional and sophisticated diagnostic and interventional practices. It encompasses general radiography, ultrasound, computed tomography (CT) scan, fluoroscopy, bone mineral densitometry, mammography, angiography, interventional radiology, and magnetic resonance imaging (MRI). Nuclear Medicine diagnostic imaging has also been included in the Medical Imaging delineation section of this framework, it uses radiopharmaceuticals (radioactive substances) to provide functional and dynamic imaging, and includes gamma camera imaging as well as more specialist investigations such as PET (positron emission tomography) scanning.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

Service Description

A Level 1 service provides low-risk ambulatory care services during business hours and may provide some limited after-hours services. This service either has access to or onsite single, mobile or fixed, general x-ray unit which is delivered by licensed operators.

Service Requirements

A mobile or fixed general x-ray unit onsite or access to licensed medical imaging service for timely referral and reporting of images

Range of imaging limited to x-ray of extremities, chest and abdomen if service is delivered by licensed operators

Workforce Requirements

Access to a radiographer or if no radiographer available, then a licensed x-ray operator with 24 hour access to an appointed radiographic advisor for supervision

Medical imaging interpreted by registered medical practitioner / health professional

Radiologist readily contactable to discuss findings and provide a report

Service Description

A Level 2 service provides services at Level 1 plus it provides a low-risk inpatient service. This service may also provide a low-risk ambulatory care service. This service is predominantly delivered by a sole radiographer and support may be provided by licensed operators. There is a designated room on-site with a fixed x-ray unit and may also include digital radiography; however, depending on the range of services provided at the facility (e.g. day hospitals), a mobile image intensifier may be the only modality available. The service may also have access to ultrasound for non-complex conditions.

Service Requirements

As for Level 1 plus:

Has dedicated x-ray room with fixed x-ray unit available

Full range of images not restricted when a radiographer is on duty

May have access to ultrasound for non-complex interpreted by registered medical practitioner/health professional and reported by a radiologist using teleradiology

As for Level 1 plus:

On-site radiographer available during business hours

Service Description

A Level 3 service provides services at Level 2 plus it has on-site ultrasound and CT services. Sites may perform examinations involving contrast, such as intravenous pyelograms and has on-site radiologists able to perform some biopsies and procedures.

Service Requirements

As for Level 2 plus:

On-site designated radiography rooms

Teleradiology facility available

On-site ultrasound and CT facilities

Workforce Requirements

As for Level 2 plus:

Radiographer in attendance who has regular access to radiological consultation

Registered medical practitioner must be on-site at all times when procedures involving contrast are performed

Ultrasound performed by a sonographer or registered medical practitioner trained in ultrasound

Service Description

A Level 4 service provides services at Level 3 plus it provides on-site MRI services.

Service Requirements

As for Level 3 plus:

Facilities for general x-ray and fluoroscopy, in addition to mobile x-ray for wards, operating room and ED

MRI scanner

Formal links with nuclear medicine services

Workforce Requirements

As for Level 3 plus:

After-hours access to consultant radiology for reporting

On-site radiographer on-call 24 hours

Registered radiographers and sonographers

RN/EN as required

Support Service Requirements

Anaesthetics Pathology Pharmacy
4 3 4

Service Description

A Level 5 service provides services at Level 4 plus a limited range of specialised interventional radiology and nuclear medicine services.

Service Requirements

As for Level 4 plus:

Nuclear medicine facilities with single-photon emission CT

Preparation or reconstitution of radiopharmaceuticals with clear and appropriate documentation in place, including details of supply source, preparation date and batch number and reconstitution in line with the Australian and New Zealand Society of Nuclear Medicine Guidelines for Good Radiopharmacy Practice

One or more gamma cameras on-site with whole body and single-photon emission CT facility

May have the facility for in vivo and/or in vitro tracer studies

Interventional radiology on-site

Workforce Requirements

As for Level 4 plus:

Clinical Director of Medical Imaging and lead radiographer

Radiologist on-site and on-call 24 hours

May have radiology registrar

Registered and licensed nuclear medicine specialist present during radiopharmaceutical administration and available for consultation 24 hours

Full-time supervision during procedures by a nuclear physician or radiologist with nuclear medicine qualification

RN with evidence of ongoing clinical competency and experience appropriate to the service being provided on-site during the hours of operation of the department and available after-hours

Access to an appropriately credentialed anaesthetist as required

Registered nuclear medicine technologists

Business hours access to a radiochemist/radiopharmacist

Business hours access to technical support staff (e.g. biomedical engineering scientific officers)

Support Service Requirements

Anaesthetics Pathology Pharmacy
5 4 5

Service Description

A Level 6 service provides services at Level 5 plus it provides complex, on-site interventional and neuro-interventional procedures and PET services that must be available on-site. It also provides an interstate referral role.

Service Requirements

As for Level 5 plus:

Special rooms for digital angiography, neuroradiology etc., as required

On-site PET scanning facilities

24 hour on-call service across multiple modalities including general radiography, CT, ultrasound, fluoroscopy, nuclear medicine and interventional angiography

Provides interstate referral role

Workforce Requirements

As for Level 5 plus:

On-site imaging modality specialists during business hours

Has radiology registrars (2 minimum according to Australian standard) and postgraduate Fellows

One or more full-time medical physicists

A full-time radiopharmacist/radiochemist available if radiopharmaceuticals are manufactured in-house

An experienced/suitably qualified RN at minimum Grade 4 level

Support Service Requirements

Anaesthetics Pathology Pharmacy
5 5 5

Pathology Services provide testing of materials, tissues or fluids from a patient to determine the cause and nature of a disease.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level. Pathology service requirements are consistent with the National Pathology Accreditation Advisory Council (NPAAC) requirements.

No Level 1 service currently described.

Service Description

A Level 2 service does not have an on-site laboratory, but may have access to Point of Care Testing (PoCT) as well as competent operators to use this equipment and appropriate supervision and training from a higher level Pathology service within the network. No frozen sections are performed.

Service Requirements

Access to pathology services including an approved specimen and blood collection service

Access to courier service for specimen and blood product transfer to laboratory for processing

Compliance with the quality and safety requirements as determined by National Association of Testing Authorities (NATA) and the NPAAC

May have on-site blood storage, but cross-matched blood managed by off-site laboratory at a higher level Pathology service

Workforce Requirements

Staff with appropriate qualifications, training and experience relevant to scope of testing being performed in accordance with standards and guidelines specified by NPAAC

Service Description

A Level 3 service provides a limited range of pathology tests, including on-site basic biochemistry and haematology, and has the ability to manage pathology specimens until transfer of the specimen to a higher level Pathology service is available. More complex testing is accessible via higher level Pathology services.

Service Requirements

On-site basic biochemistry and haematology

Access to blood bank services provided by a higher level Pathology service within the network

Routine anatomical pathology provided within 96 hours via a higher level Pathology service within the network

Routine microbiology samples (including culture of blood, urine, stool) are managed on-site and referred to a higher level Pathology service within the network

Workforce Requirements

Non-pathology specialists who are trained in the use of automated pathology testing equipment

Where appropriate, specialist pathology staff with appropriate qualifications, training and experience relevant to scope of testing being performed in accordance with NPACC requirements

Service Description

A Level 4 service provides services at Level 3 plus comprehensive testing in a local pathology laboratory.

This level of service can typically be provided by a category B (branch) accredited pathology laboratory.

Service Requirements

As for Level 3 plus:

Routine pathology services provided by laboratory scientists

Blood bank service provided by local laboratory

Electronic pathology result reporting available

Workforce Requirements

As for Level 3 plus:

Service provided by laboratory scientists with appropriate tertiary qualifications in accordance with NPACC guidelines

Service Description

A Level 5 service provides services at Level 4 plus it provides a specialist pathologist service in a dedicated pathology department.

This level of service can typically be provided by a category GX or GY accredited pathology laboratory.

Service Requirements

As for Level 4 plus:

Service provided by pathologists and/or clinical scientists as per NPAAC guidelines

Laboratory provides Haematology, Clinical Chemistry, Blood Bank, Microbiology and Histopathology services locally

May have sub-specialist pathologists in a limited range of disciplines

Has formal access to sub-specialist pathology services from a Level 6 Pathology service

Provide support to lower service level facilities within the network

Workforce Requirements

As for Level 4 plus:

Credentialed pathologists

Specialist pathology laboratory staff available locally 24 hours

Service Description

A Level 6 service provides services at Level 5 plus sub-specialty services and a statewide referral role for complex, highly specialised and sub-specialty pathology services.

This level of service can be provided by a category GX accredited pathology laboratory.

Service Requirements

As for Level 5 plus:

Sub-specialty pathology services

Cytogenetics service

Cell culture facilities and cryopreservation

Interstate referral role

Workforce Requirements

As for Level 5 plus:

Credentialed sub-specialty pathologists

Pharmacy services include preparation, dispensing and clinical monitoring and provision of information on appropriate utilisation of drugs within health services. The level of pharmacy service provided by a health facility reflects acuity of patients acuity of patients treated. Pharmacy services must comply with the Poisons Act 1971 and Pharmacy Board of Australia legislation regarding storage and security requirements.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

Service Description

A Level 1 service provides services on an outpatient basis to a local community. This level service is provided to low risk patients in health facilities and for patients living in rural and remote community settings and homes.

Service Requirements

Access to authorised prescriber to prescribe appropriate medication

If service is provided through an established facility, where there is no pharmacist employed, on-site medication service oversight provided by a pharmacist located elsewhere from a higher level Pharmacy service via telehealth where available or through a documented process with a community pharmacist

Links to other relevant services to support patients taking medications (e.g. community nursing services)

Access to registered pharmacists for medication management, patient education and support, home medicines review and formal medication reviews in collaboration with the patient’s usual general practitioner

Meets relevant licencing and regulation requirements

Access to telehealth facilities where this has been identified as a means of providing medication services and oversight

A reliable internet connection with sufficient capacity to enable access to receive consultation from a higher level Pharmacy service

Defined and appropriate supply chain where medications are sourced from a network hospital, primary health care clinic or community pharmacy

Linked to higher level Pharmacy services within the network

Provision of pharmacy drug information, drug monitoring, drug utilisation evaluation and adverse drug reaction reporting

Workforce Requirements

Access to registered pharmacists where not on-site

Must have access to a registered medical practitioner for prescriptions

Access to a registered medical practitioner and/or Nurse Practitioner (NP) for facilities in rural and remote areas

Service Description

A Level 2 service provides services at Level 1 plus it provides an inpatient clinical pharmacy service.

Service Requirements

As for Level 1 plus:

Suitable and secure on-site imprest

Medications supplied for inpatients by hospital pharmacy within the network

Medications for inpatients on discharge supplied on individual prescription from either a community pharmacy, appropriate hospital within the network, or a higher level Pharmacy service with documented processes in place for the provision of medications that require compounding

Patient education provided for inpatients from nursing or visiting pharmacy staff

Timely access to clinical information, including medical records, medication history and pathology results for patients

May provide pharmacy undergraduate and postgraduate teaching role

Workforce Requirements

As for Level 1 plus:

Access to pharmacist

Access to more specialised pharmacist support from a higher level facility within the network

Service Description

A Level 3 service provides services at Level 2 plus it provides a clinical pharmacy service on weekdays through an on-site pharmacy or a contracted service, and includes an out-of-hours medication mechanism and ideally has access to a pharmacist for emergency advice 24 hours.

Service Requirements

As for Level 2 plus:

Medications and clinical services for day patients and, where applicable, ambulatory patients in specialty clinics

Provides support to outreach and specialist services

Access to basic, non-sterile extemporaneous compounding in the network

Clinical service includes drug information, drug monitoring, drug utilisation evaluation, adverse drug reaction reporting, patient education and support, and membership on hospital based network committees (e.g. Drugs and Therapeutic Committee, Quality Control, and Clinical Governance Committees)

Timely access to clinical information, including medical records and pathology results, reliable access to a dedicated desktop and/or laptop computer in the ward/clinical area, or equivalent (e.g. electronic tablet), if wireless technology is available

May provide pharmacy undergraduate and postgraduate teaching role

Appropriate networking with higher level Pharmacy service

Must comply with Poisons Act 1971 and Pharmacy Board of Australia legislation regarding storage and security requirements

Provides pharmacy support to rural and remote areas within the network

Workforce Requirements

As for Level 2 plus:

Service provided by a pharmacy team which includes a pharmacist, pharmacy assistant and pharmacy technician

Pharmacist available during designated business hours. Documented processes in place to access medications and medicines information outside these hours (after-hours service may be provided by a higher level Pharmacy service under a documented process)

Access to relief/locum pharmacist services, as required

Referral pathways and access to allied health and complementary services, as required for patient care (ideally, access to dietetics, occupational therapy, physiotherapy and interpreter services)

Education for nursing staff and support for registered medical practitioners

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology
- - - 3

Service Description

A Level 4 service provides services at Level 3 plus it provides a medication service that is available 24 hours. The service is able to provide care for a full range of patient risk levels, and has the capacity and capability to care for patients that are likely to have complex and competing therapeutic needs, and multiple comorbidities that the service must consider when optimising therapy.

Service Requirements

As for Level 3 plus:

Provides network consultation and accepts referrals from lower level services within the network

Medication distributed and stored by the facility and, as required, to any lower level service that is safe, meets legislative requirements and assures the quality of the medicinal products (e.g. maintains cold chain)

Has responsibilities across a defined area within the network, providing support and medication service oversight to lower level services through intermittent visits, via outreach pharmacy or telepharmacy services if available, or through other means

Provides support for a range of specialty services (e.g. chemotherapy)

Provides support for clinical trial medication distribution

Provides visiting services to lower level services within the network

Workforce Requirements

As for Level 3 plus:

An after-hours, on-call service for medication supply and clinical services, including medicines information, available 24 hours

General or junior-level pharmacy staff mentored or clinically supervised by a specialist or advanced-level practitioners where applicable

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology
- - - 3

Service Description

A Level 5 service provides services at Level 4 plus provides an extended hours service that has the capacity to act as a referral service for very high-risk patients except those who need high level specialist clinical services, such as highly complex patients.

Service Requirements

As for Level 4 plus:

Basic, non-sterile, extemporaneous compounding possibly with limited small-batch manufacturing for local hospital use, and sterile, individually compounded products (e.g. chemotherapy including parenteral, targeted and oral chemotherapy) if the use of these products falls within the scope of practice of the pharmacist or trained support staff providing supporting medication services

The capacity to respond to requests for medicines information related to direct patient care in a timely manner, either through a medicines/drug information service or a service provided internally

A medicines/drug information service provided for the whole of the network and State

The service may actively participate in multidisciplinary research

Undergraduate and postgraduate pharmacy teaching role and training

Workforce Requirements

As for Level 4 plus:

Pharmacist available 24 hours

A pharmacy team structured to deliver services at multiple levels throughout the organisation

Specialist pharmacist positions which reflect the range of specialist services provided (e.g. ICU, haematology, and medical oncology)

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology
- - - 3

Service Description

A Level 6 service provides services at Level 5 plus it acts as a referral service for all lower level services across the State (i.e. a Statewide and/or super-specialty service), accepting referrals, including interstate, where applicable. The service has the capacity and capability to provide care for patients who have the most complex care needs. A team of pharmacists, including specialist advanced level pharmacists aligned with clinical specialist services, provides medication services.

Service Requirements

As for Level 5 plus:

A specialised or Statewide Medicines and Drug Information Service, and/or Poisons Information Service may be provided

Product evaluation with drug use/policy development

Participates in research, clinical trials and clinical reviews

Workforce Requirements

As for Level 5 plus:

A full range of specialist pharmacist positions which reflect the range of specialist services provided (e.g. ICU, haematology, medical oncology, cardiology, paediatrics, geriatrics, psychiatry, and drug information).

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology
- - - 5

Stroke medicine is a specialised area of clinical practice involving the diagnosis, treatment, and rehabilitation of patients who have experienced a stroke.

The scope of this Framework recognises that:

All people with stroke should be admitted to hospital and be treated in a stroke unit with a multidisciplinary team.

All people with stroke should be admitted directly to a stroke unit (preferably within three hours of stroke onset).

Smaller hospitals should consider stroke services that adhere as closely as possible to the criteria for stroke unit care. Where possible, patients should receive care on geographically discrete units.

If people with suspected stroke present to non-stroke unit hospitals, transfer protocols should be developed and used to guide urgent transfers to the nearest stroke unit hospital.

A designated Stroke Unit requires:

1. Co-located beds within a geographically defined unit.

2. Dedicated, interprofessional team with members who have a special interest in stroke and/or rehabilitation. The minimum team would consist of medical, nursing and allied health (including occupational therapist, physiotherapist, speech pathologist, social worker and dietitian). For Tasmania, the minimum team also consists of a neuropsychologists and pharmacist.

3. Interprofessional team meet at least once per week to discuss patient care.

4. Regular programs of staff education and training relating to stroke, (e.g. dedicated stroke inservice program and/or access to annual national or regional stroke conference).

No Level 1 service currently described.

No Level 1 service currently described.

Service Description

A Level 3 service provides assessment and basic hospital care for a stroke patient, either who has presented to the service or who has been transferred from another service, for which the stroke results in the patient requiring end of life care (refer to Palliative Care Service framework). Non-palliative acute strokes who present directly to a Level 3 Acute Stroke Service need to be transferred to a designated stroke unit.

Service Requirements

Capacity to provide initial assessment and diagnosis of stroke

Capacity to provide end of life care

Formal links with higher level Acute Stroke Services

Formal transfer protocols for non-palliative acute stroke patients with designated stroke units

Workforce Requirements

Carers

Registered medical practitioner or GP on-site

Access to specialist palliative care services in the network 24 hours

RNs on-site 24 hours; RNs may be supported by ENs in providing care to patients

Service Description

A Level 4 services provides specialist hospital care for stroke patients. Level 4 services do not have a dedicated stroke unit. Moderate complexity patients are transferred to a higher level Acute Stroke service.

Service Requirements

As for Level 3 plus:

Formal linkages including referral processes with Level 5 or 6 Acute Stroke Service within the network to facilitate timely transfer of stroke patients and/or provision of clinical advice via telehealth in line with agreed guidelines

Workforce Requirements

As for Level 3 plus:

Physician practicing in general medicine on-site and on-call 24 hours

Access to a pharmacist

Access to specialist stroke unit, specialist Neurology, designated allied health and Rehabilitation Services in the network

RNs with appropriate post graduate qualifications and/or extensive experience in stroke care

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- 4 4 3 3

Service Description

A Level 5 service is a designated primary stroke centre. To be classified as a primary stroke centre it must receive over 75 stroke admissions each year.

Service Requirements

As for Level 4 plus:

Dedicated stroke unit with clinicians who have stroke expertise

Close linkages with Level 6 as part of statewide stroke service

Access to ICU/HDU for complex patients

Written stroke protocols for emergency services, acute care and rehabilitation

Access to thrombolytic therapy

Protocols to transfer appropriate patients to a comprehensive stroke centre

Ability to provide acute monitoring (telemetry and other physiological monitoring) for up to 72 hours

Onsite neurovascular imaging (CT and Carotid) and timely access to expert interpretation

Rapid (within 48 hours) Transient Ischaemic Attack (TIA) assessment clinics/services

Access to standardised and early assessment for neuro-rehabilitation

Coordinated processes for patient transition to ongoing rehabilitation and secondary prevention services including referral back to acute services if required

Access to an Early Supported Discharge Service

Interdisciplinary stroke or neuro-rehabilitation team with access to staff education and professional development specific to stroke

Access to clinical neuropsychologist as part of the ongoing care after acute admission

Regular audit and stroke-specific quality improvement activities

Workforce Requirements

As for Level 4 plus:

Access to CNC providing leadership in stroke management

Dedicated medical lead who has primary focus on stroke (stroke centre director)

Clinical psychologist

Access to specialist rehabilitation services

Access to early Supported Discharge team comprising of a physiotherapist, occupational therapist, nurse, speech pathologist, physician, social worker and administrative support person

Access to allied health services with special expertise in stroke/rehabilitation

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- 5 5 5 4

Service Description

Service Requirements

As for Level 5 plus:

Statewide coordination of stroke services

Network referral role

On-call neurologist for statewide service to support lower level services in acute thrombolysis and transfer decisions

Dedicated stroke unit with specialised resources and personnel available 24 hours

Formal linkages with emergency services

Links with Level 5 Rehabilitation Service

Provides 24 hour availability of thrombolysis

Access to advanced imaging capability (MRI, advanced CT and catheter angiography)

Access to sub-specialist neurosurgical and neuro-intensive care, interventional radiology services, cardiology and palliative care

Provide outreach services to lower services

Provides clinical advice, education and training to lower level services

Leads clinical research

Workforce Requirements

As for Level 5 plus:

Access to neurosurgeons and neuro-intensive care staffOn-site clinical neuro-psychologist

On-site clinical neuro-psychologist

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
6 6 6 5 5

Alcohol and Drug Services provide a wide range of services to assist individuals, families and communities to reduce the harm caused by substance abuse.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

Service Description

A Level 1 service provides general alcohol and drug services by community health staff, registered medical practitioners and GPs.

Service Requirements

No specialist alcohol and drug professionals available on-site

Information, risk assessment and referral is provided by community health staff, registered medical practitioners and GPs

Ability to refer to alcohol and drug residential rehabilitation services (may be off-site)

Service provides information, counselling and referral to specialist services

Formal linkage to specialist alcohol and drugs services

Workforce Requirements

Visiting registered medical practitioner or GPs

Access to specialist Alcohol and Drug Medical Staff

Visiting community nursing and/or allied health staff with specialist knowledge and skills in alcohol and drugs treatment and support, as required

Service Description

A Level 2 service provides services at Level 1 plus outpatient assessment and brief intervention for alcohol, tobacco and other drugs use.

Service Requirements

As for Level 1 plus:

Provides pharmacotherapy for opioid dependence for generally low risk, stable patients (e.g. where community pharmacies are unavailable)

Provides limited access to dispensing and supervised dosing of pharmacotherapy for opioid dependence

Assessment, brief interventions for alcohol, tobacco and other drugs

Formal linkage with higher level specialist alcohol and drug treatment service

Workforce Requirements

As for Level 1 plus:

Registered medical practitioners or GPs authorised to provide pharmacotherapy for opioid dependence

Registered pharmacist accredited to provide dispensing and dosing of pharmacotherapy for drug dependence, including opioid dependence

RNs with some experience in providing treatment for patients with alcohol and drug problems. RNs may be supported by ENs in providing care to patients.

Allied health professionals with some experience in alcohol and drugs

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - - 3 2

Service Description

A Level 3 service provides services at Level 2 plus support services for patients experiencing co-occurring alcohol and drug related conditions. A Level 3 service also provides patient education and prevention Alcohol, Tobacco and Other Drug (ATOD) programs within a motivational interviewing framework.

Service Requirements

As for Level 2 plus:

Provides pharmacotherapy dispensing and dosing within business hours

Assessment and treatment provided by multidisciplinary team

Brief intervention and support (within a motivational interviewing framework) for patients and their families undertaking care coordination role including referral and transfer of care for ongoing support

Appropriate patient case management

Workforce Requirements

As for Level 2 plus:

Multidisciplinary team comprising of registered medical practitioners, nursing staff and allied health professionals

Access to addiction medicine specialists and/or medical practitioners with ATOD skills visiting or via telephone

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 3 4 3

Service Description

A Level 4 service provides services at Level 3 plus comprehensive and multidisciplinary alcohol and drug treatment services.

Service Requirements

As for Level 3 plus:

Access to multidisciplinary alcohol and drug teams

Access to higher level detoxification service

Workforce Requirements

As for Level 3 plus:

Access to specialist alcohol and drugs multidisciplinary team

Access to alcohol and drug specialist provider 24 hours in the network

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 3 4 3

Service Description

A Level 5 service provides services at Level 4 plus a range of alcohol and drug assessment and treatment services.

Service Requirements

As for Level 4 plus:

Accredited addiction medicine training program

Workforce Requirements

As for Level 4 plus:

Specialist addiction medicine physicians on-site

Access to clinical psychiatry and psychology services

Accredited addiction medicine training program

On-site consultation liaison nurse

Access to consultation liaison pharmacist

Access to specialised allied health professionals

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 3 4 3

Service Description

A Level 6 service provides services at Level 5 plus inpatient beds for medical detoxification and an onsite specialist addiction medicine service for patients with complex conditions, including but not limited to Fetal Alcohol Spectrum Disorder (FASD), alcohol related brain injury (ARBI), chronic pain, perinatal and mental health multi-morbidity

Service Requirements

As for Level 5 plus:

Training program for undergraduate, graduate, post graduates and AOD specialisation

Statewide alcohol and drug service leadership and co-ordination role

Statewide research, planning and policy role

Specialist drug and alcohol training program for all staff working with conditions related to alcohol and drug use and clinical supervision of these staff

Clinical Support and training provided for community pharmacotherapy programs

Specialist alcohol and drug services to patient groups with particular needs, including pregnant opioid dependent women and patients with blood-borne viruses.

Specialist and integrated services available for young people

Teaching and consultancy services to all other Levels

Workforce Requirements

As for Level 5 plus:

Alcohol and Drug Service Clinical Director whose primary role is to provide statewide leadership for strategic planning, policy and research

Medical officers, allied health professionals and RNs with appropriate post graduate qualifications and/or experience in drug and alcohol

Funded specialised training positions across all disciplines

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 3 4 3

Allergies occur when a person’s (including children) immune system reacts to substances that are normally harmless to most people. These substances are generally known as allergens and can be found in foods, airborne particles (e.g. dust mites, pollens or moulds), insect venoms and drugs.

