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Core services
Overview
The core RDF includes a broad range of services that enable the prevention, early detection and / or management of acute and chronic conditions. Other clinical disciplines may be reliant on core services for delivery of care.
Delineating service system roles
The capability of each service level is based on:
- Clinical capability required to provide the service.
- Clinical service interdependencies to support delivery of the service.
Service requirements
Core services are provided predominantly in inpatient settings. However, models of care for delivery of some core services include community service components.
This framework
This section of the RDF focuses on the capability requirements for cancer diagnosis and management. It does not encompass the entire cancer control continuum. Services such as palliative care, rehabilitation services and surgical services are described in separate sections of the framework.
The following cancer services are included in this section of the RDF:
Services
Emergency medicine services
Emergency medicine is the clinical specialty that is dedicated to the diagnosis and treatment of unforeseen illness or injury.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 | A Level 1 service provides advanced life support, emergency treatment and facilitates emergency transfer to higher level service. |
Emergency equipment relevant to advanced life support service scope. Designated emergency care area. Access to retrieval services for urgent transfer of patients to higher level Emergency Medicine service. Access to higher level emergency services via telehealth. |
RN and / or paramedic available 24 hours. May have access to a registered medical practitioner. |
| 2 |
As for Level 1 plus: Provides ambulatory emergency services by joint medical and intensive care paramedic emergency team. |
As for Level 1 plus: Emergency equipment relevant to service scope. Provides secondary retrieval of patients where indicated. |
As for Level 1 plus: Medical practitioner (e.g., GP) with training in anaesthetics and / or emergency medicine. Intensive care paramedic. Access to social work within business hours. |
| 3 |
As for Level 2 plus: Provides on-site emergency treatment for patients with acute illnesses or injuries and for the initial management of sick patients pending referral and transport to a higher-level facility. |
As for Level 2 plus: Emergency department with resuscitation bays. On-site short stay unit. Access to critical care facilities within the network. Infrastructure for helicopter landing bay. |
As for Level 2 plus: Medically staffed by GPs, Australian College of Rural and Remote Medicine (ACRRM) specialists, Australian College for Emergency Medicine (ACEM) specialists, ACRRM trainees or registered medical practitioner with postgraduate training in emergency medicine. Fellow of the Australasian College of Emergency Medicine (ACEM) for clinical governance and education and training on-site during business hours. Junior doctors (RMOs and interns) in emergency department 24 hours on-site. On-call rural generalists or ACEM specialists. On-site RNs with emergency medicine experience available 24 hours. Access to a pharmacist for medication services. Access to allied health including physiotherapy, occupational therapy, social work, speech pathology, dietetics, podiatry, orthotics and prosthetics. Access to allied health assistants. Access to mental health team with experience in emergency mental health presentations. |
| 4 |
As for Level 3 plus: Provides on-site emergency treatment by an emergency medicine team. |
As for Level 3. May receive sick patients with medical or surgical care needs from lower level emergency medicine services within the network. On- call access to emergency physicians 24 hours. |
As for Level 3 plus: Emergency physicians on-site 16 hours a day and on-call 24 hours. RNs with experience and/or post graduate qualifications in emergency nursing on-site 24 hours. CNC providing clinical leadership in emergency care. CNE to support undergraduate and postgraduate nursing students and skill development of nurses. Emergency registrars/RMOs on-site 24 hours. General surgeon on-site and on-call 24 hours. General medicine specialist on-site and on-call 24 hours. Clinical pharmacist on site business hours. Dedicated allied health including physiotherapy, occupational therapy, social work, speech pathology, dietetics available on-site and on-call. |
| 5 |
As for Level 4 plus: Provides on-site emergency treatment for risk patients with acute illnesses or injuries. |
As for Level 4 plus: Inpatient haematology care delivered by a specialist multidisciplinary team. On-site, or documented processes for, access to medical oncology, radiation oncology, infectious diseases, pain services, palliative care, psychiatry, medical imaging, nephrology (including renal dialysis), respiratory, cardiology, intensive care and surgical services. Access to specialist haematology advice 24 hours. On-site access to a radiotherapy unit for patient referral and transfer. Access to radiologist and pathologist advice for scheduled MDTs and during business hours. Onsite 24-hour access to aseptic, cytotoxic, biological and total parenteral nutrition therapy manufacture in a compounding facility that is compliant with GMP and staffed accordingly. Access to a medicines information service. Units providing autologous bone marrow transplants with accreditation under relevant national accreditation bodies. Access to interventional radiology service, PET service and vascular service for management of venous and arterial thrombosis where appropriate. |
As for Level 4 plus: Critical care medicine specialist on-site and on-call 24 hours. On-site intervention cardiology services on-site and on-call 24 hours. Specialist clinical pharmacist in emergency medicine on site extended hours. Consultant radiologist available 24 hours. Aged liaison multidisciplinary team including nursing, physiotherapy, occupational therapy and social work. Allied health multidisciplinary rapid response team including outreach. Dedicated primary contact allied health such as physiotherapy. Access to additional on-call allied health such as physiotherapy, orthotics & Prosthetics. Access to Occupational Therapy extended hours/weekends, including outreach from ED with Ambulance Tasmania. |
