The latest figures released by the Australasian College for Emergency Medicine (ACEM) reveal deteriorating and unacceptable access block and overcrowding, with patients in South Australia, Tasmania and Canberra most at risk.
Access block occurs when patients have to stay longer in the emergency department because there aren’t beds in wards of the hospital. It illustrates a problem with the whole hospital system.
ACEM President Dr Simon Judkins said: “Governments need to implement solutions now to avoid increased risk of complications, errors, death and increased costs to the health care system.
“Anecdotal evidence from our members point to deteriorating conditions at the Royal Adelaide Hospital, the Royal Hobart Hospital and Canberra Hospital, significantly impacting the emergency departments’ ability to deliver quality, timely care to patients when they most need it.”
Dr Judkins said increased demand on emergency departments, which happens every winter, are predictable, and “proper planning has the potential to correct our current scenario”.
“Often Governments claim that winter demand is unprecedented – but we know that it’s not; it happens every year. There needs to be capacity built into the overall hospital system with an increase in the number of available beds, to keep better pace with projected population growth and the obvious seasonal demands,” Dr Judkins said.
Access block and overcrowding in hospital emergency departments can be reduced through a combination of increased resources, realistic targets properly implemented and improved hospital management. “What is needed is accountability at the top,” Dr Judkins said. “Victoria’s model whereby the Health Minister has to be alerted when a patient stays in the emergency department longer than 24 hours, should be considered by other states and territories. In fact, we would strongly support the introduction of a 12-hour reportable target for all emergency department patients across the whole system.”
“It is unsustainable to have hospitals operating at 100 per cent capacity every day, it leads to poor patient outcomes and staff burnout,” Dr Judkins said.
“We need investments in staff to support patients’ experience of care and evidence-based solutions that are underpinned by clinical expertise.
“With one in two Australians living with a chronic condition, easy and affordable access to comprehensive primary health care close to home is essential to keeping people well and out of emergency departments.”
Dr Judkins added that emergency medicine workforce needs in Australia, especially in rural, regional and remote areas, should be considered. “Currently, half of Australian accredited emergency departments employ Visiting Medical Officers (VMOs). Hospitals need to rely less on VMOs and invest more in employing full time specialists to ensure adequate patient flow. This also needs to be strongly considered across inpatient teams also as more investment in full time staff specialists will significantly improve care and capacity.”
2018 Access Block Point Prevalence Survey
Researchers took a snapshot of emergency departments last month, with 126 Australian emergency departments reporting on the patients present at the time. It found on average 6.8 patients were waiting for beds, representing 35% of the patient workload. Of these, 62% were experiencing access block, that is, they had already been in the emergency department more than 8 hours, representing 22% of all patients being treated.
53 patients from 20 hospitals were classified as having a dangerously long emergency department waiting time of more than 24 hours, with the worst performing hospital having eight such cases.
Download the 2018 Access Block Point Prevalence Survey
ACEM Public Affairs Manager
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