Support services

Anaesthetics

Level 1
No level 1 service. Please refer to a higher level.

Level 2
Analgesia/minimal sedation available by visiting medical officer

Level 3
As for Level 2 plus: General anaesthetics on low risk patients given by GP anaesthetists or general anaesthetist May have visiting specialist anaesthetist

Level 3

As for Level 2 plus:

General anaesthetics on low risk patients given by GP anaesthetists or general anaesthetist
May have visiting specialist anaesthetist

Level 4;
As for Level 3 plus: General anaesthetics on low risk patients given by accredited medical practitioner Specialist anaesthetist appointed for consultation and to provide service for moderate risk patients Specific operating room with anaesthetic staff support available

Level 4;

As for Level 3 plus:

General anaesthetics on low risk patients given by accredited medical practitioner
Specialist anaesthetist appointed for consultation and to provide service for moderate risk patients
Specific operating room with anaesthetic staff support available

Level 5
As for Level 4 plus: Specialist anaesthetist on 24/7 roster for low, moderate and high risk patients Nominated specialist director of anaesthetic staff Anaesthetic registrar on-site 24/7

Level 5

As for Level 4 plus:

Specialist anaesthetist on 24/7 roster for low, moderate and high risk patients
Nominated specialist director of anaesthetic staff
Anaesthetic registrar on-site 24/7

Level 6
As for Level 5 plus: Sub-specialists, research and teaching of graduates and undergraduates Teaching and research role

Level 6

As for Level 5 plus:

Sub-specialists, research and teaching of graduates and undergraduates
Teaching and research role

Coronary Care Unit

Level 1
No level 1 service. Please refer to a higher level.

Level 2
No level 2 service. Please refer to a higher level.

Level 3
No level 3 service. Please refer to a higher level.

Level 4;
Able to supply critical care expertise for coronary patients Provides a level of care more intensive than ward based care Discrete area within the health facility (may be combined within an ICU or HDU) Non invasive monitoring Can provide resuscitation and stabilisation of emergencies until transfer or retrieval to a back up facility Access to specialist SRN Specialist RN with minimum standard advanced life support competency Formal links with public or private health facility(s) for patient referral and transfer to/ from a higher level of service, to ensure safe service provision

Level 4;

Able to supply critical care expertise for coronary patients
Provides a level of care more intensive than ward based care
Discrete area within the health facility (may be combined within an ICU or HDU)
Non invasive monitoring
Can provide resuscitation and stabilisation of emergencies until transfer or retrieval to a back up facility
Access to specialist SRN
Specialist RN with minimum standard advanced life support competency
Formal links with public or private health facility(s) for patient referral and transfer to/ from a higher level of service, to ensure safe service provision

Level 5
As for Level 4 plus: Able to provide additional monitoring capacity (central monitoring at staff station) for cardiac patients and increased medical and nursing support Bedside and central monitoring capacity (able to monitor patients at the staff station)

Level 5

As for Level 4 plus:

Able to provide additional monitoring capacity (central monitoring at staff station) for cardiac patients and increased medical and nursing support
Bedside and central monitoring capacity (able to monitor patients at the staff station)

Level 6
As for Level 5 plus: Provides full range of cardiac monitoring (including invasive monitoring) for cardiac patients Full cardiology support including 24/7 on-call echocardiography, angiography, angioplasty and permanent pacemaker services Invasive cardiovascular monitoring (indefinitely) Highest level referral centre for CCU patients with active liaison with lower level critical care services for referrals and transfer of patients to ensure safe service provision

Level 6

As for Level 5 plus:

Provides full range of cardiac monitoring (including invasive monitoring) for cardiac patients
Full cardiology support including 24/7 on-call echocardiography, angiography, angioplasty and permanent pacemaker services
Invasive cardiovascular monitoring (indefinitely)
Highest level referral centre for CCU patients with active liaison with lower level critical care services for referrals and transfer of patients to ensure safe service provision

Infection control

Level 1
Has a risk management approach to infection prevention and control strategies Develop and implement policies and procedures to minimise the risk of healthcare associated infections Monitor effectiveness of these policies and procedures Undertake quality improvement activities Antimicrobial stewardship program including antimicrobial stewardship team policy, antimicrobial stewardship team, access to therapeutic guidelines and clinical microbiologist, antimicrobial formulary with restricted antibiotics and management support

