GUIDE TO THE ROLE DELINEATION OF HEALTH ... - moh.govt.nz€¦ · of Hospital Roles" which was widely distributed for comment, and in 1986 the "Guide to the Delineation of the Roles

cn 1IiiI

r--____ 1_ - - - - 111110,low- - I.-CA wac

coC I

I

GUIDE TO THE ROLE DELINEATION OFHEALTH SERVICES IN NEW ZEALAND

WORKING DRAFT SEPTEMBER 1993

094280

CROWN HEALTH ENTERPRISE MONITORING UNIT

11/92 1111H Jo ,crlSiu!N

SZ)(.\J2S UO.04tj.

11UD uo!puuoJuI

Published by:

Crown Health Enterprise Monitoring Unit

Copies available fromCrown Health Enterprise Monitoring Unit

First New Zealand Working Draft - September 1993 Contact Officer:Malcolm InglisCrown Health Enterprise Monitoring UnitP0 Box 55WellingtonPh: 04 499 6070Fx: 04473 1717

11/92

-

TABLE OF CONTENTSPAGE

INTRODUCTION .............................................................................. 1.05FORMAT OF THE GUIDE ........................................................................ 1.08HOW TO USE THIS GUIDE....................................................................... 1.11ACKNOWLEDGEMENTS........................................................................ 1.12

PART 1CLINICAL SUPPORT SERVICES SERVICE NUMBER PAGE

Pathology .................................... 1.......................................... 1 .1 .1Pharmacy .................................... 2.......................................... 1.2.1Diagnostic Radiology (X-Ray) ....................... 3.......................................... 1 .3.1Nuclear Medicine............................... 4.......................................... 1.4.1Anaesthetics ................................... 5........................................... 1.5.1IntensiveCare.................................6...........................................1.6.1CoronaryCare.................................. 7.......................................... 1.7.1OperatingSuites............................... 8.......................................... 1.8.1

PART 2BASIC CLINICAL SERVICES

EmergencyServices............................. 9.......................................... 2.1.1

MEDICINE

General Medicine...............................10.........................................2.2.1Cardiology .................................... 11......................................... 2.3.1Dermatology .................................. 12......................................... 2.4.1Endocrinology................................... 13.......................................... 2.5.1Gastroenterology............................... 14......................................... 2.6.1Haematology - Clinical............................15.........................................2.7.1Immunology ................................... 16.......................................... 2.8.1Infectious Diseases .............................. 17......................................... 2.9.1Neurology .................................... 18........................................ 2.10.1Oncology - Medical ..............................19........................................2.11.1

1.01

11192

MEDICINE (Cont'd)SERVICE NUMBER PAGE

Oncology - Radiotherapeutic....................... 20........................................ 2.12.1RenalMedicine ................................. 21........................................ 2.13.1Respiratory Medicine............................ 22......................................... 2.14.1Rheumatology................................. 23......................................... 2.15.1

SURGERY

General Surgery ................................ 24......................................... 2.16.1Burns ....................................... 25........................................ 2.17.1Cardiothoracic Surgery........................... 26........................................ 2.18.1Day Surgery.................................. 27........................................ 2.19.1Ear, Nose & Throat .............................. 28........................................ 2.20.1Gynaecology.................................. 29......................................... 2.21.1Neurosurgery .................................. 30........................................ 2.22.1Ophthalmology ................................. 31.........................................2.23.1Orthopaedics .................................. 32......................................... 2.24.1Plastic Surgery ................................. 33........................................ 2.25.1Urology ...................................... 34........................................ 2.26.1VascularSurgery............................... 35........................................ 2.27.1

MATERNAL AND CHILD

Obstetrics .................................... 36........................................ 2.28.1Neonatal ..................................... 37........................................ 2.29.1Paediatric Medicine .............................. 38......................................... 2.30.1Paediatric Surgery.............................. 39........................................ 2.31.1Family & Child Health ............................ 40........................................ 2.32.1

1.02

11/92

INTEGRATED COMMUNITY & HOSPITAL SERVICES

Adolescent Health.............................. 41........................................ 2.33.1Adult Mental Health............................. 42........................................ 2.34.1Child Protection Services .......................... 43........................................ 2.35.1DentalHealth .................................. 44........................................ 2.36.1Drug & Alcohol Services ........................... 45........................................ 2.37.1Geriatrics ...................................... 46........................................ 2.38.1Health Promotion............................... 47........................................ 2.39.1HIV/AIDS.................................... 48........................................ 2.40.1Palliative Care/Hospice Services ..................... 49........................................ 2.41.1Rehabilitation .................................. 50........................................ 2.42.1Sexual Assault Services.......................... 51......................................... 2.43.1

PRIMARILY COMMUNITY HEALTH SERVICES

MaoriHealth.................................. 52........................................ 2.44.1Community Health - General ....................... 53........................................ 2.45.1Community/Domicilary Nursing ...................... 54........................................ 2.46.1Migrant/Refugee Health ........................... 55.......................................... 2.47.1Pacific People's Health........................... 56......................................... 2.48.1Sexual Health Services (S.T.D. Services) ............... 57......................................... 2.49.1Women's Health ................................ 58........................................ 2.50.1

PART SUMMARY SHEETS

Support Services Reference Card - Summary of Clinical Support Service Levels ................................. 1.9.1Hospital/Community Health Service Summary Sheets ................................................... 3.1.1Area/Region Health Service Summary Sheets........................................................ 3.2.1

1.03

11/92

-

PART 4APPENDICES

Medical and Nursing Staff Definitions (Appendix I) ......................................................4.1.1Levels of Risk (Appendix II).....................................................................4.2.1Indicative List of Surgical Procedures (Appendix Ill)....................................................4.3.1Trauma Services Correlated with Hospital Role Delineations (Appendix IV)....................................4.4.1Glossary...................................................................................4.5.1

PART 5INDEX ....................................................................................5.1.1

1.04

11/92

GUIDE TO THE ROLE DELINEATION OF HEALTH SERVICES IN NEW ZEALAND

INTRODUCTION

History This Guide is adapted for New Zealand conditions from an Australian publication of the New South Wales Departmentof Health. Full acknowledgement is given to the NSW Department for the work that has been done to produce theGuide and for allowing its adaptation for use in New Zealand. Adaptation has entailed a major rewrite of some sectionsand some minor changes on nearly every page.

In 1983 the Department of Health in New South Wales published a document entitled "Interim Guide to the Delineationof Hospital Roles" which was widely distributed for comment, and in 1986 the "Guide to the Delineation of the Rolesof Area Health Services and Hospitals" was issued. Since the mid 1980's role delineation has been applied in NSWin the capital planning of hospital facilities and in the strategic planning of services.

The guidelines were progressively revised and improved in New South Wales. Following the release of the 1990"Manual for the Role Delineation of Health Services and Hospitals, (Draft)", extensive formal consultation wasundertaken which allowed a further major revision in 1991, and the publication of the "Guide to the Role Delineationof Health Services". It is this 1991 publication that was adapted for use in New Zealand and which is now releasedas a first working draft for New Zealand conditions.

Definition Role delineation is a process which determines that the support services, staff profile, minimum safety standards andother requirements are provided to ensure that clinical services are provided safely and appropriately supported . Theaim of the Guide is to provide a consistent language which health care providers and planners can use when describinghealth services, and a tool for use when planning service developments.

The role level of a service describes the complexity of the clinical activity undertaken by that service, and is chieflydetermined by the presence of medical, nursing and other health care personnel who hold qualifications compatiblewith the defined level of care. Adequate formal appointment and credentialling processes are therefore essential forstaff in all facilities. This document does not present a description of or criteria for credentialling'11.

" Credentialling. See also page 4.1.11.05

11192

The Guide does not attempt to describe all the services which are provided by health care facilities, but confines itselfto those which are the services most generally provided by hospitals and community health facilities. The clinicalservices are presented in three major groupings: in-patient care, hospital services which are integrated with community-based services, and primarily community-based health services.

Services not described in the Guide should be covered by appropriate hospital policy. For example, the safety ofservices which depend on medical equipment must be ensured by a formal equipment maintenance program.Equipment not covered under operational maintenance contracts should be maintained by an appropriately constitutedBiomedical Engineering Service.

Application The Guide to Role Delineation applies to all public health service providers but especially to Crown Health Enterprises(CHEs). It is also of value to Regional Health Authorities (RHAs) in planning to purchase services. When developingfunctional and strategic plans, CHEs should use this document to describe the size, service profile and roles of theirinstitutions. The Guide is used as a tool to determine the necessary support services once basic clinical service levelsare resolved, or to provide a common language when describing services.

Once support and basic clinical services are delineated the CHE Board is responsible for ensuring that the criteria setout in this Guide for each service's level are maintained.

Interpretation When determining the levels in basic clinical services in each hospital or community health service, networking canbe considered. Some support services may be required to be on-site for clinical reasons (eg. intensive care). Wherethere are off-site support services available in an area or from an adjacent CHE a hospital may be credited with havingthat support service, if there is equivalent functional access to that service and if patient care is not compromised bythat service being off-site. Off-site support services must provide the same level of support or the skills ofappropriately credentialled staff which would apply were they on site.

The guide should be applied with a degree of flexibility which gives consideration to the functional level of services.Thus, a service need not satisfy all the stated criteria in order to achieve a particular level, as long as the service isprovided at a level of safety which is equivalent to that described in the guide for the level concerned.

11/92

Services described in the Medical and Surgical sections of the Guide may be provided wholly or partly on an outpatientbasis. The standards established for the inpatient service continue to apply in these instances. Similarly, it is assumedthat appropriate arrangements will be made for the completion of care of recently discharged patients, for example,by the use of the outpatients and allied health departments, and early discharge programs.

All services should have access to interpreter services and Continuous Quality Improvement plans (C.Q.l. plans). C.Q.I.activities in Level 1 and 2 services should, where possible, be complemented by participation in C.Q.I. networks withservices of similar and higher levels. In the future all patients/clients will have access to a Patient Advocate.

Overview Role delineation provides health service planners and providers with a common language to describe the servicesavailable and the minimum support services required for safety, and a tool to facilitate the development of services.The exercise of delineating health service roles should be co-ordinated by the Regional Health Authorities, and havea flexible approach in achieving service levels to best meet the needs of the community.

1.07

11/92

-U

FORMAT OF THE GUIDE

The Manual is presented in five different but interrelated parts.

Part 1 - Clinical Support Services

These 8 clinical (as opposed to "hotel" type) support services are primarily hospital based and areessential to the successful provision of basic clinical services. They are as follows:

1. Pathology2. Pharmacy3. Diagnostic Radiology (X-Ray)4. Nuclear Medicine

Part 2 - Basic Clinical Services

5. Anaesthetics6. Intensive care7. Coronary Care8. Operating Suite

This section comprises 58 major specialty areas with up to seven levels of service (0-6)in increasing complexity.

In some medical and surgical specialities lower levels are not represented as suchactivities are defined in General Medicine and General Surgery.

The basic clinical services fall into 6 categories:- Emergency, Medical, Surgical,Maternal and Child, Integrated Community and Hospital Services, and PrimarilyCommunity Health Services. They have flagged dividers for ease of reference.

In surgical specialties and anaesthetics the general terms "good, moderate and badrisk" have been used (definitions in Appendix II, page 4.2.1), rather than more specificdefinitions, to allow scope for varying circumstance and appropriate clinical judgement.The anaesthetic risk scale is based on that produced by the American Society ofAnaesthesiologists (Appendix II, page 4.2.1) and made available by the College ofAnaesthetists of Australia and New Zealand. The levels described relate to non-emergency situations. It is accepted that circumstances where life or limb isthreatened need special consideration.

1.08

11/92

Continued

Complexity of surgical procedures are described in the Guide as "minor", "common and intermediate", "major"and "complex major". The list given in Appendix Ill, page 4.3.1, entitled "Indicative List of SurgicalProcedures" is intended only as a guide to the meaning of those terms and is not prescriptive of the procedureswhich may be performed in each category. The actual range of surgical procedures which may be performedby individual practitioners appointed to a general or subspecialty surgical service of a given level will bedetermined through the credentialling process by which clinical privileges are granted. Acknowledgement isgiven to the Royal Australasian College of Surgeons for their assistance with the indicative list.

Levels of clinical services recognise the interdisciplinary nature of health by including different staffrequirements at the various levels. Definitions of staff titles used are in pages 4.1.1 - 4.1.3.

Trauma Services Currently New Zealand has no national policy on Trauma Services. In Australia Trauma Service levels havebeen described in the "Policy for Trauma Services" released by the NSW Department of Health (ISBN-07305-3317-4), in circular 89/73, and in the State Trauma Plan released in April, 1991. The correlation of NSWhospital role levels with the NSW Trauma Service levels, based on the NSW Trauma Plan, appears in AppendixIV, page 4.4.1. These levels will be of interest to those planning such services in New Zealand.

1.09

11/92

Part 3 - Summary Sheets

Two types of Summary Sheets are provided for the convenience of those undertakingthe role delineation of health care facilities. There is one for individual hospitals orcommunity health services, and one for Areas and Regions. A basic clinical servicesreference card is also provided for ease of use. This is located with page 1.9.1.

Part 4 - Appendices

The Appendices contain important supporting and definitional material and should beconsulted regularly during the role delineation process. Throughout the text, there arefootnotes to direct the user to the appropriate Appendix.

Part 5 - Index

An index is provided to assist with cross referencing.

1.10

11/92

HOW TO USE THIS GUIDE

WHEN DESCRIBING SERVICES

Step 1 Each of the 8 clinical support services (Part 1) should be assessed for your facility. The support servicesreference card should then be completed, and used when assessing the level for each basic clinical service.

Step 2 Basic clinical services (Part 2) should then be assessed, service by service, and recorded in the summary sheetsin Part 3.

Step 3 Area/Region summary sheet (Part 3) should then be completed if appropriate.

IN STRATEGIC AND FUNCTIONAL PLANNING

Step 1 Refer to Area/Region strategic plan for basic clinical services as required for facilities concerned.

Step 2 Using the text in this Guide, assign role levels to each service according to requirements in strategic plan.

Step 3 Complete the basic clinical services reference card for actual levels of support services. Refer to supportservices matrix in appropriate level of basic clinical services and list required levels of support services onreference card.

Step 4 By comparing existing and required support services, identify necessary changes. 1.11

11/92

ACKNOWLEDGEMENTS

The Crown Health Enterprises Monitoring Unit is grateful for the generous assistance and collaboration of the New South Wales Department ofHealth in making the 1991 Guide available for adaptation to New Zealand conditions. The text of the 1991 Guide has been modified as necessaryfor its use in New Zealand. Modifications for this first New Zealand draft (1993) were made by a working party as follows:

Emeritus Professor Derek North F.R.A.C.P

Ms Sally Shaw R.G.O.N. M.P.H.

Mr Edward Watson F.R.A.C.S.

-Retired Paediatrician and Health AdministratorLower Hutt

-Chief Medical AdvisorMinistry of HealthWellington

-Emeritus Professor of Medicine, University of AucklandAuckland

- Chief Executive OfficerEastbay Health LimitedWhakatane

-Retired Surgical SpecialistWellington

Dr Richard Bush F.R.A.C.P.(Convenor)

Dr Sharon Kletchko F.R.C.P.C.

A number of other health service personnel have assisted with advice and this is gratefully acknowledged.

Special appreciation is given to Ms Gayle Nolan who retyped the document from the NSW original.

This first 1993 New Zealand draft will be a dynamic document requiring modification. Comments should be directed to the Crown Health EnterpriseMonitoring Unit, P 0 Box 55, Wellington.

1.12

11/92

- - -

PART 1

CLINICAL SUPPORT SERVICES

PART 1

CLINICAL SUPPORT SERVICES

11/92

mom

1 PATHOLOGY

LEVEL DESCRIPTION

0No service.

1No on site pathology service. Blood and specimen collecting service, 24 hours per day, seven days per week. Collection of specimens controlled by,and responsibility of, an approved licensing authority (e.g. TELARC). Has a Continuous Quality Improvement pla&2.

2As Level 1 plus crossed matched blood available within one hour and blood storage facilities on site.

3As Level 2. A range of urgent tests readily available, including haemoglobin, blood gas analysis, Na, K. Keeps infection control records and monitorsthem.

4 As Level 3 plus basic pathology service on site. Has formal department of pathology with medical director. Performs range of service as in 3 plus definedrange of routine tests for a single hospital or group of hospitals. Has blood bank with on-site cross-matching. Cytology and frozen sections are availableon campus. Locally managed, but with formal link to large laboratory. 24hr on call service.

5 As Level 4 plus large pathology department providing 24hr on site service. Has full-time medical director and more than one pathologist. May provideservices for other hospitals (Group Laboratory). Divided into common subsections, e.g. Biochemistry, Haematology, etc. Each subsection has trainedtechnician in charge. May have pathology registrar". May have teaching and research role. Full involvement in infection control.

6As Level 5. All or most pathology subsections represented, each with medical director in charge. May provide National referral service. Has teachingand research role. Has pathology registrar". Immunology and virology may be available on campus.

' See"Medical and Nursing Staff Definitions in Appendix I; page: 4.1.1(2) See "Glossary, page 4.5.1.

1.1.1

11/92

2 PHARMACY

LEVEL DESCRIPTION

1 Drugs supplied on individual prescription from retail pharmacy, or drugs from a networked hospital. No pharmacist employed but regular visits frompharmacists associated with provision of the service. Visiting pharmacist may participate in Drug and Therapeutics Committee or equivalent. Has aContinuous Quality Improvement plan W . Complies with Code of Practice for Hospital Pharmacy Services.

2 As Level 1 plus pharmacist employed on part-time or sessional basis. Co-ordination of drug distribution from community pharmacy or Regional/Areasource. Limited clinical service. May provide patient and staff education. May participate in ward meetings or rounds and may have clinical servicesprovision. Has an established and regularly updated pharmacopoeia.

3 As Level 2 with at least one pharmacist employed full time. May also have support staff. May provide pre-registration training for pharmacists.Pharmacy-controlled drug distribution to in-patients. Clinical service includes drug information, drug monitoring, utilisation review, adverse drug reactionreporting. Has limited participation in ward meetings and rounds and provides patient and staff education programs. May be involved indomicilIary/community care. May provide outpatient service.

4 As Level 3 plus more than one permanent full-time pharmacist employed plus support staff. Pharmacist on-call for emergency advice. Director ofPharmacy involved in Drug (or Pharmacy and Therapeutics) Committee or equivalent. May have limited sterile and non-sterile manufacturing services,but must comply with Part Ill N.Z. Code of Good Manufacturing Practice.

5 As Level 4 plus provides regular drug information service and bulletins. Participation in ward rounds or meetings. Has clinical pharmacy service. Musthave outpatient service. Has staff development and training program for pharmacy staff. Sterile IV admixture service including cytoxic drugs if clinicalunit present in hospital. Facilities to standard of Part Ill of N.Z. Code of Good Manufacturing Practice. May supply to other hospitals. Clinical trialsupport for research activities in hospital.

