Recommendations secure maternal fetal medicine care for north Queensland women

Townsville Hospital and Health Service (HHS) has begun implementing recommendations made by external clinician Dr Glenn Gardener as part of his review into maternal fetal medicine (MFM) services across north Queensland.

Townsville Hospital and Health Service Board Chair Tony Mooney said the clinical review was undertaken late last year and looked at current service demand, model of care and areas of improvement to ensure long-term sustainability of Townsville’s MFM service.

"The Townsville Hospital and Health Service Board has reviewed the document and accepted all 11 recommendations," Mr Mooney said.

"The Board fully supports Health Service Chief Executive Kieran Keyes who is working with his health service team to deliver improvements quickly and safely."

Mr Mooney said the health service’s MFM service was a small, dedicated team consisting of two specialists, a specialist in training, four sonographers, a clinical midwife and a midwife consultant and administrative staff who began treating north Queensland women in 2014.

"The demand for this small team’s speciality services has grown since its inception with the team managing about 770 high-perinatal risk referrals or transfers in 2021 from across northern Queensland," Mr Mooney said.

"While no specific incident triggered this review, we accept planning for future MFM services must begin now and it is our task to oversee this process.

"I’d like to reassure current and past patients of this service that this review was a proactive step to ensure MFM care is available if, and when, it’s needed." 

Mr Mooney said the recommendations were clear and the Board had agreed to provide the resources to support the delivery of all recommendations. 

"An implementation plan has been developed and will guide the roll out of Dr Gardner’s recommendations. We will provide updates to the community as we progress with the rollout of these changes," he said.

Longer-term planning and funding are also being closely examined by senior management for further consideration by the Board.

"As northern Australia’s only tertiary hospital, it’s important we are equipped to deliver the care the community needs. We will be working with the Queensland Department of Health about how we ensure the long-term stability of MFM services."

Townsville HHS health service chief executive Kieran Keyes said based on Dr Gardener’s findings, staffing capacity must increase to include eleven new staff.

This will include increasing the service’s capacity to offer ongoing support to patients through the addition of a social worker, psychologist and Indigenous health worker to the team.

"We anticipate the rollout of all recommendations will require an additional annual investment of about $2.8 million and we have plans in place to relocate the team to a space specifically fitted out for the service," Mr Keyes said.

"While the location is still to be confirmed, I make it clear there always was and always will be a location for our specialist MFM service.

"This is an integral part of our long-term plan for TUH which has earmarked space for its own women’s and children’s facility."

Mr Keyes said following the completion of the review, some changes had already been rolled out.   

"Roster allocation changes have been made to ensure a five-day MFM service is available across all areas of service delivery including theatres, clinic sessions and sonography," Mr Keyes said.

"Funding has been allocated to upgrade and increase the number of MFM ultrasound machines from two to four in support of the new five-day service arrangement.

"Recruitment will commence for two additional specialists with certification in MFM and a general obstetrician is assisting in clinics under the guidance of current MFM specialists until this position is filled."

Mr Keyes said the service treated women and their babies from the local Townsville HHS catchment as well as those living as far north as Cooktown and the Torres Strait, northwest to Mount Isa and south to Rockhampton.

"Over the years, we know the demand for these highly specialised services has grown due to an increase in women with complex pregnancies or living with co-morbidities and an increase in overall birth rates across northern Queensland," he said.

"We take Dr Gardener’s recommendations very seriously and are working hard to strengthen our MFM service that routinely goes above and beyond to deliver the best possible health outcomes."

Recommendations made by Dr Glenn Gardner:

Recommendation 1:

Establish a Department of Maternal Fetal Medicine at TUH managed within the budget and governance of Women’s and Children’s Services.

Recommendation 2:

Invest in medical, sonography, midwifery, and administration staffing to provide an MFM service 5 days per week (Monday to Friday every week) that includes protected time for education, training, research, leave, and administration.

Recommendation 3:

Develop a defined operating budget under a single cost centre with the ability to maintain prospective oversight of the revenue and costs of the MFM service against performance/outcome targets.

Recommendation 4:

In the context of a subspeciality MFM service that cannot currently meet demand, consider rationalising MFM services so that MFM care can be appropriately directed to where it is most needed. MFM subspecialists and MFM Fellows should not be providing general obstetric services while women in need of MFM services cannot access care.

Recommendation 5:

The future physical environment for the TUH MFM service should be designed for the care of pregnant women with complex care needs and also to ensure that it is a safe and efficient work environment for the multidisciplinary MFM staff.

Recommendation 6:

Develop MFM referral guidelines and a formal triage process to reduce unnecessary referrals to MFM and to ensure that MFM expertise is available within a safe timeframe to the women that need it.

Recommendation 7:

Develop an appointment booking template for MFM ultrasound and consultation services that provides flexibility to book scans with different time intervals and staggered break times.

Recommendation 8:

Streamline flow through the MFM service so that MFM consultations are directed to cases where subspecialty MFM input is required. When the clinical circumstances meet the agreed requirements (e.g. normal ultrasound findings), MFM consultation is often not required.

Recommendation 9:

Support protected time for the integration of education/training and research into the TUH MFM service.

Recommendation 10:

Supporting the integration of research into the TUH MFM service requires protected time and appropriate research support.

Recommendation 11:

Create a Sonographer Educator role within MFM with FTE allocated according to proposed teaching and education activities. Engage the MFM Subspecialists, MFM trainee and MFM sonographers in annual planning for professional development leave (e.g. conferences) and recreational leave.