| 6 |
As for Level 5 plus: Provides on-site emergency treatment for high complexity, high risk patients and has capacity to manage complex trauma and provide a full range of time-critical medical services 24 hours. |
As for Level 5 plus: Cell separator accessible both for collection of peripheral blood progenitor cells (for units performing bone marrow transplants) and therapeutic apheresis (all Level 6 units), with 24-hour access to appropriately trained nursing staff for operation of cell separators. Dedicated standard isolation rooms. On-site renal dialysis, respiratory, pain management and infectious diseases services. Access to advanced diagnostic and interventional imaging services. Provide high-risk and/or complex protocols, and deliver intensive chemotherapy protocols. Provide haematological malignancy consultative services to lower level services. Units performing allogeneic transplants have accreditation under relevant national (matched family donor transplants) and international (unrelated donor transplants) accreditation bodies. Units performing bone marrow transplants have accreditation with Australian Bone Marrow Donor Registry. Advanced haematological diagnostics and transfusion services provided by a laboratory accredited under relevant national accreditation body. |
As for Level 5 plus: Medical and surgical sub-specialties available to manage complex trauma and provide full range of time-critical medical services. Interventional radiologist on-site and on-call 24 hours. Specialist clinical pharmacist in emergency medicine on site extended hours 7 days per week. |
Paediatric emergency services
| Level | Service description | Service requirements | Workforce requirements |
|---|---|---|---|
| 1 | n/a | n/a | n/a |
| 2 | n/a | n/a | n/a |
| 3 | Provides acute assessment and treatment of minor complexity injury or acute illness in paediatric patients and advanced paediatric life support. |
Equipment for management of acute paediatric presentations, acute illness and minor injury. Capacity to consult with Level 5 and 6 paediatric emergency services. |
Workforce may comprise:
Access to allied health including social work, physiotherapy, occupational therapy, speech pathology, dietetics, podiatry, orthotics and prosthetics. Access to allied health assistants. Access to Child Safety Liaison Officer. Extended access to Child and Adolescent mental health professionals. |
| 4 |
As for Level 3 plus: Provides 24-hour service including triage by qualified emergency staff and emergency care for all presentations. Mixed-age service with both adults and children presenting for care and treatment. Dedicated area for children within emergency department. Has capability to provide high-quality trauma care to medium and minor level trauma patients, and is capable of stabilising complex and severe trauma patients until transfer. |
As for Level 3 plus: Emergency Department with separate paediatric treatment area. Emergency Department equipped for paediatric presentations. Service capability includes short-term assisted ventilation capacity until transfer. Invasive monitoring capacity. Access to Child and Youth Mental Health Services (CYMHS) for consultation and/or liaison during business hours. Access to general mental health services for consultation and/or liaison after hours. |
As for Level 4 (adult) emergency service plus: Paediatrician available 24 hours. On-site paediatric skilled senior RN. |
| 5 |
As for Level 4 plus: Provides comprehensive emergency care and trauma care for high complexity paediatric patients. May provide specifically designed and separate short-stay unit for children. |
As for level 4 plus: Designated paediatric emergency zone within emergency department. Paediatric emergency zone separately staffed to general emergency department. On-site paediatric ICU and neonatal ICU. Separate waiting area for children. Children’s short-stay unit (if present) must be separate from adult service and specifically designed. Access to dedicated paediatric and adolescent inpatient beds. |
As for Level 5 (adult) emergency service plus: Consultant in paediatric / neonatal ICU available 24 hours. Consultant in paediatric surgery available 24 hours. Access to specialist pharmacist in paediatric medicine. Extended hours access to allied health with paediatric skills or experience including social work, physiotherapy, occupational therapy, speech pathology, dietetics. |
| 6 |
As for Level 5 plus: Capable of providing initial treatment and advanced care for all emergency presentations and full spectrum of trauma care for all seriously ill and injured infants, children and adolescents. |
As for Level 5 plus: Provides 24-hour emergency department and triage by qualified children’s emergency staff. Psychiatric emergency service with access to child and adolescent psychiatry service 24 hours. Access to wide range of children’s medical and surgical subspecialties on-site during business hours and accessible after hours. |
As for Level 5 plus: Paediatric medicine consultant available 24 hours. On-site paediatric emergency nurse (PEN). Provides consultation liaison and telehealth to lower-level services in the network 24-hours. |
The critical care services RDF includes intensive care, high dependency units and close observation units within its scope.
An Intensive Care Unit (ICU) is a specially staffed and equipped, separate, self-contained section of a hospital for the management of patients with potentially life-threatening conditions, and/or potentially reversible organ failures. An ICU provides clinical expertise, facilities and equipment for the support of patients and their families, utilising skills of specialist medical, nursing and allied health staff who are specifically trained in the multidisciplinary management of critically ill patients.
