TranslateSurgical services
Overview
Surgical services include a broad range of disciplines. These services focus on the surgical management of acute and chronic conditions.
Delineating service system roles
The capability of each service level is based on:
- Clinical capability required to diagnose, treat and manage the condition.
- Availability of, and access to, clinical support services to support delivery of care.
Service requirements
Surgical services are mainly provided in inpatient settings. Models of care for delivery of surgical services described in the RDF are determined by individual health services.
This framework
The following surgical services are included in this section of the RDF:
Services
General surgery includes emergency and elective surgery with varying levels of surgical complexity. Definitions for levels of complexity are described below. The levels of surgical complexity indicate the requisite levels of clinical support services required in general surgery and are especially important in determining the appropriate levels of anaesthetic, perioperative and ICU services.
Level I surgical complexity (SCI):
- is an ambulatory / office procedure
- requires local anaesthetic but not sedation
- requires a procedure room, aseptic technique but not an operating theatre
- requires access to resuscitation equipment.
Level II surgical complexity (SCII):
- is usually an ambulatory, day stay or emergency department procedure
- does not require general anaesthesia but may require local anaesthetic +/- sedation
- requires at least one operating or procedure room and separate recovery area.
Level III surgical complexity (SCIII):
- usually requires general anaesthesia or equivalent
- requires at least one operating room and a separate recovery room
- is usually an ambulatory or day stay procedure
- may have access to close observation care.
Level IV surgical complexity (SCIV):
- involves major surgical procedures with low to medium anaesthetic risk
- usually requires general anaesthesia
- has access (not necessarily on-site) to intensive care services
- has the capacity to provide emergency procedures.
Level V surgical complexity (SCV):
- major surgical procedures with high anaesthetic risk
- surgery and anaesthesia with the highest potential for intra- and post-operative complications
- provides specialist clinical staff, equipment and infrastructure
- on-site intensive care services - extensive support services available.
Burns services deliver positive outcomes for patients experiencing burn injury in Tasmania through best practice, and evidence based quality care. Burns Services have strong links across primary, public and private health facilities, providing both support and development to allow patients to be treated in their communities, where appropriate.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
n/a |
n/a |
n/a |
| 2 |
A Level 2 service has the capacity to manage minor burns not requiring surgical intervention and that do not meet the criteria for transfer under the Tasmanian Burns Service Referral and Transfer Guidelines. All other burns are stabilized and referred as per the Tasmanian Burns Transfer and referral guidelines Access to burns specific health education. |
Formal network linkages with Level 4 and 6 Burns Service for consultation and advice. Formal referral protocols established with higher level burns services.
Access to virtual care from a higher level service including digital images and clinical information electronically. Access allied health services. |
Registered medical practitioner. General Surgeon available for consultation. Paediatrician available for consultation. Access to allied health services in the network including physiotherapy, occupational therapy, speech pathology, orthotics & prosthetics, dietetics, social work. On-site RNs who have undertaken burns specific education. Access to higher level specialist burn services for follow-up and consultation for post acute intervention. |
| 3 |
As for Level 2 plus: Provides immediate surgical management of burns if required and/or stabilization prior to transfer as per the Tasmanian Burns service Transfer and referral guidelines. May admit patients for pain management. |
As for Level 2 plus: Access to Level 4 or above rehabilitation services, scar management service and consultation liaison psychiatry. Access to acute pain management service. Access to Allied Health services. |
As for Level 2 plus: General Surgeon (>3 years postgraduate) with experience on-site and on-call 24 hours. On-site access to occupational therapy and/or physiotherapy, speech pathology, dietetics, orthotics & prosthetics. |
| 4 |
As for Level 3 plus treats burns:
A Level 4 service also provides surgical management for burns that do not meet criteria for transfer under the Tasmanian Burns Service Transfer and Referral Guidelines. Provide ambulatory burns clinic for minor injuries. |
As for Level 3 plus: On-site Plastic Surgery Unit. Operating theatre available 24/7. Access to skin substitutes. Ambulatory Plastic Surgery clinic. On-site Level 4 or above emergency department and anaesthetics. Access to Level 4 or above paediatrics service. Service provides ongoing management of burns patients after discharge from higher level service through Plastic Ambulatory clinics. Access to on-site scar management services including occupational therapy and/or physiotherapy. |
As for Level 3 plus: Plastic surgeon available and on call 24 hrs. 24 hour access to adult Intensive care. Surgical Registrar on site 24hrs. Access to additional allied health including psychology. Allied health and nursing have access to telehealth / virtual consults from Level 5/6 tertiary centres. Access to on-call and after-hours allied health services including physiotherapy and social work. |
| 5 |
n/a |
n/a |
n/a |
| 6 |
As for Level 4 plus: Provides comprehensive service and treatment for burns in accordance with the agreed Tasmania Burns Transfer and Referral Guidelines. Interstate transfer may be required for:
Level 6 service coordinates all interstate transfers including back transfers. Provides a comprehensive multidisciplinary burns team for Paediatric and adult patients. Ambulatory burns clinic for referrals from lower level services including wound management and access to telehealth. Provide Burn Reconstructive surgery statewide and long term follow up for burn survivors. Provides statewide burns specific health promotion and burns education to community and clinicians. Service contributes to Burns Registry of Australia and New Zealand (BRANZ) and Co-ordinate’s data entry for BRANZ. Attends and participates in Australian and New Zealand Burns association (ANZBA) as the Tasmanian Burns Unit. Actively participates in Burns Disaster management, preparedness and prevention as part of the AUSBURNSPLAN. |
As for Level 4 plus: Dedicated inpatient beds for the management of patients with burns. On-site paediatric and adult ICU and anaesthetics. Coordinated statewide service including case-management by Burns CNC or Burns Nurse practitioner. Access to sub-specialty services including plastic surgery, general paediatrics, palliative care, ENT and ophthalmology services. Access to Rehabilitation services for inpatients and outpatients. Access to drug and alcohol services and psychiatry including child and family psychiatry service. Access to acute pain and persistent pain services. Provides ambulatory burns clinics for referrals from lower level services, including wound management, clinical support and professional development. On-site specialised multidisciplinary allied health team including occupational therapy, physiotherapy, social work, psychology, dietetics, speech pathology. |
