Planning Preliminary Information

2 Role Delineation Guide

INTRODUCTION

Role Delineation refers to a level of service that describes the complexity of the clinical activities
undertaken by that service. The level is chiefly determined by the presence of medical, nursing
and other health care personnel who hold qualifications compatible with the defined level of care.

Each level of service has associated minimum standards, support services and staffing profiles
considered appropriate.

Role delineation is a process which ensures that clinical services are provided safely, and are
appropriately supported by the provision of adequate staffing numbers and profiles, minimum
safety standards and other requirements.

The aim of this Guide is to provide a consistent language which health care providers, planners
and health officials can use when describing health services. The Guide also acts as a tool for
planning, review and approval of health facilities.

Levels of Service range from 0 to 6 for each major clinical activity or support service associated
with health facilities with Level 0 referring to the lowest complexity service and Level 6 describing
the most complex.

Not all services which are provided by health care facilities are described in the Role Delineation
Guide - only the core services for hospitals and community health facilities. Those services not
identified will generally follow the Role Delineation of the particular hospital or facility they are
applicable to.

A hospital or health care facility is deemed to be at a particular level when the majority of clinical
and support services provided are of that particular level.

It is possible to determine the role delineation level of a particular hospital component or the entire
hospital between two defined levels, eg between levels 4 & 5. This usually applies to existing
facilities which may have minor deficiencies in certain areas compared with the full definition of a
role delineation level.

This Guide does not attempt to describe all the services which are provided by Health Care
Facilities, but confines itself to those that are widely considered to be the core services for
Hospitals and Community Health Care Facilities.

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Above: Simple Role Delineation Guide

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General Service Description

Nomenclature Level
Provides low-risk inpatient and ambulatory care clinical services.
Delivered mainly by RNs and GPs with admitting rights to the local hospital.
RDL 1
Patients requiring a higher level of care can be managed for short-periods before
transfer to a higher-level service.
Primary &
Ambulatory Care Some limited visiting/outreach allied health services provided.
Manages emergency care until transfer to a higher level service.
Predominantly delivered by GPs (available 24 hours a day, 7 days a week but not
RDL 2 necessarily on-site) and RNs including midwives and/or nurses with specialty
qualifications, possibly inclusive of visiting day only specialist services as well
as low-risk surgery and/or minor procedures, and an education and training
role (longer than day only may be arranged).
Provides low to moderate-risk inpatient and ambulatory care clinical services
delivered by a variety of health professionals (medical, nursing, midwifery and
allied health) including resident and visiting specialists with access to limited
RDL 3
support services.
Manages emergency care and transfers to a higher level if required.
No intensive care unit, although the facility may have access to a monitored area.
Provides moderate-risk inpatient and ambulatory care clinical services
delivered by a variety of health professionals (medical, nursing, midwifery and
Secondary Care allied health) including resident and visiting specialists.
Medical staff on-site 24 hours a day, 7 days a week and an intensive care
RDL 4 unit (may be combined with a cardiac care unit) with related support services
also available on-site.
If higher level or more complicated care required, patients may need to be
transferred to a level 5 service. Some specialist diagnostic services also available.
Manages all but the most highly complex patients and procedures.
Acts as referral service for all but the most complex service needs which may
RDL 5
mean highly complex, high-risk patients require transfer or referral to a level 6
Tertiary Care service.
Has university affiliation(s) and education and teaching
commitments, possibly some research.
Is the ultimate high-level service delivering complex care and actingas a referral
service for all lower-level services.
RDL 6
Can also be a region-wide super specialty service accepting referralsfrom across
the jurisdiction and cross-regionally where applicable.
Generally provided at a large metropolitan hospital.
Has strong university affiliations and major teaching and research commitments
in both local and multi-centre research.

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Format

The Services and associated RDL have been classified as per the following format:

Section 1: Clinical Support Services 16. Rehabilitation

1. Laboratory 17. Renal Medicine

2. Pharmacy 18. Respiratory & Sleep medicine

3. Medical Imaging 19. Rheumatology

4. Nuclear Medicine Group C: Surgery

5. Intensive Care 1. Burns

6. High Dependency Care 2. Cardiothoracic Surgery

7. Operating Suites 3. Day Surgery

8. Anaesthetic 4. Ear, Nose & Throat Surgery

Section 2: Clinical Services 5. General Surgery

Group A: Emergency 6. Gynaecology

Group B: Medicine 7. Neurosurgery

1. Cardiology & Interventional Cardiology 8. Ophthalmology

2. Clinical Genetics 9. Oral Health/Dentistry

3. Dermatology 10. Orthopaedics

4. Endocrinology 11. Plastic Surgery

5. Gastroenterology 12. Urology

6. General Medicine 13. Vascular Surgery

7. Geriatrics

8. Haematology 1. Obstetrics

9. Immunology 2. Neonatology

10. Infectious Diseases 3. Paediatric Medicine

11. Long Term Care 4. Paediatric Surgery

12. Neurology Group E: Mental Health

13. Oncology Medical 1. Drug & Alcohol

14. Oncology Radiation 2. Psychiatry (Child & Adolescent, Women and

Adults
15. Palliative Care

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Section 1: Clinical Support Services

1. Laboratory

Laboratory role descriptions are based on the services provided at or delivered to a site, rather than what
is physically present on the site.

Laboratory Service Description

RDL Infrastructure & Service Requirements Workforce

1 Blood and diagnostic specimen Supported by a timely courier service to No Level 1 service. Refer
collecting services available. No on- an accredited laboratory for testing. to higher level 2.
site laboratory. Collection policies and procedures
established by the accredited
laboratory. Compliance with the quality
and safety requirements.
As for Level 1. In addition, a range As for Level 1. In addition, compliance Appropriately trained
2 of urgent tests may be available. No with management of blood component health workers to use
on-site laboratory but trained requirements. the automated
health workers available to collect pathology testing
and transport specimens to equipment.
laboratory.
As for Level 2. In addition, an On-site basic biochemistry and As for Level 2. In
accredited branch/satellite haematology. As for Level 2. In addition, addition, branch/satellite
laboratory providing core pathology under the overall control of, with laboratory under
3 services either on-site or through specialist scientific and clinical direction and control
networked arrangements. Range of supervision from, an accredited from pathologist or
tests available varies according to laboratory. 24 hours on call access to senior scientist of
clinical need but will usually include laboratory. Access to blood bank general laboratory.
basic haematology (e.g. full blood services. Where appropriate,
count, cross matching, blood specialist pathology staff
grouping and basic coagulation), with appropriate
biochemistry (e.g. liver and renal qualifications, training
function tests, electrolytes) and and experience relevant
microbiology (e.g. urine to scope of testing being
microscopy, Gram staining). performed
As for Level 3. In addition, part of a As for Level 3. In addition, provide an As for Level 3. In
service network providing some extended hours service to meet agreed addition, service
4 specialist diagnostic tests (e.g. fine clinical needs. Specialised pathology provided by laboratory
needle aspiration, frozen section, services provided by laboratory scientists with
bone marrow biopsy) and/or an scientists Integrated laboratory appropriate tertiary
expanded range of tests information system for referral and qualifications
results sharing.
As for Level 4. In addition, As for Level 4. In addition, provide 24- As for Level 4. In
accredited as branch/satellite or hour access to comprehensive suite of addition, service
general laboratory. Provide access pathology services. Dedicated provided by full-time
5 to comprehensive suite of pathology department. Microbiology pathologists. The
pathology services, either on-site or and histopathology available locally. supervising pathologist
through networked arrangements. Formal access to sub-specialist or senior scientist must
Provide support for clinical trial and pathology services from Level 6 be present or
Pathology services. Support provided to contactable for
laboratory, providing diagnostic and lower service level facilities. consultation during
clinical services for other hospitals normal working hours of
or laboratories in the region or the laboratory. Specialist
pathology network pathology laboratory
staff available locally 24
hours
6 As for Level 5. In addition, As for Level 5. In addition, sub-specialty As for Level 5. In
accredited as general laboratory pathology services, cytogenetics addition, credentialled