Immunology is a branch of medicine that covers all aspects of the immune system and deals with the physiological functioning of the immune system in both health and disease. These conditions include immune deficiency and immune medicated diseases.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level for Allergy and Immunology.

No Level 1 service currently described.

Service Description

A Level 2 service provides a low-acuity, single-system medical condition ambulatory and outpatient service.

It is run by a registered medical practitioner or a GP with 24 hour access.

This service can be delivered in small rural hospitals, large GP practices or community health centres.

Service Requirements

Ability to perform basic PoCT

Undertake allergy assessments

Appropriate support from higher level Allergy and Immunology services within the network

Access to advice to immediately avoid whilst waiting for further education

Workforce Requirements

24 hours access to a registered medical practitioner or a GP to manage acute issues such as anaphylaxis

Business hours access to allied health professionals expertise in allergy and immunology, as required

Service Description

A Level 3 service provides services at Level 2 plus provides inpatient and outpatient care.

Outpatient care can be provided by a registered medical practitioner or a GP or specialist with skills in allergy and immunology or a nurse or allied health professionals with specialist knowledge and skills in allergy and immunology.

Service Requirements

As for Level 2 plus:

Formal network linkage to higher level Allergy and Immunology service

Workforce Requirements

As for Level 2 plus:

Registered medical practitioner or GP with skills in allergy and immunology on-call 24 hours

On-site RN 24 hours access for inpatient services

Access to allied health professionals with specialist knowledge and skills in allergy and immunology, as required

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 3 3 3

Service Description

A Level 4 service provides services at Level 3 plus provides allergy and immunology care by a physician practicing in general medicine with experience in allergy and immunology.

A Level 4 service should be accredited by Australasian Society of Clinical Immunology and Allergy (ASCIA).

Service Requirements

As for Level 3 plus:

Inpatient care by physician practicing in general medicine with dual training or extensive experience in allergy and immunology

On-site access to allied health service

On-site allergy and immunology nurse-led education service

Inpatient access to safe meals, medications etc that are managed by suitably experienced staff

Outpatient consultation by Clinical Allergy/Immunology Specialist via telehealth

Formal network linkages with higher level Allergy and Immunology Service

Workforce Requirements

As for Level 3 plus:

On-site physician practicing in general medicine with dual training or extensive experience in allergy and immunology

RNs with appropriate experience in allergy and immunology nursing; RNs may be supported by ENs in providing care to inpatients

On-site allied health professionals with allergy and immunology expertise (e.g. dietitian, pharmacist, psychologist, social worker)

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 4 4 4

Service Description

A Level 5 service provides services at Level 4 plus provides inpatient care by a resident Clinical Allergy/Immunology Specialist.

Service Requirements

As for Level 4 plus:

An integrated multidisciplinary hospital/community allergy and immunology management service for the assessment and treatment of patients with allergy disorders, acquired and primary immunodeficiency disorders, and autoimmune disease

Designated area for formal allergen challenge testing

On-site specialised allied health services

Workforce Requirements

As for Level 4 plus:

Clinical Allergy/Immunology Specialist on-site

Clinical Allergy/Immunology Specialist or physician practicing in general medicine with dual training in allergy and immunology on-site and on-call 24 hours

Medical registrar on-site and on-call 24 hours

Specialist Allergy and Immunology RN

Specialised allied health professionals including dietitian, pharmacist, psychologist, social worker

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 5 5 4

Service Description

A Level 6 service provides services at Level 5 plus provides a full range of allergy and immunology services and emergency care. It has a statewide referral role.

Service Requirements

As for Level 5 plus:

Statewide referral role

Full range of allergy and immunology services with allergy and immunology department and programs

On-site access to laboratory service and on-call 24 hours

Accredited allergy and immunology training program

Research role

Workforce Requirements

As for Level 5 plus:

Clinical Allergy/Immunology Specialist on-call 24 hours and available to all services within the network for advice and support

CNC/Educator specialising in Allergy and Immunology Conditions

After-hours access to relevant specialised allied health professionals

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 5 6 6 6

Burns Service delivers positive outcomes for both adults and paediatric patients experiencing burn injury in Tasmania through best practise, and evidence based quality care. Burn injuries are for a lifetime and require specialised coordinated care through the State Burns Unit and Burns Service.

The Burns Service has the multi-disciplinary expertise and facilities available to manage both adult and paediatric across the range of depth and extent of burn injury without having to rely on other jurisdictions. The Burns Service has strong links across primary, public and private health facilities, providing both support and development to allow patients to be treated in their communities, where appropriate.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

No Level 1 service currently described.

Service Description

A Level 2 service provides ambulatory care services only. It has the capacity to manage minor burns, not requiring surgical intervention, that do not meet the criteria for transfer under the Tasmanian Burns Service Referral and Transfer Guidelines. All other burns are to be stabilised and transferred as per the Tasmanian Burns Service Referral and Transfer Guidelines.

Service Requirements

Formal network linkages with Level 5 Burns Service for consultation and advice

Formal referral protocols established with higher level Burns services

Workforce Requirements

Registered medical practitioner or GP

General Surgeon available for consultation

Paediatrician available for consultation

Access to allied health services including physiotherapy and occupational therapy

On-site RNs who have undertaken the Tasmanian Burns Resource Nurse Program with current certificate

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
2 - - 2 1

Service Description

A Level 3 burns service provides services at Level 2, plus provides immediate surgical management if required. A Level 3 service may admit patients for pain management and/or stabilisation prior to transfer as per the Tasmanian Burns Service Transfer and Referral Guidelines.

Service Requirements

As for Level 2 plus:

Access to general rehabilitation services

Access to scar management service

Access to liaison psychiatry

Workforce Requirements

As for Level 2 plus:

General Surgeon (≥3 years postgraduate) with experience on-call 24 hours

On-site access to allied health services

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 4 4 4

Service Description

A Level 4 service provides services at Level 3, plus treats burns:

Less than or equal to 10% Total Body Surface Area (TBSA) in adult patients that do not meet the criteria under the Tasmanian Burns Service Transfer and Referral Guidelines, and

In children equal to or greater than 2 years old and involving less than or equal to 5% TBSA with no risk of airway compromise, that do not meet the criteria under the Tasmanian Burns Service Transfer and Referral Guidelines.

A Level 4 service also provides surgical management for burns that do not meet criteria for transfer under the Tasmanian Burns Service Transfer and Referral Guidelines.

Service Requirements

As for Level 3 plus:

Plastic Surgery Unit

Operating theatre available 24/7

Access to skin substitutes

Contributes to Burns Registry of Australian and New Zealand (BRANZ) data collection

Access to Level 4 Paediatric services

Workforce Requirements

As for Level 3 plus:

Plastic surgeon on-call and available 24 hours

Surgeon with experience in the use of skin substitutes

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 4 4 4

Service Description

A Level 5 Burns service provides services at a Level 4, plus treats burns within capacity and in accordance with the agreed Tasmania Burns Transfer and Referral Guidelines following consultation with a Level 6 service (interstate).

A Level 5 service provides a comprehensive service including inter-hospital transfers for patients that meet the criteria for transfer under the Tasmanian Burns Service Transfer and Referral Guidelines, including back transfers.

Service Requirements

As for Level 4 plus:

Dedicated inpatient beds

Operating theatre available 24/7

Paediatric and Adult ICU on-site

Coordinated statewide service including case-management by Burns CNC

Links to Level 6 Plastics Surgery service and Level 5 Rehabilitation service

Pain management services on-site

Access to sub-specialty services on-site with consultation available including paediatric services, obstetrics and gynaecology services for adults, dental service for children, ENT, child and family psychiatry services, ophthalmology services

Provides telehealth and digital imaging support to lower level services, including clinical advice, skills maintenance, and professional development support for staff

Provides ambulatory burns clinics for referrals from lower level services, including wound management

On-site specialised multidisciplinary allied health team

Access to palliative care and pastoral care services

Provides burns specific health promotion statewide

Statewide teaching and research role which includes facilitation of the Tasmanian Burns Resource Nurse Program

Co-ordinates data entry for BRANZ

Key burns personnel have an active role within the Australian and New Zealand Burns Association (ANZBA), and networking opportunities as part of the Tasmanian Burns Service are fostered

Workforce Requirements

As for Level 4 plus:

Clinical Director Burns with relevant clinical experience

Plastic Registrar available 24 hours

Registered medical practitioner on-site 24 hours

NP Burns

CNC Burns

Nephrologist and Emergency Medicine Consultants on-call 24 hours

ENT Consultant and Senior Registrar on-call 24 hours

24 hour access to paediatric and adult ICU Consultants

Specialist burns nursing staff on-site 24 hours (Emergency Management of Severe Burns (EMSB)) accredited

On-site access to specialised Burns and Paediatric allied health services including dietetics, occupational therapy, physiotherapy, speech therapy, orthotics and prosthetics, play therapist/specialist, psychology and social work

Resource allocated to data collection and upload to BRANZ

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
6 6 5 6 6

Service Description

The following burn injuries will be discussed on a case by case with the Level 6 interstate Burns Service and Level 5 Tasmanian Burns Service:

greater than 40% TBSA in children,

greater than 20% TBSA in children with associated trauma or inhalation injury, and

greater than 50% TBSA in adults.

Once stabilised, transfer may be the recommended pathway for Burn Injuries.

Cancer Services refer to the overall suite of specialised services delivered by health facilities in diagnosing and treating cancer and cancer survivors.

Cancer services should be part of an integrated model and the scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required for Medical Oncology, Radiation Oncology and Malignant Clinical Haematology. There are service interdependencies between each of these services.

Haematology is the branch of medicine concerned with the study of blood, the blood-forming organs and blood diseases. This includes the overall suite of specialised services delivered by health facilities in diagnosing and treating haematological malignancy as well as non-malignant haematology. This service has interdependencies with Medical Oncology and Radiation Oncology.

No Level 1 service currently described.

No Level 2 service currently described.

No Level 3 service currently described.

Service Description

A Level 4 service has infrastructure that enables ambulatory haematology care to be provided to patients. This level of service provides outpatient consultative and day treatment services and provides only low-risk systemic therapy.

The service has links with a higher level Malignant Clinical Haematology service which coordinates the patient’s care and makes relevant treatment decisions. A visiting registered medical specialist with credentials in haematology provides on-site services.

Service Requirements

24 hour access to higher level Malignant Clinical Haematological services for emergency advice

A day treatment area for procedures that administers systemic therapy, biological agents and blood transfusions

Administers systemic therapies under the supervision of a specialist medical practitioner with credentials in haematology

Access to a central venous access serviceAccess to a full blood bank service

Access to a full blood bank service

Access to designated allied health services including social workers, occupational therapists, physiotherapists, speech pathologists, psychological and emotional support services, palliative care and a nutrition team, as required

Workforce Requirements

Formal linkages with consultant haematologist

RNs appropriately qualified and experienced in the administering and monitoring of systemic therapies

Specialist pharmacist haematology/oncology

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - - 4 4

Service Description

A Level 5 service provides specialist haematologist inpatient and outpatient treatment services for patients with haematological diseases. A Level 5 service provides inter-disciplinary care in conjunction with other consultation services, including infectious diseases, pain services, palliative care, psychiatry, radiotherapy, medical imaging, nephrology, respiratory and surgical services.

This level service manages moderate to high risk systemic therapy protocols and may perform cell separation/plasmapheresis. The service is able to provide initial courses of systemic therapy and supervise subsequent maintenance courses.

A Level 5 service coordinates all definitive diagnostics and development of a plan for treatment, which may take place at a lower level, this level or a higher level Malignant Clinical Haematology service.

The service provides multidisciplinary management of haematology patients, including case conferences and the development of treatment plans. A Level 5 service does not perform stem cell transplantation.

Service Requirements

As for Level 4 plus:

Inpatient haematology care delivered by a multidisciplinary team

On-site access to medical oncology, radiation oncology, infectious diseases, pain services, palliative care, psychiatry, medical imaging, nephrology, respiratory and surgical services

Access to specialist haematology advice 24 hours

On-site access to a radiotherapy unit for patient referral and transfer

Workforce Requirements

As for Level 4 plus:

Appointed haematologist

Medical registrar on-site 24 hours

Access to specialist medical practitioners with credentials in infectious diseases, pain, palliative care, psychiatry, radiation oncology, medical imaging, nephrology, respiratory medicine and surgical disciplines

Staff trained, and with evidence of ongoing competency, in the collection of peripheral blood progenitor cells

Specialist haematology RNs

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 5 5 5

Service Description

A Level 6 service provides services at Level 5 plus autologous stem cell transplantation and inpatient and outpatient care by a specialised haematology-led multidisciplinary team.

Service Requirements

As for Level 5 plus:

Statewide referral role for some services

Advanced haematological diagnostics and transfusion services provided by a laboratory accredited under relevant national accreditation body

Autologous stem cell transplantation service accreditation under relevant national accreditation bodies

24 hour aphaeresis cover

Dedicated standard isolation rooms

May manage all high-risk and/or complex protocols, and deliver intensive chemotherapy protocols

An accredited haematology training program

Access to interventional radiology service, PET service and vascular service for management of venous and arterial thrombosis where appropriate

Multidisciplinary meetings in malignant haematological disorders

Active participation in clinical trials and research

Workforce Requirements

As for Level 5 plus:

Clinical Haematologist on-site and on-call 24 hours

Clinical Haematology registrar/Resident Medical Officer (RMO)

Nurse Unit Manager (NUM) providing clinical leadership in haematology including in-reach and outreach

RNs appropriately qualified and experienced in clinical haematology

Clinical scientists on-site

Designated transplant coordinator on-site

Transfusion nurse

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 5 6 6 6

Medical Oncology is the component of cancer medicine that assesses patients with solid tumour cancer and manages their care, particularly through the use of systemic therapies. This service has interdependencies with Radiation Oncology and Malignant Clinical Haematology.

No Level 1 service currently described.

A Level 2 service provides outpatient management and appropriate referral of patients by a registered medical practitioner or a GP for patients who are under the care of a Level 5 or Level 6 Medical Oncology service.

Level 2 services may participate in multi-disciplinary meetings regarding the patient's management.

As for Level 2, plus a Level 3 service provides outpatient management and appropriate referral of patients by a physician practicing in general medicine or equivalent for patients who are under the care of a Level 5 or Level 6 Medical Oncology service.

Service Description

As for Level 3, plus a Level 4 service that has infrastructure enabling on-site ambulatory chemotherapy to be provided to patients. This service has links with a higher level Medical Oncology service which coordinates the patient’s care and makes relevant treatment decisions.

A Level 4 service has a visiting medical oncologist and provides appropriately qualified and/or experienced RNs with specialist cancer care nursing knowledge and expertise, including in the administration of chemotherapy to ambulatory patients.

A Level 4 service can coordinate referral to a higher level Medical Oncology service for initial diagnosis and transfer to a higher level Medical Oncology service for the assessment and management of post treatment complications.

Service Requirements

As for Level 3 plus:

Capacity to provide day treatment, with designated ambulatory day beds for treatment

Visiting medical oncologist

Formal linkages with higher level Medical Oncology service

Workforce Requirements

As for Level 3 plus:

Access to medical oncologist in the network 24 hours, seven days a week via telehealth

Access to visiting medical oncologist

RNs with post graduate qualifications and/or nursing experience in medical oncology

Specialist pharmacist haematology/oncology

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 3 3 3

Service Description

A Level 5 service provides all services at Level 4 plus some inpatient medical oncology care. A Level 5 service does not provide inpatient chemotherapy, however, patients with medical oncology care needs may be admitted as inpatients under the care of a physician practicing in general medicine.

This service has access to medical oncology multi-disciplinary teams, including at a higher service level.

Service Requirements

As for Level 4 plus:

Service has formal linkages to Level 6 Medical Oncology service

24 hour access to specialist medical practitioners with credentials in medical oncology, radiation oncology, haematology, palliative care, pain management services and microbiology for advice and support within the network

Appropriate network access to nuclear medicine

Workforce Requirements

As for Level 4 plus:

NUM providing clinical leadership in medical oncology

Physician practicing in general medicine on-site and on-call 24 hours

Access to designated allied health services including social workers, occupational therapists, physiotherapists, speech pathologists, psychological and emotional support services, palliative care and a nutrition team, as required

RNs with post graduate qualifications and/or nursing experience in medical oncology; RNs may be supported by ENs in providing care to inpatients

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 4 4 4

Service Description

A Level 6 service provides all services at Level 5 plus delivery of inpatient systemic therapy, including intensive chemotherapy protocols. The service provides initial assessment, management and treatment plans for common malignancies, in collaboration with disease-specific surgeons, radiation oncologists, pathologists and supportive care specialties.

Service Requirements

As for Level 5 plus:

Oncology department

Provides ambulatory and inpatient chemotherapy

On-site radiotherapy, palliative care and pain management services

Specialist medical oncology advice and support available 24 hours

Access on-site to renal dialysis, respiratory, cardiology and infectious diseases services

On-site access to specialist allied health professionals (social workers, dietitians, pastoral care)

Site-specific (breast, lung and colorectal) and general oncology consultative services available

Active participation in clinical trials and research

Multidisciplinary meeting in major cancer streams

Workforce Requirements

As for Level 5 plus:

Medical oncology specialist on-site and on-call 24 hours

Medical oncology registrar / RMO

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 5 4 5 4

Radiation Oncology plays a major role in cancer treatment. Radiation therapy is either used alone or combined with surgery, chemotherapy, or other therapies in the curative or palliative treatment of cancer. This service has interdependencies with Medical Oncology and Malignant Clinical Haematology.

No Level 1 service currently described.

No Level 2 service currently described.

No Level 3 service currently described.

No Level 4 service currently described.

Service Description

A Level 5 service has at least one linear accelerator that enables on-site radiation treatment to be provided to patients.

The service has links with a higher level Radiation Oncology service. Clinical pathways will be developed in collaboration with the higher level service with some of the more complex cases referred to the higher level Radiation Oncology service. The Level 6 Radiation Oncology service provides the radiation planning component of the patient's clinical pathway and may also need to support treatment in times of staff shortage to prevent patients having to travel.

Service Requirements

Accredited radiation oncology facility

Radiation treatment provided on-site and supported by Level 6 service as required

Planning for radiation treatment

Visiting medical oncology service

On-site palliative care

24 hour access to advice and support from a radiation oncologist

Network access to medical oncology, palliative care, higher level Radiation Oncology services and nuclear medicine

Workforce Requirements

Specialist Radiation Oncologist

Dedicated radiation therapists, RNs and radiation physicists with appropriate radiation oncology training and experience as determined by Level 6 Radiation Oncology service

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 4 4 4

Service Description

A Level 6 service provides all services at Level 5 plus it provides radiation oncology treatment services and facilities for planning on-site.

The service has on-site access to radiation oncologists, physicists and radiation therapists.

Service Requirements

As for Level 5 plus:

Multi-disciplinary patient management in designated cancer streams

Access to PET service either on-site or through referral network

Acute inpatient beds available on-site for specialised procedures and for supportive care

Interstate access to total body irradiation and total skin electron beam therapy

Interstate link to paediatric super-specialist facilities where children are treated

Interstate links to adolescent and young adult specialty services

Access to a clinical genetics/medical genetics service, including genetic counselling

Active participation in clinical trials and research

Access to specialised and complex Radiology Services

On-site medical oncology, palliative care and pain management

Workforce Requirements

As for Level 5 plus:

Specialist medical practitioner with credentials in radiation oncology

Radiation oncology registrars/RMOs

RNs with appropriate post graduate qualifications and/or extensive experience in radiation oncology

Radiation oncology medical physicists and radiation therapists on-site during operational hours

On-site access to specialist allied health professionals (social workers, dietitians, speech pathologists, PEG service including dedicated nurse, stomal care nurses, psychological medicine, pastoral care, pharmacists)

Access to Oncology Pharmacist

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 5 5 5

Cardiology Service involves the prevention, investigation, diagnosis, treatment and management of a range of cardiac diseases, e.g. coronary artery disease, valvular heart disease, arrhythmias, heart failure and adult congenital heart disease. Services can range from emergency care, to acute care, surgery, rehabilitation, ongoing care for chronic conditions, and palliative care.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

Service Description

A Level 1 service provides a low-acuity, ambulatory care for minor cardiac diseases and management of acute conditions with the ability to provide acute resuscitation.

It should provide health promotion/disease prevention and chronic disease management programs. This service would normally be delivered by registered medical practitioner or GP in an outpatient setting and may incorporate nurse-led services.

Service Requirements

Access to / integration into a statewide Acute Coronary Syndrome (ACS) management pathway

Provision of basic cardiovascular risk factor/disease prevention information

Workforce Requirements

A registered medical practitioner, GP or RNs with appropriate post graduate qualifications and/or experience; RNs may be supported by ENs in providing care to inpatients.

Service Description

A Level 2 service provides services at Level 1 but in addition provides a low-acuity, single-system medical condition ambulatory and outpatient service.

It is run by registered medical practitioner or GP with 24 hour access.

This service will be delivered in small community hospitals, large GP practices or rural health centres.

Service Requirements

As for Level 1 plus:

Has digital ECG machine with appropriate support from higher level Cardiology services within the network to safely and effectively operate and maintain equipment

Ability to perform PoCT

Appropriate support from higher level Cardiology services within the network

Access to pathology / medical imaging in a short timeframe

Access to Automated External Defibrillator (AED), oxygen and the ability to achieve venous access

Specialist allied health/nursing staff community rehabilitation

Workforce Requirements

As for Level 1 plus:

24 hours access to a registered medical practitioner

Access to visiting allied health professionals during business hours, as required

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 1 2 2

Service Description

A Level 3 service provides services at Level 2 plus ambulatory and non-acute services.

Outpatient care is accessible by a visiting registered medical practitioner, general internal medicine specialist or cardiologist or via telehealth.

Patients with acute cardiac care needs are transferred to a higher level Cardiology service.

Service Requirements

As for Level 2 plus:

Provides outpatient, ambulatory and non-acute care led by a cardiologist and supported by visiting medical specialists and / or via telehealth

Elective diagnostic investigations performed

Provides thrombolysis and blood gas monitoring

Ability to provide close care and monitoring at the bedside with appropriate facilities and appropriately trained nursing staff in place

Linkages to specialist medical services from a higher level Cardiology service within the network

Formal referral protocols established with higher level Cardiology services

Links to Cardiac NP

Workforce Requirements

As for Level 2 plus:

On-site 24 hour access to a registered medical practitioner or registered medical specialist

24 hour cover by RNs/ENs

Access to cardiologists in the network

On-site access to some allied health services during business hours including physiotherapy

Access to Cardiac Rehabilitation Nurse

Access to Cardiac NP or Clinical Nurse Specialist (Cardiac/Health Promotion)

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
2 - 2 3 3

Service Description

A Level 4 service provides services at Level 3 plus inpatient cardiology care by a registered medical practitioner practicing in general medicine and/or non-interventional cardiologist.

Outpatient consultation is provided by a cardiologist.

Service Requirements

As for Level 3 plus:

Capability and capacity to deliver multi-disciplinary team based care to cardiology patients

Provides a range of inpatient and outpatient cardiology services including transthoracic echocardiography, cardiac event monitoring, ambulatory blood pressure monitoring, implantable cardiac device checks, and exercise stress testing

Provides cardiac rehabilitation and preventative patient cardiac education

Discrete area within the facility for provision of level of care more intensive than ward based care (e.g. may be CCU, HDU or ICU)

Performs non-invasive monitoring

Formal referral protocols established with higher level Cardiology services

Can provide resuscitation and stabilisation of emergencies until transfer or retrieval to higher level facility

Workforce Requirements

As for Level 3 plus:

Registered medical specialist with experience in cardiology, on-call 24 hours

Access to anaesthetist

Outpatient cardiologist service provided by outreach but would include review of inpatients by visiting cardiologist

Formal liaison with higher Level 6 Cardiology service

In-hours access to allied health services appropriate to the level of cardiology services being provided (local, visiting or via telehealth dependent on availability and clinical appropriateness), including psychology, dietetics and social work

On-site emergency medicine specialist

Cardiac Rehabilitation Nurse

Cardiac NP or Clinical Nurse Specialist (Cardiac/Health Promotion)

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 4 4 4

Service Description

A Level 5 service provides cardiology services at Level 4 plus a full range of cardiac services through a dedicated cardiology department including emergency services and on-site cardiac catheterisation laboratory. A Level 5 service caters for the complex cardiology medical care. The service is usually provided at a general hospital by a multi-disciplinary team available 24 hours and has a network referral role.

