An independent review into the $1.5 billion Lady Cilento Children’s Hospital (LCCH) in Brisbane reveals confusion and dysfunction in the fortnight following its opening, but nothing that caused long-term harm to patients.
The purpose-built hospital opened in November last year as the Royal Children’s and Mater Children’s hospitals closed.
But widespread criticism prompted Children’s Health Queensland (CHQ) to bring forward a review of the LCCH’s first two weeks of operation.
A clinical review team, headed by New South Wales chief paediatrician Professor Les White, received 96 submissions, mostly from parents and families.
It found while moving day was successful, problems arose immediately afterwards.
The review found these were caused by staff being unfamiliar with the hospital, incorrect or poorly located equipment, problems in transferring patient notes and issues with new telephone and communication systems.
CHQ chair Susan Johnston said the report covered an “incredibly challenging” time but she stood by the timing of the hospital’s opening.
The report quoted a series of submissions from staff and the families of patients.
One family wrote: “Blood pressure machines were so high most staff had difficulty reaching them. In order to take my child’s blood pressure the cot had to be manoeuvred right into the corner, as the cord was not long enough.”
Another said: “None of the children’s records had been transferred to the new system, which made it very difficult for our doctor.”
The review team found the most serious quality and safety events that occurred were assessed as “leading to minimal harm”, meaning short-term pain and distress.
“There were no cases of death, permanent harm or temporary harm found,” the report found.
“However, there were several cases where the risk of a serious safety event was averted.
“There were many reports where interventions by staff and parents and families mitigated minor risks to patient safety.”
First weeks of new facility ‘the most challenging’
Ms Johnston admitted the first few weeks proved to be a tough time for all concerned at LCCH.
“It’s always the case when you commission a new facility the first couple of weeks offer you the most risk and the most challenging concern.
“For us I think the circumstances were overlaid with some external factors, which the report acknowledges.
“What is encouraging is that the report goes out of its way to praise the dedication and vigilance and intervention of our staff, and also goes out of its way to point out there were no cases of deaths, serious injury or even temporary harm caused as a result of the move to the Lady Cilento Children’s Hospital.
She admitted several unexpected problems emerged.
“We did not know, for example, that we’d be short 1,000 bins on day one.”
She said staff worked very hard to overcome the early challenges, but remained convinced the move did not happen too quickly.
“From a clinical safety point of view, we did the right thing – we moved when it was appropriate to do so.
“It is fair to say that some aspects of the move were not ideal though, and we’d be the first to acknowledge – in fact this is the reason why the board commissioned the report.”
No serious adverse events uncovered by report
Along with submissions, the review team also considered 78 reports detailing clinical incidents, 40 complaints and feedback from interviews.
It found no serious adverse events causing long-term harm occurred in the first two weeks, and acknowledged the “dedication, vigilance and inventiveness of staff in preventing potential risk causing actual harm”.
“The consequential stress, fatigue and lowered morale requires some priority in the continuing development of the new facility,” the report concluded.
The review team did not give an assessment on performance, nor did it assess whether LCCH was ready to open when it did.
But the findings in many cases appeared to support allegations by members of staff that the hospital was opened before it was ready.
The report said the former state government’s dispute over doctor contracts delayed recruitment, and that some staff only formally learnt they had a job the day before the hospital opened.
Some staff members still have not received a full orientation, while some “expressed a high level of frustration” at not knowing how their concerns, once reported, were being handled and when they were likely to be resolved, the report said.
They also expressed “continued frustration” with information systems.
“There is a continued lack of confidence in the referral management process and outpatient scheduling system as well as concerns over the inability of information systems to support contemporary clinical care models,” it says.
For the first time in Queensland, private provider Medirest was contracted to manage cleaning, linen and laundry, patient food, pest control and porterage.
The report found cleaning staff were considered undertrained for the speed or standards in the acute hospital environment.
“I had to teach the cleaner how to clean a room for the (immuno-compromised) patient,” one staff member wrote.
Another said: “There were no bins whatsoever. In my first clinic there was no soap in the dispensers, no examination equipment on the walls.”
The report found the concept of “urgent request” meant different things to Medirest staff compared with doctors and nurses.
“It was difficult to determine how many of these ‘urgent’ requests were delayed by the telecommunications system problems which further complicated responses,” the report said.
Many clinical staff said they transported the patients themselves because of delays or porters not arriving at all.
Other examples included doors being left open in the mental health unit and delays in cleaning beds.
There were also significant problems with switchboard, although the report said a telecommunications taskforce was established in December and most of the issues had since been rectified.