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and may play a region-wide referral services, cell culture facilities and sub-specialty
role for some highly complex cryopreservation, blood product pathologists.
sub specialty pathology services. storage and cross-matching.
Provide comprehensive range of
complex clinical, laboratory and
business support services. Perform
testing of a complex technical
nature in a range of fields to
support specialist clinical services.
Initiate and lead clinical trial and
research activities. Sub-specialty
services and provides highly
complex pathology services such as
clinical investigations,
transplantation services and blood
banking.

2. Pharmacy

RDL Pharmacy Services Infrastructure & Service

Description Requirements Workforce

1 Service provided by external Medications supplied on Access to registered pharmacists

pharmacy. individual prescription from a where not on-site. Must have access
community pharmacy, primary to a registered medical practitioner
health care clinic or higher level for prescriptions.
service. Links to other relevant
services to support patients
taking medications. Access to
registered pharmacists for
medication management, patient
education and support, home
medicines review and formal
medication reviews in

usual general practitioner. A

reliable internet connection with
sufficient capacity to enable
access to receive consultation
from a higher level service
2 As for level 1. As for level 1. In addition, As for level 1. In addition, Access to
medications for inpatients on more specialised pharmacist support
discharge supplied on individual from a higher level facility within the
prescription from either a network.
community pharmacy,
appropriate hospital within the
network, or a higher level service
with documented processes in
place for the provision of
medications that require
compounding
3 As for level 2. In addition, As for level 2. In addition, As for level 2. In addition, service
provide on-site clinical medications and clinical services provided by a pharmacy team which
pharmacy service (e.g. patient for day patients and, where includes a pharmacist, pharmacy
medicines information, applicable, ambulatory patients assistant and pharmacy technician.
medication chart review, staff in specialty clinics. Timely access Pharmacist available during
education). to clinical information, including designated business hours.
medical records and pathology Documented processes in place to

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results, reliable access to a access medications and medicines

dedicated desktop and/or laptop information outside these hours.
computer in the ward/clinical Education for nursing staff and
area. support for medical practitioners.
RDL Pharmacy Service Infrastructure & Service
Description Requirements Workforce

4 As for level 3. In addition, As for level 3. In addition, As for level 3. In addition, an after-
provide administration and medication service that is hours, on-call service for medication
pharmacy management available 24 hours. supply and clinical services, including
support. May provide medicines information, available 24
medicines procurement, hours.
dispensing and distribution
services.
5 As for level 3. In addition, As for level 4 plus 6 day service As for level 4. In addition, a
provide medicines and on call service. In addition, pharmacy team structured to deliver
procurement, dispensing and basic, non-sterile, services at multiple levels
distribution services. extemporaneous compounding throughout the organisation.
Contribute to drug and possibly with limited small-batch Specialist pharmacist positions
therapeutics committee or manufacturing for local hospital which reflect the range of specialist
equivalent. Provide support use, and sterile, individually services provided (e.g. ICU,
for clinical specialty services. compounded products (e.g. haematology, and medical
chemotherapy including oncology).
parenteral, targeted and oral
chemotherapy) The capacity to
respond to requests for
medicines information related to
direct patient care in a timely
manner, either through a
medicines/drug information
service or a service provided
internally. Undergraduate and
postgraduate pharmacy teaching
and training
6 As for level 5. In addition, As for level 5 plus 24 hours on- As for level 5. In addition, a full
provide support for highly call services and 7 days services. range of specialist pharmacist
specialised services. Active In addition, a specialised drug positions which reflect the range of
involvement in clinical trials information service may be specialist services provided (e.g. ICU,
and research activities. provided. Participates in haematology, medical oncology,
research, clinical trials and clinical cardiology, paediatrics, geriatrics,
reviews. Product evaluation with psychiatry, and drug information).
drug use/policy development. 24 hours on-call services and 7 days
services.

3. Medical Imaging

RDL Medical Imaging Infrastructure & Other Services

Service Description Service Workforce Required
Requirements (Mandatory)

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1 May provide low-risk A mobile or fixed Radiographer or if no N/A

ambulatory care general x-ray unit. radiographer available
services during Range of imaging then licensed x-ray
business hours and limited to x-ray of operator. Medical imaging
may provide some extremities, chest and interpreted by on-site
limited after-hours abdomen if service is doctor / health
services. This service delivered by licensed professional. Radiologist
involves a single, operators. readily contactable to
mobile or fixed, discuss findings and
general x-ray unit and provide a report.
is delivered by
licensed operators.
RDL Medical Imaging Infrastructure & Other Services
Service Description Service Workforce Required
Requirements (Mandatory)

2 As for Level 2. In As for Level 1. In As for Level 1. In addition, N/A

addition, service is addition, mobile on-site radiographer
predominantly service if present available during business
delivered by a sole limited to x-ray of hours.
radiographer and extremities, chest,
support may be abdomen. Dedicated x-
provided by licensed ray room with fixed x-
operators. There is a ray unit available,
designated room on- range of images not
site with a fixed x-ray restricted when a
unit and may also radiographer on duty.
include digital
radiography; however,
depending on the
range of services
provided at the facility
(e.g. day hospitals), a
mobile image
intensifier may be the
only modality
available. The service
may also have access
to ultrasound for non-
complex conditions.
3 As for Level 2. In As for Level 2. In As for Level 2. In addition, N/A
addition, provide low addition, on-site radiographer in
risk diagnostic designated attendance who has
radiology service as radiography rooms. regular access to
part of ambulatory Teleradiology facility radiological consultation.
and inpatient care. available. On-site Ultrasound performed by
Has a simple on-site ultrasound. a sonographer or
ultrasound capacity registered medical
for a foetal practitioner trained in
monitoring. ultrasound.

