Wednesday, July 1, 2015

Tour of the Royal Melbourne Hospital

On Friday 12 June Darlene Cox and I went on a tour of the Royal Melbourne Hospital (RMH) in North Melbourne.

We were interested in a tour of the hospital as it is in a similar situation as the Canberra Hospital. The campus is landlocked, meaning roads surround the hospital and there is nowhere to expand on the current campus. Also RMH has undergone and continues to undergo a series of infrastructure upgrades to improve the ageing facility and to accommodate the increasing demand in services.

The RMH has been upgrading older parts of the hospital with various projects completed and include the construction of additional Inpatient Units; Helipad; new buildings and refurbishment of some of the existing building. Some recent upgrades have been the intensive care unit, 300 inpatient beds, as well as upgrades to pathology and medical imaging facilities. The most recent projects are the allied health building and the Emergency Department (ED) refurbishment.

The Community Engagement manager and Director Capital Works, both from Melbourne Health, were our tour guides for the day. We met them both at the main entrance where our tour was to begin.

The main entrance to the hospital was located just off busy Flemington Road. The drop off zone was on street. This is not ideal, however the RMH is completely land locked.

You are greeted at the main foyer with a volunteer’s desk, where they can assist patients and visitors. There seemed to be a very good use of volunteers at the hospital. The main foyer also had a café (café Zouki), bank, florist and gift shop. Even through the space felt cramped with the low roofing it still felt alive and spacious. 

Main entrance to the Royal Melbourne Hospital

We were very interested in the ED, as it underwent a $53 million redevelopment upgrade in July 2009. It was good to see what was able to be done with a space that could not be extended, only refurbished. It was also useful for the planning of the refurbishment and extension of the existing ED at the Canberra Hospital. 

Triage/administration main desk

The triage/administration desk had cables across the counter rather than glass perspex. Both the patients and the staff preferred the cables over the glass as it was easier to talk to one another and felt less like a compound. The marble front counter was five years old, although you wouldn’t know it. Our tour guide said that the front desk has held up very well to wear and tear over the years. Also the wooden roofing soften both the feel of the waiting room and absorbed a lot of the sound.

The ED has a total of 107 treatment stations, however there was no paediatric stream in the ED as there was an ED at the children’s hospital just down the road. Visitors in ED also had stickers with visitor written on them. This was a great idea, as when in ED it can sometimes feel like as a visitor you are not meant to be there. The sticker provides reassurance.

ED also had write up stations in acute rooms, allowing the wirte up to be done at the bedside. However this is currently only available in ED. There were also smaller write up stations in the corridors of ED, as theses station locations allowed improved line of sight for clinical staff.

Wayfinding through ED was not very clear and we felt there was a need for improvement. It was a bit confusing as to where you were.

ED bedside write up in treatment bay

ED hallway write up station

RMH has also rolled out a Q flow system similar to the system ACT Health is about to roll out. This was located at outpatients/day services. The system had been in place for about 12 months, there has been very little issues with the system and is making it easier for patients to check in for appointments and go to the sub waiting rooms. These rooms are all colour coded, making it easier to find. Hopefully this is a good sign for the new Q Flow system that ACT Health will be rolling out in the coming months.

Q Flow machine
Outpatient waiting room

Once you got a ticket from the Q Flow system it would tell you to wait in sub wait rooms in outpatients. Each sub wait room was colour coded making it easier to find. We really liked the combination of seating in the waiting rooms. Not only were there the standard single seats you see in all waiting rooms there were also double and single lounge chairs. This meant that if you needed a little more space or had a family member with you the seating arrangement would be able to accommodate this. 

The ambulatory care reception desk also had cables across the counter with some parts covered with glass perspex

The RMH has recently completed a new allied health building that opened in October 2012. It is a three storey building connected to the North Wing of the hospital that provides allied health services for both inpatients and outpatients. This new allied health building is home to rehabilitation services such as speech pathology and a gym. 

