Internal medicine services

A Level 1 service provides low-acuity, ambulatory general medical care to patients with non-urgent internal medicine care needs.

There are no inpatient services provided at this level.

Service provision includes delivery of risk factor/disease prevention education and self-management support, and / or chronic disease management.

Health promotion professional, NP, RN or medical practitioner with relevant skills and experience.

Access to allied health professional including physiotherapy, occupational therapy, social work, speech pathology, dietetics, podiatry.

A Level 2 service provides ambulatory general medicine services.

There are no inpatient services provided at this level.

Service scope may include:

• clinic-based or mobile general medical services
• assessment, treatment and referral of patients with general medical conditions
• care coordination / case management, case monitoring and review

One or more medical, community paramedicine, nurse practitioner or registered nursing professionals.

Access to general physicians and medical subspecialties.

Provides inpatient and / or telehealth care to patients with low risk / complexity acute medical care needs.

As for Level 2 plus:

Provides patient assessment, treatment and referral.

Designated emergency care area.

Telehealth linkages to higher level general medicine service.

Level 5 or 6 general medicine outpatient services may be provided by outreach / telehealth.

As for Level 2 plus:

Registered nurse on-site 24 hours.

Registered medical practitioner on-site during business hours and available 24 hours.

Access to a pharmacist via an outreach / teleconference service.

May have access to visiting allied health professionals as required, including pharmacy, physiotherapy, occupational therapy, social work, speech pathology, dietetics and podiatry.

As for Level 3 plus:

Provides inpatient care to patients with general medical care needs.

Care provided by multidisciplinary team including a physician practicing in general medicine.

As for Level 3 plus:

Inpatient care delivered within purpose-designed and built general medicine unit.

Links to sub-specialty internal medicine disciplines.

Access to aseptically prepared, patient-specific medications manufactured in a TGA registered facility or in a hospital pharmacy facility that is compliant with Good Manufacturing Practice (GMP).

As for Level 3 plus:

Registered medical practitioner on-site 24 hours.

On-site access to physician practicing in general medicine.

On site clinical pharmacist.

Dedicated allied health professionals including pharmacy, dietetics, podiatry, social work, speech therapy, physiotherapy and occupational therapy.

Access to on-site podiatry, orthotics & prosthetics.

Access to consultant liaison psychiatry.

Access to allied health assistants.

CNE to support undergraduate and postgraduate nursing students and skills development of nurses.

RNs with relevant experience and qualifications on-site 24 hours.

As for Level 4 plus:

Provides inpatient, outreach and community care to patients with general medicine care needs.

As for Level 4 plus:

Service provision integrated with acute inpatient, short stay, subacute, ambulatory, outreach and Hospital in the Home as part of comprehensive models of care.

Consultation liaison available to general medicine patients from a broad range of medical sub-specialties.

Access to purpose designed and built older persons unit.

Onsite aseptic medication manufacture facilities that are compliant with GMP.

As for Level 4 plus:

Extended hours on-site availability of physician practicing in general medicine.

Access to on-call allied health services including physiotherapy and social work.

Onsite pharmacy services with pharmacy staff credentialled in aseptic medication manufacture.  

Medical registrar on-site and available 24 hours.

On-site expertise in complex care coordination.

As for Level 5 plus:

Provides comprehensive multidisciplinary care to patients with low to high complexity general medicine care needs including critically ill medical patients.

As for Level 5 plus:

On-site access to a comprehensive range of sub-specialty medicine expertise.

On-site Level 6 intensive care.

As for Level 5 plus:

Medical registrar on-site 24 hours.

Sub-specialists available on-site for consultation and on-call 24 hours.

RMOs in majority of sub-specialist medicine disciplines.

May have on-site NPs to supplement sub-specialty medicine roles.

A Level 1 service provides patient education, health promotion and self-management support to patients with allergy and immunology care needs.

Delivered in outpatient or community setting.

May have limited hours of operation.

Health promotion professional, NP, RN, medical practitioner or allied health professional with relevant skills and experience.

A Level 2 service provides ambulatory and outpatient allergy and immunology care.

There are no inpatient services provided at this level.

Delivered in outpatient or community setting.

May have limited hours of operation.

Capacity to undertake allergy assessment.

Equipped for emergency resuscitation of patient.

Appropriate support from higher level allergy and immunology services.

Medical practitioner with skills and experience in allergy / immunology.

May have on-site registered nurse.

Access to allied health professionals with expertise in allergy and immunology, including psychology and dietetics.

As for Level 2 plus:

Provides inpatient care to patients with acute allergy and / or immunology care needs.

As for Level 2 plus:

Able to provide acute management of patient.

Able to stabilize patient prior to transfer to higher level service if required.

As for Level 2 plus:

Registered medical practitioner with skills in acute management of allergy and / or immunology presentations available 24 hours.

On-site RN 24 hours.

As for Level 3 plus:

Provides allergy and immunology care by a physician practicing in general medicine with experience in allergy and immunology.

Service is accredited by Australasian Society of Clinical Immunology and Allergy (ASCIA).

As for Level 3 plus:

Inpatient beds for care of patients with allergy / immunology care needs.

Inpatient care by physician practicing in general medicine with dual training and / or extensive experience in allergy and immunology.

On-site allergy and immunology nurse education service.

Inpatient access to safe meals, medications etc. that are managed by suitably experienced staff.

Access to outpatient consultation from clinical allergy/immunology specialist via telehealth.