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4 As for Level 3. In As for Level 3. In As for Level 3. in addition Pharmacy - RDL3

addition, provide 24 addition, facilities for Staff radiographer on call HDU - RDL3
hour diagnostic general x-ray and 24 hours, Visiting OT - RDL3
radiology services, fluoroscopy, in specialist radiological Anaesthesia - RDL3
including urgent x- addition to mobile x- appointment. Registered
rays, Computed ray for wards, nurse as required. In
Tomography (CT), operating room and addition, after-hours
ultrasound and on-site emergency access to consultant
MRI. Provide access to department. MRI radiology for reporting.
basic diagnostic scanner CT facilities. On-site radiographer on-
angiography service; Mobile image call 24 hours Registered
may be networked. intensifier. Always has radiographers and
ultrasound. May have sonographers
CT scanner.
Teleradiology facility
available
5 As for Level 4. In As for Level 4. In As for Level 4. In addition, Laboratory - RDL4
addition, provide addition, all modalities Has radiologist incharge. Pharmacy - RDL4
access to 24 hour available including full May have radiology Nuclear Medicine -
complex diagnostic ultrasound service. registrar radiology and RDL4
radiology services. Basic digital registered nurse 24 hour OT - RDL4
Provide access to basic subtraction on site service for urgent Anaesthesia - RDL4
to intermediate level angiography (DSA) x-rays.
interventional suite for interventional
radiology service. services. Possibly MRI
and PACs available.

6 As for Level 5. In As for Level 5. In As for Level 5. In addition, - RDL5

addition, provide addition, single-plane medical officer/s in - RDL5
access to and/or biplane DSA radiology with three or -
comprehensive 24 suite. CT scanner on- more postgraduate years RDL5
hour interventional site. MRI scanner on- of experience. May have - RDL5
radiology service. site and PACs available. access to clinical imaging - RDL
Paediatric educator/tutor.
interventional
radiology provided by

hospital. May provide

MRI guided
interventional
radiology. May
provide trauma
interventional
radiology. May
provide interventional
neuroradiology

4. Nuclear Medicine

RDL Nuclear Medicine Infrastructure & Other Services

Service Description Service Requirements Workforce Required (Mandatory)

1 No Level 1 service. Refer to higher level.

2 No Level 2 service. Refer to higher level.
3 No Level 3 service. Refer to higher level.

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4 Provides basic Networking N /A

diagnostic nuclear arrangements must
medicine studies such include the provision
as bone, brain and of clinically
lung scans. Access to appropriate transport
nuclear medicine options; nursing care;
services either on-site and qualified
or with formal personnel.
networking
arrangements in place.

RDL Nuclear Medicine Infrastructure & Other Services

Service Description Service Requirements Workforce Required (Mandatory)
5 On-site (or locally Specialty services on- Nuclear medicine Laboratory - RDL3
based) licensed and site with consultation physician on-site during Pharmacy - RDL4
accredited nuclear available. One or more business hours. Medical Medical Imaging -
medicine facility gamma cameras radiation scientist (MRS) RDL4
operating during offering Single Photon nuclear medicine on-site HDU - RDL3
business hours. Emission Computed during business hours. OT - RDL3
Provide interventional Tomography (SPECT) Nuclear medicine physicist Anaesthesia - RDL3
studies requiring the combined with available during business
presence of a nuclear Computed hours. May have a
medicine physician, Tomography (SPECT- radiopharmaceutical
such as stress CT). Preparation or scientist available.
myocardial perfusion reconstitution of Nominated and trained
and captopril renal radiopharmaceuticals radiation safety officer.
studies. Offers with clear and
treatment with appropriate
radiopharmaceuticals documentation in
place, including details
of supply source,
preparation date and
batch number and
reconstitution.
6 As for Level 5. In As for Level 5. As for Level 5. In addition, Laboratory - RDL3
addition, provide 24 nuclear medicine Pharmacy - RDL5
hour on-call nuclear physician available 24 Medical Imaging -
medicine service. hours. Nuclear medicine RDL4
Provide services such physicist, preferably on- HDU - RDL3
as positron emission site. Radiopharmaceutical OT - RDL3
tomography (PET), scientist, preferably on- Anaesthesia - RDL3
cardiac stress testing, site.
bone densitometry,
and/or offer
radionuclide
therapies. Provide in
vitro tracer studies.

5. Intensive Care Unit

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RDL Intensive Care Unit Infrastructure & Other Services Required

Service Description Service Requirements Workforce (Mandatory)
1 No Level 1 service. Refer to higher level.
2 No Level 2 service. Refer to higher level.

3 No Level 3 service. Refer to higher level.

4 A Level 4 service Dedicated facility in Service director with Laboratory - RDL4

provides a self- the hospital. Staffed considerable experience in - RDL4
contained critical care and equipped bed intensive care Medical - RDL4
area with easy access capable of invasive officer competent in ear Medicine - RDL4
to the emergency medical ventilation Advanced Life Support - RDL4
department and Network arrangements responsible for reviewing - RDL4
operating theatres with Level 5/6 services patients. Specialist
within the facility. for transfer and back- Registered Nurse suitably
Provide immediate transfer. Access to qualified and experienced
resuscitation and training in Advanced nurse manager in charge
short-term Life Support (ALS) of unit. Minimum nurse-
cardiorespiratory patient ratio of 1:1 for
support for critically ill ventilated and similarly
patients. It must be critically ill patients.
capable of providing Additional supernumerary
mechanical ventilation registered nurse providing
and simple invasive assistance to bedside
cardiovascular nurses for every four
monitoring for a patients requiring 1:1
period of at least nursing All nurses trained
several hours in ALS. Access to allied
health professionals.
5 As for Level 4. In As for Level 4. In As for Level 4. In addition, Laboratory -
addition, has the addition, specialty at least one intensive care Pharmacy -
capability of providing services on-site physician or other medical Medical Imaging - RDL5
a high standard of available for specialist (intensivist) -
general intensive care consultation. accredited in intensive RDL5
including more Networked with a care medicine appointed. - RDL5
complex, extended, Level 6 service for Ideally all nursing staff - RDL5
multisystem life clinical advice and with, or working towards,
support. Provides professional recognised qualification in
mechanical ventilation, development support. intensive care or clinical
renal replacement Staffed and equipped specialty of unit. May have
therapy, invasive beds capable of clinical information system
cardiovascular invasive mechanical manager, data manager
monitoring for ventilation. Clinical and research officer.
extended periods. May workload of more than
be capable of providing 200 invasively
more advanced ventilated patients per
respiratory and annum to maintain
cardiovascular support clinical expertise.
using extracorporeal Alternatively, more
membrane than 150 invasively
oxygenation (ECMO). ventilated patients and
more than 50 patients
receiving non-invasive
ventilation (NIV).
Typically can
accommodate at least
four ventilated
patients at one time.

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6 As for Level 5. In As for Level 5. In As for Level 5. In addition, Laboratory - RDL6

addition, capable of addition, provide allied health professionals Pharmacy - RDL6
providing clinical advice and with specific skills in Medical Imaging -
comprehensive critical professional intensive care. RDL6
care, including development support Nuclear Medicine -
complex and for lower level RDL6
multisystem life networked services. OT - RDL6
support for an Clinical workload of Anaesthesia -RDL6
indefinite period. more than 300
Tertiary referral centre invasively ventilated
for patients in need of patients per annum to
complex intensive care maintain clinical
services from lower expertise. Typically can
level services within accommodate at least
region/network. eight ventilated
Provide support for patients at one time
super specialty and and extracorporeal
other complex activity. renal support services
and invasive
cardiovascular
monitoring for an
indefinite period, or
care of a similar nature

6. High Dependency Care

RDL High Dependency Care Infrastructure Other Services Required

Service Description & Service Workforce (Mandatory)
Requirements
1 No Level 1 service. Refer to higher level.
2 No Level 2 service. Refer to higher level.

