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Inside this issueAustraliasian first procedure Tips for hipsRelieving years of pain

Royal pulseautumn 2015

The new

The

W h e r e t r a d i t i o n p l u s i n n o v a t i o n e q u a l s e x c e l l e n c e

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The RPH Emergency Department (ED) is the front line of the hospital and cares for the most seriously ill and injured patients. Our staff are a team of highly skilled specialists who thrive under the pressure of emergency situations.

Providing emergency care since 1906, RPH ED is the longest-serving ED in the State and leads the way in providing the most advanced treatments and methods of care.

The multidisciplinary team of expert consultants, doctors, nurses, allied health staff and patient care assistants work together to deliver services to more than 65,000 patients every year.

The ED currently sees 80 per cent of Western Australia’s trauma cases and receives 70 per cent of rural to metropolitan patient transfers.

Leading the teamDirector of Emergency Medicine Dr David McCoubrie heads up the team of more than 200 medical, nursing and support staff and says the

ED is an exciting and rewarding place to work.

“The ED is very different to other places in the hospital,” Dr

McCoubrie said.

“Things change so quickly. One minute we are treating

a patient with a fever, and the next minute we are preparing

for the arrival of critical multi-trauma patients from a road

accident. Each person in the team has a specific role and everyone knows exactly where they need to be and when.”

Your team your care

Dr McCoubrie has worked in emergency departments around the world and said the RPH ED stands out.

“The model of care we have in place is world-class and ensures that we give each patient the best possible chance of recovery,” Dr McCoubrie said.

“I am very proud to be leading such an excellent team at Royal Perth Hospital. Every patient that walks through our doors receives the very best care by highly skilled and dedicated staff.”

“The ED is very different to other places in the hospital.”

We have revamped our magazine and in the process have uncovered a treasure trove of RPH publications.

The RPH publication has taken many forms, beginning as The Perth Hospital Journal in 1938, changing to the Servio News newsletter in 1975 and progressing to a magazine style publication in more recent years. The publication is a fascinating reflection of the life and times of RPH.

We now turn over a new chapter at RPH and will continue to celebrate our achievements in The Royal Pulse.

If you would like to subscribe contact Public Relations on 9224 3943 or email RPH.PublicRelations@health.wa.gov.au.

A royal retrospective

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Royal Perth Hospital (RPH) has hit the ground running in 2015 and I would like to thank all staff involved in the reconfiguration of services. The month of February represented the culmination of a huge amount of planning and work done by the entire team in the transition of RPH to a 450-bed tertiary teaching hospital.

This transition signifies a new chapter for RPH and represents huge opportunities for growth as we continue to deliver tertiary care, engage the community and expand health care beyond our walls. This will allow our sub-specialties to continue to flourish and build on our research and education base.

To mark the new RPH, our magazine has been revamped and given a new name. Congratulations to Caitlin Swarts who came up with our fantastic new name, The Royal Pulse!

The quarterly doseActing Executive Director Dr Aresh Anwar

We are fortunate in having an exceptional team of people and leaders in their field working at RPH. This magazine offers an opportunity for us to highlight and celebrate their work. The current edition focuses on the work of the Emergency Department and the State Adult Major Trauma Unit. We plan to build on this in future editions as well as starting to highlight patient feedback and quality and safety.

Your feedback and suggestions are very much welcome. I know you will be left with the same sense of pride that I was, having taken a few moments to read the magazine, and reflect on the great work of the organisation.

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“By preventing blood-loss we are able to buy some time to take the patient to surgery and repair their damaged organs.”

REBOA has been used at RPH in place of a resuscitative thoracotomy, a procedure where the chest is cut open in order to directly access a patient’s aorta and insert a clamp.

“The REBOA procedure is less invasive, helping to reduce the impact on the patient and shorten their recovery time,” Dr Weber said.

RPH State Adult Major Trauma Unit is the second largest trauma unit in the country and receives critical patients needing life-saving treatments on a daily basis.

“We are constantly working to improve treatments for patients, and REBOA is just one of the many advances we are using to give critical trauma patients a fighting chance,” Dr Weber said.

Australasian first: new procedure saving lives

The leading cause of death in trauma patients within the first 24-hours is the risk of

haemorrhaging and a team of RPH trauma doctors are leading the way to save

patients who are minutes from death.

The RPH State Adult

Major Trauma Unit is the first team in

Australasia to perform a new procedure which

stops uncontrolled internal bleeding.