As for Level 4 plus: Clinical Director Burns with relevant burns clinical experience. Plastics Consultant available 24 hours. CNC and/or Nurse Practitioner Burns. Nephrologist and Emergency Medicine Consultants on-call 24 hours. ENT and ophthalmology consultant on-call 24 hours. 24 hour access to paediatric and adult ICU and anaesthetics consultants. Specialist burns nursing staff on-site 24 hours (Emergency Management of Severe Burns (EMSB)) accredited. On-site access to allied health with skills and experience in burns for adults and paediatrics including dietetics, occupational therapy, physiotherapy, speech pathology, orthotics and prosthetics, play therapist/specialist, psychology and social work. Resource allocated to data collection and upload to BRANZ Including Burns data manager and Burns Data coordinator. |
Cardiothoracic surgery is the field of medicine related to the surgical treatment of diseases of the chest, particularly surgery of the heart and lungs. Services can range from emergency and trauma care to elective surgery for chronic heart, lung and chest conditions.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
n/a |
n/a |
n/a |
| 2 |
n/a |
n/a |
n/a |
| 3 |
n/a |
n/a |
n/a |
| 4 |
n/a |
n/a |
n/a |
| 5 |
A Level 5 Service provides low complexity, low risk non-acute cardiothoracic diagnosis and treatment services. Service scope may include thoracic surgical procedures. |
Access to ICU/CCU. Cardio-thoracic pre-admission services. Multi-disciplinary cardiac rehabilitation services on-site. |
Visiting cardiothoracic surgeon. On-site allied health professionals including physiotherapy, dietetics, psychology, occupational therapy and social work. Access to allied health assistants. |
| 6 |
A Level 6 service provides services at Level 5 plus the service is able to deal with high complex diagnosis and treatment in association with other specialties. It has a statewide referral role, research role and undergraduate and post graduate teaching role. Level 6 Cardiothoracic Services in Tasmania do not provide heart and lung transplantation services or paediatric cardiac surgical services. They do not provide tracheal stenting or surgical procedures, lung volume reduction surgeries and ventricular assist devices. |
As for Level 5 plus: Statewide referral role and pathways established to refer patients for elective and urgent cardiothoracic surgical procedures, including MDT processes between south and north of the state. Elective and emergency thoracic and cardiothoracic procedures by on-site cardiothoracic surgeons. Able to deal with highly complex diagnosis and treatment in association with other specialties. Ability to provide intra-aortic balloon pump and extra corporeal membrane oxygenation [ECMO] facility by having perfusion and support services available 24 hours. Radiation oncology and medical oncology, respiratory medicine, cardiology, palliative care and persistent pain services available on-site. |
As for Level 5 plus: At least 3 fully trained cardiac surgeons accredited by the RACS available 24 hours. Cardiothoracic registrar/Fellow available 24 hours. Cardiac anaesthetists - one FTE for every 100 cases treated. At least 3 cardiac medical and/or clinically accredited perfusionists. At least 3 Registrars/Fellows/Trainees with additional resident medical staff including interns. ICU specialists on-site. They should be supported by registrars or junior staff (year 3 or above in training) 24 hours for ICU management. Appropriately qualified and experienced nursing staff in operating theatres, intensive care units, wards and in rehabilitation services along with dedicated nurse managers. CNC/NP providing leadership within a collaborative model of interdisciplinary care. Physiotherapists and allied health services, and cardiac rehabilitation services. Extended hours access to consultants in subspecialty medicine and surgery including cardiology, haematology / oncology, general surgery, respiratory medicine, infectious diseases, nephrology with dialysis facility, neurologists, radiologists including interventional radiologists and vascular surgery. On-call rosters for echocardiographers, radiographers, pacemaker technician, biomedical engineers. Appropriately qualified and experienced liaison nurse with a statewide co-ordination role. |
Ear, Nose and Throat (ENT) surgical services treat diseases, injuries or deformations of the ears, nose, throat, head and neck areas. ENT surgical services encompass a broad range of complexity from uncomplicated day procedures and elective surgery to highly complex cases including intracranial procedures. ENT surgical services care for adult and paediatric patients of all age groups.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
n/a |
n/a |
n/a |
| 2 |
n/a |
n/a |
n/a |
| 3 |
A Level 3 service provides ENT surgery for low risk adult and / or paediatric patients undergoing SCI to SCIII procedures (refer to General Surgical Services framework). Surgery is performed by visiting ENT surgeon. |
At least one operating / procedure room with separate recovery area/room for post-operative care. Where paediatric patients are treated service requires appropriate paediatric operating theatre and inpatient infrastructure and equipment. Medical, anaesthetic and nursing pre-admission services specific to care needs of adult and / or paediatric patients depending on service scope. Arrangements in place for unplanned overnight admission of day cases where indicated. |
Visiting ENT surgeon. Registered medical practitioner credentialed to administer anaesthetic (requires paediatric credentials where paediatric patients are treated). RNs with appropriate post graduate qualifications and/or experience in post-operative nursing; RNs may be supported by ENs / SENs in providing care to inpatients. 24 hour access to a registered medical practitioner (on-site or on-call) for provision of medical care for urgent re-presentation of patients after discharge. Access to clinical pharmacist. Access to specialist paediatricians for care of paediatric patients. |
| 4 |
A Level 4 service provides services at Level 3 plus surgery for low to moderate risk patients undergoing SCI to SCIII ENT procedures (refer to General Surgical Services framework). Surgery is performed by specialist ENT surgeons. No neuro-optic or intracranial surgery is performed. |
As for Level 3 plus: Designated acute surgical inpatient unit with RNs/ENs/SENs with appropriate post graduate qualifications and/or experience in peri-operative and post-operative nursing. |
As for Level 3 plus: Access to diagnostic audiology services for children and adults. Surgical registrar on-site and on-call 24 hours. Consultant anaesthetist on-site and on-call 24 hours. Anaesthetics registrar on-call 24 hours. Access to speech pathology services. |
| 5 |
A Level 5 service provides services at Level 4 plus surgery is performed on low to high anaesthetic risk patients undergoing SC IV and SCV ENT procedures (refer to General Surgical Services framework). Generally, a combination of procedures with a low to high level of complexity and risk are performed, and management of some patients with comorbidities and risk of intra- and post-operative complications occurs. Surgery is performed by one or more specialist ENT surgeons. |
As for Level 4 plus: On-site ICU. On-site paediatric ICU where high risk paediatric patients are treated. Inpatient paediatric ward area where paediatric patients are treated. On-site plastic surgery service. On-site medical oncology, radiation oncology and palliative care services. May provide specialty ENT surgical training. Onsite audiometry service. |
As for Level 4 plus: ENT surgeon available extended hours. Surgical RNs with specialist ENT expertise. On-site plastic surgery, medical oncology, radiation oncology and palliative care specialists. Onsite paediatricians. Clinical pharmacist (specialist surgical). Audiology, speech pathology, dietetics, occupational therapy and physiotherapy available on-site. Extended hours access to physiotherapy and social work. Access to paediatrician and anaesthetist and intensivist credentialed for the care of paediatric patients.