3 Dedicated unit in health Dedicated Medical officer available Laboratory- DL2

facilities with no Intensive beds. 24 hours (may be on call). Pharmacy- RDL2
Care Service. Provide a Allied health professionals Medical Imaging - RDL2
higher level of monitoring such as physiotherapist, OT - RDL2
and observation than occupational therapist, Anaesthesia RDL2
standard ward based care speech therapist and/or
(e.g. cardiac monitoring, social worker available.
additional staff) as needed.
4 Dedicated unit in health
facilities with an Intensive
Care Service. Provide level
of care between standard
ward and an intensive care
unit (ICU), with close
monitoring and observation.
For example, patients
transitioning out of the ICU;
patients likely to need
intensive care outreach
support such as rapid
response or ICU liaison. May
provide non-invasive
ventilation (NIV) where the
intention is not to escalate
to invasive ventilation.
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5 As for Level 4. As for Level 4. As for Level 4. Laboratory - RDL5

Pharmacy - RDL5
Medical Imaging -
RDL5
Nuclear Medicine -
RDL5
ICU - RDL5
OT - RDL5
Anaesthesia - RDL5
6 As for Level 5. As for Level 5. As for Level 5. Laboratory - RDL6
Pharmacy - RDL6
Medical Imaging -
RDL6
Nuclear Medicine -
RDL6
ICU - RDL6
OT - RDL6
Anaesthesia - RDL6

7. Operating Suites

RDL Operating Suites Infrastructure & Other Services

Service Description Service Requirements Workforce Required (Mandatory)
1 No Level 1 service. Refer to higher level.
2 Provided in either a Dedicated procedure Appropriately Laboratory - RDL1
freestanding facility or is room and/or day credentialled - RDL2
collocated with a specialist operating room. medical Medical Imaging -
clinical service. Provide practitioner RDL2
procedures requiring available. Care - RDL2
analgesia and/or conscious predominantly
sedation (excludes general delivered by
anaesthesia). registered nurses.
3 Predominantly provided in As for Level 2. In As for Level 2. In Laboratory - RDL2
hospital setting with limited addition, appropriately addition, medical - RDL3
but designated surgical, equipped operating officer available 24 Medical Imaging -
anaesthetic and sterilising room. Access to allied hours (may be on RDL3
services. As for Level 2. In health services call). May have - RDL3
addition, provide Common commensurate with medical specialist a - RDL3
and Intermediate* surgical casemix and clinical with credentials in
procedures. May provide load. 24 hour cover for surgery. Registered
selected Major* surgical caesarian section if nurses utilised as
procedures performing obstetrics. surgical assistants
performing only
that role and not
duties of
instrument nurse.
Infection control
coordinator. Allied
health
professionals
available. Staff
available for
patient transfers.
4 As for Level 3. In addition, As for Level 3. In As for Level 3. In Laboratory - RDL4
provide Major* surgical addition, access to addition, access to - RDL4
procedures. image intensifier. May registered medical -

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have a second specialists with RDL4

operating room credentials in - RDL4
commensurate with general surgery - RDL4
patient load. available 24 hours.
Nursing staff with
perioperative
experience may be
utilised in variety of
roles. Sterilising
service assistants
and technical aides
appropriate to
service provided.
Access to
laboratory staff.
5 As for Level 4. In addition, As for Level 4. In As for Level 4. In - RDL5
provide selected Complex addition, specialty addition, access to - RDL5
Major* surgical procedures. services on-site with registered medical Medical Imaging - RDL5
24 hour on call availability. consultation available. specialists with - RDL5
Usually more than two credentials in - RDL5
operating rooms. general surgery or
Provide support for surgical
lower level networked subspecialties
services. available 24 hours.
Medical officer with
three or more
postgraduate years
of experience on
call 24 hours,
ideally training or
qualified as
anaesthetist.
6 As for Level 5. In addition, As for Level 5. In As for Level 5. In - RDL6
provide Complex Major* addition, equipped for addition, medical - RDL6
surgical procedures. highly specialised officer with three -
Manage patients at the procedures (e.g. or more RDL6
highest level of surgical cardiopulmonary postgraduate years - RDL6
risk^. Provide specialised bypass, extracorporeal of experience on- Anaesthesia - RDL6
surgery such as membrane site 24 hours,
cardiothoracic surgery oxygenation (ECMO). ideally training or
and/or neurosurgery. May qualified as
have regional role (e.g. anaesthetist.
major trauma service, Trained assistant to
transplant services). surgeon, as
required.

8. Anaesthetics

RDL Anaesthetics Infrastructure & Other Services

Service Description Service Requirements Workforce Required (Mandatory)
1 No Level 1 service. Refer to higher level.
2 Analgesia and conscious Formal network Registered medical Laboratory - RDL2
sedation available. Provide linkages with specialist practitioner Visiting - RDL2
anaesthesia for ASA 1 and anaesthetist for registered medical - RDL2
2^ patients undergoing consultation Medical specialist with
Minor* surgical procedures. practitioner to provide credentials to

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analgesia/ minimal administer general

sedation. May have anaesthetic.
operating/ procedure Registered nurses
room. Recovery area with
for post surgical experience/post
procedures may be graduate
combined with general qualifications in
ward, with trained anaesthetic nursing
recovery staff and
facilities as required.
3 As for Level 2. In addition, As for Level 2. In As for Level 2. In - RDL3
provide anaesthesia for ASA addition, at least one addition, - RDL2
1, 2^ and selected ASA 3^ operating/ procedure anaesthetist RDL3
patients undergoing room with separate appointed for - RDL3
Common and Intermediate* on-site, dedicated consultation and - RDL3
surgical procedures. May recovery area/ room service.
provide anaesthesia for ASA for post-operative
1 and 2^ patients care. Access to High
undergoing selected Major* Dependency or
surgical procedures. Provide Intensive Care Unit
anaesthesia for ASA 3 and (ICU) (may be off-site)
selected ASA 4^ patients On-site emergency
undergoing Minor* surgical service able to stabilise
procedures and transfer patients
that experience
deterioration. Elective
anaesthetic services
are generally provided
during business hours
for regularly scheduled
lists. On-site
medication.
4 Broad range of day and As for Level 3. In As for Level 3. In Laboratory - RDL4
general surgery and some addition, more than addition, medical - RDL4
specialty surgery. As for one theatre. head of service Medical Imaging- RDL4
Level 3. In addition, provide with considerable - RDL4
anaesthesia for ASA 1, 2^ experience in
- RDL
and selected ASA 3^ anaesthesia.
patients undergoing Major* Anaesthetist
available 24
surgical procedures. Provide
hours. Medical
anaesthesia for ASA 3^ and
officer on-site 24
some ASA 4^ patients hours.
undergoing selected
Common and Intermediate*
surgical procedures. Provide
appropriate care for ASA 5^
and ASA 6^ patients.
5 As for Level 4. In addition, As for Level 4. In As for Level 4. In Laboratory - RDL5
provide anaesthesia for ASA addition, specialty addition, - RDL5
1 and 2^ patients services on-site for anaesthetist on-site
undergoing selected consultation. in business hours. Imaging RDL5
Complex Major* surgical Medical officer in - RDL5
procedures. Provide anaesthesia with - RDL5
anaesthesia for ASA 3 to 5^ three or more
patients undergoing postgraduate years
Common and of experience on
Intermediate*, and selected call 24 hours.
Major* surgical procedures

