This guideline outlines the requirement for clarity concerning responsibility for clinical care for each patient, public or private, at Ballarat Base Hospital.

It is not uncommon for patients who have been booked or treated elsewhere as a private patient to attend or be admitted to Ballarat Health Services as an emergency for public hospital care. This may be by arrangement by their private doctor or may occur when patient attends or is brought by ambulance to the emergency department of Ballarat Base Hospital.

Patients may also be privately booked to deliver at Ballarat Health Services and choose to be admitted publicly for an admission.

This guideline outlines the requirement for clarity concerning responsibility for clinical care for each patient, public or private, at Ballarat Base Hospital.

Private patient a Medicare eligible patient who elects to be a private patient and who chooses her/his own doctor and is responsible for the payment of hospital accommodation, medical and other fees. Private patients may elect to use their health insurance or may self-fund.

Public patient - a Medicare eligible patient who elects to be a public patient and to receive treatment by hospital doctors and to receive their hospital treatment free of charge.

Nurses and midwives are responsible for escalation to the appropriate medical practitioner.

Junior medical staff are responsible for escalation to the appropriate Consultant practitioner.

Consultant medical staff are responsible for the provision of care to public patients in accordance with their roster and to private patients.

Guideline

Admitted patients

A patient who requires public admission and has had care and/or has been booked elsewhere as a private patient, or is booked at BHS as a private patient.

• If clinically appropriate may be given the option of admission to the private hospital at which she is booked.       

• If she is admitted to Ballarat Health Services she must be given the option of being admitted as a private or as a public patient.

• May be admitted to Ballarat Health Services as a private patient in accordance with BHS procedure on Private Maternity Bookings and Admission procedure, if her doctor has admitting rights at BHS and if the doctor accepts the private admission, and is available to provide the care.

• May be admitted as a public patient if the patient so chooses, or if the private doctor does not have admitting rights or if the private doctor is not available to provide the care.

If a patient is admitted as a public patient

Check the Election Form for Admission in the medical record to determine if public or private.

Hospital staff may:

• As a courtesy, advise the private practitioner of the admission and of discharge.

• Seek clinical information or investigation results from the private practitioner.

Hospital staff will:

• Escalate clinical decision making, including decision to discharge, to the public consultant responsible for the care and not to the private practitioner.

The private practitioner may:

• Attend the patient in the hospital as a courtesy

• Provide clinical information or investigation results to the treating team

• Contact directly, the hospital public consultant responsible for the patients care to discuss any aspect of the patients care.

The private practitioner may not:

• Make decisions concerning care and treatment of the patient, including discharge, nor communicate these to junior medical or nursing/midwifery staff.

• Bill for any attendance on a public inpatient.

• The patient's admission status cannot be changed partway through the admission from Public to Private.

If a patient is admitted to Ballarat Health Services as a private patient

Only Consultants who are credentialed to practice at Ballarat Health Services may provide care to private patients. This includes the admitting practitioner, any attending locum or relieving practitioner, anaesthetist, neonatologist/paediatrician or surgical assistant. If a credentialed private practitioner is not available to provide private care, the patient may be admitted as a public patient. Private practitioners are expected to comply with Ballarat Health Services policies and procedures and to provide care to private patients in accordance with Ballarat Health Services clinical practice guidelines.

 The private practitioner may:

• In an emergency ask a junior doctor / public consultant on call to attend a private patient to make an assessment and provide emergency treatment.

• Invite a junior doctor to participate in the care of a patient which provides a particular learning opportunity for the junior doctor.

The private practitioner must:

• Escalate any clinical concerns regarding the private patient to the O and G public consultant on call / Anaesthetic public consultant on call / Consultant pediatrician/ neonatologist on call (public) especially if involving management from another unit or planning to deliver a patient who has been previously booked at a tertiary centre.

• Consent the private patient for any procedure themselves and not ask junior staff to organise to open theatre or to consent the patient.

• Ensure that a credentialed practitioner is available to provide care during periods of leave, and communicate this to the hospital staff.

 Compliance to this guideline will be monitored by an annual audit of a sample of medical records.