Level 1

Has a risk management approach to infection prevention and control strategies
Develop and implement policies and procedures to minimise the risk of healthcare associated infections
Monitor effectiveness of these policies and procedures
Undertake quality improvement activities
Antimicrobial stewardship program including antimicrobial stewardship team policy, antimicrobial stewardship team, access to therapeutic guidelines and clinical microbiologist, antimicrobial formulary with restricted antibiotics and management support

Level 2
As for Level 1 plus: Infection prevention and control nurse service Healthcare associated infection surveillance program

Level 2

As for Level 1 plus:

Infection prevention and control nurse service
Healthcare associated infection surveillance program

Level 3
As for Level 2 plus: Infection prevention and control team Medical infection prevention and control oversight Infection prevention and control committee

Level 3

As for Level 2 plus:

Infection prevention and control team
Medical infection prevention and control oversight
Infection prevention and control committee

Level 4
As for Level 3 plus: Antimicrobial stewardship program to include infectious diseases pharmacist (where possible) and infectious diseases physician consultancy

Level 4

As for Level 3 plus:

Antimicrobial stewardship program to include infectious diseases pharmacist (where possible) and infectious diseases physician consultancy

Level 5
As for Level 4 plus: Hospitals with Emergency Departments have on-site medical Infection Prevention and Control service Director of antimicrobial stewardship program Multidisciplinary antimicrobial stewardship team

Level 6
As for Level 5 plus: Possible designated inpatient area for management of infectious and communicable diseases On-site medical infection prevention and control service

Level 6

As for Level 5 plus:

Possible designated inpatient area for management of infectious and communicable diseases
On-site medical infection prevention and control service

Intensive Care / High Dependency Unit

Level 1
No level 1 service. Please refer to a higher level.

Level 2
HDU Recovery area for post-operative patients Different high dependency area for general ward patients requiring observation over and above that available in general ward area

Level 2

HDU

Recovery area for post-operative patients
Different high dependency area for general ward patients requiring observation over and above that available in general ward area

Level 3
HDU 24/7 access to medical officer on-site or available within 10 minutes RN equivalent to 6 hrs/patient/day (1:4) desirable for high dependency beds Has NM or nurse in charge Access to psychiatric services via visiting specialist or Teleheath Access to medical and nursing education program

Level 3

HDU

24/7 access to medical officer on-site or available within 10 minutes
RN equivalent to 6 hrs/patient/day (1:4) desirable for high dependency beds
Has NM or nurse in charge
Access to psychiatric services via visiting specialist or Teleheath
Access to medical and nursing education program

Level 4
Equivalent to level I CICM Guidelines Mechanical ventilation and simple invasive cardiovascular monitoring for several hours Separate and self-contained facility in the hospital capable of providing basic, multi-system life support usually for less than 24 hours Medical director with training and experience in intensive, emergency medicine or general medicine who meet CICM requirements At least one RMO on-site or available to the unit at all times

Level 4

Equivalent to level I CICM Guidelines

Mechanical ventilation and simple invasive cardiovascular monitoring for several hours
Separate and self-contained facility in the hospital capable of providing basic, multi-system life support usually for less than 24 hours
Medical director with training and experience in intensive, emergency medicine or general medicine who meet CICM requirements
At least one RMO on-site or available to the unit at all times

Level 5
Equivalent to level II of CICM Guidelines Mechanical ventilation, extra- corporeal renal support services and invasive cardiovascular monitoring for a period of several days Separate and self-contained facility in hospital capable of providing complex multi-system life support Medical director accredited intensive care specialist or consultant physician in intensive care At least one specialist accredited with appropriate experience in intensive care Plus one RMO(s) who is on- site, predominantly present in the unit and exclusively rostered to the unit at all times NM with post- registration qualifications in intensive care or the clinical specialty of the unit Nurse in charge of the shift is a permanent staff member and appropriately qualified All nursing staff of unit responsible for direct patient care are RNs Majority of nursing staff have post-registration qualifications in intensive care or clinical specialty of the unit 1:1 care for ventilations or equivalently critically ill Capacity to provide greater than 1:1 care if required At least two RNs in unit if there is a patient in the unit Active medical and nursing education programs Access to the CNE 24/7 access to pharmacy, pathology, operating suite and imaging Appropriate access to physiotherapist, social worker, dietitians, pastoral care and other allied health services