A High Dependency Unit (HDU) may be combined with an ICU or located separately. A HDU is a specifically staffed and equipped section of a hospital that provides a level of care intermediate between intensive care and general ward care. It may be located in a hospital with Level 4, 5 or 6 ICU's or as a satellite unit supported by ICU in another hospital within a reasonable transport time, as long as transfer systems are available, safe and robust.
ICU's / HDU's provide high level acute, clinical support for the various specialist and subspecialist medical and surgical services practicing within a health service or hospital. In this sense, ICU provides a safety net for those patients undergoing major surgery, procedures and treatments, and for managing complications of these. ICU also supports those patients who present to the Emergency Department with severe acute reversible illness or injury, ICU care may also include end of life care and support for potential organ donation. Additionally, Intensive Care medical and nursing staff will provide a wide variety of outreach services to support patients on acute hospital medical and surgical wards.
A Close Observation Unit (COU) provides a higher level of monitoring and observation than standard ward base care, but it does not have the capability for invasive monitoring, or support from an aligned ICU.
The provision of paediatric ICU services requires specialised skills in the critical care of paediatric patients. The paediatric critical care RDF is outlined in the women’s and children’s module of this RDF.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 | n/a | n/a | n/a |
| 2 |
A Level 2 service is a COU that is a specifically staffed and equipped section of the hospital. A COU provides a level of care intermediate between a HDU and that of standard ward base care. A COU provides close clinical and noninvasive vital sign monitoring of acutely ill medical or surgical (overnight or short stay) patients within pre-defined clinical criteria, who do not meet criteria for urgent transfer to a higher level of critical care. A COU may provide immediate resuscitation or lifesaving intervention under direct medical supervision, prior to urgent transfer to a higher level of critical care. |
Service capability includes close clinical observation with continuous cardiac ECG and pulse oximetry monitoring but not invasive pressure monitoring. Admission and discharge policy and protocols in place. May provide nursing support for ward-based emergency calls (MET Code Blue) as per developed policy and protocols. Established referral pathways with higher level services, including defined transfer policy and access to telehealth support. Formal audit and review of activities and outcomes including need for urgent transfer, length of stay and morbidity/mortality. |
Medical practitioners with experience and qualifications in relevant critical care specialty. Access to specialists from relevant disciplines to provide consultation and support, including via telehealth. NUM with experience and post registration qualification in either intensive care, high dependency or emergency medicine nursing (or equivalent). RNs with post registration experience in a critical care environment and minimum requirement of electrocardiography (ECG) interpretation and advanced life support (ALS) competence. Educational program for nursing staff which may include links with higher level referral centres and tertiary education institutions. Access to technical support staff (e.g., biomedical engineers and scientific officers), as required. Access to clinical pharmacist, physiotherapist, pastoral care, social worker, occupational therapy, dietetics, speech pathology, orthotics and prosthetics. Nursing staffing levels in accordance with relevant industrial instruments. |
| 3 |
A Level 3 service is a HDU that is a specifically staffed and equipped section of a hospital. A HDU may be in a hospital with an ICU but is physically separate. Alternatively, a HDU may be a satellite unit in a different facility to an ICU but is supported by an ICU. Patients may be admitted to the HDU as a step-down from ICU prior to transfer to the ward, or directly from the ward, post-anaesthetic care unit (recovery) or ED. |
As for Level 2 plus: Service capability includes routine monitoring and support of stable patients including ECG, oximetry, and short-term invasive measurement of blood pressure with pre-defined acceptable parameters that trigger escalation pathways. Protocols and Guidelines include invasive monitoring and the safe use of vasoactive therapies. All patients admitted to the HDU for more than 24 hours are referred to an attending Intensive Care Specialist for input towards care management. Access to anaesthetic, emergency medicine, or intensive care specialist attendance within 15 minutes for acute medical emergencies. Access to theatre recovery or the Department of Emergency Medicine for short term ventilation and stabilisation whilst awaiting retrieval services. |
As for Level 2 plus: Lead clinician with responsibility for clinical governance of service. Access to Intensive Care Specialist. Nurse Unit Manager with post registration qualification in intensive care. RNs with post registration qualification in intensive care or high dependency nursing. Access to Equipment Officer. |
| 4 |
A Level 4 ICU service provides immediate resuscitation and short-term cardiorespiratory support for critically ill patients. It can provide mechanical ventilation and simple invasive cardiovascular monitoring for up to 24 hours. |
As for Level 3 plus: Service capability includes basic, multisystem life support, for up to 24 hours, mechanical ventilation and simple invasive cardiovascular monitoring. Admission and discharge protocols for all beds to be determined by Medical Director. Established referral relationship with a Level 5 or Level 6 ICU including defined transfer policies and access to telemedicine support. Formal audit and review of activities and outcomes through participation in the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation database activities. 24-hour access to on-call pharmacy, pathology, operating theatres and medical imaging services. |
