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Senior doctors raise concerns about RAH Ward 2F

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South Australia’s Chief Psychiatrist has conducted a review into a ward at the Royal Adelaide Hospital after concerns were raised by doctors about the care of patients.

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Dr John Brayley has confirmed to InDaily he has inspected Ward 2F – a 16-bed facility catering for a range of patients including those with mental health issues – but his report is being kept under wraps for now.

SA Health told InDaily the ward was a specialist toxicology service but this has been disputed by senior clinicians who say it is a general ward which includes some toxicology patients.

The doctors’ union said there had been problems with Ward 2F relating to the combination of patients grouped together.

Bernadette Mulholland, chief industrial officer of the SA Salaried Medical Officers Association, told InDaily the “issues” had been about “the mixture of patients with various clinical conditions waiting in the same ward for specialist care, including mental health and toxicology patients”.

“This was done to assist in unblocking the RAH ED (emergency department), which is understandable, however it was unclear who had care of the patients and what their clinical pathway was,” she said.

In a wide-ranging interview with InDaily last month, Brayley confirmed he had just finished an inspection of Ward 2F and also an adjacent area being used for extra short-stay capacity.

“That report has just been finalised,” he said.

When asked if he had concerns about the ward, he said “all I can do is really confirm that I have inspected it… as well as some other beds that will be used to support people that would otherwise be waiting in the emergency department, that are being used for that purpose”.

Brayley said to further answer questions about Ward 2F he would prefer to have the report in front of him and more preparation.

Chief Psychiatrist Dr John Brayley. Photo: Tony Lewis/Indaily

InDaily followed up with his office through SA Health, seeking more information, and a spokesperson said Brayley “expects to provide an update… early in the new year, and respond to questions then”.

“As it happens, the RAH existing plans for its emergency department’s mental health response will also assist Ward 2F,” the spokesperson said.

“The impact of these plans will be reviewed.”

Mulholland said senior doctors escalated their concerns for patients “and an articulated process was agreed, to improve patient care”.

“This improved mental health pathway for patients is a direct result of engagement with frontline medical staff, which reinforces how critical it is for health administrators to listen to their medical workforce,” she said.

Mulholland said the next challenge would be to see how effectively the new privately-operated mental health crisis centre – due to open in February – would integrate with the RAH ED and the public mental health system.

However, she emphasised in a later statement that “any issues that may have been raised relate to the utilisation of the physical space ward 2F, not the practices of the Toxicology Service”.

“The management of poisoning, overdoses and drug and alcohol withdrawal must be a priority in 2021 for SA,” she said.

“The mental health sector is chronically underfunded. And the alcohol and other drug sector fares even worse.

“The bulk of current contemporary evidence supports well-funded and distinct alcohol and other drug services that collaborate with all hospital services to meet the needs of people with complex problems.

“We know that treatment is effective and we know that every dollar spent on alcohol and other drug treatment returns significant efficiencies for health service and the community, so it is worth the investment.”

Dr Mark Morphett, chair of the SA Faculty of the Australasian College for Emergency Medicine told InDaily: “The Australasian College for Emergency Medicine would be very supportive of novel approaches to the care of patients who have combined mental health and drug and alcohol and other toxicology presentations in a coordinated manner and would be very keen to see the development of safe patient care options in that space.”

 An SA Health spokesperson said “in line with international best practice, patients receive one-on-one care from a clinician at all times in the RAH toxicology unit to ensure their safety remains a priority”.

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