The Australasian College for Emergency Medicine (ACEM; the College) acknowledges the significant healthcare investment announcement by the Victorian Government today, and welcomes a number of measures outlined.
The College and its members have long been raising concerns about access block (the inability to move patients to appropriate inpatient care within eight hours), which has been progressively overwhelming the Victorian hospital system for the past decade, and is now at the point of being unsafe.
ACEM supports any measures which may help address long-standing systemic issues and improve patient flow and safety.
“In particular the College is pleased to see a focus from the Victorian Government on initiatives which may assist in improving the flow of patients, into and through emergency departments, and onto the next phase of their care. This is preferable to focusing on diversion of patients, which has had limited impact on ED wait times,” said ACEM Victoria Acting Chair Dr Belinda Hibble.
“It is heartening to see a commitment to considering ongoing management of influenza and other respiratory illnesses, and evidence-based flow strategies, as we continue to emphasise the importance of investing throughout the system rather than focussing entirely on the emergency department front door.”
The College is hopeful the announced partnership with the Institute for Healthcare Improvement will contribute to improvements in patient flow. ACEM also encourages the government to look at centralised management of patient access and flow within the health system which has been effective in other jurisdictions.
The College acknowledges the planned investment in and deployment of additional specialist staff across 12 major hospitals, and is hopeful the implementation of discharge coordinator positions will assist with patient flow, and free up acute beds for the most unwell patients.
In relation to the introduction of triage doctors, triage is currently performed by ED nurses with training and expertise in the triage process, and there is evidence that triage nurses perform this role safely and well when they have adequate staffing, space and time to do it, and they currently escalate questions to specialist emergency physicians as required. Changing this practice, without other system changes, would be disruptive and lead to new bottlenecks. To help address this issue, the College is eager to see investment in additional clerical and clinical support staff, to allow all ED staff to focus on their primary roles adequately.
“As a healthcare system, we must acknowledge that COVID-19 will be with us for the foreseeable future, and governments must continue to invest in systems that can cope with increasing - and likely ongoing - patient demand,” said Dr Hibble.
“The current high volume of COVID-19 cases, as well as ongoing significant high numbers of flu and other respiratory virus cases in the community, continues to place extreme pressure on systems, not least of all as a result of the huge numbers of healthcare workers unable, or unavailable, to work due to illness, furlough or leave.
“We welcome the acknowledgment and commitment from the government to address the many difficult issues currently being experienced, and are eager to work collaboratively to see genuine solutions implemented as a priority.”

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