As the emergency department treated its first patients and the wards continued to be filled yesterday, the much anticipated, $2.4 billion, high-tech Royal Adelaide Hospital was officially open for business.
Since Monday more than 300 patients have been transported the short journey along North Terrace from the old RAH in a fleet of 16 ambulances and an ambulance bus, while the new 65-cubicle emergency department accepted its first patient — a walk-in — just after 7am yesterday.
Following a decade of controversy, including a delay of 17 months, cost blow-outs, political infighting and construction fatalities, the mammoth task of relocating South Australia’s flagship hospital will be complete today when the last patient is transferred.
For Executive Director and CIO at SA Health Bill Le Blanc, the man responsible for implementing the technologies in the third most costly building in the world, it’s the culmination of an “extremely demanding” and collaborative process.
“Probably a more significant challenge than the technology, in my view, is bringing people on the change journey,” Le Blanc told Healthcare IT News Australia.
“This is compounded by the workload on hospital staff having to participate in and support this project while simultaneously maintaining high quality care at the old RAH. It’s been extremely demanding on executive, administrative and clinical staff at all levels.”
For a hospital touted as the most technologically advanced in Australia, according to Le Blanc the process to now has been clinically led.
“The technology was designed as an integral part of the entire program. It is part and parcel of the new model of care and its integration into hospital business processes was designed in collaboration with the most senior clinicians. It needed to be a clinically led initiative, supported by the latest technology, not the other way around,” he said.
“One example of this was the Activation Committee. This was one forum where leaders of all hospital disciplines met to discuss the what and the how they would move from current practices to new business models and their interdependencies upon each other.
“The technology was an integrated part of that whole activation journey and not handled as an independent stream of activity. This type of clinical collaboration, in my view, is the key to a successful implementation.”
The outcome is a hospital designed to not only integrate today’s best tech but to anticipate the future.
“There is so much leading edge technology to talk about but the stuff with the most ‘cool’ quotient would be robotics, wireless location, and clinical digital integration.”
The new RAH has the largest Automated Guided Vehicles fleet in Australia, with 25 driverless AGV robots moving over 1600 trolleys each day delivering food, linen, medication and surgical instruments throughout the facility. They work behind the scenes, travelling via 14 dedicated lifts and 27 lift lobbies. Benefits include increased efficiency and traceability, decreased costs and reduced damage to equipment that would otherwise be manually wheeled by staff.
Both of the pharmacies use medication-dispensing robots. The robotic dispensing units automate dispensing of prescriptions, picking both imprest orders and outpatient prescriptions, and manage a centralised inventory.
This technology decreases dispensing errors and frees pharmacist time to focus on the quality and effectiveness of medicine use. It also decreases turnaround time for dispensing, improving productivity, and reduces the amount of inventory required by 20-30 per cent and reduce wastage from expired stock.
There are more than 100 automated dispensing cabinets in patient wings to support the accurate and timely distribution of medicines. Nurses input the patient-ID and biometric authorisation via staff fingerprint. The ward-based cabinet ejects a drawer containing only the medication (and correct dosage) prescribed for the patient, reducing the time nurses require to administer medication.
This technology also contributes to significant reduction in medications lost through ‘diversion’, especially for narcotics and other controlled drugs.
New RAH has a mesh wireless network comprised of 3200 access points. The saturation of wireless access points is such that the location of assets (such as wheelchairs, infusion pumps and barouches) via embedded RFID chips is tracked in real time, much like triangulation from mobile phone towers. This locates the nearest available asset when it is needed, directing staff to the exact location.
The tracking of staff is a key safety system providing a ‘mobile duress’ alarm capability through wearable technology. It allows security staff to be dispatched directly to the location of staff who require assistance.
Clinical data integration
The very latest in CDI technology has been deployed into all 40 of the theatres and technical suites. Providing integration of clinical data onto monitors allows surgical teams real-time access to clinical data, including the camera data from medical scopes, the electronic medical record, biomedical metrics, and imaging such as X-ray, CT-scan and MRI.
There is also high-definition video capture and recording in all treatment suites to help with training and clinical collaboration through telehealth.
The complexity of the challenge of integrating so many advanced systems wasn’t only limited to the new RAH building but expanded throughout the SA Health system.
“New RAH is a central piece in an integrated health system, so the technology is not standalone,” Le Blanc said.
“While there is certainly a host of leading edge technology not found in any of our other hospitals, one of the technical challenges is integrating such a high-tech asset into our hospital network, with many shared core systems across our hospital network such as our EPAS electronic health record.
“We have an enterprise system strategy at SA Health where we have only a single enterprise copy of our core system used from all hospitals. This includes systems for patient administration, electronic medical records, radiology and PACS, and pathology.”
According to SA’s Health Minister Jack Snelling, the project, which has been more than 10 years in the making, will revolutionise health care.
“The new RAH is home to the most advanced medical technology in the world,” Snelling said at Sunday’s ribbon-cutting event.
“Designed with the input of some of the brightest minds in the medical world, we've delivered a hospital that puts every aspect of patient care at the forefront.”
In the lead-up to the move, other metropolitan and nearby country hospitals took in patients to allow the old RAH to wind down to less than half its usual capacity.
This week, a control centre with similar protocols and procedures to a mass casualty event coordinated the relocation effort, with extra staff working across the two hospitals and additional ambulance crews joining the effort.