As for Level 3 plus:

On-site physician practicing in general medicine with dual training or extensive experience in allergy and immunology.

RNs with appropriate experience in allergy and immunology nursing; RNs may be supported by SENs / ENs in providing care to inpatients.

On-site clinical pharmacist.

On-site access to allied health professionals, including dietetics and psychology.

Outpatient care can be provided by a registered medical practitioner or a GP or specialist with skills in allergy and immunology or a nurse or allied health professionals with specialist knowledge and skills in allergy and immunology.

As for Level 4 plus:

Inpatient and outpatient care provided by multidisciplinary team that includes a clinical allergy / immunology specialist.

As for Level 4 plus:

An integrated multidisciplinary hospital/community allergy and immunology management service for the assessment and treatment of patients with allergy disorders, acquired and primary immunodeficiency disorders, and autoimmune disease.

Service infrastructure includes designated area for formal allergen challenge testing.

As for Level 4 plus:

Clinical Allergy/Immunology Specialist available during business hours.

Medical registrar available 24 hours.

Specialist Allergy and Immunology RN.

Allied health professionals with specialist allergy / immunology knowledge and skills part of multidisciplinary team, including dietitian, pharmacist and psychologist.

As for Level 5 plus:

Services has a statewide referral role.

As for Level 5 plus:

On-site allergy and immunology laboratory services, available 24 hours.

Accredited allergy and immunology training program.

As for Level 5 plus:

Clinical Allergy/Immunology Specialist available 24 hours.

CNC/Educator specialising in allergy and immunology conditions.

A Level 1 service provides low-acuity, ambulatory cardiac care to patients with non-urgent cardiac care needs.

There are no inpatient services provided at this level.

Service provision includes delivery of cardiovascular risk factor/disease prevention education and self-management support, and / or chronic disease management.

Health promotion professional, NP, RN, medical practitioner or allied health professional with relevant skills and experience.

As for Level 1 plus:

Provides ambulatory cardiac services to patients with non-acute and / or urgent cardiac care needs.

Service delivered in outpatient, community health and / or primary care settings.

As for Level 1 plus:

Capacity to assess and manage patients with acute cardiac care needs.

Support patients whilst awaiting transfer to a higher level cardiology service.

Access to digital ECG machine, Automated External Defibrillator (AED), oxygen and the ability to achieve venous access.

Integration into a statewide Acute Coronary Syndrome (ACS) management pathway.

Appropriate support from Level 5 or 6 cardiology services.

Access to pathology / medical imaging in a short timeframe.

Formal referral protocols established with higher level cardiology services.

Registered medical practitioner, paramedic, NP and / or registered nurse with skills and experience in diagnosing and managing cardiac conditions.

Access to emergency patient transport.

Access to retrieval medicine team for emergency patient transport.

As for Level 2 plus:

Provides ambulatory and inpatient cardiac services to patients with urgent and non-acute care needs.

As for Level 2 plus:

Provides some elective diagnostic investigations.

Service provision may include ability to perform point of care troponin testing, administration of thrombolysis and blood gas monitoring.

Service model may include outpatient care from a visiting general internal medicine specialist or cardiologist or via telehealth.

As for Level 2 plus:

Registered medical practitioner on-site and available 24 hours.

Registered nurse on-site 24 hours.

Access to cardiologists.

On-site access to allied health services during business hours including physiotherapy, occupational therapy, social work, dietetics and pharmacy.

Access to Cardiac NP or Clinical Nurse Specialist (cardiac).

As for Level 3 plus:

As for Level 3 plus:

Capability and capacity to deliver multi-disciplinary team based care to cardiology patients.

Provides a range of inpatient and outpatient cardiology diagnostic services and coronary risk factor clinics.

Provides cardiac rehabilitation and preventative patient cardiac education.

Discrete area within the facility for provision of level of care more intensive than ward-based care (e.g., may be CCU, HDU or ICU).

Performs non-invasive monitoring.

Formal referral protocols established with higher level cardiology services.

As for Level 3 plus:

Registered medical practitioner with experience in cardiology, available 24 hours.

Access to physiotherapy, psychology, occupational therapy, dietetics and social work.

Clinical pharmacist.

RNs with cardiology skills and experience on-site 24 hours.

NP / Clinical Nurse Specialist cardiac care/cardiac rehabilitation / heart failure.

Access to anaesthetist.

Access to allied health assistants for ambulatory programs.

As for Level 4 plus:

Provides a full range of cardiac services through a dedicated cardiology department including emergency services and on-site cardiac catheterisation laboratory.

A Level 5 service caters for the complex cardiology medical care. The service is usually provided at a general hospital by a multi-disciplinary team available 24 hours and has a network referral role.

As for Level 4 plus:

On-site CCU area capable of providing a dedicated ward area for patients requiring cardiac monitoring and/or resuscitation, with appropriate levels of staff and specialised resources including monitoring equipment and appropriate investigations.

Access to on-site central haemodynamic monitoring capacity.

Provides on-site diagnostic coronary angiography, permanent pacemaker, percutaneous revascularisation and angioplasty.

Paediatric liaison service and shared care model with Royal Melbourne Hospital for Adult Congenital Heart Disease.

Comprehensive cardiac rehabilitation and heart failure services.

Formal links to cardiothoracic service.

On-site Level 5 respiratory service.

Formal liaison with Level 6 cardiology service.

Provides specialist consultation and diagnosis including telehealth and outreach to lower level services.