Level 5

Equivalent to level II of CICM Guidelines

Mechanical ventilation, extra- corporeal renal support services and invasive cardiovascular monitoring for a period of several days
Separate and self-contained facility in hospital capable of providing complex multi-system life support
Medical director accredited intensive care specialist or consultant physician in intensive care
At least one specialist accredited with appropriate experience in intensive care
Plus one RMO(s) who is on- site, predominantly present in the unit and exclusively rostered to the unit at all times
NM with post- registration qualifications in intensive care or the clinical specialty of the unit
Nurse in charge of the shift is a permanent staff member and appropriately qualified
All nursing staff of unit responsible for direct patient care are RNs
Majority of nursing staff have post-registration qualifications in intensive care or clinical specialty of the unit
1:1 care for ventilations or equivalently critically ill
Capacity to provide greater than 1:1 care if required
At least two RNs in unit if there is a patient in the unit
Active medical and nursing education programs
Access to the CNE
24/7 access to pharmacy, pathology, operating suite and imaging
Appropriate access to physiotherapist, social worker, dietitians, pastoral care and other allied health services

Level 6
Equivalent to level III CICM Guidelines Mechanical ventilation, extra corporeal renal support services and invasive cardiovascular monitoring for an indefinite period Separate and self- contained unit in hospital capable of providing complex, multi system life support for an indefinite period Referral centre for intensive care patients Medical director accredited intensive care specialist or consultant physician in intensive care Plus one RMO who is in the hospital, predominantly present in the unit and exclusively rostered to the unit at all times NM with post- registration qualifications in intensive care or units clinical specialty Nurse in charge of shift is permanent staff member and appropriately qualified Must be RNs if providing direct patient care. Majority of nursing staff have post- registration qualifications in intensive care or unit clinical specialty 1:1 care for ventilations or equivalent critically ill, greater than 1:1 for selected patients More than two RNs present in the unit if patient in the unit CNE and formal nursing educational program Physiotherapy services are accessible Appropriate access to other allied health services Active research Designated social worker Biomedical engineering services onsite

Level 6

Equivalent to level III CICM Guidelines

Mechanical ventilation, extra corporeal renal support services and invasive cardiovascular monitoring for an indefinite period
Separate and self- contained unit in hospital capable of providing complex, multi system life support for an indefinite period
Referral centre for intensive care patients
Medical director accredited intensive care specialist or consultant physician in intensive care
Plus one RMO who is in the hospital, predominantly present in the unit and exclusively rostered to the unit at all times
NM with post- registration qualifications in intensive care or units clinical specialty
Nurse in charge of shift is permanent staff member and appropriately qualified
Must be RNs if providing direct patient care.
Majority of nursing staff have post- registration qualifications in intensive care or unit clinical specialty
1:1 care for ventilations or equivalent critically ill, greater than 1:1 for selected patients
More than two RNs present in the unit if patient in the unit
CNE and formal nursing educational program
Physiotherapy services are accessible
Appropriate access to other allied health services
Active research
Designated social worker
Biomedical engineering services onsite

Operating theatres

Level 1
No level 1 service. Please refer to a higher level.

Level 2
Minor procedure capability by credentialed clinicians treatment or procedure room only no emergency operating theatre

Level 3
As for Level 2 plus: Single operating theatre for minor/same day procedures 24/7 cover for caesarian section if performing obstetrics Separate recovery

Level 3

As for Level 2 plus:

Single operating theatre for minor/same day procedures
24/7 cover for caesarian section if performing obstetrics
Separate recovery

Level 4
As for Level 3 plus: More than one operating theatre/ procedure room Accredited medical practitioner providing anaesthetic services Specialist RN Access to specialist SRN

Level 4

As for Level 3 plus:

More than one operating theatre/ procedure room
Accredited medical practitioner providing anaesthetic services
Specialist RN
Access to specialist SRN

Level 5
As for Level 4 plus: Specialist anaesthetist on 24/7 roster for low, moderate and high risk patients Medical officer on-site 24/7 Access to ICU

Level 6
As for Level 5 plus: Multiple operating theatres and procedure rooms Major and complex procedures (cardiothoracic and transplant) Teaching and research role

Level 6

As for Level 5 plus:

Multiple operating theatres and procedure rooms
Major and complex procedures (cardiothoracic and transplant)
Teaching and research role

Pain medicine

Level 1
No level 1 service. Please refer to a higher level.