Dr Dieter Weber has performed the lifesaving procedure, and says Resuscitative Endovascular Balloon Occlusion of the Aorta, or REBOA as it is commonly known, is a last chance for patients who are haemorrhaging.

“REBOA is performed in the Emergency Department on patients who often have no pulse, and without this procedure wouldn’t make it from the Emergency Department to the operating theatre in time,” Dr Weber said.

REBOA involves inserting a tube into the artery in the groin and feeding it up into the aorta.

“We take an x-ray to ensure the tube is in place and then inflate a small balloon to stop blood from flowing out of the heart and leaking out of the damaged organs,” said Dr Weber.

“REBOA is performed on patients

who often have no pulse, and without

this procedure wouldn’t make it

to the operating theatre in time.”

Dr Sudhakar Rao Director of Trauma, Dr Dieter Weber, Dr Rene Zellweger.

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RPH welcomed 79 interns this year who will spend the first 12-months of their careers completing a number of rotations across different specialties.

The future of the frontline

Double accolades for top intern When Dr James Preuss was a child he was admitted to the ED with what he calls ‘foolish injuries’.

As foolish as his injuries may have been, his visit to the ED sparked a passion for medicine that would see Dr Preuss complete an internship at RPH, and take out two Goatcher Awards for the top intern in medicine and surgery.

“As a child I was fascinated by the fast-paced nature of the ED and became determined to pursue a career in medicine,” said Dr Preuss.

“When I didn’t quite reach the entrance requirements to study undergraduate medicine, I completed a Bachelor of Science in Pharmacology, during which I spent a year working in RPH’s Department of Anaesthesia and Pain Medicine.”

After graduating with honours in Pharmacology in 2007, Dr Preuss spent the next five years studying medicine before enlisting as an intern in 2013.

Dr James Tee was Dr Preuss’ supervising registrar and says that James often went the extra mile to deliver the highest standards of patient care.

“James has an excellent attitude and his medical knowledge was well beyond that expected of an intern,” Dr Tee said.

“This award is a well-deserved recognition of James’ commitment to ensuring the safety and comfort of his patients.”

The awards were established in 1991 by Emeritus Consultant Mr Phillip D Goatcher to recognise interns who exemplify the RPH values of Servio, Latin for ‘to serve’.

“To have received such positive feedback about my time as an intern, when you often question your abilities, is very rewarding,” said Dr Preuss.

“This award is a well-deserved

recognition of James’ commitment

to ensuring the safety and comfort

of his patients.”

“As one of Western Australia’s premier teaching hospitals, our interns will learn from some of the very best clinicians in their field.”

Interns are mentored by consultants who are renowned in their speciality and receive practical bedside training. They are expected to regularly perform basic clinical procedures and are guided through new procedures as opportunities arise.

“The most important lesson I have learnt so far, is to expect the unexpected. Even though we spend years at university, there is still so much we don’t know about medicine,” Dr Lim said.

“I feel very fortunate to be working at RPH, the staff are so knowledgeable, supportive and willing to teach.”

Dr Michelle Lim, currently in her first intern rotation, said that transitioning from student to a full-time doctor was an exciting time.

“I have learnt so much already, despite only having been here for a matter of weeks,” Dr Lim said.

“There is also a great sense of comradery at RPH, and I look forward to learning more about the fascinating world of medicine from the amazing staff here.”

Royal Perth Group Acting Executive Director Dr Aresh Anwar welcomed the interns and said RPH offers a strong platform for junior doctors to launch their careers.

“RPH interns are expected to work to a very high standard, and RPH provides excellent educational and skill development opportunities for junior doctors,” Dr Anwar said.

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One step at a time towards recovery

Danelle was rushed into surgery and work began to repair her injuries in a bid to save her legs. After all night in surgery Danelle’s surgeons emerged quietly confident that they may have succeeded.

“After the surgery, there was a good chance that we had saved not one, but both of her legs,” said Dr Rao.

In the two months that followed, Danelle underwent eight operations to repair the bones, muscles, nerves, tendons and skin on her injured legs.

“The repair needed for Danelle’s injuries was extensive and required the expertise of a number of different surgeons, intensive care specialists and trauma unit staff,” Dr Rao said.

“We saved Danelle’s legs but it was only the start of her road to recovery.”

Danelle spent the majority of her time in the State Adult Major Trauma Unit where she formed close relationships with the team of doctors, nurses, physiotherapists, occupational therapists and psychologists who cared for her.