As for Level 4 plus:

24/7 cover by an interventional cardiologist.

Physiotherapy, psychology, occupational therapy, dietetics, NP / CNS and social work part of cardiology multidisciplinary team.

Specialist clinical pharmacist (cardiology).

Cardiology registrar (advanced trainee) on-site.

RMO or intern in cardiology.

Medical registrar on-site 24 hours.

CNC providing clinical leadership in cardiology.

RNs with appropriate post graduate qualifications and/or extensive experience in cardiac nursing.

NP / Clinical Nurse Specialist cardiac care, cardiac rehabilitation and heart failure.

Cardiac rehabilitation multi-disciplinary team (rehabilitation medicine, nursing, physiotherapy, dietetics, occupational therapy, psychology, social work).

A full complement of cardiac technicians for echocardiography with 24/7 on-call roster and pacing services.

Intensive care specialist available 24 hours.

Access to on-call allied health services such as social work.

Access to Occupational Therapy for both in and outpatients.

As for Level 5 plus:

Provides a full range of cardiac services through a dedicated cardiology department including emergency services and on-site cardiac catheterisation laboratory.

A Level 6 service caters for the most complex cardiology medical care. The service is usually provided at a large referral hospital by a multi-disciplinary team available 24 hours and includes an interstate referral role.

As for Level 5 plus:

Full range of cardiology services, with dedicated cardiology department, emergency care, diagnostic and interventional cardiology services with on-site cardiac catheter laboratory, on-site cardiothoracic surgery and access to inpatient and outpatient cardiac rehabilitation services.

Able to manage patients requiring highly complex diagnostic and treatment procedures in consultation with other specialties.

Provides implant and follow up service for complex cardiac devices.

On-site Level 6 respiratory medicine service with advanced bronchoscopy capability.

Provides statewide pulmonary hypertension service.

Provides an electrophysiology service (EPS) including radiofrequency ablation and a structural heart disease program including Trans-aortic valve implant (TAVI).

Provides adult congenital disease service.

On-site cardiothoracic surgery, invasive cardiovascular monitoring, cardiac MRI and cardiac PET.

Statewide referral role.

Provides clinical advice, education and training to lower level services.

Provides specialist cardiac services via telehealth.

As for Level 5 plus:

Staff specialist in cardiology available 24 hours.

Cardiology registrars (advanced trainees) on-site extended hours and on-call 24 hours.

The Clinical Genetics Service is an out-patient service providing consultations on diagnosis, testing, counselling and management of genetic conditions across the following areas:

• Paediatric syndromes, including developmental delay and intellectual disability
• Adult onset inherited neuro-muscular, skeletal and cardiac conditions
• Risk assessment and carrier testing for inherited genetic disorders
• Prenatal diagnosis for inherited genetic disorders
• Diagnosis and counselling when a birth defect is detected during pregnancy
• Familial cancer syndromes Chromosomal disorders
• Metabolic disorders
• Abnormal newborn screening results for cystic fibrosis

Access to appropriate clinic space for consultations at each acute hospital site in all three regions of the state.

Access to telehealth facilities.

Suitable office accommodation, with space for storage of genetic files, and including privacy or sound proofing for provision of telephone counselling by genetic counsellors.

Access to Cytogenetics and Molecular Pathology Laboratories (intrastate or interstate).

Access to and linkages with neonatology, maternity, oncology and gynaecological oncology and gastroenterology services.

An independent patient database program, which is able to store medical information in family files and is capable of operating the reminder service provided by the Familial Cancer Registry.

Dedicated software program for drawing family trees (pedigrees) such as Progeny.

Education/Training and Professional Development opportunities for Clinical Geneticists, Genetic Counsellors and Associate Genetic Counsellors.

Clinical Geneticist/s.

Genetic Counsellor with full certification in Genetic Counselling by the Human Genetics Society of Australasia to enable supervision of Associate Genetic Counsellors in training Associate Genetic Counsellors on-site.

Data manager with expertise in management of genetic databases and pedigree drawing software.

Administrative support for clinic organisation and appointment scheduling.

A Level 1 service provides low-acuity, ambulatory care to patients with non-urgent endocrinology care needs.

Service provision includes delivery of risk factor/disease prevention education and self-management support, and / or chronic disease management.

Health promotion professional, NP, RN, medical practitioner or allied health professional with relevant skills and experience.

A Level 2 service provides care to people with uncomplicated endocrinology care needs by one or more general clinicians with knowledge and experience in endocrinology.

Care is delivered in inpatient, outpatient and / or community setting.

There are no inpatient services provided at this level.

Provides clinical advice, assessment and education for patients with uncomplicated endocrinology care needs.

May provide short-term inpatient or virtual management of patients with uncomplicated endocrinology care needs.

Medical, paramedic, nursing and / or allied health professional with knowledge and skills in endocrinology conditions for outpatient / community management.

Inpatient services require:

• Registered medical practitioner available onsite during business hours and on-call 24 hours.
• RNs on-site 24 hours.
• Access to pharmacist and credentialled diabetes educator.
• Extended hours access to endocrinologist via telehealth.

Access to allied health services including dietetics, optometry, podiatry and social work.

Provides specialist ambulatory (outpatient) multidisciplinary care for patients with diabetes.

Multidisciplinary model of care that bridges the gap between acute hospital care and primary care within the community for patients with diabetes.

There are no inpatient services provided at this level.