Service Requirements

As for Level 4 plus:

On-site CCU capable of providing a dedicated ward area for patients requiring cardiac monitoring and/or resuscitation, with appropriate levels of staff and specialised resources including monitoring equipment and appropriate investigations

Provides a range of cardiology of diagnostic services including, CT coronary angiography, transthoracic echocardiograph, stress echocardiogram, transeosophageal echocardiography cardiac event monitoring, ambulatory blood pressure monitoring, implantable cardiac device checks, tilt table testing and functional assessment

Access to on-site central haemodynamic monitoring capacity

On-site diagnostic coronary angiography, permanent pacemaker, percutaneous revascularisation and angioplasty

Provides a range of outpatient services, coronary risk factor clinics as well as cardiac rehabilitation and preventive patient education programs

Paediatric liaison service and shared care model with Royal Melbourne Hospital for Adult Congenital Heart Disease

A comprehensive heart failure service with a NP

Formal links to cardiothoracic service and Level 5 Respiratory service

Specialist consultation or diagnosis provided by telehealth to smaller sites and services

Formal liaison with Level 6 Cardiology service

Provides specialist consultation and diagnosis to lower level services

May have research role

Clinical audit and monitoring

Outreach provided to lower level services

Workforce Requirements

As for Level 4 plus:

24/7 cover by an Interventional Cardiologist

Cardiology registrar (advanced trainee)

RMO or intern in cardiology

Medical registrar on-site 24 hours

CNC providing clinical leadership in cardiology

RNs with appropriate post graduate qualifications and/or extensive experience in cardiac nursing

Heart Failure NP

Designated multi-disciplinary Cardiac Rehabilitation service

24/7 access to relevant allied health service provision including physiotherapy

A full complement of cardiac technicians for echocardiography with 24/7 on-call roster and pacing services

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 5 5 5 5

Service Description

A Level 6 service provides services at Level 5 plus a full range of cardiac services through a dedicated cardiology department including emergency services and on-site cardiac catheterisation laboratory. A Level 6 service caters for the most complex cardiology medical care. The service is usually provided at a large referral hospital by a multi-disciplinary team available 24 hours and includes an interstate referral role.

Service Requirements

As for Level 5 plus:

Full range of cardiology services, with dedicated cardiology department, emergency care, diagnostic and interventional cardiology services with on-site cardiac catheter laboratory, on-site cardiothoracic surgery and cardiac rehabilitation services

Able to deal with highly complex diagnostic and treatment procedures in consultation with other specialties

Provides implant and follow up service for complex cardiac devices

Provides statewide pulmonary hypertension service

May provide an electrophysiology service (EPS) including radiofrequency ablation and a structural heart disease program including Trans-aortic valve implant (TAVI)

Capable of providing an adult congenital disease service

Cardiac MRI and cardiac PET scanning services available on-site

On-site cardiothoracic surgery

Access to invasive cardiovascular monitoring on-site

Statewide referral role

Provides clinical advice, education and training to lower level services via telehealth

Active research role

Clinical audit and monitoring

Workforce Requirements

As for Level 5 plus:

Staff Specialist in cardiology on-site and on-call 24 hours

Cardiology Registrars (advanced trainees) on-site and on-call 24 hours

Cardiology RMO or intern

NP providing high level nursing expertise in cardiac care/cardiac rehabilitation

Senior allied health professionals including physiotherapists with advanced specialty skills and involved in education and research appropriate to their specialty, as required

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
6 6 6 6 5

Cardiothoracic surgery is the field of medicine related to the surgical treatment of diseases of the chest, particularly surgery of the heart and lungs.Services can range from emergency and trauma care to elective surgery for chronic heart, lung and chest conditions.

Services can range from emergency and trauma care to elective surgery for chronic heart, lung and chest conditions.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

No Level 1 service currently described.

No Level 2 service currently described.

No Level 3 service currently described.

No Level 4 service currently described.

Service Description

A Level 5 Service may provide pre-operative and post-operative cardiothoracic surgical services on-site by a visiting cardiothoracic surgeon. A Level 5 Service has on-site cancer, palliative care and pain management services.

Service Requirements

Radiation oncology and medical oncology available on-sitePalliative care and pain management services available on-site

Palliative care and pain management services available on-site

On-site ICU/CCU

Access to specialised allied health services

Workforce Requirements

As for Level 4 plus:

Visiting cardiothoracic surgeons

On-call cardiothoracic surgeons available 24 hours

General surgeon on-site and on-call 24 hours

Specialist anaesthetists on-site

Medical oncologist, radiation oncologist, palliative care physician, pain medicine specialist on-site

Access to CNC providing high level nursing expertise to a collaborative model of interdisciplinary care

Access to designated allied health services appropriate to the level of cardiothoracic services being provided

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 5 5 5 5

Service Description

A Level 6 service provides services at Level 5 plus the service is able to deal with high complex diagnosis and treatment in association with other specialities. It has a statewide referral role, research role and undergraduate and post graduate teaching role.

Level 6 Cardiothoracic Services in Tasmania do not provide heart and lung transplantation services.

Service Requirements

As for Level 5 plus:

Statewide referral role and pathways established to refer patients for elective and urgent cardiothoracic surgical procedures

Elective and emergency thoracic and cardiothoracic procedures by on-site cardiothoracic surgeons

Able to deal with highly complex diagnosis and treatment in association with other specialties

Ability to provide intra-aortic balloon pump and extra corporeal membrane oxygenation [ECMO] facility by having perfusion and support services available 24 hours

Research role

Workforce Requirements

As for Level 5 plus:

At least 2 fully trained cardiac surgeons accredited by the RACS available 24 hours

Cardiothoracic registrar/RMO available 24 hours

A cardiac anaesthetist – one for every 100 adult cases treated

At least 2 cardiac medical and/or clinically accredited perfusionists

At least 2 Registrars/Fellows/Trainees with additional resident medical staff including interns

ICU specialists on-site. They should be supported by registrars or junior staff (year 3 or above in training) 24 hours for ICU management

Appropriately qualified and experienced nursing staff in operating theatres, intensive care units, wards and in rehabilitation services along with dedicated nurse managers

CNC/NP providing leadership within a collaborative model of interdisciplinary care.

Physiotherapists and allied health services, and cardiac rehabilitation services

Actively practising medical specialists in the following specialities should be available at all times for clinical consultation:

Cardiologists

Haematologists

General surgeons

Urologists

Respiratory physicians

Neurologists

Neurosurgeons

Nephrologists

Endocrinologists

Infectious diseases consultants

ENT specialists

Dental surgeons

Vascular surgeons

On-call rosters for echocardiographers, radiographers, pacemaker technician, biomedical engineers

Audit manager, educators and data collectors

Appropriately qualified and experienced liaison nurse with a statewide co-ordination role

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
6 6 6 6 6

Child and adolescent mental health services (CAMHS) are specialist multidisciplinary services for infants, children, adolescents and their families between the age of 0 and 18 years, who present with severe and complex mental health problems that cause functional impairment and have an adverse impact on social and emotional development or risk of harm. As well as the provision of specialist care, CAMHS will provide support for other service sectors to provide mental health services to children with mild to moderately severe problems.

The definition is underpinned by the following principles:

Promotion of social inclusion and recovery in intervention services;

Enhancing prevention and early intervention services;

Improving access co-ordination and continuity of care within service systems; and

Strengthening research and performance monitoring.

No Level 1 service currently described.

Service Description

A Level 2 service is capable of providing limited short-term (up to 72 hours) or intermittent inpatient mental health care to low-risk/complexity voluntary mental health consumers up to 18 years (time frames beyond this require specific consultation with higher level Child and Adolescent Mental Health Acute Inpatient Service that will contribute in ongoing manner to case review and management).

Care is delivered predominantly by team of general health clinicians within a hospital that does not have dedicated mental health staff (on-site) or allocated beds. Consumers are admitted by registered medical practitioner.

Service provision typically includes assessment, brief interventions and monitoring; consumer and carer education and information; documented case review; consultation-liaison with higher level mental health services; and referral, where appropriate.

Service Requirements

Provides general healthcare and some limited mental health care 24 hours a day

Identification, initial acute assessment, brief intervention and monitoring of uncomplicated mental health problems

Development of care plan

Medication management

Forward referrals for expert assessment, diagnosis and intervention as required

Limited psychoeducation (including information about available mental health services, mental health problems and illnesses, indicated treatment options and support services)

Additional mental health interventions may be directly provided by mental health clinicians using telehealth facilities, visiting and/or community-based workforce

Daily care coordinated by a registered medical practitioner or GP who has access to registered medical specialist with credentials in psychiatry and certificate in child and adolescent psychiatry (or equivalent) to assist and guide assessment, treatment, case management and case review (may be via telehealth)

Assessments and interventions conducted in consultation with child and adolescent mental health clinician where clinically indicated, and associated with documented review process

Documented processes with Level 5 or 6 Child and Adolescent Mental Health Acute Inpatient Service

Considers necessity of parent / carer being admitted with child aged 5 years and younger

Medical services provided on-site or in close proximity to provide rapid response at all times

Workforce Requirements

Registered medical practitioner or GP

Access to registered medical specialist with credentials in psychiatry and certificate in child and adolescent psychiatry (or equivalent)

RNs with appropriate post graduate qualifications and/or experience in child and adolescent mental health nursing

Access during business hours to allied health professionals

Assistants-in-nursing (AINs) or equivalent may support clinical team at discretion of nurse in charge (however titled)

Bachelor of Nursing students (second or third year undergraduate) may support clinical team at discretion of nurse in charge (however titled) and under RN supervision

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 1 2 2

Service Description

A Level 3 service is capable of providing short and medium term (1 week to 10 days) or intermittent inpatient mental health care to low-risk/complexity voluntary mental health consumers up to 18 years (time frames beyond this require specific consultation with higher level acute inpatient service for Child and Adolescent Mental Health who will continually contribute to case review and management).

Care is delivered predominantly by team of general and children’s health professionals within hospital that has paediatric unit or beds. A Level 3 service does not have allocated mental health beds or staff on-site.

Consumers are admitted by registered medical practitioner or registered medical specialist with credentials in paediatrics.

Service provision typically includes assessment, interventions and monitoring; consumer and carer education and information; documented case review; consultation-liaison with higher level mental health services; and referral, where appropriate.

Service Requirements

As per Level 2 plus:

Provides mental health care for high prevalence mental conditions 24 hours a day

Identification, acute assessment, intervention and monitoring of mental health problems (that may be associated with simple comorbidities and/or resistance to treatment)

Daily care coordinated by registered medical practitioner, GP or registered medical specialist with credentials in paediatrics who has access to registered medical specialist with credentials in psychiatry and certificate in child and adolescent psychiatry (or equivalent) to assist and guide assessment, treatment, case management and case review (may be via telehealth)

Limited range of primary (e.g. parenting support) and secondary (e.g. weight management) prevention services

Basic clinical data collection to inform assessment, diagnosis, intervention and recovery

Psychoeducation (including information about available mental health services, mental health problems and illnesses, indicated treatment options and support services)

Access to perinatal health services

Workforce Requirements

As per Level 2 plus:

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 1 2 3

Service Description

A Level 4 service is capable of providing short- to long-term (4 to 6 weeks) or intermittent inpatient mental health care to low- and moderate-risk/complexity voluntary and, if authorised to do so, involuntary mental health consumers up to 18 years (time frames beyond this require specific consultation with higher level Child and Adolescent Mental Health Acute Inpatient service that will contribute in ongoing manner to case review and management).

Care is delivered predominantly by a team of mental health clinicians and children’s health professionals within hospital that has allocated mental health beds for children and/or adolescents. Consumers are admitted under registered medical specialist with credentials in psychiatry and certificate in child and adolescent psychiatry (or equivalent).

Service provision typically includes multidisciplinary assessment, targeted interventions and monitoring; consumer and carer education and information; documented weekly case review; appropriate group programs; consultation-liaison with higher level mental health services; and referral, where appropriate.

Service Requirements

As for Level 3 plus:

Provides mental health care 24 hours a day

Flexible use of paediatric and mother-baby beds co-located with inpatient psychiatric services

Identification, ongoing assessment, monitoring and interventions for mental health problems (that may be associated with comorbidities and/or indicators of treatment resistance)

Integrated approach to identification, assessment and intervention of any co-occurring substance-use disorders

Development of comprehensive individual mental health recovery plans within 1 week of assessment

Daily care coordinated by registered medical specialist with credentials in psychiatry who has 24 hours access to registered medical specialist with credentials in psychiatry and certificate in child and adolescent psychiatry (or equivalent) to assist and guide assessment, treatment, case management and case review (may be via telehealth)

May be an authorised mental health service under Mental Health Act 2000

Comprehensive clinical data collection to inform assessment, diagnosis, intervention and recovery

Range of primary (e.g. parenting support) and secondary (e.g. weight management) prevention services

Psychoeducation for consumer and family / carer (including information about available mental health services, mental health problems and illnesses, indicated treatment options and support services)

Documented processes and collaborative partnerships established with schools, education networks and service providers

Workforce Requirements

As for Level 3 plus:

24 hour access to a registered medical specialist with credentials in psychiatry and certificate in child and adolescent psychiatry (or equivalent)

Two or more RN per shift qualified and experienced in mental health. If inpatient unit occupancy is low, only one RN per shift

Access during business hours to community or hospital based allied health staff with qualifications and/or experience in mental health

Access to some on-site and/or visiting specialties in health / mental health

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 2 2 4

Service Description

A Level 5 service is capable of providing short to long term and intermittent inpatient mental health care to low, moderate and high risk/complexity voluntary and involuntary mental health consumers up to 18 years 24 hours a day.

Care is delivered predominantly by child and adolescent mental health professionals within dedicated child and adolescent mental health unit.

Service provision typically includes multidisciplinary assessment and targeted interventions by mental health professionals; consumer and carer education and information; documented weekly case review; group programs; extensive primary and secondary prevention programs; consultation-liaison with higher and lower level mental health services; and referral, where appropriate.

Service Requirements

As for Level 4 plus:

Designated child and adolescent inpatient mental health beds

Identification, ongoing assessment, monitoring and interventions for mental health problems ranging in risk and complexity (that may be associated with complex comorbidities and/or indicators of treatment resistance)

Targeted clinical programs for individuals / groups / families / carers (e.g. group therapy for families / carers of patients with psychotic illness)

Extensive range of primary (e.g. parenting support) and secondary (e.g. weight management) prevention services

Authorised mental health service under Mental Health Act 2000

As clinically indicated, ECT services may be facilitated and/or provided by mental health service authorised to provide ECT under Mental Health Act 2000, and under care of registered medical specialist with credentials in psychiatry and certificate in child and adolescent psychiatry (or equivalent), and in accordance with Mental Health Act 2000

May provide a range of additional clinical programs and service components, such as telehealth services or a day program

Workforce Requirements

As for Level 4 plus:

Qualified and/or experienced RN in charge of each shift with extensive skills appropriate to service being provided

Majority of unit nursing staff have mental health qualifications and/or experience, and/or qualifications and/or experience in child and adolescent mental health, and/or children’s health

Access during business hours to community or hospital based allied health staff with qualifications and/or experience in child and adolescent mental health (postgraduate qualifications desirable)

Access to psychology, social work, occupational therapy, speech pathology and dietetic services

Access to dedicated pharmacy services for mental health

Access to extensive range of on-site and/or visiting specialties in health/mental health

May have hospital based school teacher dedicated to mental health consumer

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
3 - 6 5 5

Service Description

A Level 6 service is capable of providing short to long term and intermittent inpatient mental health care 24 hours a day to voluntary and involuntary mental health consumers up to 18 years who present with highest level of risk and complexity.

Consumer group may be targeted population with special care needs who may demonstrate extreme comorbidities and/or indicators of treatment resistance.

Highly specialised and/or statewide inpatient service delivered from child / adolescent hospital that incorporates dedicated mental health unit or may be delivered from purpose designed and built mental health facility.

Care is delivered by a highly specialised, multidisciplinary team of child and adolescent mental health professionals.

A Level 6 service has statewide and/or interstate health service functions. It demonstrates specialist expertise in delivery of mental health services to a patient group that cannot be safely and effectively cared for in any other level of acute inpatient mental health service.

Service provision includes multidisciplinary assessment and specialised interventions by mental health professionals; consumer and carer education; documented daily case review; targeted group programs; all levels of prevention programs / services; consultation liaison with lower level mental health services; and referral, where appropriate.

Service Requirements

As for Level 5 plus:

Identification, ongoing assessment, monitoring and interventions for complex mental health problems (that may be associated with most complex comorbidities and/or indicators of treatment resistance)

Extensive clinical data collection to inform assessment, diagnosis, intervention, recovery and broader service delivery in all levels of service

Extensive range of primary (e.g. parenting support), secondary (e.g. weight management) and tertiary (e.g. psychosis treatment maintenance) prevention services

Statewide clinical forums to assist dissemination of clinical expertise

Separate clinical services for families / carers, if required

Specialist consultation-liaison to other health and non-health services / agencies for target population

Psychoeducation for consumer, families / carers and groups (including information about available mental health services, mental health problems and illnesses, indicated treatment options and support services)

Forms part of integrated mental health service and is based in a network that also includes Child and Adolescent Mental Health Ambulatory Service

May provide extensive range of additional clinical programs and service components, such as an outreach service, telehealth services or day program

Medical services provided on-site or in close proximity to provide rapid response at all times

Workforce Requirements

As for Level 5 plus:

24 hours access to registered medical practitioner (psychiatry registrar / principal house officer / senior medical officer / career medical officer) with credentials relevant to the discipline

Extended-hours access to community or hospital based allied health staff with qualifications and experience in child and adolescent mental health

Access to extensive range of on-site and/or visiting specialties in children’s health

Access to on-site school with school teachers who can provide range of educational services dedicated to children and/or adolescents with mental illness

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
3 - 6 5 5

The Clinical Genetics Service provides diagnosis, medical management advice, genetic testing, genetic counselling and support for individuals and families affected by a wide range of genetic conditions.

This is a statewide service operating from a single site with outreach services.

Service Description

The Clinical Genetics Service is an out-patient service providing consultations on diagnosis, testing, counselling and management of genetic conditions across the following areas:

Paediatric syndromes, including developmental delay and intellectual disability

Adult onset inherited neuro-muscular, skeletal and cardiac conditions

Risk assessment and carrier testing for inherited genetic disorders

Prenatal diagnosis for inherited genetic disorders

Diagnosis and counselling when a birth defect is detected during pregnancy

Familial cancer syndromes Chromosomal disorders

Metabolic disorders

Abnormal newborn screening results for cystic fibrosis

Service Requirements

Access to appropriate clinic space for consultations at each acute hospital site in all three regions of the state

Access to telehealth facilities

Suitable office accommodation, with space for storage of genetic files, and including privacy or sound proofing for provision of telephone counselling by genetic counsellors

Access to Cytogenetics and Molecular Pathology Laboratories (intrastate or interstate)

Access to and linkages with neonatology, maternity, oncology and gynaecological oncology and gastroenterology Services

An independent patient database program, which is able to store medical information in family files and is capable of operating the reminder service provided by the Familial Cancer Registry

Dedicated software program for drawing family trees (pedigrees) such as Progeny

Education/Training and Professional Development opportunities for Clinical Geneticists, Genetic Counsellors and Associate Genetic Counsellors

Workforce Requirements

Clinical Geneticist/s

Genetic Counsellor with full certification in Genetic Counselling by the Human Genetics Society of Australasia to enable supervision of Associate Genetic Counsellors in training

Associate Genetic Counsellors on-site

Data manager with expertise in management of genetic databases and pedigree drawing software

Administrative support for clinic organisation and appointment scheduling

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 6 6 -

Ear, Nose and Throat (ENT) Surgical Services treat diseases, injuries or deformations of the ears, nose, throat, head and neck areas. ENT surgical services encompass a broad range of complexity from uncomplicated day procedures and elective surgery to highly complex cases including intracranial procedures.

Higher level ENT services work in close partnership with other specialist medical and surgical services. In particular patients with complex ENT problems may require radiotherapy and plastic and reconstructive surgery to maximise the quality of the care they receive. Patients with complex ENT problems may also require specialist allied health support from audiology, speech pathology, dietetics and physiotherapy services.

The scope of this Framework describes the surgical services, their requirements and the minimum staffing needs and clinical support services required within each level.

May provide surgical procedures on children (refer to Paediatric Surgery Service Framework within this document).

No Level 1 service currently described.

No Level 2 service currently described.

Service Description

A Level 3 service provides ENT surgery for low risk patients undergoing SCI to SCIII procedures (refer to General Surgical Services framework). Surgery is performed by visiting ENT surgeon.

Service Requirements

As for Level 2 plus:

At least one operating/procedure room with separate recovery area/room for post-operative care

Workforce Requirements

Visiting ENT surgeon

On-site diagnostic audiology services for children and adults

Registered medical practitioners or a GP credentialed to administer anaesthetic

RNs with appropriate post graduate qualifications and/or experience in post-operative nursing; RNs may be supported by ENs in providing care to inpatients

Medical, anaesthetic and nursing pre-admission services

24 hour access to a registered medical practitioner or a GP (on-site or on-call)

Access to some allied health services

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
3 - 3 4 3

Service Description

A Level 4 service provides services at Level 3 plus surgery for low to moderate risk patients undergoing SCI to SCIII ENT procedures (refer to General Surgical Services framework). Surgery is performed by specialist ENT surgeons. No neuro-optic or intracranial surgery is performed.

Service Requirements

As for Level 3 plus:

Designated acute surgical inpatient unit with RNs/ENs with appropriate post graduate qualifications and/or experience in peri-operative and post-operative nursing

Workforce Requirements

As for Level 3 plus:

ENT surgeon on-site

Surgical registrar on-call 24 hours

Consultant anaesthetist on-site and on-call 24 hours

Anaesthetics registrar on-call 24 hours

Access to designated allied health services, including speech pathology

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 4 4 4

Service Description

A Level 5 service provides services at Level 4 plus surgery is performed on low to high anaesthetic risk patients undergoing SC IV and SCV ENT procedures (refer to General Surgical Services framework). Generally, a combination of procedures with a low to high level of complexity and risk are performed, and management of some patients with comorbidities and risk of intra- and post-operative complications occurs.

Surgery is performed by one or more specialist ENT surgeons with the ability to support patients in the post-operative stage 24 hours.

Service Requirements

As for Level 4 plus:

On-site ICU

On-site plastic surgery service

On-site medical oncology, radiation oncology and palliative care services

May provide specialty ENT surgical training

Workforce Requirements

As for Level 4 plus:

ENT surgeon on-site and on-call 24 hours

Surgical RNs with specialist ENT expertise

On-site plastic surgery, medical oncology, radiation oncology and palliative care specialists

On-site allied health staff, including audiology, speech pathology, dietetics and physiotherapy

Access to a CNC specialising in ENT and providing leadership for the service

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 5 5 5 5

Service Description

A Level 6 service provides all services at Level 5 plus the service has the ability to deal with a full range of complex cases in association with other specialists including neuro-optic and intracranial procedures,

Service Requirements

As for Level 5 plus:

On-site neurosurgical services

Coordinates statewide cochlear implant service delivery face to face and / or via telehealth

Workforce Requirements

As for Level 5 plus:

Neurosurgeon on-site; and on-call 24 hours

Neurosurgical registrar on-site 24 hours

Allied health professionals available 24 hours, as required

Allied health staff with specialist skills in the assessment and ongoing management of patients with cochlear implants, including specialist audiology, speech pathology and social work

Audiometry service

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
6 6 6 6 6

Emergency Medicine is the clinical specialty that is dedicated to the diagnosis and treatment of unforeseen illness or injury.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

Service Description

A Level 1 service provides basic life support by an RN with access to a registered medical practitioner or GP for attendance at the facility within 30 minutes.

Service Requirements

Basic emergency equipment as referenced in “Tasmania’s Rural Hospitals – 2016’ Report

Classified as a Tier 2 facility or equivalent as referenced in “Tasmania’s Rural Hospitals – 2016’ Report

Designated emergency care area

Local paramedic ambulance service

Formalised transfer protocols with Ambulance Tasmania for rapid retrieval and transport

Access to telehealth services

Workforce Requirements

On-site RN 24 hours for basic life support

Access to a registered medical practitioner or GP (Tier 2) under the relevant Practitioner’s Agreement

Service Description

A Level 2 service provides services at a Level 1, plus provides 24 hour advanced life support by an RN with access to a registered medical practitioner or GP, and/or paramedic for attendance at the facility within 15 minutes.

Service Requirements

As for level 1, plus:

Extra emergency equipment available as referenced in “Tasmania’s Rural Hospitals – 2016’ Report

Classified as a Tier 1 facility or equivalent as referenced in “Tasmania’s Rural Hospitals – 2016’ Report

Access to retrieval services for urgent transfer of patients to higher level Emergency Medicine service

Workforce Requirements

As for level 1, plus:

Access to a registered medical practitioner or GP (Tier 1) under the relevant Practitioner’s Agreement

On-site RN 24 hours for advanced life support

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 1 2 2

Service Description

A Level 3 service provides services at level 2, plus on-site emergency treatment for low risk patients with uncomplicated minor acute illnesses without the need for referral to a higher level Emergency Medicine service and for the initial management of sick patients pending referral and transport to a higher level facility. A level 3 service does not manage major trauma.

Ambulance Tasmania patients are not managed on-site with the exception of suspected acute coronary syndrome and subacute patients.

Service Requirements

As for Level 2 plus:

Formal linkage with higher level Emergency Medicine services within the network

Emergency department with resuscitation bays

On-site short stay unit

Access to critical care facilities within the network

Workforce Requirements

As for Level 2 plus:

Medically staffed by GPs, Australian College of Rural and Remote Medicine (ACCRM) specialists, ACCRM trainees or registered medical practitioner with postgraduate training in emergency medicine

Fellow of the Australasian College of Emergency Medicine (ACEM) for clinical governance and education and training on-site during business hours

RMO in emergency department 24 hours on-site

On-site RNs with emergency medicine experience available 24 hours

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 3 3 3

Service Description

A Level 4 service provides services at Level 3, plus is medically staffed by emergency physicians with on-call access to emergency physicians 24 hours.

Service Requirements

As for Level 3 plus:

On-site HDU or ICU

Accredited for advanced training with the ACEM

May have a NP (Emergency)

Workforce Requirements

As for Level 3 plus:

Emergency physicians on-site 16 hours a day and on-call 24 hours

RNs with experience and/or post graduate qualifications in emergency nursing on-site 24 hours

Emergency registrars/RMOs on-site 24 hours

General surgeon on-site and on-call 24 hours

General medicine specialist on-site and on-call 24 hours

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 4 4 4

Service Description

A Level 5 service provides services at Level 4, plus has access to on-site interventional cardiology and critical care medicine services 24 hours.