6

As Level 5 plus extensive involvement in research, clinical trials, clinical review. Must have intensive clinical pharmacy service including a programmefor therapeutic drug monitoring. Provides pre- and post-graduate pharmacy training. Has pharmacist on call 24 hours.

(1) See"Glossary", page 4.5.1 1.2.1

11192

3 DIAGNOSTIC RADIOLOGY (X-RAY)

LEVEL DESCRIPTION

0No service.

1Visiting/mobile service and limited to X-ray of extremities, chest, abdomen. Has a Continuous Quality Improvement plan 121 . Interpreter serviceavailabl&21.

2As Level 1 plus access to designated room with bucky table. Has film processing capacity.

3As Level 2 plus has on site designated room with bucky table. Access to fluoroscopy facility. Has mobile condenser discharge (CD) for perioperativeuse. Radiographer in attendance who has regular access to radiologist consultation. Ultrasound capacity for foetal monitoring.

4 As Level 3 with facilities for general X-ray, fluoroscopy, in addition to mobile CD for wards, operating suite and A.& E. (where present). Has automaticfilm processing capacity. Has mobile image intensifier in theatre and/or CCU or ICU. Has staff radiographer on call 24 hours. Has specialist radiologistappointed. Requires ultrasound capacity and/or a CAT scanner. Registered nurse as required. Level 3 Anaesthetics, ICU, CCU and Operating Suiteservices are required on site.

5 As Level 4 plus established Department. Full ultrasound service available. Has radiologist in charge. May have radiology registrar' 11 . Has registerednurse'". 24hr on site service for urgent x-rays. CAT scanner on site or locally available. Level 3 Pharmacy and Level 4 Pathology, Anaesthetics, ICUand Operating Suite services are required on site.

6 As Level 5 plus special rooms for cardiac investigation and digital angiography, neuro-radiology etc. CAT scan and full ultrasound service, appropriatelystaffed, available 24 hours. May have MRI, digital angiography or cardiac catheter laboratory. Has radiology registrar'". Performs invasive procedures.Level 4 Pharmacy and Level 5 Pathology, ICU, CCU and Level 6 Operating Suite Services are required on site.

See "Medical and Nursing Staff Definitions" in Appendix 1, page: 4.1.1.(2) See "Glossary", p. 4.5.1.

1.3.1

11/92

4 NUCLEAR MEDICINE

LEVEL DESCRIPTION

0No service.

3Access to a Level 4 Nuclear Medicine facility. Has a Continuous Quality Improvement plan 2 . Interpreter service availabl&2.

4 On site facility which includes at least a gamma camera and computer based quantitation. Has nuclear medicine physician appointed with trainedtechnicians; may have scientific officer; registered nurse"' support where necessary. Level 3 Pathology, Pharmacy, Anaesthetics, ICU and CCU servicesand Level 4 Diagnostic Radiology service, are required on site.

5 As Level 4 plus more than one gamma camera including at least one SPECT camera and able to perform more demanding studies related to specialiseddiagnoses and special groups, e.g. children. More than one Nuclear Medicine Physician. Medical registrar". Has scientific officers and physicist;ultrasound may be available; 24hr on call service. Adequate "hot laboratory" facilities for radioisotope treatment of thyrotoxicosis. Level 4 servicesfor Pathology, Pharmacy, Anaesthetics, ICU and CCU are required on site.

6 As Level 5 plus routinely undertakes research projects. Has registered nurse"'. May have positron emission tomography. May have bone densitometerand neutron activation analysis. Access to magnetic resonance imaging (MRI). Holding tanks for radioactive waste disposal. May have radiopharmacist.Has radiation safety officer. Level 5 services required for Pathology, Pharmacy, Diagnostic Radiology, Anaesthetics, ICU and CCU.

See "Medical and Nursing Staff Definitions" in Appendix 1, page: 4.1.1.(2) See "Glossary". page 4.5.1.

1.4.1

11/92

--

5 ANAESTHETICS

LEVEL DESCRIPTION MINIMUM LEVEL OF SUPPORT SERVICES

PPXNAIC0

ahRMnCCp

taaeeUUI

hryds S

0No service Not applicable

1Analgesia/sedation available by medical officer. Has a Continuous Quality Improvement plan'3'.100-010Interpreter service available'31.

2As Level 1 plus general anaesthetics on good risk 121 patients given by accredited medical1120-212practitioner (anaesthetics)'". May have specialist anaesthetist' 1 ' appointed for consultation.

3As Level 2 plus specialist anaesthetist" appointed for consultation and to provide service for 3230-333moderate risk 12) patients. Specific operating room anaesthetic staff support available.

4As Level 3 plus specialist anaesthetist'" on 24hr roster for good, moderate and bad risk'2' 4443-433patients. Nominated specialist director of anaesthetic staff. Medical officer(s)'" on site 24 hours.

5

As Level 4 plus specialist anaesthetic staff on site during day. Anaesthetic registrar' 1 ' on site 24 4454-443hours or available within 10 minutes. May have teaching and research role.

6

As Level 5, with subspecialists, research and teaching of graduates and undergraduates. 24hr 5555-556on site anaesthetic registrar'". Has teaching and research role.

See "Medical and Nursing Staff Definitions" in Appendix 1, page: 4.1.1.(2) See "Levels of Risk" in Appendix II, page: 4.2.1.

See "Glossary". page 4.5.1. 1.5.1

11/92

6 INTENSIVE CARE

LEVEL

DESCRIPTION MINIMUM LEVEL OF SUPPORT SERVICES

PPXNAIC0aIiRM, nCCptaaeaUU

0No service. Not applicable

2

Recovery area for post-operative patients or high dependency area for general ward patients 22202-10requiring observation over and above that available in general ward area. Registered nursingequivalent to 4 hours/patient/day (1:6) desirable. Has a Continuous Quality Improvement plan121.Interpreter service availabl&2t.

3

As Level 2 plus 24hr access to medical officert on site or available within 10 minutes. 32303-32Registered nursing equivalent to 6 hours/patient/day (1:4) desirable for designated highdependency beds. Has a unit manager"'. Separate recovery area preferable. The services of aspecialist paediatrician are essential for children requiring management in Level 3 Intensive Care.Liaison psychiatry available.

4As Level 3 plus separate area with minimum 4-6 beds. Defined admission and discharge policies 44434-33and patient care review. Nominated specialist director with designated daytime medical officertand priority for 24 hour medical officer cover plus medical registrar"' on site or available within10 minutes. Specialist on call 24 hours. Registered nursing equivalent to 8 hours/patient/day(1:3) is desirable, or according to dependency of patients. Has unit manager"' and experiencedregistered nurses"'. 24 hour access to physiotherapist. Capable of short to medium termventilation. Simple invasive monitoring.

m See "Medical and Nursing Staff Definitions" in Appendix 1, page: 4.1.1.(21 See "Glossary", page 4.5.1.

1.6.1

11/92

Continued

6 INTENSIVE CARE

MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCptaa00UUIhryds S

LEVEL

DESCRIPTION

5As Level 4 plus designated medical officer(s)'" on site 24 hours and specialist director on site 55545-44during day. Capable of medium term ventilation and external life supports. Can provide limitedisolation facilities. Registered nursing equivalent to 16 hours/patient/day (1:1.3) desirable, oraccording to dependency of patients. Access to specialist clinical nurse is desirable'". Formalaudit and review of procedures. Link with Level 5 Rehabilitation Service.

6As Level 5 plus medical and/or ICU registrar" ) on site 24 hours. Supported by consultants and 55656-56full-time staff specialists. Capable of all forms of Intensive Care monitoring and therapy ofcritically ill in all environments, having sub-specialty intensive care units. Registered nursingequivalent to 24hr/patient/day (1:1) desirable, or according to dependency of patients. Mayprovide specialty training posts for ICU registrars. Participates in research.

See "Medical and Nursing Staff Definitions" in Appendix 1, page: 4.1.1.

1.6.2

11/92

7 CORONARY CARE

LEVEL DESCRIPTION MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCptaaeeUUIhryds S

0No planned service. Can provide cardiopulmonary resuscitation. Not applicable

1Capable of providing Basic Life Support prior to referral to a more sophisticated unit. Basic111010-0resuscitation equipment available. Has a Continuous Quality Improvement plafl12. Interpreterservice

3Intensive Care with bedside monitoring of coronary care patients. Has 24hr access to medical 323033-2rostered for emergencies on site or within 10 minutes. Registered nursing equivalent to

6 hours/patient/day (1:4) desirable, or according to dependency of patient. Has a unit manager(".

4As Level 3 plus designated coronary care area (') with clearly defined admission and discharge 434344-3policy and patient care review. Nominated specialist director. Day time medical officer(s)'";experienced medical officer(s) (" on call after hours. Has cardiologist or general physician on call24 hours. Registered nursing equivalent to 8 hours/patient/day (1:3) desirable or according todependency of patient. Has experienced registered nurses'" Has bedside and central monitoring.

5As Level 4 plus rostered cardiologist director. Cardiologist/general physicians on call 24 hours. 555555Medical officer(s)' 1 ' on site 24 hours. Has medical registrar" ) on call 24 hours. Invasivemonitoring available. Isolation facilities available. Registered nursing equivalent to approximately12 hours/patient/day (1:2) desirable, or according to dependency of patient. Access to specialistclinical nurse is

(1) See "Medical and Nursing Staff Definitions" in Appendix 1. page: 4.1.1.(2) See "Glossary". page 4.5.1.(3) Not necessarily physically separate from ICU. May be within the ICU facility. 1.7.1

11/92

Continued

7 CORONARY CARE

MINIMUM LEVEL OF SUPPORT SERVICESPPXNA1C0ahRMnCCptaaeeUUIhryds S

LEVEL

DESCRIPTION

6As Level 5 plus specialist cardiologists with procedural expertise available on site or available556566-6within 10 minutes on 24hr basis. Capable of all forms of cardiac assessment, monitoring andtherapy including bypass support. Access to cardiac surgery. Registered nursing equivalent to16 hours/patient/day (1:1.3) desirable, or according to dependency of patient. Has cardiologyregistrar 3 . Medical registrar" on site 24 hours.

Not necessarily physically separate from ICU. May be within the ICU facility.(1) See "Medical and Nursing Staff Definitions" in Appendix 1, page: 4.1.1.

Designated registrar may be advanced trainee (RACP)

1.7.2

11192

-a

8 OPERATING SUITE SERVICES

LEVEL

DESCRIPTION

0No service

2Operating room equipped for minor' diagnostic and therapeutic surgical procedures. Anaesthetic induction undertaken within area. Recovery for postsurgical procedures combined with general ward. Has a Continuous Quality Improvement plan 31 . Interpreter service availabl&31.

3 As Level 2 plus operating room equipped for intermediat& 1 surgical and day surgery procedures. The facilities for inpatients and day patients musthave comparable standards with regard to size of operating theatre, lighting, ventilation, equipment and quality of staff, including anaesthetic andtechnical staff. More than one operating room. Separate anaesthetic room. Separate recovery area with registered nurse for every 3 recoveringpatients. A minimum of 3 nurses of whom one should be a registered nurse per operating team. The surgeon's assistant (where applicable) would bean additional team member. Has a unit manager (2).

4 As Level 3 plus operating room equipped for major"' procedures. Inpatient admisson area should be separate from day patient admission and receptionarea. Xray and pathology services should be available equally to both groups of surgical patients. More than two operating rooms. There may beseparate operating room for day surgery and special endoscopy procedures. Separate recovery area with full time staff. Experienced registered nurses'2available 24 hours.

6As Level 4 plus operating rooms equipped for major and complex major" diagnostic and treatment procedures. May have extra ventilation and otherdedicated facilities. Specialist units and teaching role. Access to specialist clinical nurse" ) is desirable.

" See "Indicative List of Surgical Procedures" Appendix III, page: 4.3.1(2) See "Medical and Nursing Staff Definitions" in Appendix I, page: 4.1.1

See "Glossary", page 4.5.2.

1.8.1

11/92

SUPPORT SERVICES REFERENCE CARD

1. ISummarise existing support service levels on left hand side of card, and planned support service levels on right hand side.

2. Use the card when referring to minimum level of support services required for each core service.

SUPPORT SERVICES REFERENCE CARD

1

Summarise existing support service levels on left hand side of card, and planned support service levels on right hand side.

2

Use the card when referring to minimum level of support services required for each core service.

1.9.1

11192

PART 2

BASIC CLINICAL SERVICES

PART 2

BASIC CLINICAL SERVICES

11192

EMERGENCY SERVICES

EMERGENCY SERVICES

11/92

9 EMERGENCY SERVICES

MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCptaaeaUUIhryds S

LEVEL

DESCRIPTION


No planned Emergency Service. Able to provide first aid and treatment prior to moving to higher1101010level of service, if necessary. Access to a medical practitioner. Has a Continuous QualityImprovement plan 131 . Interpreter service available131.

2Emergency service in small hospital. Designated assessment and treatment area. Can cope with 11201210minor injuries and ailments. Resuscitation and limited stabilisation capacity prior to referral tohigher level of care. Nursing staff" from ward available to cover emergency presentations.Visiting medical officer on call. May be Local Trauma

3As Level 2 plus designated nursing staff"' available 24hr. Has a unit manager". Some registered 32303333nurses having completed or undertaking relevant post-basic studies. Has 24hr access to medical

on site or available within 10 minutes. Specialists in General Surgery, Anaesthetics,-Paediatrics and Medicine available for consultation. Full resuscitation facilities in separate area.

Access to allied health professionals and liaison psychiatry.

4As Level 3 plus can manage most emergencies. Purpose designed area. Full-time director. 44434444Experienced medical officer(s)" ) and nursing staff"' on site 24 hours. Experienced registerednurses(l) on site 24 hours. Specialists in general surgery, paediatrics, orthopaedics, anaestheticsand medicine on call 24 hours. May send out medical and nursing teams to disaster site.Participation in regional adult retrieval system (country base hospitals) is desirable. May be anArea Trauma Service (2)

Footnotes are on page 2.1.2

2.1.1

11/92

Continued



PPXNAIC0

ahRMnCCp

taaaeUUI

hrvdS S

5As Level 4 plus can manage all emergencies and provide definitive care for most. Access to 45534554specialist clinical nurse" is desirable. Has undergraduate teaching and undertakes research. Hasdesignated registrar'". May have neurosurgery service.

6

As Level 5 plus has neurosurgery and cardiothoracic surgery on site. Sub-specialists available on 55656666rosters. Has registrar'" on site 24 hours. May be a Supra-Area Trauma Service121.

(1) See "Medical and Nursing Staff Definitions" in Appendix I, page: 4.1.1.(2) See Appendix IV, p. 4.4.1 for related services required.

See "Glossary". page 4.5.1.

2.1.2

11/82

10 GENERAL MEDICINE

LEVEL

DESCRIPTION

MINIMUM LEVEL OF SUPPORT SERVICES

PPXNAIC0

ahRMnCCp

taaeeUUI


1

Management and appropriate referral by medical practitioner. Registered nurse"' in charge on11101210each shift. Has a Continuous Quality Improvement plan 121 . Interpreter service

2

As Level 1 plus general physician consultation available. Continuing education programs for 12201210nurses available specific to the needs of the service. Access to allied health professionals.

3

As Level 2 plus referral and management primarily by accredited medical practitioners" or general 33302332physicians. Has 24hr access to medical officer" on site or available within 10 minutes.Consultations available from other specialists. Has a unit for general ward. Someregistered nurses having completed or undertaking relevant post-basic studies. Access to healthpromotion services, and liaison psychiatry.

4

As Level 3 plus service provided by general physicians rostered on call 24 hours. May have 44404442subspecialty interest/skills. Medicalofficer(s)"' on site 24 hours. Has medical registrar". Hasa unitand experienced registered nurses. Allied health professionals on site. Formallink with Level 4 Rehabilitation Service.

5As Level 4 plus department of medicine. Subspecialists available for consultation. Has medical 55544442on call 24 hours. Access to specialist clinical is desirable. May have

subspecialties on site. May have teaching and research role. Has link with Level 5 RehabilitationService which may include conjoint appointments.

(1) See "Medical and Nursing Staff Definitions" in Appendix I; page: 4.1.1.(2) See"Glossary", page 4.5.1.

2.2.1

1/92

Continued

10 GENERAL MEDICINE

MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCpC aaeaUUIhryds S

LEVEL DESCRIPTION

6As Level 5 plus division of medicine with subspeciality departments. As appropriate level forHas medical registrar'" on site 24 hours. Experienced registered nurses", subspecialtyon most shifts. Has teaching and research role. May have National role.

(1) See "Medical and Nursing Staff Definitions" in Appendix I; page: 4.1.1.(2) See Glossary", page 4.5.1

2.2.2

11/92

11 CARDIOLOGY


PPXNAIC0

ahRMnCCp

taaeeUUIh ryds S

0-3As for General Medicine As appropriate level in General Medicine.

4

As for General Medicine Level 4 plus general physicians with interest in cardiology on call 24 44434442hours.

5As Level 4 plus medical registrar" on call 24 hours. Appointed cardiologist. Access to specialist 55544552clinical nurse"' is desirable. May have teaching and research role. Link with cardiothoracic unit.Link to Level 5 Rehabilitation Service.

6As Level 5 plus medical registrar"' on site 24 hours. Has cardiology registrar". Cardiology 6department including cardiology sub-specialties. Cardiologist on call 24 hours. Has teaching andresearch role. Has cardiac catheterisation facility and cardiothoracic surgery on site.

See "Medical and Nursing Staff Definitions" in Appendix I, page: 4.1.1.

5665666

2.3.1

11/82

12 DERMATOLOGY

MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCptaaeeUUhryds S

LEVEL

DESCRIPTION

0-4As for General Medicine. As appropriate level in General Medicine.

5As General Medicine Level 4 plus appointed specialist dermatologist. Has medical registrarW on 44434442call 24 hours. May have teaching and research role. Link with Radiotherapy Level 3.

6As Level 5 plus dermatology registrar". Has dermatology department. May have dermatologist 55434442on call 24 hours. Has teaching and research role.

" See "Medical and Nursing Staff Definitions" in Appendix I. page: 4.1.1.

2.4.1

11/92

13 ENDOCRINOLOGY


LEVEL

DESCRIPTION


4As for General Medicine Level 4 plus general physician with interest in endocrinology. Has 44434442diabetic education service. Link with Level 4 Health Promotion Service. Has an integratedhospital/community diabetes management service.

5As Level 4 plus medical registrar" ) on call 24 hours. Appointed endocrinologist. Access to 55554444specialist clinical nurse'" is desirable. May have teaching and research role. Link to Level 5Rehabilitation Service.

6As Level 5 plus medical registrar' 1 ' on site 24 hours. Has department of endocrinology. 66555554Endocrinologist is on call 24 hours. Has endocrinology registrar". Has teaching and researchrole.

(1) See "Medical and Nursing Staff Definitions" in Appendix I, page: 4.1.1.