|
| 6 |
A Level 6 service provides all services at Level 5 plus the service has the ability to deal with a full range of complex cases in association with other specialists including neuro-optic and intracranial procedures. |
As for Level 5 plus: On-site neurosurgical services. |
As for Level 5 plus: Neurosurgeon available 24 hours. |
Hyperbaric and diving medicine is a specialised area of clinical practice involving the diagnosis and management of dysbaric (diving) illness of all levels of severity, and the utilization of Hyperbaric Oxygen Therapy for patients with medical (non-diving) conditions that respond to elevated partial pressures of oxygen, including arterial gas embolism, gangrene and necrotizing infections, complex problem wounds, radiation injury and necrosis, acute ischaemic conditions and trauma.
Hyperbaric oxygen treatment is administered in a pressurised hyperbaric chamber capable of delivering 100% oxygen at 2.8 atmospheres absolute pressure for medical cases and up to 6 atmospheres absolute for divers. Hyperbaric chambers are major pieces of capital infrastructure and require highly specialised skillsets (medical, nursing and technical) to operate. There is only one medical hyperbaric chamber in Tasmania, located at the Royal Hobart Hospital. As a single-site service it must be able to provide the highest level of service at all times (Level 6), and provide 24/7 outreach and consultative services to all other areas of the State.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
n/a |
n/a |
n/a |
| 2 |
n/a |
n/a |
n/a |
| 3 |
n/a |
n/a |
n/a |
| 4 |
n/a |
n/a |
n/a |
| 5 |
n/a |
n/a |
n/a |
| 6 |
This service has critical care capability and manages the highest level of patient acuity and complexity with an extensive range of comorbidities. The service provides emergency recompression treatment for all divers (up to 6 atmospheres absolute pressure) and acute hyperbaric oxygen treatment to medical and surgical patients of all illness severity. This service also provides a tertiary wound care service in association with medical hyperbaric treatment of hypoxic complex wounds, trauma and radiation injury. To be defined as a comprehensive hyperbaric facility the service needs to be capable of providing hyperbaric oxygen therapy at a treatment pressure of at least 2.8 atmospheric pressure absolute (180 kilopascal gauge pressure), and capable of managing critical care patients with mechanical ventilation and invasive monitoring. The precise definition of a comprehensive hyperbaric facility is governed by Commonwealth Department of Health Medicare regulations. |
State-wide referral and network role – providing at least quarterly outreach clinics to the North and North-West, and 24/7 telephone support to all areas of the State. Linkage to Level 6 integrated retrieval service with direct rotary-wing access for time critical cases. Hyperbaric facility with full critical care capability delivering hyperbaric oxygen treatment to ventilated patients with or without circulatory and inotropic support, in support of other specialties managing patients with multisystem disease, or specialties such as cardiac surgery where specific complications require emergency hyperbaric treatment. On-site Level 6 Emergency Department with resuscitation and monitoring facilities available. On-site Level 6 critical care support. Hyperbaric medical specialist and registrar cover, 24 hours per day for emergencies. RNs with appropriate post graduate qualifications and/or extensive experience in hyperbaric medicine, 24 hours per day for emergencies. Hyperbaric technician cover, 24 hours per day for emergencies. Broad range of surgical sub-specialties on-site and available at close proximity 24 hours. Capability of treatment of divers with serious neurological injury, unconscious and those requiring critical care or ventilation. Capability of procedural interventions such as intubation and ventilation, invasive monitoring, and thoracostomy tubes. Provides specialist advice and diving medicine support for Tasmania's diving industry, and to relevant Federal agencies operating out of or around Tasmania (e.g. Australian Antarctic Division, Australian Defence Force). Provides specialist technical support to the Coroner in forensic investigation of diving accidents. Provides specialist and complex wound management. Accredited for post-graduate specialist registrar training and post-graduate nurse training. Provides education, research and quality improvement activities and opportunities at a level appropriate for a State-wide tertiary referral centre in accordance with national recommendations and College/Society guidelines. |
Full-time Medical Director with postgraduate qualifications in Diving and Hyperbaric Medicine. Hyperbaric specialists with postgraduate qualifications in Diving and Hyperbaric Medicine, plus Acute Care specialty training (Anaesthesia, Emergency Medicine, Intensive Care, etc) adequate to provide full-time in-hours cover for both the chamber and hyperbaric clinics at RHH, plus outreach services to LGH and NWRH, and State-wide on-call support 24 hours. Director of clinical training for supervision of registrar training in-hours. Registrar on-call 24 Hours. Specialist RNs with appropriate post-graduate qualifications and/or extensive experience in critical care and wound care on-call 24 hours (Minimum 30% of nursing staff with critical care post graduate qualifications). Full time specialist technical staff with hospital-based Hyperbaric technical training, including advanced commercial and/or Navy diving experience on-call 24 hours. Full-time administrative support on site in-hours. Access to allied health services including podiatry, dietetics, occupational therapy, physiotherapy for post hyperbaric intervention follow-up. |
