DEPARTMENT OF INTERNAL MEDICINE BUSINESS PLAN 2012-2017 Introduction Internal Medicine has moved to a position where it can offer a portfolio of subspecialities, which can run independently for purposes of service delivery and training. General Medicine can be based at a regional level [Edendale Hospital] and be developed to provide a robust service to Pietermaritzburg and Area 2 of KZN. Strong District hospitals[ Northdale and Appelsbosch Hospitals] can refer patients primarily to Edendale Hospital. A few patients may need to be referred directly to Grey s Tertiary Hospital[ eg: those needing urgent cardiac catheterisation] but most can be referred to Edendale Regional Hospital first, from the District Hospitals. Grey s Hospital therefore doesn t need a General Medicine ward or a Medical admissions Ward. Patients will be referred directly to a subspeciality, that will accept the patient to their own beds and will be looked after by their own staff. Unstable patients will first be admitted to Medical High Care, be stabilized and then sent on to the ward [or to ICU, if required]. The ICU will be co-managed by many departments at Grey s, in the spirit of collegiality and good team spirit. Edendale Hospital will run with 4-5 medical firms and have an active undergraduate teaching programme and a research programme. A QI programme will also be established/supported at Edendale. Consultants at Edendale Hospital will be encouraged to attend a specialist clinic at Grey s [ of their own choice]- to improve their enjoyment of their post and therefore as part of a retention strategy. An active outreach programme from Grey s will be supported: the aim is for Grey s to accept patients from the Major regional hospitals in Area 2: Edendale for the South of Area 2 and Madadeni and Ladysmith in the North of Area 2. It is planned for Madadeni to have an ECHO service and a Dialysis programme [mainly peritoneal dialysis]. They have posts for 2 Internal medicine specialists. The relationship with UKZN is not optimal and the Chief of Medicine at Grey s has to meet with Professor Hift and Dr Nyamande, to take this further. Sections to follow: A] ORGANOGRAM 2012-2017 B] Inpatient Beds and Staffing C] Internal Medicine Clinics D] Ward Allocation to Internal Medicine Specialities E] Internal Medicine Physical space requirements F] Services by speciality G] Ambulatory Services: Outpatient Procedures H] Notes
A] ORGANOGRAM 2012-2017 1 x Head Clinical Department 1x Personal Assistant Subspecialities Cardiology 4 x Specialists 2 x Registrars 12 Technologists 1 x Porter Medical High Care 2 x Technologists 1 x Porter CCU 2 x Technologists 1 x Porter Subspecialties Renal 3 x Specialists 2 x Registrars 2 x Ward Clerks 8 x Technologists 1 x Porter
Pulmonology 2 x Specialists 2 x Medical Officers 2 x Technologists GIT 2 x Medical Officers Medical ICU Subspecialties Infectious Diseases 2 x Specialists Dermatology 2 x Specialists Endocrinology 1 x Medical Officer Rheumatology 1 x Medical Officer Subspecialties Neurology
3 x Specialists 2 x Registrars 4 x Technologists 1 x Porter Outreach Edendale Block 14 x Registrars Research Block 2 x Registrars Haematology 1 x Medical Officer
B] Inpatient Beds and Staffing Speciality Inpatient beds 164 Specialists: Head Specialists Medical Officers Registrars Ward clerks Secretary Technologists Porters Medical High Care 8 1 1 4 1 1 0 2 1 Neurology 20 1 3 4 2 1 1 4 1 Cardiology 20 1 4 4 2 1 1 12 1 Renal 20 1 3 4 2 2 1 8 1 Pulmonology 17 1 2 2 1 1 1 2 0 GIT 16 1 1 2 1 0 0 0 0 Infectious diseases 16 1 2 4 1 1 0 0 0 Dermatology 8 1 2 4 1 0 0 0 0 Endocrinology 6 1 1 1 1 0 0 0 0 Haematology 6 1 1 1 1 0 0 0 0 Rheumatology 4 1 1 1 1 0 0 0 0 CCU 8 1 1 4 1 1 0 2 1 Chief Specialist 0 1 0 0 2 Outreach 0 1 1 4 0 0 1 0 Medical ICU 5 1 1 4 1 0 0 0 1 Edendale block 14 Research block 2 Isolation beds 4 Medical Oncology 6
C] Internal Medicine Clinics 6months stats Clinics 2011 Haematology 240 Haemophilia 102 Infectious Dis 120 Pulmonology 722 Renal 343 Diabetes 747 Rheumatology 654 Cardiology 1780 GIT 773 Endocrinology 865 Dermatology 2411 Neurology 899 ECG/ECHO/Stress ECG Room 3 roomed unit