Level 2
No level 2 service. Please refer to a higher level.

Level 3
Development of pain management plan via Telehealth GP can manage patient with short term pain issues, with advice from higher level services

Level 4
As for Level 3 plus: Limited inpatient care with part- time medical and nursing staff Access to physiotherapist Visiting pain medicine physician (or via Telehealth)

Level 4

As for Level 3 plus:

Limited inpatient care with part- time medical and nursing staff
Access to physiotherapist
Visiting pain medicine physician (or via Telehealth)

Level 5
As for Level 4 plus: Comprehensive multidisciplinary inpatient pain service Comprehensive array of interventional procedures Access to rehabilitation specialist, psychiatrist, rheumatologist and addiction specialist Research role with data collection

Level 6
As for Level 5 plus: A director or coordinator of the multidisciplinary pain clinic At least three medical specialties should be represented on the staff of a multidisciplinary pain clinic including rehabilitation specialist, psychiatrist/ psychologist, rheumatologist and addiction specialist Access to neuromodulation and intrathecal infusion devices (pumps) Pain medicine physician on-call to support on-site senior personnel Leads research role and supports other centres Undergraduate and post-graduate teaching role with close affiliation to a major educational or research institution in the health sciences Provides Telehealth service

Level 6

As for Level 5 plus:

A director or coordinator of the multidisciplinary pain clinic
At least three medical specialties should be represented on the staff of a multidisciplinary pain clinic including rehabilitation specialist, psychiatrist/ psychologist, rheumatologist and addiction specialist
Access to neuromodulation and intrathecal infusion devices (pumps)
Pain medicine physician on-call to support on-site senior personnel
Leads research role and supports other centres
Undergraduate and post-graduate teaching role with close affiliation to a major educational or research institution in the health sciences
Provides Telehealth service

Pathology

Level 1
No level 1 service. Please refer to a higher level.

Level 2
Specimen collection by RN or GP Specimens transmittal to referral laboratory

Level 3
As for Level 2 plus: Specimen collection by pathology staff Able to perform a defined range of urgent tests

Level 3

As for Level 2 plus:

Specimen collection by pathology staff
Able to perform a defined range of urgent tests

Level 4
As for Level 3 plus: Performs range of basic tests Has blood gas analyser Able to provide specimen collection and initial plating microbiology Blood bank Services surrounding areas Full-time laboratory scientists

Level 4

As for Level 3 plus:

Performs range of basic tests
Has blood gas analyser
Able to provide specimen collection and initial plating microbiology
Blood bank
Services surrounding areas
Full-time laboratory scientists

Level 5
As for Level 4 plus: 24/7 on-site service Pathology department Full-time pathologist Microbiology and histopathology available Regional referral role

Level 6
As for Level 5 plus: Statewide referral role Teaching and research role Specialist registrar in training

Level 6

As for Level 5 plus:

Statewide referral role
Teaching and research role
Specialist registrar in training

Pharmacy

All Pharmacy services must follow and comply with the Australian Pharmaceutical Advisory Council (APAC) Guidelines, Society of Hospital Pharmacists of Australia (SHPA) Practice Standards 2011,

WA DoH Pharmaceutical Review Policy, ACSQHC Mandatory Criteria Standard 4 (Medication Safety) and all current legislative requirements that apply to each service level.