Neurosurgery is the surgical specialty that deals with the diagnosis and treatment of disorders which affect any portion of the nervous system, including the brain, spinal cord, peripheral nerves and extracranial cerebrovascular system.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
n/a |
n/a |
n/a |
| 2 |
n/a |
n/a |
n/a |
| 3 |
n/a |
n/a |
n/a |
| 4 |
n/a |
n/a |
n/a |
| 5 |
A Level 5 services provides elective uncomplicated minor neurosurgical services and delivers care for patients upon back transfer from a Level 6 service. Urgent procedures may be performed only after discussion with a Level 6 Neurosurgery Service. A consultant neurosurgeon participates in the credentialing and scope of practice decisions regarding neurosurgery. |
Network access to Level 6 Neurosurgery Service 24 hours. Outpatient clinics by a visiting neurosurgeon. Multidisciplinary spinal assessment clinic. Onsite persistent pain service. Link with a Level 4 Rehabilitation Services. Elective services may include spinal and peripheral nerve surgery. A Level 5 service does not perform elective cranial procedures. |
Surgeons whose scope of practice includes minor neurosurgical procedures. RNs with appropriate post graduate qualifications and/or experience in neurosurgical nursing. Allied health professionals with skills in neurosurgery including speech pathology, occupational therapy, dietetics, neuropsychology, psychology, physiotherapy, orthotics and prosthetics, and social work. Extended hours access to physiotherapy and social work. Clinical pharmacist (specialist surgical). Allied health assistants. |
| 6 |
A Level 6 service is a specialist neurosurgical service that has the capability to deal with all elective and emergency neurosurgical cases. A Level 6 service is responsible for coordinating all neurosurgical interstate transfers. |
As for Level 5 plus: Provides statewide advice on all neurosurgical interstate transfers. On-site neuro-interventional radiology. Designated neurosurgical ward. Designated neurosurgical ICU / HDU. One or more dedicated neurosurgical theatres. Link with Level 5 Rehabilitation Service. Neurosurgical training program. On-site access to medical sub-specialties including infectious disease and neurology. |
As for Level 5 plus: Neurosurgical consultant on-site and on-call 24 hours. Neurosurgical registrar on-site and on-call 24 hours. |
Ophthalmology deals with diseases of the eye. Ophthalmology surgical services are delivered by medical practitioners who are specialists in the surgical care of the eyes and visual system and in the prevention of eye diseases and injury across all age groups.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
n/a |
n/a |
n/a |
| 2 |
n/a |
n/a |
n/a |
| 3 |
n/a |
n/a |
n/a |
| 4 |
A Level 4 service provides common diagnostic, assessment, testing and treatment of ophthalmological procedures for low and moderate risk patients. These services would normally be performed in an ambulatory setting by ophthalmic surgeons. |
Appropriately equipped treatment rooms. |
Consultant ophthalmologist. Accredited registered medical practitioner in anaesthetics. RNs with appropriate post graduate qualifications and/or experience in ophthalmology. Access to orthoptists. |
| 5 |
As at Level 4 plus: Provides diagnostic services and surgery on low, moderate and high-risk patients, procedures. |
As for Level 4 plus: Accredited ophthalmology medical training. |
As for Level 4 plus: 24 hour access to on-call ophthalmologist. Ophthalmology registrar. Anaesthetists on-call 24 hours. RNs with appropriate post graduate qualifications and/or experience in perioperative and postoperative nursing. Access to orthoptists and occupational therapists. |
| 6 |
As for Level 5 plus: Manages complex major diagnostic and treatment procedures in association with other specialties. |
As for Level 5 plus: Ability to accept referrals for complex cases from lower level services. |
As for Level 5. |
Oral health and maxillofacial surgery services treat diseases, injuries or deformations of the head, neck, mouth, jaw or face. Oral and maxillofacial surgical services encompass a broad range of complexity from uncomplicated day procedures and elective surgery in paediatric and adult patients to highly complex cases including head and neck cancers in adults. Highly complex paediatric patients are referred to interstate services.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
n/a |
n/a |
n/a |
| 2 |
A Level 2 service provides ambulatory general oral health care. Service scope includes consultation and simple treatment. |
Fixed (stand-alone or part of another facility) or mobile dental clinic infrastructure. Minimum of one dental chair. Access to dental x-ray services. |
One or more dental practitioners (dentist, oral health therapist, and / or hygienist). |
| 3 |
As for Level 2 plus: Provides oral surgery for low risk patients undergoing minor complexity procedures. |
As for Level 2 plus: Dental suite with two or more dental chairs. Access to inhalational sedation (nitrous oxide). Access to cone beam computed tomography and orthopantomogram (OPG). Medical, anaesthetic and nursing pre-admission services specific to care needs of adult and / or paediatric patients depending on service scope. |
Dentist. Access to oral health therapist and hygienist. |
| 4 |
As for Level 3 plus: Provides specialist oral health services (e.g., orthodontic services, fixed prosthodontics). |
As for Level 3 plus: Access to dental laboratory providing both fixed and removable prosthetics. |
As for Level 3 plus: Dentist with specialised experience or specialist dental practitioner. Dental prosthetist available. Dental technician available. |
| 5 |
As for Level 4 plus: Provides oral and maxillofacial services for low to moderate risk / complexity patients. |
As for Level 4 plus:
On-site plastic surgery, ICU and anaesthesia service. On-site medical oncology, radiation oncology and palliative care services. Designated acute surgical inpatient area. Inpatient paediatric ward area where paediatric patients are treated. Where paediatric patients are treated service requires appropriate paediatric operating theatre and inpatient infrastructure and equipment. |
