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The Ideal Hospital Document
Minimum Standards of Care required by Positive People
This document was prepared in September 1995 by Bradley
Engelmann, Joe McCluskey and Gary Glare to set down the minimum standards of care
required by positive people.
The document was included by then Victorian Health Minister, Marie Tehan, in the
tender documentation made available to hospitals competing for HIV/AIDS and Infectious
Diseases Services, following the dismantling of a world-renowned Centre of Excellence at
Fairfield Hospital in late 1995. It was also included in documentation for members of a
so-called "Expert Evaluation Panel" charged with evaluating the tender bids and
recommending the relocation of these services.
This cynical exercise ignored totally the insistence of the Metropolitan Hospitals
Planning Board that these services should be tendered to ensure a cross-network, statewide
service. HIV/AIDS and Infectious Diseases services were then split: the Alfred Hospital
winning the HIV/AIDS tender, and Infectious Diseases going to the Royal Melbourne
Hospital.
There remain ongoing and serious problems and dissatisfaction with the primary HIV/AIDS
service at the Alfred Hospital. Senior staff of the VAC/GHMC Support Program have made
their concerns very clear in no uncertain terms.
The Ideal Hospital Document remains a benchmark by which positive people can
measure the quality and appropriateness of the services they receive. It was, after all,
supposed to have been taken into account by the Alfred in preparing their tender.
Please go to Feedback to report any concerns
or experiences you have had with the Alfred or with any other service provider. In the
mean time, use our Contact Details or phone the Victorian AIDS
Council Support Program on (03) 9 865 6700 or People Living with HIV/AIDS (Victoria)
People Living with HIV/AIDS (Victoria)
THE IDEAL HOSPITAL
This discussion paper is the product of a lengthy consultation process
within and outside the organisations
Input was received from:
 | PLWHA (Victoria), Volunteers & Staff |
| VAC/GMHC Support Program, Volunteers & Staff |
| Positive Women |
| Medical and Allied Health Hospital Staff |
| General Practitioners with special interest in HIV |
Co-ordinated by:
Bradley Engelmann, Joe McCluskey, Gary Glare
1. UNDERLYING PHILOSOPHY
1.1 Name and Recognition of Fairfield Hospital’s Culture of Care
| The specialist HIV/AIDS unit to be named the Fairfield Institute |
1.2 Guarantee of Patient Confidentiality
| Philosophy of patient confidentiality essential in all aspects of the hospital with
agreed grievance procedure |
1.3 Commitment to Research and Trials
| The Unit to be a leader in clinical and other trials |
| Commitment to research into all aspects of HIV/AIDS, including allied health and social
issues (i.e. Centre for Social Health) |
1.4 Recognition of Significant Others
| Recognition of our concept of "significant others" and "family of
choice", including:
 | recognition of rights |
| acceptance of displays of affection |
| sensitivity to gay/lesbian issues |
| preparedness to display gay/lesbian literature etc... |
| overnight accommodation for significant others/carers if required |
| sensitivity to needs of family, friends and patient during and after dying process |
| no restriction on visiting hours
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| Above to be part of staff selection criteria |
| Recognition of role and involvement of VAC/GMHC carers |
1.5 Particular Approach to Care and Treatments
| Direct Admission to the HIV ward(s) |
| "Hospital in the Home" to be available |
| Maintenance of link with general Infectious Diseases (including TB) and with Travel
Clinic (access to staff who are knowledgeable about effects of various vaccinations on
people with HIV/AIDS) |
| All medical and allied staff must
| ensure patients are informed of various treatment options |
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| support patients’ right to make informed choices |
| support women’s rights to contraception, pregnancy and abortion |
| be aware and sensitive to medical and cultural issues for women with HIV/AIDS |
1.6 Continuing Care and Palliation
| Continuing Care Unit to be provided |
| in close proximity to Acute Care to allow for flexibility and ease and of transfer
between acute and continuing care beds |
| including availability of respite care |
| Palliation philosophy to provide |
| optimum symptom control in and out of hospital |
| appropriate pain management (especially for IDUs) |
| continuing care |
| community outreach |
| facilitation of patients’ wishes to return home to die |
| ease of access for significant others, family, friends and VAC Support Carers when
client is dying |
2. LABORATORIES AND RESEARCH
| VIDRL to be on site, located in proximity to clinical facilities |
| access to speediest viral load and broad range of tests for opportunistic and other
infectious diseases tests |
| preparedness to encourage MacFarlane Burnet Institute to be on site |
3. PROFESSIONAL RELATIONSHIPS AND LINKING
3.1 Inclusion of VAC/GMHC Support Program in integrated care
| acceptance of the professional role of VAC/GMHC Support Program, including |
| attendance of Regional Support Officers at discharge planning and other meetings |
| access and inclusion in patient care of support volunteer carers |