Lead clinician who is a Fellow of the CICM. Support available to unit 24 hours from registered medical specialists with experience in intensive care medicine, anaesthetics, emergency and general medicine. Medical practitioner on-site 24 hours. A nurse in charge of the unit who has a post registration qualification in intensive care. Access to a dedicated unit nursing educator. Extended hours access to pharmacist, physiotherapist, social work and pastoral care. |
| 5 |
As for Level 4 plus: Provides general intensive care including extended, multisystem life support. A Level 5 service provides mechanical ventilation, renal replacement therapy, invasive cardiovascular monitoring for extended periods. A Level 5 ICU with suitably trained clinical and support staff and resources, may be capable of providing more advanced respiratory and cardiovascular support using ECMO. |
As for Level 4 plus: Has sufficient clinical workload and case mix of patients to maintain high level of clinical expertise and adequate clinical exposure. Capable of accommodating at least six ventilated patients simultaneously. Manages more than 200 ventilated patients per year. Accredited CICM training program. 24-hour access to urgent echocardiography services. Specialised bariatric lifting equipment integrated into bed spaces. Adequate clerical and administrative support, as per CICM guidelines. Systems for the facilitation and support of organ donation. |
As for Level 4 plus: Registered medical specialist with credentials in intensive care medicine, rostered and accessible to cover intensive care unit at all times. Specialist Critical Care Medicine pharmacist on-site. Dedicated multidisciplinary allied health team with specialist skills in intensive care including physiotherapy, social work, dietetics, speech pathology. |
| 6 |
As for Level 5 plus: Is the highest-level referral unit for intensive care patients and can provide comprehensive critical care, including complex and multisystem life support for an indefinite period, and support for complex Level 6 activity. Elective transfer of patients to lower-level ICUs is supported where services exist to support the patient, and the transfer facilitates better proximity to the patient's family. |
As for Level 5 plus: Capable of accommodating at least 12 ventilated patients simultaneously. Manages more than 400 ventilated patients per year. Hyperbaric chamber available at short notice. Capacity for extended advanced respiratory and cardiovascular support using ECMO. |
As for Level 5 plus: Fellow of CICM qualified ICU Consultant specialists on-site and on-call 24 hours. ICU registrar on-site and exclusively rostered to the Unit 24 hours. Specialist Critical Care Medicine pharmacist on-site 7 days per week. |
Pre-hospital and Retrieval Medicine (PHRM) provides time-critical treatment for seriously sick and injured people, and rapid transport for urgent access to specialist care within Tasmania and interstate. Services may be provided in the community or in remote environments (pre-hospital), assisting hospital clinicians (in-hospital patient stabilisation) and between hospitals (inter-facility transport) using a variety of platforms including road ambulance, helicopter, and fixed wing aircraft.
PHRM services include a critical care management advice service that provides a) urgent clinical management advice for doctors, nurses and paramedics b) clinical coordination of patient transfers, and c) support for system-wide quality improvement via incident review, policy and protocol development, and health professional training.
PHRM services also include support during mass casualty incidents and disasters, providing medical interventions at the incident scene, clinical support for lower-level local services, and strategic advice including prioritisation and patient distribution decisions at the local and statewide level.
Staffing requirements for interfacility transfers are case specific. The level and urgency of clinical care required is determined according to clinical risk. Many interfacility transports can be provided by appropriately skilled nurses, paramedics, non-specialist doctors and doctors-in-training.
Pre-hospital medical response and retrieval involves provision of high risk-clinical procedures in potentially uncontrolled environment. As such, specialised workforce skill and expertise is required, including direct PHRM specialist staffing oversight or involvement.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 | n/a | n/a | n/a |
| 2 | n/a | n/a | n/a |
| 3 | n/a | n/a | n/a |
| 4 | n/a | n/a | n/a |
| 5 |
Provides a regional or supra-regional service. Interfacility transfers for patients with low to moderate clinical risk. Pre-hospital medical response and retrieval in low to moderate-risk settings (non-wilderness, non-rescue). |
Access to suitable road transport platforms and drivers. Access to aeromedical platforms. Access to a Level 6 critical care management advice service. |
Retrieval paramedics &/or nurses with specialist critical care skills based with transport platforms 24 hours. Access to hospital-based doctors (registrar grade or above) available during business hours for orientation, training and supervised missions. Access to hospital-based doctors (registrar grade or above) for an immediate response after hours. PHRM specialist doctors present on-base during business hours to provide supervision and training and available on call for emergency response attendance after hours. |
| 6 |
Provides a statewide service. Interfacility transfers for patients up to high clinical risk. Pre-hospital medical response and retrieval in all setting types including wilderness, marine, and rescue. Hosts statewide critical care management advice service. Co-ordinates the pre-hospital and retrieval medicine services response to disaster and mass casualty incidents, and provides expert advice to health, emergency services and other key response stakeholders. |
