Improving flow in emergency departments

As I travel around Australia and New Zealand and meet FACEMs and trainees at their workplaces, it is clear that our emergency departments are under unreasonable pressure.

As I heard one FACEM quip, ‘delayed care is denied care’. It is a day-to-day experience of many emergency physicians – patients staying longer in the emergency department, because there are not beds on the wards for them to go to, leads to overcrowding and impacts negatively on patient care.

We are about to release new figures which confirm what FACEMs are telling us – the levels of access block is getting worse, with patients in Canberra and South Australia facing terrible conditions. Access block also causes ambulance ramping outside hospitals as they wait to hand over seriously ill or injured patients and our South Australian colleagues have borne the brunt of some of the worst ambulance ramping in recent months.

As if this issue isn’t enough to cope with, what is even more frustrating is when we hear and read comments from either politicians or health bureaucrats throwing up a red herring as to why we face this problem. The one we are most familiar with is the myth that emergency departments are clogged with GP-type patients. The fact remains the workload of GP-type patients in emergency departments is not the main reason for overcrowding, staff burnout and poor patient outcomes.

The real issue is the lack of capacity across the hospital system to deal with ever increasing patient numbers, in line with projected population growth of communities across Australia and New Zealand.

Access block can be reduced through a combination of increased resources and more effective use of them, realistic targets and improved hospital management.

The College has proposed solutions to these challenges we face, and we will continue our advocacy campaigns – through increased collaboration with jurisdictions and awareness raising in the media – to ensure our members are part of the reforms so desperately needed to continue to improve our health systems.

Responsible governance

We, as a College, are in a state a significant change. We must evolve and adapt to ensure we are able to advocate for our members and provide the services that are expected of us.  We must change and adapt to ensure our specialty remains an international leader in Emergency Care and a strong, influential voice for health reform. And we must change and adapt to ensure that we can meet the increasing requirements of the bodies that accredit us and make it possible for us to continue what we do.  But as we know, whilst necessary, change and the accompanying adaptations is not necessarily comfortable, nor to everyone’s liking.
In my role at the College, I get a lot of feedback. As with all feedback, some is positive, some is not. I have recently noticed some feedback about the College being seen as ‘bureaucratic’ and ‘corporate’. I can understand why some may see the necessary changes we as a College have had to make as bureaucratic, but I see it differently. The scale of running an operation like the College, coupled with the dramatic increase in trainees and the demands placed on us as a contemporary organisation with significant requirements and expectations, mean we must apply strong and consistent governance to all aspects of our work.
As health professionals, we work in complex systems. The College is no different. Delivering the work of the College requires a contemporary approach to governance, strong, collaborative engagement between Fellows and professional staff; and rigorous policies to ensure that our work is delivered in an effective, accountable, transparent and equitable manner.

We don’t always get it right when we communicate major changes and we certainly can’t keep everyone happy when we make changes.  I understand that. We are making changes to ensure ACEM’s future, and our future relies on our team, our members, being engaged.  So I urge you to participate with us. There are so many ways to be involved - get on Committees, respond to consultations and get in touch if you ever want to chat, email [email protected]
FACEMs recognised

Whenever members or trainees are recognised for their work or research, obviously it is a great achievement for them personally. The recognition also does the speciality of emergency medicine good, highlighting the important role it plays in health care.

So it was with immense pride to learn three FACEMs were recognised for their significant contributions to emergency medicine in the Queen's Birthday 2018 honours list.

Congratulations to former ACEM President, Associate Professor Andrew Singer AM, Professor Anthony FT Brown AM and Dr Gary Ayton OAM. Also recognised was Dr Jeremy Raftos OAM, who has served as a supervisor of ACEM trainees doing paediatric emergency medicine rotations.

Their successes should serve as an inspiration for all of us. They are a testament to the importance of emergency medicine throughout Australia and New Zealand.

ACEM leading the way in advancing emergency medicine internationally

As a founding member of the International Federation for Emergency Medicine (IFEM), ACEM is committed to advancing the growth of emergency medical care around the world, which saw me travel to Mexico this month for IFEM’s annual conference.

It was a great experience to be among the best scientists, academics and researchers, all exchanging and sharing their experiences and results in the fields of emergency medicine. I picked up a lot of the innovations and practical challenges happening in emergency departments across the world, and look forward to discussing the solutions adopted with colleagues in various College forums to see what can be applied in Australia and New Zealand.

At the meeting former ACEM President Associate Professor Sally McCarthy was elected President-Elect of IFEM while former President Dr Anthony Cross was re-elected Treasurer and Immediate Past President Professor Tony Lawler was re-elected as the Regional Board Representative for Australasia.

We are thankful to having these committed and high-performing individuals at the forefront of our international work.

Until next time,