As for Level 4 plus: Surgeon credentialled to perform oral and maxillofacial services commensurate with service complexity. On-site ENT surgery, plastic surgery, medical oncology, radiation oncology and palliative care specialists. RNs with appropriate qualifications and/or experience; RNs may be supported by ENs / SENs in providing care to patients. Registered medical practitioner credentialed to administer anaesthetic (requires paediatric credentials where paediatric patients are treated). Clinical pharmacist – specialist surgical. On-site speech pathology, dietetics and audiology. CNS Complex Care Coordination. CNC providing cancer navigation and surveillance. Access to specialist paediatricians for care of paediatric patients. |
| 6 |
As for Level 5 plus: Provides oral and maxillofacial surgery on low to high anaesthetic risk patients. Generally, a combination of procedures with low to high level of complexity and risk are performed, and management of some patients with comorbidities and risk of intra- and post-operative complications. |
As for Level 5 plus: Onsite neurosurgery services. |
As for Level 5 plus: Specialist maxillofacial surgeon available extended hours. Neurosurgeon available extended hours. Allied health staff with specialist skills in the assessment and ongoing management of patients with oral and maxillofacial care needs including specialist audiology, speech pathology and social work. Access to paediatrician, and anaesthetist and intensivist credentialed for the care of paediatric patients. |
Orthopaedics is the clinical specialty involving the treatment of diseases and abnormalities of the musculoskeletal system due to trauma, congenital developmental abnormalities, degenerative or disease processes. Orthopaedic surgical services are provided to paediatric and adult patients.
n/a
n/a
n/a
A Level 2 service provides minor reduction of fractures performed on low-risk patients by a registered medical practitioner or visiting general surgeon with experience in orthopaedics.
Treatment rooms with plaster equipment.
Access to speicialist orthopaedic surgeons in the network.
Registered medical practitioner or general surgeon with credentials in orthopaedics.
Accredited medical practitioner to administer regional or general anaesthesia.
May have access to plaster technician.
Access to advice from specialist orthopaedic specialists.
May have access to allied health outpatient services as required including physiotherapist led musculoskeletal clinic with links to pain management service, podiatry, occupational therapy, orthotics and prosthetics.
As for Level 2 plus:
Provides common and intermediate orthopaedic day procedures on low or moderate risk patients by a visiting orthopaedic or general surgeon credentialed in orthopaedics.
A Level 3 service does not provide overnight inpatient orthopaedic services.
As for Level 2 plus:
At least one operating/procedure room with separate recovery area/room for post-operative care.
General orthopaedic equipment and theatre x-ray.
Where paediatric patients are treated service requires appropriate paediatric operating theatre and inpatient infrastructure and equipment.
Medical, anaesthetic and nursing pre-admission services specific to care needs of adult and / or paediatric patients.
Service provides ongoing ambulatory management of orthopaedic patients after discharge from higher level orthopaedic service.
Arrangements in place for unplanned overnight admission of patients where indicated.
As for Level 2 plus:
Visiting orthopaedic surgeon.
RNs with appropriate qualifications and/or experience; RNs may be supported by ENs / SENs in providing care to patients.
Registered medical practitioner credentialed to administer anaesthetic (requires paediatric credentials where paediatric patients are treated).
Access to specialist paediatricians for care of paediatric patients.
Access to physiotherapy, podiatry, speech pathology, occupational therapy and social work.
Access to plaster technician.
As for Level 3 plus:
Provides common and intermediate elective procedures on low or moderate risk patients and emergency procedures.
Surgery performed by an orthopaedic surgeon.
As for Level 3 plus:
Provides inpatient and outpatient orthopaedics services.
One or more operating theatres with separate recovery room.
Access to Level 4 Rehabilitation Service.
Designated orthopaedic inpatient beds.
Inpatient paediatric ward where paediatric patients are treated.
Accredited orthopaedics surgical training.
Access to individual and group programs for self-management support and persistent pain management.
As for Level 3 plus:
Appointed orthopaedic specialists on-site and on-call 24 hours.
Registered medical practitioner on-site 24 hours.
Infectious diseases physician.
Appointed specialist anaesthetists on-site; and on-call 24 hours.
RNs with appropriate orthopaedic post graduate qualifications and/or experience.
On-site plaster technician services and orthotist and prosthetist.
Clinical pharmacist.
As for Level 4 plus:
Provides a full range of major diagnostic and treatment procedures (elective and emergency) on low, moderate and high risk patients.
Surgery performed by orthopaedic surgeons.
As for Level 4 plus:
On-site ICU.
On-site paediatric ICU where high risk paediatric patients are treated.
As for Level 4 plus:
Orthopaedic surgeons on-site and on-call 24 hours.
Radiologist on-call 24 hours.
Access to paediatrician and anaesthetist and intensivist credentialled for the care of paediatric patients.
Clinical pharmacist – specialist surgical.
CNC Complex Care Coordination.
CNC providing specialised orthopaedic clinical leadership.
Extended hours access to physiotherapy. On-site access to occupational therapy, social work, podiatry, plaster technicians and allied health assistants.
