57 Following receipt of the Report, the Sub Branch's request for a trial of an 18 field matrix was rejected. A request for a further trial of the matrix data was also rejected. However, the Ambulance Service subsequently agreed to supply patient data for the month of November 2006. That data and the results of a review undertaken by Mr Qvist were also attached to his affidavit. Following the review, Mr Qvist concluded that the matrix fields should contain the same clinical fields as set out in the Patient Health Care Record. Mr Qvist stated his conclusions were also supported by New South Wales Health Sustainable Access Program brochures and contended a broader matrix would enable a Nurse Unit Manager to better establish the type of patient being transported to the relevant hospital.
58 Mr Qvist stated that in his opinion an 18 field matrix would provide for a better transport decision to be made. It would also provide for more effective monitoring of patient flow and, where necessary, the manual re-distribution of patients to other appropriate hospitals which would reduce pressure on access block. In his view, the present matrix provides inadequate clinical information and is very restrictive in its application.
59 Mr Qvist contended the Sydney matrix worked well because of the number of hospitals within the respective Area Health Services and the fact that the geolocating software allowed ambulances to cross Area Health Service borders and boundaries. However in the Hunter there is a single major trauma hospital and a number of small satellite hospitals. In his view, the small hospitals were unable to deal with some of the clinical specialties that specific patients required. In addition, a matrix with increased clinical fields could be used in the future to monitor community pandemics where, for example, a field for respiratory problems could trigger the early warning of an outbreak of influenza.
60 In response to examination by Mr Murphy, Mr Qvist confirmed that part of the Union's complaint in relation to the 11 field matrix was the fact that approximately 60 per cent of patient transports fell into the "other category" which had a dramatic impact on a hospital emergency department, particularly where there had been an influx of patients by self or ambulance presentation.
61 Mr Qvist contended that in the case of a cardiac patient, a Nurse Unit Manager had the capacity to consult the ambulance status board in the emergency department and subsequently organise a cardiac monitoring bed for that patient. However, where the Nurse Unit Manager is confronted with the "other category", no details as to the patient's condition are known or set out on the status board. He elaborated that the "other" category could include respiratory and gastro patients, a patient with an altered level of consciousness or one requiring dialysis. In his view, the "unknown factor" under the matrix put great pressure on the emergency department to resource beds because they are "basically unaware of what's coming in". Further, there are some 64 per cent of patient transports where hospitals have no idea of the patient's condition and cannot plan for that admission efficiently. According to Mr Qvist, it is this "unknown factor" that impacts adversely upon patient flow and their effective treatment within the emergency department due to access block.
62 Mr Qvist explained it was quite daunting during periods of access block for patients, particularly the elderly or intoxicated, to be asked personal questions whilst under care in the ambulance bay area prior to their admission.
63 Mr Qvist said that where a child is admitted to a hospital under the paediatrics field, there was no way to distinguish whether the child had a broken bone or whether the child was postictal following an epileptic seizure. Simply put, the paediatrics field does not tell the emergency department what is wrong with the child. Despite paediatrics at the John Hunter Hospital having its own separate bed status, the fact remains that a paediatric admission forms part of the John Hunter threshold of seven ambulances per hour and when the threshold level for the hospital has reached seven, the matrix would direct a paediatric patient to either Wyong or Maitland hospital. To underpin this point, Mr Qvist said that a child with a cut finger who resided on the southern side of Charlestown would be directed to go to Wyong Hospital in the event that John Hunter Hospital had reached its threshold level. In such cases and in response to parental concern, it is commonplace for the ambulance officer to manually override the software so as to present the patient at the John Hunter Hospital where it might be found that a number paediatric beds not reflected in the matrix were empty.
64 Mr Murphy referred Mr Qvist to his written evidence where he had made a number of comments concerning the ORH Consultancy firm. It was Mr Qvist's evidence that the model used by ORH to create the 11 field matrix and establish hospital threshold levels did not take into account specific factors such as the availability of the rescue helicopter, which drew a large number of trauma and medical patients to the John Hunter from the Upper North Coast, Central Coast and Hunter Valley. In that regard, he said the helicopter was capable of transporting up to four trauma patients from a serious motor vehicle accident and in the event the helicopter brought four patients to the John Hunter, the threshold at the hospital for the next two hours would be three ambulances. These factors were not incorporated into the matrix by ORH. Mr Qvist confirmed that matters related to the helicopter were subsequently rectified. However, the Union's concerns regarding the re-admission of recently discharged patients for "warranty work" had not been addressed. Mr Qvist noted that this problem had been addressed in the original 18 field paper version of the matrix. He contended the implementation of the 11 field matrix had taken the hospital system back to a pre-18 field paper destination protocol where the John Hunter Hospital was "a beacon" and as such it becomes difficult to redistribute patients to other facilities so as to even out the workload and reduce the impact of access block.
65 In cross examination, Mr Qvist confirmed that his interest in Destination Protocol and Emergency Demand Protocol issues commenced in approximately 2002. He also confirmed that he had been active in the deliberations concerning the Protocols within the Hunter sector. He said that in or about 2003, the Ambulance Liaison Committee was established and that Committee comprised representatives of the Area Health Service, initially the John Hunter Hospital and later the Mater, Belmont and Maitland Hospitals. The Committee also comprised representation from the Ambulance Service and the Union.
66 Mr Qvist said he had been a member of the Liaison Committee for much of the time since its inception in 2003 and as part of his contribution to that Committee he undertook significant work on the development of the Protocols and was able to inject various experiences of ambulance officers and emergency department staff into the Committee's deliberations.
67 With respect to the Matrix Working Party established by Mr McPherson on behalf of the Ambulance Service in or about May 2006, Mr Qvist confirmed he was a member of that group, which had met on a number of occasions between May and June 2005. Whilst he described the Working Party as being "very one sided", he agreed Mr McPherson had explained that the purpose of the Working Party was to establish consultation about the introduction of the matrix package in the Inner Hunter Sector. However, he reiterated his disappointment that the Ambulance Service had ignored some 22 issues identified by the Union and subsequently raised in proceedings before the Industrial Relations Commission.
68 Mr Qvist said that on occasions, Mr Peter Rumble, a Committee member of the Sub Branch who "was knowledgeable" of access block issues and destination protocols, had attended Working Party meetings on his behalf. With respect to the 22 issues identified by the Union and put before the Matrix Working Party, Mr Qvist said that despite the opinion or pressure of the Ambulance Service, he was not deterred from articulating the Union's position. Mr Qvist confirmed that he had been afforded the opportunity to put a case in favour of an 18 clinical field matrix during deliberations of the Ambulance Liaison Committee.