Critical Care



Director: Dr Stephen Warrillow
Deputy Directors: Dr Bill NimoDr Simon Reilly


Services​


The Critical Care Clinical Institute encompasses the specialties of anaesthetics, emergency medicine and intensive care medicine.

 

Activity

 

   FY 2014 ​FY 2015 ​​FY 2016

Services ​Attend
an​ces
Admiss
ions
Bed days
Attend
ances​
Admiss
ions
Bed days Admis​s
ion​s
Bed days​

​Anaesthetics  ​76,882* n/a
n/a 81,303* n/a
n/a 85,893​ N/A​
​Emergency presentations  26,704 n/a
​n/a 25,774 n/a
n/a 27,761​ N/A​
​Intensive care admissions ​n/a ​3,101
7,454
​n/a
2,982
7,169
​​​    3,326   7,513
 

 *Anaesthetics ​attended is an event when the patient requires the services of an anaesthetist.


Clinical Institute Executive


The Critical Care Clinical Institute Executive Members are:




Highlights – Emergency Department

 

  • Approx 26,000 presentations to emergency per year, making Epworth Richmond the busiest private emergency department in Victoria. However, the opening of the new emergency department on 1 February 2016 is expected to increase this number by approximately 10,000.
  • Higher rate of emergency physician specialists working in Epworth Emergency Department compared to other hospitals’ emergency departments.
  • The brand new Emergency Department features a purpose-designed clinical space with the best of medical technology to treat patients with extremely serious conditions, including heart attack, stroke, trauma and infections, as well as an experienced team of emergency medicine professionals. 
  • Admits approximately 10,000 patients per year. 
  • Most specialties are covered with a comprehensive on-call roster
  • Accredited for advanced trainees in emergency medicine for a 12-month period
  • Teaching Hospital: Medical student on rotation from both Monash and Melbourne Universities
  • Extremely low bypass rate 
  • Actively involved in research


Highlights – Intensive Care


Intensive care is where complex monitoring and care are provided. Patients are admitted to the Intensive Care Unit after complex or long operations, to manage illness in multiple organs systems and to manage serious illness. Epworth admits approximately 3,000 patients to our three state-of-the-art intensive care units each year at Epworth Eastern, Epworth Freemasons and Epworth Richmond.


A brand new, purpose-designed ICU opened at Epworth Richmond on 1 February 2016, co-locating critical care services in close proximity. The new ICU consists of 26 private rooms, providing patients with privacy and a much quieter environment in which to recover. Each of the rooms features the latest medical equipment for monitoring of patient condition, as well as switchable glass that is transparent to enable monitoring, but can be switched to opaque when privacy is required.


Epworth Geelong ICU will open mid-2016, when the new Epworth Geelong Hospital opens. This will be a state-of-the-art facility supporting the activities of the new hospital.



Highlights – Anaesthetics

Anaesth​esia


Epworth delivers anaesthesia and sedation for over 80,000 patients per year in 54 operating theatres over 5 campuses. All anaesthesia is delivered by fully credentialed highly trained specialist anaesthetic doctors working closely with our surgical colleagues and perioperative teams. Our aim is to deliver personalised anaesthetic care for you, minimise your perioperative risks and enhance your safe and comfortable recovery after the operation. Anaesthesia is backed up by a dedicated team of anaesthesia and post anaesthesia care nurses who help to maintain and enhance your recovery. 


Anaesthesia is delivered for a huge range of procedures from small excisions under local anaesthesia and sedation to complex Open Heart, Neurosurgical and Orthopaedic procedures. We are involved in anaesthesia for Robotic Surgery, Cancer Surgery, Obstetric procedures, IVF and many other types


At Freemasons we have a very busy obstetric unit for which we provide pain relief and an epidural service for labour ward as well as anaesthesia for delivery including elective and emergency Caesarean Section. 


Recently we have opened 6 new operating theatres in Lee Wing at Richmond incorporating 2 open heart theatres, 3 neuro theatres and a hybrid vascular neuro-interventional theatre as well as new theatres at Epworth Freemasons in East Melbourne and Epworth Eastern in Box Hill.

In July we will open our latest hospital at Waurn Ponds in Geelong which will have 11 state of the art operating theatres.


Each hospital campus has a slightly different mix of operations and procedures performed as indicated below by the top specialties for which anaesthesia is provided at teach of those facilities.



Epworth Freemasons

Procedural specialty

Anaesthetics

Gynaecology

5,574

Urology​

3,132

General Surgery

2,970

Gastroenterology

2,155

Ophthalmology

1,946

Obstetrics

1,331

Plastic Surgery

1,120

Orthopaedic Surgery

815

Otolaryngology

416

Oral & Maxillofacial

185

The above table includes more than 2,200 epidurals administered for analgesia in labour



Epworth ​​Eastern

Procedural specialty

Anaesthetics

General Surgery

6,095

Gastroenterology

2,904

Urology

2,631

Orthopaedic Surgery

2,269

Plastic Surgery

2,115

Cardiology

864

Gynaecology

739

Otolaryngology

646

Vascular Surgery

557

Cardiothoracic Surgery

337

 

Epworth Rich​mond

Procedural specialty

Anaesthetics

Orthopaedic Surgery

10,283

General Surgery

5,018

Gastroenterology

4,719

Cardiology

2,874

Urology

2,872

Neurosurgery​​​

2,063

Vascular Surgery

​1,670

Gynaecology

1,663

Plastic Surgery

1,654

Cardiothoracic Surgery​

718

 

Epworth Hawthorn

Procedural specialty

Anaesth​etics

Gynaecology (incl IVF)​​

2,599

​Plastic Surgery

​510

Orthopaedic Surgery

456

Urology

442

Vascular Surgery

90

Oral & Maxillofacial

69

General Surgery

59

Neurosurgery

15


Epworth Camberwell provides anaesthetic services in support of psychiatric therapies including Electroconvulsive therapy (ECT).​ 

Acute pain ​management


Since the establishment of the acute pain service (APS) in September 2015 to October 2016:


  • APS has reviewed just over 1000 patients, of whom 40 % (400) have chronic pain
  • The main source of referrals to the service is from anaesthetists (45%), followed by surgeons (7%), ICU/MET calls (5%) and physicians (2%).
  • The main referring specialist group is orthopedics (52%), followed by neurosurgery (21%) and general (10%).
  • 80% of patients referred to the APS are seen and discharged within 3 days.