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6 As for Level 5. In addition, As for Level 5 As for Level 5. In Laboratory - RDL6

provide anaesthesia for all addition, - RDL6
levels of patient risk^ subspecialist -
undergoing Complex Major* anaesthetists. RDL6
surgical procedures. Medical officer in - RDL6
Subspecialty anaesthesia anaesthesia with T - RDL6
on site, such as three or more
neurosurgery, postgraduate years
cardiothoracic surgery of experience on-
and/or burns. site 24 hours.
Broad range of
surgical
sub specialties on-
site and available at
close proximity 24
hours.
Levels of Patient Risk:
Based on the American Society of Anesthesiologists (ASA) Physical Status Classification System

ASA1 A normal, healthy patient.

ASA2 A patient with mild systemic disease and no functional limitations.
ASA3 A patient with moderate to severe systemic disease that results in some functional limitation.
ASA4 A patient with severe systemic disease that is a constant threat to life and functionally incapacitating.
ASA5 A moribund patient who is not expected to survive 24 hours with or without surgery.
ASA6 A declared brain-dead patient whose organs are being removed for donor purposes.

Section 2: Clinical Services

9. Part A: Emergency

Emergency Infrastructure & Other Services

RDL Service Description Service Requirements Workforce Required (Mandatory)

Provide primary care Referral arrangements Staff on-site during N/A

assessment within for higher level business and operational
1 designated area of emergency medicine hours with basic life
facility. Primarily nurse service. Formal support capability for
and medical escalation plan for adults and children.
practitioner-led obtaining immediate
clinical assistance
when critically ill
patient received.
2 As for Level 1. As for Level 1. As for Level 1. In addition, Laboratory RDL1
medical practitioner on Pharmacy RDL1
call or available via Medical Imaging
telehealth. RDL1

Provide emergency As for Level 2. In As for Level 2. In addition, - RDL3

care within a addition, purpose some nurses with extra - RDL2
designated area of specific area to receive training in emergency care -
facility. Emergency and manage and triage. May have RDL3
caseload may be emergency allied health professionals - RDL3
intermittent. Basic presentations, available. - RDL3
primary and secondary including a collocated - RDL3
assessment should be resuscitation area with
available, including appropriate equipment

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Advanced Life Support for advanced

3 (ALS) and stabilisation paediatric, adult and
of critically ill trauma life support
paediatric, adult and prior to transfer to
trauma patients prior definitive care. Access
to arrival of the to specialty services
retrieval service. On- (may be via telephone
site, 24-hour access to and/or hospital
designated emergency outreach) such as
registered nurses and surgical, medical,
triage of all orthopaedics, mental
presentations. health, paediatrics,
obstetrics and
gynaecology; with
ability to transfer and
refer. Access to formal
ALS education and
training for staff. May
have access to allied
health. On-site ICU or
HDU.
Manage full range of As for Level 3. In As for Level 3. In addition, Laboratory - RDL4
emergency addition, full specialist emergency Pharmacy - RDL4
presentations, resuscitation facilities medicine staff on-site in Medical Imaging -
including some in a separate space. line with casemix and RDL4
complex emergency Services that receive clinical load. Medical Nuclear Medicine -
cases. Provide primary paediatric patients officers with a range of RDL4
emergency care, must have dedicated postgraduate years of ICU - RDL4
including short term area for paediatric experience rostered to OT - RDL4
mechanical assessment and work in the emergency Anaesthesia - RDL4
4 ventilation, pending management, department over 24 hours.
transfer to definitive including resuscitation. Allied health professionals
care. Provide a 24 Documented processes such as social worker,
hour clinical triage to guide clinical physiotherapist,
service. May have a management, occupational therapist,
dedicated short stay including paediatrics, and/or dietitian available.
unit managed within mental health and Administrative and service
and by the emergency obstetrics/gynaecology support staff on-site 24
department. as appropriate. Access hours
to medical and surgical
specialties; tertiary
level paediatrics;
higher level critical
care services; mental
health services; drug
and alcohol
dependency services;
and community
services. Access to
allied health services in
line with casemix and
clinical load. Formal
processes to ensure
readily available, 24
hour patient transfer
and back transfer.
Clinical information
system that records
patient details, clinical

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information and data.

Point of care
ultrasound service. On-
site ICU.

As for Level 4. In As for Level 4. In As for Level 4. In addition, Laboratory - RDL5

addition, provide addition, specialty 24 hour specialist Pharmacy - RDL5
definitive care for services on-site for emergency medicine cover Medical Imaging -
most emergency consultation. Purpose (may include on call). RDL5
5 presentations, built resuscitation area Extended hours access to Nuclear Medicine -
including invasive for trauma and other selected allied health RDL4
monitoring. May have life-threatening professionals, such as ICU - RDL5
short stay unit or presentations. Specific social worker and/or OT - RDL5
similar model, safe area for mental physiotherapist. Anaesthesia - RDL5
managed within and health patients.
by the emergency Emergency medicine
department. Able to short stay unit capable
manage critically ill of monitoring and
patients assessment. Extended
hours access to allied
health services.
6 As for Level 5. In As for Level 5. In As for Level 5 Laboratory RDL6
addition, manage all addition, on-site back- Pharmacy RDL6
complex emergencies. up from a full range of Medical Imaging
Major referral centre medical and surgical RDL6
for complex patients sub specialists and Nuclear Medicine
from lower level diagnostic services, RDL5
services within the including ICU RDL6
region neurosurgery, OT RDL6
cardiothoracic surgery, Anaesthesia RDL6
vascular surgery and
angiography.

