PROVISION OF EMERGENCY DEPARTMENT SERVICES FOR CHILDREN ON THE
NORTH SIDE OF THE BRISBANE RIVER – AN EXPERT COMMENTARY
There has been much controversy recently about the construction of a single children’s
hospital at the Mater site at South Brisbane and the proposed closure in 2014 of Royal
Children’s Hospital at the Herston site on the north side of the Brisbane River. The provision
of emergency department services to children on the north side of the Brisbane River has
become a central part of the health debate in the run up to the March 21 election. Despite
being the most senior children’s emergency physician in Queensland my advice has been
ignored in the decision making, nor has the advice of the Australasian College for Emergency
Medicine or the relevant Emergency Department Network been sought. The important
recommendations of the Foster Commission of enquiry appear to have become a distant
memory. I therefore wish to outline for the community on the north side of the Brisbane
River the factual information which should have underpinned political decisions on this issue,
and based upon this provide expert comment on the respective policy proposals of the 2 major
political parties.
The Emergency Department of Royal Children’s Hospital is an award winning ED. Last year
it received the 2008 award for Emergency Department of the Year from the College of
Emergency Nursing Australasia. This is the first time this award has been given to a
Queensland Emergency Department, and the first time any paediatric Emergency Department
in Australia has ever received the award. Its Director and Nurse Unit Manager were jointly
awarded the 2008 Vitae Lampada medal for excellence in Medical and Health Education.
So what does it take to run a very high quality children’s emergency department? In fact
there are three essential requirements. Firstly it takes high quality fully trained paediatric
emergency physicians to staff the Emergency Department, to directly supervise clinical care
and to underwrite very high standards. Secondly it takes high quality and very experienced
paediatric emergency nursing staff to work with the children’s emergency physicians to assist
in the delivery of patient care. Thirdly it takes the full infrastructure of a specialist children’s
hospital to support the clinical staff working in the Emergency Department.
A children’s emergency department located at Prince Charles Hospital campus could never
deliver the standard of care which is currently being delivered by Royal Children’s Hospital
ED, because none of these three basic requirements for delivering such care could be put into
place. The reasons are as follows.
One of the first principles of trauma care is that seriously injured patients must whenever
possible go directly to the hospital which will provide definitive care. Thus if there was a
single children’s hospital in Brisbane, then all seriously injured children would have to be
taken to it directly, and all other hospitals would be on trauma bypass for children.
Additionally it would be essential for all subspecialty and other complex paediatric patients to
present directly to the single children’s hospital, because the subspecialty expertise required
to manage their problems would be based at the single children’s hospital on the South
Brisbane campus. For these reasons expert children’s emergency medical and nursing staff
would insist on working at the single children’s hospital, so that the high level knowledge and
skill base that they possess would be put to regular use. An ED which does not see major
paediatric trauma and complex subspecialty patients would not present sufficient challenge
for them, and they would never be attracted to work in what could only be termed a dumbed
down paediatric general clinic. Additionally a Paediatric Emergency Department at Prince
Charles Hospital would not have paediatric radiologists, paediatric neurosurgeons, paediatric
orthopaedic surgeons, paediatric plastic surgeons etc to support it, nor would paediatric
medical subspecialists like respiratory physicians, gastroenterologists, metabolic physicians
etc be available for on site support. These personnel would only be available at the single
children’s hospital site on the Mater campus.
The optimal solution for emergency care of children on the north side of the Brisbane River is
for the Royal Children’s Hospital Emergency Department to continue providing its expert
paediatric emergency services, and for the existing Mixed ED at Prince Charles Hospital to
have a physically discrete area for children within their department so that children who do
present there are managed under improved conditions.
The proposal by the Queensland Labour Party to close Royal Children’s Hospital and its
award winning Emergency Department has been very poorly thought through, and would be
utterly destructive for the provision of expert emergency services for children on the north
side of the Brisbane River. The proposal to substitute RCH ED with an equivalent standard
paediatric emergency service at Prince Charles Hospital campus is functionally undeliverable,
and reveals a complete lack of insight into what is required to run a very high quality
Paediatric Emergency Department.
The proposal by the Liberal National Party to preserve Royal Children’s Hospital and its
Emergency Department is the only sensible option available to provide high quality children’s
emergency services on the north side of the Brisbane River. The LNP proposal can be easily
complimented by providing a dedicated paediatric area within the existing Mixed ED at
Prince Charles Hospital. However the LNP proposal to build a paediatric primary care centre
adjacent to Royal Children’s Hospital is unnecessary, and would seriously struggle to attract
staff to work in it given there is a serious shortage of General Practitioners. Furthermore
General Practitioners see no need for such a facility, and believe that primary care is best
provided within their current general practices.
In short the Bligh Labour Party proposal will result in a serious reduction in the standard of
emergency care which would be available for children on the north side of the Brisbane
River, while the Springborg LNP proposal will preserve the existing very high standards of
care. The LNP proposal does however require some fine tuning.
Dr Ronald C Clark
Department of Emergency Medicine
Royal Children’s Hospital