Suitable operating base and all types of transport platform on site for rapid response (road vehicle, fixed wing aircraft, helicopters) and staff (pilots, drivers, aircrew). All aircraft (fixed wing and helicopter) with adequate range/endurance for statewide service delivery and rapid transport to tertiary care (including interstate) without refueling, and sufficient cabin space for managing critically ill patients. All helicopters winch-equipped for remote area missions and team delivery to areas where landing is not possible, and with adequate power to meet CASA regulations to carry all core equipment and to be re-tasked (e.g. from interhospital to prehospital rescue/winching) in flight as required. 24 hours access to interfacility transport coordination nurses located on-site at the Ambulance Tasmania Communications Centre. Documented network arrangements including joint operating procedures and joint protocols with Tasmania Police Search and Rescue, Ambulance Tasmania Communications Centre, Neonatal and Paediatric Emergency Transport Service (NPETS), interstate retrieval services and other THS hospital services including emergency departments, intensive care, anaesthesia, state trauma service, neurosurgery, cardiology, stroke. Co-location or close proximity to the Neonatal and Paediatric Emergency Transport Service (NPETS). |
Retrieval paramedics &/or nurses with specialist critical care skills based with transport platforms 24/7. Retrieval paramedics with recognised skills and expertise in rescue and training. PHRM specialist doctors, on base 24/7 for immediate response with recognised skills and expertise in rescue and training. PHRM specialist doctors available on call by telephone to support the Communications Centre and available to respond to base or direct to scene for additional and disaster responses if needed (in addition to immediate response roster). |
Medical Imaging encompasses a spectrum of both conventional and sophisticated diagnostic and interventional practices. It encompasses general radiography, ultrasound, computed tomography (CT) scan, fluoroscopy, bone mineral densitometry, mammography, angiography, interventional radiology, and magnetic resonance imaging (MRI). Nuclear Medicine diagnostic imaging has also been included in the Medical Imaging delineation section of this framework, it uses radiopharmaceuticals (radioactive substances) to provide functional and dynamic imaging and includes gamma camera imaging as well as more specialist investigations such as PET (positron emission tomography) scanning.
All levels of medical imaging services outlined in this RDF must comply with RANZCR Standards of Practice for Clinical Radiology (current version 11.2, July 2020).
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
A Level 1 service provides low-risk ambulatory care services during business hours and may provide some limited after-hours services. This service either has access to or onsite single, mobile or fixed, general x-ray unit which is delivered by licensed operators under supervision of licensed radiographer. |
A mobile or fixed general x-ray unit onsite. Access to licensed medical imaging service for timely referral and reporting of images. Range of imaging limited to x-ray of extremities, chest and abdomen if service is delivered by licensed operators. Computed radiography equipment is available to acquire images and facilitate image transfer. |
Radiographer or licensed x-ray operator under supervision of licensed radiographer. Access to radiologists for reporting and to discuss findings. |
| 2 |
As for Level 1 plus: Provides low-risk imaging services by licensed radiographers. May be a designated room on-site with a fixed x-ray unit and computed radiography. Depending on range of services provided at the facility (e.g., day hospital), a mobile image intensifier may be the only modality available. Access to ultrasound for non-complex conditions or an outreach service may be available. |
As for Level 1 plus: Access to point of care ultrasound. Mobile image intensifier may be available to provide fluoroscopy assistance for minor procedures. |
As for Level 1 plus: On-site radiographer available during business hours. Where the facility / service provides mobile fluoroscopy services, a radiographer licenced for fluoroscopy must be in attendance during this procedure. Access to medical practitioner with credentials in diagnostic ultrasound where ultrasound provided. |
| 3 |
As for Level 2 plus: Provides imaging services by licensed radiographers. Sites may perform examinations involving contrast and have on-site radiologists able to perform some diagnostic procedures. May have diagnostic ultrasound services for more complex conditions, which may include obstetric and breast ultrasound. |
As for Level 2 plus: On-site designated radiology rooms. Teleradiology facilities available. On-site ultrasound and / or CT facilities. Where ultrasound services are provided, imaging is undertaken by sonographer or medical practitioner trained in ultrasound. Where intravenous contrast examinations are performed, resources are readily available for emergency management of complications, including resuscitation trolley and automatic defibrillator and paediatric resuscitation equipment where children are treated. |
As for Level 2 plus: Radiographer in attendance. Registered medical practitioner on-site at all times when procedures involving contrast are performed. Ultrasound performed by a sonographer or registered medical practitioner trained in ultrasound. Access to a radiologist to interpret / report on diagnostic images. |
| 4 |
As for Level 3 plus service scope may include:
|
As for Level 3 plus: Equipment and resources consistent with service scope. Electrocardiograph, blood pressure monitoring and pulse oximeter where angiography is performed, patient acuity is high or sedation is used. Formal links with nuclear medicine services. On-site or network access to MRI services. Where Tier A procedures performed, must be:
|
As for Level 3 plus: After-hours access to consultant radiology for reporting. On-site radiographer on-call 24 hours. Registered radiographers and sonographers. RN/EN as required. |
| 5 |