Service Requirements

As for Level 4 plus:

On-site ICU

On-site interventional cardiology service

Accepts transfers from other hospitals in the region

Workforce Requirements

As for Level 4 plus:

General medicine specialist on-site and on-call 24 hours

Critical care medicine specialist on-site/on-call after-hours

On-site intervention cardiology services on-site / on-call 24 hours

CNC providing clinical leadership in emergency care

CNE to support undergraduate and postgraduate nursing students and skill development of nurses

Specialist pharmacist, emergency

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 5 5 4 5

Service Description

A Level 6 service provides services at Level 5, plus has capacity to manage complex trauma and provide a full range of time-critical medical services 24 hours.

Service Requirements

As for Level 5 plus:

On-site back-up from a full range of medical and surgical sub specialists and diagnostic services, including neurosurgery, cardiothoracic surgery, vascular surgery and angiography

Workforce Requirements

As for Level 5 plus:

On-site medical and surgical sub-specialists to support emergency service, including neurosurgery, cardiothoracic surgery, vascular surgery and angiography

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 6 5 5 5

Endocrinology is the branch of medicine that deals with the medical aspects of hormones and their associated diseases and conditions. The minimum service and workforce requirement for a Tertiary Diabetes Centre is outlined below.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

No Level 1 service currently described.

No Level 2 service currently described.

Service Description

A Level 3 service provides registered medical practitioner or GP inpatient and outpatient care.

Outpatient care can be provided by an endocrinologist, a medical officer or specialist with skills in endocrinology or a diabetes nurse educator.

Service Requirements

As for Level 2 plus:

Inpatient hospital beds

Formal linkage with all higher level Endocrinology services

Formal access to diabetes educators

Workforce Requirements

As for Level 2 plus:

GP on-call 24 hours

On-site RN 24 hours for inpatient services

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 1 3 3

Service Description

A Level 4 service provides endocrinology care by an endocrinologist or physician practicing in general medicine with dual training in endocrinology.

A component of a level 4 service is a designated Diabetes Centre accredited by the National Association of Diabetes Centre.

A Diabetes Centre provides inpatient care as well as ambulatory (outpatient) multidisciplinary care for individuals with a clinical diagnosis of diabetes. The Centre aims to bridge the gap between acute hospital care and primary care within the community, including the prevention of hospitalisation.

The Diabetes Centre does not need to operate from a single site. The service and workforce requirements will require a close interrelationship with each of the hospital sites to which the Diabetes Centre is attached.

The primary role of the Diabetes Centre is to optimise health outcomes for people with diabetes by reducing hospital lengths of stay and initiating hospital avoidance where possible, by supporting inpatient care and outpatient flow within its affiliated hospital.

Service Requirements

As for Level 3 plus:

On-site diabetes nurse-led education service

On-site access to designated allied health services in particular to dietetic and psychologist services

Diabetes Centre

Provide peri-operative and post hospital discharge support

Clinical inpatient advice, assessment and education

Ambulatory care for patients with diabetes

Appropriate patient case management

Specialist clinics to meet the acute and sub-acute needs of patients with diabetes

Multidisciplinary led outpatient clinics

On-site nurse-led diabetes education services and allied health group therapy sessions for patients and carers

In-service training and education for primary, secondary and tertiary health care providers, as well as community based diabetes providers

Research role

Workforce Requirements

As for Level 3 plus:

On-site endocrinologist or physician practicing in general medicine with dual training in endocrinology

Endocrinologist or physician practicing in general medicine on-call 24 hours

RNs with appropriate post graduate qualifications and/or extensive experience in endocrinology/complex diabetes nursing; RNs may be supported by ENs in providing care to inpatients

Diabetes Centre

Access to specialist endocrinologist and paediatrician with expertise in diabetes care

NUM

On-site NP with experience in diabetes to provide specialised diabetes patient assessment, management and education

On-site Australian Diabetes Educator Association Credentialed Diabetes Educator/s with expertise in the management of diabetes

Intern trainee diabetes educator position

On-site specialised Diabetes allied health services including; dietitian, psychologist, podiatrist, and social workers

Support Service Requirements

Level 4 Endocrinology Service

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 4 4 4

Diabetes Centre

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 1 4 3

Service Description

A Level 5 service provides inpatient care by resident endocrinologist.

Service Requirements

As for Level 4 plus:

An integrated hospital/community interface diabetes management service

On-site specialist endocrinology allied health services

Workforce Requirements

As for Level 4 plus:

Endocrinologist on-site

Access to endocrinologist or physician practicing in general medicine with dual training in endocrinology on-call 24 hours

Access to subspecialists surgeons with endocrine surgical expertise

Medical registrar on-site during business hours and on-call 24 hours

CNC/Educator specialising in endocrinology

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 5 5 4

Service Description

A Level 6 service provides a full range of endocrinology services with endocrinology department and emergency care. It has a statewide referral role and is the statewide provider for pituitary surgery, pancreatic surgery, complex thyroid cancer and endocrine malignancy management.

Service Requirements

As for Level 5 plus:

Statewide referral and support role

Endocrinology department

On-site access to staff and facilities for thyroid and endocrine cancer management, including direct access to an on-site nuclear medicine and PET service with radioiodine treatment and radiation isolation treatment rooms

On-site neurosurgical services

On-site access to laboratory service to support specialist endocrine pathology testing

Full on-site weekday supervision of clinical services and advanced training by specialists with credentialing in endocrinology

Accredited endocrinology training program

Research role

Endocrinologist inpatient and outpatient diabetes and specialist endocrine related activities

Workforce Requirements

As for Level 5 plus:

Endocrinologist on-call 24 hours and available for advice and support for acute emergency services, consultant to consultant Endocrinology registrar on-site

Neurosurgeon on-site

Neurosurgeon on-call 24 hours

Neurosurgical registrar on-call 24 hours

Access to subspecialists surgeons with endocrine surgical expertise

CNC/Educator specialising in Diabetes

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 5 6 6 6

Gastroenterology refers to a branch of medicine focused on the digestive system and its disorders.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

No Level 1 service currently described.

Service Description

A Level 2 service provides inpatient care under the supervision of a registered medical practitioner or GP and 24 hour on-site access to a RN. The service provides care for minor, uncomplicated gastrointestinal illnesses. The service does not provide any procedural gastroenterology services.

Service Requirements

Formal network linkages with specialist gastroenterologist for consultation

Workforce Requirements

Registered medical practitioner or GP

24 hour cover by a RNs; RNs may be supported by ENs in providing care to inpatients

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 1 2 2

Service Description

Level 3 service provides services at Level 2 plus same day and outpatient care by a visiting gastroenterologist and RNs with appropriate post graduate qualifications and/or experience in gastroenterology.

Elective endoscopy services and outpatient gastroenterology services are provided by a specialist gastroenterologist. No overnight inpatient gastroenterology care is provided.

Service Requirements

As for Level 2 plus:

On-site endoscopy suite and recovery area

On-site resuscitation equipment

Access to general surgical services and inpatient beds within the network

Workforce Requirements

As for Level 2 plus:

Visiting gastroenterologist

RNs with appropriate post graduate qualifications and/or experience in gastroenterology and credentialed to undertake associated procedures

Medical officer credentialed to provide analgesia/sedation

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
3 - 3 3 3

Service Description

A Level 4 service provides services at Level 3 plus inpatient care by a specialist gastroenterologist and credentialed RNs for patients with gastroenterology and hepatology care needs.

Service Requirements

As for Level 3 plus:

Inpatient general medical beds

On-site general surgical services and operating theatres available 24 hours

May include multi-disciplinary gastroenterology clinics providing a range of service

Workforce Requirements

As for Level 3 plus:

Specialist gastroenterologist

On-site general surgeon available 24 hours

On-site specialist anaesthetist available 24 hours

On-site access to drug and alcohol counselling

Access to allied health services

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 4 4 4

Service Description

A Level 5 service provides services at Level 4 plus inpatient care by a gastroenterology team. The service provides a full endoscopy service, including access to ERCP (endoscopic retrograde cholangiopancreatography) services and hepatology services.

Service Requirements

As for Level 4 plus:

On-site ICU

Accredited gastroenterology training program

Workforce Requirements

As for Level 4 plus:

On-call gastroenterologist available 24 hours

Gastroenterology registrar/RMOs

Medical registrar on-site 24 hours

Medical and surgical sub-specialists available on-site for consultation

CNC specialising in gastroenterology and providing clinical leadership for the service

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 5 5 5

Service Description

A Level 6 service provides services at Level 5 plus the service provides a full range of gastroenterology and hepatology services, with a gastroenterology department and emergency care.

Service Requirements

As for Level 5 plus:

Access to medical sub-specialists from majority of disciplines on-site

Statewide referral role

Research role

Workforce Requirements

As for Level 5 plus:

RNs with appropriate post graduate qualifications and/or extensive experience in gastroenterological nursing on-site 24 hours

Specialised gastroenterology allied health services

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 5 5 5 6

General medicine refers to the maintenance of health and the diagnosis, management and non-surgical treatment of diseases. General medicine care is provided to adult patients.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

No Level 1 service currently described.

Service Description

A Level 2 service provides a low-acuity medical care service. It is a nurse-led service. A Level 2 service also has the ability to monitor patients, with 24 hour access to a RN and access to a registered medical practitioner or GP.

Service Requirements

Access to registered medical practitioner or GP

May host outreach service from higher level General Medicine service within the network

Workforce Requirements

24 hour access to a RN; nursing services also provided by EN

Service Description

A Level 3 service provides services at Level 2 plus it has the ability to provide acute resuscitation prior to transfer. It provides a low-acuity, multi-system medical condition ambulatory and/or inpatient service.

Service Requirements

As for Level 2 plus:

Has a designated emergency care area

Must have telehealth linkages to some specialist medical services, including emergency care, from a higher level service within the network

Workforce Requirements

As for Level 2 plus:

Inpatient care by a registered medical practitioner or GP

May have access to allied health professionals, as required

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 1 2 2

Service Description

A Level 4 service provides outpatient care by a visiting physician practicing in general medicine/general internal medicine specialist, including by telehealth. A Level 4 service has established linkages to a higher level general medical inpatient and ambulatory care service. No inpatient medical admissions occur at a Level 4 service. Service requirements

Service Requirements

As for Level 3 plus:

Outpatient care provided by a physician practicing in general medicine

Links to a service providing streamlined access to general medical inpatient care beds

Links to sub-specialty medical services and allied health services within the network

Workforce Requirements

As for Level 3 plus:

Visiting physician practicing in general medicine

Specialist dietetics and nutrition, podiatry, social work, physiotherapy and occupational therapy services (visiting or on-site)

RNs with experience and/or post graduate qualifications in nursing on-site

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 3 3 3

Service Description

A Level 5 service provides services at Level 4 plus inpatient care by a physician practicing in general medicine supported by inpatient and outpatient consultations for a (limited) range of medicine subspecialties.

Service Requirements

As for Level 4 plus:

Inpatient care provided by an on-site physician practicing in general medicine

Inpatient consultation provided by limited number of on-site medical sub-specialist services

Outpatient consultation provided by limited on-site medical sub-specialist services supplemented by visiting medical sub-specialists

Access to networked sites for advice and consultation for inpatients and outpatients by full range of sub-specialty medical services utilising telehealth services where appropriate

Endoscopy services (acute and elective)

Formal linkage to interventional cardiology services within the network

Access to on-site cardiac investigations, including exercise stress testing and echocardiography

Workforce Requirements

As for Level 4 plus:

24 hour on-call roster for physicians practicing in general medicine

Registered medical practitioner on-site 24 hours

Nursing staff with appropriate experience and post graduate qualifications

Full range of generalist allied health services

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 4 4 4

Service Description

A Level 6 service provides services at Level 5 plus a multidisciplinary team approach to treat complex and critically ill medical patients. The service provides inpatient care by a team of on-site physicians practicing in general medicine with on-site access to a comprehensive range of sub-specialty medicine expertise.

Service Requirements

As for Level 5 plus:

Physicians practicing in general medicine providing consultative services to other departments for inpatients admitted from other sites requiring local expertise in these disciplines

On-site access to a comprehensive range of medical sub-specialty services

On-site interventional cardiology and bronchoscopy services

Provider of general medicine consultation service by telehealth to lower level services

Workforce Requirements

As for Level 5 plus:

Medical registrar on-site 24 hours

Sub-specialists available on-site for consultation

RMOs in majority of sub-specialist medicine services

Specialised allied health services on-site

May have on-site NPs to supplement sub-specialty medicine roles

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 5 5 5 5

General surgery includes emergency and elective surgery with varying levels of surgical complexity.

The levels of surgical complexity indicate the requisite levels of clinical support services required in general surgery and are especially important in determining the appropriate levels of anaesthetic, perioperative and ICU services.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

May provide surgical procedures on children (refer to Paediatric Surgery Service Framework within this document).

Surgical Acuity Characteristics (QLD Health CSCF 2005):

Level I surgical complexity (SCI):

is an ambulatory / office procedure

requires local anaesthetic but not sedation

requires a procedure room, aseptic technique but not an operating theatre

requires access to resuscitation equipment

Level II surgical complexity (SCII):

is usually an ambulatory, day stay or emergency department procedure

does not require general anaesthesia

requires at least one operating or procedure room and separate recovery area

Level III surgical complexity (SCIII):

usually requires general anaesthesia or equivalent

requires at least one operating room and a separate recovery room

is usually an ambulatory or day stay procedure

may have access to close observation care

Level IV surgical complexity (SCIV):

involves major surgical procedures with low to medium anaesthetic risk

usually requires general anaesthesia

has access (not necessarily on-site) to intensive care services

has the capacity to provide emergency procedures

Level V surgical complexity (SCV):

major surgical procedures with high anaesthetic risk

surgery and anaesthesia with the highest potential for intra- and post-operative complications

provides specialist clinical staff, equipment and infrastructure

on-site intensive care services

extensive support services available

No Level 1 service currently described.

Service Description

A Level 2 service performs low complexity surgery on low to medium-risk patients undergoing SCI procedures. Surgery is performed by a registered medical practitioner. The surgery is performed on outpatient or same-day basis.

Service Requirements

On-site perioperative service

Outpatient care

Must have one procedure room

Workforce Requirements

Registered medical practitioner or a GP to coordinate care

RNs with appropriate post graduate qualifications and/or experience; RNs may be supported by ENs in providing care to low complexity general surgical patients

General surgeon available for consultation

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
2 - 2 3 2

Service Description

A Level 3 service provides services at Level 2 plus surgery is performed on patients undergoing SCI to SCIII procedures. Surgery is performed by specialist surgeons on a day case basis.

Service Requirements

As for Level 2 plus:

At least one operating/procedure room with separate recovery area/room for post-operative care

On-site medical practitioners credentialed to administer anaesthetic

Workforce Requirements

As for Level 2 plus:

Visiting registered medical specialist with credentials in general surgery or other surgical specialties may be available

Medical practitioners credentialed to administer anaesthetic

RNs with appropriate post graduate qualifications and/or experience in perioperative nursing; RNs may be supported by ENs

Medical, anaesthetic and nursing pre-admission services

Access to allied health services, as required

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
3 - 3 4 3

Service Description

A Level 4 service provides services at Level 3 plus surgery is performed on low to medium risk patients undergoing SCIV procedures. Surgery is performed by one or more consultant surgeons.

Service Requirements

As for Level 3 plus:

Broad range of day and general surgery and some specialty surgery

More than one theatre

Designated acute surgical inpatient unit with appropriately qualified/experienced nursing staff

Provides specialty surgical training

Workforce Requirements

As for Level 3 plus:

Specialist surgeons on-site; and on-call 24 hours

Surgical registrar on-call 24 hours

Specialist anaesthetists on-site; and on-call 24 hours

Anaesthetics registrar on-call 24 hours

Critical care specialist on-site; and on-call 24 hours

RNs with appropriate post graduate qualifications and/or extensive experience in perioperative nursing; access/ on-call 24 hours

RNs with appropriate post graduate qualifications and/or experience in post-operative nursing; RNs may be supported by ENs in providing care to inpatients

CNC providing leadership in peri-operative and post-operative care

CNE

Access to designated allied health services appropriate to the level of general surgical services being provided

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 - 4 4 4

Service Description

A Level 5 service provides services at Level 4 plus surgery is performed on low to high anaesthetic risk patients undergoing SCV procedures. Generally, a combination of procedures with a moderate to high level of complexity and risk are performed, and management of some patients with comorbidities and risk of intra- and post-operative complications occurs.

Surgery is performed by consultant surgeons with the ability to support patients in the post-operative stage 24 hours. This service has the ability to undertake most emergency surgeries.

Service Requirements

As for Level 4 plus:

Has an active research role

On-site ICU

Workforce Requirements

As for Level 4 plus:

Access to specialised allied health services

Access to multiple surgical sub-specialties on-site; and on-call 24 hours

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 4 4 4

Service Description

A Level 6 service provides services at Level 5 plus this service manages the most complex and highly specialised surgical presentations with the highest level of risk in specified areas of expertise.

Service Requirements

As for Level 5 plus:

On-site cardiothoracic and neurosurgical services

Comprehensive acute and persisting pain management services

PET scanning services

Workforce Requirements

As for Level 5 plus:

Broad range of surgical sub-specialists available on-site

Dedicated surgical staff with clinical competency in a range of sub-specialty areas available at close proximity 24 hours

Allied health professionals available 24 hours, as required

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
6 6 6 6 6

Geriatric medicine is a speciality that focuses on the health care of older people. It aims to promote health by preventing and treating diseases and disabilities in older adults.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

No Level 1 service currently described.

A Level 2 service provides outpatient and outreach care from a higher level Geriatrics service. These services have access to a health practitioner specialising in geriatric assessment and access to some allied health services.

Service Description

A Level 3 service provides services at Level 2 plus provides inpatient and outpatient care by an on-site registered medical practitioner or GP. Access to a visiting geriatrician or general physician, via telehealth.

Service Requirements

Inpatient beds available within the facility

Access to rehabilitation services within the network

Access to higher level Geriatrics service in the network

Workforce Requirements

On-site registered medical practitioner or GP

Access to a visiting geriatrician or general physician, or via telehealth

24 hour cover by RN; RNs may be supported by ENs in providing care to inpatients

Access to some allied health services

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 1 2 2

Service Description

A Level 4 service provides services at Level 3 plus provides inter-disciplinary assessment and management of the care and needs of older people. A Level 4 service provides services to day patients and inpatients by a general physician or geriatrician.

Service Requirements

As for Level 3 plus:

Access to appropriate geriatric clinics

May have access to inpatient geriatrics rehabilitation beds

Access to Geriatric Assessment service

Access to psychogeriatric service

Workforce Requirements

As for Level 3 plus:

General physician or geriatrician on-site

Access to a psychogeriatrician

Registered medical practitioner available 24 hours

RNs with appropriate post graduate qualifications and/or experience in geriatric nursing

Access to allied health and rehabilitation services, as required

Access to palliative care consultation and services

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 3 3 3

Service Description

A Level 5 service provides services at Level 4 plus provides inpatient care by a geriatrician. It has links with inpatient rehabilitation services, geriatric psychiatry services, and ortho-geriatric services, and provides support to lower level services in the network.

Service Requirements

As for Level 4 plus:

Designated geriatric medicine beds

Rehabilitation services available on-site

Provides ortho-geriatrician services

Provides outreach services to lower level services

Provides specialty training in geriatrics

Workforce Requirements

As for Level 4 plus:

Geriatrician on-site

Geriatrics registrar/RMO

Access to CNC

Access to specialised allied health professionals

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 4 4 4

Service Description

A Level 6 service provides services at Level 5 plus provides inpatient care for specialised geriatric management.

Service Requirements

As for Level 5 plus:

Access to medical sub-specialists on-site

Advanced training in geriatrics

Research role

Workforce Requirements

As for Level 5 plus:

Specialist geriatrician on-site and on-call 24 hours

Medical registrar on-site 24 hours

May have NPs providing high level nursing expertise in geriatrics

Specialised allied health professionals

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 5 5 5

Gynaecology is the branch of medicine that deals with the treatment of diseases of the female reproductive system. Services are delivered by registered medical practitioners who are credentialed in gynaecology.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

No Level 1 service currently described.

No Level 2 service currently described.

Service Description

A Level 3 service performs minor procedures on low risk patients by an appropriately trained and credentialed health professional. There are no inpatient services provided at this level.

Service Requirements

Visiting outreach service that provide clinic-based gynaecological procedures

Formal linkages with higher level Gynaecology Service

Workforce Requirements

Appropriately trained and credentialed health professional

Access to visiting gynaecologist or via telehealth

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
3 - 3 3 3

Service Description

A Level 4 service provides services at Level 3 plus some major procedures on low and moderate risk patients performed by a Fellowship of Royal Australian and New Zealand College of Obstetricians and Gynaecologists (FRANZCOG) gynaecologist.

This unit must have the capacity to resuscitate patients and have access to an emergency theatre on a 24 hour basis. This unit must have access to a FRANZCOG on a 24 hour basis that is able to attend within 30 minutes.

Service Requirements

As for Level 3 plus:

Inpatient surgical beds for gynaecology patients

At least one operating/procedure room with separate recovery area/room for post-operative care

Network links with specialist gynaecological oncology, medical oncology, radiation oncology and palliative care services

Specialty training in gynaecology

Workforce Requirements

As for Level 3 plus:

On-site gynaecologists registrars on-call 24 hours

On-call gynaecologist accessible within 30 minutes if required

RNs with appropriate post graduate qualifications and/or experience in peri-operative nursing

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 - 4 4 4

Service Description

A Level 5 service provides services at Level 4 plus it provides a diagnostic service and performs surgery on all patients by specialist gynaecologists. It has the ability to manage a broad range of patients in association with other specialists, with appropriate formal links and referrals in place with higher level Gynaecology services for certain complex cases.

Service Requirements

As for Level 4 plus:

Inpatient surgical beds for gynaecology patients

On-site Level 4 Maternity Service

Provides medical specialty training in gynaecology

Network access to gynaecology oncology specialists

Outpatient services that provide clinic-based gynaecological procedures

Workforce Requirements

As for Level 4 plus:

On-site gynaecologists on-call 24 hours

Gynaecology registrars on-site; and on-call 24 hours

RNs with appropriate post graduate qualifications and/or experience in gynaecological nursing

CNC providing leadership in gynaecological care

Access to designated allied health services

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 4 4 4

Service Description

A Level 6 service provides services at Level 5 plus this service has the ability to manage complex cases in association with other specialists including reproductive endocrinology, infertility, and gynaecological malignancy.

Service Requirements

As for Level 5 plus:

Provides specialist consultation to lower level services

Performs complex gynaecological surgery

On-site ICU

Gynaecologic oncology multidisciplinary team with representation from medical oncology, radiation oncology, and gynaecological oncology

Designated gynaecological cancer care coordinators

Dedicated women's health ward

Ability to accept referrals for complex cases from lower level services

Research role

Workforce Requirements

As for Level 5 plus:

On-site gynaecological oncologist

On-site gynaecological registrar with gynaecological oncology responsibilities

On-site gynaecologists with sub-specialty interest in uro-gynaecology, minimally invasive surgery and reproductive endocrinology

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 5 5 5 5

State Referral Centre – Single Site Service

Hyperbaric and Diving Medicine Services

Hyperbaric and diving medicine is a specialised area of clinical practice involving the diagnosis, management and treatment of dysbaric illness of all levels of severity and for patients with medical conditions that respond to hyperbaric oxygen, including arterial gas embolism, gangrene and necrotizing infections, complex problem wounds, radiation injury and necrosis, acute ischaemic conditions and trauma.

Hyperbaric oxygen treatment is administered in a pressurised hyperbaric chamber capable of delivering 100% oxygen at 2.8 atmospheres absolute pressure for medical cases and up to 6 atmospheres absolute for divers.

The scope of this framework describes the service, its requirements and the staffing needs and clinical support services required within each level.

Service Description

This service has critical care capability and manages the highest level of patient acuity and complexity with an extensive range of comorbidities. The service provides emergency recompression treatment for all divers (up to 6 atmospheres absolute pressure) and acute hyperbaric oxygen treatment to medical and surgical patients of all illness severity.

This service also provides a tertiary wound care service in association with medical hyperbaric treatment of hypoxic complex wounds, trauma and radiation injury.

To be defined as a comprehensive hyperbaric facility the service needs to be capable of providing hyperbaric oxygen therapy at a treatment pressure of at least 2.8 atmospheric pressure absolute (180 kilopascal gauge pressure), and capable of managing critical care patients with mechanical ventilation and invasive monitoring. The precise definition of a comprehensive hyperbaric facility is governed by Commonwealth Department of Health Medicare regulations.