Rehabilitation gymnasium

The Gym was bright with floor to ceiling windows surrounding almost the whole room. Although the gym was not massive, it seemed to use the space proved quite well. Also the flooring in the gym was colour coded for different types of exercises, this was incorporated into the design quit well.

The image cover the whole wall as you walk into allied health. The people featured are people who had used the services previously.
Entrance into a speech 
pathology room, with a nice 
use of people on the sign 
who have been using the 
Occupational Therapy 

One of the Allied Health sub waiting rooms, with different seating
The new allied health building also incorporated some great signs for services. The inclusion of people in the signs makes it that much easier and relatable. Particularly the sign that has great messages on it such as achieving better health and respecting our community, as you can see in the pictures.

We came across the You Made a Difference Awards on our tour and were interested in what the award meant. The You Made a Difference Awards recognise individuals or teams for making a difference for patients, visitors or staff. We thought this was a great idea as it promotes and shows appreciation to those who most deserve it, as nominations are provided by patients, visitors and staff. Simple things such as this award promotes better care and can be very rewarding to staff and volunteers.

Pictures of past and present winners of the You Make a Difference Award

On our tour we came past a group playing some great live music. RMH has been running music therapy almost daily since 1997 with great results. We definitely noticed a positive difference around the live music, everyone seemed more relaxed and had a smile on their face. This is certainly something health services in Canberra need more of. 

The live band playing some great songs with a piano accordion and all

The inpatient units were refurbished about 10 years ago. These units where divided into 32 bed pods, there were single bed rooms in this arrangement but unfortunately we could not find out what the ratio was for single bed to multi-bed rooms.  The room layout for both single and multi-bed rooms were a standard layout, similar to the current layout at the Canberra Hospital. There seemed to be limited future proofing done at the time of refurbishment, this includes no bedside write up infrastructure and a large central nursing station with poor line of site to rooms. There was also the constraints of the old building layout. The 32 bed inpatient units were shaped liked a capital T, making it very difficult to design nursing stations that maintain line of site to rooms. In a situation such as this it might had been better to work off a decentralised nurse station model.

There were clocks in each room at the end of the beds with dates and days on them. This was a great idea, as it allowed patents to keep track of what day and date it is. This was in responses to feedback from consumers and carers.

Inpatient clock at the end of patients beds

There were also very informative messages on porters through the hospital such as fall prevention and how you rate your exerances with the health services. What was even better about them was the amount of different languages these signs were in. All in all the hospital provided a lot of information in several different languages.

One of the many posters around the hospital with messages in several different languages and interpreter services

We gained a lot from the tour of RMH and it would be worth noting a with a few key points that in the case of RMH need to be kept in mind when planning for both refurbishment and constructing new facilities:

  • Always plan for the future, not for what you providing currently. This means including future proofing in design.
  • You need evidence base design to work with spatial constraints to gain the best outcomes.
  • The use of colour and green spaces are very important.
  • Line of site from nursing stations needs better incorporation with the design of inpatient units.
  • Incorporating a wide range of languages with all information and clearly mark interpreter services 
  • Adaptable seating arrangements in waiting rooms are very important.
  • The use of people in signs provides a greater message than just words.
  • Volunteers are very valuable and can be used for more than just finding your way around the hospital

HIP Project Officer
Nicholas Wales

1 comment:

Jo Harris said...

Dear Nicholas Thank you for this report I was especially interested as I spent a few days last week visiting relative in Peninsula Health Care specifically Frankston Hospital There Ed is new too. Very well laid out with a large light and airy foyer. Again no glass on the triage desk. A volunteer's desk is situated in the foyer before you get to the triage station.

Each patient bay includes a computer, phone & write up space. It's in an alcove at the entrance to the bay which means staff can see the main ED station and can conduct conversations outside patient's hearing when necessary. Interestingly the main overhead lights in the bays are a problem. They interfere with some of the measuring devices.

The wards I visited are also new. They have solved the write up space problem very innovatively. Each nurse has her own small trolley which has a built in computer, keyboard, heart rate monitor etc. Vital signs are recorded in real time at the bedside. Jo Bothroyd