Part B: Medicine

1. Cardiology & Interventional Cardiology

Cardiology &
RDL Interventional Infrastructure & Workforce Other Services
Cardiology Service Service Requirements Required (Mandatory)
Description

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Provides primary care Protocols to manage Medical practitioner N/A

assessment as low- thrombolysis and available. All medical
1 acuity, ambulatory arrhythmias. Provision practitioners trained in
care for minor cardiac of basic cardiovascular Advance life support.
diseases and risk factor/ disease Access too suitably
management of acute prevention qualified and experienced
conditions with the information. Access to Registered Nurse/ Nurse
ability to provide basic an electrocardiogram Assistant.
life support. Health (ECG) reading service.
promotion, disease Access to emergency
prevention and patient transport to
chronic disease facilitate escalation of
management care and patient
programs available. transfer when required
Delivered by general
practitioners in an
outpatient setting,
may incorporate nurse
led services.
2 As for Level 1. . In As for Level 1. . In As for Level 1. In addition, Laboratory RDL3
addition, provides a addition, 24 hour medical practitioner Pharmacy RDL3
low-acuity, access to specialist available 24 hours (may Medical Imaging
single system medical support and advice include telehealth). Access RDL3
condition ambulatory (may include too suitably qualified and OT - RDL2
and outpatient telehealth). Access to experienced Registered Anaesthesia - RDL2
service. Provided by digital ECG machine Nurse/ Nurse Assistant.
medical practitioner with appropriate Qualified to carry out 12
who may be general support from higher
practitioner or level services to safely access to allied health
cardiologist. Basic and effectively operate professionals, as required.
primary and secondary and maintain
assessment should be equipment. Ability to
available, including perform point of care
Advanced Life Support testing. Access to allied
(ALS) and stabilisation health services in line
of critically ill with casemix and
paediatric, adult and clinical load. Access to
trauma patients prior automated external
to arrival of the defibrillator, oxygen
retrieval service. and ability to achieve
Ability to assess and venous access.
stabilise patients and
initiate low level care,
prior to transfer for
specialist assessment
and treatment where
appropriate. Patient
who require complex
diagnostic
investigations will also
be referred to high
level cardiac medicine
services. May initiate
treatment for ST
elevation myocardial
infarction (STEMI)
prior to transfer to
facility with
angiography. Service

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provided by registered
medical practitioner in
an outpatient setting.

As for Level 2. In As for Level 2. In As for Level 2. In addition, Laboratory RDL3

addition, provides addition, provides medical practitioner or Pharmacy RDL3
ambulatory and inpatient, outpatient specialist on site 24 hour Medical Imaging
inpatient services that and non-acute care led access. Access to RDL3
may require by a cardiologist and cardiologists at higher OT RDL3
subspecialty supported by visiting level services. 24 hour Anaesthesia RDL3
outpatient referral. medical specialists cover by Registered Nurse. HDU-RDL3
Provide cardiac care and/or via telehealth. Access to cardiac Anaesthesia - RDL3
for stabilisation of Stabilisation of patient rehabilitation nurse,
arrhythmias, acute where required prior cardiac nurse practitioner
3 coronary syndrome to transfer to higher or clinical nurse specialist
(ACS), and nonST level service. Elective (cardiac/health
elevation myocardial diagnostic promotion). Access to
infarction (NSTEMI). investigations some allied health services
Manage ACS/STEMI in performed. Ability to ie physiotherapy
consultation with high provide thrombolysis,
level cardiology and blood gas
service. Admitted monitoring. Formal
patients managed by referral protocols
cardiologist or established with higher
physician with level services.
experience in
cardiology. Provide
follow up care for
permanent
pacemakers. May be
able to insert
temporary
transvenous pacing
wire prior to transfer
(desirable)
As for Level 3. In As for Level 3. In As for Level 3. In addition, Laboratory RDL4
addition, provides addition, transvenous cardiologist head of Pharmacy RDL4
inpatient cardiology pacing available. May service responsible for Medical Imaging
care to patients with have Cardiac clinical governance RDL4
moderate level of Catheterisation procedures and audit. OT RDL4
complexity. Laboratory (CCL). Cardiologist or physician Anaesthesia RDL4
Outpatient with cardiology experience Nuclear Medicine -
consultation is available 24 hours. RDL4
provided by a Medical officer with three ICU - RDL4
cardiologist. On site or more postgraduate
access to intensive years of experience on-
care and/or cardiac site 24 hours. Allied health
4 care unit. Admitted professionals on-site.
patients managed by
cardiologist or internal
registered medical
specialist with
experience in
cardiology. May
provide cardiac
rehabilitation service
and heart failure

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program. May provide

diagnostic coronary
angiography.

As for Level 4. In As for Level 4. In As for Level 4. In addition, Laboratory RDL5

addition, manages all addition, a CCL. cardiologist with Pharmacy RDL5
but most highly Designated cardiology procedural expertise Medical Imaging
complex cardiac beds available 24 hours. Cardiac RDL5
medicine patients and technician or OT RDL5
procedures. echoradiographer Anaesthesia RDL5
Designated cardiology available 24 hours Nuclear Medicine
beds providing RDL5
comprehensive ICU RDL5
subspecialty services,
with advanced range
of supporting clinical
5 and diagnostic services
to match complexity
of patients admitted
and referred. All
admitted patients
managed by
designated registered
medical specialist with
credentials in
cardiology. Provide
interventional cardiac
catheterisation
service. May provide
electrophysiology
services such as
pacemaker insertion.
May provide 24 hour
on call service for
urgent Acute
Myocardial Infarction
(AMI) presentations.
6 As for Level 5. In As for Level 5. In As for Level 5. In Laboratory RDL6
addition, provide addition, addition, cardiologist on Pharmacy RDL6
tertiary/quaternary cardiothoracic call 24 hours, with Medical Imaging
referral service for surgery available on- sufficient cardiologists to RDL6
complex and critical site. provide sustainable 24
OT RDL6
cardiac conditions, hour cover. Medical
Anaesthesia RDL6
including officer in cardiology with
electrophysiology three or more Nuclear Medicine
services and postgraduate years of RDL6
management of experience ICU RDL6
adult congenital
heart disease.
Provide 24 hour
primary
Percutaneous
Coronary
Intervention (PCI)
services. Act as a
referral service for all
lower level cardiac
medicine services.

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2. Clinical Genetics

RDL Clinical Genetics Infrastructure & Other Services

Service Description Service Requirements Workforce Required (Mandatory)
1 No Level 1 service. Refer to higher level.
2 No Level 2 service. Refer to higher level.
Consultative genetics Access to specialist Clinical geneticist Laboratory RDL1
service provided via support and advice. and/or other Medical Imaging -
networked arrangement Access to genetics medical specialist RDL1
with higher level service. information resources, available. Certified
3 Documented processes for education programs or associate genetic
screening and recognising at and genetics services counsellor
risk patients. Provide information. available.
information and education
through established support
groups after diagnosis.
As for Level 3. In addition, As for Level 3. In As for Level 3. In Laboratory RDL3
provide information and addition, access to addition, certified
counselling for individuals genetic counselling and or associate genetic RDL2
and family members. diagnostic services. counsellor. Allied
4 Arrange genetic testing as Access to genetic health
required. May be provided testing laboratory. professionals
within a multidisciplinary Access to other clinical available in line
setting. specialties on-site. with patient
casemix and clinical
load.
5 As for Level 4. In addition, As for Level 4. In As for Level 4. In Laboratory RDL6
provide consultative service addition, other clinical addition, clinical
within a multidisciplinary specialties on site geneticist RDL2
setting. Provide counselling available for appointed. May
and diagnostic services by consultation. Access to have other medical
clinical geneticists. May other specialties that specialists with a
provide specialised genetic use genomics such as scope of practice in
services such as metabolic oncology, neurology, genetics. May have
medicine, cancer cardiology. May have medical officer in
genetics/familial cancer, specialised genetic clinical genetics
high risk reproductive testing laboratory with three or more
disorders, cardiac genetics, service onsite (e.g. postgraduate years
neurogenetics, prenatal metabolic genetics). of experience
genetics.
As for Level 5. In addition, As for Level 5. In As for Level 5. In Laboratory RDL6
6 may have specialist role addition, genetics addition, head of
(e.g. expertise in a specific department. service. Medical RDL2
disorder, newborn screening officer in clinical
program, metabolic genetic genetics with three
service), including support or more
for acute inpatient care of postgraduate years
metabolic genetic of experience.
conditions.