Service Requirements

Statewide referral and network role

Linkage to Level 6 integrated retrieval service with direct rotary wing access for time critical cases

Hyperbaric facility with full critical care capability delivering hyperbaric oxygen treatment to ventilated patients with or without circulatory and inotropic support, in support of other specialities managing patients with multisystem disease, or specialities such as cardiac surgery where specific complications require emergency hyperbaric treatment

On-site Level 6 Emergency Department with resuscitation and monitoring facilities available

On-site Level 6 critical care support

Hyperbaric medical specialist and registrar cover, 24 hours for emergencies

RNs with appropriate post graduate qualifications and/or extensive experience in hyperbaric medicine and technical cover, 24 hours for emergencies

Broad range of surgical sub-specialties on-site and available at close proximity 24 hours

Capability of treatment of divers with serious neurological injury, unconscious and those requiring critical care or ventilation

Capability of procedural interventions such as intubation and ventilation, invasive monitoring, and thoracostomy tubes

Provides specialist advice and diving medicine support for Tasmania’s diving industry

Provides specialist technical support in forensic investigation of diving accidents

Provides specialist and complex wound management

Accredited for post-graduate specialist registrar training and post-graduate nurse training

Has an active research role

Workforce Requirements

Medical Director with postgraduate qualifications in Diving and Hyperbaric Medicine

Hyperbaric specialists with postgraduate qualifications in Diving and Hyperbaric Medicine and Acute Care Speciality training (Anaesthesia, Emergency Medicine or Critical Care) on –call 24 hours

Director of clinical training for supervision of registrar training

Registrar on-call 24 Hours

Specialist RNs with appropriate post graduate qualifications and/or extensive experience in critical care and wound care on-call 24 hours (Minimum 30% of nursing staff with critical care post graduate qualifications)

Full time Specialist technical staff with hospital based Hyperbaric technical training, including advanced commercial and/or Navy diving experience on-call 24 hours

Administrative support on site

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 6 5 5 4

No Level 1 service currently described.

No Level 2 service currently described.

A Level 3 service provides outpatient care by a visiting infectious medical diseases specialist. A level 3 service does not provide inpatient management of infectious diseases.

Service Description

A Level 4 service provides services at Level 3 plus it provides ambulatory and inpatient consulting services provided by a physician practicing in general medicine.

Service Requirements

General inpatient beds for the care of patients with infectious diseases

Isolation room(s) with internal wash basins and toilets

Staff wash basins immediately outside the room

Separate ventilation for isolation room(s)

Formal access to specialist infectious diseases and sexual health physicians within the network

On-site infection prevention and control service

Workforce Requirements

On-site physician practicing in general medicine

Appointed infection prevention and control personnel

RNs with appropriate post graduate qualifications and/or experience in sexual health nursing

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 4 4 4

Service Description

A Level 5 service provides services at Level 4 plus has on-site specialist infectious diseases personnel and appointed sexual health medicine personnel.

Service Requirements

As for Level 4 plus:

Facilities to treat transmissible diseases (including negative pressure rooms and appropriate isolation facilities)

Has a research role

On-site comprehensive infection control service

Workforce Requirements

As for Level 4 plus:

Appointed on-site infectious diseases and on-site or visiting sexual health physicians

On-site clinical microbiologist

Medical registrar on-site 24 hours

CNC providing clinical leadership in infectious diseases

Specialist infectious diseases pharmacist

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 5 5 5

Service Description

A Level 6 service provides services at Level 5 plus a Medical Registrar on site 24 hours with specialist Infectious Diseases Physicians on-call 24 hours and advanced trainee Infectious Diseases Registrar(s) and Fellow(s) available

Service Requirements

As for Level 5 plus:

Accredited infectious diseases medical training program

Facilities to treat most transmissible and quarantined diseases

Major teaching and research role

Has statewide referral role

Workforce Requirements

As for Level 5 plus:

On-site infectious diseases registrars

On-site infectious diseases physicians on-call 24 hours

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 5 6 5 5

Maternity services provide care for mother and baby along the continuum of care. This includes during pregnancy, during labour and birth, and during the postnatal period.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level. Safety in the provision of maternity care depends upon appropriate consultation and / or referral and transfer of patients consistent with well-defined clinical pathways.

This framework is consistent with the National Maternity Services Framework.

Service Description

A Level 1 service provides community antenatal and/or postnatal care for women and infants who have normal care (As per National Capability Framework for Maternity Services) needs for antenatal and postpartum care. Outpatient and ambulatory care are available. There are no planned birthing services. The service has capacity to provide emergency resuscitation and care to critically ill mother and babies until transfer or retrieval takes place. A Level 1 service accepts back transfer of physiologically stable women and neonates from a higher level Maternity service, following midwifery/obstetric consultation.

Service Requirements

Emergency resuscitation equipment (adult and neonate)

Basic equipment for antenatal and postnatal care

Access to offsite pathology and medical imaging services

Network access to high level maternity services

Access to specialist obstetric services via telehealth

Workforce Requirements

Registered midwives or RN with access to midwifery support where registered midwives are not available

Visiting GP

Access to an obstetrician via telehealth

Access to allied health professionals including physiotherapy, social work, continence advisors and dietitians

Access to maternal and child health nurses and perinatal mental health services

Access to Child Protection and Child Health and Parenting Services

Access to lactation consultants

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 1 2 2

Service Description

A Level 2 service provides services at Level 1 plus antenatal, intrapartum and postnatal inpatient services for women with uncomplicated pregnancy from 37 weeks gestation. A Level 2 service must have immediate transfer arrangements in place for retrieval and transfer to appropriate higher level Maternity service. A Level 2 service provides referral for planned lower segment caesarean section (LSCS)

Service Requirements

As for Level 1 plus:

Dedicated birthing rooms for planned births for gestation of 37 weeks or more

Antenatal cardiotocograph (CTG) monitoring with access to remote assessment and interpretation

Access to consultation from higher level Maternity services within the network face to face or via telehealth

On-site Level 3 or above neonatology service

Workforce Requirements

As for Level 1 plus:

Registered midwives available on-site and on-call 24 hours

24 hour on-site access to a DRANZCOG registered medical practitioner who is able to attend within 30 minutes

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 3 4 2

Service Description

A Level 3 service provides services at Level 2 plus it provides services for planned normal births for women ≥37 weeks gestation where the mother and baby have uncomplicated care needs.

Service Requirements

As for Level 2 plus:

Service can perform continuous electronic foetal monitoring in labour where clinically indicated

On-site facilities for emergency delivery (abdominal or vaginal)

Able to support vaginal birth after following ≥39 weeks of pregnancy

Able to support induction of labour following ≥39 completed weeks of pregnancy

Able to perform elective caesarean section at ≥39 weeks gestation

Urgent retrieval to Level 4 or above Maternity Service available

Formal linkages with higher level Maternity services within the network

Workforce Requirements

As for Level 2 plus:

24 hour access to a registered medical practitioner with credentials in anaesthetics who can attend within 30 minutes

24 hour access to a registered medical practitioner credentialed to provide care to the neonate and who can attend within 30 minutes

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
3 - 3 5 3

Service Description

A Level 4 service provides services at Level 3 plus it is able to provide intrapartum care for low and moderately complex mothers and babies with pregnancy ≥34 weeks gestation.

In utero transfer of neonates should be undertaken where there is a risk of delivery below this threshold when this is clinically and logistically possible. When this is not possible and the neonate is close to the transfer criteria threshold, clinical discretion should be applied to the decision to transfer dependant on the condition of the neonate, in consultation with a qualified neonatologist and the Level 5 or Level 6 maternity and neonatology service as appropriate.

Service Requirements

As for Level 3 plus:

As for Level 3 plus:

24 hour on-site access to foetal scalp pH or lactate sampling

Access to on-site urgent blood and specimen testing, blood and volume expanders

Blood storage facilities on-site and cross-matched blood readily available

Access on-site to 24 hour ultrasound services

Access to consultation from higher level Maternity services within the network face to face or via telehealth

Provides training of specialist obstetricians and midwives

On-site Level 4 Neonatology Service

Access to Level 4 or above ICU/HDU services within the network

Access to genetics service in the network

Workforce Requirements

Appointed FRANZCOG (Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists) or equivalent registered medical specialist with credentials in obstetrics on-site and on-call 24 hours who can attend within 30 minutes

Nominated obstetric clinical leader for the service

Obstetric registrars and RMOs

On-site specialist anaesthetist on-call 24 hours and able to attend within 30 minutes

On-site specialist paediatrician with experience in neonatal care on-call 24 hours and able to attend within 30 minutes

24 hour access to Level 4 or above General Surgery Service in the network

Resident medical officer on-site 24 hours

Registered midwives on-site 24 hours

Access to allied health professionals as required, including physiotherapy and social work

On-site access to perinatal mental health professionals able to provide perinatal mental health assessment and support for perinatal loss

Nominated midwifery clinical leader

Access to a midwifery educator

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 4 5 4

Service Description

A Level 5 service provides services at Level 4 plus it is capable of providing intrapartum care for low, moderate and high complexity mothers and babies with gestation ≥32 weeks gestation. This service is a multidisciplinary service with the capacity to manage all unexpected pregnancy and neonatal emergency presentations.

In utero transfer of neonates should be undertaken where there is a risk of delivery below this threshold when this is clinically and logistically possible. When this is not possible and the neonate is close to the transfer criteria threshold, clinical discretion should be applied to the decision to transfer dependant on the condition of the neonate, in consultation with a qualified neonatologist and the Level 6 Maternity and Level 6 Neonatology service.

Service Requirements

As for Level 4 plus:

A full range of antenatal, birthing and postnatal care facilities, including dedicated birth suites, an antenatal day assessment unit, allocated inpatient beds within a maternity unit and dedicated maternity beds for the acute care of high-acuity patients

On-site Level 5 Neonatology Service

On-site Level 4 or above General Surgery Service

The capacity to measure and permanently document foetal scalp sampling and cord blood gases

Portable ultrasound in birth suite 24 hours used by practitioners credentialed in ultrasound

Access to interventional radiology and vascular services within the network

Provides training of specialist obstetricians and midwives

May have research role

Workforce Requirements

As for Level 4 plus:

Clinical leadership roles in obstetrics, midwifery, nursing and neonatology

Obstetric registrars and RMOs

Paediatrics registrars and RMOs

Anaesthetics registrars and RMOs

On-site allied health professionals including occupational therapy, continence advisors, dietitians, and drug and alcohol services

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 5 5 5 5

Service Description

A Level 6 service provides services at Level 5 plus it provides all levels of care, including the highest level of complex care for women with serious obstetric and foetal conditions that require high-level multidisciplinary care.

A Level 6 service provides clinical advice and support by a consultant registered medical specialist credentialed in obstetrics 24 hours.

Service Requirements

As for Level 5 plus:

A 24 hour maternity service that provides comprehensive specialist services, including, but not restricted to, midwifery, obstetric, mental health and surgical care for women with high-risk and complex needs

On-site dedicated acute observation area within the maternity unit

On-site 24 hour access to obstetric imaging service

On-site Level 6 Neonatology Service

Access to maternal foetal medicine specialty services

Access to foetal surgical services

On-site perinatal mental health service

On-site vascular surgery and interventional radiology services

Support and statewide clinical leadership provided to lower level services

Active research role

Workforce Requirements

As for Level 5 plus:

Specialist neonatologists on-site and on-call 24 hours

Obstetricians with certification or special interest in maternal foetal medicine and obstetric ultrasound

24 hour on-site access to consultant-level medical imaging, paediatrics, anaesthetics and adult ICU staff

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 6 6 5 5

Mental Health is a specialist area of health care that promotes recovery to enable people living with mental disorders or mental health problems to lead a contributing life. Mental health services are concerned with the clinical assessment, diagnosis, monitoring and treatment of people who have a mental illness or disorder.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

No Level 1 service currently described.

No Level 2 service currently described.

Service Description

A Level 3 service provides mental health care to low complexity mental health patients. It has the capacity for non-authorised mental health treatment only.

Service Requirements

Capacity for non-authorised mental health treatment only

Admission and management by GP or other registered medical officers

Capacity to cope with acutely unwell pending transfer

Limited assessment and treatment for severe and persistent mental health conditions

Limited access to mental health multidisciplinary team

Workforce Requirements

GP or other medical officers

Access to psychiatrist within the network

RNs with appropriate post graduate qualifications and/or experience in mental health nursing; RNs may be supported by ENs in providing care to patients

Limited access to mental health multidisciplinary team

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 2 3 3

Service Description

A Level 4 service provides services at Level 3 plus it provides mental health care to moderate complexity mental health patients. It has the capacity for dedicated but non-authorised mental health treatment only.

Service Requirements

As for Level 3 plus:

Capacity for dedicated but non-authorised mental health treatment only

Assessment and treatment for severe and persistent mental health conditions

Workforce Requirements

As for Level 3 plus:

Multidisciplinary staff available 24 hours, seven days a week on-call

Clinical pharmacist

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 3 3 4

Service Description

A Level 5 service provides services at Level 4 plus it has the capability of providing mental health care to low, moderate and high complexity mental health patients. It has the capacity for authorised mental health treatment.

Service Requirements

As for Level 4 plus:

Capacity for authorised mental health treatment

Comprehensive multidisciplinary team routinely available on-site

Consultation liaison services to general health wards

Mental health high dependency unit

Workforce Requirements

As for Level 4 plus:

Comprehensive multidisciplinary team routinely available on-site

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
3 - 3 5 3

Service Description

A Level 6 service provides services at Level 5 plus it has the capability of providing mental health care for patients who present with the highest level of mental health risk and complexity. This service provides mental health care 24 hours.

Service Requirements

As for Level 5 plus:

Assessment and treatment for complex mental health conditions

Comprehensive multidisciplinary teams available 24 hours, seven days a week

Secure mental health unit

Psychiatric consultation liaison services available to general wards

Psychiatric intensive care service on-site

Workforce Requirements

As for Level 5 plus:

Comprehensive mental health multidisciplinary teams available 24 hours, seven days a week on-site

Specialist pharmacist, mental health

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 5 5 5

Neonatology Service provides a range of care from well infant care to highly specialised care, for sick, low birth weight and/or premature infants, and/or infants born with congenital or other conditions.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level. Safety in the provision of neonatal care is depends upon appropriate consultation and / or referral and transfer of patients consistent with well-defined clinical pathways.

The proposed framework is consistent with the National Maternity Services Framework.

This Framework also describes a Level 6 paediatric ICU role delineation, which is co-located with Level 6 Neonatology services.

No Level 1 service currently described.

No Level 2 service currently described.

Service Description

A Level 3 service has the ability to initiate and maintain intravenous therapy and for all births greater than 37 weeks gestation and with a birth weight greater than 2500 grams. At least one clinician is available exclusively for neonatal resuscitation.

Service Requirements

Well-equipped special care nursery

Provides phototherapy and controlled oxygen therapy in consultation with a higher level Neonatology service

Workforce Requirements

Nursing ratio of 1:4 cots; access to RNs with appropriate post graduate qualifications and/or experience in neonatal nursing; RNs may be supported by ENs in providing care

24 hour on-site access to a health professional skilled in initiating (accredited) neonatal resuscitation

On-site medical practitioner with credentials in advanced neonatal resuscitation and the necessary skills in post-resuscitation assessment, stabilisation and potential referral for emergency retrieval to a centre at a higher service level. Medical practitioner should be on-call 24 hours and available within 30 minutes of hospital

Access to outreach, community or hospital based health professionals such as dietitians, physiotherapists and social workers

Access to infant and child neuropsychology services for cognitive and developmental assessment and management of at-risk and symptomatic infants

Access to paediatric rehabilitation services, including occupational therapy for patients with rehabilitation needs and / or who require specific medical intervention and surveillance

Access to perinatal mental health services

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 - 3 3 3

Service Description

A Level 4 service provides services at Level 3 plus has the capability to plan and deliver care for infants greater than or equal to 34 weeks with minimal complications or who are back-transferred from a higher level Neonatology service.

In utero transfer of neonates should be undertaken where there is a risk of delivery below this threshold when this is clinically and logistically possible. When this is not possible and the neonate is close to the transfer criteria threshold, clinical discretion should be applied to the decision to transfer dependant on the condition of the neonate, in consultation with a qualified neonatologist and the Level 5 or Level 6 Maternity and Neonatology service as appropriate.

Service Requirements

As for Level 3 plus:

Commence mechanical ventilation in consultation with a higher level Neonatal service pending transfer to a higher level Neonatology service

On-site neonatal facilities for apnoea monitoring, low level oxygen therapy (including monitoring) and nasal/orogastric feeding

Short-term intravenous therapy available

All patients managed by attending paediatrician

Accredited paediatrics training program

Workforce Requirements

As for Level 3 plus:

On-site paediatrician with experience in neonatology on-call 24 hours

Access to dietetic, physiotherapy, social work and speech pathology services

Access to a lactation consultant

RNs with appropriate post graduate qualifications and/or experience in neonatal nursing; RNs may be supported by ENs in providing care

Specialist pharmacist

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 4 4 4

Service Description

A Level 5 service provides services at Level 4 plus it has the capability to plan and deliver care for infants with risk factors or complex care needs who were born at the hospital or back transferred from a higher level Neonatology service and who are greater than or equal to 32 weeks gestational age.

In utero transfer of neonates should be undertaken where there is a risk of delivery below this threshold when this is clinically and logistically possible. When this is not possible and the neonate is close to the transfer criteria threshold, clinical discretion should be applied to the decision to transfer dependent on the condition of the neonate, in consultation with a qualified neonatologist and the Level 6 Maternity and Level 6 Neonatology service.

Service Requirements

As for Level 4 plus:

Specialist nursery beds to manage increased workload associated with regional referral role

Provision of short-term mechanical ventilation (less-than 6 hours) pending transfer

Nasal CPAP (continuous positive airway pressure) with facilities for arterial blood gas monitoring

Non-invasive BP (blood pressure) monitoring

Receives transfers from lower level services and back-transfer from higher level Neonatology services

Workforce Requirements

As for Level 4 plus:

Neonatal nursing staff to provide back-transfer support, local education and training

Consultant paediatrician with scope of practice including neonatology

On-site paediatrics registrar on-call 24 hours

Specialist neonatology allied health providers

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 4 5 5 5

Service Description

A Level 6 service provides services at Level 5 plus it provides the highest level of care to infants and has personnel and equipment to provide continuous life support and comprehensive multidisciplinary care for newborns, including those less than 32 weeks gestation.

Service Requirements

As for Level 5 plus:

On-site neonatal intensive care unit (NICU)

Provision of medium to long-term mechanical ventilation and full life support

Supports infants of high-risk pregnancies and births

On-site 24 hour access to neonatal echocardiography services

Provides consultation and leadership for emergency neonatal transport

On-site neonatal emergency transport team on-call 24 hours

On-site neonatal surgery

Active participation in clinical trials and research

Workforce Requirements

As for Level 5 plus:

On-site specialist neonatologists on-call 24 hours

Advanced trainees in neonatology

Neonatology registrars/RMOs

Specialist nursing positions including neonatal intensive care nurse educators and intensive care equipment nurse

RNs with post graduate qualifications and/or experience in neonatal intensive/critical care nursing on-site 24 hours

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
6 6 6 6 6

Service Description

A Level 6 Neonatology service also provides Level 6 Paediatric Intensive Care services within this framework.

Service Requirements

As for Level 5 plus:

On-site paediatric intensive care unit (PICU)

Provision of medium to long-term mechanical ventilation and full life support for paediatric patients

Provides consultation and leadership for emergency paediatric transport

On-site paediatric emergency transport team on-call 24 hours

On-site paediatric surgery

Workforce Requirements

As for Level 5 plus:

On-site specialist paediatric intensive care specialists on-call 24 hours

Paediatric intensive care registrar

Neonatology registrars/RMOs

Data collector for reporting to national benchmarking organisations, data audit and to support active research role

Specialist nursing positions including paediatric intensive care nurse educators and intensive care equipment nurse

RNs with post graduate qualifications and/or experience in paediatric intensive/critical care nursing

Specialist pharmacist

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
6 6 6 6 6

Nephrology is the specialised area of medical practice involving the investigation, diagnosis and treatment of clinical abnormalities and diseases of the kidneys. The clinical presentation of kidney disease ranges from no symptoms (asymptomatic), a sudden onset of clinical symptoms (acute) or symptoms that develop over months or years (chronic).

Care for people with kidney disorders is delivered in a range of different health settings. While most care is delivered in an outpatient or ambulatory setting, a significant proportion also require inpatient services under specialist supervision or advice. A range of health professionals are involved, and deliver various services, including dialysis, transplantation and renal supportive care.

The scope of this Framework describes the nephrology service profile, its requirements, the minimum staffing needs and clinical support services required within each level of the service. This profile does include community based outpatient services provided via satellite units and home dialysis services.

No Level 1 service currently described.

A level 2 service provides local support and care to renal patients as part of a formal network. This could include a self-dialysis room in an ambulatory setting for self-managing home dialysis patient if considered clinically appropriate by their nephrologist or higher level Nephrology service. This is for patients who are medically stable.

Service Description

A Level 3 service provides inpatient care by a GP who manages renal patients who do not have a need for haemodialysis.

A Level 3 service has links to a higher level Nephrology service for specialist renal advice and acute treatment.

Service Requirements

Inpatient beds

Formal network linkage to higher level Nephrology service

Workforce Requirements

Inpatient care provided by a GP

Outpatient consultation by visiting renal specialist or via telehealth

Nursing and Allied health service on-site

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - - 3 -

Service Description

A Level 4 service provides inpatient care by a physician practicing in general medicine with links to a higher level Nephrology service for specialist renal advice and acute treatment.

A Level 4 service does not provide haemodialysis.

Service Requirements

As for Level 3 plus:

Access to specialised allied health services

Workforce Requirements

As for Level 3 plus:

Inpatient care by physician practicing in general medicine, on-call 24 hours

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - - 3 4

Service Description

A Level 5 service provides services at Level 4 plus it provides definitive acute renal medical care and treatment by an appointed renal physician for patients with acute and chronic renal disease.

A Level 5 service provides ambulatory dialysis services (satellite units).

Service Requirements

As for Level 4 plus:

Nephrology department with formal linkages with Level 6 Nephrology Service

Renal biopsies performed by a Nephrologist

Access to acute inpatient dialysis services

Access to visiting vascular surgeons and radiological interventions at an appropriate level

Access to sub-specialties services: rheumatology and infection disease services

Provision of outpatient clinics for chronic kidney disorder, including general nephrology, dialysis, renal supportive care and renal transplantation

Provision of acute inpatient nephrology consolation

Provides medical governance and clinical outreach to regional dialysis centres (satellite unit/s) and smaller community dialysis units

Manages a home therapies service (providing education, professional and technical support) to allow home haemodialysis or peritoneal dialysis locally or remotely

Accredited Nephrology Advanced Training Program

Undergraduate and postgraduate teaching role

May have a research role

On-site specialised allied health service

Workforce Requirements

As for Level 4 plus:

Nephrologist on-site and on-call 24 hours

Medical registrar on-site 24 hours

24 hour access to on-call RN with specialised experience in renal replacement modalities of haemodialysis and peritoneal dialysis

Specialist RNs with specialised experience in renal nursing and dialysis treatments, supported by ENs

NUM

RNs dedicated for vascular access, chronic kidney disease education and home therapies training

RN dedicated to coordination for renal transplant workup for recipients and donors

CNC to provide supportive care for patients choosing a non-renal replacement therapy pathway

Access to visiting vascular surgeons

Operational support staff

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 4 5 5

Service Description

A Level 6 service provides services at Level 5 plus it provides nephrology support and co-ordinated care for patients with acute renal failure, chronic kidney disease and end-stage kidney disease.

It has a statewide referral role.

Service Requirements

As for Level 5 plus:

Statewide referral role and coordination for renal transplant cases

Provides clinical advice, education and training to lower level services via telehealth

Provides statewide data collection; in home dialysis therapies; transplantation; and renal supportive care

24 hour apheresis

On-site 24 hour sub-specialties services: vascular surgery, neurosurgery, cardiothoracic surgery, interventional radiology

On-site Level 6 Neonatal and Paediatric ICU

Active research role

Workforce Requirements

As for Level 5

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
6 6 6 6 6

Neurology is the specialty that deals with diseases of the nervous system (including the brain, spinal cord and peripheral nerves) especially those due to vascular, inflammatory, autoimmune or degenerative causes (e.g. stroke, epilepsy, multiple sclerosis, Parkinson’s disease and neuropathy).

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level. Stroke services are referred to separately in the Stroke Services framework.

No Level 1 service currently described.

No Level 2 service currently described.

Service Description

A Level 3 service provides inpatient care by a registered medical practitioner or GP for low acuity neurological conditions with 24 hour cover by a RN/EN.

Service Requirements

Inpatient care by registered medical practitioner or GP

Established referral relationship with higher level Neurology services including defined transfer policies and protocols

Access to specialist clinical advice and education from a higher level Neurology service through telehealth

Access to allied health services as required

Workforce Requirements

Registered medical practitioner or GP

24 hour cover by RNs which may be supported by ENs in providing care to inpatients

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 1 3 3

Service Description

A Level 4 services provides services at Level 3 plus inpatient care by an on-site physician practicing in general medicine and outpatient medical consultation by a visiting specialist neurologist.

This level of service is able to manage uncomplicated presentations relating to common neurological conditions. Outpatient electroencephalogram (EEG) is available via visiting service.

Service Requirements

As for Level 3 plus:

Outpatient visiting EEG testing

Consultation with neurologist for management decisions for complex patients

Access to neurological advice through higher level Neurology service in the network

Workforce Requirements

As for Level 3 plus:

On-site physician practicing in general medicine on-call 24 hours

Medical practitioner on-site 24 hours

Visiting specialist neurologists

Access to designated allied health services

Visiting neurophysiology scientist for visiting EEG service

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 4 4 4

Service Description

A Level 5 service provides services at Level 4 plus it provides inpatient care by neurologist(s).

