South Australia Health CEO Dr Robyn Lawrence has written to GPs who raised concerns about maternity services in the state’s Southern Flinders Ranges area, defending the decision to trial a rotating birth unit across two regional hospitals.
The hospitals in question are Crystal Brook and Jamestown.
Earlier this year, birthing services at both hospitals were temporarily suspended due to workforce shortages.
While birthing services were restored after six weeks, the Local Health Network planned to pilot a “one-term, one-site” model where the designated birthing suite alternated between Jamestown and Crystal Brook hospitals on a one- or two-month basis.
The trial has now started but is only operating on weekends.
State shadow health minister Jack Batty likened the trial to a “timeshare model”, referencing a letter to health minister Blair Boyer signed by four local GPs.
According to Mr Batty, the letter said that because the model effectively closed one maternity unit every few months, it increased the risk of errors in clinical handover and unintentional gaps.
A spokesperson for Mr Boyer provided The Medical Republic with Dr Lawrence’s response to the GP concerns.
“The SA Health Maternal and Neonatal Services Capability Framework requires a Level 3 maternity service to have appropriately credentialled medical practitioners rostered and available to respond to a Category 1 Caesarean section, including one practitioner to perform the Caesarean, one to provide the anaesthetic and one to attend to the neonate immediately following birth,” the letter read.
“These three functions require three separate doctors who are genuinely available at the same time and are not committed to another clinical responsibility that could prevent them responding when required.
“Crystal Brook and Jamestown are the only two sites across South Australia Health that are non-compliant with these requirements and therefore a change to the current model is required to ensure sustainable, safe, quality care.”
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Because it was a requirement that the local health network implement the framework in order to meet organisational requirements, Dr Lawrence said wider community consultation was not undertaken.
“The risk of maternal or foetal complications or death due to non-compliance with these organisational requirements, is not accepted,” she wrote.
“As discussed with you and nursing staff in regular meetings with [Yorke and Northern Local Health Network], the revised work instruction is intended to address the risk of competing clinical demands, and ensure the provision of a safe, sustainable model of care.
“A clinician may be credentialled across several areas of practice; the issue is whether all required clinicians would be simultaneously available when an obstetric emergency occurs.
“The current model does not provide such assurance. YNLHN’s review identified this as a particular risk where clinicians are covering multiple roles at more than one site, with this practice no longer supported or endorsed.”
In relation to the concerns about errors arising from handovers, Dr Lawrence said women due to give birth would be contacted by their local maternity team to discuss the arrangement, and that clear handovers would be an “important component” of the trial’s evaluation.
In response to a question from Mr Batty in SA parliament, Mr Boyer said the decision to run the pilot rotating model was “expressly for the reason of safety”.
“People who know these areas much better than I do in terms of birthing came to me and to the local health network and said that some kind of change needed to be made because the existing operation and the existing processes that were in place across Crystal Brook and Jamestown with regard to birthing were not in line with SA Health policy—in fact, I think they contravened SA Health policy,” he said.
Mr Boyer also acknowledged the concerns that the local GPs had raised, saying the state was “bloody lucky” to have passionate doctors working in rural areas.
“The choice that we had here was either to trial this rotation policy between Jamestown and Crystal Brook across weekends, in the knowledge that that would give us the confidence and certainty that it would be safe for mothers and their babies, or the option to essentially to close the services altogether, and I did not want to do that and the community does not want to do that,” he said.
“I want to make sure that we can sustain all our birthing services in regional South Australia, but we have to be able to do it in a safe way.”
The post ‘Change needed to be made’ in SA maternity units appeared first on Medical Republic.
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