2.5.1

11/92

14 GASTROENTEROLOGY

LEVEL DESCRIPTION


PPXNAIC0

ahRMnCCp

taa0eUUI


3

As General Medicine Level 3. May have fibre optic endoscopy performed by accredited medical 33402332practitionert.

4

As General Medicine Level 4 plus service provided by general physicians with interest in 44404443gastroenterology. Regular endoscopy service including colonoscopy. Has access to drug andalcohol counselling.

5

As Level 4 plus medical registrar" on call 24 hours. Gastroenterologist appointed. Access to 55544444specialist clinical nurse"' is desirable. May have teaching and research role.

6As Level 5 plus medical registrar"' on site 24 hours. Has gastroenterology registrar. Has 66555544gastroenterology department. Gastroenterologist on call 24 hours. Has teaching and researchrole. May have National role.

See "Medical and Nursing Staff Definitions" in Appendix I; page: 4.1.1.

2.6.1

11/92

15 HAEMATOLOGY -CLINICAL 12

MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCptaaeeUUIhrvds S

LEVEL

DESCRIPTION

0-3As for General Medicine. As appropriate level in General Medicine

4As for General Medicine Level 4 plus service provided by general physician with interest in 44434442haematology. May have haematologist visiting regularly. Link with palliative care service.

5As Level 4 plus general medical registrar" on call 24 hours. Appointed haematologist. Access 55554544to specialist clinical nurse" ) is desirable. May have teaching and research role.

6As Level 5 plus medical registrar" on site 24 hours. Has department of haematology. 65555544Haematologist on call 24 hours. Has haematology registrar'". Has teaching and research role.May provide cell separation. May perform bone marrow transplant.

'" See "Medical and Nursing Staff Definitions" in Appendix I, page: 4.1.1.(2) concerning New Zealand blood transfusion service see information booklet "Reconfiguration of Blood Transfusion Service" June 1993.

2.7.1

1/92

16 IMMUNOLOGY

LEVEL

DESCRIPTION

MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCpta8a0UUI


4As for General Medicine Level 4 plus service provided by general physician with interest in 44434442immunology.

5As Level 4 plus medical registrar" ) on call 24 hours. Appointed immunohematologist. Access to 55554443specialist clinical nurse" is desirable. May have teaching and research role.

6As Level 5 plus medical registrar" on site 24 hours. Has department of immunology. 66555544Immunohematologist on call 24 hours. Has immunohematology registrart. Has teaching andresearch role.

(1) See "Medical and Nursing Staff Definitions" in Appendix I, page: 4.1.1.

2.8.1

11/92

17 INFECTIOUS DISEASES


LEVEL DESCRIPTION

0No specific communicable diseases ward or unit. Infection control policy in place Not applicableincluding body substances isolation and suitable contaminated water disposal.


4As General Medicine Level 4 plus services provided by general physician with interest in 44434442subspecialty. Facilities include isolation rooms(s) with internal washbasins and toilets, as well asstaff washbasins immediately outside the room(s). An area with separate air conditioning maybe available.

5As Level 4 plus medical registrar"' on call 24 hours. Appointed specialist. May have teaching 55543443and research role. Link with Sexual Health (STD) and HIV Services.

6As Level 5 plus medical registrar'" on site 24 hours. Has specialist infectious diseases 65544544physician(s) and infectious diseases registrar' 1 '. Access to specialist clinical nurse"' is desirable.Designated in-patient area for infectious and communicable diseases with separate airconditioning. Has a teaching and research role.

(1) See "Medical and Nursing Staff Definitions" in Appendix I, page: 4.1 .1

2.9.1

11/92

18 NEUROLOGY

LEVEL

DESCRIPTION


PPXNAIC0

ahRMnCCp

taaaaUU


4

As for General Medicine Level 4 plus service provided by general physician with interest in 44404442neurology. Formal link with at least Level 4 Rehabilitation and Level 4 Geriatrics service.

5

As Level 4 plus medical registrar"' on call 24 hours. Appointed neurologist. Access to specialist 54544544clinical nurse"' is desirable. May have teaching and research role. Neurosurgery support, EMG,nerve conduction, evoked responses and EEG available.

6

As Level 5 plus medical registrar"' on site 24 hours. Has neurology department, neurology 65655644specialist(s) and neurology registrar'". Has teaching and research role. Has access to CTscanning, 24 hour basis. May have MRI. May have PET.

See"Medical and Nursing Staff Definitions" in Appendix I, page: 4.1.1

2.10.1

11192

19 ONCOLOGY -MEDICAL


PPXNAIC0

ahRMnCCp

taaaeUUh ryds S


4

As for general medicine Level 4 plus service provided by general physician with interest in medical 45434443oncology. May have visiting medical oncologist clinics. Established liaison and consultation fromradiotherapy, palliative care/hospice service, psychiatric and social work services.

5As Level 4 plus medical registrar" on call 24 hours. Appointed medical oncology specialist.55554544Access to specialist clinical nurse is desirable. May have teaching and research role.Multidisciplinary management of oncology patients, including case conferences withradiotherapists. May have pain clinics. Links with palliative care/hospice service and participatesin Health Promotion.

6

As Level 5 plus medical registrar" ) on site 24 hours. Has oncology department, oncology 66565646specialist(s) and oncology registrar'". Has teaching and research role.

" See "Medical and Nursing Staff Definitions" in Appendix I. page: 4.1.1.

2.11.1

11/92

20 ONCOLOGY -RADIATION


LEVEL

DESCRIPTION

0No service. Not applicable11101210

4Visiting radiotherapist, working in conjunction with a comprehensive cancer care service. Notreatment facilities.Has a Continuous Quality Improvement plan ' 2 .Interpreter serviceavailabl&2.

5Basic modern radiation oncology department; comprising a minimum of superficial and deep x- 5ray therapy and megavoltage machine(s). Has intracavity irradiation equipment. May havemould room. Access to simulator and some form of computerised planning. Has data programfor annual recording and monitoring of work undertaken. Has radiation oncologists, physicistsand therapeutic radiographers. Works in conjunction with, or as part of, a comprehensivecancer service.Access to Palliative Care/Hospice Level 5.Formal quality assuranceprogram2.

5554544

6As Level 5 plus has radiation oncology registrar(s)"'. Multiple linear accelerators with at least 66665646one linear accelerator of 10-25 ME V potential with photon and electron capabilities. A fullyintegrated, computer assisted, planning and treatment system with system(s) for verifyingprecision, planning and treatment modalities. Remote control intracavity equipment withafterloading techniques. Mechanical workshop and biomedical support facilities. May providetraining in biomedical engineering, mould room techniques and medical physics. Has researchrole. Located in a principal referral hospital with ready access to all subspecialties.

See"Medical and Nursing Staff Definitions" in Appendix 1, page: 4.1.1.(2) See "Glossary", page 4.5.1.

2.12.1

11/92

21 RENAL MEDICINE

MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCptaaeeUUhrvds S

LEVEL

DESCRIPTION


3As for General Medicine Level 3 plus renal patients managed by general physician. May have 33302332self care dialysis centre with patients under the care of larger renal unit.

4As Level 3 with management of patients by general physician with interest in nephology. 44404443Nephrologist consultation available. Has medical on site 24 hours. Has a unitmanager" and experienced registered nurses"'. Has self care renal dialysis centre with formallink to larger renal unit.

5As Level 4 plus medical registrar" on call 24 hours. Specialist renal physician. Part-time unit 55554544director or co-ordinator. All types of dialysis available including treatment of patients requiringhaemodialysis (2 or more patients treated on average at any one time). Renal biopsiesperformed. Registered nursing at or above 6 hours/patient/day (1:4) desirable. Access tospecialist clinical nurse"' is desirable. May have teaching and research role.

6As Level 5 plus medical registrar"' on site 24 hours. Has nephrology department. Renal 65655644transplantation available and co-ordinated by full-time renal unit director. Has nephrologyregistrar"'. Experienced registered nurses'" on most shifts. Has teaching and research role.

See "Medical and Nursing Staff Definitions" in Appendix I, page: 4.1.1.

2.13.1

11/92

22 RESPIRATORY MEDICINE

MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCptaaaaUUIhryds S

LEVEL

DESCRIPTION


4As for General Medicine Level 4 plus service provided by general physician with interest in 44434442respiratory medicine.

5As Level 4 plus medical registrar tm on call 24hr. Appointed respiratory medicine specialist.55534543Access to specialist clinical nurse"' is desirable. May have teaching and research role. Hasaccess to Level 5 cardiothoracic surgery and Level 5 cardiology service.

6As Level 5 plus medical registrar"' on site 24 hours. Has Respiratory Medicine Department 55555644with subspecialist respiratory physicians. Has respiratory medicine registrar. Has teachingand research role. Has a respiratory function laboratory.

" See "Medical and Nursing Staff Definitions" in Appendix I, page: 4.1.1.

2.14.1

11/92

23 RHEUMATOLOGY


PPXNAIC0

ahRMnCCptaaaaUUI

hryds S


4

As for General Medicine Level 4 plus service provided by general physician with interest in 44404442rheumatology.

5

As Level 4 plus medical registrar' on call 24 hours. Appointed rheumatology specialist. 45434443Access to specialist clinical nurse"' is desirable. Link to Level 5 rehabilitation service. Mayhave teaching and research role.

6

As Level 5 plus medical registrar"' on site 24 hours. Has rheumatology registrar' 11 . Has 55555443teaching and research role.

" See "Medical and Nursing Staff Definitions" in Appendix I, page: 4.1.1.

2.15.1

11/92

24 GENERAL SURGERY

LEVEL DESCRIPTION MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCptaa eeUUhryds S


1Minor procedures under local anaesthetic in procedures room. Appropriate referral by medical11101010practitioner.Registered nurse"' in charge on each shift.Has a Continuous QualityImprovement plan 5 . Interpreter services availabl&5.

2Minort3 diagnostic and therapeutic surgical procedures on good risk 2 patients performed by 12202212accredited medical practitioner 1 with postgraduate training in surgery. Anaesthesia given byaccredited practitioner in anaesthetics. General surgeon available for consultation.Continuing nursing educational programs"' available specific to the needs of the service. Mayhave access to allied health professionals.

3As Level 2 plus intermediat& 3 surgical procedures on good or moderate risk 21 patients 33303333performed regularly by specialist surgeon"'. Accredited medical practitionert (in anaesthetics)may provide anaesthetics for good risk patients, specialist anaesthetists" ) providinganaesthetics for moderate risk 12) patients. Hasr access to med

ical officer(s)"' on site or

available within 10 minutes. Consultation available from other specialties. Has a, unitmanager" for general ward. Some registered nurses having completed or undertaking relevantpost-basic studies. Access to allied health professionals.


2.16.1

11/92

Continued

24 GENERAL SURGERY

LEVEL DESCRIPTION MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCptaaeeUUhryds S

4As Level 3 plus selected'4 major 131 surgical procedures on gopd or rpoderate risk 121 patients 44434434performed regularly by specialist surgeons'" and specialist anaesthetiis'". Specialists on call24 hours. Has designated medical officer(s)". Some surgical subspecialties available. Hasnursing unit manager"' and experienced registered nurse&U . Links with oncology, radiotherapyand palliative care/hospice services. Allied health professionals on staff, and liaison psychiatryavailable.

5As Level 4 plus full range of major' 3' diagnostic and treatment procedures on good, moderate 44545536and badpatients performed regularly by specialist surgeons" ) and specialistanaesthetists"'. Has general surgical registrar'" on call 24 hours. Access to subspecialties.Access to specialist clinical nurse" ) is desirable. May provide Area/Regional service: May haveteaching and research role. Usually a major referral hospital with department of surgery.

6As Level 5 plus ability to deal with complex major" ) diagnostic and treatment procedures in 55665646association with other specialties.Has division of surgery. Has registrars" , in surgicalsubspecialties. Experienced registered on most shifts. May have National role in aspecific field. Has teaching and research role. Usually a principal referral hospital with divisionof surgery.

At all levels there needs to be assessment of the minimum throughput levels to maintain expertise especially in non-routine procedures.This should be addressed in the clinical privileges delineation process for all professional staff.

" See "Medical and Nursing Staff Definitions" in Appendix I, page: 4.1.1(2) See "Levels of Risk" in Appendix II, page: 4.2.1

See "Indicative List of Surgical Procedures" in Appendix III, page: 4.3.1(4) Based on clinical privileges determined at relevant hospital.

See "Glossary", page 4.5.1. 2.16.2

11192

25 BURNS


PPXNAIC0

ahRMnCCptaaaeUU

hryds S

0No planned burns service. Not applicable

2

As for General Surgery Level 2 plus emergency casualty service for burns (able to manage 11001010minor burns, i.e. less than 5% total body surface area). All other burns stabilised andtransferred to a higher level unit. Has a Continuous Quality Improvement plan' 31 . Interpreterservice availabl&31.

3

As Level 2 plus continuing service by general surgeon for partial thickness burns estimated at 32203212less than 18% total body surface area and full thickness burns of less than 10% total bodysurface area, or any other burns not defined for referral to a higher level unit. I.V. fluidtherapy available. May have access to allied health professionals. Consultation with plasticsurgical service available.

4

As for Level 3 plus general surgical registrar"' on call 24 hours. Part-time director or co- 43304433ordinator of separately located burns unit. Manages patients with partial thickness burns notexceeding 27% of total body surface area. Has unit manager"' and experienced registerednurses'". Some registered nurses having completed or undertaking relevant post-basic studies.Link with Level 4 Rehabilitation Service and Plastic Surgical service. Has access to liaisonpsychiatry, allied health professionals, and health promotion service.

6

As for Level 4 plus medical officer"' on site 24 hours. Specialty registrars on call 24 hours. 55435546Full-time burns unit registrar on duty 8 hours/day. Director of burns unit. All severe burnscases accepted, including inter-hospital transfers. Renal and emergency care consultants oncall 24 hours. Registered nursing equivalent 16 hours/patient/day (1:1.3) desirable, oraccording to dependency of patient. Specialist clinical nurse'" is desirable. Links to Level 5Rehabilitation Service and Plastic Surgery Service.

See "Medical and Nursing Staff Definitions" in Appendix I, page: 4.1.1.(2) See Circulars 88/25 and 89/48.

See "Glossary", page 4.5.1. 2.17.1

11/92

26 THORACIC/CARDIOTHORACIC SURGERY


PPXNAIC0

aIiRM nCCptaaaeUU

hryds S

0No planned thoracic/cardiothoracic surgery service. Not applicable

5

As for General Surgery Level 5 plus elective and emergency thoracic and emergency 44545546cardiothoracic procedures (such as closed pulmonary embolectomy) performed bythoracic/cardiothoracic surgeons"' and specialist anaesthetists. Has liaison psychiatry andhealth promotion services. Level 5 Rehabilitation Service available on site. Link with palliativecare/hospice service.

6

As for Level 5 plus elective and emergency cardiac surgery (e.g. mitral valvotomy). 56656666Cardiopulmonary by-pass performed regularly by cardiothoracic surgeons and specialistanaesthetists. Able to deal with highly complex diagnostic and treatment procedures inassociation with other specialties. Minimum caseload of 300 heart - lung bypass cases and atotal of 900-1000 cardiac surgery cases per year is desirable. Has registrar" in cardiothoracicsurgery. Experienced registered nurses"' on most shifts. May have National role in a specificfield. Has teaching and research role.

(1) See Medical and Nursing Staff Definitions" in Appendix I; page: 4.1.1.

2.18.1

11/92

27 DAY SURGERY

LEVEL DESCRIPTION MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCptaaeeUUhryds 5

Minor"' diagnostic and therapeutic procedures on good risk 121 patients by accredited medical11102212Registeredin charge on each shift. Procedures restricted to those

requiring local anaesthesia (excluding spinal, epidural or regional blocks) or I.V. sedation.Endoscopies not requiring general anaesthesia included. Where unit is free-standing,emergency back-up is provided by nearby hospital. Has a Continuous Quality Improvementplan"". Interpreter service

2As Level 1 plus minor11 ' diagnostic and therapeutic procedures requiring general or regional12202212anaesthesia on good risk' 2' patients performed by accredited medical practitioners'3' withanaesthesia performed by accredited medical practitioners (3) in anaesthesia.Medicalpractitioner on site until patients have recovered from anaesthesia and medical practitionersrostered for emergencies available within 10 minutes.Continuing nursing educationalprograms available specific to the needs of the service.

3As Level 2 plus common and intermediate" diagnostic and therapeutic procedures performed 32302212on good risk 121 patients by specialist surgeons 131 and specialist anaesthetists (31 or accreditedmedical practitioners 13' in anaesthesia. Has a unit manager' 31 . Minimum support services onsite or available within 10 minutes.

4As Level 3 plus common and intermediate" diagnostic and therapeutic procedures performed 32303333on good and moderate risk 121 patients by specialist surgeons"' and specialistProcedures on children 12 months to 4 years performed by General Surgeon' 3' accredited inpaediatric surgery and anaesthesia performed by anaesthetist accredited in paediatricanaesthesia. (Children under 12 months referred to paediatric surgical service). Has a unitmanager"' and experienced registered Consultation available from other specialtiesespecially Paediatric Surgery. Access to allied health professionals.

See "Indicative List of Surgical Procedures" in Appendix Ill, page 4.3.1(2) See "Levels of Risk" in Appendix II, page 4.2.1° See Medical and Nursing Staff Definitions" in Appendix I; page: 4.1.1.

See "Glossary". page 4.5.1

2.19.1

11/92

28 EAR, NOSE AND THROAT

MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCpt8888UUhryds S

LEVEL

DESCRIPTION

0No planned ENT service. Not applicable

4As for General Surgery Level 3 plus common and ENT surgical procedures on 43404333good or moderatepatients performed regularly by ENT surgfl53 and specialist

excluding neuro-otic or intracranial surgery.Has designated medicalofficer(s) 13 ' or surgical Has a unit manager' 3 ' and experienced registeredSpecialists on call 24 hours. Audiology service available. Access to liaison psychistry.

5As Level 4 plus major" diagnostic, and treatment procedures on good, moderate and bad risk'2' 44555536patients, including neuro-otic surgery if Level 6 neurosurgery is available.Has surgicalregistrar(s) 13 ' on call 24hrs. Access to specialist clinical nurse 131 is desirable. May provideArea/Regional service.May have teaching and research role.Links with oncology,radiotherapy and palliative care/hospice services.

6As Level 5 plus ability to deal with full range of complex major" diagnostic and treatment 55656646procedures, in association with other specialties including neuro-otic and intracranialprocedures where Level 6 Neurosurgery is available on site. Has ENT registrar' 31 , may haveNational role in specific field.

'" See "Indicative List of Surgical Procedures" in Appendix III, page: 4.3.1(2) See "Levels of Risk" in Appendix II, page: 4.2.

See "Medical and Nursing Staff Definitions" in Appendix I, page: 4.1.1

2.20.1

11/92

29 GYNAECOLOGY

MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCptaaaeUUhryds S

LEVEL

DESCRIPTION

0No planned gynaecology service. Not applicable.