Level 1
Provides services to an ambulatory population Service not limited to rural and remote areas and may include services provided from other community health centres Medications supplied on discharge by individual prescription from a community pharmacy, primary health care clinic or higher level service Access provided to basic medicines information to patients verbally and in writing Where no pharmacist employed, on- site medication oversight provided by a pharmacist located elsewhere from a higher service (e.g. via Telehealth) or via a process with a community pharmacist approved by the regional chief pharmacist Access to medical practitioner or nurse practitioner (within scope of practice) for prescriptions

Level 1

Provides services to an ambulatory population
Service not limited to rural and remote areas and may include services provided from other community health centres
Medications supplied on discharge by individual prescription from a community pharmacy, primary health care clinic or higher level service
Access provided to basic medicines information to patients verbally and in writing
Where no pharmacist employed, on- site medication oversight provided by a pharmacist located elsewhere from a higher service (e.g. via Telehealth) or via a process with a community pharmacist approved by the regional chief pharmacist
Access to medical practitioner or nurse practitioner (within scope of practice) for prescriptions

Level 2
As for Level 1 plus: Provides limited ambulatory and inpatient clinical pharmacy Provides medication service to patients assessed as having a medication risk (i.e. paediatric patients polypharmacy, high risk medicines etc) via regional resource centres/IDHS Sessional or part- time pharmacist or visiting pharmacist from regional hospital or a contracted service approved by the regional chief pharmacist Access to more specialised pharmacist support from higher level facility Services may be provided from registered nurses or other allied workers as allowed by the legislation Medication for inpatients may be supplied from regional resource centre, community pharmacy, registered medical practitioner or hospitals

Level 2

As for Level 1 plus:

Provides limited ambulatory and inpatient clinical pharmacy
Provides medication service to patients assessed as having a medication risk (i.e. paediatric patients polypharmacy, high risk medicines etc) via regional resource centres/IDHS
Sessional or part- time pharmacist or visiting pharmacist from regional hospital or a contracted service approved by the regional chief pharmacist
Access to more specialised pharmacist support from higher level facility
Services may be provided from registered nurses or other allied workers as allowed by the legislation
Medication for inpatients may be supplied from regional resource centre, community pharmacy, registered medical practitioner or hospitals

Level 3
As for Level 2 plus: Service is predominantly to inpatients but includes a limited service to dispense medication to ambulatory patients Provides clinical pharmacy on weekdays through an on-site pharmacy An established out-of-hours medication mechanism and access to a pharmacist for emergency advice 24/7 Services provided by a pharmacist on-site or a contracted community pharmacy approved by the regional chief pharmacist Supported by technical or assistant staff to provide services Access to other multidisciplinary professionals as required May provide basic, non sterile extemporaneous compounding May have regional responsibilities May provide internships in pharmacy services Provision or recipient of tele- pharmacy services from specialist pharmacist

Level 3

As for Level 2 plus:

Service is predominantly to inpatients but includes a limited service to dispense medication to ambulatory patients
Provides clinical pharmacy on weekdays through an on-site pharmacy
An established out-of-hours medication mechanism and access to a pharmacist for emergency advice 24/7
Services provided by a pharmacist on-site or a contracted community pharmacy approved by the regional chief pharmacist
Supported by technical or assistant staff to provide services
Access to other multidisciplinary professionals as required
May provide basic, non sterile extemporaneous compounding
May have regional responsibilities
May provide internships in pharmacy services
Provision or recipient of tele- pharmacy services from specialist pharmacist

Level 4
As for Level 3 plus: Services provided to inpatients and to ambulatory patients for general and specialty clinics Provides a medication service to patients with a medium to high medication risk An on-site pharmacy with appropriately maintained facilities Provision of clinical pharmacy services for inpatient and outpatients and may provide a dedicated clinical services to specific areas e.g. ED, AMU An after-hours, on-call service for medication supply and clinical service Medication information service available during business hours Access to non sterile extemporaneous compounding and sterile individual compound products (excluding cytotoxic, chemotherapy and medications requiring higher level support) Staffing requirements should comply with the APAC and SHPA guidelines May provide support for clinical trials medication dispensing and distribution May receive telepharmacy input from a specialist pharmacist from a higher level service

Level 4

As for Level 3 plus:

