Australasian College for Emergency Medicine (ACEM; the College) NSW Acting Chair Dr Rachael Gill said that while the HAT results presented in the Bureau of Health Information (BHI) quarterly release made for difficult reading, they were a good first step in reducing ED wait times.
“ACEM designed the HAT to better understand the complexity of patient needs and the different paths they take following their time in ED. We welcome the decision by the NSW Government to lead the way and become the first Australian jurisdiction to make this data public,” Dr Gill said.
“Instead of looking at the average time all patients spend in EDs, the HAT breaks this down further so we can clearly see who is waiting the longest. This means we get a better picture as to where the delays are, and what is causing the blockages in our health system. We can’t start to address these issues without understanding the full extent of the problem.
“What we can see from this new data is that 67 per cent of patients who don’t require admission are able to leave the ED within four hours. That’s still not reaching our target of 80 per cent, but it’s streets ahead of what we’re seeing for those who need to be admitted to a ward,” Dr Gill said.
“For those patients who require admission to a ward or transfer to another hospital – in other words, our sickest patients – only 36 per cent have left the ED after six hours.”
Dr Gill encouraged the NSW Government to continue to collect and report this HAT data, as it provided new opportunities to best address the issue of access block*.
“For these people who are waiting in EDs for hours to be admitted, it’s generally because our hospitals are full. As they’re staying in the ED for longer, there are fewer ED spaces available for new patients arriving. The knock-on effect is that everyone waits longer. It’s felt on our ambulance ramps, down along our corridors and out into our waiting rooms,” she said.
“What will make a difference is greater capacity across the whole system, with a seven-day-a-week hospital model and more step-down community services. Government investment in initiatives such as urgent care centres and telehealth – while welcomed – are aimed at low-acuity patients and do little to ease these pressures on our EDs.”
Dr Gill said that ACEM would continue to work with the government to achieve a fairer, safer and better-functioning healthcare system and called on other state and territory governments to follow NSW’s lead in publicly reporting the HAT.
* Access block is where people requiring hospital admission are waiting in the ED for longer than eight hours for an inpatient bed, after their initial ED assessment is complete. Access block is not caused by EDs but is a whole-of-health-system issue caused by factors such as insufficient inpatient beds, a lack of staffing, limited resourcing and ineffective systems that are otherwise aimed at improving patient flows through the hospital. It is shown to increase the risk of adverse patient outcomes, with research showing that new patients presenting to an ED have a 10% greater chance of dying when more than 10% of patients waiting for admission are access blocked.
Background:
ACEM is the peak body for emergency medicine in Australia and Aotearoa New Zealand, responsible for training emergency physicians and advancement of professional standards. www.acem.org.au
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