2As for General Surgery Level 2 plus minor" diagnostic and therapeutic gynaecological surgical12202212procedures on good risk'2' patients performed by general surgeons"' with post graduate trainingin gynaecological surgery.Anaesthesia given by accredited medical practitioner' 3' inanaesthetics. Gynaecologist available for consultation.

3

As Level 2 plus common and gynaecological procedures on good or moderate22303333risk 121 patients performed regularly by gynaecologists" or general surgeons"' credentialled inrural areas for these types of procedures. Accredited medical may provideanaesthetics for good risk Q1 patients, specialist providing anaesthetics formoderate risk patients. Has 24hr access to medical officer(s)' 3' on site or available within 10minutes. Has nursing unit manager"' for general ward. Some registered nurses havingcompleted or undertaking relevant post-basic studies. Consultation available from otherspecialties. Access to allied health professionals.

(1) See "Indicative List of Surgical Procedures" in Appendix Ill page: 4.3.1See "Levels of Risk" in Appendix II, page: 4.2.1See "Medical and Nursing Staff Definitions" in Appendix I, page: 4.1.1See "Glossary" page 4.5.1.

2.21.1

11/92

Continued

29 GYNAECOLOGY

LEVEL DESCRIPTION MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCptaaeaUUhryds S

4As Level 3 plus selected major"' gynaecological procedures, including colposcopy and 44404434laparoscopic surgery, on good or moderate risk 121 patients performed regularly bygynaecologists"' and specialist anaesthetists' 31 . Has designated medical officer' 3' and/orsurgical registrar 131 . Has a unit manager 131 and experienced registered nurses 131 . Specialists oncall 24 hours. Allied health professionals on staff. Some surgical subspecialties available.Links with oncology, radiotherapy and palliative care/hospice services. Access to liaisonpsychiatry.

5As Level 4 plus major"' diagnostic and treatment procedures on good, moderate and bad risk 121 55544546patients performed regularly by gynaecological surgeons 13) and specialist anaesthetists 131 . Mayhave gynaecology registrar'31 . Access to specialist clinical nurse"' is desirable. May haveteaching and research role.

(1) See "Indicative List of Surgical Procedures" in Appendix III page: 4.3.1See "Levels of Risk" in Appendix II. page: 4.2.1See "Medical and Nursing Staff Definitions" in Appendix I, page: 4.1.1See "Glossary" page 4.5.1.

2.21.2

11/92

Continued

29 GYNAECOLOGY


LEVEL

DESCRIPTION

6As Level 5 plus ability to deal with complex major° diagnostic and treatment procedures in 55556546association with other specialties. These include reproductive endocrinology, infertility andmultidisciplinary management of gynaecological malignancy (including chemotherapy andradiotherapy), and laser endometrial ablation. Has registrar& 3 in gynaecological subspecialties.May have National role in a specific field. Has teaching and research role.

See indicative List of Surgical Procedures" in Appendix Ill page: 4.3.1(2) See "Levels of Risk" in Appendix II, page: 4.2.1

See "Medical and Nursing Staff Definitions" in Appendix I, page: 4.1.1See "Glossary" page 4.5.1.

2.21.3

11/92

30 NEUROSURGERY

LEVEL DESCRIPTION MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCptaaaaUUhryds S

0No planned neurosurgery service. Not applicable

4As for General Surgery Level 3 plus management of minor head injuries by general surgeon. 44534434Has medical officers"' on site 24 hours. Neurosurgical consultation available. Operating roomequipment adequate for emergency neurosurgery. Link with Level 4 Rehabilitation Service.

5As Level 4 plus full range of major 121 diagnostic and treatment procedures on good, moderate 5and bad risk patients. Neurosurgeons and accredited specialist anaesthetist&" available 24hours. Surgical registrar' on call 24 hours. Has a unit manager' and experienced registerednurses"'. Some registered nurses having completed or undertaking relevant post-basic studies.Designated neurosurgical beds. 24hr access to CAT scanner. Link with brain injury and spinalinjury rehabilitation service. May undertake research. May have teaching role.

5545536

6As for Level 5 plus complex major 121 procedures. Neurosurgery ward and neurosurgical high 55656646dependency/ICU. Neurosurgery registrar t11 on call 24 hours. Neurosurgical anaesthetists.Experienced registered nurses"' on most shifts. Access to specialist clinical nurs&" isdesirable. Link with Level 5 Rehabilitation Service. May provide a National role in a specificfield. Has teaching and research role. Access to MRI desireable.

" See "Medical and Nursing Staff Definitions" in Appendix I, page: 5.1.1(2) See "Indicative List of Surgical Procedures" in Appendix Ill, page 4.3.1. 2.22.1

11/92

31 OPHTHALMOLOGY

LEVEL DESCRIPTION MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCptaaeeUU/hryds S

0No planned ophthalmology service. Not applicable

2As for General Surgery Level 2 plus minor extra ocular diagnostic and treatmentophthalmological procedures on good riskpatients performed regularly by ophthalmic12103212surgeons 12 . Consultation available from other specialists. Allied health professionals on site.

See "Levels of Risk" in Appendix II, page: 4.2See "Medical and Nursing Staff Definitions" in Appendix I, page: 4.1.1

2.23.111/92

Continued

31 OPHTHALMOLOGY


PPXNAIC0

ahRMnCCptaaeaUU

hryds S

3As General Surgery Level 3 plus common and intermediat&3 procedures on good or moderaterisk t1 patients performed regularly by ophthalmic surgeons"'. Accredited medical practitioner 233333333in anaesthetics may provide anaesthetics for good risk patients with specialist anaesthetists"providing anaesthetics for moderate risk patients. Medical officer' 2 on call 24hrs. Has a unitmanager 121 and experienced registered nurses"'. Access to orthoptists.

5

As Level 3 plus major"' diagnostic and treatment procedures on good, moderate and bad risk" 44534436patients performed regularly by ophthalmic surgeons"' and specialist anaesthetists 2'. Hasdesignated medical officer 121 and/or surgical registrar 121 on call 24 hours. Has orthoptists onstaff. May have teaching and research role. Access to liaison psychiatry.

6

As Level 5 plus ability to deal with complex major" ) diagnostic and treatment procedures in 55555446association with other specialities. Has ophthalmology registrar 121 on call 24 hours. Access tospecialist clinical nurse 121 is desirable. Able to undertake neuro-ophthalmology where level 6Neurosurgery is available on site. May have National role in a specific field. Has access toLevel 5 Radiotherapy Service. Has teaching and research role.

1) See Levels of Risk" in Appendix II. page: 4.2(2) See Medical and Nursing Staff Definitions" in Appendix I, page: 4.1.1

See "Indicative List of Surgical Procedures" in Appendix Ill. page: 4.3.1

2.23.2

11192

32 ORTHOPAEDICS

LEVEL DESCRIPTION MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCptaaaaUUhryds S

0No planned orthopaedic service. Not applicable

2As for General Surgery Level 2 plus minor reduction of fractures performed on good risk 12111202212patients by accredited medical practitioners 131 with post graduate experience in orthopaedicsurgery.General or regional anaesthesia given by accredited medical practitioners inanaesthetics.Orthopaedic consultation available. Has access to allied health professionals.

3As Level 2 plus common and intermediat&1 ' orthopaedic surgical procedures on good or 3moderate risk 121 patients performed regularly by orthopaedic surgeons. Accredited medicalpractitioners 131 may provide anaesthesia for good risk patients, specialist anaesthetists'providing anaesthesia for moderate risk patients. Has 24hr access to medical officers 13' on siteor available within 10 minutes. Has a unit manager 131 for general ward. Some registerednurses having completed or undertaking relevant post-basic studies. Consultation availablefrom other specialties. Has access to allied health professionals including physiotherapist.Power drills, power saws and theatre x-ray available.

2303333


2.24.1

11/92

Continued

32 ORTHOPAEDICS


PPXNAIC0

ahRMnCCptaaeeUUI

hryds S

4As Level 3 plus major" orthopaedic surgical procedures on good or moderate risk 1 21 patients 43434434performed regularly by orthopaedic surgeons and specialist anaesthetists 31 .Has a unitmanager 131 and experienced registered nurses 131 Rostered specialists available. Has designatedmedical officer and/or surgical registrar 31 .Has allied health professionals includingphysiotherapist. Has access to Level 4 . Rehabilitation Service. Access to liaison psychiatry.

5

As Level 4 plus full range of major" diagnostic and treatment procedures on good, moderate 44535436and bad risk 2 patients performed regularly by orthopaedic surgeons and specialistanaesthetist&31 . Access to specialist clinical nurse"' is desirable. May provide area/regionalservice. May undertake research. Has orthopaedic registrar' 31 on call 24 hours. Access tosubspecialties. May have teaching and research role. Link to Level 5 Rehabilitation Service.

6

As Level 5 plus ability to deal with major complex'" diagnostic and treatment procedures in 55556646association with other specialties. Experienced registered nurse&3' on most shifts. May haveNational role in a specific field. Link with Level 6 Rehabilitation service. Has teaching andresearch role.

"1 See "Indicative List of Surgical Procedures" in Appendix III, page: 4.3.1See "Levels of Risk" in Appendix II, page: 5.2See "Medical and Nursing Staff Definitions" in Appendix I, page: 4.1.1See "Glossary". page 4.5.1.See "Trauma Services - Related Support and Core Services" in Appendix VII. page 4.7.1

2.24.2

11/92

33 PLASTIC SURGERY

LEVEL DESCRIPTION MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0aIiRMnCCptaaeaUUhryds S

0No planned Plastic Surgery service Not applicable

4As for General Surgery Level 3 plUs slected major"' plastic surgery procedures on good or 44434434moderate risk' 21 patients performed regularly by plastic surgeons"' and specialistanaesthetists' 31 . Medical officers' 3' on site 24 hours. Specialist on call 24 hours. Has unitmanager 131 and experienced registered nurses ' 31 . Allied Health professional on staff, and liaisonpsychiatry available.

5As General Surgery Level 5 plus full range of major"' plastic surgical diagnostic and treatment 44545536procedures on good, moderate and bad risk"' patients performed regularly by plasticsurgeons12' and specialist anaesthetists 121 Link with Level 5 Rehabilitation Service, BurnsService and Dental Health Service (Level 5).

6As Level 5 plus ability to deal with complex major"' diagnostic and treatment procedures in 55556546association with other specialties. Has registrar 121 in plastic surgery. Access to specialistclinical nurse"' is desirable. May have National role in specific field. May have teaching andresearch role.

(1) See "Indicative list of Surgical procedures" Appendix 111, Page 4.3.1See "Levels of Risk" in Appendix 11,4.2.1See "Medical and Nursing Staff' Definitions" in Apendix 1, Page 4.1.1. 2.25.1

11/92

34 UROLOGY

LEVEL DESCRIPTION MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC08hRMnCCptaaaaUUIiryds S

0No planned urology service Not applicable

3As General Surgery Level 3 plus common and intermediate'" urological procedures on good or 32303333moderate risk 121 patients performed regularly by specialist urologists or general surgeon s'3'credentialled in urology.

4As Level 3 plus selected major"' urological procedures on good or moderate risk' 2' patients 44434434performed regularly by urologist&3' and specialist anaesthetists 131 . Medical officer(s)' 3' on site24 hours. Specialist on call 24 hours. Has a unit manager 131 and experienced registerednurses '31 . Links with oncology, radiotherapy and palliative care/hospice services. Allied healthprofessionals on staff, and liaison psychiatry available.

5As Level 4 plus full range of major'" diagnostic and treatment procedures on good, moderate 44535536and bad risk patients'2 ' performed regularly by urologists and specialist anaesthetists' 3'. Accessto specialist clinical nurse"' is desirable. May provide Area/Regional service. May haveteaching and research role. Has surgical registrar'3' on call 24 hours.

6As Level 5 plus ability to deal with complex major'" diagnostic and treatment procedures in 55656646association with other specialties. Has urology registrar' 31 . Has Urodynamic Unit. May haveNational role in a specific field. Has teaching and research role.

See indicative list of Surgical Procedures" in Appendix 111 • page 4.3.1(2) Sea "Levels of Risk" in Appendix 11, page 4.2.1."I Sea "Medical and Nursing Staff Definitions" in Appendix 1. page 4.1.1. 2.26.1

11/92

35 VASCULAR SURGERY

LEVEL DESCRIPTION MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCptaaeeUUhryds S

0No planned vascular surgery. Not applicable

4As for General Surgery Level 3 pIus common and vascular surgical procedures 4on good or moderate risk 121 patients performed regularly by vascular or general surgeon s'31credentialled in Vascular Surgery. Specialist anaesthetists 131 providing anaesthesia. Has a unitmanager 131 and experienced registered nurses 13). Specialists on call 24 hours. Has designatedmedical officer 131 and/or surgical registrar' 31 . Allied health professionals on staff. Some surgicalsubspecialties available.Pre-operative rehabilitation specialist consultation available (forelective amputees). Access to liaison psychiatry.

4434434

5As Level 4 plus major" diagnostic and treatment procedures on good, moderate and bad risk' 2' 4454patients performed regularly by vascular or general surgeons credentialled in Vascular Surgeryand specialist anaesthetiStS 131 . May provide area/regional service. May undertake research.Has surgical registrar 131 on call 24hrs. May have teaching and research role. Link with Level 5Rehabilitation Service.

6As Level 5 plus ability to deal with complex major"' diagnostic and treatment procedures in 5565association with other specialties. Access to specialist clinical nurse 131 is desirable. May haveNational role in a specific field. Has teaching and research role. Has surgical registrar131.

546

6 646

See indicative List of Surgical Procedures in Appendix Ill, page: 4.3.1(2) See "Levels of Risk" in Appendix II. page: 4.2.1' See "Medical and Nursing Staff Definitions" in Appendix I, page 4.1.1 2.27.1

11/92

MATERNAL AND CHILD

11/92

36 OBSTETRICS



Either (i) postnatal" ) only. Normal post-partum mothers and babies delivered elsewhere11001000returned for post-natal care provided there are no complications or (ii) Birthing Unit for goodrisk (normal) 3 delivery with discharge to home care within 24 hours. Care by generalpractitioner and/or midwives credentialled in obstetrics' 2 . Limited additional staff depending onneeds of the service.(l#)

2Good risk (normal)" delivery only. Able to cope with sudden unexpected complications until 22102212transfer. Accredited medical or midwife practitioners 121 in obstetrics. Has access to medicalofficer&2 on site or readily available. Unit manager 12) is desirable for general ward. Midwivesavailable (either on staff or as midwife practitioners). Has Level 2 (level l#) Neonatal Service.Link for continuing education, referrals and transfers with units at higher levels of service.Periodic structured medical/midwife refresher programmes; RNZCGP, RACOG, NZCM. Hasmore than 80 deliveries per year. (If minimum caseload cannot be achieved, considerationsmay be made for the degree of geographic isolation). Has Level 2 General Surgery available.Has a Continuous Quality Improvement plan 3 . Interpreter service avaiIabl&3.

Good risk (normal) delivery - care by primary practitioner (medical and/or midwife). See page 4.2.3.

Footnotes are on page 2.28.32.28.1

11/92

Continued36 OBSTETRICS

LEVEL DESCRIPTION MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0

hRMnCCpt88eaUU

(llb#)/

hryds S

3As Level 2 plus may deliver selected*low"' risk pregnancies. Access to obstetrician for 22102212consultation and for caesarean section. Has accredited medical and midwife practitioners 12 ' inobstetrics and paediatrician available for Neonatal care. Sufficient accredited medicalpractitioners 121 to provide simultaneous care of mother and neonate in theatre. Specialistanaesthetist (may be general practitioner anaesthetist credentialled for obstetric anaesthesia)and specialist obstetrician (may general surgeon accredited in obstetrics and credentialled forLSCS). Some nurses with experience in neonatal care and/or having or undertaking relevantpost-basic studies. Full resuscitation facilities available.

(IIa#)4As Level 3 plus care for mothers and babies at low and moderate risk'". Obstetricians, 43434333

paediatricians and specialist anaesthetists (2) on call 24 hours. Accredited (21 medicalpractitioners or medical officer(s)' 2 ' on site 24 hours. Obstetric Registrar available. Has a unitmanager (21 and experienced registered nurses '2 '. Experienced midwives on all shifts. Accessto specialist clinical nurse (2) is desirable. Has a minimum of Level 3 (level llb#) neonatalservice. Allied health professionals and liaison psychiatry available. Full resuscitation facilitiesavailable.

(Ill5As Level 4 plus may deliver selected Thigh risk pregnancies. Has Level 4 (Level lla#) neonatal 44434433

service.

Low risk pregnancies - consider consultation with specialist obstetrician. See page 4.2.3 - 4.2.4.Moderate and high risk pregnancies - direct care by specialist obstetrician. See page 4.2.4 - 4.2.6.


2.28.2

11/92

Continued36 OBSTETRICS


(IlI#)6As level 5 plus care of good, low, moderate and high risk 1 ' deliveries. Obstetric registrar 4 on 54536534

site 24 hours. Obstetricians may have specific subspecialties/skills/training. Experiencedregistered nurses"' on most shifts. Usually a specialist supra regional unit or National role. Atleast 2,500 deliveries per year. Has Level 5 (level lll#) neonatal service.

(1) See "Risk Factor Criteria - Obstetrics" in Appendix II. page 4.2.3 to 4.2.6.(2) See "Medical and Nursing Staff Definitions" in Appendix I. page 4.1.1.

See "Glossary". p. 4.5.1.Designated registrar may be advanced trainee (RACOG)

#Roman numerals relate to levels currently used in New Zealand to describe obstetric units.

2.28.3

11/92

37 NEONATAL

LEVEL DESCRIPTION MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCptaaaeUUhryds S


Either (i) postnatal care of mothers and babies delivered elsewhere with no complications or (ii) 110000*0Birthing Unit for good risk (normal) deliveries only, with discharge to home care within 24hours, care by medical and/or midwife practitioners. In both types of service emphasis onparenting, bonding, and breastfeeding. Basic Life Support for neonates available. Midwives,and/or mothercraft nurses and general practitioner care with very limited additional staff.

2(l#)As Level 1 plus provision for good risk 121 pregnancies and healthy infants of greater than 36 222012*2weeks gestation. Accredited medical practitioners" in obstetrics and newborn paediatrics.Has 24hr access to medical officer(s)"' on site or readily available. Unit manager"' for generalward. Some nurses with experience in neonatal or paediatric care and/or undertaking relevantpost basic studies. Structured periodic medical refresher program (RNZCGP, RACOG). Linkwith higher level unit. Has Continuous Quality Improvement plan'31 . Interpreter serviceavailable'3'.

