St Andrew's Hospital Annual Report 2014/15

Annual Report

2014 2015

St Andrew’s Hospital Medical & Surgical Excellence St Andrew’s is a 201-bed private surgical hospital overlooking Adelaide’s south eastern parklands. It houses nine operating theatre suites, an 18-bed Critical Care Unit, an Emergency Department plus two procedure rooms, an Angiography Suite, a Day Patient Suite and arguably South Australia’s most comprehensive private cancer-care facility.

The team at St Andrew’s has received numerous National Quality and Clinical Excellence Awards, highlighting our belief that we have some of the best people in South Australia working here.

Mission

Vision

Values

Medical and Surgical Excellence

St Andrew’s will be known as the best private hospital in Australia with a culture where relationships matter.

We care, we create, we deliver

We will achieve this by creating an environment that promotes: •Q uality health care supported by exemplary customer service •B est-practice patient care and support •P artnerships with patients, carers, consumers that facilitate a service responsive to their needs •A positive culture based on teamwork that allows us to attract and retain the best staff •S ound business and financial practices to maintain a stable base for future growth •A strong affiliation with the Uniting Church and its agencies • I nnovation and creativity in all of our pursuits

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•T he use of up-to-date facilities and equipment

Highlights Purchase of a new da Vinci Xi Surgical Robot

Development of the new Fertility SA laboratory

Approval obtained for the Eastern Clinical Development

Sale of our East Terrace property

Addition of the third floor to the St Andrew’s Medical Centre

Application for Self Insurance Completion of an Engineering Services Master Plan

Key senior management appointments

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Chairman’s Report This was another successful year for St Andrew’s, highlighted by continuing growth in the number of procedures and separations performed, an increase in the breadth and complexity of the Hospital’s medical and surgical activities, and continuing favourable feedback from the regular audits of our safety and quality framework.

A major milestone was the acquisition of a new da Vinci Surgical Robot to replace an earlier model purchased in 2013. This was made possible by a very generous donation of $2.6 million to the St Andrew’s Hospital Foundation by Mr Gordon Pickard. On behalf of the Hospital and staff I would like to take this opportunity to thank Mr Pickard for his outstanding contribution and continuing support.

Robotic surgery has been undertaken at St Andrew’s since 2013 under an agreement with the State Department of Health to also use of the machine for public patients.

This arrangement is working well and is meeting or exceeding the targeted numbers for public patients, which bodes well for the future cooperation of South Australian public and private health care providers.

Through our Foundation’s exceptional fundraising efforts, we also were able to purchase other important equipment, and this will ensure St Andrew’s remains at the forefront of surgical technology in South Australia for many years.

Another milestone during the year was the completion of the third floor of the St Andrew’s Medical Centre on South Terrace, which opened in 2014. The Centre provides state-of-the-art facilities for our cancer patients, and now provides accommodation of equal quality for the Hospital’s administrative staff, who until now were scattered around various locations near the Hospital.

As foreshadowed in last year’s Annual Report, strong growth in demand for our services requires a significant upgrade and expansion of our building infrastructure. To that end, it is very pleasing to report that the Hospital has recently obtained Development Assessment Commission approval for the construction of the Eastern Clinical Development.

This will include additional underground parking.

A great deal of planning and consultation with internal stakeholders and the local community has been undertaken to develop plans which will considerably enhance the existing operating theatre facilities and allow for relocation and greater optimisation of other existing patient facilities.

Construction will commence in early 2016 and community consultation will continue throughout the project.

Our strong financial performance and sound balance sheet will allow us to undertake this development with confidence and ensure that the Hospital retains its role as the leading private surgical hospital in South Australia.

I wish to thank all of our team who worked very hard and showed great commitment during what has been another outstanding year for the Hospital.

Ken Williams Chairman

CEO’s Report We are all so proud of what we achieved at St Andrew’s during the 2014/15 year. The Chairman has covered some of the major milestones and I echo his positive sentiments about our progress. These milestones are only possible through the hard work, dedication and commitment of all of our staff, specialists and volunteers.

Our nursing team continues to provide an outstanding level of care and support for all patients. We have been fortunate to have had good leadership in the Division for many years and this continues with the appointment of Jacquie Wiley as our Director of Nursing and Clinical Services. Jacquie has made an impressive impact and her review of the nursing structure resulted in the appointment of Tracy Clark and Adrian Saunders to the new Associate DON positions.

Of course, Jacquie’s appointment came at the retirement of Lorri Bruun, who served St Andrew’s with distinction for 14 years. I also must note the retirement of Di Lane, who held a number of senior nurse management positions at St Andrew’s for 43 years.

Our Clinical Managers again worked tirelessly during the year, devoting themselves to their staff and patients and upholding the high quality of care everyone has come to expect from St Andrew’s.

It was a pleasure to welcome back Sharon Kendall into a new role as Director of Performance and Business Development. Her unique skills and experience will once again serve us well in to the future. We also welcomed Rebecca Wyness to the new position of Director Human Resources. This important role is a natural progression given the continued growth of the Hospital. One of Rebecca’s main priorities is leading us through the process of achieving self insurance.

I have always held the view that for a hospital to achieve excellent patient safety standards it must have a positive and vibrant culture that recognises the importance of teamwork. We have that at St Andrew’s. In this year’s annual report we have included a number of clinical indicators that clearly demonstrate our outstanding commitment to patient safety. We consistently perform extremely well in all of our benchmarking.

Our non-clinical staff are an integral part of our team and provide a range of services that ensures the Hospital runs efficiently and safely. We place an enormous amount of importance on providing a clean facility that is well maintained and on ensuring our patients receive highquality meals.

This past year also saw the appointment of Amy Bredon to the role of Foundation Manager. Amy has brought fresh new ideas to the Foundation and has fitted in so well with the rest of the Hospital team.