“The physios pushed me really hard and I’m so glad they did. I had a goal and they kept me on track to achieve it.”

Today Danelle is walking with aids and she recently visited her treating team at RPH.

“Visiting Royal Perth Hospital brings back many memories and I am so grateful for the care that I received. Without the help of everyone involved, the surgeons, nurses and physios, I wouldn’t be walking today,” said Danelle.

Even though it was more than four years ago, Danelle is a patient who is remembered by many staff.

“Danelle was an inspiring patient. We provided her with the tools to her recovery, but it was her strength of character and her positivity that has gotten her to where she is today,” Dr Rao said.

“Those first two months in hospital was the hardest time in my life as I had to come to terms with the fact that my life had changed forever,” Danelle said.

“I was stuck in a hospital bed, barely able to move and I really struggled with the concept of not being able to get up and walk.

“All the staff, particularly the nurses, were so good to me. I was in the trauma unit for such a long time that I almost felt part of the team. They were like a second family helping me to get through each day and keeping me positive during my recovery.”

Danelle was later transferred to the RPH Shenton Park Campus to undergo rehabilitation and despite how tough her recovery was, she reflects fondly on the support she received.

“To wake up and realise that as an adult I had to learn how to walk again was daunting but I was focused on getting my independence back,” Danelle said.

Danelle Miller is an energetic, hardworking and vibrant young woman. Known for her zest for life and love of the great outdoors, Danelle led a full and active life. But on the second of January 2011, Danelle’s life changed forever.

“When they told me what might happen, I couldn’t believe it. I never thought that at 21-years of age I could lose my legs,” said Danelle.

Danelle spent the day water skiing in the Mandurah estuary with friends. On her last turn, she fell out of the inflatable sea biscuit and as the boat came to collect her, she grabbed the ski rope which suddenly became caught in the boat’s propeller. Unable to let go in time, she was dragged at a frightening speed directly into the propeller.

Sustaining horrific injuries to the back of her legs, friends dialled 000 and immediately started first aid to help slow her dramatic blood loss. With the propeller now jammed, the boat was stranded in the middle of the estuary. The RAC rescue helicopter was dispatched and Danelle was rushed to the RPH Emergency Department.

On arrival Danelle was treated by the State Adult Major Trauma team, led by the Director of Trauma Dr Sudhakar Rao.

“Danelle was still conscious when she arrived which was incredible given the extent of her blood loss,” Dr Rao said.

“When we saw her injuries, our team knew that we would be very lucky to save both of her legs.”

“I am so grateful for the care that I received. Without the help of everyone involved, the surgeons, nurses and physios, I wouldn’t be walking today.”

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Appsolutely fabulous

To make sure the only extra layers you’ll be wearing this winter are warm clothes, our RPH dietitians have some great tips to help your hips.

By making these small changes, and setting simple and realistic goals, you can create healthier habits to see you float rather than bloat through the winter months!

Tips for hips

3) C25K With the HBF Run for a

Reason just around the corner, there’s no better way to get motivated than Couch to 5K (C25K), the worldwide phenomenon that has helped millions of people reach their running potential. Whether you’re just getting started or you’re a seasoned runner, C25K will help you achieve your goals.

4) Gain self-guided workouts

Do you have trouble staying focused at the gym? You start off with the best intentions, but after finalising the ultimate playlist, updating your status and taking a few selfies, you find 30-minutes has passed and you’ve not even broken a sweat! If this sounds like you, Cross Trainer is perfect! With an in built personal trainer to keep you focused, feel the burn as you see results with fully customised workout plans.

As autumn approaches and we start our retreat indoors, eating comfort-food and reclining in front of the television often become our ‘go-to’ activities.

Don’t think of foods as ‘good’ or ‘bad’ have your favourite treat sometimes and remember to savour and enjoy it, without guilt.

So you can ignore the tantalising call of the vending machine, prepare a selection of healthy bite-sized snacks for your work-day, such as cherry tomatoes, carrot sticks with hummus, or a piece of fruit.

The healthiest foods don’t come in wrappers - try to add some ‘nude food’ to your day!

Feeling ‘hungry’ between meals or snacks? Drink two full glasses of water, sometimes our brains confuse hunger and thirst.

Ditch the sugary drinks and reach for a refreshing soda water, with fresh lemon, orange and lime slices.

1) My fitness pal Keep track of your

nutrition and fitness goals with the integrated My Fitness Pal app that records your daily calorie intake and calculates how many calories you burn at the gym. The easy-to-use app helps you set sustainable targets to make sure you achieve your goals!

