IT systems are continuing to cause headaches for patients and staff at the new $2 billion Fiona Stanley Hospital, which had its opening delayed by months largely because of problems with the advanced technology.
The litany of IT issues are outlined in a long-awaited review of clinical services at the hospital, which was ordered after a string of complaints about patient care, and released last week.
Fiona Stanley Hospital (FSH) was the first in WA to implement a digital medical record (DMR) system and each patient also has a bedside computer to order food.
The review revealed long delays to access patients’ records and to admit and manage them because of integration issues with the DMR system.
It also revealed disabled and elderly patients had been unable to order food because they did not know how to use the bedside computers.
“Currently to open all applications within the DMR to admit and manage a patient takes approximately 15 minutes due to the integration issue,” the review stated.
“Problems were also reported with the DMR’s inability to put an alert on the system (warning about an impending potential issue e.g. a reaction to a type of drug or the need for the patient to be seen urgently); this was seen as a safety and quality issue.”
The DMR system allows each patient’s clinical notes to be available to multiple staff members at the same time, which means, for example, the surgical team can access a patient’s notes on a ward at the same time as a social worker can be accessing them to facilitate a patient’s transfer to a rehabilitation facility.
“Technology changes are also an issue within the outpatients department where it can also take in excess of 15 minutes to open all the software to manage patient’s notes,” the review stated.
More staff hired after failure of cardiac equipment
The review found the hospital has been hit with additional expenses because of the intermittent failure of the cardiac telemetry system, which has required specialist nursing staff to be brought in to monitor cardiac patients.
“Currently the system fails intermittently and the source of failure remains obscure,” the review stated.
“The facility manager subcontracted IT network services [to British Telecom], electronic equipment installation and maintenance [to Siemens] and has purchased a Philips telemetry system.
“To mitigate patient risk, senior cardiac trained nurses are rostered to monitor patients in the cardiac wards, necessitating extra expense by the hospital to ensure patient safety.”
Staff also raised concerns with the review team that work on fixing the IT problems at Fiona Stanley Hospital would be further delayed because the same IT staff would be installing systems at the new children’s hospital at the QEII Medical Centre site.
The review also revealed the establishment of an all-encompassing help desk, combining telephony with numerous support services including IT support and patient and relative inquiries, continued to cause challenges.
As well as IT issues the review, conducted over a four-week period from April 24 to May 22, 2015, reveals at that time there was a shortage of 40 full-time equivalent (FTE) midwifery positions at the hospital.
“The current vacancy rate is limiting the capacity of the service to deliver a safe, quality service and any increase in activity will further exacerbate this situation,” the review states.
“Skills mix of the midwifery team is also of concern with the increased acuity of some unbooked and complex pregnant women presenting to FSH.”
There were also more than 13 FTE nursing positions vacant within the neonatal unit at the time of the review.
Porters not allowed to touch patients
A separate problem was that the contract with the private-service provider did not allow for porters to physically touch patients.
The report said this created a major difficulty for the hospital because a significant part of the porter’s role is transferring patients to and from beds, wheelchairs and theatre tables.
“FSH has subsequently employed 120 assistants in nursing and Serco has added 70 additional porters to meet the hospital needs,” the review states.
“This is both inefficient and costly.
“Clinical staff reported instances where three individuals were each required to perform a task such as moving a patient from theatre and cleaning the theatre floors that in other jurisdictions would be performed by only one person.”
In a statement, FSH acting executive director Dr Paul Mark said where the reviewers had identified areas for improvement the hospital was already taking steps to address them.
Dr Mark said further improvements were being undertaken to the hospital’s DMR system as part of WA Health’s ongoing process of improvement to IT systems across all hospitals.
The hospital was confident all initial problems with the specialist heart monitoring system, known as the cardiac telemetry system, had been addressed.
“We are continuing to monitor the telemetry devices for a period of time to ensure patient safety, however anticipate this will be withdrawn sometime later this week,” Dr Mark said.
Acting Health Minister John Day and the Health Department have been contacted for comment.