A Royal Perth Hospital Publication

ServioNews

A Royal Perth Hospital publication Summer 2014

Greetings from the Executive Director By the end of the year we will have seen more than 82,000 patients come through the Emergency Department, provided 440,000 outpatient appointments and served more than 1.3million meals to our patients. We have also celebrated more than 300 staff members reaching the milestone of 10, 20, 30, 40 and 50 years of service, secured millions of dollars in research grants, congratulated countless award winners, and delivered a range of life-saving treatments to patients.

This year also marked the closure of Shenton Park Campus (SPC) after 121-years of service to the Western Australian community. On 4 October all SPC patients were safely transferred to the new Fiona Stanley Hospital State Rehabilitation Centre, with many staff also relocating there or moving to our Wellington Street Campus.

By March, RPH will be a 450-bed tertiary hospital providing a range of services including adult major trauma, emergency medicine, surgical services and mental health. We will also say farewell to a number of services as they transition to Fiona Stanley Hospital or other health sites, and this edition of Servio News recognises their contributions.

All this change unfortunately brings with it great uncertainty for individuals. The stresses associated with uncertainty around jobs have been, I believe, a low point for the organisation and against this background it is difficult to clearly articulate to staff how critical and valued their dedication and professionalism are to the organisation and its future. I would like to thank staff for their commitment and hard work throughout 2014. It has been a year of change which will continue through 2015, and together I am confident that the new Royal Perth Hospital will not only survive but thrive.

As the holiday season approaches, I hope you all enjoy a well-deserved rest and return ready for the exciting challenge of 2015. Dr Aresh Anwar Acting Executive Director Royal Perth Group

Closing the gap in Aboriginal kidney transplants A new model of care for kidney transplants for Aboriginal and Torres Strait Islander people was awarded top honours at the 2014 WA Health Excellence Awards.

The Department of Nephrology Renal Transplant Unit took out the Aboriginal Health category, and were also this year’s recipient of the Director General’s Award.

Medical Renal Transplant Unit (MRTU) lead Dr Suda Swaminathan says prior to 2012, the transplant failure rate in the WA Aboriginal population was three to four times greater than non-Aboriginal patients.

“This poor outcome could not be ignored, so we were determined to do something about it and two years on, we have seen huge improvements in transplant success,” Dr Swaminathan said.

“Since 2012 there have been no transplant failures in Aboriginal patients and those patients are leading a life free of dialysis. This is a result we are all very proud of and it shows we are providing better care for our patients.”

By encouraging patients to make lifestyle changes before their transplant, altering dosages of post-transplant medication and providing daily follow-up for four weeks after the transplant, infections have reduced.

“One of the main causes of transplant failure in Aboriginal patients is infection and the team have reduced infection rates to numbers similar to non-Aboriginal transplant patients,” Dr Swaminathan said.

Mr Lloyd Henry, MRTU Aboriginal transplant patient, received an early morning phone call with news that his new kidney was waiting. He travelled from his home in Collie and was in surgery by 3pm that afternoon.

“Receiving a kidney is very emotionally overwhelming as I have been given a second chance at life and want to do all the right things to make it work,” Mr Henry said.

“The entire team have been marvellous the whole way through the process. They have provided me with all the information and advice I need to take care of myself and are willing to answer any questions I have, day or night.”

Once Mr Henry fully recovers and heads back home he will continue to receive high quality care. “Through communication via tele-health and by working more closely with health professionals in rural and remote areas, patients continue to receive high quality care and support once they return home,” said Dr Swaminathan.

“This is just one of the many ways Royal Perth Hospital helps patients to continue good health once they leave the hospital.”

Securing RPH’s rich history After eight years of negotiations, the Royal Perth Hospital Heritage Society has achieved their goal to have the heritage buildings on Murray Street officially handed over to the National Trust of Australia (WA).

Founding member and Heritage Society Chair, Mr Fred Ordinski said handing the land and buildings over to the National Trust ensures the RPH Museum will be permanently housed on the grounds of RPH and the names of Royal Perth Hospital and Colonial Hospital remain linked to the site.