3(Ilb#)As Level 2 plus manages low or moderate risk (21 pregnancies.Special care nursery. 333043•3Management of babies with minimal complications. Facilities include humidicribs,card iorespiratory monitoring, IV fluid therapy, tube feeds, and phototherapy. Obstetricians andpaediatricians or accredited' 1 ' medical practitioners on call 24 hours; medical officer(s)" ) onsite. Nursing ratio of 1:4 cots desirable. Has unit manager and experienced registerednurses" ) . Minimum of one registered nurse on all shifts. Established link with Level 5 (Ill#)Unit. Allied health professionals and liaison psychiatry available. Formal link to communitychild and family health service, and/or Plunket.

Footnotes are on page 2.29.2 2.29.1

11/92

Continued 37 NEONATAL

MINIMUM LEVEL OF SUPPORT SERVICESPPX ,NAIC0ahRMnCCpt8aeeUUhrVds S

LEVEL DESCRIPTION

4(IIa#)As Level 3 plus provides short term assisted ventilator care. Accredited specialist physician 444044*4(neonatal paediatrician). Paediatric registrar on call 24 hours. A minimum of one registerednurse (preferably with post-basic qualifications) per shift. Link with Level 5 (lll#) unit mayinclude rotation of physicians/neonatologist(s).

5(lll#)As Level 4 plus manages high risk 121 pregnancies. Provides for all aspects of neonatal care 555454*4including intensive care for the critically ill baby and medium/long term ventilation and totalparenteral nutrition. 24 hour availability of neonatal paediatricians. Medical Director aneonatalogist. Neonatal intensive care trained nursing. Medical officer(s)" I on site 24 hours.Has access to clinical and diagnostic paediatric subspecialties. Multi-disciplinary follow upservice provided. May participate in neonatal retrieval. Role in post-graduate medical andnursing education. Undertakes research and evaluation.

6(lll#)As Level 5 plus provides neonatal surgery and care for complex congenital and metabolic 655465*6diseases of the new born. On site clinical and diagnostic paediatric subspecialty services. HasLevel 6 paediatric medicine and Level 6 paediatric surgery. Experienced registered nurses'" onall shifts.

(1) See "Medical and Nursing Staff Definitions" in Appendix I, page 4.1.1(2) See "Risk Factor Criteria - Obstetrics and Neonatal" in Appendix II. pages 4.2.3-4.2.7

See "Glossary", page 4.5.1.*Adult CCU - not applicable#Roman numerals relate to levels currently used in New Zealand to describe Neonatal units.

2.29.2

11192

38 PAEDIATRIC MEDICINE


LEVEL DESCRIPTION

0No service oooooo*o

No planned in-patient paediatric medical service or designated beds.Provides first aid111010*0treatment and stabilisation for children prior to moving to appropriate higher level of service.Interpreter service available'21.

2Designated paediatric in-patient beds as part of a general ward in a hospital in an outlying and 323032•2geographically isolated area. May have isolation capacity. Accredited'" medical practitioneron call. Paediatrician consultation availabl& 21 . Would be used for only minor medicalconditions or convalescence following referral from a higher level unit. Experienced registerednurse(l) available for each shift. Continuing nursing educational programs'" available. Able toprovide accommodation for parents. Has a Continuous Quality Improvement plan121.

3As Level 2 plus designated paediatric ward/area with parent accommodation. Has isolation 333032*2capacity in separate rooms. Specialist Paediatrician appointed. Provides care for commonmedical conditions. Has a unit manager" ) and experienced registered nurses (". Someregistered nurses having or undertaking relevant post basic studies. Has 24 hour access tomedical officer'" on site or readily available. Access to allied health professionals. Formal linkto community child and family health service, and/or Plunket.

(1) See "Medical and Nursing Staff Definitions" in Appendix I. page: 4.1.1See "Glossary. page 4.5.1.

* Adult ccu - not applicable 2.30.1

11/92

-I

Continued 38 PAEDIATRIC MEDICINE


PPXNAIC0

ahRMnCCp

taaaaUU

4

As Level 3 plus designated Director of Paediatric Medical Services, plus provides integrated 444444*2hospital in-patient unit, non-inpatient family and child health services, and community healthservices for most paediatric medical conditions. May have designated adolescent area.Specialist paediatrician on call 24 hours. Designated medical officer'11 . May have paediatricregistrar' 11 .Has a unit manager"'.Majority of registered nursing staff have paediatricqualifications. Access to audiology services. Allied health professionals on site. May havechild protection service.

5

As Level 4 plus specialised paediatric in-patient unit. May have some paediatric sub-specialty 555545*2skills. Support offered to other paediatric units within the area or region. May have designatedadolescent unit. Has paediatric registrar"' on site 24 hours. Active program of undergraduateand post graduate teaching and research co-ordinated with a Level 6 service. Access tospecialist clinical consultant" is desirable. Rostered allied health staff, including recreationaltherapy.School teacher available and preschool (kindy) teacher available.Has childprotection service. Specialist nutrition services available.

6As Level 5 plus most paediatric medical and surgical sub-specialties available. Designated666645*2adolescent unit. Clinical and diagnostic services provided by appropriately trained paediatricspecialists. Experienced registered nurses" on most shifts. Provides some National services.Subspecialty consultant on call 24 hours. Has designated subspecialty registrar 121 . Provides24hr Child Protection Service with consultant paediatrician and social worker. School serviceand preschool service for in-patients both available. Has research and specialist paediatricteaching role. Specialist nutrition services on-site.

See Medical and Nursing Staff Definitions" in Appendix I, page: 4.1.1Adult ccu - not applicable

2.30.2

11192

39 PAEDIATRIC SURGERY


PPXNAIC0

ahRMnCCp

taaaaUU

hryd$ S

No planned in-patient paediatric surgical service. Provides first aid treatment and stabilisation111012*0to children prior to moving to appropriate higher level of service. Interpreter service available.

3

As for General Surgery, Level 3. Except in emergencies, children under the age of five years 333033*3should not be admitted. Minor" elective and selected intermediate"' surgical procedures ongood risk12 children over the age of 5 years performed by general surgeons"' credentialled inpaediatric surgery, and specialist anaesthetists or medical practitioner& 3 accredited inpaediatric anaesthesia.Appropriate surgical, anaesthetic and resuscitation equipmentavailable. Has 24 hour access to medical officers (' ) on site or available within 10 minutes.Registered nurs&3 in charge on each shift. Continuing nursing educational program&3available specific to the needs of the service. Formal consultative links with paediatrician andpaediatric surgeons. Able to accommodate parents. Operating suite and recovery roomprovide for the special needs of children and parents. Has a Continuous Quality ImprovementpIan4.

4Except in emergencies, children under the age of one month should not be admitted. 444344*4Designated children's surgical ward with parent accommodation facilities. Intermediate("paediatric surgical procedures on good and moderate risk' 2 children performed by specialistsurgeons (paediatric) or general surgeons t3 credentialled in paediatric surgery, and specialistanaesthetist& 3 . Paediatric accredited anaesthetists for children under 12 months. Medicalofficer 3 on site 24 hours. Consultation available from specialist paediatrician. Facility toisolate in single room. Has a unit manager 131 and experienced registered nurses"'. Someregistered nurses having or undertaking relevant post-basic studies. Has access to alliedhealth professionals.

Footnotes are on page 2.31.22.31 .1

11/92

39 PAEDIATRIC SURGERY

LEVEL DESCRIPTION MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahAMnCCptaaeaUUIhrvds S

5As Level 4 plus specialised paediatric in-patient unit with specialist paediatric surgeons.555555*6Provides most major diagnostic and treatment procedures on good, moderate and bad risk12'children excluding complex major'" paediatric surgery on rare complex congenitalmalformations (frequency of less than one in 2,500 births). Specialist surgeons (paediatric),general surgeons"' credentialled in paediatric surgery, and specialist anaesthetist& 3 ' (paediatric)on call 24 hours. Participates in undergraduate and post-graduate teaching. May have anArea/Regional role providing support to other paediatric units. Training positions for paediatricnurses. Paediatric registrar (31 on call 24 hours. Surgical registrar 13) on call 24 hours. Majorityof nursing staff with paediatric qualification desirable. Access to specialist clinical nurse (31 isdesirable. May have teaching and research role. Rostered allied health staff, includingrecreational therapy and educational services.

6As Level 5 plus has sub-specialty units in most areas of paediatric surgery (e.g. may have 666656*6paediatric neurosurgery, cardiac surgery). Provides a National service. Active program ofundergraduate and post graduate teaching and research and development. Paediatricians andspecialist surgeons (paediatric) (3) with sub-specialty interests on call 24 hours. Designatedpaediatric surgical registrars 3 in sub-specialty units. Experienced registered nurses"' on mostshifts. Has research and specialist paediatrics teaching role.

Sea "Indicative List of Paediatric Surgical Procedures" in Appendix Ill. page: 4.3.2 Information Centre(2) See "Levels of Risk - Children" in Appendix II. page: 4.2.2

' See "Medical and Nursing Staff Definitions" in Appendix I, page 4.1 .1 Information Services" See "Glossary", page 4.5.1. Ministry of Health' Adult ccu - not applicable

Definition of child: 0-14 years inclusive. 2.31.2

11/92

H -----.

40 FAMILY AND CHILD HEALTH '3

LEVEL DESCRIPTION MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCptaaeeUU/hryds S


Early Childhood Services and school health screening programmes conducted by appropriately 00000000qualified registered nursing'" staff. Home visiting capacity, access to general practitioners andother secondary screening and referral services. Links with higher level service formanagement of children with identified needs. Has a Continuous Quality Improvement plan'2'.Interpreter service available' 2'. Access to other child and family care providers, e.g. education,Plunket, D.S.W.

3As Level 1 plus access to community paediatrician or accredited medical practitioner' 1 '11100000available for consultation. May have speech therapy services and multi-disciplinary child andfamily counselling. Access to allied health professionals such as Social workers andpsychologists. Link with paediatric medicine in-patient services where specialist maternal andpaediatric units serve the same catchment population. Access to a range of other communityhealth specialist services. Links with other child and family care providers, e.g. Education,Plunket, D.S.W. May have links with Maori Health Services and Pacific People's Services.

See"Medical and Nursing Staff Definitions in Appendix I, page: 4.1.1(21 See Glossary", page 4.5.1.

In many areas in New Zealand this is not a discrete separate service but parts may be performed by Paediatric medicine service,or child psychiatry, or community health. 2.32.1

11/92

40 FAMILY AND CHILD HEALTH

LEVEL DESCRIPTION MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCptaaaeUUIhryds S

4As Level 3 plus hospital and community service integrated, with a hospital service of Level 311201010Paediatric Medicine, Paediatric Surgery and Obstetric Services, with FIT communitypaediatrician.Access to a range of specialist services, such as family planning clinic,pregnancy support services etc. Has wide range of professional disciplines e.g. socialworkers, well established child and family counselling service, and staff with appropriateexperience. Access to audiology and orthoptic services. Access to child, adolescent andfamily mental health services. May provide screening and follow-up services to school agedhandicapped children. Has interagency liaison mechanisms such as Child At Risk Committee.Provision of a broad range of educative and preventive services at centres, schools, hospitaland community venues.

5As Level 4 plus provision of some specialist sub-units such as day care, infant 44444442stress/mothercraft day stay program. Community paediatrician may have joint hospitalappointment. Consultant child psychiatrist available with access to child psychiatry in-patientunit.

(1) See "Medical and Nursing Staff Definitions in Appendix I, page: 4.1.1

2.32.2

11192

INTEGRATED COMMUNITY AND HOSPITAL SERVICES

INTEGRATED COMMUNITY AND HOSPITAL SERVICES

11/92

41 ADOLESCENT HEALTH (2)

LEVEL DESCRIPTION

0No service

1Limited range of community and hospital services provided by non-specialist staff. Access to specialist adolescent health services for referral andconsultation when appropriate. Has a Continuous Quality Improvement plan". Interpreter service availabl&1.

4 Specialist multi-disciplinary adolescent health team linked with Level 4 Child and Family Health Service and with designated geographic catchment.Activities include specifically targeted health promotion programs, referral, assessment and treatment services, intensive family intervention: caseco-ordination and supervision. Formal network of interagency collaboration with other government departments and relevant local non-governmentorganisation. Staff to include part-time psychiatrist. Extended hours and crisis intervention services. Links where appropriate with Maori Healthand Pacific People's Health Services.

6 Designated adolescent service in major referral hospital with full-time staff specialist physician and psychiatrist, nursing and allied healthprofessionals with appropriate training and experience. Designated adolescent unit. Provides consultancy to lower level services. Support servicesfor in-patient care as for Paediatric Medicine Level 5. May have National Role.

'" See Glossary. page 4.5.1.(2) Adolescent Health Services are currently not sufficiently developed for detailed assessment of levels of service.

2.33.1

11/92

42 ADULT MENTAL HEALTH

MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahR

I MnCCp

t8a0eUUI

hryds S

LEVEL DESCRIPTION


Limited service provided by general practitioners (GPs) and hospital and community health11000000staff. Assessment and referral of appropriate patients to higher level services. Regular liaisonbetween GPs and public health facilities. Has a Continuous Quality Improvement plan2.Interpreter service availabI&2.

2 Designated interdisciplinary team comprising specialist psychiatrist and experienced nursing,social work and psychology staff. Consultation with specialist psychogeriatricians may beavailable. Assessment and treatment for common conditions. Conducts preventive and earlyintervention programmes relevant to the catchment population. Continuing staff educationprogrammes" ) available specific to the needs of the service. Links, where appropriate, withMaori Health and Pacific People's Health Services.

12100000

3As Level 2, plus has a broad range of specialist programmes (e.g. day centre, living skills).33202210Access to range of complementary health and hospital services including in-patient facilities.Formal link with in-patient unit for mentally ill. Has a unit manager" and experiencedregistered nurses"'.Specialist clinical nurse"' desirable.Clinical leadership by specialistpsychiatrist. Link with sheltered accommodation. Psychogeriatrician available.


2.34.1

11192

Continued

42 ADULT MENTAL HEALTH


LEVEL DESCRIPTION

4As Level 3, plus an integrated hospital and community service comprising extended hours, 33203330assesssment, treatment, accomodation, rehabilitation and recreational programmes for in-patients and out-patients. Facilities in conformity with requirements of the Mental Health(Compulsory Assessment and Treatment) Act 1993, including "responsible clinician"requirement, and a designated psychiatrist. Able to deal with psychiatric emergencypresentations in hospital and in community settings with in-patient and out-patient facilitiesspecifically designed for the mentally ill. Majority of nurses with psychiatric qualifications.

5As Level 4, plus has some subspecialty programmes operating 5 days per week. Secure 33233330facilities for in-patients.Has Director of Psychiatry.May have registrars" , undertakingtraining. Has specialist clinical nurse"' available.

6As Level 5, plus full range of subspecialty and related services, including psychogeriatrics, and 34434332forensic psychiatry. May have registrars" ) in subspecialty training postions. Experiencedregistered nurses" ) on most shifts. Undertakes a range of teaching and research functions.May provide a National referal service.

(1) See "Medical and Nursing Staff Definitions" in Appendix I, page: 4.1.1(2) See "Glossary", page 4.5.1

2.34.2

11/92

43 CHILD PROTECTION SERVICES("CHILD ABUSE SERVICES)

LEVEL DESCRIPTION

1No planned Child Protection Service. Management and appropriate referral by medical practitioner. Access to Children and Young Persons Serviceof Department of Social Welfare in accordance with Child, Young Persons and their Families Act 1989.

3 As Level 1 plus counselling and medical staff providing ongoing care for victims of sexual and physical abuse and their families. Service provided bymedical practitioners with experience in paediatrics or in dealing with child abuse victims. Formal links with Level 4 sexual assault service for 24hours crisis counselling and medical care and with paediatric medical service Level 2. Has a Continuous Quality lmrovement plan 2 . Interpreterservice available'2 . Polaroid photography available.

4 As Level 3 plus 24 hour on call service provided by medical practitioner or paediatrician with experience in subspeciality who may also providesexual assault service. Access to allied health professionals. Formal links with other child protection services and sexual assault services forinservice education. Designated area in Emergency Department or elsewhere in hospital for crisis care. Referrals from lower level servicesaccepted. Paediatric Medicine Level 4 on site and Paediatric Surgery Level 4 available. Clinical photography available and colposcopy maybeavailable.

5 As Level 4 plus designated multidisciplinary team consisting of paediatrician, psychiatrist, social worker, psychologist, occupational therapist andnursing staff. Has designated director. Has active undergraduate and postgraduate teaching role and conducts research. Paediatric Medicine Level5 on site and Paediatric Surgery Level 5 available. Colposcopy available.

6As Level 5 plus child protection paediatrician on call 24 hours. Has designated medical officer. Paediatric subspecialists available for consultation.Paediatric Medicine Level 6 and Paediatric Surgery Level 6 on site.

See "Glossary", page 4.5.1

2.35.1

11/92

44 DENTAL HEALTH

LEVEL DESCRIPTION

0No dental service

1Organised dental programmes staffed by dental therapists for pre-school, primary and intermediate school children and dental benefits programmefor teenagers. Has a Continuous Quality Improvement plan").

2As Level 1 plus access for emergency dental care for in-patients (may be by formal arrangement with local dental surgery).

3As Level 2 plus general dental services to long stay in-patients and eligible out-patients (may be by formal arrangement with local dental surgery).

4As Level 3 plus specialised dental services for in-patients and eligible out-patients. Has on-site dental surgery facilities with appointed staff, dentalsurgeon and dental assistant. Support services as for General Surgery Level 3. Interpreter service availabl&11.

5As Level 4 plus maxillo-facial specialiset services with oral surgeon specialists, orthodontists and access to prosthetics. Undertakes research anddevelopment. Provides undergraduate and postgraduate training. Links with plastic surgery Level 5. Support services as for General Surgery Level4.

6As Level 5 with full range of specialist services and in-patient treatment services, with Level 5 plastic surgery on-site. Support services as forGeneral Surgery Level 5.

(1) See "Glossary", page 4.5.1.

2.36.1

11/92

45 DRUG & ALCOHOL SERVICES

LEVEL DESCRIPTION

0No service.

1Limited range of drug and alcohol services provided by general practitioner (GP) or non-specialist staff. Consultation available with specialist drugand alcohol services. Interpreter service available(').

3 As at Level 1 plus formalised education programmes to clinicians and staff in early detection skills of harmful and hazardous drug and alcohol use.Capacity to provide medicated detoxification and support for patients assessed to be low risk of life threatening sequelae. Management supervisedby medical officer(s)" with specific drug and alcohol experience/training and liaison psychiatry available. Provision of training to doctors, nurses andother professionals. May have outpatient methadone management programme. Has access to allied health professional services (health, welfare,legal). Access to detoxification service. Has a Continuous Quality Improvement pIant2.

4 As Level 3 plus provision of non-medicated detoxification and medicated detoxification of single and multiple drug dependencies. These servicesmust be integrated with other hospital and community services comprising extended hours assessment and treatment. Has capability to providemethadone assessment, dispensing and dosing. Registered nurse"' experienced in drug and alcohol interventions on staff. Support services forinpatient care as for General Medicine Level 3.