As we enter our 80th year we all look forward to an exciting future at St Andrew’s. A major building redevelopment to commence in 2016 will create a new day surgery centre and a 28-bed ward on the eastern side of the Hospital.

This expansion will provide state-of-the-art facilities and more capacity to grow our services, which are increasingly in demand.

In closing I would like to thank and acknowledge the enormous contribution of all of our dedicated staff, volunteers and medical specialists, as well as our Board of Governors.

Stephen Walker Chief Executive Officer

Patient safety is always a priority at St Andrew’s Hospital and to ensure this our Pre-admission Clinic staff ensure patients are assessed and systems put in place prior to admission.

Nursing Division New faces and a new structure The 2014/15 financial year proved to be one of significant evolution for the Nursing Division, with the departure of two long-serving senior personnel prompting first a review then a change to our leadership structure.

Lorri Bruun left St Andrew’s in October 2014 after 14 years as Director of Nursing, then in May our Risk and Resource Manager, Di Lane, retired after an incredible 43 years with the Hospital. We thank them both for their service and commitment.

Jacquie Wiley, who has been part of the Nursing team since 1995, was appointed as Director Nursing & Clinical Services in January and quickly began to make her mark, with the creation of two new Associate Director of Nursing (ADON) roles to co-ordinate the operational management of defined clinical areas.

Improving medication management Patient safety is always a priority at St Andrew’s and the Nursing Division is undertaking some important initiatives, in partnership with Bupa, Adelaide Cardiology and HPS Pharmacies, to try and reduce medication risks before, during and after people spend time in the Hospital.

This has included working with a number of the GP clinics that refer patients to our medical specialists to better understand the complexities from a GP’s perspective and how we can help ensure they are fully informed about each patient’s medication requirements on discharge.

Within the Hospital, we are working on a project to “map” the many different information sources we have about what medications a patient is taking. Identifying the true situation on admission can be quite complex.

For example, the directions on the pack that a patient brings from home may not reflect how they are currently taking the medication. The patient may also attend a number of GP clinics and information may not be shared.

Tracey Clark was appointed ADON for Procedural Areas, which include theatres, our Angiography areas, and the procedure rooms where we undertake Endoscopies, Colonoscopies and Bronchoscopies. Tracey has extensive theatre experience and was previously the ADON at Pindara Hospital in Queensland.

The successful candidate for the ADON for Ward Areas is Adrian Saunders, who has held a number of pivotal senior management positions within our Nursing Division over the past two decades. Adrian is responsible for all inpatient clinical areas, including specialty areas, as well as the offsite Chemotherapy service.

Jacquie’s vision is for St Andrew’s to be the employer of choice for nursing staff and that we leverage our position as an organisation known for and recognised for continued quality and patient safety and where staff are supported to enhance their knowledge and leadership skills.

Robot brings new opportunities Nursing staff have undergone extensive training on the Hospital’s new da Vinci Xi Surgical Robot and have worked closely with surgeons to ensure excellent outcomes for patients.

The new equipment has allowed us to provide general surgical intervention for complex hernia repair for the first time in South Australia. The intention is to also provide colorectal robotic surgery early in the new financial year.

The Division’s Management Team participated in a series of planning sessions to review process and documentation across all aspects of the patient journey. The team identified areas for advancement and projects are being undertaken to develop these areas in relation to documentation to enhance the time staff spend delivering patient care.

Also planned is a Clinical Handover project to ensure patient involvement throughout their hospital admission.

Personify Trial We are in the early stages of trialling an IT messaging system to monitor the status and progress of patients both before and after hospital admission.

A group of patients identified as requiring breast surgery are receiving information and questions about their current health status via their smartphone.

The system identifies those patients “at risk” prior to surgery and allows us to monitor their progress and recovery post discharge. It also lets us provide ongoing education and prompts, as appropriate, post discharge.

The trial is being conducted via our Pre Admission Clinic and Breast Clinic so we can monitor the progress of patients and either review in clinic or refer to the Medical Specialist.

The intent is that this system will enable early detection of issues and provide patients with support in their preparation for admission and confidence in their ongoing recovery, thereby promoting a seamless transition from home to hospital and back into the community.

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Quality and Risk Management St Andrew’s completed its midpoint external survey in the Australian Council on Healthcare Standards (ACHS) four-year accreditation cycle during the year and passed with flying colours.

This was the first time we have been formally assessed against the national standards and we achieved a “satisfactorily met” rating for all criteria, which is an outstanding achievement.

We were required to be measured against three of the National Safety and Quality Health Service (NSQHS) Standards – Governance for Safety and Quality, Partnering with Consumers and Infection Prevention and Management. In addition, we chose to be assessed against five ACHS standards – Service Delivery, Provision of Care, Workforce Planning and Management, Information Management, and Corporate Systems and Safety.

It was particularly pleasing to meet all the requirements for the Partnering with Consumers standard, including the developmental criteria, for which accreditation is not required at this stage. The ACHS surveyors commended the engagement of our Consumer Reference Group, which was established in January 2014 and has provided significant input into strengthening this area of providing excellence in healthcare.

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The surveyors also recognised the Hospital’s commitment to safety and quality with the following comment: “At survey there was strong evidence of commitment to their vision ‘to be known as the best private hospital in Australia with a culture where relationships matter’. Throughout the survey there was evidence to support a strong governance framework.

The clinician managers have an understanding of the governance framework and of the application of the framework. Several examples were presented demonstrating bed to board communication of patient safety and quality issues.”

Our ability to demonstrate our culture of seeking to achieve the safest and best experience for our consumers is underpinned by our extensive measurement of safety and quality throughout the organisation. Our 500+ performance measures continue to drive a culture of continuous improvement and this is supported when we benchmark our results against our peers via the ACHS Clinical Indicator program. There are a vast number of Clinical Indicators where our performance is consistently in the top 20% of all hospitals submitting data, these include areas such as Falls, Hand Hygiene and Hip and Knee replacements.