Service Requirements

As for Level 4 plus:

Inpatient care by neurologists

24 hour access to CT and MRI

May provide undergraduate teaching

May have a research role

Inpatient and outpatient EEG and nerve conduction studies (NCS) / electromyography (EMG) available

Designated neurology beds and outpatient services

Workforce Requirements

As for Level 4 plus:

Neurologist available on-site

Network access to on-call neurologist at Level 6 service 24 hours

On-site access to medical specialist with neurology scope of practice 24 hours

RNs with appropriate post graduate qualifications and/or extensive experience in neurological nursing; RNs may be supported by ENs in providing care to inpatients

Access to CNC providing leadership in neurology

Access to specialised allied health services

On-site rehabilitation specialist

On-site neurophysiology scientist for EEG services

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 5 5 5 5

Service Description

A Level 6 service provides services at Level 5 plus it provides most neurological services within designated neurology department.

Assessment and surgery for epilepsy surgery and movement disorders will be referred interstate by a neurologist from a Level 5 or Level 6 service.

Service Requirements

As for Level 5 plus:

Statewide and interstate referral role

Designated neurology beds

A Level 6 HDU for neurology inpatients

Inpatient and outpatient EEG and specialised neurophysiological testing

Capacity for 24 hours inpatient video EEG monitoring with appropriate infrastructure and staffing support available

Brain PET scanning available

Provides clinical advice, education and training to lower level services

Accredited neurology training program

Access to on-site neurosurgical services

Active research role

Workforce Requirements

As for Level 5 plus:

Consultant neurologists on-site and on-call 24 hours

Neurology registrars / RMOs

Access to on-site and on-call neurosurgeons

On-site neurophysiology scientists for EEG, NCS/EMG and evoked potential (EP) testing

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
6 6 6 6 6

Neurosurgery is the surgical specialty that deals with the diagnosis and treatment of disorders which affect any portion of the nervous system, including the brain, spinal cord, peripheral nerves and extra-cranial cerebrovascular system.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

May provide surgical procedures on children (refer to Paediatric Surgery Service Framework within this document).

No Level 1 service currently described.

No Level 2 service currently described.

No Level 3 service currently described.

No Level 4 service currently described.

Service Description

A Level 5 services provides elective uncomplicated minor neurosurgical services. Elective services include spinal and peripheral nerve surgery. A Level 5 service does not perform elective cranial procedures. Urgent procedures may be performed only after discussion with a Level 6 Neurosurgery Service. A consultant neurosurgeon participates in the credentialling and scope of practice decisions regarding neurosurgery. Service requirements

Service Requirements

Network access to Level 6 Neurosurgery Service 24 hours

Outpatient clinics by a visiting neurosurgeon

Multidisciplinary spinal assessment clinic

Link with a Level 4 Rehabilitation Services

Workforce Requirements

As for Level 4 plus:

Surgeons whose scope of practice includes minor neurosurgical procedures

RNs with appropriate post graduate qualifications and/or experience in neurosurgical nursing

Access to designated allied health services with specialist skills in the management of patients with neurosurgical care needs

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 5 4 4

Service Description

A Level 6 service is a specialist neurosurgical service that has the capability to deal with all elective and emergency neurosurgical cases.

A Level 6 service is responsible for coordinating all neurosurgical interstate transfers.

Service Requirements

As for Level 5 plus:

Provides statewide advice on all neurosurgical interstate transfers

On-site interventional neuro-radiology

Designated neurosurgical ward

Designated neurosurgical ICU / HDU

One or more dedicated neurosurgical theatres

Link with Level 5 Rehabilitation Service

Neurosurgical training program

Active research role

Comprehensive clinical assessment and triage of chronic spinal pain conditions with access to pain management multidisciplinary team on–site

On-site access to medical sub-specialties including infectious disease and neurology

Workforce Requirements

As for Level 5 plus:

Neurosurgical consultant on-site; and on-call 24 hours

Neurosurgical registrar on-site; and on-call 24 hours

CNC providing leadership in neurosurgical care

On-site specialist infectious diseases and neurology services

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
6 6 6 5 5

Ophthalmology deals with diseases of the eye. Ophthalmology surgical services are delivered by medical practitioners who are specialists in the surgical care of the eyes and visual system and in the prevention of eye diseases and injury.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

No Level 1 service currently described.

No Level 2 service currently described.

No Level 3 service currently described.

Service Description

A Level 4 service provides common diagnostic, assessment, testing and treatment of ophthalmological procedures for low and moderate risk patients. These services would normally be performed by visiting ophthalmic surgeons.

Service Requirements

Appropriately equipped treatment rooms

Operating theatre

Workforce Requirements

As for Level 3 plus:

Visiting ophthalmologist

Accredited registered medical practitioner in anaesthetics

Registered medical practitioner or a GP on-call 24 hours

RNs with appropriate post graduate qualifications and/or experience in ophthalmology

Access to orthoptists

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
3 - 3 4 3

Service Description

A Level 5 service provides services at Level 4 plus it provides diagnostic services and surgery on low, moderate and high risk patients, procedures by appointed ophthalmologists.

Service Requirements

As for Level 4 plus:

Accredited ophthalmology medical training

Research role

Workforce Requirements

As for Level 4 plus:

24 hour access to on-call ophthalmologist

Ophthalmology registrar

Appointed anaesthetists on-call 24 hours

RNs with appropriate post graduate qualifications and/or experience in perioperative and postoperative nursing

Access to orthoptists

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 - 4 4 4

Service Description

A Level 6 service provides services at Level 5 plus this service has the ability to manage complex major diagnostic and treatment procedures in association with other specialties.

Service Requirements

As for Level 5 plus:

On-site neurosurgery

On-site radiation oncology

Ability to accept referrals for complex cases from lower level servicesMay provide interstate referral role

May provide interstate referral role

Workforce Requirements

As for Level 5 plus:

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 5 5 5 5

Oral health includes emergency and elective treatment of oral health problems of varying levels of clinical complexity.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

A level 1 service is provided by non-oral health professionals that are trained to identify disease and refer to a Level 2 Service.

Service Description

A Level 2 service performs low complexity oral health care to paediatric patients. Clinical care is provided by dental therapists or oral health therapists on a minor outpatient or same-day basis. Treatments provided include dental hygiene, restorations for patients aged less-than 18 years and extractions of deciduous teeth. A level 2 service does not extract permanent teeth, but refers these patients to a Level 3 service.

Service Requirements

On-site or mobile dental services

Outpatient care in a community setting or dental clinic

Infrastructure required to provide routine oral health services including:

Dental chair

Compressor

Evacuation facilities

Dental light

Operator and assistant chairs

Intra-oral x-ray machines

Workforce Requirements

Dental and oral health therapists with skills in low complexity general oral health services

Dentist available for consultation or referral

Service Description

A Level 3 service provides services at Level 2 plus provides services to adult and paediatric patients by registered dentists credentialed to provide community dental services.

Service Requirements

As for Level 2 plus:

Access to dental laboratory within the network

Workforce Requirements

As for Level 2 plus:

On-site prosthetists

Registered dentists

Dental nurse with the appropriate education and expertise

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 2 - -

Service Description

A Level 4 service provides services at Level 3 plus inpatient and outpatient dental services for patients with complex medical and/or dental care needs.

Service Requirements

As for Level 3 plus:

Dental suite with two or more dental chairs

At least one operating/procedure room with separate recovery area/room for post-operative care

Access to designated acute surgical inpatient unit with RNs with appropriate post graduate qualifications and/or experience in post-operative nursing; RNs may be supported by ENs in providing care to inpatients

Workforce Requirements

As for Level 3 plus:

Specialist paediatric anaesthetists on-site for children under three years of age

On-site medical practitioners credentialed to administer anaesthetics

Access to maxilla-facial services in the network or on-site

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 - 4 3 3

Service Description

A Level 5 service provides services at Level 4 plus moderate to high level of complexity and risk dento-alveolar, osteotomy and oral oncology procedures are performed, and management of some patients with comorbidities and risk of intra- and post-operative complications occurs. This service has the ability to undertake most emergency surgeries.

Service Requirements

As for Level 4 plus:

Outreach services to lower level services in the network

On-site facio-maxillary surgery service

Formal linkage with interstate Level 6 Oral Health Service

Workforce Requirements

As for Level 4 plus:

On-site facio-maxillary surgeon

Formal access to oral medicine specialist

RNs with appropriate post graduate qualifications and/or experience in peri-operative and post-operative nursing

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 - 5 4 4

Service Description

A Level 6 service provides services at Level 5 plus this service manages the most complex and highly specialised oral health problems with the highest level of risk in specified areas of sub-specialty expertise. Level 6 Oral Health Services is not currently provided in Tasmania and referred interstate.

Service Requirements

As for Level 5 plus:

Dedicated inpatient oral health ward

Workforce Requirements

As for Level 5 plus:

Full range of dental sub-specialists on-site; and on-call 24 hours

Allied health professionals available 24 hours, as required

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 4 5 5 5

Orthopaedics is the clinical specialty involving the treatment of diseases and abnormalities of the musculoskeletal system due to trauma, congenital developmental abnormalities, degenerative or disease processes.

Depending on the role level of service, this service may include general orthopaedics, trauma, joint replacement, orthotics and a range of other specialised components. Treatment ranges from non-surgical management to surgical management on an emergency, acute and elective basis. Higher level Orthopaedic Services rely on access and links to other appropriate specialists.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

May provide surgical procedures on children (refer to Paediatric Surgery Service Framework within this document).

No Level 1 service currently described.

Service Description

A Level 2 service provides minor reduction of fractures performed on low-risk patients by a registered medical practitioner, or a GP, or visiting general surgeon with experience in orthopaedics. Regional or general anaesthesia is given by accredited medical practitioner. An orthopaedic consultation service is also available.

Service Requirements

Treatment rooms with plaster equipment

Workforce Requirements

Registered medical practitioner or a GP

May have access to plaster technician

Access to advice from specialist orthopaedic specialists

May have access to allied health outpatient services as required including physiotherapist led musculoskeletal clinic with links to pain management service

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
3 - 2 3 3

Service Description

A Level 3 service provides services at Level 2 plus it performs common and intermediate day procedures on low or moderate risk patients by a visiting orthopaedic or general surgeon credentialed in orthopaedics. A Level 3 service does not provide overnight inpatient orthopaedic services.

Service Requirements

As for Level 2 plus:

General orthopaedic equipment and theatre x-ray available

Workforce Requirements

As for Level 2 plus:

Visiting orthopaedic surgeon

RNs with appropriate qualifications and/or experience; RNs may be supported by ENs in providing care to patients

Registered medical practitioner accredited to provide anaesthetic

Registered medical practitioner on-site 24 hours; and on-call within 30 minutes

Access to allied health services including physiotherapist

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
3 - 3 4 3

Service Description

A Level 4 service provides services at Level 3 plus it performs common and intermediate procedures on low or moderate risk patients by an orthopaedic surgeon.

Service Requirements

As for Level 3 plus:

Access to Level 4 Rehabilitation Service

Dedicated orthopaedic inpatient beds

Accredited orthopaedics surgical training site

Workforce Requirements

As for Level 3 plus:

Appointed orthopaedic specialists on-site

Appointed specialist anaesthetists on-site; and on-call 24 hours

RNs with appropriate orthopaedic post graduate qualifications and/or experience

Designated orthopaedic allied health services for inpatients at a Level 3 Orthopaedics Service or above

Provision of musculoskeletal outpatients at a Level 2 Orthopaedics Service or above

Specialist allied health outpatient services for pre-surgical and post-surgical follow up

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 4 4 4

Service Description

A Level 5 service provides services at Level 4 plus it provides a full range of major diagnostic and treatment procedures on low, moderate and high risk patients performed by orthopaedic surgeons.

Service Requirements

As for Level 4 plus:

On-site ICU

May have research role

Workforce Requirements

As for Level 4 plus:

Orthopaedic surgeons on-site; and on-call 24 hours

Radiologist on-call 24 hours

Specialist intensive care physician on-site 24 hours

On-site infectious diseases physician

CNC providing leadership in orthopaedic care

Access to specialised allied health services Level 3 service and above for inpatients, as required

Access to a greater range of pre and post-surgical allied health programs available for outpatients

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 4 5 4 4

Service Description

A Level 6 service provides services at Level 5 plus it has the ability to deal with all cases including full range of complex cases (and all emergencies) in association with other specialists.

Service Requirements

As for Level 5 plus:

Statewide referral role

Research role

Links/access to comprehensive acute and persisting pain management and rheumatology services

Use of consultant led but allied heath delivered comprehensive clinical assessment and triage systems for degenerative musculoskeletal and soft tissue conditions

Link to Level 5 Rehabilitation Service

Workforce Requirements

As for Level 5 plus:

Dedicated surgical staff with clinical competency in a range of sub-specialty areas available at close proximity 24 hours

Allied health professionals available for weekend/after-hours service for inpatients, as required

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
6 5 5 5 5

Paediatrics is a medical specialty that manages medical conditions affecting babies, children and young people.

The scope of this Framework describes each level of paediatric medicine service, its requirements and the minimum staffing needs and clinical support services required within each level.

Service Description

A Level 1 service has no planned inpatient medical service or designated inpatient beds.

A Level 1 service provides outpatient care and stabilisation for children, including first line management of paediatric emergencies by registered medical practitioners or GPs prior to moving to appropriate higher level Paediatric Medicine service.

Service Requirements

Services delivered in an accredited health care facility

Access to advice and ability to refer to higher level Paediatric Medicine services

Formal link to community child and family health service

Access to paediatric emergency training including resuscitation

Workforce Requirements

Registered medical practitioner or GP

Formal consultative links with paediatrician

Service Description

A Level 2 service has a designated inpatient area where care can be provided to paediatric patients with minor medical conditions.

Service Requirements

As for Level 1

Workforce Requirements

As for Level 1, plus:

Registered medical practitioner or GP available on-call 24 hours

RNs with appropriate post graduate qualifications and/or experience in paediatric nursing

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 2 3 2

Service Description

A Level 3 service provides specialist care for paediatric patients, within a designated paediatric inpatient area. A Level 3 services has formal linkages with higher level Paediatric Medicine services.

Service Requirements

As for Level 2 plus:

Designated paediatric ward/area where children and adolescents are physically separated from adult patients

Isolation capacity in separate rooms

Access to audiology services

Access to allied health services for children including physiotherapy, occupational therapy, speech pathology, dietetics, mental health and social work

Access to appropriate Level 6 sub-specialty outreach services allowing for Continuing Professional Development (CPD) for staff

Access to paediatric specific education and training for all staff

Workforce Requirements

As for Level 2 plus:

Specialist paediatricians on-site and on-call 24 hours

Specialist paediatric registrars and RMOs on-site

Access to allied health professionals with paediatric knowledge/experience

Educator and diversional therapy staff for patients

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 - 4 4 5

Service Description

A Level 4 service provides an integrated hospital paediatric unit able to deliver care for paediatric patients with higher levels of clinical complexity that can be delivered by Level 3 services. A Level 4 service has formal linkages with Level 5 and 6 services.

Service Requirements

As for Level 3 plus:

Provides child protection assessments and referral as necessary

Workforce Requirements

As for Level 3 plus:

CNC specialising in and providing leadership in paediatric care

Designated specialist paediatric allied health professionals available on-site

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 5 5 5 5

Service Description

As Level 4, plus a dedicated Paediatric Inpatient Unit with medical, surgical, intensive care and neonatology sub-specialty services. Also has formal linkages with a Level 6 service.

Service Requirements

As for Level 4 plus:

On-site paediatric ICU and neonatal ICU

On-site paediatric mental health services

Provides some statewide services

Provides 24 hour Child Protection Services with consultant paediatrician and social worker

Active research program

Access to designated Adolescent Unit so adolescents and small children are cared for in separate spaces

On-site school facility

Workforce Requirements

As for Level 4 plus:

On-site paediatric surgeons and specialist paediatric anaesthetist

On-call paediatric surgical and ICU specialists available 24 hours Paediatric surgical, anaesthetics, intensive care, neonatology and mental health medical sub-specialists

Specialist pharmacist

Allied health professionals on-staff with specialist paediatric skills, including recreational staff and education professionals

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
6 6 6 6 6

Service Description

As for Level 5 service, plus most paediatric medical and surgical sub-specialities are available.

Service Requirements

As for Level 5 plus:

Full suite of clinical and diagnostic sub-specialty services provided by appropriately trained sub-specialty providers

Sub-specialty consultants available on-site and on-call 24 hours

Designated sub-specialty registrars

School service for inpatients provided by Department of Education

Has sub-specialist paediatric research and teaching role

Workforce Requirements

As for Level 5 plus:

Sub-specialist paediatricians in all clinical sub-specialties

Sub-specialty paediatric registrars and RMOs

CNCs specialising in sub-specialty paediatric care and providing leadership within the service

Allied health professionals on staff with sub-specialist paediatric skills

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
6 6 6 6 6

Paediatric surgery is a surgical specialty that manages medical conditions affecting babies, children and young people.

The scope of this Framework describes each level of paediatric surgery, its requirements and the minimum staffing needs and clinical support services required within each level.

In addition this Framework covers Anaesthesia and sedation of infants and small children who require this for diagnostic procedures and other simple non-surgical interventions, mandating post-procedural care with similar staffing and clinical support needs to the post-surgery child.

Where facilities provide surgical or anaesthetic services for term infants (less-than 1 year) and ex-premature infants (less-than 52 weeks post conceptual age), registered medical specialists providing anaesthesia or surgery must have appropriate credentials.

Service Description

A Level 1 service provides primary and emergency outpatient care prior to transfer only. No inpatient services available.

Service Requirements

Services delivered in an accredited health care facility

Access to more specialised paediatric surgical care at a higher level Paediatric Surgery Service

Requires formal referral pathway for surgical patients

Workforce Requirements

Registered medical practitioner delivering services

Formal consultative links with paediatrician

Formal consultative links with paediatric surgeons from higher level service available 24 hours

Service Description

A Level 2 service provides services at Level 1 plus manages low-risk (ASA8 1-2) paediatric patients undergoing SCI procedures (refer to General Surgery Framework).

A Level 2 service can be performed in an ambulatory, day surgery or emergency room setting. There are no planned inpatient paediatric surgical services available.

Service Requirements

As for level 1, plus:

At least one procedure room

Isolation capacity

Workforce Requirements

As for level 1, plus:

Registered medical practitioner delivering services

Registered medical practitioner available 24 hours with demonstrated competency in the application of paediatrics anaesthetics

RNs with appropriate postgraduate qualifications and/or experience in paediatric nursing; RNs may be supported by ENs in providing care to patients

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
3 3 3 3 3

Service Description

A Level 3 service provides services at Level 2 plus performs surgery on low anaesthetic risk (ASA 1-2) paediatric patients undergoing SC11 and SC111 procedures, as well as anaesthesia for simple non-surgical procedures.

This level of service provides inpatient and outpatient care by a paediatrician.

Service Requirements

As for Level 2 plus:

Appropriate surgical, anaesthetic and resuscitation equipment available

Access to operating surgeon until patient has recovered from anaesthesia and meets the post-anaesthetic care service discharge criteria, as per facility guidelines and Australian and New Zealand College of Anaesthetics (ANZCA)

Access to emergency services 24 hours

Perioperative services available

Continuing nursing educational programs available specific to the needs of the service

Designated children’s ward with parent amenities

Facility to isolate in single room

Operating suite and recovery room provide for the special needs of children and carers

Amenities for parents or carers

Workforce Requirements

As for Level 2 plus:

Operating surgeons credentialed in paediatrics with the approved clinical scope of practice

Anaesthetists credentialed in paediatrics, with the approved clinical scope of practice

Paediatrician on-site during business hours and available 24 hours

Paediatrics registrar available 24 hours

Registered medical practitioner on-site 24 hours

Access to specialist paediatric allied health professionals

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 4 4 4

Service Description

A Level 4 services provides services at a Level 3 plus performs surgery on:

high anaesthetic risk (ASA ≥4) paediatric patients undergoing SC1 procedures,

medium anaesthetic risk (ASA 3) paediatric patients undergoing SC11 procedures; and

low to medium anaesthetic risk (ASA 1-3) paediatric patients undergoing SC111.

Emergency procedures are performed where operators are competent, and appropriately credentialed with the approved clinical scope of practice.

Service Requirements

As for Level 3 plus:

On-site paediatric services able to stabilise emergency paediatric surgical patients, that are outside its capacity to manage prior to transfer to higher level service

Where facilities provide surgical services for term infants and well, ex-premature infants (>52 weeks post conceptual age), registered medical specialists providing anaesthesia or surgery must have recognised training, currency of practice and credentials in paediatrics

Be capable of providing extended apnoea monitoring

Workforce Requirements

As for Level 3 plus:

Access to staff competent in providing paediatric life support

Specialist paediatric allied health professionals on-site

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 5 5 5 5

Service Description

A Level 5 service provides services at a Level 4 plus performs all diagnostic and treatment procedures on ASA categories 1 to 5 in children excluding complex major paediatric surgery on rare cases.

A Level 5 services has a specialised paediatric inpatient unit with nominated Director of Paediatric Surgery.

Service Requirements

As for Level 4 plus:

Designated paediatric surgical ward area

Specialist paediatric surgeons and specialist anaesthetists (paediatric) available 24 hours

Provides some statewide services

On-site specialist neonatal and paediatric ICU services

Postgraduate paediatric surgical teaching and research role

Workforce Requirements

As for Level 4 plus:

Statewide Director of Paediatric Surgery

Paediatric surgeons on-site and on-call 24 hours

Specialist anaesthetists (paediatric) on-site and on-call 24 hours

Specialist neonatologists on-site

Paediatric intensive care specialists on-site

Paediatric surgical registrar during business hours. After-hours on-call paediatric surgical specialist reported to by the on-call general surgical registrar

RNs with appropriate post graduate qualifications and/or extensive experience in paediatric nursing

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
6 6 6 6 6

Service Description

A Level 6 services provides services at a Level 5 plus has sub-specialty units in most areas of Paediatric Surgery (e.g. may have paediatric neurosurgery, cardiac surgery).

Service Requirements

As for Level 5 plus:

Designated sub-specialty paediatric surgical wards with parent amenities

Paediatric surgeons on-site 24 hours

General paediatricians on-site 24 hours

Sub-specialty paediatric surgeons on-call 24 hours, seven days a week

Specialist anaesthetists (paediatric) on-site 24 hours

Designated paediatric surgical sub-specialty registrars in sub-specialty units

Active program of paediatric surgical sub-specialty teaching, research and development

Workforce Requirements

As for Level 5 plus:

Sub-specialty paediatric surgeons

Paediatric surgical sub-specialty registrars

Paediatric surgical sub-specialty nurses

Sub-specialist allied health services

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
6 6 6 6 6

Palliative care services refer to a group of services that cover the continuum of care required for all people who are experiencing a life limiting illness with little or no prospect of a cure. Services also extend to the patient's family, friends and their carers and are provided in acute hospital, sub-acute and community settings.

The scope of this Framework recognises that:

Patients with life-limiting illnesses require different levels of involvement from the Department of Health and Human Services Palliative Care Service (Palliative Care Service) based on their needs and the primary care provider’s capability and capacity to meet those needs;

Many patients receive primary palliative care without having any contact with the Palliative Care Service (Level 1) and makes a clear distinction between the consultation-liaison (Level 2), shared care (Level 3) and services provided directly by the Palliative Care Service (Level 4); and

The Palliative Care Service supports palliative care service provision across all four levels.

Service Description

A Level 1 service provides culturally appropriate palliative care for the patient, carer and family in accordance with the National Standards for Palliative Care by a primary care provider. This includes patients, carer and family being informed and involved in decision making. The primary care provider is the designated Coordinator of Care.

A Level 1 service can consult with a higher level Palliative Care service if information is needed or refer the patient for assessment if the patient needs exceed the primary care provider’s capability and/or capacity.

Service Requirements

Assess patient needs

Pain and symptom control

Provides social, spiritual and emotional support to patients and their carers and family

Patient risk assessments

Agreed care plans

Provides after-hours support

Co-ordination of patient, carer and family needs

Offers bereavement support

Service Description

A Level 2 service coordinates and manages all the patient’s needs using a palliative care approach by a primary care provider but with consultation and liaison from a higher level Palliative Care service.

A Level 2 service can consult with a higher level Palliative Care service if information is needed or re-refer the patient for further assessment if the patient needs exceed the primary care provider’s capability and/or resources.

Service Requirements

As for level1 plus care is provided in accordance with the National Standards for Palliative Care.

Service Description

A Level 3 service provides multidisciplinary services to patients with complex and unstable conditions to receive ongoing high level care. Level 3 patients have been admitted to the Palliative Care Service. Care of patients is shared between the primary care provider and the Palliative Care Service.

A Level 3 service negotiates and formalises arrangements to meet the patient’s needs with the primary care provider, patient, carer and family. The designated co-coordinator of care (lead agency) may be a palliative care physician.

Service Requirements

Patient assessment and care coordination and management shared between the Palliative Care Service and the primary care provider

24 hours, seven days a week support and advice to the patient, carer and primary care provider

Provide episodic assessment, care planning and/or advice to lower level services (primary care providers)

Provide after-hours services

Regular reviews of the plan of care with the primary care provider, patient, carer and family as required

Access to bereavement support

Provide training and professional development for lower level services (primary care providers) through the provision of resources and information

Access to some allied health services and social worker for psycho-emotional, social and spiritual problems

Workforce Requirements

Access to a palliative medicine specialist

24 hour cover by RNs with appropriate post graduate qualifications and/or experience in palliative care nursing; RNs may be supported by ENs in providing care to inpatients

CNC specialising in palliative care and providing leadership across the service

May have NP

Social worker with palliative care expertise

Service Description

A Level 4 service is provided predominantly by the multidisciplinary Palliative Care Service to patients with complex and unstable conditions to receive ongoing high level care.