3.2 Consumer Representation
| maintenance of an HIV Liaison Committee with community input and representation |
| use of funds donated to the HIV Unit to be used in that area as decided by the donor or
HIV Liaison Committee if not specified |
3.3 Interdisciplinary Approach
| interdisciplinary meetings to ensure total care |
| medical staff |
| allied health staff |
| discharge planning etc ... |
| inclusion of patient’s own GP in shared care |
| close liaison with RDNS |
4. STAFFING OF HIV/AIDS UNIT
4.1 Creation of Chair of Infectious Diseases
| appointment of Professor of Infectious Disease, important for wide recognition of Unit |
4.2 Education and Training
| ongoing in-service for staff to ensure they are up to date with treatments and other
issues |
| VAC/GMHC to be consulted and be involved in in-service where appropriate |
| staff to be educated about and sensitive to HIV issues including |
| general issues (confidentiality etc...) |
| gay male issues |
| other cultural issues (including people from different backgrounds) |
| issues for women with HIV/AIDS |
| Resource Centre/Library to be part of HIV Unit |
| possible relocation of Vivien Bullwinkel Centre or provision of library/resource centre
of similar or better standard |
| Unit to continue in specialised education role (e.g. GPs course, training for allied
health staff, possible Centre for Social Health) |
4.3 Deployment of Staff
| Fairfield Hospital medical, nursing and allied health staff to be invited to transfer to
the new Unit and to be designated Unit staff |
| range of allied health services (e.g. physiotherapy, social work, occupational therapy,
dietetics) to be provided and seen as integral to care plan |
| consultant specialists (e.g. psychiatry, oncology, neurology, gastroenterology etc...)
to continue relationship with HIV unit until expertise and culture is developed in the
receiving hospital |
5. TREATMENT AND CARE
5.1 Trials
| Unit to be a leader in clinical trials |
5.2 Outpatient Services
| maintain a separate Day Care Unit (with input from existing Fairfield Day Care Staff) |
| separate Outpatients Clinic with |
| consistency of doctor |
| appointment times |
| short waiting time |
| computerised booking system |
| ambulatory care centres to be created or co-located within exisiting appropriate
facilities |
| "Hospital in the Home" |
| access to advanced technology (scans etc...) |
| outpatients able to obtain all prescriptions through hospital |
5.3 Food services and nutrition
| 24 hour food services available |
| dietary supplements and associated equipment (pumps, pump sets etc...) to be provided as
needed for both in- and outpatients, and without charge |
5.4 Psychiatric services and dementia
| access to expert consultant psychiatrists and counsellors |
| 24 hour availability of psychiatric nurses if required |
| designated dementia beds in HIV ward |
5.5 Special needs of Women with HIV/AIDS
| access to appropriate gynaecological services (e.g. pap smears, colposcopy etc..) |
| support for women’s rights to contraception, pregnancy and abortion |
5.6 Pharmacy
| Unit to have own pharmacy |
| Drugs policy to be |
| based on patient needs |
| minimum timeline for approval |
| infected community able to initiate drug approval process |
| Procedures to guarantee confidentiality |
| Outpatients able to obtain all prescriptions through hospital |
5.7 Dental Care
| Dental Clinic either to be established by receiving Hospital or provided in conjunction
with the Dental Hosptal |
5.8 Pain Management
| provision of optimum level of pain control and management to both in- and outpatients |
| recognition of particular pain management needs of patients with drug dependencies |
5.9 Patients with Drug Dependencies
| drug dependency treatment programs for IDUs and other patients with dependencies |
6. PHYSICAL
6.1 General Location
| Unit to be in or close to quiet treed area, if possible |
| access to garden space (AIDS Memorial Garden to be re-established) |
| AIDS Memorial (funded, as promised by Minister MacLellan) |
6.2 Number of beds and configuration
| Current number of HIV beds to be maintained with the capacity to expand if necessary |
| mix of single and double rooms |
| each bed to have remote control TV (without charge to patient) |
| each bed to have telephone |
| patients to be able to personalise rooms (e.g. bringing in personal possessions) |
| female patients to have options on single-sex rooms, with female only toilet and
bathroom facilities |
6.3 Other facilities
| patients to have access to cooking facilities and dining area outside room |
| social space where patients can meet outside their room(s) |
| "retreat" rooms for privacy (meeting with friends, lawyers, carers etc...) |
| access to physiotherapy, occupational therapy and gymnasium |
| smoking area |
| pet visiting permitted |
| Unit to support any supported accommodation (subject to funding currently being sought) |
6.4 PLWHA Community Centre
| PLWHA community centre to be provided (to allow outpatients/in patients to meet socially
and to have access to services provided by PLWHA (treatments advice, massage, nutrition
advice, information etc...) |
6.4 Car Parking and Access
| sufficient car parking to be provided, together with carers’ access for patient
drop-off/pick-up (with appropriate spaces and access permits) |
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