Patient feedback was again integral to informing us on patient safety and quality, clinical services, future service planning, infrastructure and organisational learning and development via the strategic planning process. In 2014, more than 56% of the 3305 compliments received were about our staff, recognising them for being welcoming, caring, cheerful, friendly, efficient, helpful and professional, for providing a positive attitude and excellent care, and for making patients feeling at ease and safe.

At survey there was strong evidence of commitment to their vision ‘to be known as the best private hospital in Australia with a culture where relationships matter’.

Standards Indicator Report Aug 2015

We are pleased to present a sample of our clinical indicators in this year’s Annual Report.

St Andrew’s Hospital has been measuring, monitoring and improving its quality and safety performance over many years. Our positive culture, teamwork and high quality care underpins our excellent patient safety record.

Standard 1: Governance for Safety & Quality in Health Service Organisations (SQ) Quality The Number of Indicators Measured each Month and The Corresponding Catergories of these Indicators

600

Green Indicators - Outstanding Performance Amber Indicators - Satisfactory Performce but monitor 500

Red Indicators - Poor Performance and requires action

Green Indicators

1

400

Number

Amber Indicators

300 Red Indicators

200

Total Number of Indicators

0

Jan-06 Mar-06 May-06 Jul-06 Sep-06 Nov-06 Jan-07 Mar-07 May-07 Jul-07 Sep-07 Nov-07 Jan-08 Mar-08 May-08 Jul-08 Sep-08 Nov-08 Jan-09 Mar-09 May-09 Jul-09 Sep-09 Nov-09 Jan-10 Mar-10 May-10 Jul-10 Sep-10 Nov-10 Jan-11 Mar-11 May-11 Jul-11 Sep-11 Nov-11 Jan-12 Mar-12 May-12 Jul-12 Sep-12 Nov-12 Jan-13 Mar-13 May-13 Jul-13 Sep-13 Nov-13 Jan-14 Mar-14 May-14 Jul-14 Sep-14 Nov-14 Jan-15 Mar-15 May-15

100

Month Jun 2015

Clinical indicators are mapped and action taken to address results outside expected norms. The graph above shows the total number of indicators (541) and the performance of these indicators.

The majority of indicators are “amber”, which means the performance is satisfactory and can be monitored.

Green indicates outstanding performance. Currently there are two red indicators which we believe need to be improved. Overall, services are improving.

Indicator Measure (27) © St Andrew’s Hospital Inc

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Standard 2: Partnering with Consumers

80

Patient Dissatisfaction Non Nursing Related Issues each Month to Date

75

Room / Other Aesthetics

70 65

Hospital maintenance

60

2

Cleaning

55 50

Bathroom / Shower / Toilet

Number

45 40

Air Conditioning

35 30

Televisions / Radio / Entertainment

25 20

Food / Catering

15 10

Accommodation

There are a number of non clinical indicators which are internally monitored resulting from patient

feedback. This provides us with information to review and improve our process and systems.

Standard 3: Preventing & Controlling Healthcare Associated Infections

We currently track 111 clinical indicators which relate to infections.

These include types of infections, surgical procedures as well as

interventions to manage infections.

This graph depicts superficial surgical site infection rates for patients undergoing a hip replacement.

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Month Aug 2015

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Non Nursing Issues (30) © St Andrew’s Hospital Inc

These indicators include cleaning, maintenance, air conditioning, catering and accommodation.

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The graph shows that we have not had a patient with a superficial hip infection since 2010.

4

Standard 4: Medication Safety

0.006

Pharmacy - Nursing Reported Incidents Hospital Wide Rate of Incidents Reported by Nursing Staff per Occupied Bed Day with Risk Reported per Month

0.005

Medication Incident Rate per OBD

Rate of Incident Reports

0.004

Average Rate of Medication Incidents

0.003

0.002 6 per. Mov. Avg. (Medication Incident Rate per OBD)

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Oct-14

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0.001

Month Nov 2015

There are 74 clinical indicators which monitor all aspects of medication safety within St Andrew’s. The graph displayed shows the number of incidents relating to medication errors.

Rate Nursing Incidents Reported (4) © St Andrew’s Hospital Inc

All these incidents are reviewed by the Clinical Pharmacist in relation to harm or potential harm to patients and then discussed at the relevant committees (Drugs & Pharmacy Committee,

Clinical Review and Risk and Quality Committee) to ensure systems are improved.

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Standard 5: Patient Identification & Procedure Matching Patient Identification Theatre List from Rooms made in Patient Identification for patients to be admitted

50

45

40

Number of Incidents

35

30

Theatre List from Rooms

25

20

6 per. Mov. Avg. (Theatre List from Rooms)

15

10

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Month Sep 2015

This graph displays the results of incorrect patient identification and procedure details provided by the

medical officer’s rooms that have been identified by our administrative staff. It shows a steady decrease in the

Documentation of error made (18) © St Andrew’s Hospital Inc

number of incidents over time.

These errors are detected and rectified prior to the patient’s admission.

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Standard 7: Blood and Blood Product (BBP) Blood Management Total Number of Incident Reports Received by the Blood Management Committee each Month

20

18

16

Number of Incidents

14 Total Number of Incidents

12

10

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Mov. Avg. (Total Number of Incidents)

8

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Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15

2

Month

There are 14 indicators in this standard.

The graph shows the number of incident reports received and reviewed by the Blood Management Committee

Sep 2015

each month. The majority of these incidents relate to documentation, none of which have resulted in patient harm.

Standard 8: Prevention and Management of Pressure Injuries (PI)

There are 11 indicators in this standard. The graph depicts the rate of pressure injury that patients develop in St Andrew’s. The rate has decreased

significantly from early 2014. There have been changes made to education, the skin risk assessment tool, as well as improved documentation.