“After many years of petitioning, meetings, countless letters, and much hard work by the Heritage Society and friends of the society, we are now the proud recipients of the Crown Land Title,” Mr Ordinski said.

“This is the largest medical precinct ever handed over to the National Trust, which is an exciting recognition for the hospital and the society.”

The five buildings, which make up the Heritage Precinct are the Colonial Hospital, the old administration block, old kitchens, nursing quarters, and radium therapy.

“The fig tree on Murray Street and the land on which the buildings stand are also covered by the title,” Mr Ordinski said. “Our next step is to be officially recognised as the caretakers of the land and buildings, and we are in the process of putting together a business plan to achieve that.”

The Heritage Society, made up mostly by RPH Museum volunteers, began as a steering committee in 2006 and became incorporated in April 2009 with the aim of ensuring RPH stays linked to its rich history.

Hot tips for warm weather with Dr Michelle Johnston  Dr Michelle Johnston is an Emergency Medicine Consultant who has worked in the RPH Emergency Department for 20 years, giving her a wealth of knowledge and experience in all things emergency.

Summertime has come calling on the good citizens of Perth and we’ve emerged from winter, blinking and enchanted by the brilliant sunshine, ready to bask and unwind in the toasty warm weather. Or are we? Could there be dangers lurking behind this sunny façade? Absolutely! One must be wary of the hidden perils waiting to pounce and deposit you, surprised and confused, in front of the triage nurse in the Emergency Department.

Hay fever and allergies Perth has a particularly high pollen count which erupts during the warmer weather, leading to an epidemic of itchy noses, watery eyes, and perpetual sneezing. Although rarely necessitating a visit to the Emergency Department, the symptoms can still be debilitating.

Hot tip Antihistamines can take the scratching edge off your symptoms, however a short burst of potent nasal steroids (prescription only) will be the best relief.

Sunburn Sunburn is more than an amusing annoyance, it is a cancerous radiation burn that creeps up with the stealth of a ninja and can fry your skin quicker than you can say “aloe-vera”. Sun exposure is cumulative, and can be damaging even on mild sunny days.

Hot tip Remember Slip, Slop, Slap and get back into the habit of applying sunscreen before you head out, reapplying every two to four hours and after swimming.

Food poisoning The barbecue season is upon us and it’s not just the bird and bee type of romances going on out there. All sorts of microbiologic beings are taking advantage of the warmer weather to procreate in your food!

Hot tip Refrigerate your meat and your left overs. Don’t be responsible for the unwitting consumption of flagrantly breeding bacteria which may translate into gastrointestinal disease- there are better places to spend summer than the lavatory!

The pioneers of Royal Perth Hospital RPH has a rich history spanning more than 180-years of leading the way for Western Australia’s healthcare services and is renowned for leading the State’s, and even some of Australia’s, best medical services. As the pioneer in leading and developing WA healthcare services, the RPH legacy will be handed over to the new Fiona Stanley Hospital in February 2015 which will, no doubt, build upon what we have achieved throughout the years at RPH. We take the opportunity to recognise their outstanding achievements and thank staff for their dedicated service over the years. Bone Marrow Transplant Unit WA’s first bone marrow transplant took place at RPH on 17 January 1979 and in March 1994, the purpose built Bone Marrow Transplant Unit (BMTU) was officially opened.

The BMTU has come a long way since 1979, from patients originally isolated in plastic bed spaces called ‘life islands’ for up to eight weeks, to performing the world’s first ‘at-home’ transplant program in 1994.

 Since 1979 RPH has performed more than 1,300 bone marrow transplant procedures.

Sleep Disorders Service Providing a 24-hour service, the small group of dedicated scientists and clinicians provide around-the-clock support for the study and management of patients with Obstructive Sleep Apnoea. Today, 24 new patients are seen each week with 20 per cent referred for a sleep study.

The Burns Service As one of Australia’s leading burns service the RPH Burns Service is the source for specialist knowledge on burns injuries in WA and beyond.