(1) See "Medical and Nursing Staff Definitions" in Appendix I, page: 4.1.1(2) See "Glossary". page 4.5.1.

2.37.1

11/92

Continued

45 DRUG & ALCOHOL SERVICES

LEVEL DESCRIPTION

5 As Level 4 plus multidisciplinary drug and alcohol team on site providing full assessment and treatment services including assessment for brairdamage, management of drug related brain damage, clinical supervision of staff, public education and prevention activities. Has capability toprovide methadone assessment, prescribing, dispensing and dosing to a maximum of 100 patients. Has relevant subspecialty consultancy service,e.g. gastroenterology, neurology, infectious diseases including HIV. Provides advanced postgraduate training. Has a unit manager. Access tospecialist clinical nurse"' is desirable. Support services for inpatient care as for General Medicine Level 4.

6 As Level 5 plus specialist drug and alcohol training program for all staff working with conditions related to drug and alcohol use and clinicalsupervision of these staff. Relevant subspeciality consultancy on site. Experienced registered nurses"' on most shifts. Teaching and consultancyservices to all other levels (1-5), research into early detection, early intervention and treatment of drug and alcohol related problems; providingspecialist services to groups with particular needs, e.g. pregnant opioid dependent women or HIV antibody positive individuals. May provideadvanced post graduate training. May have a National role. Support services for inpatient care as for General Medicine Level 5.

See "Medical and Nursing Staff Definitions" in Appendix I. page: 4.1.1

2.37.2

11/92

46 GERIATRICS

LEVEL DESCRIPTION MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnC Cpt8800UUIhryd$ S


Primarily supportive.Personal and nursing care available as necessary.Referral and11101210management by general practitioner. Links to Community Care Services and hostel andnursing home accommodation. Registered nurse"' in charge on each shift (in-patient unit).Has a Continuous Quality Improvement plan 121 . Interpreter service available121.

2As Level 1 plus general physician consultation available. Continuing nursing educational12101210programst" available specific to the needs of the service. Access to allied health professionals.Can provide respite care.

3As General Medicine Level 3 plus provides limited rehabilitation. 33302332

4As Level 3 plus active assessment and rehabilitation involving inter-disciplinary team providing33403333services to day patients and in-patients. Has a unit manager'" and experienced registerednurses'".Medical services provided by specialist geriatricians supported by medicalregistrars"' or medical officers'".Access to consultant physician in geriatric medicine.Consultation and referral links to relevant medical and surgical services.

5As Level 4 plus integrated assessment in-patient unit and domiciliary consultant service serving54534443a defined geographical catchment. Link with in-patient rehabilitation unit. Nominatedspecialist medical director and medical registrar"'. Access to specialist clinical nurse'" isdesirable. Has, or links with psychogeriatric service. May have teaching and research role.

6As Level 5 plus admission rights including from emergency services department, for acute 66554444patients under specialist geriatricians. Has teaching and research role. Has geriatrics registrar.May have National role.

See "Medical and Nursing Staff Definitions" in Appendix 1, page: 5.1.1.(2) See "Glossary", page 4.5.1. - 2.38.1

11/92

47 HEALTH PROMOTION 2

LEVEL DESCRIPTION

0No health promotion or patient education activities undertaken.

1Provide health information through pamphlets, publications and other media. Provide patient education to clients and family members for personalhealth promotion/prevention activities.

2 As Level 1, plus patient access to standard health promotion and patient education programs in community and hospital settings (e.g. diabeteseducation groups, antenatal education). Provide preventive health services, including screening and referral for specific health issues (e.g. Papsmears). Mechanisms for community participation. Links with Maori Health and Pacific People's Health Services. Has Continuous QualityImprovement plan 1 . Interpreter service availabl&1.

3 As Level 2, plus have specific health promotion staff for population promotional services. Plan, implement and monitor health promotion programsdeveloped by the Public Health Commission. Conduct programs in response to Local Strategic Plans and National campaigns. Consult withclinicians on patient education programs. Specific programs for ethnic groups where indicated. Documentation of programs. Access to audio-visualand communication, public relations support services.

4 As Level 3 plus maintain continuous and substantial health promotion and patient education activities. Ongoing strategic and program planning forhealth promotion. Consultation and collaboration with public health resources in the Area/Region. Collaboration with clinical staff in thedevelopment of health promotion interventions. Evaluation of selected programs and resources. Train and supervise health educators. Provideconsultancy training and supervision in health promotion to other staff. The service has established policies and ongoing patient educationprograms. Consultancy training and supervision of clinical staff in patient education.

(1) See Glossary", page 4.5.1Health promotion is about changing the behaviour of populations using various strategies such as:- health education, media campaigns, community development, lobbying forlegislative change etc. It extends across a number of services in health and cannot be easily catagorised into levels of complexity for a specific health promotional service. Thelevels given here are tentative only and have only minor adaptations from the New South Wales Guide.

2.39.1

11/92

47 HEALTH PROMOTION

LEVEL DESCRIPTION

5 As Level 4 plus conduct extensive and diversified health and patient education activities. Conduct formal outcome evaluation of healthpromotion/patient education activities. Develop and implement innovative and demonstration health promotion and patient education programmes.Area/region planning and service development. Collaboration with tertiary education institutions. Develop intersectoral collaboration on healthpromotion intervention.

6 As Level 5 plus conduct formal research projects and outcome evalution of health promotion and patient education activity. Has specialised healthpromotion and patient education staff. Provides a comprehensive health information and education resource service. Conjoint appointments withtertiary education institutions. Established intersectoral committee or other structure at senior executive level to address health issues.

(1) See"Glossary", page 4.5.1.

2.39.2

11/92

48 HIV/AIDS

LEVEL DESCRIPTION

0No service.

1Limited range of community services provided by non-specialist staff in consultation with general practitioners (GPs). Access to specialised- community health services for consultation and referral -e-g- service availabl&2.

2 As Level 1 plus access to HIV counselling and testing, interdisciplinary community health (STD/IDU programmes), STD/Sexual Health Services, orcommunity AIDS support staff providing a range of assessment, home care, counselling, information, education and prevention programs.(Prevention programmes seperated into those targeted to "at risk groups" and those focused on the general population). Counselling and supportservices by a range of disciplines. Link with palliative/hospice care. Link to Drug and Alcohol Services. Has a Continuous Quality ImprovementPlan2.

3As Level 2 plus access to in-patient beds managed by physician or medical practitioner with skills in HIV medicine. Has experienced registerednurses"'. Access to STD/Sexual Health Service and/or Community AIDS support desirable. Support services as for General Medicine Level 3.

4As Level 3 plus strong links between hospital and community support services including home care and respite care and at least Level 3 PalliativeCare Services. Management by physicians with interest in AIDS and related diseases. Support services as for General Medicine Level 4.

5 As Level 4 plus specialist multidisciplinary team including allied health professionals and social worker. Management by specialists with expertise inHIV/AIDS such as infectious disease physicians, haematologists, respiratory physicians. Participates in research, community education andprofessional development programs and consultative outreach programs. Strong link with Level 5 Palliative/Hospice Care Service. Communitysupport program including link with home and voluntary non government organisations. Day Hospital. On site specialist medical staff in areas suchas neurology, oncology, psychiatry, respiratory and gastrointestinal. Accepts referrals from lower levels. Specialist 0/P clinic. Access to clinicalnurse consultant 1 is desirable. Level 4 Operating Suite, other support services as for General Medicine Level 5.

6As Level 5 plus nominated director of HIV/AIDS In-patient and Community Services. May have designated unit. May provide National referral role.Has a Unit manager'. Formal teaching and research role. Level 6 Operating Suite, other support services as for Immunology Level 6.

" See "Medical and Nursing Staff Definitions" in Appendix I, page: 4.1 .1See "Glossary". page 4.5.1. 2.40.1

11/92

49 PALLIATIVE CARE/HOSPICE SERVICES

LEVEL DESCRIPTION MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahAMnCCptaaaeUUI


1Primarily supportive. Management by general practitioners and generalist community nurses 11101000(community patients). In-patient management has registeredin charge on each shift.

11Has a Continuous Quality Improvement plfl2• Interpreter service available .

2As Level 1 plus consultation available from specialist physician'".Continuing nursing11101000eucation programs available specific to the needs of the service.

3As Level 2 plus consultative support from a specialist clinical nurse'". In-patient management21101210by accredited medical practitioners'" or by specialist physicians'". Has a unit manager'".Access to social worker.

4As Level 3 plus mobile consultancy support from medical practitioner specialising in palliative 32203213care (community patients) and designated palliative care/hospice beds managed by medicalpractitioner specialising in palliative care. Social worker and allied health professionals onstaff.

5As Level 4 plus integrated community/hospice consultative service under direction of medical 44234213practitioner accredited" ) in palliative care or palliative care physician. Has medical officer" ormedical registrar". Specialist clinical nurse", social worker and allied health professional staffattached to service.Has links with oncology, radiotherapy, anaesthetics, psychiatry,multidisciplinary pain clinic, rehabilitation and surgical services.

(1) See"Medical and Nursing Staff Definitions" in Appendix 1 • page: 5.1.1.(2 See "Glossary". page 4.5.1. 2.41.1

11/92

Continued

49 PALLIATIVE CARE/HOSPICE SERVICES

MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCpt880eUUhryds S

LEVEL DESCRIPTION

6As for Level 5 plus palliative care specialist'" providing liaison consultancy to various units at44535314major referral hospitals. Link with multidisciplinary pain clinic. Has registrar 1 ' in palliativemedicine. Based in or has staff with conjoint appointments between hospice and majorreferral hospital.

" See"Medical and Nursing Staff Definitions in Appendix I, page: 4.1.1.See Glossary". page 4.5.1.

2.41.2

11/92

50 REHABILITATION

LEVEL DESCRIPTION MINIMUM LEVEL OF SUPPORT SERVICESPPXNAIC0ahRMnCCpt88eaUU

0No Service Not Applicable

3Some slow stream or restricted rehabilitation provided. Allied health professionals on staff. 122022Referral and management by accredited medical practitioners"' or by specialist physicians.Medical officer"' on call 24 hours. Has a unit manager'. Some registered nurses having orundertaking post basic studies. Access to liaison psychiatry. Has a Continuous QualityImprovement plan 121 . Interpreter service available 121

4As Level 3 plus active rehabilitation programs available, involving salaried inter-disciplinary32303212team.Services provided by medical practitioner or physician with special interest inrehabilitation medicine supported by medical officer(s)"'. Consultation with a rehabilitationspecialist available. Has a unitand experienced registeredOutpatientservices supported by accessible transport. Access to allied health professionals, e.g.occupational therapist, physiotherapist, psychologist, podiatrist, social worker, speechtherapist, dietitian.

(1) See Medical and Nursing Staff Definitions in Appendix I, page: 4.1.1

12) See "Glossary", page 4.5.1.

2.42.1

11/92

Continued

50 REHABILITATION


LEVEL DESCRIPTION

5As Level 4 plus active in-patient and outpatient rehabilitation programs serving a defined 33434213geographical catchment. Unit directed by a rehabilitation specialist t11 . Access to specialistclinical nurse"' is desirable. In-patient beds may be off-site but under the control of thedirector. Has medical registrar"'. Has access to hydrotherapy and a limb-fitting service. Co-ordinates with orthopaedic, neurology and neurosurgery departments. Has an accessibletransport service for outpatients. May have teaching and research role.

6Has links with major referral hospital. Has teaching and research role. Experienced registered 34434334nurses on most shifts. May have a supra-regional role (e.g. spinal unit).

" See Medical and Nursing Staff Definitions in Appendix I, page: 4.1.1

2.42.2

11/92

51 SEXUAL ASSAULT SERVICES

LEVEL DESCRIPTION

0No service.

1No planned service. Able to provide initial treatment or support prior to referral to designated sexual assault service. Able to assist with transportto referral centre. Has a Continuous Quality Improvement plan"'. Interpreter service available"'.

3 As Level 1 plus specialist counselling staff providing follow up counselling for victim and for non-offending family. This includes individual, groupand family counselling. Formal links with Level 4 for 24 hours crisis counselling and medical care. May provide follow up medical care. PathologyLevel 1.

4 As Level 3 plus 24 hour service with counsellor and medical officer on call. Staffing includes co-ordinator of service. Has medical officer 3 trainedin the care of sexual assault victims, including completing a New Zealand Police Assult Medical Protocol and use of NZ Police Medical examinationkits (assult kit and toxicology kit)'2 . Designated area in emergency department or elsewhere in a special facility for crisis care, with support servicesas for Level 3 Emergency Services.

5As Level 4 plus conducts research. Extensive program of community education and professional training. Paediatrician available for consultationand links with specialist gynaecology services (Level 4).

See "Glossary", page 4.5.1.(2) Protocol and kits available from police. See also booklet "Sexual Assault Examinations. A Guide for Medical Practitioners"

2nd Edition 1990 M.E. Lawton at al. ISBN 0-477-02573-0See "Medical and Nursing Staff Definitions" in Appendix I, page 4.1.1.

2.43.1

11/92


--- --- ---- --


11/92

52 MAORI HEALTH

AN INTRODUCTION TO MAORI HEALTH

Health Services must recognise and emphasise Maori Health concept that health is all embracing. The emphasis must be on the importance of the wairua(spiritual), whanau (family), hinengaro (mental) and tinana (physical) aspects. Issues involving the whenua (land), te reo (language), te ao turoa(environment) and whanaungatanga (extended family), are central to Maori culture, central to Maori health and well-being, and are intrinsic in the Treaty ofWaitangi. (Tiriti 0 Waitangi). Each article of the Treaty contains a significant provision that relates to health. Maori place considerable emphasis on theseprovisions (as opposed to the principles of the Treaty) and hold that they remain relevant.

Kawangatanga

Article I provides for the Government to govern, though not in isolation to other provisions in the Treaty of Waitangi. The right to govern is qualifiedby an obligation to protect Maori interests and health.

Tino Rangatiratanga

Article II provides for tribes to exercise authority in respect of their own affairs. The extent of that authority and its relationship to the authority ofthe Crown is a matter which will become clearer as partnerships are formed and debate occurs. Tino Rangatiratanga denotes the prerogatives ofIwi/Hapu in their own affairs including their own physical, social, cultural resources (and therefore health services) within a tribal developmentalcontext. Tino Rangatiratanga can be described as Maori people pursuing greater Maori autonomy. However, it is at its strongest when it refers tothe position of Iwi/Hapu as tangata whenua in a particular area or region, Tino Rangatiratanga is Iwi/Hapu autonomy. It is for Iwi to determine therole they might wish to play in their own development and having decided on that role they might then reasonably expect a significant relationshipwith the Crown or its agencies providing health services.

Oritetanga

Article III contains a provision which guarantees equality and equity between Maori individuals and other New Zealanders. As long as socio-economic disparities remain, (including health) the provision is unratified.

2.44.1

11/92

52 MAORI HEALTH

LEVEL DESCRIPTION

0No specific service for special Maori needs within mainstream services, but acceptance of Treaty of Waitangi.

1Provision of Maori services, mainstream or community based with acceptance of Te Tiriti 0 Waitangi as a focus of Maori health provision.Accessibility to Maori personnel, information and access of Te Reo Maori personnel. Recognition of tribal boundaries, lwi/Hapu development. Has aContinuous Quality Improvement plan"' in accordance with Maori Health lntroduction12.

3 As level 1, plus Maori health workforce personnel both within mainstream services, Maori specific services, and Iwi/Hapu services. Maoriparticipation focuses on Primary Care, Health Promotion, Health Education, Health Prevention, Information Resources. Recognition by Maori of theservice's acceptability, appropriateness and accessibility. Cultural programmes or cultural safety of service provision. Maori auditors participating inContinuous Quality Improvement plan process.

4 As Level 3, plus mainstream service responsiveness to Maori health development. Maori participation in the designing, focusing and in delivery ofappropriate Maori health services. Health promotion activities through Maori media. Established Maori liaison personnel to general practitioner,hospital staff and administrators and other agencies. Experience in communication in Maori.

6As Level 4, plus Maori controlled health services providing a comprehensive range of health services.Skills in service delivery require a high Maori profile in methods of health promotion, disease prevention, primary health administration and provision.Preference for Maori designed and implemented educational packages and liaison service through the primary, secondary and disabilities supportservices where Maori utilisation and contact is high. Strategies for professional/ technical development to ensure qualified Maori personnel.The work force requires a mix of both health professional and community health workers who are Maori in services for Maori people and theirwhana u.Experience in communication with Maori is required to be of a high standard to achieve behavioural change to improve Maori health. Healthpromotional and educational activities must be effectively defined and delivered by Maori staff members.A Maori health services data base is required to demonstrate effectiveness and efficiency of the Maori health service.Active participation of Whanau, Hapu, Iwi and other Maori organisations is required in assisting in the provision of services.

See"Glossary", page 4.5.1(2)Maori Health Introduction page 2.43.1

2.44.2

11/92

53 COMMUNITY HEALTH -GENERAL 121

LEVEL DESCRIPTION

0No service

1Limited range of community services provided by non-specialist staff. Access to specialised community health services for consultation and referral.Has a Continuous Quality Improvement plan'". Interpreter service available'".

2 As Level 1 pIus designated interdisciplinary community health team providing a range of assessment, treatment, information, education andprevention programs based on needs of catchment area wider than one local neighbourhood. Regular liaison with general practitioners (GPs),hospital services, and Maori Health and Pacific People's Health Services.

3 As Level 2, plus some specialist staff and access to a range of consultants/specialist teams appropriate to services provided. Well developedplanning and review of service provision based on community needs. Links with in-patient services, other agencies and specialist services. Provisionof a broad range of programs for all population sub-groups across several local neighbourhoods (e.g., in an urban setting). May operate from multiplecentres.

4 As Level 3, plus integrated hospital and community services with full time staff specialising in specific community health programs targetingparticular health problems or population groups. May have specialised sub-teams or functional units. Registered nurses"' with relevant experience,(e.g. in mental health, child and family, drug and alcohol) on staff. Should have extensive inter-agency liaison mechanisms. Co-ordinated serviceswith multiple centres operating out of central base.

5 As Level 4, plus full range of community services relevant to the needs of catchment population provided by designated specialist teams. Full-timemanager. May have some general (non-specialist) workers at the neighbourhood centre level for first-line assessment, referral and communitydevelopment roles. Extensive (Level 5) health promotion and prevention program with formal outcome evaluation. Access to specialist clinical

is desirable.6As Level 5, plus link to relevant tertiary institutions providing regular undergraduate and postgraduate training for a range of professional disciplines.

Conducts formal research projects.

> See "Glossary", page 4.5.1(2) Designated Community Health Service not necessarily applicable in New Zealand.

2.45.1

11/92

54 COMMUNITY/DOMICILIARY NURSING 3

LEVEL DESCRIPTION

0No service.

1Co-ordination and provision of direct care service and development of care plan in close liaison with general practitioner and other communitysupport services. Links to other community-based and in-patient health facilities. Has a Continuous Quality lmrovement plan 121. Interpreter serviceavailabl&2'.