As for Level 2 plus provides:

• Diabetes case management
• Diabetes education services
• Group education and self-management support for patients and carers

In-service diabetes training and education for primary, secondary and tertiary health care providers, as well as community providers.

Access to specialist endocrinologist with expertise in diabetes care.

On-site clinicians with experience in diabetes to provide specialised diabetes patient assessment, management and education.

On-site Australian Diabetes Educator Association credentialed Diabetes Educator/s with expertise in the management of diabetes.

Intern trainee diabetes educator position.

Access to medicines information service.

As for Level 3 plus:

Provides inpatient and ambulatory endocrinology care by an endocrinologist or physician practicing in general medicine with dual training in endocrinology.

A component of a level 4 service is access to a designated Diabetes Centre (diabetes-specific Level 3 service).

As for Level 3 plus:

Inpatient beds in designated internal medicine inpatient ward area.

On-site diabetes nurse-led education service.

Equipped for emergency resuscitation and stabilisation of patient.

As for Level 3 plus:

On-site endocrinologist and / or physician practicing in general medicine with dual training in endocrinology during business hours and on-call 24 hours.

RNs with appropriate post graduate qualifications and/or extensive experience in endocrinology / diabetes nursing; RNs may be supported by SENs / ENs in providing care to inpatients.

On-site access to allied health services including credentialled diabetes educator, dietitian, psychologist, podiatrist, and social worker.

Clinical pharmacist.

A Level 5 service provides inpatient and outpatient care by specialist endocrinology team.

As for Level 4 plus:

An integrated hospital/community interface diabetes management service.

Service provides consultation liaison support to virtual care models (e.g., HITH, ComRRS team) care in the community.

Service provides support to diabetes maternity services.

As for Level 4 plus:

Endocrinologist on-site during business hours.

Endocrinologist or physician practicing in general medicine with dual training in endocrinology on-call 24 hours.

Access to subspecialist surgeons with endocrine surgical expertise.

Medical registrar on-site during business hours and on-call 24 hours.

CNC/Educator specialising in endocrinology.

Senior nurse manager.

On-site specialised diabetes multidisciplinary team including endocrinologist, credentialed diabetes educator, dietitian, psychologist, podiatrist and social worker.

Specialist clinical pharmacist (endocrinology).

Access to allied health assistants.

A Level 6 service provides a full range of endocrinology services with endocrinology department and emergency care. It has a statewide referral role and is the statewide provider for pituitary surgery, pancreatic surgery, complex thyroid cancer and endocrine malignancy management.

As for Level 5 plus:

Designated endocrinology inpatient ward area.

Statewide referral and support role.

Endocrinology department.

On-site access to staff and facilities for thyroid and endocrine cancer management, including direct access to an on-site nuclear medicine and PET service with radioiodine treatment and radiation isolation treatment rooms.

On-site neurosurgical services.

On-site access to laboratory service to support specialist endocrine pathology testing.

Full on-site weekday supervision of clinical services and advanced training by specialists with credentialing in endocrinology.

Accredited endocrinology training program.

Endocrinologist inpatient and outpatient diabetes and specialist endocrine related activities.

As for Level 5 plus:

Endocrinologist on-call 24 hours and available for advice and support for acute emergency services.

Endocrinology registrar on-site.

Neurosurgeon available 24 hours.

Access to subspecialists surgeons with endocrine surgical expertise.

CNC/Educator specialising in Diabetes.

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A Level 2 service provides care for minor, uncomplicated gastrointestinal illnesses by one or more general clinicians with knowledge and experience in gastroenterology.

Care is delivered in inpatient, outpatient and / or community setting.

Office-based procedures may be provided in a Level 2 service.

Formal network linkages with specialist gastroenterologist for consultation.

Provides clinical advice, assessment and education for patients with uncomplicated gastroenterology care needs.

May provide short-term inpatient or virtual management of patients with uncomplicated gastroenterology care needs.

Equipped for emergency resuscitation of patient.

Medical, nursing and / or allied health professional with knowledge and skills in gastroenterology conditions for outpatient / community management.

Access to alcohol and other drug health worker.

Inpatient services require:

• Registered medical practitioner available onsite during business hours and on-call 24 hours.
• RNs on-site 24 hours.
• Access to pharmacist, speech pathologist, specialist hepatology RN and dietitian.
• Extended hours access to gastroenterologist via telehealth.

A Level 3 service provides services at Level 2 plus same day and outpatient care by a visiting gastroenterologist and / or RNs with appropriate specialist postgraduate qualifications in gastroenterology.

Non-emergency endoscopy services are provided.

Outpatient gastroenterology services are provided.

As for Level 2 plus:

On-site endoscopy suite and recovery area.

On-site resuscitation equipment.

Access to general surgical services and inpatient beds.

Access to sterilization services accredited to AS/NZS 4360.

As for Level 2 plus:

Specialist gastroenterologist.

Clinicians with appropriate post graduate qualifications and/or experience in gastroenterology and credentialed to undertake associated procedures.

Clinicians credentialed to provide analgesia/sedation.

Access to sterilization technicians for equipment sterilisation.

Access to specialist hepatology RN where hepatology services are provided.

Access to specialist stomal therapy RNs.

Access to addiction medicine specialist team (medical, nursing, psychology, pharmacy, social work, alcohol and other drug worker).

A Level 4 service provides services at Level 3 plus inpatient care by a specialist gastroenterologist and credentialed RNs for patients with gastroenterology and hepatology care needs.