3. Dermatology

RDL Dermatology Service Infrastructure & Other Services

Description Service Requirements Workforce Required (Mandatory)

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1 No Level 1 service. Refer to higher level.

Limited service with Access to clinical Appropriately Laboratory RDL
management primarily by advice and support credentialled Medical Imaging -
general practitioner or (may include medical RDL1
general physician. Access to telehealth) practitioner or
2 patient education and physician. Medical
support programs. and/or nurse
practitioner
available on site.
Access to
emergency patient
transport service.
As for Level 2. As for Level 2. In As for Level 2. In Laboratory RDL4
3 addition, allied health addition, Pharmacy RDL2
services on-site in line dermatologist
with patient casemix available via
and clinical load. network, telehealth
or outreach.
Physician available
24 hours. Medical
officer with three
or more
postgraduate years
of experience.
Access to allied
health
professionals.
4 As for Level 3. In addition, As for Level 3. In Laboratory RDL4
provide inpatient addition, consultation Pharmacy RDL2
consultative service to other available from other Medical Imaging -
specialties. May provide clinical specialties RDL2
outpatient clinic. May on site. Access to OT - RDL2
provide Minor* community nursing Anaesthesia - RDL2
dermatological procedures
on ASA 1, 2 and 3^ patients.
5 As for Level 4. In addition, As for Level 4. In As for Level 4. In Laboratory RDL4
provide inpatient service addition, access to addition, may have Pharmacy RDL2
with management by facilities for surgical medical officer with Medical Imaging -
medical practitioner or procedures. May have three or more RDL2
dermatologist. Provide phototherapy unit. postgraduate years OT - RDL2
outpatient services. Provide Access to Level 5 of experience. Anaesthesia R DL2
Minor* dermatological radiation oncology Nuclear Medicine -
procedures on ASA 1, 2 and service. Access to Level RDL4
3^ patients. Provide 4 general surgery - RDL4
consultative service for
complex conditions (e.g.
drug reactions, autoimmune
diseases, infections). May
provide specialised clinics
(e.g. psoriasis, eczema).
6 As for Level 5. In addition, As for Level 5. In As for Level 5. In Laboratory RDL6
provide inpatient services. addition, dermatology addition, medical Pharmacy RDL5
Provide Common and department. head of service. Medical Imaging
Intermediate* and Major* Dermatology beds. May have RDL5
dermatological procedures Phototherapy unit. dermatologist OT RDL5
on all levels of patient risk^. Provide support to available 24 hours. Anaesthesia RDL5
Provide consultative service lower level networked Medical officer with Nuclear Medicine -
to patients with complex services, including three or more RDL4

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conditions within a clinical advice and postgraduate years RDL5

multidisciplinary setting professional of experience.
(e.g. emergency medicine, development support. Medical officer on-
oncology, haematology, Access to procedural site 24 hours to
immunology, rheumatology, facilities for advanced provide patient
infectious diseases). surgical procedures care. Phototherapy
Specialised dermatology (e.g. complex/wide nurse.
clinics (e.g. psoriasis, excision, skin grafts,
eczema, skin cancer, flaps). Access to laser
transplant). Provide patient equipment (may be
education and support off-site) for treatment
programs. May have a of non-cosmetic
regional role or expertise in medical conditions
a particular area (e.g. (e.g. birthmark,
melanoma service, neonatal congenital
dermatology, burns, malformation) where
cutaneous lymphoma). relevant to casemix
and patient load.
Access to radiotherapy
where relevant to
casemix and patient
load. May have access
to electron
microscopy.

4. Endocrinology

RDL Endocrinology Service Infrastructure & Other Services

Description Service Requirements Workforce Required (Mandatory)
1 No Level 1 service. Refer to higher level.
Provide limited outpatient Access to specialist Medical or nurse Laboratory RDL
service, with management support and advice practitioner Pharmacy - RDL1
and appropriate referral by (may include available 24 hours. - RDL1
medical or nurse practitioner. telehealth). Access to Formal relationship -
2 emergency patient with emergency RDL1
transport service to patient transport
facilitate escalation of service. Physician
care and patient consultation
transfer when available (may
required. Access to include telehealth).
telehealth support and Allied health
limited outreach clinics professionals such
(e.g. podiatry, as podiatrist and
dietetics). Access to dietician available.
allied services in line
with patient case mix
and clinical load.

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As for Level 2. In addition, As for Level 2. In Laboratory RDL3

provide inpatient service, addition, consultation Pharmacy RDL3
predominantly diabetes, with available from other Medical Imaging -
management by general clinical specialties. RDL3
practitioner (GP) or general Access to health HDU - RDL3
3 physician. May provide education services OT - RDL2
diabetes relevant to endocrine Anaesthesia -
outpatient/ambulatory diseases such as RDL2
service. May provide local diabetes. Access to
support in diabetes dietetic service. Access
management for primary care to podiatry service
and aged care facilities. (may be off-site).
Access to high risk foot
service via network or
telehealth. Access to
community nursing.
As for Level 3. In addition, As for Level 3. In As for Level 3. In - RDL4
provide diabetes addition, on-site addition, physician - RDL4
outpatient/ambulatory dietetic service. On- available 24 hours.
services. Provide diabetes site podiatry service. Paediatrician RDL4
education service. May have Access to an integrated appointed if -
access to paediatric diabetes hospital/community children seen. RDL4
4 service (e.g. initial diabetes management Medical officer on- - RDL4
assessment, acute and service. Access to renal site 24 hours. May - RDL4
chronic management) and cardiology services have visiting - RDL4
provided by general for consultation endocrinologist.
paediatrician. May provide Medical officer with
gestational diabetes service. three or more
May provide basic bone postgraduate years
metabolism and thyroid of experience.
services; lipid disease Allied health
management; management of professionals on-
disorders of appetite and site, including
weight. dietitian and
podiatrist
Infrastructure & Other Services
RDL Endocrinology Service Service Workforce Required
Description Requirements (Mandatory)

5 As for Level 4. In addition, As for Level 4. In As for Level 4. In - RDL5

manage a range of addition, provide addition, - RDL5
endocrinology presentations, networked support to endocrinologist -
including some complex lower level services, appointed. Medical RDL5
cases. Provide inpatient including clinical advice officers with three -
consultative service to other and professional or more RDL5
specialties. May provide development support. postgraduate years - RDL5
services in thyroid, adrenal, Allied health services of experience on- - RDL5
pituitary medical on-site in line with site 24 hours. Allied - RDL5
management; reproductive casemix and clinical health
endocrinology; bone load. Links with renal professionals on-
metabolism; disorders of (especially for dialysis), site in particular,
appetite and weight; and/or vascular, orthopaedic social worker,
lipid disorders. May provide and neurosurgery physiotherapist,
high risk foot service. May services. Access to and/or
provide insulin pump rehabilitation services, occupational
education/provider service. particularly amputee, therapist. May have
stroke and cardiac exercise
rehabilitation. Access physiologist and