As for Level 4 plus: Provides MRI services. Provides selected Tier B interventional radiology services. Provides nuclear medicine services. |
As for Level 4 plus: Nuclear medicine facilities with single-photon emission CT. Preparation or reconstitution of radiopharmaceuticals with clear and appropriate documentation in place, including details of supply source, preparation date and batch number and reconstitution in line with the Australian and New Zealand Society of Nuclear Medicine Guidelines for Good Radiopharmacy Practice. One or more gamma cameras on-site with whole body and single-photon emission CT facility. May have the facility for in vivo and/or in vitro tracer studies. For Tier B interventional radiology procedures, facility requires:
Access to medicines information service. |
As for Level 4 plus: Clinical Director of Medical Imaging and lead radiographer. Radiologist on-site and on-call 24 hours. Interventional radiologist for Tier B interventional radiology services. May have radiology registrar. Registered and licensed nuclear medicine specialist present during radiopharmaceutical administration and available for consultation 24 hours. Full-time supervision during procedures by a nuclear physician or radiologist with nuclear medicine qualification. RN with evidence of ongoing clinical competency and experience appropriate to the service being provided on-site during the hours of operation of the department and available after-hours. Access to an appropriately credentialed anaesthetist as required. Registered nuclear medicine technologists. Business hours access to a radiochemist /radiopharmacist. Business hours access to technical support staff (e.g. biomedical engineering scientific officers, medical physicist, radiation safety officer). |
| 6 |
As for Level 5 plus: MRI service that supports more complex service profile / higher acuity patients. Provides full scope of Tier B interventional radiology procedures including:
PET services available on-site. Interstate referral role. |
As for Level 5 plus: Designated suites for digital angiography and neuroradiology. On-site PET scanning facilities. On-site neurosurgery. 24 hour on-call service across multiple modalities including general radiography, CT, ultrasound, fluoroscopy, nuclear medicine and interventional angiography. |
As for Level 5 plus: On-site imaging modality specialists during business hours. Has radiology registrars (2 minimum according to Australian standard) and postgraduate Fellows. One or more full-time medical physicists. A full-time radiopharmacist / radiochemist available if radiopharmaceuticals are manufactured inhouse. An experienced /suitably qualified RN at minimum Grade 4 level. |
Pathology services provide testing of materials, tissues or fluids from a patient to determine the cause and nature of a disease.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
n/a |
n/a |
n/a |
| 2 |
A Level 2 service does not have an on-site laboratory but may have access to Point of Care Testing (PoCT) as well as competent operators to use this equipment and appropriate supervision and training from a higher level pathology service within the network. No frozen sections are performed. |
Access to pathology services including an approved specimen and blood collection service. Access to courier service for specimen and blood product transfer to laboratory for processing. Compliance with the quality and safety requirements as determined by National Association of Testing Authorities (NATA) and the NPAAC. May have on-site blood storage, but cross-matched blood managed by off-site laboratory at a higher level pathology service. |
Staff with appropriate qualifications, training and experience relevant to scope of testing being performed in accordance with standards and guidelines specified by NPAAC. |
| 3 |
A Level 3 service provides a limited range of pathology tests, including on-site basic biochemistry and haematology, and has the ability to manage pathology specimens until transfer of the specimen to a higher level pathology service is available. More complex testing is accessible via higher level pathology services. |
On-site basic biochemistry and haematology. Access to blood bank services provided by a higher level pathology service within the network. Routine anatomical pathology provided within 96 hours via a higher level pathology service within the network. Routine microbiology samples (including culture of blood, urine, stool) are managed on-site and referred to a higher level pathology service within the network. |
Non-pathology specialists who are trained in the use of automated pathology testing equipment. Where appropriate, specialist pathology staff with appropriate qualifications, training and experience relevant to scope of testing being performed in accordance with NPACC requirements. |
| 4 |
As for Level 3 plus: Provides comprehensive testing in a local pathology laboratory. This level of service can typically be provided by a category B (branch) accredited pathology laboratory. |
As for Level 3 plus: Routine pathology services provided by laboratory scientists. Blood bank service provided by local laboratory. Electronic pathology result reporting available. |
As for Level 3 plus: Service provided by laboratory scientists with appropriate tertiary qualifications in accordance with NPACC guidelines. |
| 5 |
As for Level 4 plus: Provides a specialist pathologist service in a dedicated pathology department. |
As for Level 4 plus: Service provided by pathologists and/or clinical scientists as per NPAAC guidelines. Laboratory provides Haematology, Clinical Chemistry, Blood Bank, Microbiology and Histopathology services locally. May have sub-specialist pathologists in a limited range of disciplines. Has formal access to sub-specialist pathology services from a Level 6 pathology service. Provide support to lower service level facilities within the network. |
As for Level 4 plus: Credentialed pathologists. Specialist pathology laboratory staff available locally 24 hours. |
| 6 |
As for Level 5 plus: Provides sub-specialty services and a statewide referral role for complex, highly specialised and sub-specialty pathology services. This level of service can be provided by a category GX accredited pathology laboratory. |