A Level 6 service provides services at Level 5 plus it has the ability to deal with all cases including full range of complex cases in association with vascular, cardiothoracic and neurosurgical specialists.
As for Level 5 plus:
- Link to Level 5 Rehabilitation Service.
As for Level 5.
Plastic and reconstructive surgery refers to the surgical discipline that delivers services to repair, remodel and / or restore body parts in paediatric and adult patients.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
n/a |
n/a |
n/a |
| 2 |
n/a |
n/a |
n/a |
| 3 |
A Level 3 service provides minor plastic and reconstructive surgery outpatients and same day procedures by a visiting plastic surgeon. |
At least one operating / procedure room with separate recovery area/room for post-operative care. Where paediatric patients are treated service requires appropriate paediatric operating theatre and inpatient infrastructure and equipment. Medical, anaesthetic and nursing pre-admission services specific to care needs of adult and / or paediatric patients. Arrangements in place for unplanned overnight admission of patients where indicated. |
Visiting specialist plastic surgeon. Registered medical practitioner credentialed to administer anaesthetic (requires paediatric credentials where paediatric patients are treated). Perioperative trained RNs. 24 hours access to a registered medical practitioner (off-site or on-call). Access to specialist paediatricians for care of paediatric patients. |
| 4 |
As for Level 3 plus: Provides selected procedures on low and moderate risk patients by visiting plastic surgeons. |
As for Level 3 plus: Designated acute surgical inpatient unit. Inpatient paediatric ward area where paediatric patients are treated. Links to Level 5 rehabilitation services. |
As for Level 3 plus: General surgeon on-site and on-call 24 hours; Surgical registrar on-site extended hours. Specialist anaesthetists on-site and on-call 24 hours; Anaesthetics registrar on-site extended hours. Access to allied health services including psychology, occupational therapy, physiotherapy, speech pathology, orthotics and prosthetics. |
| 5 |
As for Level 4 plus: Provides a full range of plastic and reconstructive procedures on low, moderate and high risk patients by specialist plastic surgeons. |
As for Level 4 plus: On-site ICU. Post-operative rehabilitation and comprehensive scar management services. |
As for Level 4 plus: Appointed plastic surgeon on-site; and on-call 24 hours. Plastic surgery registrar. Access to paediatrician and anaesthetist intensivist credentialled in paediatrics where high risk paediatric patients are treated. Clinical pharmacist – specialist surgical. Specialist allied health staff part of multidisciplinary team, including physiotherapy, dietetics, occupational therapy, psychology, orthotics and prosthetics. CNC Complex Care Coordination. CNC providing cancer navigation and surveillance. RNs with appropriate post graduate qualifications and/or post-operative experience in plastics and reconstructive care. |
| 6 |
As for Level 5 plus: Provides all forms of plastic and reconstructive surgery and offers a full range of plastic surgery techniques. |
As for Level 5 plus: Service scope includes cleft and craniofacial techniques. On-site paediatric ICU where high risk paediatric patients are treated. Dedicated plastic surgery inpatient area. |
As for Level 5 plus: Plastic surgery registrar available extended hours. Extended hours access to allied health services. Play therapist/specialist. |
Trauma care provides initial assessment, stabilisation and management of patients presenting with trauma.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
n/a |
n/a |
n/a |
| 2 |
n/a |
n/a |
n/a |
| 3 |
A Level 3 service provides care for minor trauma only, and an initial trauma response including reception, assessment, resuscitation and stabilisation for major trauma and who require emergency transfer to a higher level trauma service in accordance with statewide major trauma bypass procedures. |
Primary response for trauma cases that do not activate statewide major trauma bypass criteria. Stabilisation prior to retrieval by road, fixed wing or rotary wing retrieval service. Helicopter landing site. Initial disaster response in a mass casualty event where it is the nearest emergency health service. May have access to emergency blood stock (e.g. O negative units) if supported by a higher level blood service. Contributes data to state trauma registry. |
Registered medical practitioner with postgraduate training in emergency management in attendance within 30 minutes. On-site RN available 24 hours. |
| 4 |
As for Level 3 plus: Provides primary response for trauma cases that do not activate statewide major trauma bypass criteria) plus service has capability for: Limited emergency surgical resuscitation and bleeding control of exsanguinating major trauma; and Limited local holding for stable major trauma cases for up to 24 hours in ICU. Paediatric and obstetric major trauma may have primary trauma care, and management of immediately life threatening conditions only, prior to transfer to a Level 6 Trauma Service. A Level 4 service is able to receive patients from a Level 3 service where transfer to a Level 5 or 6 Trauma Service is not feasible or not warranted. |
As for Level 3 plus: On-site emergency and surgical management of non-major trauma. Operating suites with 24 hour availability. Prompt assessment, resuscitation and stabilisation of seriously injured patients prior to transfer to higher level trauma service. Trauma reception capability based on trauma team response. Formal transfer arrangements in place with Level 5 and Level 6 trauma services. On-site emergency department with 24 hours. On-site critical care service with limited holding capacity. Emergency blood stocks and limited blood product availability supported by a higher level blood service. Role in management, assessment and treatment of minor trauma in mass casualty disaster response. Hospital trauma committee. Contribute data to the regional trauma registry (Tasmanian Trauma Registry) in collaboration with the Level 6 trauma centre. |
Consultant surgeon (Fellow of the Royal Australasian College of Surgeons (RACS)) available within 30 minutes. Consultant anaesthetist (Fellow of the Australian and New Zealand College of Anaesthetists) available within 30 minutes. Emergency medicine consultants and RNs with experience and/or post graduate qualifications in emergency nursing available 24 hours. Trauma service staffing consistent with RACS Trauma Verification Level III centre including:
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| 5 |
A Level 5 service is responsible for the provision of high-quality care to non-major level trauma, with the capability of stabilising major trauma patients prior to higher trauma level referral and transfer. It can provide definitive care to a limited number of major trauma patients in concert with the regional Level 6 service, where these patients do not activate statewide major trauma bypass criteria. A level 5 service will be able to provide prompt assessment, resuscitation, emergency surgery, and stabilisation of a small number of seriously injured patients, while arranging for their transfer to the responsible Level 6 trauma centre. A Level 5 service is able to receive patients from Level 3 or 4 Trauma Service where transfer to a Level 6 Trauma Service is not feasible or not warranted. |