In June 2016, a rotating medical roster was introduced to which includes pain management  specialists The pain specialists work at other pain services around Melbourne and bring with them a wealth of knowledge. The APS is also supported by anaesthetists.


In September 2016, a rotating chronic pain roster was introduced. Patients who are identified as high risk or who need further management and assistance with their pain management when discharged, can be referred to a chronic pain specialist. The chronic pain specialists will review patients and provide support the patient with their discharge pain management plan.


In consultation with the Anaesthetic Advisory Committee, Clinical Institutes and the education department, the APS has reviews and implements the pain protocols and practices at Epworth, and will soon release additional resources to supplement the care we provide. This is supported by education sessions to hospital staff. 


 

Our performance – Emergency Department 


Average waiting tim​e to see a doctor* 23 minutes​
Proportion staying > 24hrs (%) 0.06%​

 * In private hospitals this includes triage and provision of financial information. 

Comment: We see100% of critically unwell patients immediately and meet time targets for other categories of urgency


Our performance – Intensive Care


To measure our performance, our intensive care results are compared with other hospitals that participate in the Centre for Outcome and Resource Evaluation (CORE) hosted at the Australian and New Zealand Intensive Care Society. 


Image: Graph depicting funnel plot Jan-Dec 2015 (ANZROD)

One of the key measures of success in intensive care is the proportion of patients who survive. There are a large number of factors that can affect a patient’s individual risk of a poor outcome. Older patients and those undergoing emergency procedures are more likely to have a poorer outcome than younger patients having planned operations. To compensate for this, risk adjustment is used to take into account factors that affect a patient’s outcome so that a fair comparison can be made between hospitals. Benchmarking can then be undertaken using a standardised mortality ration (SMR), where an SMR of 1 is the expected outcome for a patient of a particular condition and clinical risk; and less than 1 being a better than expected outcome. A simple way to demonstrate a hospital’s performance is the use of a funnel plot (above). The chart shows a funnel of expected performance. Unit results are displayed as dots with the aim being to fall within the funnel. Further examination is required where a dot falls outside the funnel.


When compared to other intensive care units in the country, Epworth’s ICUs perform extremely well. This is a very good result, as intensive care in Australia is known to be of a high standard compared to international standards.

.


Our performance – ACHS emergency, anaesthetic and ICU


​​A​rea ​Indic​ator ​Epworth performance % ​Benchmark or average national performance % Result comment​
​Anaes ​3.1 Relief of respiratory distress in the recovery period  ​0.05% ​0.04% As per bench​mark
​Anaes
​3.4 Severe pain not responding to pain protocol in the recovery period  ​0.36% ​0.37% As per bench​mark
​Anaes ​3.5 Unplanned recovery room stay of longer than 2 hours for medical reasons ​0.76% ​1.01% Performance better than benchmark

​​​​​

All patients presenting to an emergency department (ED) are assessed and assigned a triage category, as defined by the Australasian College for Emergency Medicine. The five triage categories range from patients who require resuscitation (Category 1) to patients whose medical needs are not urgent (Category 5), and the Australasian College for Emergency Medicine has identified the maximum time patients should wait until they are seen by a nurse or medical officer for treatment for each of these categories. Triage systems are fundamental to the effective management of emergency departments, as they ensure consistency and fairness for the patient requiring medical attention and provide an effective tool for departmental organisation, monitoring, and evaluatio​n. Waiting time relative to triage category is the critical performance indicator for an emergency department.

​ ​
​ED ​1.1 Australasian Triage Scale Category 1 patients attended to immediately ​100.00 ​99.65 Performance better than bench​mark
ED ​1.2 Australasian Triage Scale Category 2 patients attended to within 10 minutes ​94.81 ​76.84 Performance better than bench​mark
ED ​1.3 Australasian Triage Scale Category 3 patients attended to within 30 minutes ​77.39​* ​65.23 Performance better than benchmark​
ED ​1.4 Australasian Triage Scale Category 4 patients attended to within 60 minutes ​86.18 ​74.47 Performance better than benchmark
ED ​1.5 Australasian Triage Scale Category 5 patients attended to within 120 minutes ​97.97 ​91.30 Performance​ better than benchmark
​ICU ​1.5 Patients discharged from the ICU between 6pm and 6am  ​5.29 ​13.67 Performance better than benchmark

* The old Epworth emergency department was a small facility, which is reflected in this number. On 1 February 2016, Epworth opened a new, larger emergency department, with increased capacity and state of the art technology and facilities. In the first month of operation, 75% of our Cat 3 patients were seen within 30 minutes, and all were seen in an average of 23 minutes. 


# The Epworth patient flow differs from that of many other hospitals. As part of our aim to provide optimal patient care and comfort, we aim to minimise the number of times a patient is transferred between departments. For example, a patient may stay in the emergency department and then be transferred directly to theatre or to the relevant ward. 


Queries

If you have any queries regarding the data on this page, please email: ClinicalProfile@epworth.org.au



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