As for Level 3 plus:

Inpatient general medical beds.

On-site general surgical services and operating theatres available 24 hours.

Onsite sterilization services accredited to AS/NZS 4360.

As for Level 3 plus:

On-site general surgeon available 24 hours.

On-site specialist anaesthetist available 24 hours.

Onsite sterilization technicians.

Clinical pharmacist.

A Level 5 service provides services at Level 4 plus inpatient care by a gastroenterology team. The service provides a full endoscopy service, including access to ERCP (endoscopic retrograde cholangiopancreatography) services and hepatology services.

As for Level 4 plus:

On-site ICU.

Accredited gastroenterology training program.

Onsite colorectal and hepatobiliary surgical services, oncology services and interventional radiology services.

Access to palliative care services.

As for Level 4 plus:

On-call gastroenterologist available 24 hours.

Gastroenterology registrar/RMOs.

Medical registrar on-site 24 hours.

Medical and surgical sub-specialists in oncology (medical and radiation), colorectal, general and hepatobiliary surgery, and interventional radiology available on-site for consultation.

CNC specialising in gastroenterology and providing clinical leadership for the service.

On-site specialist hepatology RN.

On-site specialist stomal therapy RN.

Consultation liaison addiction medicine specialist team available for on-site review.

Speech pathology, dietetics, social work available onsite.

Specialist clinical pharmacist (gastroenterology).

A Level 6 service provides services at Level 5 plus the service provides a full range of gastroenterology and hepatology services, with a gastroenterology department and emergency care.

As for Level 5 plus:

Access to medical sub-specialists from majority of disciplines on-site.

Statewide referral role.

As for Level 5 plus:

RNs with appropriate post graduate qualifications and/or extensive experience in gastroenterological nursing on-site 24 hours.

Specialist speech pathology, dietetics, social work part of care team.

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A Level 3 service provides care to people with uncomplicated infectious diseases care needs by one or more general clinicians.

Care is delivered in outpatient and / or community setting.

Provides clinical advice, assessment and education for patients with uncomplicated infectious diseases care needs.

May provide short-term home-based or virtual (e.g., HITH) management of patients with uncomplicated infectious diseases care needs.

Access to specialist infection prevention and control expertise.

Equipped for emergency resuscitation and stabilisation of patient.

Access to microbiology and pathology services.

Medical, nursing, paramedic and / or allied health professional with knowledge and skills in infectious diseases for outpatient / community management.

Access to pharmacist.

Access to infectious diseases physician via telehealth.

A Level 4 service provides ambulatory and inpatient consulting services provided by a physician practicing in general medicine.

As for Level 3 plus:

General inpatient beds for the care of patients with infectious diseases.

Isolation room(s) with internal wash basins and toilets.

Separate ventilation for isolation room(s).

On-site infection prevention and control service.

RNs with appropriate post graduate qualifications in infection prevention and control.

On-site physician practicing in general medicine or infectious diseases physician (physician available during business hours and on-call 24 hours).

RNs with appropriate post graduate qualifications and/or extensive experience onsite 24 hours; RNs may be supported by SENs / ENs in providing care to inpatients.

Clinical pharmacist. 

On-site allied health services including physiotherapy, dietetics, psychologist, credentialled diabetes educator and social worker.

A Level 5 service provides ambulatory and inpatient services by on-site specialist infectious diseases personnel.

As for Level 4 plus:

Negative pressure rooms (number commensurate to hospital size).

Onsite MRI, cardiology (including trans-oesophageal echocardiography).

Microbiology laboratory onsite.

Service provision includes infectious diseases consultation liaison support to HITH service and community nursing service.

Onsite access to gastroenterology services with hepatology nurse specialist.

Access to addiction medicine specialist team (medical, nursing, psychology, social work, alcohol and other drug worker).

General and subspecialty surgical services teams onsite and available extended hours.

General and subspecialty medical services teams onsite and available extended hours.

ICU services available onsite.

As for Level 4 plus:

Infectious diseases physicians on-call 24 hours and available for advice and support for acute emergency services.

Medical registrar on-site during business hours and on-call 24 hours.

On-site clinical microbiologist during business hours and on-call extended hours.

CNC providing clinical leadership in infectious diseases.

Specialist clinical pharmacist (infectious diseases).

Access to specialist hepatology RN.

A Level 6 service provides extended hours specialist infectious diseases services.

As for Level 5 plus:

Accredited infectious diseases medical training program.

Facilities to treat most transmissible and quarantined diseases.

Access to PET scanner.

As for Level 5.

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A level 2 service provides local support and care to medically stable patients with renal care needs as part of a formal nephrology network.

Provides clinical advice, assessment and education for patients with uncomplicated renal care needs.

Service may have infrastructure to support ambulatory self-dialysis.

Formal network linkage to higher level nephrology service.

No inpatient beds at this level.

Access to health professionals with relevant renal knowledge and skills.

Medical and/or nursing professional with knowledge and skills in renal conditions for outpatient / community care.

Access to diabetes educator.

Access to allied health services including occupational therapy, physiotherapy, podiatry, psychology.

A Level 3 service provides inpatient care by a GP who manages renal patients who do not have a need for haemodialysis.

A Level 3 service has links to a higher level Nephrology service for specialist renal advice and acute treatment.

As for Level 2 plus:

Inpatient beds.

Access to palliative care service.

Equipped for emergency resuscitation and stabilisation of patient.

Access to pharmacy services.