As for Level 4 plus: On-site surgical specialty and sub-specialty disciplines available 24 hours. Emergency department, operating theatres, adult ICU available 24 hours for trauma. Role in management of major trauma cases up to 72 hours according to State Incident Management directives and longer if directed during mass casualty disaster response mandating whole-of-state response. Access to transfusion service support in the network, including blood bank and specialist haematology. Medical imaging including MRI and limited interventional radiology services. Access to specialist haematology and transfusion medicine service in the network. Hospital trauma committee Contribute data to the regional trauma registry (Tasmanian Trauma Registry) in collaboration with the Level 6 trauma centre. |
As for Level 4 plus: Specialist general, orthopaedic, urology and plastic reconstructive surgeons available on-site and on-call 24 hours. 24 hour availability of consultant specialist anaesthetists in general capacity (Fellows of the Australian and New Zealand College of Anaesthetists), emergency medicine physicians (Fellow of the Australasian College for Emergency Medicine) and critical care medicine physicians (Fellowship of the CICM of Australia and New Zealand). Appointed medical head of trauma. RNs with appropriate post graduate qualifications and/or extensive experience across Trauma services such as Emergency Medicine and Intensive Care Services. 24 hour availability of general surgery registrar, anaesthetic registrar, emergency department registrar, and ICU registrar. All surgical, anaesthetic, ICU and emergency department consultants on-call 24 hours. Critical care medicine specialist (Fellow of the CICM of Australia and New Zealand) available 24 hours. |
| 6 |
A Level 6 trauma service is synonymous with the Royal Australian College of Surgeons Trauma Verification Model resource criteria for a Level 1 Trauma Centre. A Level 6 service is a Level 1 Trauma Centre that provides a full spectrum of care for the most critically injured patients, from initial reception and resuscitation through to discharge and rehabilitation. It is the principal hospital for all major trauma cases across the state, including capacity to receive of inter-hospital transfer of major trauma patients from all other levels of care. A Level 6 service will have significant case volumes to sustain clinical excellence, be a consultant led 24/7 service and have direct responsibility for admitted major trauma patients. Service scope includes:
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As for Level 5 plus: On-site elective and emergency surgery and perioperative care for statewide surgical services: neurosurgery, cardiothoracic, vascular, oral and maxillofacial surgery and paediatric surgery. On-site statewide services for neonatal and paediatric intensive care, and high risk obstetrics. Interventional radiology services capable of intravascular intervention. State trauma outreach responsibilities, both in terms of consultation and advice, to support pre-hospital responses, transport and intra-hospital retrieval in concert with Ambulance Tasmania and the Aeromedial Retrieval Service. Maintain an up-to-date mass casualty and disaster plan. Lead regular tests of the components of the mass casualty and disaster plan. Maintain the ability to raise a Medical Assistance Team for in support of the management of a mass casualty at short notice. Support coordination of interstate transfers in collaboration with the Statewide Retrieval Coordinator (AMR). Trauma education: statewide trauma grand rounds, support to Emergency Management of Severe Trauma Course, support to multidisciplinary trauma team training. Hospital trauma committee. Maintain regional trauma registry (Tasmanian Trauma Registry). Regular reporting of major trauma outcomes. Lead trauma research program for Tasmania in conjunction with external academic institutions. Establish pathways for timely transfer of patients to interstate major trauma centres for provision of subspecialty trauma interventions including but not limited to major pelvic surgery, certain major burns surgery and spinal rehabilitation. Participate in primary injury prevention advocacy efforts (such as through government submissions, participation in injury prevention committees or through the media). |
As for Level 5 plus: Trauma Service staffing consistent with RACS Level I Trauma Verification critieria, including:
24 hour availability of all senior consultant level surgical disciplines. 24 hour availability of senior consultant specialist anaesthetists with both general and subspecialty capacity (Fellows of the Australian and New Zealand College of Anaesthetists), emergency medicine physicians (Fellow of the Australasian College for Emergency Medicine) and critical care medicine physicians(Fellowship of the CICM of Australia and New Zealand). 24 hour availability of neonatologists, paediatric intensive care specialists, and obstetricians. On-site specialist haematologist and transfusion medicine scientists. |
Urology deals with the diagnosis and treatment of diseases of both the male and female urinary tract as well as the male reproductive tract. Depending on the role level of surgical service provided, service components may range from day stay surgery and basic endoscopic procedures to complex elective and acute procedures.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
n/a |
n/a |
n/a |
| 2 |
n/a |
n/a |
n/a |
| 3 |
n/a |
n/a |
n/a |
| 4 |
A Level 4 service provides common and intermediate day procedures on low risk patients performed by a visiting urologist or general surgeon credentialed in urology. |
At least one operating / procedure room with separate recovery area/room for post-operative care. Pre-admission services. Access to continence service including specialist continence nursing and physiotherapy. Arrangements in place for unplanned overnight admission of patients where indicated. |
Visiting urologist or general surgeon credentialed in urology. RNs with appropriate qualifications and/or experience; RNs may be supported by ENs / SENs in providing care to patients. Access to comprehensive continence service including specialist continence nursing and physiotherapy. Access to physiotherapist with pelvic health training. Access to dietitian. |
| 5 |
As for Level 4 plus: Urology services provided by specialist urologist across low to high complexity procedures. |
As for Level 4 plus: Designated acute surgical inpatient unit with appropriately trained surgical specialist nursing staff. Access to medical oncology, radiation oncology and palliative care services. On-site continence services. |
As for Level 4 plus: Visiting urologist. On-site general surgeon on-call 24 hours. Surgical registrar on-site and call 24 hours. Specialist anaesthetists on-site; and on-call 24 hours. Anaesthetics registrar on-site and on-call 24 hours. RNs with appropriate post graduate qualifications and/or experience in urology. Clinical pharmacist – specialist surgical. CNS care coordination. Access to CNC specialising in urology. |
| 6 |
A Level 6 service has the ability to deal with a full range of complex cases on low, moderate and high risk patients performed by an appointed urologist in association with other specialists. |
As for Level 5 plus: Accredited urology surgical training program. |
As for Level 5 plus: Urology consultant on-site; and on-call 24 hours. Urology registrars on-site; and on-call 24 hours. CNC specialising in urology and providing leadership within the service. |
Vascular surgery is a specialty of surgery in which diseases of the venous, lymphatic, and arterial systems are diagnosed and managed. Depending on the level of service provided, vascular surgical services may include medical, minimally invasive endovascular and open surgical procedures.
