The Australasian College for Emergency Medicine (ACEM; the College) is concerned ‘GP-type patients’ are once again being blamed for crowding in Queensland hospital emergency departments (EDs) while the root systemic causes contributing to ED crowding and hospital access block remain un-addressed.
This follows a Queensland Government media release indicating 30%-40% of monthly ED presentations were classified as being ‘non-urgent’. Such a statement suggests that EDs are providing GP or pharmacy services to more than one third of people attending, which is simply not the case.
ACEM Queensland Faculty Chair Dr Kim Hansen said the College was concerned this painted an overly simplistic picture which failed to acknowledge the major systemic issues that contribute to hospital access block.
“This is another example of the popular but disingenuous public narrative that ‘patients who should have gone to a GP instead’ are the main cause of ED crowding and access block. These arguments miss the point that the most dangerous waiting times are experienced by patients who are really sick or injured and require admission to hospital, and must wait for long periods of time in the ED before they are admitted,” said Dr Hansen.
“Access to primary healthcare in the community, including GPs, is of course very important, and everybody should have access to the healthcare they need, when and where they need it. In reality though, patients with relatively minor ailments who might be considered GP-type patients and present to EDs do not require admission to hospital, and therefore are treated quickly and sent home. They are given lower triage (priority) categories, wait in the waiting room, and are not resource-intensive. It is the dangerous systemic issues preventing more acute patients from accessing inpatient wards for definitive care that are the true cause of overcrowded EDs.”
Analysis by ACEM has shown that even though patients who might be considered lower urgency presentations accounted for over one third of ED presentations in 2018-19, these presentations did not ‘block up’ the ED and do not cause people to stay longer in beds in EDs. The argument that lower urgency presentations are blocking up EDs is not backed by data or experience.
“Public narratives which lay blame at people presenting to EDs, usually for very valid reasons, are deeply unhelpful and distract from the need to address the dangerous underlying systemic factors contributing to hospital access block – a whole of system issue manifest in the ED,” said Dr Hansen.
The most serious driver of overcrowding is access block which occurs when a person, who has received their initial care and stabilisation in an ED from emergency medical staff; and is sick enough to need to be admitted to hospital for ongoing care; is unable to go to a ward and must stay in the ED. These patients are often left waiting in corridors and/or treatment spaces, requiring ongoing ED staff attention and preventing new patients coming in to commence their care. This can also lead to patients having to remain in ambulances (sometimes with dire consequences) due to a lack of physical space in EDs.
ACEM President Dr John Bonning said this fatuous argument is rolled out again and again in state after state, often by state health funders wishing to pass the blame to federal governments who fund GPs, to obfuscate the problem. Access block occurs due to a combination of hospital capacity, resourcing and systemic issues, which must all be addressed.
“We know hospital access block is very dangerous for all patients,” said Dr Bonning. “Research has shown that a person attending an emergency department experiencing access block is 10% more likely to die than a patient attending a non-access blocked ED.
“ACEM wholly supports seeking to keep people out of hospital via preventative measures or early healthcare intervention. However, it is overly simplistic to suggest we just need to stop people coming to hospital and have them go to a GP instead.
“Holistic, systemic measures and initiatives such as extended hours access to specialists and clinics, including GPs, are part of the solution. However, to truly address access block, we must also improve patient flow and discharge arrangements in our hospitals.”
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