Registered medical practitioner available onsite during business hours and on-call 24 hours.

RNs on-site 24 hours.

Access to clinical pharmacist.

Extended hours access to renal physician via telehealth.

Access to a clinical pharmacist.

A Level 4 service provides inpatient and ambulatory care by a renal physician or by a physician practicing in general medicine.

As for Level 3 plus:

Inpatient beds in designated internal medicine inpatient ward area.

Palliative care team accessible onsite.

As for Level 3 plus:

On-site renal physician / physician practicing in general medicine available during business hours and on-call 24 hours.

RNs with appropriate post graduate qualifications and/or extensive experience in renal nursing; RNs may be supported by SENs / ENs in providing care to inpatients.

Clinical pharmacist.

On-site allied health services including credentialed diabetes educator, dietitian, psychologist, podiatrist, and social worker.

As for Level 4 plus:

Provides nephrology support and coordinated care for patients with acute renal failure, chronic kidney disease and end-stage kidney disease.

A Level 5 service provides ambulatory dialysis services (satellite units).

As for Level 4 plus:

Service provides consultation liaison support to virtual care models (e.g., HITH, ComRRS team) care in the community.

Service has nephrology department with formal linkages with Level 6 nephrology service.

Provides clinical advice, education and training to lower level services including via telehealth.

Provides transplant donor and recipient work up, post-transplant follow-up including transplant biopsies.

Interventional radiology and vascular surgical services for vascular access available onsite.

Acute inpatient dialysis and plasmapheresis capability.

Outpatient clinics for chronic kidney disorder, including general nephrology, dialysis and renal supportive care.

Provides medical governance and clinical outreach to regional dialysis centres (satellite unit/s) and smaller community dialysis units.

Service manages home therapies services (providing education, professional and technical support) to allow home haemodialysis or peritoneal dialysis locally or remotely.

Accredited Nephrology Advanced Training Program, and undergraduate and postgraduate teaching role.

Participates in national renal data collection systems.

As for Level 4 plus:

Nephrologist on-site during business hours.

Nephrologist or physician practicing in general medicine on-call 24 hours.

Medical registrar on-site 24 hours.

RNs with specialist expertise in renal nursing and dialysis treatments, supported by SENs/ENs.

CNC / Educator specialising in renal medicine.

RNs dedicated for vascular access, chronic kidney disease education and home therapies training.

RN dedicated to coordination for renal transplant workup for recipients and donors.

Specialist clinical pharmacist (nephrology) providing clinical services to inpatients and ambulatory patients.

Service has access to vascular surgery, interventional radiology, palliative care and infectious diseases specialists.

Access to on-call allied health services including social work.

Access to allied health assistants.

As for Level 5 plus:

Provides renal transplantation services.

As for Level 5 plus:

Provides outreach renal transplantation services for assessment of donors and transplant recipients.

As for Level 5 plus:

On-site renal transplantation multidisciplinary team.

A Level 1 service provides outpatient care to people with uncomplicated neurology care needs by one or more general clinicians (e.g., general practitioners) with knowledge and experience in neurology.

Provides clinical advice, assessment and education for patients with uncomplicated care needs in outpatient setting.

Medical, nursing and / or allied health professional with general knowledge and skills in neurology conditions for outpatient / community management.

As for Level 1 plus:

Provides some ambulatory and inpatient neurology services via general practitioner or general physician at service level described below.

As for Level 1 plus:

Service capability may include:

• management of simple, common neurological conditions (e.g., migraine) in an emergency setting or rural hospital.
• provision of post-acute care

Service model may include outpatient care from a visiting general internal medicine specialist or neurologist via telehealth.

As for Level 1 plus:

Registered medical practitioner on-site and available 24 hours.

Registered nurse on-site 24 hours.

Access to neurologist via telehealth.

On-site access to some allied health services during business hours including physiotherapy and pharmacy.

A Level 3 services provides inpatient care by an on-site physician practicing in general medicine and outpatient medical consultation by visiting specialist neurologist(s).

As for Level 2 plus:

Inpatient beds in designated internal medicine inpatient ward area, with facilities and support for higher acuity patients.

Outpatient electroencephalogram (EEG) is available via visiting service.

Consultation with neurologist for management decisions for complex patients.

Access to neurological advice through higher level neurology service.

As for Level 2 plus:

On-site physician practicing in general medicine on-call 24 hours.

Medical practitioner on-site 24 hours.

Visiting specialist neurologists.

Visiting neurophysiology scientist for visiting EEG service.

Clinical pharmacist.

Access to physiotherapy, psychology, speech pathology, occupational therapy and social work.

Extended hours access to neurologist via telehealth.

As for Level 3 plus:

Provides inpatient and outpatient care by specialist neurology team for most neurological conditions.

As for Level 3 plus:

Co-located inpatient neurology and stroke services.

24 hour access to CT and MRI.

Inpatient and outpatient EEG and NCS / EMG and EP neurophysiological testing.

Access to Level 5 or above rehabilitation service.

As for Level 3 plus:

Neurologist on-site during business hours.

Neurologist or physician practicing in general medicine on-call 24 hours.

On-site neurophysiology scientists for EEG, NCS/EMG and evoked potential (EP) testing.

CNC / Educator providing leadership in neurology.

RNs with appropriate post graduate qualifications and/or extensive experience in neurological nursing; RNs may be supported by SENs / ENs in providing care to inpatients.

Specialist clinical pharmacist (neurology).