Services provided to inpatients and to ambulatory patients for general and specialty clinics
Provides a medication service to patients with a medium to high medication risk
An on-site pharmacy with appropriately maintained facilities
Provision of clinical pharmacy services for inpatient and outpatients and may provide a dedicated clinical services to specific areas e.g. ED, AMU
An after-hours, on-call service for medication supply and clinical service
Medication information service available during business hours
Access to non sterile extemporaneous compounding and sterile individual compound products (excluding cytotoxic, chemotherapy and medications requiring higher level support)
Staffing requirements should comply with the APAC and SHPA guidelines
May provide support for clinical trials medication dispensing and distribution
May receive telepharmacy input from a specialist pharmacist from a higher level service

Level 5
As for Level 4 plus: Provides services to patients with high medication risk The service has capacity to act as a referral service for very high risk patients except those who need state-wide specialist clinical service Extended hours of service with a pharmacist available 24/7 Medications and clinical pharmacy services for inpatients, day patients, ambulatory patients in specialty clinic Non sterile extemporaneous compounding and sterile individual compound products(e.g. chemotherapy including parenteral, targeted and oral chemotherapy) A medicine/ drug information service available 24/7 Staffing to include advanced level pharmacy practitioners, employed full-time and located on- site Pharmacist available on-site for assessment of competency, medication services for regional and community role, provision of remote pharmaceutical review Participate in clinical medication trials and ability to provide management and support for clinical trials May actively participate in multidisciplinary research activities Training site for medical and nursing, allied professions and contributes to teaching programs and collaborates with higher education providers Provides and receives telepharmacy services

Level 5

As for Level 4 plus:

Provides services to patients with high medication risk
The service has capacity to act as a referral service for very high risk patients except those who need state-wide specialist clinical service
Extended hours of service with a pharmacist available 24/7
Medications and clinical pharmacy services for inpatients, day patients, ambulatory patients in specialty clinic
Non sterile extemporaneous compounding and sterile individual compound products(e.g. chemotherapy including parenteral, targeted and oral chemotherapy)
A medicine/ drug information service available 24/7
Staffing to include advanced level pharmacy practitioners, employed full-time and located on- site
Pharmacist available on-site for assessment of competency, medication services for regional and community role, provision of remote pharmaceutical review
Participate in clinical medication trials and ability to provide management and support for clinical trials
May actively participate in multidisciplinary research activities
Training site for medical and nursing, allied professions and contributes to teaching programs and collaborates with higher education providers
Provides and receives telepharmacy services

Level 6
As for Level 5 plus: Statewide organisational or institutional resource Participating in guideline/policy development processes for statewide organisational, institutional and/or national guidelines Involved in research, clinical trials, clinical review and drug use evaluation A specialised or statewide medicines and drug information/ policy and/ or poisons information service may be provided Provide telepharmacy to smaller sites/ services

Level 6

As for Level 5 plus:

Statewide organisational or institutional resource
Participating in guideline/policy development processes for statewide organisational, institutional and/or national guidelines
Involved in research, clinical trials, clinical review and drug use evaluation
A specialised or statewide medicines and drug information/ policy and/ or poisons information service may be provided
Provide telepharmacy to smaller sites/ services

Radiology

Level 1
No level 1 service. Please refer to a higher level.

Level 2
Mobile service and limited to x-ray of extremities, chest, pelvis Interpreted by on-site doctor/health professional or interpreted and reported on by a radiologist by electronic means Teleradiology available PACS available

Level 3

As for Level 2 plus:

On-site designated room
Radiographer in attendance who has regular access to radiological consultation
Simple ultrasound capacity for foetal monitoring
Teleradiology facility available

Level 4

As for Level 3 plus:

Facilities for general and fluoroscopy, in addition to mobile x-ray unit, OR and ED
Auto film processing capacity
Mobile image intensifier in OR and/or ICU/CCU
Staff radiographer on-call 24/7
Ultrasound available
May have CT scanner, MRI and nuclear medicine
Registered nurse as required
Teleradiology facility available

Level 5

As for Level 4 plus:

Established department
Full ultrasound
Has radiology head of department
May have radiology registrar
CT scanner service available 24/7
Has MRI
RN available 24/7 on-site

Level 6

As for Level 5 plus:

Special rooms for digital angiography, neuroradiology etc
CT scan and full ultrasound service available 24/7
Has MRI and digital angiography
Radiology registrar and post graduate fellows
Performs invasive procedures
Has nuclear medicine and laboratory facilities
May have PET