Total Number of Incidents (6) © St Andrew’s Hospital Inc

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Standard 9: Recognising & Responding to Clinical Deterioration in Acute Health Care

There are 17 indicators in relation to this standard. The detection of those patients displaying signs of clinical deterioration are plotted on the same graph as patients who have had a cardiac arrest. This graph

demonstrates that our rate of detecting patients who are deteriorating has increased alongside a picture of a low rate for cardiac arrests. This indicates we have strong systems in place to ensure patients are identified and treated early.

Standard 10: Preventing Falls & Harm from Falls

There are currently 36 indicators for this standard. This graph indicates the outstanding work undertaken at

St Andrew’s to ensure that the falls rate remains below the 20th percentile against the National ACHS average.

9 10

The arrows on this graph indicate different strategies and projects undertaken to ensure safety of our patients around this standard.

Finance and Administration Finance

Administration

Supply

The final stage of the St Andrew’s Medical Centre was completed in May and the Finance, Human Resources and Foundation staff moved to their new home on the third floor. The environment is far superior to that in the old offices in Gilles Street.

This year the volume of admissions increased by 3% and attendances at the Emergency Department increased by 12%. The increasing demand and consequent management of additional staff resources has been aided by the introduction of an electronic shift rostering system. This has been implemented in the Patient Services Department on a trial basis prior to a roll-out across the Hospital.

The Supply Department primarily provides services to the Hospital’s clinical areas. This year regular meetings were scheduled with all Clinical Managers to discuss specification, suitability and alternative sourcing of medical and surgical supplies. Commonly used items such as suction tubing, Y suction catheters and anaesthetic filters were considered and alternative options were purchased, resulting in significant cost savings.

Although now a little further away from the main Hospital building, the Finance team continues to work closely with all other areas of the Hospital.

Capital St Andrew’s makes significant capital investments to support its commitment to medical and surgical excellence.

Capital expenditure was $6.2m in the financial year 2014/15. Major purchases included: • state-of-the-art da Vinci Xi surgical robot • coffee shop refurbishment • In Vitro Fertilisation laboratory expansion for Fertility SA • image intensifier (Theatre) • steriliser • anaesthetic machine • ventilators (CCU) • fitout of the new third floor at the St Andrew’s Medical Centre In addition to our normal capital expenditure, considerable effort was put into the feasibility study for a major capacity expansion opportunity, culminating in the proposed Eastern Clinical Development. Finance staff have supported the project through analysis of business performance and financial modelling.

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A recent Federal Government review of the health sector has brought to light the increasing complexity of health fund insurance policies and arrangements. Our Eligibility, Customer Liaison and Claims Assessment team works closely with health funds and doctors’ rooms to ensure all patients are well aware of their commitment prior to arrival at the Hospital. We aim for a smooth admission process with no surprises.

Medical Records and Clinical Coding Medical Records staff are now managing patient records from both the Royal Adelaide Hospital and Queen Elizabeth Hospital in relation to the da Vinci Xi surgical robot. They ensure all public patient information is managed properly within agreed timeframes.

Clinical Coding staff continue to maintain a high level of skill and contemporary knowledge. This year staff members attended the HIMAA NCCH 2015 National Conference in Sydney and trained with the Health Information Management Association of Australia.

In preparation for self insurance, the Department took a closer look at its workplace to identify and minimise any risk of injury. Equipment and work practices were reviewed. A new forklift with horizontally moving tynes was purchased, inappropriate pallet racking was replaced with easy-access shelving, and all stock was lifted at least 300mm off the floor to reduce bending. Items have been removed from high shelves and placed in new tub containers at the face of bays.

People, Organisational Development and Workplace Safety It was a very busy and exciting year flavoured with firsts and change.

Rebecca Wyness joined St Andrew’s in October 2014 to take up the new position of Director, Human Resources and develop an HR Division that would support the delivery of organisationwide learning and development, HR management, and workplace health and safety strategies and functions.

The new HR team is working well and has delivered a number of key outcomes for the Hospital over the last eight months.

Organisational Learning and Development ELSA (E-Learning at St Andrew’s) went live in April 2015 and became the conduit for the introduction of electronic mandatory training in the Hospital. This project is a key platform to achieve our objective of delivering training anytime, anywhere, for managers and staff. Staff feedback has been very positive, with comments that ELSA is quick and easy to use, with all relevant information in the one place.

The St Andrew’s Graduate Nurse Program (GNP) continues to be an important part of the Hospital’s commitment to the training of nursing students and graduates in South Australia and bridging the transition from university to the workplace.

Our program focuses on identifying graduate nurses who are a strong fit with the Hospital’s values and who show genuine interest in building their clinical skills and experience. The 10 graduates who commenced in 2014 successfully completed the program and accepted permanent positions with us in early 2015. Twelve graduates commenced the GNP in 2015 and are progressing well through their graduate year of training.

Twenty of the Hospital’s Enrolled Nurses undertook additional study over the last year to achieve compliance with the medication administration education standards set by the Nursing and Midwifery Board of Australia as part of the Hospital’s focus on maintaining excellence in patient safety.

The Hospital’s Orientation program was extended to three days for all new clinical staff, including two days of clinical training for new Nursing staff. This enables all new nurses to absorb vital information on the NSQHS Standards and participate in core education on Open Disclosure, Patient Centred Care and Aggression Management.

Workplace Health and Safety In March 2015, Cos Lamberto was appointed to the new position of Workplace Health and Safety (WHS) Manager. The WHS work program for the year focused on strengthening

the Hospital’s WHS and injury management systems, policies and procedures as well as preparing for the commencement in July 2015 of the new return to work legislation in South Australia. The Hospital has a very active and engaged group of Health and Safety Representatives, from a broad range of clinical and non-clinical work areas, who are identifying and driving WHS initiatives and a number of Performance Improvement Projects.