With a multi-disciplined team of more than 30 staff, the Burns Service has been providing specialist services since the 1960’s.On average 400 inpatients come through the service each year with the outpatient clinic providing rehabilitation treatments to more than 5,000 patients each year.

One of the most significant achievements of the Burns Service was the treatment of 32 Bali bombing victims in 2002, led by Dr Fiona Wood. The mammoth task of treating so many seriously injured patients earned the Burns service international recognition and contributed to Dr Wood being awarded Australian of the Year in 2005.

 The Burns Service has been providing specialist services for more than 50-years and has helped more than 20,000 inpatients.

Cardiothoracics The Cardiothoracic Department performs all of the States heart and lung transplants and leads the way in organ retrieval and usage. The service is the only one in the country to achieve 100 per cent survival rate for the lifesaving pulmonary thromboarterectomy procedure.

Alongside the Cardiothoracics Department we will also farewell the Advanced Heart Failure and Cardiac Transplant Service, as well as the Transcatheter Aortic Valve Insertion (TAVI) program. The TAVI program greatly improves the quality of life for high-risk patients with heart conditions, and is the second largest program in Australasia, recently celebrating its 200th patient.

 Since the year 2000 the service has performed more than 200 transplants.

Medical Oncology The Medical Oncology Department opened in 1979 with a team of four housed in a single room next to the chapel. With the development of successful supportive therapies, treatment is now mainly outpatient based and patients can return to the comfort of their home. The Department has an active clinical trials unit and facilitates oncology outreach clinics and treatment to country centres including Geraldton, Kalgoorlie, Northam, Albany and Esperance.

Renal Transplant Unit RPH performed the first renal transplant in WA on 5 January 1967. Since then the service has grown and now performs 40 transplants each year. In July 2012, a separate Medical Renal Transplant Unit (MRTU) was formed as a sub-speciality of Nephrology to provide highly specialised care to patients. The team implemented a new program in 2012 to improve outcomes for Aboriginal patients and to-date has seen excellent results.

 The Renal Transplant Unit is the State centre for performing blood-type incompatible transplants and performs 80 per cent of the state’s Aboriginal renal transplants.

Clinical Immunology In the early 1990’s RPH’s Clinical Immunology Department was the first lab in Australia, and among the first in the world to do tissue typing with DNA sequencing, which involves using DNA to match donors for kidney, liver, lung, heart and bone marrow transplants. By using DNA to match donors, RPH has been able to increase the number of successful transplant outcomes.

 Established in 1976, Clinical Immunology is the sole Statewide provider of HIV monitoring tests.

Da Vinci trial un-clots mystery treatment Venous thromboembolism (VTE) is a significant health problem in Australia, and accounts for more than 5,000 deaths each year.

RPH researcher and Intensive Care Clinician Dr Kwok Ho has been awarded $340,000 to evaluate the effectiveness of a current method used to manage blood clots which has trauma clinicians across the world divided. Dr Ho explains that VTE is the process where a blood clot in the deep veins of usually the legs, known as deep vein thrombosis, travels and creates a blockage of the main artery in the lung.

“Most patients can be givenanti-clotting medication to prevent VTE but for patients where the risks of uncontrolled bleeding are high, such as a major trauma patient, this medication can be dangerous,” Dr Ho said.

“An alternative to the anticlotting medication is the insertion of a device called an Inferior Vena Cava filter, or IVCF, into a patient’s major vein inside the abdomen.”

Although IVCFs are already used in place of medication, Dr Ho highlights that their effectiveness in preventing VTE is still uncertain. His project, named the Da Vinci Trial, aims to assess IVCFs impacts, benefits and harms.

“My aim is to uncover evidence that looks at the value of early intervention of IVCFs, within 72-hours for patients admitted to hospital with severe injuries,” Dr Ho said.

“Providing evidence of the effectiveness of IVCFs will allow clinicians around the world to make more informed choices.

“This research has the potential to greatly impact the lives of thousands of patients both in Australia and around the world, so I am very glad to receive this support,” Dr Ho says.

