Service scope
Type of service provided (e.g. setting and general hours of service); type of patient (e.g. multiple comorbidities); providers and subspecialties, where relevant; and inter-service and/or interlevel relationships, with each level providing a more in-depth description of the service level capacity, not covered in the module overview.
Service requirements
Infrastructure and service requirements including additional detail and service-specific requirements such as nature of the service provided (e.g. particular interventions or treatment pathways, which could involve telehealth), specialty skills, specific hours and work-ordered timing of the service; providers (e.g. specific expertise of the team/s); and inter-service and/or inter-level relationships (e.g. service networking, referral pathways, transfer arrangements and interaction with other services, general practitioners, multidisciplinary teams and specialists). Also lists infrastructure, asset and equipment requirements including, but not limited to:
- equipment suitable for the needs of the patients (e.g. paediatric, bariatric or geriatric) and/or service
- staff responsible for using the equipment are trained and competent in equipment use
- users of equipment and infrastructure have access to appropriate maintenance and support services, including biomedical engineering and technical services, information communications technology support, and building maintenance services
- all level 6 services have access to on-site biomedical engineering and technical support services
Workforce requirements
Medical, nursing, allied health and other workforce specifications relevant to the levels within each module (exception being anaesthetic services where reference is made to anaesthetic and anaesthetic assistant workforce). These may be further defined within the service levels as the service level complexity increases. The CSF does not prescribe staffing ratios, absolute skill-mix, or clerical and/or administration workforce requirements for a team providing a service, as these are best determined locally.
Support service requirements
Identifying the minimum suite of services needed to deliver a service at a particular capability level i.e. Pharmacy, Laboratory, ICU/HDU, Operating theatres, Nuclear Medicine, Anaesthetics, Medical Imaging.
- Role Delineation Levels for services and in aggregate for a facility enable role delineation of hospitals and health facilities.
- Role delineation is a process which determines the clinical capability of a health facility to provide services of a defined clinical complexity. It is based on an assessment of the service provided, infrastructure, equipment and other service requirements, support services, as well as the number, range and expertise of medical, nursing and other healthcare personnel in a given clinical discipline to provide a service.
Summary of role delineation levels
Hospitals or Health Facilities can be largely grouped as Primary, Secondary or Tertiary. There will be a range of complexities and services provided under each, hence the need to further differentiate through the Role Delineation Levels.
| General nomenclature |
Service level |
Description |
| Primary and ambulatory care |
Level 1 |
- Provides low-risk inpatient and ambulatory care clinical services.
- Delivered mainly by RNs and GPs with admitting rights to the local hospital.
Patients requiring a higher level of care can be managed for short periods before transfer to a higher-level service.
|
| Level 2 |
- Some limited visiting/outreach allied health services provided.
- Manages emergency care until transfer to a higher-level service.
- Predominantly delivered by GPs (available 24 hours a day, 7 days a week but not necessarily on-site) and RNs including midwives and/or nurses with specialty qualifications, possibly inclusive of visiting day only specialist services as well as low-risk surgery and/or minor procedures, and an education and training role (longer than day only may be arranged).
|
| Secondary care |
Level 3 |
- Provides low to moderate-risk inpatient and ambulatory care clinical services delivered by a variety of health professionals (medical, nursing, midwifery and allied health) including resident and visiting specialists with access to limited support services.
- Manages emergency care and transfers to a higher level if required.
- No intensive care unit, although the facility may have access to a monitored area.
|
| Level 4 |
- Provides moderate-risk inpatient and ambulatory care clinical services delivered by a variety of health professionals (medical, nursing, midwifery and allied health) including resident and visiting specialists.
- Medical staff on-site 24 hours a day, 7 days a week and an intensive care unit (may be combined with a cardiac care unit) with related support services also available on-site.
- If higher level or more complicated care required, patients may need to be transferred to a level 5 service.
- Some specialist diagnostic services also available.
|
| Tertiary care |
Level 5 |
- Manages all but the most highly complex patients and procedures.
- Acts as referral service for all but the most complex service needs which may mean highly complex, high-risk patients require transfer or referral to a level 6 service.
- Has university affiliation(s) and education and teaching commitments, possibly some research.
|
| Level 6 |
- Is the ultimate high-level service delivering complex care and acting as a referral service for all lower-level services.
- Can also be a region-wide super specialty service accepting referrals from across the jurisdiction and cross-regionally where applicable.
- Generally provided at a large metropolitan hospital.
- Has strong university affiliations and major teaching and research commitments in both local and multi-centre research.
|