2) Women’s Health 15-minute workouts

If you are short on time and need to squeeze in a workout this app is great! With workouts including ‘Love-Your-Lower-Body’, ‘Core’ and ‘Stretch and Strengthen’, this app has something for everyone.

Are you trying to improve your health and fitness, but need a little help? Never fear, the perfect app is near! Here are our top four picks for a ‘healthier you’ in 2015.

“No excuses - these apps are all free!”

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Avoid eating in front of the television or computer. Take a ‘timeout’ to notice what you’re eating and enjoy each mouthful.

Downsize your bowls, plates and utensils! Research shows that if you can fit more on your plate, you will, regardless of how hungry you actually are.

Variety is the spice of life! Swap your favourite, nutritious recipes with friends and family and add some tried and tested meals to your repertoire.

Get sweaty! Make exercise more fun by trying a new class, exercising with friends or playing a sport.

Struggling to find 30? Include snippets of exercise in your daily routine like walking the dog, parking further away from your destination or seeing how many times you can take the stairs at work.

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The RPH Wound Management Clinic launched the Low Frequency Ultrasonic Debridement (LFUD) treatment in September 2013. The technique uses low frequency ultrasound waves to destroy the damaged tissue in a patient’s wound.

Wound Management Nurse Practitioner Ms Donna Angel said that LFUD is effective because it isolates damaged tissue and ensures that healthy tissue remains intact.

“We have treated around 46 patients using LFUD and the majority of them have achieved excellent results,” said Ms Angel.

With our strong research links, our patients are treated using the latest methods and most technologically advanced treatments available.

Here is a sample of our researchers and the latest projects they’re involved in.

Professor Tomas Corcoran, Department of Anaesthesia and Pain Medicine

PADDI

The PADDI trial or Perioperative Administration of Dexamethasone and Infection, is the largest ever study of its kind and will examine the safety of dexamethasone, a commonly prescribed drug used to prevent post-operative nausea and vomiting.

Ultrasonic healing

RPH innovators

Mr Donald Moore, 78-year old Northam local, had been suffering from a venous leg ulcer condition since 1987 with each outbreak taking a long time to heal. The latest painful ulcer covered a large part of Mr Moore’s lower

leg and required daily dressings because of the liquid discharge from the wounds.

Mr Moore came to RPH for his first

treatment in August last year and said the results have been phenomenal.

“I saw results within a week of the very first treatment and after only six weekly, 30-minute treatments my life was changed,” Mr Moore said.

“Before the treatment,

the wound placed many limitations on

our day-to-day lives. The pain

meant I had to use crutches to walk

and so much of our time was taken up by

daily dressings and trips to the local hospital.

“The wound is now only the size of a 50 cent piece so I am able to walk without crutches and daily dressings are a thing of the past.

“I saw results within a week of the very

first treatment and after only six, 30-minute

treatments my life was changed.”

An innovative method to treat chronic wounds is changing the lives of RPH patients, relieving them of the pain they have suffered for years.

As a tertiary hospital RPH has a strong focus on research and many of our health professionals provide both clinical care and lead innovative research projects.

Even the nurses at the local hospital are stunned at how dramatically the wound has healed, it really is unbelievable,” Mr Moore said.

Ms Angel says getting these results for patients is what working at RPH is all about.

“This technology is a massive step forward in wound management and to see such excellent results for our patients is both personally and professionally rewarding,” said Ms Angel.

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Professor Daniel Fatovich, Emergency Department

Quantifying Alcohol-Related Harm Presenting to Emergency Departments in Australasia

Part of a national trial, the Quantifying Alcohol-Related Harm Presenting to Emergency Departments in Australasia involves having a team of researchers in the ED for 24-hours a day over a week, to assess alcohol related presentations. The study will determine the impact of alcohol related presentations on ED operations and the costs involved.

Professor John Buchanan, Allied Health

SCIPA

As the largest clinical trial of its kind, the SCIPA or Spinal Cord Injury and Physical Activity trial investigates how intensive exercise after a spinal cord injury can improve the recovery of patients. The trial is being conducted across eight spinal injury units in Australia and New Zealand. It works with patients from four weeks after their arrival in hospital right through to planning for their day-to-day life when they return home.

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Visionary: remembering Margaret HuberyOne of RPH’s most influential nurses, Mrs Margaret Hubery sadly passed away on Wednesday 3 January, at the age of 86.