A Level 4 service negotiates and formalises arrangements to meet the patient’s needs with the primary care provider, patient, carer and family and assumes primary responsibility for patient management, usually in its dedicated inpatient specialist palliative care unit.

Service Requirements

As for Level 3 plus:

24 hour clinical management by the specialist palliative care team

Team consists of allied health members with specialised palliative care experience and knowledge

Research and development

Workforce Requirements

As for Level 3

Pain management specialists are experts in the diagnosis of causes of pain and in the management of pain. Anaesthetists, rheumatologist, neurologists and sub-specialist surgeons may specialise in pain management. Specialist pain services are comprised of multidisciplinary teams of medical practitioners, specialist nurses, allied health professionals, and psychologists.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

No Level 1 service currently described.

No Level 2 service currently described.

A Level 3 service provides appropriate referral of patients by a registered medical practitioner or GP and outpatient management by designated nursing, psychology and allied health services, for patients who have been assessed by a higher-level Persistent Pain Medicine Service.

A Level 3 service may participate in multidisciplinary meetings regarding patient management.

Under a Level 3 service, management of treatment is supervised by a health professional team with persistent pain medicine experience/training.

Service Description

A Level 4 service provides ambulatory persistent pain medicine services by a multidisciplinary team led by a specialist medical practitioner with sub-specialty training in pain medicine. No inpatient pain medicine services are provided.

A Level 4 service has strong network linkages with a higher level Persistent Pain Medicine Service.

Service Requirements

Formal network linkage with Level 6 Persistent Pain Medicine service for the referral of patients with pain management conditions (as specified in designated statewide musculoskeletal clinical pathways)

Access to visiting pain management specialist

Access to Level 6 interdisciplinary persistent pain medicine team

On-site medically supervised ambulatory service, with therapies determined in consultation with Level 6 Persistent Pain Medicine Service

Workforce Requirements

Visiting registered medical practitioner with sub-specialty training in pain medicine

Designated allied health professional team on-site, supported by visiting specialist team

On-site care co-ordinator

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
3 - 3 3 3

Service Description

A Level 5 service provides services at Level 4 plus may provide procedural pain management services.

Service Requirements

As for Level 4 plus:

Pain management services provided by designated multidisciplinary team with formal network linkage to Level 6 Persistent Pain Medicine Service

Access to interventional radiology in the network

Access to neurosurgery and spinal orthopaedics in the network

May have research role

Workforce Requirements

As for Level 4 plus:

Designated pain management multidisciplinary team including pain medicine consultant

Access to pain medicine CNCs

Medical registrar on-call 24 hours

Sub-specialists available on-site for consultation

Specialised allied health services on-site

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 4 4 4

Service Description

A Level 6 service provides services at Level 5 plus a full range of pain medicine services including clinical supervision, education and prevention activities.

A Level 6 service provides Persistent Pain Medicine inpatient services.

Service Requirements

As for Level 5 plus:

Statewide referral role

On-site interdisciplinary pain management service (with a minimum of pain medicine, rheumatology, anaesthetics, specialist physiotherapy and psychology expertise)

On-site neurosurgery and spinal orthopaedics

On-site interventional radiology and day case procedure facilities

Accredited pain medicine training programs

Research role

Workforce Requirements

As for Level 5 plus:

On-site pain medicine registrar

Medical registrar on-site 24 hours

Specialist pain medicine CNC

Specialised psychology services

Physiotherapists with advanced scope of persistent pain practice

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 4 5 5 5

Plastic and reconstructive surgery refers to the surgical discipline that delivers services to repair, remodel and / or restore body parts.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

No Level 1 service currently described.

No Level 2 service currently described.

Service Description

A Level 3 service provides minor plastic and reconstructive surgery outpatients and same day procedures by a visiting plastic surgeon.

Service Requirements

At least one operating/procedure room with separate recovery area/room for post-operative care

On-site registered medical practitioner credentialed to administer anaesthetic

Medical, anaesthetic and nursing pre-admission services

IV (intravenous) fluid therapy available

Workforce Requirements

Visiting specialist plastic surgeon

Registered medical practitioner credentialed to administer anaesthetic

Perioperative trained RNs

24 hours access to a registered medical practitioner (off-site or on-call)

Access to allied health services, as required

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
3 - 3 4 3

Service Description

A Level 4 service provides selected procedures on low and moderate risk patients by visiting plastic surgeons.

Service Requirements

As for Level 3 plus:

Designated acute surgical inpatient unit with appropriately trained surgical specialist nursing staff

Workforce Requirements

As for Level 3 plus:

Visiting plastic surgeon

General surgeon on-call 24 hours

Surgical registrar on-call 24 hours

Specialist anaesthetists on-site, and on-call 24 hours

Anaesthetics registrar on-call 24 hours

RNs with appropriate post graduate qualifications and/or post-operative experience in plastics and reconstructive care

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 - 4 4 4

Service Description

A Level 5 service provides services at Level 4 plus a full range of major diagnostic services and surgery on low, moderate and high risk patients by specialist plastic surgeons.

Service Requirements

As for Level 4 plus:

On-site ICU

Links to Level 5 Rehabilitation Services

Workforce Requirements

As for Level 4 plus:

Appointed plastic surgeon on-site; and on-call 24 hours

Plastic surgery registrar

Access to CNC providing leadership in plastics and reconstructive care

Specialist allied health staff, including physiotherapy, occupational therapy and psychology

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 5 5 5 5

Service Description

A Level 6 service provides all forms of plastic and reconstructive surgery and offers a full range of microsurgery techniques, hand surgery, cleft and craniofacial surgery, brachial plexus and peripheral nerve surgery.

Service Requirements

As for Level 5 plus:

Dedicated plastic surgery ward

Post-operative rehabilitation and comprehensive scar management services

Workforce Requirements

As for Level 5 plus:

Plastic surgery registrar on-site 24 hours

Sub-specialist hand surgeon available 24 hours

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
6 6 6 6 6

Rehabilitation Services provides care that is goal-directed, time limited, and multidisciplinary that aims to:

Restore functional ability for a person who has experienced illness or injury

Enable regaining function and self-sufficiency to the level prior to that illness or injury within the constraints of the medical prognosis for improvement

Develop function ability to compensate for deficits that cannot be medically reversed

Services provided in this category range from ambulatory services or those delivered in a community setting, to inpatient Rehabilitation Services with access to dedicated multidisciplinary teams for those with complex care needs.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

No Level 1 service currently described.

Service Description

A Level 2 service provides ambulatory care to via outreach from higher level Rehabilitation services. Care may be provided in home or community settings and/or in healthcare facilities, generally delivered by nursing and/or allied health led services with oversight from higher level Rehabilitation services.

Service Requirements

Care coordination with multidisciplinary team input using documented rehabilitation care and treatment plan

Individualised self-managed therapy and treatment programs

Access to higher level Rehabilitation service in the network including the consultation and co-ordination of rehabilitation services based in the community

Access to appropriate rehabilitation equipment, as required

Workforce Requirements

24 hours access to a registered medical practitioner, or a GP

24 hours access to RN

Access to allied health professionals, including physiotherapist, occupational therapist, speech pathologist, dietitian, psychologist, and social worker

Access to Allied Health or Rehabilitation Assistant

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 1 2 2

Service Description

A Level 3 service provides services at Level 2 plus it provides ambulatory care to clients whose rehabilitation needs are not highly complex.

Ambulatory care will include outpatient clinics for ongoing treatment or review; which may be provided by a visiting medical specialist from a higher level Rehabilitation service or via telehealth.

Service Requirements

As for Level 2 plus:

May have designated therapy areas and equipment

Multidisciplinary team with access to medical, nursing and allied health staff provided as outreach by higher level Rehabilitation service to co-ordinate

Access to clinical support services and post-hospital services to facilitate ongoing community management

Established referral pathway between acute, sub-acute, and community rehabilitation services

Workforce Requirements

As for Level 2 plus:

Access to consultant physician with knowledge and skills in rehabilitation from a higher level Rehabilitation service via telehealth

On-site RNs with experience in rehabilitation nursing

On-site allied health professionals with experience in rehabilitation

On-site allied health assistants or rehabilitation assistants to support rehabilitation management programs

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 2 3 3

Service Description

A Level 4 service provides services at Level 3 plus it provides rehabilitation assessment and management of a full range of programs across all settings (admitted, outpatient, community and home).

Service Requirements

As for Level 3 plus:

Designated rehabilitation unit

Access to manufacture of specialist aids and equipment

Dedicated multidisciplinary team involvement and case management approach that provides in-reach across the acute, sub-acute and community health settings

Co-ordinated ambulatory services for ongoing management of patients

Workforce Requirements

As for Level 3 plus:

Access to rehabilitation physician from higher level Rehabilitation service

Visiting specialist consultant rehabilitation physician

On-site CNC and / or NP providing leadership in rehabilitation

On-site psychology, occupational therapy, physiotherapy, dietetics, speech pathology orthotics and prosthetics

Access to additional specialty services (i.e. neuropsychology)

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
3 - 3 4 3

Service Description

A Level 5 service provides services at Level 4 plus it focuses on patients for targeted rehabilitation programs.

Service Requirements

As for Level 4 plus:

Dedicated multidisciplinary team led by a rehabilitation physician and comprising specialists with extensive experience in all disciplines (medical, allied health, nursing) that are involved in leadership, liaison, research and support for other lower level Rehabilitation Services

Accredited training site for Australasian Faculty of Rehabilitation Medicine trainees

Additional infrastructure and equipment commensurate with rehabilitation needs of most complex patients, which may include hydrotherapy

Workforce Requirements

As for Level 4 plus:

Consultant rehabilitation physician

Rehabilitation registrar

Geriatrician

Neuropsychologists

CNC

Access to paediatric rehabilitation specialists

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 5 5 5 5

Service Description

A Level 6 service provides services at Level 5 plus it provides services for clients with care needs of the highest complexity, including those with traumatic brain injury, brachial plexus injury, spinal cord injury, multiple fractures, complex multi-trauma and limb amputation care needs.

Service Requirements

As for Level 5 plus:

A range of diagnostic services relating to the individual specialty available on-site

Networked with hydrotherapy and work conditioning programs

Designated daily living and therapy areas for activities of daily living and group programs

Specialist consultancy services, and specialty outreach services provided

Access to a pool of specialty equipment pertaining to specialty areas

Has a step down unit

Has a teaching role

Has a research role

Workforce Requirements

As for Level 5 plus:

Sub-specialty rehabilitation physicians, including brain injury, spinal cord injury and amputee management

An extensive range of allied health professionals available on-site, with demonstrated specialist level knowledge and skills pertaining to casemix

On-site physiotherapist available 7 days a week during business hours

Access to a social worker, 7 days a week during business hours

A rehabilitation engineer

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
6 6 6 6 6

Respiratory and Sleep Medicine is the branch of medicine that diagnoses and manages diseases of the respiratory system. The service can be delivered by respiratory specialists at larger hospitals, performing emergency care and diagnostic tests through to registered medical practitioner or GPs providing outpatient services in smaller facilities.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

No Level 1 service currently described.

Service Description

A Level 2 service provides inpatient management of low-acuity respiratory conditions, under the management of a registered medical practitioner.

Service Requirements

Basic patient monitoring including oximetry

Provides on-site oxygen therapy

May have access to allied health services

Management and appropriate referral to a higher level Respiratory and Sleep Medicine service, including network access to specialist support

Workforce Requirements

Access to a registered medical practitioner or a GP

On-site RN; RNs may be supported by ENs in providing care

May have access to respiratory nurses and physiotherapists

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - - 2 2

Service Description

A Level 3 service provides services at Level 2 but in addition provides ambulatory respiratory care. Patients requiring admission for dedicated inpatient respiratory care should be transferred to a higher level Respiratory and Sleep Medicine Service.

Service Requirements

As for Level 2 plus:

If outpatient respiratory specialist services are provided, there is a need for basic lung function testing with spirometry

Workforce Requirements

As for Level 2 plus:

Access to a visiting physician practicing in general medicine

24 hour access to a RN

Access to allied health services, as required

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 1 3 3

Service Description

A Level 4 service provides services at Level 3 plus it provides care by a resident physician practicing in general medicine and / or specialist respiratory physician. Outpatient consultation is provided by respiratory physicians.

Service Requirements

As for Level 3 plus:

Access to a basic lung function laboratory (spirometry, volumes and gas transfer)

Link with sleep service

Designated allied health services

Workforce Requirements

As for Level 3 plus:

Physician practicing in general medicine on-site and on-call 24 hours

Access to a respiratory physician via telehealth

Access to RNs with appropriate post graduate qualifications and/or extensive experience in respiratory nursi

Access to designated allied health services

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 4 4 4

Service Description

A Level 5 service provides services at Level 4 plus it provides inpatient care by a resident respiratory physician.

Service Requirements

As for Level 4 plus:

Strongly linked with Level 6 respiratory services

Category 3 or above respiratory function unit on-site and a bronchoscopy suite

Ward based non-invasive ventilatory capability

Access to specialist cardiology and cardiothoracic surgery services on-site or within the network

Provision of specialist pulmonary rehabilitation services

Accredited respiratory advanced training program

Strongly linked with a sleep service

Access to specialised allied health services

Workforce Requirements

As for Level 4 plus:

On-site respiratory physician

Respiratory physician on-call 24 hours

Accredited respiratory medicine registrar

Medical registrar on-site 24 hours

CNC specialising in respiratory nursing and providing leadership for the service

Access to specialised allied health services

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 5 5 5 5

Service Description

A Level 6 service provides services at Level 5 plus it provides a complete range of diagnostic services, a full range of respiratory services, with a respiratory department and provision of emergency care. This service plans and delivers statewide services and develops statewide protocols for management of respiratory conditions.

The following procedures are not currently performed in Tasmania and are sent interstate:

Bronchial thermoplasty

Endobronchial lung volume reduction techniques

Service Requirements

As for Level 5 plus:

Category 4 Respiratory function unit on-site

Provides full diagnostic procedures

Provides advanced bronchoscopy

Integrated public sleep service with laboratory on-site

Specialised medical ward with non-invasive ventilation (NIV) capability/area

On-site Cardiothoracic Surgery and PET scanning

Statewide and interstate referral role

Active research role

Workforce Requirements

As for Level 5 plus:

On-call respiratory medicine specialist

Accredited respiratory medicine registrar(s)

Advanced bronchoscopy provider(s)

CNC position that complements RNs with specialist skills e.g. Lung cancer, Tuberculosis

Specialist Respiratory Physiotherapist

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
6 6 6 6 5

Rheumatology is a sub-specialty in internal medicine that diagnoses and manages non-surgical joint, muscle and bone conditions, and other rheumatic diseases.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

No Level 1 service currently described.

A Level 2 service provides outpatient management and appropriate referral of patients by a registered medical practitioner or a GP for patients who are under the care of a Level 5 or Level 6 Rheumatology service.

A Level 2 service has links with community nursing and allied health services.

A Level 3 service provides outpatient management and appropriate referral of patients by a physician practicing in general medicine or equivalent, and nurse-led ambulatory rheumatology services, for patients who are under the care of a Level 5 or Level 6 Rheumatology service.

A Level 3 service may participate in multi-disciplinary meetings with higher-level services regarding patient management and has links with community nursing and allied health services.

Service Description

A Level 4 service, in consultation with a visiting rheumatologist from a higher-level service, provides on-site ambulatory rheumatology services.

The visiting rheumatologist from higher-level service is responsible for clinical decisions regarding treatment and co-ordinating care.

A level 4 service is responsible for referring patients to a visiting rheumatologist from a higher level Rheumatology Service for diagnosis, assessment and management of their condition.

Service Requirements

As for Level 3 plus:

Designated ambulatory day beds with capacity to provide day case therapies in consultation with a higher level Rheumatology Service, under medical supervision by an on-site physician practicing in general medicine

Access to visiting rheumatologist for outpatient care (including via telehealth)

Formal network linkage with higher level Rheumatology Service for the referral of patients with rheumatological conditions (as specified in designated statewide musculoskeletal clinical pathways)

Access to allied health services within the network

Workforce Requirements

As for Level 3 plus:

Registered medical practitioner or a GP on site 24 hours

Access to visiting specialist rheumatologist (including via telehealth)

24 hour access to physician practicing in general medicine (on-call)

Qualified and/or experienced RNs in the administration of biological and other therapies

Access to designated allied health professional and psychological services

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 4 4 4

Service Description

A Level 5 service provides services at Level 4 plus may provide some inpatient rheumatology services. This service has access to rheumatology multidisciplinary teams.

Service Requirements

As for Level 4 plus:

Ambulatory and inpatient rheumatological care provided by appointed rheumatologist

Access to multidisciplinary team including specialised allied health services, including pharmacy

Formal network linkage to Level 6 Rheumatology Service

Access to infectious diseases service

Access to on-site orthopaedic service

Access to PET scanning and interventional radiology in the network

Access to neurosurgery, spinal orthopaedics, vascular surgical services and pain management service in the network

May have research role

Access to rheumatology clinical trials in the network

Workforce Requirements

As for Level 4 plus:

Appointed rheumatology specialist

Access to specialist rheumatology CNCs

Medical registrar on-site and physician practicing in general medicine on-call 24 hours

Sub-specialists available on-site for consultation

Access to designated specialised allied health services

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 5 4 5

Service Description

A Level 6 service provides services at Level 5 plus a full range of clinical rheumatology services with 24 hour clinical and laboratory services available on-call.

Service Requirements

As for Level 5 plus:

Rheumatology department with statewide referral role

Provision of inpatient and ambulatory services

Specialist rheumatology advice and support available 24 hours

On-site pain management, infectious diseases, nephrology, and respiratory services

On-site neurosurgery and spinal orthopaedics

On-site PET scanning and interventional radiology

On-site vascular surgical service

Accredited rheumatology training programs

Active participation in clinical trials and research

Workforce Requirements

As for Level 5 plus:

On-site rheumatology registrar

May have rheumatologist on-call 24 hours

Specialist rheumatology RNs

Specialist allied health services on-site

Designated physiotherapists with advanced scope of musculoskeletal practice on-site

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 5 5 5 5

Sexual Assault Services provide medical care to children and adults who have experienced a recent sexual assault (within the preceding 7 days).

The service offers forensic medical examinations (FME) to victims of recent sexual assault. FMEs are conducted principally to aid the investigation of a criminal/legal matter through the collection of biological and other materials. It also allows initial treatment for injuries and provides a plan for ongoing medical care for victim to address the risks of pregnancy or sexually transmitted infections.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

No Level 1 service currently described.

No Level 2 service currently described.

A Level 3 service provides an integrated assessment and management of children, young people and/or adults prior to referral to higher level sexual assault service, so as to preserve forensic evidence and provide psychosocial crisis response.

It will have formal network linkages with a higher level sexual assault service, including agreed protocols, referral processes, clinical advice and support (may include telehealth).

Service Description

A Level 4 service undertakes FMEs on adults who have experienced a recent sexual assault (within the preceding 7 days). It does not perform acute FMEs on children. A Level 4 service also facilitates access to initial and follow-up medical care and counselling services.

Service Requirements

Has qualified Forensic Examiner/s on-call

Designated area for sexual assault care and examination separate to emergency department care but within the hospital setting

No after-hours sexual assault medical service

Able to assist with transport to a higher level Sexual Assault Service

Formal links with a 24 hours crisis counselling service

Access to medical care

Training and adherence to Child, Young Persons and Their families Act 1997; Family Violence Act 2004; and collaborative Interagency Agreements in all regions for Victims of Recent Sexual Assault

Workforce Requirements

Qualified Forensic Nurse/Midwife Examiner

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - - 3 3

Service Description

A Level 5 service undertakes FMEs on children and adults who have experienced a recent sexual assault (within the preceding 7 days).

A Level 5 service also facilitates access to initial and follow up medical care and counselling services.

Service Requirements

As for Level 4 plus:

Has qualified Forensic Medical Examiner and/or Forensic Nurse/Midwife Examiner

Designated area for sexual assault care and examination separate to emergency department but within the hospital setting

Access to a Level 3 Emergency Medicine Service

Access to specialist care including mental health, surgery, gynaecology, and alcohol and drug services

Colposcopy for children available

Program of community education and professional training

Workforce Requirements

As for Level 4 plus:

Qualified Forensic Medical Examiner or Forensic Nurse/Midwife Examiner

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - - 4 4

Service Description

A Level 6 service provides a statewide service and accepts referrals from a Level 5 service.

Service Requirements

As for Level 5 plus:

Statewide referral role

Has a designated coordinator

Statewide Clinical Director to provide specialist advice

Research role

Provide extensive community education and professional training program

Workforce Requirements

As for Level 5 plus:

Designated coordinator (can be a nurse or a midwife)

Statewide Clinical Director

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - - 4 4

Trauma services provide initial assessment, stabilisation and management of patients presenting with trauma.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

No Level 1 service currently described.

No Level 2 service currently described.

Service Description

A Level 3 service provides care for minor trauma only, and an initial trauma response including reception, assessment, resuscitation and stabilisation for major trauma and who require emergency transfer to a higher level Trauma Service in accordance with statewide major trauma bypass procedures.

Service Requirements

Primary response for trauma cases that do not activate statewide major trauma bypass criteria

Stabilisation prior to retrieval by road, fixed wing or rotary wing retrieval service

Helicopter landing site

Initial disaster response in a mass casualty event where it is the nearest emergency health service

May have access to emergency blood stock (e.g. O negative units) if supported by a higher level blood service

Contributes data to state trauma registry

Workforce Requirements

Registered medical practitioner or a GP with postgraduate training in emergency management in attendance within 30 minutes

On-site RN available 24 hours

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
- - 2 3 2

Service Description

A Level 4 service provides services at Level 3 (i.e. primary response for trauma cases that do not activate statewide major trauma bypass criteria) plus the options for:

limited emergency surgical resuscitation and bleeding control of exsanguinating major trauma; and

limited local holding for stable major trauma cases for up to 24 hours in ICU.

Paediatric and obstetric major trauma may have primary trauma care, and management of immediately life threatening conditions only, prior to transfer to a Level 6 Trauma Service.

A Level 4 service is able to receive patients from a Level 3 service where transfer to a Level 5 or 6 Trauma Service is not feasible or not warranted.

Service Requirements

As for Level 3 plus:

On-site emergency and surgical management of non-major trauma

Operating suites with 24 hour availability

Prompt assessment, resuscitation and stabilisation of seriously injured patients prior to transfer to higher level Trauma Service

Trauma reception capability based on trauma team response

Formal transfer arrangements in place with Level 5 and Level 6 Trauma Services

On-site emergency department with 24 hours

On-site Critical Care Service with limited holding capacity

Emergency blood stocks and limited blood product availability supported by a higher level blood service

Access to sub-speciality surgery services (e.g. neurosurgery and cardiothoracic) services within the network

Role in management, assessment and treatment of minor trauma in mass casualty disaster response

Workforce Requirements

As for Level 3 plus:

Consultant surgeon (Fellow of the Royal Australasian College of Surgeons (RACS)) available within 30 minutes

Consultant anaesthetist (Fellow of the Australian and New Zealand College of Anaesthetists) available within 30 minutes

Emergency medicine personnel available 24 hours

RNs with experience and/or post graduate qualifications in emergency nursing

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 4 4 4

Service Description

A Level 5 service is a major trauma service that may provide primary response for trauma cases that do not activate statewide major trauma bypass criteria. This service also provides comprehensive clinical care for major trauma patients whose care needs do not include neurosurgery (including spinal injuries), cardiothoracic surgery, paediatric trauma, obstetric trauma and any other services and interventions not provided by the Level 5 Trauma Service.

These cases may have primary trauma care and management of immediately life threatening conditions prior to transfer to the Level 6 Trauma Service.

A Level 5 service is able to receive patients from Level 3 or 4 Trauma Service where transfer to a Level 6 Trauma Service is not feasible or not warranted.

Service Requirements

As for Level 4 plus:

On-site surgical specialty and sub-speciality disciplines available 24 hours

Emergency department, operating theatres, adult ICU available 24 hours for trauma

Role in management of major trauma cases up to 72 hours according to State Incident Management directives and longer if directed during mass casualty disaster response mandating whole-of-state response

Access to transfusion service support in the network, including blood bank and specialist haematology

Medical imaging including MRI and limited interventional radiology services

Workforce Requirements

As for Level 4 plus:

Specialist general, orthopaedic, urology and plastic reconstructive surgeons available or on-call 24 hours

24 hour availability of consultant specialist anaesthetists in general capacity (Fellows of the Australian and New Zealand College of Anaesthetists), emergency medicine physicians (Fellow of the Australasian College for Emergency Medicine) and critical care medicine physicians (Fellowship of the CICM of Australia and New Zealand)

Director of Surgery (Fellow of the RACS) as Head of Trauma

RNs with appropriate post graduate qualifications and/or extensive experience across Trauma services such as Emergency Medicine and Intensive Care Services

24 hour availability of general surgery registrar, anaesthetic registrar, emergency department registrar, and ICU registrar

Speciality registrars on-call 24 hours

All surgical, anaesthetic, ICU and emergency department consultants on-call 24 hours

Critical care medicine specialist (Fellow of the CICM of Australia and New Zealand) available 24 hours

Access to specialist haematologist and transfusion medicine scientist in the network

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 5 5 5 5

Service Description

A Level 6 service is a major trauma service that provides a full spectrum of care for the most critically injured patients, from initial reception and resuscitation through to discharge and rehabilitation.

It is the principal hospital for all major trauma cases across the state, including capacity to receive of inter-hospital transfer of major trauma patients from all other levels of care.

