The Australasian College for Emergency Medicine (ACEM; the College) holds grave concerns about the impact of a ‘blitz’ of elective surgeries on Tasmania’s struggling emergency health system. While ACEM recognises the importance of elective procedures and maintains that the government must deliver on its pre-election promise, there must also be immediate and commensurate investment in increasing in-patient capacity, to enable this to be successfully delivered.
This must include a focus on workforce sustainability across Tasmania’s hospital system, otherwise the increase in elective surgery will further negatively impact patients and healthcare workers in Tasmania’s already overwhelmed emergency departments (EDs).
Due to many years of neglect, and a lack of funding and resources, the Tasmanian hospital system is in deep crisis and cannot function with the current workload. We applaud the work being done to try and reduce the elective wait times. It is unacceptable that Tasmanians are waiting so long for elective surgeries. We must however progress in a structured and planned manner. To not do so will directly negatively impact EDs and increase already dangerous bottlenecks in EDs, or ‘access block’. As has already been evidenced across Tasmania, this then has the knock-on effect of forcing cancellations of elective surgeries due to the hospitals running at dangerous levels.
Access block is the situation where ED patients who have been admitted and need a hospital bed are delayed from leaving the ED for more than eight hours due to a lack of inpatient bed capacity, or safe disposition location.
Access block directly causes negative patient outcomes, increased waiting times and increased morbidity – somebody presenting to an ED experiencing access block is 10% more likely to die within the next seven days than somebody presenting to an ED that is not experiencing access block.
Tasmania already has the worst access block in Australia. The need for post-operative beds, including Intensive Care Unit (ICU) admissions from elective surgeries, will cause the admission of ED patients needing a bed, to be delayed even further. There will also be increases in the numbers of patients who experience complications after their elective surgeries and then present to the ED for care, with many of these requiring re-admission.
ACEM recognises a careful balance must be struck - many elective surgeries are vital medical procedures that must be undertaken promptly.
However, the College believes that there should not be a ‘blitz’ anywhere in the healthcare system, ever. Instead, resources across the health system should be used consistently and intentionally to ensure maximum efficiency and equity between emergency and elective patients. ACEM has recently called for a whole-of-system approach to fix Tasmania’s healthcare system.
ACEM notes the government has committed to recruiting staff to support the extra surgeries. It also communicated that it will determine the amount of surgeries for each region for each year ‘in consultation with clinicians’. Our Tasmanian clinicians are eager to work with the Tasmanian Government to determine how the elective backlog can be tackled safely while ensuring that Tasmanians who need emergency medical care can also receive the urgent help they need.
ACEM Tasmania Faculty chair Dr Juan Ascencio-Lane said, “The hospital system in Tasmania already cannot cope with the current levels of demand. While the government must deliver on their election promises, without an immediate increase in sustainable in-patient capacity across the hospital system, which includes completed staff hires, not just planned, the increase in elective surgery will put pressure on our acute health system that is already struggling beyond anything we have seen before.”
“Colleagues have told me of instances where recovery staff in theatres have had to care for patients, instead of the ICU, because the ICU did not have the staff or space to care for them. We cannot safely increase elective surgeries when the hospital system can’t cope with the current workload.”
ACEM President Dr John Bonning said, “Whilst patients awaiting elective procedures know who they are and eagerly await their turn, tomorrow’s acute emergency patient who will need management in a Tasmanian ED (with pneumonia, diabetes complications, a broken hip) does not yet know that they will need healthcare. They do not yet know that they might be stuck on an ambulance ramp, that they might be stuck in an ED corridor waiting for admission, that they might suffer significant delays to their care at their hour of greatest need. This could be your parent, your child, your friend, or you. It is an equity issue. We cannot forget the acute patients.
“All patients deserve the same level of care. We cannot hold one group above the others. We need to ensure that the needs of the elective patients and the acute patients are met in an equitable manner, otherwise we risk the whole system collapsing.
“Tasmania’s emergency healthcare system is struggling worse than ever, and the government must explain how and where it will support the system to cope with an influx of patients from elective surgeries.
“We should never see a ‘blitz’ in healthcare. Instead, we must plan carefully and develop a system that meets the needs of both emergency and elective patients and ensure equity between planned and emergency care.”
Background:
ACEM is the peak body for emergency medicine in Australia and New Zealand, responsible for training emergency physicians and advancement of professional standards. www.acem.org.au