Journey to Self-Insurance In late 2014, St Andrew’s set out to attain self-insurance status.

During the year, significant planning and preparation work was undertaken to ensure we would be well positioned for the initial evaluation process scheduled for September 2015 and that the time frames and activity required to achieve self-insurance around April 2016 would be met.

Over the last six months the Hospital has completed significant pieces of work to review and realign WHS policies, procedures and Safe Operating Procedures (SOPs) and to develop and implement WHS training matrices to refine contractor management processes and upskill key staff to undertake Job Safety Assessments (JSAs).

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“Volunteering at St Andrew’s Hospital is like being a member of a big happy family and is most enjoyable and rewarding.”

Information Systems Information Systems refreshed the Hospital’s PC fleet during the year, including a new Office software suite. PC numbers were increased in ward areas to assist clinical staff.

All staff were provided with log-in credentials to access networked systems, including the Hospital’s Intranet and online training. Multi-function devices were deployed to replace retired printers, faxes, photocopiers and scanners.

IT Security systems were re-evaluated and replaced with the latest protection mechanisms. Work continues in this area to ensure the security and confidentiality of data.

IT and telecommunication systems were extended to the 3rd floor of the new St Andrew’s Medical Centre, including a voice-grade wi-fi capability. Infrastructure for patient/guest wi-fi access has been installed on the 1st and 3rd floors.

The 3rd floor conference facility now has state-of-the-art audio visual equipment.

The transition from the older Electronic Data Interchange based invoicing method to the Medicare Eclipse Hospital Inpatient Claims system was a success. The remaining Health Funds are to be approached post the TrakCare upgrade scheduled for the third quarter of 2015.

Document and email archiving systems were reviewed and improved.

Engineering and Support Services Engineering & Support Services provides the following services to the Hospital and six off-site facilities: Maintenance; Major / Minor Projects; Dietary Services; Bio Medical Services; Cleaning; Security; and Property Services.

Capital Works

Biomedical Engineering Services

In addition to routine maintenance and repairs, significant projects were completed to assist in the completion of the 3rd floor fit out of the St Andrew’s Medical Centre, continue with the modernisation of the theatres, ensuring state of the art infrastructure is in place.

During the year, the Biomedical Engineering Services department attended to 1617 breakdowns and 2217 programmed maintenance tasks.

It is now seeking to expand its services to clients outside the Hospital.

Dietary Services The Dietary Services department provides approximately 290,000 meals a year as well as catering for Hospital functions. It has retained its prestigious HACCP Accreditation every year since achieving the standard in March 2006.

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Cleaning Services ISS Health Services Pty Ltd has provided cleaning services to the Hospital and to the Medical Centre since July 2014.

In addition to cleaning, ISS personnel make beds in all wards and provide specialised services for the Theatre, Vancomycin Resistant Enterococci (VRE) and Methicillin/Multi – Resistant Staphylococcus aureu (MRSA). The audit program in place validates the standard of cleaning that is evident.

Current Research and Ethics Projects All research is administered by the Research & Ethics Committee. We adhere to Australian Standards in the conduct of all research or projects. St Andrew’s is committed to clinical research and currently supports the following projects.

Collection of data for the Australian Orthopaedic Association National Joint Replacement Registry

Application to become an Authorised Prescriber for the Trabecular Metal Glenoid Augment (TMGA)

The South Australian Audit for the Clinical Management of Advanced Colorectal Cancer

International, Non-randomized, First-In-Human Study of the EnligHTN Generation 2 System in Patients with Drug-Resistant Uncontrolled Hypertension

Bi-National Colorectal Cancer Audit Prospective evaluation of a model to predict outcomes following Endovascular Aortic Aneurysm Repair (EVAR) Endurant Stent Graft Natural Selection Global Postmarket Registry (ENGAGE) Magnetic Resonance Imaging (MRI) vs Computed Tomography (CT) for radiological assessment of fusion following anterior lumbar interbody fusion (ALIF) Spine Tango Registry for Spinal Surgery – Mr David Hall’s Private Patients, St Andrew’s Hospital MRI Evaluation of PIP Breast Implants The SNAPSHOT Acute Coronary Syndrome (ACS) Registry

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International long-term follow-up study of patients implanted with a PORTICO valve.

The South Australian Prostate Cancer Clinical Outcomes Collaborative (SAPCCOC): In pursuit of a state-wide population based cancer registry The Australian Prostate Cancer BioResource BlastGen for couples with implantation problems or previous miscarriage A prospective MRI evaluation of multifidus structure and composition following percutaneous facet joint denervation in chronic lower back pain Understanding the basis of female infertility through analysis of ovarian cells Use of Glubran2 to prevent seroma formation after mastectomy and/or axillary lymphadenectomy

Determining the prevalence and fertility outcomes in couples undertaking IVF when the female partner has ultrasonographically defined endometriosis Artificial blastocoele shrinkage prior to vitrification: A prospective randomised controlled trial Australian Breast Device Registry “A Clinical Evaluation of the Medtronic Polymer-Free Drug-Eluting Cornary Stent System in De Novo native Cornary Artery lesions – (PolymerFree DES Trial)” Actioning end of life care and advance care directives in an emergency department context.

Clinical evaluation of a novel suture anchor for rotator cuff repairs.

Arthroscopic Trans-Osseous Knotless.

Medical Education This was the sixth year of the partnership between St Andrew’s and the University of Adelaide and we provided four-week clinical placements for 22 final year medical students across three specialties: Cardiology, Urology, and Breast / Endocrine surgery plus Surgical Oncology (BESO).