D] Ward Allocation to Internal Medicine Specialities Ward sharing Ward 1 Neurology Endocrinology Ward 2 Cardiology Ward 3 Renal Medical Oncology Ward 4 Pulmonology Rheumatology Ward 5 GIT Haematology Ward 6 Infectious Diseases Dermatology Ward 7 Medical High Care [8 beds] Ward 8 CCU [8 beds] Ward 9 Medical ICU [5 beds]
E] Internal Medicine Physical space requirements 1] 6X General wards: shared by specialities as in D] 2] 1X Medical High Care : 8 beds [ would like 2 ventilator capable for patients awaiting transfer to ICU] 3] 1X CCU: 8 beds: 4 ventilator capable and 4 High Care beds. Coronary Cath Lab included with CCU: 1 unit 4] OPD Clinics as per clinic schedule. [ Includes a 3 roomed unit for ECG/Stress ECG and ECHO] 5] 1X Chronic Dialysis unit: a] Haemodialysis unit : 24 dialysis machines, Mon Saturday, 3 shifts b]peritoneal dialysis Unit: waiting room, training room storage and also procedure room [ 4 large rooms] 6] 1X Acute Dialysis unit: 4 haemodialysis machines: 24/7 operation 7] Renal Transplant unit 8] 2 cough Rooms: with laminar flow ventilation. 1 in OPD, 1 in the Infectious Diseases ward 9] Registrar seminar room and study room possibly funded by UKZN 10] Undergraduate seminar room possibly funded by UKZN 11] [ 6 beds to Oncology, 5 beds to Combined ICU] 12] [ Medical High Care, CCU and combined ICU each need a haemodialysis machine and Reverse Osmosis system for dialysis]
F] Services by speciality Specialty services Cardiology Inpatients Outpatients cath lab ECHO/ECG/stress ECG lab Cardiac rehab outreach Neurology Inpatients outpatients EEG/EMG stroke unit Neuro rehab outreach Pulmonology Inpatients outpatients bronchoscopy Lung function cough room outreach Gastroenterology Inpatients Outpatients Gastroscopy Colonoscopy ph studies outreach Endocrinology Inpatients outpatients outreach Rheumatology Inpatients Outpatients outreach Haematology Inpatients Outpatients Infectious Diseases Inpatients outpatients 4 isolation wards 2 cough rooms ID Hospital support outreach Nephrology Inpatients Outpatients Haemodialysis Peritoneal Dialysis Transplant programme outreach Dermatology Inpatients Outpatients outreach Postgrads Greys specialities EDH General Med Research Block Exam prep Parts 1 & 2 portfolio Undergrads teaching exams
G] Ambulatory Services: Outpatient Procedures Ambulatory services Bronchoscopy GI-endoscopy ECHO Stress ECG, ECG Cath Lab EEG and EMG Lung Functions Podiatry Sleep studies Day Ward [ Bone marrow Aspiration, venesection, etc]
H] Notes Medical staff above will cover wards, clinics and ambulatory services Nursing and Allied staff will provide their staff needs according to their allocation protocols Specialist trainees in Dermatology and Neurology are from Medical officer ranks Subspecialist trainees in other Internal medicine divisions come from Specialist ranks Statisticians, telemedicine, IT and data capturers - from a general Greys pool Internal Medicine accepts a Combined ICU and will contribute beds and staff as above Internal med wants to run its own separate Medical High Care [ for the adequate training of med regsthey need the exposure] CCU must be run by the cardiologists- minimum of 4 ventilator capable beds and staff and 4 High Care beds Neurology and Cardiology: Adult non- interventional Outpatient services will cater for some Paeds services and should get enough staff to handle the extra load. 4 single bed isolation units will also be available to Paeds Cardiac tech group include staff for non-interventional lab, CCU and Cath Lab, hence the large number No MAW and no General Medicine, in line with 100% tertiary policy. General med will move to EDH. See proposal below to have option to cover internal and external referrals of all emergencies Proposal Have a small General Admissions Ward: run by nurses and Medical Officers- who answer to the CEO Greys. Internal Referrals: Run a triage and do basic initial assessment to refer to appropriate specialty. 24/7 facility. Also for use of patients coming in for Radiology from outreach hospitals