Appropriate levels of infrastructure and clinical support service provision are important in vascular surgical services, especially anaesthetics, perioperative, intensive care, imaging, renal medicine, endocrinology and pharmacy services.
| Level | Service Description | Service Requirements | Workforce Requirements |
|---|---|---|---|
| 1 |
n/a |
n/a |
n/a |
| 2 |
n/a |
n/a |
n/a |
| 3 |
A Level 3 service provides routine day case vascular surgery for low risk patients requiring low complexity surgery. A Level 3 service can receive patients transferred from Level 4 or higher vascular surgery services. |
At least one operating / procedure room with separate recovery area/room for post-operative care. Pre-admission services. Appropriate vascular surgical and anaesthetic equipment available on-site. \Arrangements in place for unplanned overnight admission of patients where indicated. Formal consultative links with specialist vascular surgeons 24 hours. |
General surgeons credentialed to perform low complexity vascular surgical procedures with scope of practice determined by the relevant credentialing committee with advice where deemed necessary from a specialist vascular surgeon. RNs with appropriate post graduate qualifications and/or experience; RNs may be supported by ENs / SENs in providing care. May have visiting vascular surgeons. Access to allied health services including podiatry. Access to allied health professionals with skills and/or experience in lymphoedema management including physiotherapy and occupational therapy. |
| 4 |
As for Level 3 plus: Provides minor and moderately complex vascular procedures. Surgery performed by appropriately credentialed general surgeons or by visiting vascular surgeons. Emergency vascular surgical services may be provided within the scope of practice for on-site surgeons. |
As for Level 3 plus: Service capability may include routine vascular procedures, management of low complexity vascular trauma, surgical management of non-complex diabetic foot. Elective renal access surgery performed by visiting vascular surgeons. Infrastructure includes hybrid operating theatre or appropriately equipped and staffed angiography suite. Formal consultative links with specialist vascular surgeons 24 hours. Ability to receive back from a Level 5 or 6 Vascular Service. Specialist inpatient and outpatient consultations by visiting vascular surgeons. On-site high dependency or intensive care services available to stabilise vascular surgical patients with emergency vascular surgical needs prior to their transfer to a higher level vascular service. |
As for Level 3 plus: General surgeons credentialed to perform vascular surgical procedures with scope of practice determined by the relevant credentialing committee with advice where deemed necessary from a specialist vascular surgeon. General surgeon on-site and on-call 24 hours. Specialist vascular sonographers. Anaesthetists with appropriate vascular surgical anaesthetic experience and/or qualifications as determined by the credentialing process. RNs with post graduate qualifications and/or experience in vascular nursing. On-site allied health including dietetics, podiatry, social work, speech therapy, physiotherapy and occupational therapy. On-site access to allied health assistants. Access to 7 days week allied health services including physiotherapy. On-site allied health professionals with skills and/or experience in lymphoedema management including physiotherapy, occupational therapy. |
| 5 |
As for Level 4 plus: Performs minor, moderate and major complexity elective vascular surgical procedures on low, moderate and high risk patients by vascular surgeons credentialed to perform vascular and endovascular surgical procedures. Emergency procedures are performed by vascular surgeons. |
As for Level 4 plus Operating theatres and equipment to perform complicated open vascular surgery and complex endovascular procedures, including equipped and staffed angiography suite. Statewide provision of emergency vascular surgery services. Outreach elective renal access surgery performed at lower level vascular sites in the network. Management of complex vascular trauma. Surgical management of complex diabetic foot. Access to Level 5 Rehabilitation Service. Multidisciplinary meeting with associated specialties including medical imaging, renal medicine, stroke medicine. On-site specialist endocrinology, renal medicine, cardiology and persistent pain services. |
As for Level 4 plus: Appointed vascular surgeons on-site; and on-call 24 hours. Accredited vascular surgery trainee. Specialist vascular sonographers. RNs with appropriate postgraduate qualifications and/or perioperative experience in vascular surgery. Specialist vascular surgery nurses in the operating theatres and outpatient clinics. Clinical pharmacist – specialist surgical. On-site, diabetes educator. Extended hours access to allied health services including physiotherapy, occupational therapy and social work. Allied health assistants. |
| 6 |
As for Level 5 plus: Provides vascular surgical services including complex, infrequent major vascular surgical diagnostic and treatment procedures in association with other specialties. |
As for Level 5 plus Dedicated vascular surgical ward area. On-site interdisciplinary amputee service. Access to Level 6 Rehabilitation Service. |
As for Level 5 plus RNs with appropriate post graduate qualifications and/or extensive experience in vascular surgery. Multidisciplinary vascular team includes physiotherapy, occupational therapy, dietetics, social work, podiatry and prosthetics. |