Cardiology students attended diverse sessions in the angiography lab, and in consultancy rooms at Adelaide Cardiology, with great support from all of the cardiologists and staff, particularly their supervisor, Dr Peter Sage, and his proxy for September, Dr Daniel Cehic. The students also interviewed a patient admitted for open heart surgery, and followed them through theatre and to CCU postoperatively.

Feedback from students was extremely positive and, as in previous years, it is clear that students consider a placement at St Andrew’s as highly desirable. The following are just two “Having OPD sessions with different consultants that have of the many positive comments: different area of interests/niches has also illuminated me that cardiology is not that ‘narrow’. There are so many subspecialities and areas in cardiology that you can aspire to do”

“The rotation has been most enjoyable and I would easily rate it as one of the best rotations I have done in medical school, if not the best!”

“Overall: Great allrounded surgical experience! It was a really good rotation and I would highly recommend this elective to future sixth year students.”

All students attended an enlightening session on “Grief, loss and breaking bad news” run by the Hospital chaplain, Peter Morel.

At the completion of their placement, each student made a presentation covering various topics associated with their particular specialties. These were of a high standard, very informative and enjoyed by staff who attended.

Urology and BESO students followed a specimen from the theatre to Adelaide Pathology Partners, observing the pathology procedure and methods of diagnosis under the guidance of expert pathologists. They then discussed the results with their medical supervisor, deliberating over subsequent treatments and patient outcomes. Both groups also attended a two-day session at Adelaide Radiotherapy which highlighted the various treatments available. We are very appreciative of the time given by the staff of Adelaide Radiotherapy Centre and Adelaide Pathology Partners.

Our CCU consultants also spent a morning with each student, providing insight into intensive care.

Urology students also attended a wide variety of surgical procedures including robotics, under the guidance of our consultant urologists. They were also able to attend consulting sessions and spent time with the Stomal Therapy Nurse, which enabled them to see the other side of patient care. Particular thanks must go to their supervisors, Mr Richard Wells, Mr Darren Foreman and Mr Andrew Fuller.

BESO students spent an average of 16 sessions observing in theatre, with most surgeons allowing them to scrub in for a closer look. The consultants all spent time teaching and questioning the students, providing them with an exceptional learning opportunity. In particular, they received fantastic support from their medical supervisor, Dr Melissa Bochner.

A morning was spent with our breast care nurses, visiting both pre-op and post-op patients. They were also involved in two sessions in the Chemotherapy suite under the direct supervision of the oncologists.

“A lot of teaching during chemotherapy sessions - Dr Malden and Dr Dickson were great!”

On behalf of all of the students, the Hospital would like to thank every specialist who contributed to a great selective program at St Andrew’s, as well as the patients who gave their permission for the medical students to observe their consultation, treatment and especially surgical procedures, for which over 1300 individual consents were obtained.

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St Andrew’s Hospital Foundation

Pictured – (L-R) Volunteer, Ken Turnbull; Foundation Assistant, Valerie Turnbull; Coffee Shop Manager, Tony Malavazos; Admissions, Evelyn Munoz; Foundation Manager, Amy Bredon; Volunteer Kersti Zikas and Foundation Chairman, Chris Wright.

Our volunteers contributed to raising funds in the coffee shop, supporting the orientation of patients to rooms on admission and helping with events. They blend a wide range of capabilities and experience with the common thread of our motto “not for ourselves”. Their generosity in providing their time to support our work is highly valued.

The St Andrew’s Hospital Foundation continues to play an important role ensuring St Andrew’s is at the forefront of medical and surgical excellence. As always, the driving force behind our work during the year was our wonderful Volunteers.

It was also a time of change, with our Foundation Director, Heather Allanson, leaving St Andrew’s to take on other challenges. We thank Heather for her dedication and contribution and wish her well for the future. We were then delighted to welcome Amy Bredon as our new Director. Amy’s experience in the not-forprofit sector spans 10 years and she brings a wealth of knowledge to the role.

There were changes also on the Foundation Board, which plays a critical role in guiding our strategic direction.

It was with sadness that we farewelled two long-serving Directors – Rev Mark Dickens and Gail Wicks. We thank them both for their contribution. In turn, I am delighted to welcome Kristen Greber as a new Director. Kristen has extensive experience in the private banking sector and is very active in the not-for-profit arena.

Of course, our work would not be possible without the generous financial support from so many within the St Andrew’s community. Thank you to everyone who donated to the Foundation. Our donors help make St Andrew’s a better place for the thousands of people who access our Hospital each year.

The Foundation was extremely fortunate to receive a number of bequests throughout the year and would like to acknowledge those who made the decision to leave the ultimate gift to the the Hospital. We would also like to thank those families who chose the Foundation to receive donations in memory of loved ones.

One of our most significant achievements this year was the acquisition of the da vinci Xi Surgical Robot. Thanks to the extraordinary generosity of Mr Gordon Pickard, we are able to continue to offer our patients robotic surgery across a number of specialities.

Other highlights include funding: • patient televisions for the new Chemotherapy Suite • MRI Compatible Transport Ventilator for the Critical Care Unit • a Criticare Patient Monitor for Ward 3A • scholarships for further tertiary education for four nurses • refurbishment of the Café The Foundation coordinated a number of its own fundraising events throughout the year as well as assisting with Hospital events. Another highly successful Golf Day was held at Royal Adelaide Golf Club, thanks to Clinpath who were again our major sponsor and to all other sponsors who help make the day a success.

The hospital held its first SALA Exhibition featuring the work of three of our surgeons (Dr Randall Sach, Dr Tony Reiger and Dr John Tomich) and we also enjoyed the Hospital’s Memorial Day and our Annual Wine Dinner.

Thank you to all the “Friends of St Andrew’s” members who support us via their annual membership fee. Although small, the fee allows us to continue to support the Hospital.

Thanks also must go to Dr Jones & Partners and HPS Pharmacies who continue to support this program offering generous discounts to our members.