An ACHS survey team assessed BHS against the National Safety and Quality Health Service Standards (NSQHS) commenting on Bentley’s commitment to patient-centred care.

BHS Acting General Manager Ms Maree Thomter said the feedback is a testament to the hard work and dedication of staff, whose efforts in preparation for accreditation was outstanding.

“I would like to commend all staff for their contributions to our momentous achievement following accreditation,” said Ms Thomter.

Accreditation success

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Your health services at Bentley Bentley Health Service (BHS) is a fully specialist public hospital and a member of the Royal Perth Group.

Improving services for patients

The transformation of Ward 5 at BHS into a multi-purpose rehabilitation facility is underway.

Acting General Manager Ms Maree Thomter says the refurbishments began last year and are on schedule to be completed in August this year.

“The new facilities will improve the specialist rehabilitation services BHS provides to the community,” said Ms Thomter.

“The completed ward will have 18 new rehabilitation beds, two specialist bariatric rooms and will enhance the way rehabilitation and specialist health care is delivered.”

BHS delivers a range of health care services to the local community including rehabilitation, aged care, elective surgery, mental health and maternity services.

The Bentley Mental Health Service (BMHS) provides a comprehensive range of specialist mental health services for adults and older adults. Working with other specialties including medical, nursing, psychology and social work, BMHS uses a multidisciplinary approach to provide the best possible care to consumers.

The Maternity Unit delivered more than 1000 babies in 2014 and provides a range of antenatal and post natal services including specialised clinics for Aboriginal and Torres Strait Islander mothers.

Many of the services at BHS have built strong links with local community organisations which support patients on their journey to recovery after they have left the hospital.

Margaret’s nursing career spanned over 45 years, beginning at RPH in 1946. She spent time overseas, interstate and at other hospitals but returned to RPH on many occasions, most notably as the Director of Nursing in 1984.

Margaret was instrumental in shaping the hospital’s nursing operations, implementing a new career structure and providing nurses with avenues for further education and specialist training.

Human Resource Nurse Manager Ms Chris Ralph worked with Margaret for 15-years

and said she was a great role model and advocate of professional development for nurses.

“Margaret’s contributions to the profession were remarkable and the legacy of her work continues to make a difference at RPH,” Ms Ralph said.

After her retirement in 1991, Margaret maintained a close relationship with RPH as a volunteer for the Friends of Royal Perth Hospital. Among her many achievements, Margaret was appointed a Member of the Order of Australia in 1993 for her service to nursing and the community.

In December 2014, BHS achieved accreditation in the new Australian Council on Healthcare Standards (ACHS) EQuIPNational program.

The community culture at BHS, the cohesiveness of the multi-disciplinary teams, and the integration of general and mental health was also noted by the surveyors.

“The surveyors were very impressed by our commitment and enthusiasm to improve our service which is something that we all should be proud of,” said Ms Thomter.

“These outstanding results illustrate the pride we take in providing superior health care.”

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Our volunteers are valued members of the RPH community, committed to making our patient’s hospital experience as comfortable as possible.

Friends of Royal Perth HospitalBeing a Friend gives you the opportunity to make a real difference in the lives of patients and visitors in a friendly and supportive environment.

Our Friends undertake a variety of valued services, including:

visiting patients on the wards

helping out in the Friends shop

beverage service in outpatient clinics

book and magazine delivery to the wards

helping out in the RPH Museum.

Become part of the RPH community

Voluntary Transport IncorporationDo you enjoy driving? The voluntary transport team travel more than 200,000 kilometres and provide transportation assistance to more than 11,000 patients each year.

Become a volunteerVolunteering at RPH offers a range of benefits including complimentary parking, access to the pool and gymnasium and the opportunity to make lifelong friends.

Join more than 300 volunteers by contacting the Friends office on (08) 9224 2036, or the Voluntary Transport office on (08) 9224 2054.

Looking for a rewarding way to be active in your community? Become a volunteer at RPH today!

© State of Western Australia, Department of Health 2014. RPH M150123001

Where t rad i t ion p lus innova t ion equa ls exce l l ence

The Royal Pulse is produced by RPH Public Relations. If you would like to share your story contact Public Relations on (08) 9224 3943. Editor: Niki Theodoropoulos Stories: Hayley Noblett and Matthew Avery. Pictures: Brydon Dunstan and Steve Wise. Graphic Design: James Goodchild

healthywa.wa.gov.au