2Designated team of community nurses providing a range of primary care services and additional services based on identified needs of the catchmentpopulation such as domiciliary nursing'", supportive counselling/advice to clients and relatives. Continued nursing education programs specific to theneeds of the service.

3As Level 2, plus designated unit manager" )12) and an administratively seperate service from in-patient services. Some nurses having completed orundertaking relevant studies. Population-based screening and health promotion activities.

4 As Level 3, plus component of an integrated, comprehensive hospital and community health service relevant to the identified health needs of theentire catchment population. Links to hospital discharge planner. Ready access for consultation with a range of health disciplines, and services, e.g.specialist medical care, residential centres and family day care cottages. Has a unit manager'" and experienced registered nurses"'.

5As Level 4, plus local access to experienced registered nurses " desirable. (e.g. community psychiatry, palliative care, stomal therapy, maternal andinfant welfare etc). Has specialty sub-teams. Provides limited after-hours service.

6As Level 5, plus provision of 24 hour service with experienced registered nurses"' on most shifts. Provision of consultation to other communitynursing services. Provision of formal teaching and research functions (e.g. in conjunction with Schools of Nursing and University Departments).

See "Medical and Nursing Staff Definitions" in Appendix I, page: 4.1 .1See "Glossary", page 4.5.1

Where services are organised in a service management structure, community nursing may be part of service management and not a separate service in itself.

2.46.1

11/92

55 MIGRANT AND REFUGEE HEALTH1

LEVEL DESCRIPTION

0No specific service for recognition of migrant and refugee health needs within mainstream services.

1Access to telephone interpreter services of comprehensive range of languages, these interpreters being specificially trained and competant. Has aContinous Quality Improvement plan (21 specific to migrant and refugee health.

3As Level 1 plus access to ethnic health worker(s) eg ethnic health worker providing a range of services in association with locally based teams. Mayhave on-site interpreter services for the major languages.

5 As for Level 3 plus on-site ethnic health worker(s). On-site access to interpreter services for the main language groups. Formally integrated hospitaland community multicultural health services. Extensive inter-agency liaison and co-operation in the delivery of the community-based projects formigrants and refugees. On-going curltural awareness programmes.

6As for Level 5 plus bilingual health professionals providing a full range of specialist services targeted to the main ethnic groups. Involvement inresearch and teaching on multicultural health issues for undergraduate and postgraduate health disciplines.

Excludes initial screening and resettlement programmes available on arrival(2) See "Glossary". page 4.5.1.

2.47.1

11/92

56 PACIFIC PEOPLE'S HEALTH

LEVEL DESCRIPTION

0No specific service for recognition of Pacific People's health needs in mainstream services.

1 Limited range of services available with non-specialist staff and liaison with Pacific People in the local community. Access to interpreter services forthe four main Pacific People's languages"', the interpreters being specifically trained and competent in these languages. Has a Continuous QualityImprovement plan 121 specifically for Pacific People's health.

3 As Level 1, plus in areas with significant Pacific Peoples populations, cultural liaison officers providing advice to management, medical practitionersand the community. Specified staff providing direct nursing and/or counselling services. Should have Pacific people as Community Health Worker(s)providing health promotion, community development etc. Cultural awareness programmes available for all staff. Established links to other healthservices in hospitals or in the community.

4 As Level 3 plus, community controlled culturally safe health services providing a range of specialist health programmes appropriate to local needssuch as dental, public health, drug and alcohol and community nursing. Primary medical practitioner based in a community controlled health service.Integrated hospital and community health services specifically for Pacific people available and extensive interagency liaison mechanisms. Pacificpeople membership on the management board of the service.

6As Level 4 plus mainstream services employing Pacific people in various staff categories in similar proportions to the catchment population.Extensive involvement in research into Pacific People's health issues.

(1) The four main Pacific People's languages in New Zealand are cook Island, Samoan, Tongan, Niuean. Fijian and Tokolean are two other important languages.(2) See Glossary page 4.5.1.

2.48.1

11192

57 STD/SEXUAL HEALTH SERVICES

LEVEL DESCRIPTION

0No planned service.

1Emergency services provide assessment, treatment and appropriate referral by registered nurse (l) or medical practitioner with limited training inSTD/HIV. Interpreter service available'2.

2As Level 1 plus designated outpatient clinic sessions. Has medical director and experienced registered nurse"'. Limited outreach facility (partnernotification, health promotion, including safer sex). Onsite microscopy. STD/HIV specific statistics kept.Has Continous Quality Improvementplan'2.

3 As level 2 plus specialist medical director and specialist counselling service available at least during clinic hours. Substantially involved in communityeducation and STD/HIV prevention programs. Access to a range of consultant specialist services (e.g. gynaecology, colposcopy). Link withHIV/AIDS Service Level 3. Formal link with community health services, Maori Health Services, Pacific People's Health Services and Migrant/RefugeeHealth Services.

4As Level 3 plus on-site colposcopy.

5As Level 4 plus actively involved in professional development and consultative outreach programs. Access to specialist clinical nurse () is desirable.May undertake research. Link with HIV/AIDS services at Level 4.

6 As Level 5 plus medical team comprising director and additional specialists. Some clinics conducted by specialists"' in other relevant specialties (e.g.gynaecology, AIDS physicians). Research and development programs. Has outreach facility and foreign language clinics as required. ProvidesNational co-ordination, consultative and referral service. Close link with Level 5 HIV/AIDS Service.

See "Medical and Nursing Staff Definitions" in Appendix 1, page 4.1.1(2)See "Glossary". page 4.5.1

2.49.1

11/92

- F -

58 WOMEN'S HEALTH

LEVEL DESCRIPTION


1 Range of community services by general staff (including self-help and support groups for women). Community development in health initiatives.Access to identified women's health services and general practitioners (GPs), for consultation and referral. Has a Continous Quality Improvementplan'". Interpreter service available'".

2 As Level 1 plus general staff providing programs specifically targeting women's health issues, e.g. promoting breast self examination. Consultationand referral to GPs with access to specialist medical services. Health promotion and prevention programs available. Links to Maori Health andPacific People's Health Services.

3As Level 2 plus FIT designed women's health nurse practitioner(s) providing range of services. Formal interagency collaboration on health promotionand prevention programs. Link to specialist multidisciplinary women's health teams. (Level 4).

4 As Level 3 plus specialist multidisciplinary women's health teams offering primary medical care. May have on-site medical practitioner. Links withlocal GPs. Specifically targeted women's health programs. Multi-disciplinary health promotion programs with evaluation and monitoring of thoseprograms. Extensive health promotion and prevention programs with formal outcome evaluation. Formal interagency collaboration with otherrelevant government departments, and non government organisations. Links with specialist medical and surgical in-patient services (gynaecology,oncology).

6As Level 4 plus specialist relevant medical and surgical services (e.g. gynaecology, oncology). May provide undergraduate and postgraduate trainingfor professional disciplines. Research projects in women's health and health promotion. Has teaching and research activities.

See "Glossary". page 4.5.1. 2.50.1

11/92

PART 3

SUMMARY SHEETS

PART 3

SUMMARY SHEETS

11/92

I -

PART 3: SUMMARY SHEET: HOSPITAL/COMMUNITY HEALTH SERVICE SUMMARY (page 1)

HOSPITAL/COMMUNITY HEALTH SERVICE .........................................................................................................

Service Number and Name ActualProp.Approved COMMENTSLevelLevelLevel

1 PATHOLOGY

2 PHARMACY

3 DIAGNOSTIC RADIOLOGY

4 NUCLEAR MEDICINE

5 ANAESTHETICS

6 INTENSIVE CARE

7 CORONARY CARE

8 OPERATING SUITE


10 GENERAL MEDICINE

11 CARDIOLOGY

12 DERMATOLOGY

13 ENDOCRINOLOGY

14 GASTROENTEROLOGY

15 HAEMATOLOGY - CLINICAL

16 IMMUNOLOGY

3.1.1

11/92

ContinuedPART 3: SUMMARY SHEET: HOSPITAL/COMMUNITY HEALTH SERVICE SUMMARY (page 2)


Service Number and nameActualProp.Approved COMMENTSLevelLevelLevel

17 INFECTIOUS DISEASES18 NEUROLOGY19 ONCOLOGY-MEDICAL20 ONCOLOGY-RADIATION21 RENAL MEDICINE22 RESPIRATORY MEDICINE23 RHEUMATOLOGY24 GENERAL SURGERY25 BURNS26 CARDIOTHORACIC SURGERY27 DAY SURGERY28 EAR, NOSE AND THROAT29 GYNAECOLOGY30 NEUROSURGERY31 OPHTHALMOLOGY32 ORTHOPAEDICS

3.1.2

11/92



Service Number and NameActualProp.Approved COMMENTSLevelLevelLevel

33 PLASTIC SURGERY34 UROLOGY35 VASCULAR SURGERY36 OBSTETRICS37 NEONATAL38 PAEDIATRIC MEDICINE39 PAEDIATRIC SURGERY40 FAMILY & CHILD HEALTH41 ADOLESCENT HEALTH42 ADULT MENTAL HEALTH43 CHILD PROTECTION SERVICE44 DENTAL HEALTH45 DRUG & ALCOHOL SERVICES46 GERIATRICS47 HEALTH PROMOTION48 HIV/AIDS49 PALLIATIVE CARE/HOSPICE SERVICE

3.1.3

11/92




50REHABILITATION51SEXUAL ASSAULT SERVICES52MAORI HEALTH SERVICES53COMMUNITY HEALTH - GENERAL54COMMUNITY/DOMICILIARY

NURSING55MIGRANT & REFUGEE HEALTH56PACIFIC PEOPLE'S HEALTH57SEXUAL HEALTH SERVICES (STD)58WOMEN'S HEALTH

DATE: .../.... . /91.

ASSESSEDBY......................................................................................(name and designation)

3.1.4

11/92

HEALTH SERVICE NAME:PART 3: SUMMARY SHEET: AREA/REGION HEALTH SERVICE SUMMARY (page 1)

SECTION 1: HOSPITALS, COMMUNITY HEALTH SERVICES AND OTHER FACILITIES INCORPORATED

HOSPITALS:

COMMUNITY HEALTH SERVICES /OTHER FACILITIES:

3.2.1

11192

PART 3: SUMMARY SHEET AREA/REGION HEALTH SERVICE SUMMARY (page 2)

AREA/REGION HEALTH SERVICE NAME .....................................................................

SECTION 2: MAXIMUM LEVELS ATTAINED/LEVELS PROPOSED


1 PATHOLOGY

2 PHARMACY

3 DIAGNOSTIC RADIOLOGY

4 NUCLEAR MEDICINE

5 ANAESTHETICS

6 INTENSIVE CARE

7 CORONARY CARE

8 OPERATING SUITE


10 GENERAL MEDICINE

11 CARDIOLOGY

12 DERMATOLOGY

13 ENDOCRINOLOGY

14 GASTROENTEROLOGY

15 HAEMATOLOGY - CLINICAL

16 IMMUNOLOGY

3.2.2

11/92

Continued PART 3: SUMMARY SHEET: AREA/REGION HEALTH SERVICE SUMMARY (page 3)

AREA/REGION HEALTH SERVICE NAME ........................................................................................

MAXIMUM LEVELS OF ATTAINED/LEVEL PROPOSED


17 INFECTIOUS DISEASES18 NEUROLOGY19 ONCOLOGY-MEDICAL20 ONCOLOGY-RADIATION21 RENAL MEDICINE22 RESPIRATORY MEDICINE23 RHEUMATOLOGY24 GENERAL SURGERY25 BURNS26 CARDIOTHORACIC SURGERY27 DAY SURGERY28 EAR, NOSE AND THROAT29 GYNAECOLOGY30 NEUROSURGERY31 OPHTHALMOLOGY32 ORTHOPAEDICS

3.2.3

11/92

ContinuedPART 3: SUMMARY SHEET: AREA/REGION HEALTH SERVICE SUMMARY (page 4)

AREA/REGION HEALTH SERVICE NAME ........................................................................................MAXIMUM LEVELS OF ATTAINED/LEVEL PROPOSED


33 PLASTIC SURGERY34 UROLOGY35 VASCULAR SURGERY36 OBSTETRICS37 NEONATAL38 PAEDIATRIC MEDICINE39 PAEDIATRIC SURGERY40 FAMILY & CHILD HEALTH41 ADOLESCENT HEALTH42 ADULT MENTAL HEALTH43 CHILD PROTECTION SERVICE44 DENTAL HEALTH45 DRUG & ALCOHOL SERVICES46 GERIATRICS47 HEALTH PROMOTION48 HIV/AIDS

IL 49 PALLIATIVE CARE/HOSPICE SERVICE

3.2.4

11/92

.-.------.--,-.----4

ContinuedPART 3: SUMMARY SHEET: AREA/REGION HEALTH SERVICE SUMMARY (page 5)

AREA/REGION HEALTH SERVICE NAME ........................................................................................

MAXIMUM LEVELS OF ATTAINED/LEVEL PROPOSED


50REHABILITATION

51SEXUAL ASSAULT SERVICES

52MAORI HEALTH

53COMMUNITY HEALTH - GENERAL

54COMMUNITY/DOMICILIARY NURSING

55MIGRANT & REFUGEE HEALTH

56PACIFIC PEOPLE'S HEALTH

57SEXUAL HEALTH SERVICES (STD)

58WOMEN'S HEALTH

DATE ...I.../19...ASSESSEDBY ....................................................................................

(name and designation)

3.2.5

11/92

PART 4

APPENDICES

PART 4

APPENDICES

11192

PART 4

APPENDIX I

MEDICAL AND NURSING STAFF DEFINITIONS

MEDICAL OFFICERMedical officers are registered medical practitioners employed/contracted by hospitals. They are usually responsible to service or clinical managers, and tothe senior clinicians contracted in the service in which they perform their duties.

They do not require experience specific to the area of practice and may be a career medical officer, a full-time or part-time resident medical officer, ageneral practitioner, senior House Surgeons etc.

REGISTRARRegistrars are experienced medical officers appointed to positions in hospitals or community health services. They may participate in a formal trainingprogram approved by a learned college and may have prior experience in the relevant specialty area. Medical officers may occupy registrar positions insome circumstances provided they are experienced in the relevant specialty area.

ACCREDITED MEDICAL PRACTITIONER (previously M.O.S.S. = Medical Officer of Special Scale)Is a general practitioner appointed to a hospital and to whom specific clinical privileges have been granted e.g. In surgery, anaesthetics, obstetrics,endoscopy, etc.), following review of his/her training and continuing skills, by a credentials committee"'. The committee will have given regard to medicalpractitioners' documented post-graduate training and the volume, and type of past and recent clinical practice considered to be essential for themaintenance of skills in the requested privileges. In the case of infrequently performed procedures, skills maintenance should be through exchange releaseprograms at base hospitals with level 4, 5, or 6 of appropriate service. In addition there should be a demonstrated level of special skills, a commitment tocontinuing education, and a continuing assessment of the ready availability of specialist medical practitioners in the sphere of practice in which privilegesare requested.

SPECIALIST ANAESTHETISTIs a medical practitioner whose training has been acknowledged by the award of fellowship in the College of Anaesthetists of Australia and New Zealand;or one who holds an equivalent post graduate qualification accepted by the Medical Council of New Zealand.

ACCREDITED SPECIALIST ANAESTHETISTIs a specialist anaesthetist as defined and who, as a result of additional training and acquisition of skills, has been granted additional clinical privileges bythe credentials committe& beyond the usually accepted parameters of specialist anaesthetic practice.

GENERAL PHYSICIANIs a registered medical practitioner whose training has been acknowledged by the award of the accolade of Fellowship in the Royal Australasian College ofPhysicians; or one who holds an equivalent post-graduate qualification accepted by the Medical Council of New Zealand.

Credentials committee. This Guide does not stipulate the format or process of credentialling and credentialling committees. Such a process is being considered on a National basis.

4.1.111/92

Continued

SPECIALIST GENERAL PHYSICIAN WITH SUB-SPECIALTY INTERESTIs a specialist general physician as defined who, as a result of further training and acquisition of skills, has been granted privileges by the credentialscommittee"' in areas of medical practice usually considered to be sub-specialties outside the accepted field of general medicine.

SPECIALIST PHYSICIAN (SPECIALTY TYPE)(e.g. cardiology, paediatrics, geriatrics, psychiatry, rheumatology, dermatology, etc).Is a physician who has completed a learned college approved training program with the award of a fellowship, and who has successfully undertakenadditional training programs as a specialist in the indicated sub-speciality approved by the appropriate College.

SPECIALIST SURGEON

This title includes:

(A) General Surgeon

Is a registered medical practitioner whose training has been acknowledged by the award of the accolade of Fellowship in General Surgery in theRoyal Australasian College of Surgeons; or one who holds an equivalent postgraduate qualification accepted by the Medical Council of New Zealandand holds a hospital appointment as a specialist surgeon.

(B) General Surgeon (credentialled for a specialist interest in a subspecialty).

Is a general surgeon as defined, whose training has included areas of surgical practice additional to the current training program in general surgeryand who has been granted privileges by the credentials committeeW to practise in those additional fields.

The current training program in general surgery includes:alimentary surgerya) upper gastro-intestinal surgeryb) cola-rectal surgeryhead and neck surgeryvascular surgeryendocrine and breast surgeryendoscopy and other diagnostic procedures

For subspecialty privileges to be granted to a general surgeon evidence of training in relevant subspecialty of 6-12 months duration in a hospitalwhich has level 5 or 6 in the subspecialty must be demonstrated.

(C) Subspecialty Surgeon: (Subspecialty type)

(e.g. urologist, gynaecologist, ophthalmologist, orthopaedic surgeon, vascular surgeon, plastic surgeon, oral surgeon, etc).Is a surgeon who has successfully completed a college approved training program with the award of a fellowship in the indicated specialty; orsubsequent to the award of a fellowship in general surgery, has undertaken successfully the approved post fellowship training in a surgicalsubspecialty; or a surgeon whose training has been accepted by the appropriate college.

4.1.2

11/92

Continued

MEDICAL AND NURSING STAFF DEFINITIONS

ENROLLED NURSE means a nurse enrolled by the Nursing Council of New Zealand.

REGISTERED NURSE means a nurse registered by the Nursing Council of New Zealand.

MIDWIFE means a person registered by the Nursing Council of New Zealand as a registered midwife.

AN EXPERIENCED REGISTERED NURSE is a registered nurse with at least two years' post basic registration experience including one year's experience inthe relevant clinical field or experience as deemed appropriate by the facility nursing administration. An experienced registered nurse may be a specialistclinical nurse.

A UNIT MANAGER means a person in charge of a ward or unit or group of wards or units in a hospital or health service. Preferably will have completed inservice management course as minimum. May have a management qualification.

SPECIALIST CLINICAL NURSEA definition of a clinical nurse specialist is:

A registered nurse with a minimum of four years post basic registration experience including a minimum of one year experience in the relevant specialistfield together with an approved formal post basic qualification in that field.