As for Level 5 plus: Sub-specialty pathology services. Cytogenetics service. Cell culture facilities and cryopreservation. |
As for Level 5 plus: Credentialed sub-specialty pathologists. |
Medication services include a range of activities aimed at enhancing the safe and effective use of medicines to optimise patient outcomes, including medication storage, distribution, dispensing, compounding, medicines information, clinical pharmacy services, medication monitoring and safety systems.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
Provides medication supply and dispensing services to ambulatory populations with low medication risk. Records patient medication history and confirms current medications. Documents and reports patient medication allergies. Maintains records of dispensing and medication supply. Manages medication inventory. Orders, distributes and stores medications in accordance with relevant legislation and guidelines. Service may be provided by a community pharmacist or by a nurse practitioner or medical practitioner with oversight from a pharmacist located from a higher level service. |
Access in dispensary (either on-site or located off-site where services provided under service agreement) to computer hardware and software needed to meet statutory requirements for recording and dispensing medications and to support medication inventory management. Access to communication technologies including:
Access to contemporary reference material, and published guidelines for medication management and medication information services. Access to suitable medication distribution for supply of medications to maintain requisite medication inventory. Medications may be sourced from regional hospital pharmacy or by direct delivery where appropriate medication management procedures are in place. Medication storage facilities compliant with legislation. |
Access to an authorised prescriber. Access to a registered pharmacist either contracted via a community pharmacy or provided from a higher level medication service for supervision and monitoring of services. |
| 2 |
As for Level 1 plus: Provides ambulatory and some inpatient medication services. Access to clinical pharmacy services and consultation from a contracted provider or Level 3 (or higher) service for patients with medication risk. |
As for Level 1 plus: Access to clinical pharmacy services by referral including:
Access to basic, non-sterile extemporaneous compounding. Documented multidisciplinary processes for overseeing, monitoring and reporting on drug utilisation, medication service provision and medication safety practices. Periodic/regular visits from a contracted pharmacist, or pharmacist from a Level 3 Pharmacy Service (or higher) (may be via outreach pharmacy or telepharmacy services). Documented process for access to specialised pharmacist support from higher level facility within the network. |
As for level 1 plus: On site medical practitioner or nursing staff or pharmacist. Access to clinical pharmacist(s) to provide clinical services (on site or via telehealth) and oversee medication services. Access to a registered pharmacist for medication dispensing services. Pharmacy technician (on site or visiting) providing medication inventory support under supervision of a registered pharmacist. |
| 3 |
As for Level 2 plus: Provides inpatient and ambulatory pharmacy service to patients up to moderate risk. Service includes clinical pharmacy, dispensing and distribution services on weekdays through on-site pharmacy. Provides on-call access to pharmacist for emergency medication supply and medication advice 24 hours. |
Onsite pharmacy service including medication distribution, dispensing and medication-related counselling for inpatient and ambulatory patients during business hours. After-hours service may be provided by higher level service under documented process. Clinical pharmacy service as described in the APAC guidelines for patients with high and moderate medication risk. Access to sterile, individual patient compounding including cytotoxic / chemotherapy and other medications sourced commercially from a registered TGA manufacturer or from a higher level hospital pharmacy manufacturing facility. Access to other multidisciplinary health professionals, as required. Provision of medicines information to general or junior-level health professionals within scope of practice of pharmacist. Provision of low complexity medicines information and documented access pathway for medicines information support from at a higher level service within the network. Timely access to clinical information, including medical records and pathology results. May be recipient of telepharmacy services for patients with specialised or complex medication support needs. |
As for Level 2 plus: Services provided by on-site pharmacists supported by pharmacy technician staff, during business hours with documented processes for access to medications and pharmacy services after hours. |
| 4 |
As for Level 3 plus: Provides medication service to patients with medium to high medication risk. Provides clinical pharmacy and dispensing services 7 days a week through onsite pharmacy. May provide support for clinical trial medication distribution as part of limited clinical trial management service where other clinical services sponsor or participate in clinical medication trials. Does not provide support for trails that include onsite aseptic preparation of medications. |
As for Level 3 plus: Provides network consultation and accepts referrals from lower-level services. Medication distributed and stored by the facility and, as required, to any suitably equipped lower level service. Provides support and medication service oversight to lower level services through intermittent visits, via outreach pharmacy and / or telepharmacy services. Provides a limited range of specialist clinical pharmacy services. Participates in quality use of medicines programs and statewide medication access programs. Participates in quality use of medicines programs and statewide medication access programs. |