Coffee Shop Manager Tony Malavazos has contributed greatly to the successful implementation of our new Coffee Shop, as well as the day-to-day management of our Volunteers. Valerie Turnbull continues to be a valuable member of the Foundation Team and we thank her for her ongoing commitment both as a Volunteer and as Foundation Assistant.

In conclusion, I would like to thank the Hospital for its ongoing support of the Foundation. The Foundation is well supported by many departments within St Andrew’s which assists us to maximise funds we can donate to the Hospital.

Chris Wright Chairman

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Donations Every year hundreds of individuals, community groups and service providers give generously to support the work of the Foundation.

Their support enhances the quality of care provided to our patients and their families. On behalf of our grateful patients and families we say a sincere thank you.

Air Comfort Services Clippers Hair Designs Club Epicurean Ian’s Western Hotel Local Matters Grill’d Norwood Mundulla Concert Committee Inc Nippy’s Australia Port Vincent Vetnor Hotel Social Club Inc Respiratory Consultants RGB Integration Pty Ltd SA Liberal Party System Solutions Engineers Westmead Fertility Centre Dr John Agzarian Ms Marjorie Ahrens Ms Elinor Alexander Mr Peter Allan Ms Lorna Aplin Dr Sanjeev Arulampalam Ms Margaret Baker Mr Ben Beamond Mr John Bishop AO Mr Graham Blacket Dr Martin Borg Ms Pamela Buchdahl Mr David Bullock Ms Carolyn Byrne Ms Kathy Cameron Mr & Mrs Don & Lesley Catford Mr & Mrs Brian & Marion Chapman Ms Margaret Clark Mr & Mrs Tom & Yvonne Clayton Mr & Mrs Keith & Janet Crawford Mrs Jillian Crouch Ms Christine Elo Mr & Mrs Chas Errock Dr Timothy Fischer Mr Graeme French Drs Andrew & Karyn Fuller Mr Tony Gaynor The Hon Roger Goldsworthy Dr & Mrs Ian & Christine Gould Mrs Valerie Griffin Mr & Mrs Peter & Ros Griffiths Mr Craig Hall M D Hannemann N N Hannemann Mr & Mrs DG & AA Harding Mr Peter Holdt Mr Terry Holland Ms Collette Houlahan Dr RA Hunter Mr & Mrs Peter & Sonya Kerin Mr & Mrs David & Maggie Klingberg PA & HM McBride T McClement Mr Richard McKay

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Mr & Mrs Peter & Pamela McKee Mr Tony McLarty Mr Ian McSporran Mr Peter Morel Ms Shirley Morris Mr & Mrs Frank & Kaye Mothersole Sharda Nettle Mr Grant Octoman Mr Kevin Palumbo Mr Rob Parkyn Mr Reg Pearce Mr Mark H Penniment Mr Gordon Pickard Ms Angela Powell Prof Robert Norman Mr Rob Rigoni Mr & Mrs Steve & Mary Robson Mr Bill Santos Mr Richard Sarre Mr Randall Sach Mr & Mrs Mark & Merryn Schoeman Ms Desma Shillaker Ms Karen Simpson Mr David John Smith Mr Peter Stavrou Ms Shirley Stone Dr’s Peter & Mary Sutherland Ms Linda Swaney K Thamm Mr Walford Thyer Mr & Mrs Terry & Joy Trainer Mr James Trott Mr & Mrs Ros & Kevin Tucker Mrs Valerie Turnbull Mr Malcolm Tyrrell Mr Thomas Vaughan Ms Joanne Walkley Ms Pheobe Ware Dr Darren Waters Dr Mary White Dr J D Whitford Mrs Sau Lan Wong Mr Barry Worrall Ms Heather Wright

We gratefully acknowledge donations received in memory of the following people who have been in our care.

Mr Stow Penniment Mr Dieter Wischeropp Mr Ian McArthur Mr Tom Thomas Mrs Betty Mack Mr Dale Tils Hon Trevor Griffin Mrs Monica Rocca Mr Paul Guidolin

We gratefully acknowledge the kind contribution of the medical specialists who have participated in the sixth year medical student clinical placement program and have kindly donated to the Medical Education Research Fund.

Dr Tim Baillie Mr Michael Berce Dr Melissa Bochner Mr John Bolt

Dr Andrew Bowie Dr Michael Brown Mr Jim Burnett Dr Daniel Cehic Dr Georgy Chacko Dr Ray Cheng Dr William Cobain Mr Trevor Collinson Mr Rod Cooter Dr James Dickson Dr Patrick Disney Mr Darren Foreman Dr Mary-Ann Fox Dr Peter Franklyn Prof Rob Fraser Mr Andrew Fuller Prof Grantley Gill Mr Clive Hoffman Mr Andrew Hunter Dr Tom Jaensch Mr David King Dr Steve Kinnear Mr Jim Kollias Dr Jimmy Lam Dr Quoc Lam Mr Matt Lawrence Dr Trevor Malden Mr Peter Malycha Dr Bill McLeay Dr Ian Metcalfe Dr Joe Montarello Dr Jamie Morton A/Prof Susan Neuhaus Mr Markus Nikitins Dr Oseka Onuma A/Prof Robert Parkyn Dr Steve Petito Mr Randall Sach Dr Peter Sage Dr Luay Samaraie Dr Maria Santos Mr Richard Sarre Dr Bob Singh Dr Govindarajan Srinivasan Dr Peter Steele Dr Rob Stuklis Mr Peter Sutherland Dr Karen Teo Dr Charles Tie Mr Jim Trott Dr Michelle Thomas Mr Jehan Titus Mr Paul Varley Mr David Walsh Mr David Walters Mr Richards Wells Mr Robert Whitfield Mr Malcom Wicks Mr Neil Williams Mr Roger Woods Mr Phil Worley Mr Michael Worthington Mr Chris Worthley Prof Stephen Worthley A/Prof Glenn Young