4.1.3

11/92

PART 4APPENDIX II

LEVELS OF RISK - ADULTS

CLASSIFICATION OF PHYSICAL STATUS FOR PRE-OPERATION ASSESSMENT:

NEGLIGIBLE RISK

There is no organic, physiological, biochemical or psychiatric disturbance; the pathological process for which operation is to be performed is localised andnot conducive to systemic disturbance.

GOOD RISK

Mild to moderate systemic disturbance caused by either the condition to be treated surgically or by other patho-physiological processes.

MODERATE RISKSevere systemic disturbance or pathology from whatever cause.

BAD RISKA patient with a severe life-threatening systemic disorder which may not be corrected by the operation or procedure.

DESPERATEA moribund patient with little chance of survival.

With acknowledgement to the American Society of Anaesthesiologists.

4.2.1

11/92

PART 4

APPENDIX II

LEVELS OF RISK - CHILDREN (Ages 0-14 inclusive)

GOOD RISK

Healthy children.

MODERATE RISK

Any patient with a history of

(a) prematurity at birth,(b) asthma

Any patient who presents with an acute surgical emergency.

BAD RISK

Any patient with an associated medical condition such as diabetes, bleeding disorder, congenital heart disease, steroid dependent asthma

Any patient with an associated congenital malformation.

With acknowledgement to the Royal Australasian College of Surgeons (Paediatric Surgeons).

4.2.2

11/82

PART 4

APPENDIX II

RISK FACTOR CRITERIA - OBSTETRICS AND NEONATAL

SEE BASIC CLNICAL SERVICES "OBSTETRICS, "NEONATAL"

OBSTETRICS

The suggested levels of care for women presenting with or developing any condition during pregnancy are:

POST PARTUM:

Normal postpartum mothers and babies.

GOOD RISK (Normal Pregnancy):

No adverse conditions are present or develop subsequently. (This is the largest group of women). The following conditions are compatible with good risk:

General Factors

*Anaemia, Mild - Hb.lOg/lOOml or more.*Age - primigravida - MORE than 17 years and LESS than 35 years old.

LOW RISK FACTORS:

The following conditions are deemed to be low risk factors:

Consideration should be given to consultation with an obstetrician when women present with, or develop any conditions listed below:

General Factors:

*Primary infertility*Age - primigravida - LESS than 17 years and MORE than 35 years old.

Maternal Disease

*Essential hypertension, mild - diastolic pressure 90 - 100 mm Hg in the first trimester*Sexually transmitted disease diagnosed during pregnancy - active genital herpes.*Epilepsy*Gestational diabetes mellitus controlled by diet.

4.2.3

11/92

LOW RISK FACTORS Continued

RISK FACTOR CRITERIA

Obstetric History

*Threatened miscarriage in the first trimester (incidence of preterm labour after a threatened miscarriage is 18%)*Parity - para 5 or more*Previous prolonged labour*Previous Caesarean section

Previous retained placenta*Previous postpartum haemorrhage

Complications of present pregnancy

*Multiple pregnancy - twins only*Hypertensive disease of pregnancy, mild-moderate - B.P. elevated, but less than 145/100 with or without proteinuria and/or oedema.*Term breech or any other malpresentation*Placenta Praevia

MODERATE RISK FACTORS:

The moderate risk factors should be an indication for referral to a consultant obstetrician. The following conditions are deemed to be moderate risk:

General Factors*Non-narcotic drug dependence, eg benzodiazepines*Foetus at risk of genetic disease or birth defect; and/or indication to consider prenatal diagnosis.*Where both parents are heterozygous for haemoglobinopathy or other inherited disorders*Heavy alcohol consumption*History of psychotic illness*Skeletal abnormality likely to preclude vaginal delivery*Congenital abnormalities of the genital tract*Uterine fibroids

4.2.4

11/92

MODERATE RISK FACTORS - continued RISK FACTOR CRITERIA

Maternal Disease

*Acute pyelonephritis in the present pregnancy*Anaemia, less than 1 0g/1 OOml*Cardiovascular disease : grades I & II*Uncomplicated diabetes mellitus - Insulin dependent•Essential hypertension, severe diastolic pressure over 1 00mm Hg in the first trimester*Previous venous thrombosis/embolism*Previous uterine surgery*Severe respiratory disease*Carriers of serious infections:

- Hepatitis B positive- HIV positive

Obstetric History

*Previous pre-term labour*Habitual abortion•Previous perinatal mortality*Previous congenital abnormality

Complications of present pregnancy

*Potential delivery from any cause at 33-34 weeks transfer in utero*Polyhydramnios*Abruption placentae*Hypertensive disease of pregnancy - moderate-severe - BP 145/100 or higher with or without proteinuria and/or oedema*Oligohydramnios*Intra - uterine growth retardation*Placenta praevia following LSCS*Pre-term - pre-labour rupture of membranes (Approx 85% of pre-term rupture of membranes deliver in one week)

4.2.5

11/92

RISK FACTOR CRITERIAContinued

HIGH RISK FACTORS:

High risk factors require Level 6 care in most cases. The following conditions are deemed to be high risk factors:

General Factors

Hard drug dependence - opiate addiction*Blood group isoimmunisation

Maternal Disease

*Cardiovascular diseases - Grades III - IV*Chronic renal disease*Insulin dependent diabetes with vascular complications.*Auto-immune disease - systemic lupus erythematous, idiopathic thrombocytopenic purpura, obstetric lupus syndrome.

Complications of Present Pregnancy*Multiple pregnancy - triplets or more*Potential delivery from any cause at 32 weeks or less - transfer in utero.

A pregnancy that is considered to be "at risk" and referred to a specialist obstetrician, may proceed normally and be referred back to the referring doctor ormidwife by the obstetrician.

Non specialist obstetric practitioners (medical and midwife practitioners) are expected to seek consultant advice either by telephone or referral as soon asactual or potential problems are recognised which put the outcome of the pregnancy at risk.

Problems of transport and accommodation for the isolated population coming to Level 4, 5 or 6 maternity units must be discussed and conclusions reachedwell in advance of the woman requiring transfer. This will help the woman and her family to have a reasonable knowledge of what will be expected ofthem. Particular consideration needs to be given to air transport facilities and special retrieval teams.

Lines of communication should be established with a regional perinatal centre and with a special obstetric unit. (Level 6).

4.2.6

11/92

RISK FACTOR CRITERIAContinued

NEONATE:

HIGH RISK FACTORS

+Apgar score 7 or less at 5 minutes*Birth weight less than 2000 gm*Evidence of respiratory distress+Persistent hypothermia*Neonatal hypoglycaemia+Major congenital anomaly

Whenever possible any transfer should be directly to the appropriate level of care, bearing in mind the severity of the condition and the time and distanceinvolved in the transfer.

4.2.7

11/92

MINOR SURGICAL PROCEDURESExcision of skin lesionExcision of subcutaneous tumourDrainage of abscessToe-nail surgery

MAJOR SURGICAL PROCEDURESThyroidectomyVascular graftCholecystectomyBowel resectionMastectomyExploratory laparotomy

COMMON AND INTERMEDIATE SURGICALPROCEDURESAppendicectomyVaricose vein surgeryHerniorrhaphyHaemorrhoidectomyExcision of breast lump

COMPLEX MAJOR SURGICALPROCEDURESAbdomino-perineal resectionAnterior resectionOesophagectomyAortic surgeryPancreatic resectionNeck dissectionSolid Organ Transplant

PART 4APPENDIX III

INDICATIVE LIST OF SURGICAL PROCEDURES

GENERAL SURGERY

Note: The procedures listed are indicative of the complexity of surgical activity in each category. The actual range of procedures which may be performedby individual practitioners appointed to a general or subspecialty surgical service of a given level will be determined through the credentialling process atwhich clinical privileges are granted.

Acknowledgement is given to the Royal Australasian College of Surgeons for assistance with the indicative list of surgical procedures. The procedures andtheir ranking are extracted from the R.A.C.S. operative summary sheet, page 4.

4.3.111/92

PART 4APPENDIX Ill

INDICATIVE LIST OF PAEDIATRIC SURGICAL PROCEDURES

MINOR SURGICAL PROCEDURES

Suture of lacerationExcision of skin lesionDrainage of abscessCircumcisioni.e. any operation which in competent hands takesless than half an hour

MODERATE COMPLEXITY

PyloromyotomyHerniotomy after the first year of lifeOrchidopexy after the first year of lifeAppéndicectomy

MAJOR SURGICAL PROCEDURES

Neonatal surgeryMajor reconstructive surgery (anorectoplasty,rectosigmoiodectomy, etc)

PyeloplastyThoracotomyLymphangioma

Uretic reimplantationFundoplicationSplenectomy

Cleft lip/palate surgeryHerniotomy in first year of lifeOrchidopexy in the first year of life

Burns graftingUrethroplasty

Operative reduction of intussusceptionClosure of colostomyInsertion of central line in first two years of lifei.e. any procedure which in the hands of competentsurgeon takes more than one hour

Note: The procedures listed are indicative of the complexity of surgical activity in each category. The actual range of procedures which may be performedby individual practitioners appointed to a general or subspecialty surgical service of a given level will be determined through the credentialling process atwhich clinical privileges are granted.

Acknowledgement is given to the Royal Australasian College of Surgeons (Paediatric Surgeons) for assistance with the indicative list of paediatric surgicalprocedures. The procedures and their ranking are based on complexity definitions of the Board of Paediatric Surgery of the RACS.

4.3.2

11/92

PART 4

APPENDIX IV

N.S.W. TRAUMA SERVICES

RELATED SUPPORT AND BASIC CLINICAL SERVICES

CURRENTLY NOT DIRECTLY APPLICABLE TO NEW ZEALAND"'

TRAUMA PXNAI0EGNG C N00PUVRSERVICE AR NCPMEEEIEPALRAEDESIGNATIONTAMAU ENUN T UHTA0SHWITHIN TRAUMAHYEE SR RH RTHSLCASERVICES PLAN DS UGM05 0 0H010UB1991 I IEELURSAPIGL

C TND0R A ULACYAI ECIGGCRME R

N YCYEIGIDE I RCECI

N VR C

E V SLOCAL Support and core services as delineated for the individual hospiAREA 4444444444* ** *444

5SUPRA-AREA665666655556555556

*Access to Level 5 of this service by appropriate interhospital transfer.

**Where Level 5 Neurosurgery not appropriate Level 4 plus access to Level 5 by established interhospital transfer is adequate.

See notes on Trauma Services page 1.09

4.4.1

11/92

t-

PART 4APPENDIX IV

N.S.W. PAEDIATRIC TRAUMA SERVICESRELATED SUPPORT AND BASIC CLINICAL SERVICES

CURRENTLY NOT DIRECTLY APPLICABLE TO NEW ZEALAND (1)

TRAUMA SERVICEPXA0IEBCN0PPFRARNPCMU/ERAAAEIAA UERIUIEEMHHVER RNHRHDD AS0 GS0.00 &B

0 E RS MSM N AU EUC

C CR DRHY IG IGI

CE CEL

R IAD

Y NYE H

EALTH

(LOCAL) As for _General _Medicine/Surgery appropriate to the _hospitalAREA 45444444434434PAEDIATRIC 56666625666666REFERRALCENTRES

(1) See notes on Trauma Services page 1.094.4.2

11/92

1•-- -,--- ..-----___-..:S----. -

PART 4

APPENDIX V

GLOSSARY

ACCESS: The ability to make use of without difficulty or delay. If referring to an individual, such a person may or may notnecessarily be a full-time employee of the hospital concerned, but formal arrangements regarding this person's service tothe hospital have been made.

COMMITMENT TO: Involvement in employing (such as actively attempting to attract into employment personnel whose demand exceedssupply).

CONSULTATION AVAILABLE: A formal arrangement has been made with a consultant, (e.g. an obstetrician), who has agreed to provide advice in personor by telephone under agreed circumstances.

DESIGNATED: Obligation to a defined or specified purpose.

DESIRABLE: Recommended, but not mandatory or obligatory.

FORMAL: To follow established or agreed process.

LINK: To connect with or be connected with by formal association.

NETWORKING: Refers to an inter-connected group, e.g. of hospitals.

This arrangement may be a vertical one, as instanced by reference of patients to a hospital providing overall increasedlevels of skills or facilities; or horizontally by referral of patients to a hospital of similar level but having greater expertise orfacilities in a specific service in patient management.

If there is ready access to a support service, and where patient care is not compromised by that service being off site, ahospital may be credited with itself providing that level of support service for the purposes of role delineation.

4.5.1.

11/92

Continued PART 4

APPENDIX V

GLOSSARY

INTERPRETER SERVICE Small hospitals should have a list of available interpreters appropriate for the community they serve. Large hospitals and allmetropolitan hospitals should have a formalised interpreter service with properly trained and paid interpreters. Both formsof service should guarantee confidentiality for the patient.

CONTINUOUS QUALITYA C.Q.I. Plan"' is a component of an organisation's strategic and business plan that addresses the quality of all majorIMPROVEMENT PLAN (C.Q.l.) patient/client services including health outcomes, risks and complications, and client satisfaction.

While the scope and complexity will depend on the level of service provision, a C.Q.I. plan should define systems for:

-assesment of patient/client requirements (including cultural perspectives)

-specification and monitoring of quality (including quantified clinical and service indicators)

-specification of objective quality improvement

-provision of resources for quality activities including, staff time and training in quality, improvement techniques, andinformation system support

-regular reporting of quality trends and activities to senior management and directors

-internal peer review (clinical or technical) and audit by professional staff involved in the provision of the service

-external review of quality activities and systems leg consumer reviews, participation incollege audits, accreditation)

Note:- Assistance with C.Q.I. planning can be obtained from The New Zealand Council on Health Care Standards, P 0 Box 12 071, Wellington, phone:(04) 499 0367 and fax: (04) 499 0368.

(l)With acknowledgement to the New Zealand Council on Healthcare Standards 4.5.2.

11/92

INDEX

Adolescent Health . 2.33.1AdultMental Health.....................................................................................2.34.1Anaesthetics............................................................................................1 .5.1Area/Region Health Service Summary Sheet....................................................................3.2.1Burns...............................................................................................2.17.1Cardiology............................................................................................2.3.1Cardiothoracic Surgery ...................................................................................2.18.1Child Protection Services .................................................................................2.35.1Community Health - General..............................................................................2.45.1Community/Domiciliary Nursing............................................................................2.46.1Core Services Reference Card - Summary of Clinical Support Service Levels ..............................................1.9.1CoronaryCare..........................................................................................1.7.1DaySurgery .........................................................................................2.19.1Definitions, Medical and Nursing Staff (Appendix I) ................................................................4.1 .1DentalHealth .........................................................................................2.36.1Domiciliary/Community Nursing ............................................................................2.46.1Dermatology............................................................................................2.4.1Diagnostic Radiology (X-Ray) ...............................................................................1 .3.1Drug & Alcohol Services..................................................................................2.37.1Ear, Nose & Throat .....................................................................................2.20.1EmergencyServices.....................................................................................2.1.1Endocrinology.........................................................................................2.5.1Family & Child Health...................................................................................2.32.1Gastroenterology..........................................................................................6.1GeneralMedicine.......................................................................................2.2.1GeneralSurgery .......................................................................................2.16.1Geriatrics...........................................................................................2.38.1Glossary.............................................................................................4.5.1Gynaecology...........................................................................................2.21.1Haematology - Clinical...................................................................................2.7.1Health Promotion......................................................................................2.39.1HIV/AIDS ...........................................................................................2.40.1Hospice Services/Palliative Care ............................................................................2.41.1Hospital/Community Health Service Summary Sheet ...............................................................3.1 .1

5.1 .1

11/92

Immunology . 2.8.1Indicative List of Surgical Procedures (Appendix Ill) ................................................................ 4.3.1Infectious Diseases ...................................................................................... 2.9.1IntensiveCare..........................................................................................1 .6.1Levels of Risk (Appendix II)................................................................................ 4.2.1MaoriHealth Services ..................................................................................... 2.44.1Medical and Nursing Staff Definitions (Appendix I) ................................................................ 4.1 .1Migrant/Refugee Health................................................................................. 2.47.1Medicine, General ....................................................................................... 2.2.1MentalHealth, Adult .................................................................................... 2.34.1Neonatal............................................................................................ 2.29.1Neonatal Risk Factor Criteria (Appendix II) ....................................................................... 4.2.7Neurology ........................................................................................... 2.10.1Neurosurgery ........................................................................................... 2.22.1NuclearMedicine....................................................................................... 1.4.1Obstetrics ........................................................................................... 2.28.1Obstetrics, Risk Factor Criteria (Appendix II)..................................................................... 4.2.3Oncology - Medical ..................................................................................... 2.11.1Oncology - Radiation .................................................................................... 2.12.1OperatingSuite........................................................................................ 1.8.1Ophthalmology ........................................................................................ 2.23.1Orthopaedics .......................................................................................... 2.24.1Pacific People's Health.................................................................................. 2.48.1PaediatricMedicine ..................................................................................... 2.30.1Paediatric Surgery...................................................................................... 2.31 .1Paediatric Trauma Services correlated with Hospital Role Delineations (Appendix VII) ......................................... 4.4.2Palliative Care/Hospice Services ............................................................................ 2.41.1Pathology ............................................................................................. 1 .1 .1Pharmacy .............................................................................................. 1.2.1PlasticSurgery ........................................................................................ 2.25.1Rehabilitation ......................................................................................... 2.42.1RenalMedicine ......................................................................................... 2.13.1Respiratory Medicine................................................................................... 2.14.1Risk Factor Criteria - Adults (Appendix II)...................................................................... 4.2.1Risk Factor Criteria - Obstetrics and Neonatal (Appendix II) .......................................................... 4.2.3Risk Factor Criteria - Paediatric (Appendix II) ..................................................................... 4.2.2Rheumatology ......................................................................................... 2.15.1

5.1.211/92

Sexual Assault Services . 2.43.1Sexual Health Services (STD) ..............................................................................2.49.1Summary Sheet, Area/Region Health Service .....................................................................3.2.1Summary Card, Assessed Levels of Clinical Support Services .........................................................1.9.1Summary Sheet, Hospital/Community Health Service ..............................................................3.1.1Surgery, General .......................................................................................2.16.1Thoracic/Cardiothoracic Surgery ............................................................................2.1 8.1Trauma Services Correlated with Hospital Role Delineations (Appendix VII) ...............................................4.4.1Urology.............................................................................................2.26.1VascularSurgery .......................................................................................2.27.1Women's Health .......................................................................................2.50.1

5.1.311/92

Issue card removedEtectroflic issue on1y

[RPT] 94280

942801993

Infr'i:ation CentreIstry of Heait!17,:iinon

Documents

GUIDE TO THE ROLE DELINEATION OF HEALTH ... - moh.govt.nz€¦ · of Hospital Roles" which was widely distributed for comment, and in 1986 the "Guide to the Delineation of the Roles