As for Level 3 plus: Some specialist clinical pharmacists in areas such as Haematology/oncology, paediatrics and mental health. Access 24-hours to on call pharmacist. Advanced scope of practice pharmacists and pharmacy technicians as appropriate to service profile. |
| 5 |
Provides services to patients up to very high medication risk level. Capacity to act as referral service for very high-risk patients except those who need statewide specialist clinical services. Provides clinical pharmacy, dispensing and distribution services across 7 days. Provides on-site manufacture of aseptically prepared medications including cytotoxic and biological products. |
As for Level 4 plus: On site facilities for preparation of sterile, individual patient compounding including aseptic, cytotoxic and biological. Facilities and process of manufacture is compliant with Code of Good Manufacturing Practice. |
As for Level 4 plus: Specialist pharmacist positions which reflect the range of specialist services provided. Pharmacy staff credentialled in complex medication manufacture including aseptic, cytotoxic and biological medications. Specialist clinical pharmacist advice available (through on-call pharmacist) 24 hours. Credentialled pharmacy technician staff on call for after-hours complex manufacture. |
| 6 |
Provides services for patients with highest level of medication risk. Acts as referral service for all lower level services across the state. Provides specialist clinical pharmacy services including highly specialised medication advice in complex areas such as paediatric oncology, and stem cell transplant. Facilitates implementation and monitoring of statewide multidisciplinary medication safety initiatives. Provides clinical and distribution services across 7 days and extended hours. |
As for Level 5 plus: Provides a responsive specialised medication information service that is accessible by the network. Provides credentialling, oversight and support for advanced scope of practice pharmacists and pharmacy technicians across the network. |
As for Level 5 plus: A full range of specialist pharmacists for all relevant service areas. |
Anaesthetic services are provided by a multidisciplinary anaesthetic and anaesthetic-assistant workforce with a range of skills in providing procedural and operative anaesthesia. Anaesthetics may be delivered by anaesthetic senior medical practitioner or appropriately credentialed registered general medical practitioners in health centre settings through to large tertiary referral hospitals.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
n/a |
n/a |
n/a |
| 2 |
A Level 2 service generally provides analgesia/minimal sedation performed by a registered medical practitioner credentialed to provide anaesthetic services. |
Formal network linkages with specialist anaesthetist for consultation. Registered medical practitioner or GP to provide analgesia/minimal sedation. Some anaesthetic drug supplies on imprest. |
Registered medical practitioner or GP credentialed to provide anaesthetic services. Access to specialist anaesthetist for consultation. ALS credentialled staff. |
| 3 |
A level 3 service provides low to medium-risk local anaesthetics, neuraxial block and regional block for low to medium anaesthetic risk patients undergoing Surgical Complexity I (SCI) and Surgical Complexity II (SCII) procedures. Low to medium-risk general anaesthetics are provided to patients (ASA 1-3) undergoing Surgical Complexity III (SCIII) procedures (refer to General Surgical role delineation framework). |
As for Level 2 plus: At least one operating/procedure room with separate on-site, dedicated recovery area/room for post-operative care. On-site emergency service able to stabilise and transfer patients that experience deterioration. Elective anaesthetic services are generally provided during business hours for regularly scheduled lists. |
As for Level 2 plus: RN with experience/post graduate qualifications in anaesthetic nursing. |
| 4 |
A Level 4 service provides all Level 3 services plus general anaesthetics on moderate to high anaesthetic risk patients (ASA1-4) undergoing SCIII to Surgical Complexity IV (SCIV) procedures. Anaesthesia is administered by a specialist anaesthetist. |
As for Level 3 plus: 24 hour access to perioperative services where emergency services are provided. Broad range of day and general surgery and some specialty surgery. More than one theatre. High-dependency or ICU (24 hour ventilation capability) on-site. On-site pathology, diagnostic and medical services. |
As for Level 3 plus: Specialist anaesthetists on-site. Specialist anaesthetists on-call 24 hours. Anaesthetics registrar on-call 24 hours. |
| 5 |
A Level 5 service provides services at Level 4 plus surgery is performed on low to high anaesthetic risk patients (ASA 1 -4) undergoing Surgical Complexity V (SCV) procedures. Generally, a combination of procedures with a moderate to high level of complexity and risk are performed, and management of some patients with comorbidities and risk of intra- and post-operative complications occurs. Anaesthesia is administered by a specialist anaesthetist with support from anaesthetic registrars. |
As for Level 4 plus: Provides emergency anaesthetic services. |
As for Level 4 plus: Specialist anaesthetist on 24 hour roster for low, moderate and high risk patients. |
| 6 |
A Level 6 service manages the highest level of anaesthetic risk in a range of specialties in conjunction with the most complex surgical and medical presentations that have a high level of complexity or risk to patients with an extensive range of comorbidities requiring specialist staff. |
As for Level 5 plus: Procedural/operative anaesthesia performed on patients with high potential for intra- and postoperative complications. Sub-specialty paediatric, cardiothoracic, neurosurgical, obstetric and trauma/retrieval anaesthetists. Credentialed paediatric and cardiac sub-specialty anaesthetists. |
As for Level 5 for: Anaesthetic registrar on-site 24 hours. Broad range of surgical sub-specialties services on-site and available 24 hours. Specialist perioperative medicine pharmacist on-site. |