Service Requirements

As for Level 5 plus:

On-site elective and emergency surgery and perioperative care for statewide surgical services: neurosurgery, cardiothoracic, vascular, oral and maxillofacial surgery

On-site statewide services for neonatal and paediatric intensive care, and high risk obstetrics

Interventional radiology services capable of intravascular intervention

State trauma outreach responsibilities, both in terms of consultation and advice, as well as capability for pre-hospital responses, transport and intra-hospital retrieval

Ability to raise and sustain a Medical Assistance Team for deployment to assist in the management of a mass casualty at short notice

Responsibility for coordination of interstate transfers

Trauma education: trauma curriculum including RACS: Emergency Management of Severe Trauma Course with access to immersive simulation training

Research role

Workforce Requirements

As for Level 5 plus:

24 hour availability of all senior consultant level surgical disciplines

24 hour availability of senior consultant specialist anaesthetists with both general and subspecialty capacity (Fellows of the Australian and New Zealand College of Anaesthetists), emergency medicine physicians (Fellow of the Australasian College for Emergency Medicine) and critical care medicine physicians(Fellowship of the CICM of Australia and New Zealand)

24 hour availability of neonatologists, paediatric intensive care specialists, and obstetricians

Statewide major trauma service: appointed Director of Trauma Services;

Statewide major trauma service: appointed trauma nurse coordinator

On-site specialist haematologist and transfusion medicine scientists

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
6 6 6 6 6

Urology deals with the diagnosis and treatment of diseases of both the male and female urinary tract as well as the male reproductive tract. Depending on the role level of surgical service provided, service components may range from day stay surgery and basic endoscopic procedures to elective and acute procedures including trans-urethral or trans-rectal procedures and trauma cases.

Appropriate levels of clinical support service provision are extremely important especially for anaesthetics, perioperative, pathology, medical imaging and pharmacy as well as access to appropriate allied health services. Higher level Urologic Services rely on access and links to other appropriate specialists.

The scope of this Framework describes the surgical service, its requirements and the minimum staffing needs and clinical support services required within each level.

May provide surgical procedures on children (refer to Paediatric Surgery Service Framework within this document).

No Level 1 service currently described.

No Level 2 service currently described.

No Level 3 service currently described.

Service Requirements

A Level 4 service provides common and intermediate day procedures on low risk patients performed by a visiting urologist or general surgeon credentialed in urology.

Workforce Requirements

Visiting urologist or general surgeon credentialed in urology

RNs with appropriate qualifications and/or experience; RNs may be supported by ENs in providing care to patients

Access to allied health services, as required

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
3 - 3 4 3

Service Description

A Level 5 service provides services at Level 4 plus it performs procedures on low or moderate risk patients by a visiting urologist.

Service Requirements

As for Level 4 plus:

Designated acute surgical inpatient unit with appropriately trained surgical specialist nursing staff

Has links with cancer services and palliative care services

Workforce Requirements

As for Level 4 plus:

Visiting urologist

On-site general surgeon on-call 24 hours

Surgical registrar on-call 24 hours

Specialist anaesthetists on-site; and on-call 24 hours

Anaesthetics registrar on-call 24 hours

RNs/ENs with appropriate post graduate qualifications and/or experience in urology

Access to CNC specialising in urology

Access to designated allied health services

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 - 4 5 4

Service Description

A Level 6 service provides services at Level 5 plus it has the ability to deal with a full range of complex cases on low, moderate and high risk patients performed by an appointed urologist in association with other specialists.

Service Requirements

As for Level 5 plus:

Accredited urology surgical training program

Workforce Requirements

As for Level 5 plus:

Urology consultant on-site; and on-call 24 hours

Urology registrars on-site; and on-call 24 hours

Dedicated CNC specialising in urology and providing leadership within the service

Comprehensive continence service

Access to specialised allied health services

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 5 5 5 5

Vascular surgery is a specialty of surgery in which diseases of the venous, lymphatic, and arterial systems are diagnosed and managed. Depending on the level of service provided, vascular surgical services may include medical, minimally invasive endovascular and open surgical procedures.

Appropriate levels of infrastructure and clinical support service provision are important in vascular surgical services, especially anaesthetics, perioperative, intensive care, imaging, renal medicine, endocrinology and pharmacy services. Higher level Vascular Surgery Services rely on access and links to other appropriate specialists, including cardiothoracic and interventional radiology services.

The scope of this Framework describes the service, its requirements and the minimum staffing needs and clinical support services required within each level.

No Level 1 service currently described.

Service Description

A Level 2 service provides routine day case vascular surgery for low risk patients requiring low complexity surgery.

Service Requirements

Appropriate vascular surgical and anaesthetic equipment available on-site

Formal consultative links with specialist vascular surgeons 24 hours

Workforce Requirements

Visiting vascular surgeons

General surgeons credentialed to perform low complexity vascular surgical procedures with scope of practice determined by the relevant credentialing committee with advice where deemed necessary from a specialist vascular surgeon

RNs with appropriate post graduate qualifications and/or experience; RNs may be supported by ENs in providing care

On-site allied health professionals with knowledge and experience caring for patients who receive vascular surgery

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
3 - 3 4 3

Service Description

A Level 3 service provides inpatient, ambulatory and outpatient consulting for vascular surgery. General surgeons may perform basic vascular surgical procedures.

Service Requirements

As for Level 2 plus:

Appropriate vascular surgical and anaesthetic equipment available on-site

Routine, day case and short stay superficial venous procedures

On-site high dependency or intensive care services available to stabilise vascular surgical patients with emergency vascular surgical needs prior to their transfer to a higher level Vascular Service

Formal consultative links with specialist vascular surgeons 24 hours

Specialist inpatient and outpatient consultations by visiting vascular surgeons

Ability to receive back from a Level 5 Vascular Service with patients requiring low level rehabilitation

Workforce Requirements

As for Level 2 plus:

General surgeons credentialed to perform vascular surgical procedures with scope of practice determined by the relevant credentialing committee with advice where deemed necessary from a specialist vascular surgeon

General surgeon available on-site; on-call 24 hours

RNs with post graduate qualifications and/or experience in vascular nursing

Specialist vascular sonographers

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
4 4 4 4 4

Service Description

A Level 4 service provides elective vascular surgical procedures performed by appropriately credentialed general surgeons or by visiting vascular surgeons. Emergency vascular surgical services are provided within the scope of practise for on-site surgeons.

Service Requirements

As for Level 3 plus:

Routine vascular procedures

Management of vascular trauma

Surgical management of diabetic foot

Elective renal access surgery performed by visiting vascular surgeons

Hybrid operating theatre or appropriate angiography suite

Workforce Requirements

As for Level 3 plus:

Anaesthetists with appropriate vascular surgical anaesthetic experience and/or qualifications as determined by the credentialling process

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
5 5 5 5 5

Service Description

A Level 5 service provides services at Level 4 plus it performs minor, moderate and major complexity elective vascular surgical procedures on low, moderate and high risk patients by vascular surgeons credentialed to perform vascular and endovascular surgical procedures. Emergency procedures are performed by vascular surgeons.

Service Requirements

As for Level 4 plus:

Complicated open vascular surgery

Highly complex endovascular procedures

Statewide provision of emergency vascular surgery services

Outreach elective renal access surgery performed at lower level vascular sites in the network

Management of complex vascular trauma

Surgical management of complex diabetic foot

Link with Level 5 Rehabilitation Service

Multidisciplinary meeting with associated specialties e.g. medical imaging, renal medicine, stroke medicine

Hybrid operating theatre or appropriate angiography suite

Workforce Requirements

As for Level 4 plus:

Appointed vascular surgeons on-site; and on-call 24 hours

Accredited vascular surgery trainee

Specialist vascular sonographers

RNs with appropriate postgraduate qualifications and/or perioperative experience in vascular surgery

CNC specialising in and providing leadership in vascular surgical nursing

Specialist vascular surgery nurses in the operating theatres and outpatient clinics

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
6 6 6 6 6

Service Description

A Level 6 service provides services at Level 5 plus it has the ability to deal with complex, infrequent major vascular surgical diagnostic and treatment procedures in association with other specialties.

Service Requirements

As for Level 5 plus:

Dedicated vascular surgical ward

On-site interdisciplinary amputee service

On-site Level 6 Rehabilitation Service

Workforce Requirements

As for Level 5 plus:

Advanced vascular surgery fellow on-site; and on-call 24 hours

Credentialed specialist vascular anaesthetists on-call 24 hours

RNs with appropriate post graduate qualifications and/or extensive experience in vascular surgery on-site 24 hours

Specialist vascular allied health professionals available on-site 24 hours

Support Service Requirements

Anaesthetics ICU/HDU Imaging Pathology Pharmacy
6 6 6 6 6

Community health services are services that are delivered in the community and provided in a variety of settings, including peoples’ homes and established health facilities. In Tasmania, community health centres can be distinguished from rural hospitals and multi-purpose centres and services as they do not offer inpatient services. The current Tasmania Health Service (THS) – community health centre sites are listed at Appendix 3.

Community health services work in partnership at each point of the health care continuum comprising of:

Health promotion, illness prevention and early intervention

partners include public health, local government, schools, other state government departments, non-government organisations, pharmacists, GPs, workplaces, community groups and in some instances the private sector

Assessment and investigation

partners include GPs, community health centres, integrated care centres, other state government departments, Aged Care Assessment Teams (ACAT) and non-government organisations

Community treatment

partners include GPs and hospitals, other state government departments, Human Services, pharmacists, private allied health providers, non-government health service providers, and Australian Government funded services such as Commonwealth Home Support Program (CHSP) and Home Care Packages.

Continuing care

partners include GPs, hospitals, other state government departments, Human Services, pharmacists, non-government organisations, aged care providers and Australian Government funded services such as Commonwealth Home Support Program (CHSP) and Home Care Packages. Various models of care may support the provision of specialist community health services across a range of settings to meet population and patient need.

Community health service provision is also impacted by a number of current national health reforms including the National Disability Insurance Scheme, Consumer Directed Care and Primary Health Networks – rural health care programs as well as outreach services for people living in remote, rural and some urban areas.

Accordingly, the levels have not been delineated for community health services within this iteration of the TRDF.

The next iteration of the TRDF will aim to describe and delineate more accurately the community health service level and demand based on available data analysis and aligning services with need and sustainability.

The range of community health services offered vary across Tasmania, depending on the needs of the local area, but may include the following:

Community Nursing consisting of:

Generalist community nursing service

Specialist community nursing service

Acute and Community interface nursing service

Rapid Response community nursing service (current pilot program in North and North West regions)

Alcohol and Drug Services

Cancer Screening Services (Breast Screen mobile bus)

Cardiology Services

Child Health and Parenting Services

Community Dementia Services

Continence Services

Diabetes Services

Geriatrics Services

Maternity Services

Mental Health Services

Ophthalmology Services

Oral Health Services

Palliative Care Services

Respiratory Services

Wound Care Services

Youth Health Services

Allied Health Services including:

Audiology

Occupational therapy

Physiotherapy

Podiatry

Psychiatry

Social work

Speech therapy

Community Health based programs

Counselling

Day Centre services

Home help and maintenance, and personal care

Housing services

Refugee Health

Rehabilitation programs

Transport

Volunteer assistance

Women’s and Men’s Health programs

Health education and literacy

Health promotion programs

In Australia, primary health care is typically the first contact an individual with a health concern has with the health system. Primary health care covers health care that is not related to a hospital visit, including health promotion, prevention, early intervention, treatment of acute conditions, and management of chronic conditions.

Primary health care and services are delivered in settings such as general practices, community health centres, allied health practices, and via communication technologies such as telehealth and video consultations.Primary health services may be targeted to the general population but in some circumstances to particular age groups (such as aged persons or young people) and priority populations (such as Aboriginal and Torres Strait Islanders, socioeconomically disadvantaged communities, and migrant and refugee communities).

Other primary health services are provided for specific health conditions (such as dementia, palliative care, mental health or people with chronic diseases). In Tasmania, primary health services are based and delivered from sites that are generally targeted to meet the needs of the surrounding community and local government area.

The Tasmanian public health system only has responsibility for part of the primary health sector, and relies on effective collaboration and commissioning with general practice and private providers to provide a continuum of care for primary health services. For this reason, the 2017 Tasmanian Role Delineation Framework and Clinical Service Profile have only been expanded to publically funded rural hospital inpatient facilities.

On 1 July 2015, the Australian Government established Primary Health Networks (PHNs) as part of its reform of the primary health care system. Primary Health Tasmania (PHT) is one of the organisations established around Australia as part of the Primary Health Networks Programme.

Primary Health Tasmania is a non-government, not-for-profit organisation working to connect care and keep Tasmanians well and out of hospital. It is also responsible for improving the efficiency, effectiveness and coordination of primary care.

PHT manages a range of programs and services based on national priorities set by the Australian Government in areas including Aboriginal health, after hours care, aged care, coordinating and streamlining care, chronic conditions, eHealth, mental health, immunisation, refugee health, rural health and the social determinants of health, as well as supporting general practice to help ensure streamlined care for people moving through the health, aged care and social care systems.

The development of the Tasmanian HealthPathways (THP) is a dynamic collaboration between PHT, THS and DHHS. The pathways program gives health professionals access to a single website that provides information on how to assess and manage a wide range of health conditions, and how to refer patients to local specialists and services in the most timely and efficient way.

THPs enable GPs and other health professionals to better help patients by outlining:

the best available management and treatment options for common medical conditions

information on how to refer to the most appropriate local services and specialists

educational resources and information for patients and clinicians

Ongoing collaboration and co-commissioning between the DHHS, THS and PHT and other primary health stakeholders is critical to improve service coordination and long term health outcomes particularly for Tasmanian’s living in rural and remote communities.

The Statement of Purchaser Intent (SoPI) is an iterative annual (rolling) document, signalling the Department’s intentions (as Purchaser) for the coming financial year. The SoPI articulates the Strategic Priorities of the Health System and provides direction for the transactional activity of purchasing as articulated via the Service Agreement. These priorities naturally relate to health services, many of which are described in the TRDF. The final articulation of purchasing, and therefore funding, is made through the Service Agreement (SA).

The Department, as System Manager, produces the annual Service Agreement (SA) between the Minister for Health and the THS. This Agreement is a legislated agreement that progresses One Health System White Paper reforms and the delivery of health services including the TRDF via the CSP, as well as safety, quality and cost efficiency.

The SA includes services to be provided by or on behalf of the THS and the funding for those services, the requisite performance standards, performance targets and performance measures, and the standards of patient care and service delivery, and performance monitoring measures.

A key mechanism for system management is through informed, appropriate purchasing. The nature and volume of services purchased in the SA will impact on the effectiveness and value-for-money of the Tasmanian health system. As part of this purchasing process, the Department must also signal, as far as possible, its future purchasing intentions to support service providers’ planning capacities.

In order to ensure Tasmanians have access to appropriate levels of safe care it is expected that the THS, as a service provider, delivers the contractual volume of activity for the specified services in the SA while not exceeding the service level capability approved and delineated within the TRDF and CSP.

Community Health Centre Region LGA

1

Brighton/Bridgewater Health Centre

South

Brighton

2

Bruny Island Community Health Centre

South

Kingborough

3

Central Highlands Community Health Centre, Ouse

South

Central Highlands

4

Clarence Integrated Care Centre

South

Clarence

5

Cygnet Community Health Centre

South

Huon Valley

6

*Esperance Multi-Purpose Centre

South

Dover

7

Glenorchy Community Health Centre

South

Glenorchy

8

Huon Community Health Centre

South

Huon Valley

9

Kingston Community Health Centre

South

Kingborough

10

*May Shaw Health Centre, Swansea

South

Glamorgan-Spring Bay

11

Midlands Community Health Centre

South

Southern Midlands

12

New Norfolk Community Health Centre

South

Derwent Valley

13

Sorell Community Health Centre

South

Sorell

14

Spring Bay Community Health Centre, Triabunna

South

Glamorgan-Spring Bay

15

*Tasman Community Health Centre, Nubeena

South

Tasman

16

Beaconsfield Community Health Centre

North

West Tamar

17

Campbell Town Community Health Centre

North

Northern Midlands

18

Deloraine Community Health Centre

North

Meander Valley

19

Flinders Island Community Health Centre

North

Flinders

20

George Town Community Health Centre

North

West Tamar

21

King's Meadows Community Health Centre

North

Launceston

22

*Toosey Community Health Centre, Longford

North

Northern Midlands

23

Northern Integrated Care Service, Launceston

North

Launceston

24

Ravenswood Community Health Centre

North

Launceston

25

Scottsdale Community Health Centre

North

Dorset

26

St Helens Community Heath Centre

North

Break O'Day

27

St Marys Community Heath Centre

North

Break O'Day

28

Westbury Community Health Centre

North

Meander Valley

29

Burnie Community Health Centre

North West

Burnie

30

Devonport Community Health Centre

North West

Devonport

31

HealthWest - Rosebery Community Health Centre

North West

West Coast

32

HealthWest - Strahan Community Health Centre

North West

West Coast

33

HealthWest - Zeehan Community Health Centre

North West

West Coast

34

James Muir Community Health Centre, Wynyard

North West

Waratah-Wynyard

35

King Island Hospital and Community Health Centre

North West

King Island

36

Smithton Community Health Centre

North West

Circular Head

37

Ulverstone Central Coast Community Health Centre

North West

Central Coast

* These community health services are operated by non-government organisations but do provide some THS services.

24 hour/s

Unless otherwise stated, refers to 24 hours a day, 7 days a week.

Acute Care

Acute care is usually provided in hospitals or day clinics by specialised personnel, often using complex and sophisticated technical equipment and specialised consumables. Unlike chronic care, acute care is often necessary only for a short time.

Allied Health

Allied Health is a term used to describe the broad range of health professionals who are not doctors, dentists or nurses.

Ambulatory Care

Care provided to hospital patients who may not undergo a formal admission process, such as patients of emergency departments and outpatient clinics. Can also refer to care provided to hospital patients in non-hospital settings such as a residential aged care facility, school or workplace, through initiatives such as Hospital in the Home (HITH).

Analgaesia

Medication that acts to relieve pain.

Chronic disease

A diverse group of diseases (such as cardiovascular disease, diabetes and arthritis) which tend to be long-lasting and persistent in their symptoms or development and are generally not cured completely. Chronic diseases are mostly characterised by:

complex causality

long latency periods

multiple risk factors

a prolonged course of illness

functional impairment or disability

Dysbaric Illness

A term that covers a broad range of complex pathophysiological conditions associated with decompression.

GX category of pathology laboratory

A Category GX laboratory comprises of a laboratory, or a number of co-located laboratories, performing services in 1 or more groups of pathology:

(a) under the direction, control and full-time supervision of a supervising pathologist or senior scientist who is expert in the group, or groups, concerned; and

(b) at which the number of working pathologists (whether full-time or part-time) is equivalent to more than 2 full-time pathologists.

GY category of pathology laboratory

A Category GY laboratory comprises of a laboratory, or a number of co-located laboratories, performing services in 1 or more groups of pathology:

(a) under the direction, control and full-time supervision of a supervising pathologist or senior scientist who is expert in the group, or groups, concerned; and

(b) at which the number of working pathologists (whether full-time or part-time) is equivalent to not more than 2 full-time pathologists.

Hybrid Operating Room

A surgical theatre that is equipped with advanced medical imaging devices such as fixed C-Arms, CT scanners or MRI scanners. These imaging devices enable minimally-invasive surgery, which is less traumatic for the patient.

Interdisciplinary team

A group of health care professionals from different clinical specialties who work in a coordinated fashion toward a common goal for the patient (e.g. palliative care, pain management).

Interprofessional

A collaborative practice which occurs when healthcare providers work with people from within their own profession, with people outside their profession and with patients and their families.

Minimal Sedation

A drug-induced state during which patients respond normally to verbal commands. Although cognitive function and physical coordination may be impaired, airway reflexes, and ventilatory and cardiovascular functions are unaffected.

Multidisciplinary team

Team with different professional disciplines (e.g. nursing, medical, allied health) who coordinate the contributions of each profession, which are not considered to overlap, in order to improve patient care.

Networked services

Two or more interconnected health services and/or clinicians that ensure continuity of patient care, especially for smaller or more remote services. This may include the use of technology such as telehealth. Some service levels require that a formal network is established and these are generally negotiated locally, between health services, or with non-government or private sector agencies.

Some networking arrangements are governed by policy.

Networking arrangements should be documented and regularly reviewed by all participants. The following should be agreed and documented for each site:

Criteria for patient transfer and back transfer

Processes for patient referral and transfer, including clinical review requirements

Defined communication pathways

Safety and quality indicators for the agreed documented process.

On-call

Staff, services and/or resources located off-site but available to be called in if needed.

Outpatient care/service

Clinical services provided to non-admitted patients.

Outreach/Inreach

Provision of mobile clinical services to patients external to the originating health facility/service.

Pastoral care

Pastoral care provide support and affirmation through a difficult period, offer to explore the ultimate meaning and value of life as it is experienced by being in hospital.

Point of care testing (POCT)

Is the testing of a sample from a patient, performed in the surgery/clinic, at or near the time of consultation, in order to facilitate a prompt clinical decision regarding patient management.

Telehealth

Transmission of images and/or voice and/or data between two or more health units via telecommunication channels (including phone, mobile or V/C) to provide clinical advice, consultation, education and training services.

Telehealth has become an important means of networking but remains in a state of development as new uses and systems are implemented. A properly developed telehealth system within a network may enable a hospital to have a support service where there is equivalent functional access to that service and where patient care is not compromised by that service being off-site.

ACCESS Nurse

An ACCESS nurse provides “on-the-floor” Australian College of Critical Care Nurses (ACCCN) ICU Staffing Position Statement (2003) on Intensive Care Nursing Staffing Assistance, Coordination, Contingency (for a late admission on the shift, or staff sick mid-shift), Education (of junior staff, relatives, and others), Supervision and Support.

Anaesthetic Technician

An allied healthcare worker who assists with the administration and monitoring of anaesthesia and has an extensive knowledge of anaesthesia techniques, instruments, supplies, and technology.

Clinical Nurse Educator

A Clinical Nurse Educator (CNE) holds a minimum of a bachelor's degree in nursing and also has completed a nurse educator training program. They educate and train aspiring nurses or newly graduated nurses.

Clinical Nurse Specialist

A Clinical Nurse Specialist (CNS) is a registered nurse who is recognised as a senior member of staff across all areas of practice but particularly in acute care.

Enrolled Nurse

An enrolled nurse is a division 2 nurse who is registered with the Australian Health Practitioner Regulation Agency-Nursing and Midwifery Board of Australia. The EN completes a 2 year or equivalent Diploma of nursing within the vocational education training (VET) sector. They include general enrolled nurses and specialist enrolled nurses (for example, mothercraft nurses in some states) who provide basic medical care under the supervision of more senior nurses.

General Physician

Medical practitioner who has the postgraduate qualification of Fellowship of the Royal Australasian College of Physicians (FRACP) or equivalent; and actively practises general medicine.

General Practitioner (GP)

Medical practitioner who has postgraduate qualifications in general practice and who may have specialist registration as a general practitioner.

Plaster Technician

Plaster technicians (sometimes called orthopaedic technicians or orthopaedic technologists) work with orthopaedic surgeons in caring for patients with injured joints and bones. Principally, orthopaedic technicians are responsible for applying casts, splints and braces.

Resident Medical Officer (RMO)

A Resident Medical Officer (RMO) is a Medical Officer who has obtained full registration and who has completed the equivalent of at least one year of full time clinical experience In general, most doctors spend two to three years practicing as a Resident Medical Officer (RMO) or Hospital Medical Officer (HMO) in a hospital before commencing specialist training.

Registered Medical Practitioner (RMP)

Doctor practising medicine who is registered with the Medical Board of Australia. Relevant registration categories include specialist, general, provisional, and limited registration.

Medical practitioners work in a range of different roles, including as general practitioners, clinicians, administrators, teachers/educators and researchers.

Registered Nurse (RN)

A Registered Nurse (RN) is a graduate nurse who has passed a state board examination and been registered and licensed to practice nursing and provides a high level of day-to-day care and performs some minor procedures. The RN completes 3 years or equivalent of tertiary study in a Bachelor of Nursing.

ACEM

Australian College of Emergency Medicine

ACS

acute coronary syndromes

ACRRM

Australian College of Rural and Remote Medicine

ADON

Assistant Director of Nursing

AED

Automatic External Defibrillator

COU

Close Observation Unit

CCU

Coronary Care Unit

CICM

College of Intensive Care Medicine

CNC

Clinical Nurse Consultant

CT

computed tomography

DRANZCOG

Diploma of Obstetrics and Gynaecology from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists

ECG

electrocardiograph

EEG

electroencephalogram

ENT

Ear, Nose and Throat

FME

Forensic medical examination

GEM

Geriatric Evaluation Management

GP

General Practitioner

HDU

High Dependency Unit

ICU

Intensive Care Unit

Imaging

Medical Imaging

LSCS

Lower segment caesarean section

MRI

magnetic resonance imaging

NP

Nurse practitioner

NUM

Nurse Unit Manager

PACS

Picture Archive and Communication System

Path

Pathology

PET

positron emission tomography

Phar

Pharmacy

PoCT

Point of care testing

RMO

Resident medical officer

RN

Registered nurse

SCI

Surgical Complexity I

SCII

Surgical Complexity II

SCIII

Surgical Complexity III

SCIV

Surgical Complexity IV

SCV

Surgical Complexity V

TBSA

Total body surface area