On-site physiotherapy, psychology, speech pathology, occupational therapy and social work.

Extended hours access to neurologist via telehealth.

A Level 5 service provides a thorough range of neurology services with neurology department and emergency care. It is the statewide specialist provider for some neurological conditions.

As for Level 4 plus:

Dedicated inpatient neurology service co-located with inpatient stroke unit with specialised resources and personnel available 24 hours, including ward-based HDU for neurology/stroke inpatients.

Onsite Level 6 ICU.

Service provision includes 24 hour inpatient video EEG monitoring and brain PET scanning.

Specialised neurophysiological tests and services including single fibre EMG, somatosensory evoked potentials and vagus nerve stimulator checks.

Provides clinical advice, education and training to lower level services.

Accredited neurology training program.

On-site neurosurgical services, stroke unit and interventional radiology service.

Access to Level 6 rehabilitation service.

As for Level 4 plus:

Consultant neurologists available 24 hours.

Neurology registrars / RMOs in 24/7 roster, plus intern(s).

Access to neurosurgeons on site.

Allied health professionals with post graduate qualifications and experience in neurological conditions part of multidisciplinary team including physiotherapy, neuropsychology, speech pathology, occupational therapy and social work. Allied health specialists may be supported by allied health assistants.

Medical, nursing and allied health support for ward-based HDU care of neurology/stroke inpatients.

Nurse practitioners in neurology to assist management of common outpatient conditions with complex treatments.

Comprehensive specialist and subspecialty service in neurology, including all inpatient, outpatient and ambulatory services.  Subspeciality statewide referral services may include epilepsy surgery, deep brain stimulator implants, vestibular testing +/- autonomic testing.

As for Level 5 plus:

Above subspecialty services.

Associated subspecialty services including:

• subspecialty neurosurgeons
• neuropsychology expertise
• neuropsychiatry
• prolonged inpatient video EEG monitoring
• neurology/stroke HDU facility and staffing
• specialist nurse practitioners in subfields of neurology (e.g., neuromuscular/ neuroimmunology, epilepsy, headache, movement disorders).

As for Level 5 plus:

Subspecialty neurologists with 24/7 on call roster.

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A Level 3 service provides outpatient multidisciplinary management of patients with persistent pain.

A Level 3 service may participate in multidisciplinary meetings regarding patient management with a Level 5 or 6 persistent pain service.

Provides individual and group education and self-management support.

Communication and information sharing with patient’s usual medical practitioner.

Psychology and / or social work plus physiotherapy providers with specialist training in persistent pain part of multidisciplinary team.

Service may be supported with peer workforce in persistent pain.

Access to a pharmacist and pharmacy services.

Access to RN with specialist training in care coordination.

May have access to RN and / or medical practitioner with specialist skills in persistent pain.

A Level 4 service provides multidisciplinary ambulatory persistent pain medicine services and includes a specialist medical practitioner with sub-specialty training in pain medicine as part of the team.

As for Level 3 plus:

Service provision includes care coordination where required.

Medication management in conjunction with patient’s usual medical practitioner.

As for Level 3 plus:

Registered medical practitioner with sub-specialty expertise in pain medicine.

On-site RN with specialist training in care coordination.

Clinical pharmacist.

Psychology, social work, physiotherapy and occupational therapy part of multidisciplinary team.

As for Level 4 plus:

Provide procedural pain management services.

As for Level 4 plus:

At least one operating/procedure room with separate recovery area/room for post-procedural care.

Access to interventional radiology, addiction medicine, neurosurgery and spinal orthopaedics.

Onsite aseptic medication manufacture facilities that are compliant with GMP.

As for Level 4 plus:

Designated pain management multidisciplinary team including pain medicine consultant.

Access to addiction medicine service.

Access to pain medicine CNCs.

Medical registrar on-call 24 hours.

Sub-specialists available on-site for consultation.

Pharmacy staff credentialled in aseptic medication manufacture.

A Level 6 service provides leadership and support for lower level persistent pain services.

Provides services at Level 5 plus a full range of pain medicine services including clinical supervision, education and prevention activities, and inpatient services.

As for Level 5 plus:

Statewide referral role.

Statewide role in implementing guidelines for persistent pain management across acute and community settings.

Service provision includes pain education and support for primary care providers.

On-site interdisciplinary pain management service (with a minimum of pain medicine, addiction medicine, rheumatology, anaesthetics, specialist physiotherapy and psychology expertise).

On-site neurosurgery and spinal orthopaedics.

On-site interventional radiology and day case procedure facilities.

Accredited pain medicine training programs.

As for Level 5 plus:

On-site pain medicine registrar.

Medical registrar on-site 24 hours.

Specialist pain medicine CNC.

Allied health professionals with advanced scope of persistent pain practice.

A Level 1 service provides low-acuity, ambulatory general medical care to patients with non-urgent respiratory care needs.

Service provision includes delivery of risk factor/disease prevention education and self-management support, and / or chronic disease management.

Health promotion professional, NP, RN, medical practitioner or allied health professional with relevant skills and experience.

A Level 2 service provides inpatient management of low-acuity respiratory conditions, under the management of a registered medical practitioner.

Basic patient monitoring including oximetry.

Provides on-site oxygen therapy.

May have access to physiotherapy services.

Management and appropriate referral to a higher level Respiratory and Sleep Medicine service, including network access to specialist support.

Access to a registered medical practitioner.

On-site RN; RNs may be supported by SENs / ENs in providing care.