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to ophthalmology psychologist
service with expertise
in the management of
diabetes-related eye
conditions, including
laser therapy.
6 As for Level 5. In addition, As for Level 5. In As for Level 5. In - RDL6
manage complex cases addition, addition, medical - RDL6
including specialised surgical endocrinology beds. head of service. -
and medical interventions. Endocrinology Endocrinologist on RDL6
Provide consultative department. Shielded call 24 hours. -
inpatient, outpatient and treatment room if Medical officer in RDL5
ambulatory service to ablative thyroid endocrinology with - RDL6
patients with complex treatment is offered. three or more RDL6
conditions in a On-site ophthalmology postgraduate years - RDL
multidisciplinary setting (e.g. laser service. Access to of experience.
intensive care, bone densitometry
transplantation, diagnostic equipment.
ophthalmology, neurosurgery, Access to surgical
high risk obstetrics, services such as
gynaecology, oncology). neuroendocrine,
Paediatric service provided by cardiac, vascular,
orthopaedics, relevant
Provide high risk foot service. to the casemix and
Provide insulin pump service. patient load. Access to
May provide specialty cardiovascular, renal
outpatient/ambulatory clinics. and cancer care
May support neuroendocrine services and other
surgery. May have regional speciality services
role (e.g. neuroendocrine relevant to the casemix
surgery) and patient load.

5 Gastroenterology

Infrastructure & Other Services

RDL Endocrinology Service Service Workforce Required
Description Requirements (Mandatory)

1 Management and appropriate Access to specialist Medical or nurse RDL1

referral by medical support and advice. practitioner RDL1
practitioner or nurse Access to emergency available during
practitioner patient transport business hours. RDL1
service to facilitate RDL1
escalation of care and RDL1
patient transfer when
required.
2 As for Level 1. In addition, As for Level 1. In As for Level 1. In RDL2
may have networked addition, access to addition, physician RDL2
endoscopy and colonoscopy health education or
services (predominantly service. May have gastroenterologist RDL2
diagnostic) on ASA 1, 2^, and access to hepatology available. May have RDL2
selected ASA 3^ patients, service. May have access to dietitian. RDL2
provided by a specialist access to Inflammatory
proceduralist from a higher Bowel Disease (IBD)

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level, performed under service. May have

sedation only. access to allied health
services in line with
casemix and clinical
load.
3 As for Level 2. In addition, As for Level 2. In As for Level 2. In Laboratory RDL3
provide endoscopy and addition, consultation addition, RDL3
colonoscopy service with available from other appropriately
some therapeutic clinical specialties. credentialled RDL3
interventions, on ASA 1, 2^ Access to allied health medical RDL3
and selected ASA 3^ patients. services, including practitioner, RDL3
dietetics service in line physician, surgeon
with casemix and and/or
clinical load. Access to gastroenterologist
community nursing. appointed. Medical
officer available 24
hours. Access to
dietitian.
4 As for Level 3. In addition, As for Level 3. In As for Level 3. In
provide enteral procedures addition, allied health addition,
(e.g. insertion, replacement services on-site in physician and/or
and removal of gastrostomy line with casemix and surgeon available
tubes). Provide home clinical load. 24 hours. Medical
enteral nutrition including officer on-site 24
follow-up care, nutrition hours. Medical
support officer with three
(oral/enteral/parenteral) or more
and equipment (e.g. postgraduate
feeding pumps, giving sets, years of
syringes). May provide experience. Allied
manometry health
professionals
such as dietitian,
social worker and
speech
pathologist.

Role delineation level (RDL)

To illustrate the difference in RDL for an Intensive Care Service provided by a major Metropolitan
hospital. They incorporates Teaching and Research will be at RDL 6. The same service provided
at a small General hospital without Teaching and Research facilities will be at RDL 4. At higher
RDLs the service provision will require access to higher levels of skill and additional,
complementary services. For example Surgery at RDL 5 will require Intensive Care and more
supporting services.

The relationships between all the services and the inter-dependence of the services at each RDL
results in a large matrix in one side and 6 RDLs on the other side.

The operators of health facilities and/or the designers need to decide what services they wish to
provide as well as the RDL for those services. Only then, the facility requirements can be
determined and verified. For example, the number, type and size of rooms for an ICU service at
RDL 6 will be different to one at RDL 4.

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Ministry of Health provide a Role Delineation Guide which sets out the most common health
services under each RDL. Under each category the requirements and dependencies are stated.
The Role Delineation Guide is enclosed at the end of this section.

A blank version of the Role Delineation Guide is available in electronic spreadsheet format to
allow the proposed services and RDLs to be listed. This is known as the Role Delineation Matrix.
This RDL Matrix can be used by the Health Facility Planning team to prepare the Facility Brief. It is
also used by the Ministry of Health Authority to assess applications for health facilities (refer to
Part A of the International Health Facility Guidelines)

Role delineation guide

The Role Delineation Guide is described in Part B, Volume 1, Appendix A of this document.

3 Standard Components
The FPU Schedules of Accommodation by RDL includes listings of Standard Room Types
required. In order to assist designers to have a better understanding of the requirements of each
room type, the International Health Facility Guidelines includes a comprehensive set of Standard
Components. These Standard Components are represented by two sets of documents:

Room Data Sheets (RDS)

These are written descriptions of each room type, described under various categories:

Room Primary Information; includes Briefed Area, Occupancy, Room Description and
relationships, and special room requirements.
Building Fabric and Finishes; identifies the fabric and finish required for the room ceiling,
floor, walls, doors and glazing requirements.
Furniture and Fittings; lists all the fittings and furniture typically located in the room.
Fixtures and Equipment; includes all the serviced equipment typically located in the room
along with the services required such as power, data and hydraulics.
Building Services; indicates the requirement for communications, power, Heating, Ventilation
and Air conditioning (HVAC), medical gases, nurse/ emergency call and lighting along with
quantities and types as relevant.

Refer to Volume 2 and Volume 3 of Part B for the full set of Room Data Sheets.

Room Layout Sheets (RLS)

These are individual sheets incorporating typical design of rooms at 1:50 scale with abbreviations,
dimensions etc. Each Room Layout Sheet includes a Plan as well as 4 or more elevations
showing the installation height of elements.

Note: These Room Layouts are indicative plan layouts and elevations illustrating an example of
minimum acceptable design standard. The Room Layouts shown are deemed to satisfy these
Guidelines. Alternative layouts and innovative planning shall be deemed to comply with these
Guidelines provided that the following criteria are met:

Compliance with the text of these Guidelines.

Minimum floor areas as shown in the schedule of accommodation.
Additional 2m2 added for each additional door above the minimum required area.
Heights and dimensions where shown.
Any Clean/ Dirty separations shown or implied.

International
Health Facility Guidelines © TAHPI Part B: Version 4 2014 Page 32