Dr Ho thanks both the State Health Research Advisory Council and the RPH Medical Research Foundation who have provided the funding.

RPH leading the way in health care

Top honours at the 2014 WA Health Excellence Awards  Winner of the Primary Care category was the Improving the care of inherited high cholesterol disease in families program.  Winner of the Director General’s Award and the Aboriginal Health categories was the Closing the gap in Aboriginal kidney transplants program (front page).

The Improving the care of inherited high cholesterol disease in families program, is a joint effort by RPH, WA Health’s Health Strategy and Networks and Office of Population Health Genomics branches, PathWest and a number of other external organisations.

The program has developed a model of care to enable GP’s and other primary care providers to diagnose and treat familial hypercholesterolaemia (FH). FH is the most common and serious form of inherited high blood cholesterol and the Primary Care Model of Care for FH aims to integrate primary care services with tertiary centres, laboratories, academic centres and WA Health, so care can be provided closer to home. The program raises awareness of the disease and its treatment, and provides GPs’ with the training they need to care for patients with FH.

Top dollar grant! Director of Research, Department of Anaesthesia and Pain Medicine Professor Tomas Corcoran was recently awarded $4.6 million from the National Health and Medical Research Council, the largest research project grant awarded in the 2014- 2015 round.

Professor Corcoran is the Chief Investigator for the Perioperative Administration of Dexamethasone and Infection (PADDI) trial, and along with his colleagues will conduct a major international study investigating the safety of dexamethasone, a commonly prescribed drug used to prevent postoperative nausea and vomiting.

Achieving good outcomes Congratulations to RPH Consultant Geriatric Psychiatrist Professor Osvaldo Almeida who was recognised for his excellence in research at the 2014 Mental Health Good Outcomes Awards.

The awards recognise outstanding contributions to mental health in Western Australia and Professor Almeida won the GESB Award for improved outcomes in seniors mental health.

RPH takes P.A.R.T.Y time seriously

The RPH State Major Trauma Unit treats over 6,000 patients each year and of those patients, more than 500 are teenagers who need treatment after accidents involving alcohol or risk-taking behaviour. The Prevent Alcohol and Risk-related Trauma in Youth (P.A.R.T.Y.) Program has been running at RPH since 2006 and more than 8,000 high school students have been taken on the confronting journey of a trauma patient.

PARTY Program Coordinator Ms Michaela Copeland explains that students are taken through the arrival of a trauma patient in the Emergency Department, shown the stark reality of the Intensive Care Unit and visit patients recovering in trauma wards.

“As part of the program, a St John Ambulance paramedic and a victim of road trauma speak with students about the gruesome reality of a crash scene and the life-changing effects injuries can have on a victim and their loved ones,” said Ms Copeland. Dr Sudhakar Rao Director of Trauma Services says RPH is the first hospital in Australia to adopt the program from Canada and is now receiving national attention, with a number of States around Australia also establishing the program.

“The Program’s success prompted a recent visit from Australian Medical Association Federal President Associate Professor Brian Owler,” said Dr Rao. “Associate Professor Owler was highly impressed at our commitment to trauma prevention and the impact the program has on teenagers.”

The Program has won two awards this year, an Injury Control Council of WA Injury Prevention and Safety Excellence Award in April, and in August the WA Government Department Award at the 2014 Constable Care Child Safety Awards

Employee of the Month

Shenton Park Campus

August 2014 Joe Lopez, Patient Care Assistant Ward 2

September 2014 Michelle Watts, Clinical Nurse Specialist Ward 1

October 2014 Carlo Divito, Senior Occupational Therapist Occupational Therapy

Wellington Street Campus

August 2014 Ellen Henden, Enrolled Nurse Medical Oncology

September 2014 Ian Suttie, A/Clinical Nurse Specialist Ward 9A/B

October 2014 Gillian Watt, Staff Development Nurse Ward 9C

November 2014 Deepan Krishnasivam, Registrar Acute Medical Unit