May have access to respiratory nurses and physiotherapist.

As for Level 2 plus:

Provides specialist respiratory medicine ambulatory care.

As for Level 2 plus:

Service provision includes basic lung function testing with spirometry.

As for Level 2 plus:

Visiting physician practicing in general medicine.

Access to physiotherapy services, as required.

Allied health assistants.

As for Level 3 plus:

Provides inpatient and outpatient management of respiratory conditions.

As for Level 3 plus:

Lung function laboratory (spirometry, volumes and gas transfer).

Access to sleep service.

Access to medicines information service.

As for Level 3 plus:

Physician practicing in general medicine available 24 hours.

Access to a respiratory physician including via telehealth.

RNs with appropriate post graduate qualifications and/or extensive experience in respiratory nursing. Access to physiotherapy, social work, clinical pharmacy, OT and mental health professional.

As for Level 4 plus:

Provides specialist respiratory medicine inpatient and outpatient services.

As for Level 4 plus:

Strongly linked with Level 6 respiratory services.

Category 3 or above respiratory function unit on-site.

Onsite bronchoscopy suite.

Ward based non-invasive ventilatory capability.

Access to specialist cardiology and cardiothoracic surgery services on-site.

Service provision includes specialist pulmonary rehabilitation services.

Accredited respiratory advanced training program.

Strongly linked with a sleep service.

As for Level 4 plus:

On-site respiratory physician.

Respiratory physician or physician practicing in general medicine on call 24 hours.

Medical registrar on-site 24 hours.

CNC specialising in respiratory nursing and providing leadership for the service.

Specialist clinical pharmacist (respiratory).

Physiotherapist, social worker, OT part of multidisciplinary respiratory team.

Access to mental health services as part of the network.

As for Level 5 plus:

Provides a complete range of diagnostic services, a full range of respiratory services and provision of emergency care.

This service plans and delivers statewide services and develops statewide protocols for management of respiratory conditions.

As for Level 5 plus:

Respiratory department.

Accredited respiratory function unit on-site.

Service provision includes advanced bronchoscopy.

Integrated public sleep service with laboratory on-site.

Specialised medical ward with non-invasive ventilation (NIV) capability/area.

On-site cardiothoracic surgery and PET scanning.

Statewide and interstate referral role.

As for Level 5 plus:

Respiratory physician on-call 24 hours.

Accredited respiratory medicine registrar(s).

Advanced bronchoscopy provider(s).

CNC position that complements RNs with specialist skills e.g., Lung cancer, Tuberculosis management.

Access to psychologist.

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A Level 3 service provides outpatient management of patients with rheumatology care needs.

A Level 3 service may have limited hours of operation.

Service provision includes patient monitoring, coordination of care and ambulatory medication management.

Service may participate in multi-disciplinary meetings with higher-level services.

Level 5 or 6 general rheumatology services may be provided by outreach / telehealth.

Access to patient-specific, aseptically prepared biological therapies compounded in a TGA registered facility or a hospital facility that complies with GMP.

Physician practicing in general medicine.

Qualified and/or experienced RNs in the administration of biological and other therapies.

Access to community nursing, physiotherapy, occupational therapy, podiatry, social work and clinical pharmacy.

Access to rheumatologist via telehealth or outreach.

A Level 4 service provides on­site ambulatory specialist rheumatology services for the assessment, diagnosis and management of rheumatology conditions.

As for Level 3 plus:

Service provision includes administration of day therapies under medical supervision.

Designated ambulatory day beds.

Visiting rheumatologist for outpatient care including via telehealth.

Formal network linkage with higher level Rheumatology Service for the referral of patients with rheumatological conditions (as specified in designated statewide musculoskeletal clinical pathways).

Registered medical practitioner during business hours.

Pharmacist part of multidisciplinary team.

Access to visiting specialist rheumatologist (including via telehealth).

Access to physiotherapy, occupational therapy, podiatry, social work.

As for Level 4 plus:

Provides inpatient rheumatology services.

As for Level 4 plus:

Ambulatory and inpatient rheumatological care provided by appointed rheumatologist.

Formal network linkage to Level 6 rheumatology service.

Infectious diseases, respiratory medicine, nephrology, orthopaedics and persistent pain services available on-site.

Access to interventional radiology.

Access to neurosurgery, spinal orthopaedics and vascular surgical services.

On site access to pharmacy services providing patient specific aseptically prepared biological therapies in a facility compliant with GMP.

As for Level 4 plus:

Appointed rheumatology specialist.

Access to specialist rheumatology CNCs.

Medical registrar on-site and physician practicing in general medicine on-call 24 hours.

Access on-site to physiotherapy, occupational therapy, podiatry, social work.

Specialist clinical pharmacist – rheumatology.

Pharmacy staff validated to manufacture biological therapies under aseptic conditions.

As for Level 5 plus:

Provides a full range of clinical rheumatology services with 24 hour clinical and laboratory services available on-call.

As for Level 5 plus:

Rheumatology department with statewide referral role.

Specialist rheumatology advice and support available 24 hours.

On-site neurosurgery, spinal orthopaedics, PET scanning, interventional radiology and vascular surgical service.

Accredited rheumatology training program.

As for Level 5 plus:

On-site rheumatology registrar.

May have rheumatologist on-call 24 hours.

Specialist rheumatology RNs.

Multidisciplinary rheumatology team including physiotherapy, occupational therapy, podiatry and social work.