Financial Report Statement of Financial Position as at 30 June 2015

Auditor BDO Audit (SA) Pty Ltd Level 7, 420 King William St Adelaide SA 5000

2015 $,000

2014 $,000

Current Assets

33,184

20,484

Non Current Assets

77,184

81,635

110,368

102,119

17,016

14,726

619

609

17,635

15,335

Solicitors Rossi Legal Level 7, 185 Victoria Square Adelaide SA 5000

(Extracted from audited accounts)

Total Assets Current Liabilities Non Current Liabilities Total Liabilities Net Assets

92,733

86,784

Total Accumulated Funds

92,733

86,784

The accounts have been compiled in line with appropriate accounting standards which require, inter alia, the inclusion of donations. The directors of the hospital are of the belief that, as a result of the need to comply with accounting standards, these donations, certain other items of revenue, as well as the non take up of certain other expenses, has resulted in an abnormally high result for the year.

Banker Commonwealth Bank of Australia 96 King William St Adelaide SA 5000

DW Fox Tucker Level 14, 100 King William St Adelaide SA 5000

St Andrew’s Hospital Statistics 2014-2015

2014/15

2013/14

OBD’s Medical Surgical

51,530

50,032

Separations

27,868

27,176

1.85 days

1.84 days

12,291

12,088

Day Suite Procedures

5,360

5,695

Emergency Department Attendances

4,015

3,800

Emergency Department Admissions

1,515

1,355

20 minutes

18 minutes

Average Length of Stay Theatre Procedures

Emergency Department Average Waiting Time Workforce Statistics Employees

598

573

(367 Nursing, 231 non-Nursing)

(355 Nursing, 218 non-Nursing)

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Organisational Structure Board of Governors Chief Executive Officer Mr Stephen Walker

Director of Nursing Mrs Jacquie Wiley (from Dec 2015)

Quality Coordinator Mrs Robyn Ware

Assistant Director of Nursing (Acting) - Mr Adrian Saunders

Case Manager Ms Elizabeth Jones

Risk & Resource Manager Ms Di Lane (retired May 2015)

Pre Admission Coordinator Ms Annie Filsel

Clinical Manager Theatre Ms Leandra White Clinical Educator Theatre Ms Anne Sherlock Clinical Manager Recovery/ Anaesthetics - Ms Sharon Blaney Day Patient Suite Ms Sharon Maslen Clinical Manager – 2nd Floor Ms Liz Knight/Ms Caroline Guest Clinical Manager – 3a Ms Karen Shannon Clinical Manager – 3b Ms Lisa Walters Clinical Manager – 4th Floor Mrs Sarah Schulze Clinical Manager – Angiography Suite Mrs Joyce Restell Clinical Manager – Critical Care Unit Ms Edel Silke (from October 2015) Clinical Manager – Emergency Service - Ms Catherine Turner Clinical Manager – Day Chemotherapy Suite Ms Lisa Mucklow Bookings Manager Ms Viv Gill

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Director Business Performance and Development - Ms Sharon Kendall (from Feb 2015) Director of Finance Mr Garry Crispin Manager – Patient Services Mrs Meredith Staggs Management Accountant Mr David Ormsby Financial Accountant Mr Stuart Campbell Supply Manager Mr John Ioannou Payroll Supervisor Ms Sharyn Wood Director of Engineering & Support Services - Mr Peter Cooper Maintenance Controller Mr James Crinson Manager – Dietary Services Mr Gary Fountain Bio Medical Engineer Mr Maged Shenouda

Director of Human Resources Ms Rebecca Wyness (from Oct 2014) HR & Organisational Development Coordinator - Ms Alison Sarles Graduate Coordinator Mrs Kerry Holm WHS Manager Mr Cos Lamberto Director of Information Systems Mr Greg Laing Director of Emergency Service Dr Steven Schueler Director of Critical Care Unit Dr Alex Wurm Director of Medical Services Dr Chris Farmer St Andrew’s Hospital Foundation Director - Ms Heather Allanson (to December 2014) Mrs Amy Bredon (from January 2015) Coordinating Chaplain Rev Peter Morel

14/15

Board of Governors Chair

Board Members

Mr K G Williams BEc (Hons) MAppFin MAICD

Mr R J Armstrong MAMBA FCPA FCIA

Dr D Cehic (from June 2015) MBBS, GAICD, FRACP, FCSANZ

Ms S M Daw GAICD, FGLF (03)

Mr R McLachlan (from September 2015) BBus(Prop), GradDipMktg

Prof R D Fraser AM MBBS MD FRACS FAOrthA

Mr T Lambert (from September 2015) BE (Civil), MEnvSt, GradDip BusMgt

Ms M Phythian RN

Ex Officio Member

Deputy Chair Dr M F Sutherland MBBS FFARACS FANZCA

Mr J L Sweeney MBBS FRACS Mr D J Walters MBBS DDU FRACS

Rev R Miller The Moderators Alternate, SA Synod Uniting Church in Australia

Ms S C Furey LLM (Corp & Commercial), BEc (Acc) GAICD, GDLP, CTA, CA

Rear (l-r): Prof R Fraser, Mr R McLachlan Mr D Walters, Mr G Crispin, Mr S Walker, Dr D Cehic, Mr T Lambert, Mr K Williams Rev R Miller Front (l-r): Ms S Kendall, Ms S Furey, Ms S Daw, Mr R Armstrong Dr M Sutherland, Ms M Phythian, Ms J Wiley, Ms R Wyness Absent: Mr J Sweeney, Mr FG Moretti (retired)

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St Andrew’s Hospital 350 South Terrace Adelaide, South Australia 5000 Telephone 08 8408 2111 Facsimile 08 8232 0328 www.stand.org.au