In the lead up to the State Election on Saturday, March 25, ACEM will be highlighting key fixes from the NSW ramping inquiry, that will help the people of NSW get the emergency care they need, when and where they need it.
Statement attributable to ACEM President, Dr Clare Skinner:
Last year, the New South Wales upper house did something really good: it established an inquiry to determine how ambulance ramping and access block affected the operation of emergency departments, and it invited emergency doctors to give evidence, including me.
My colleagues and I told the inquiry that all hospital beds were full most of the time, which means we can’t move patients from the ED, so the EDs fill up, the ambulance paramedics can’t hand over their patients, and we must examine and treat patients in public spaces, such as waiting rooms and corridors. I also described to the inquiry a bad day in an emergency department is like working with a conveyor belt full of things you can't get to fast enough, but what's on that conveyor belt is human distress and suffering.
It’s a heartbreaking situation: the ED becomes a place where there are simply too many patients with immediate and significant needs, but not enough staff, resources or space to ensure that they receive the timely and effective care they so desperately require.
What does this look like in practice? On TV, most of the patients in emergency are victims of car accidents, bomb scares and heart attacks. In real-life, most patients are frail elderly people, small children and babies, and people experiencing psychological distress, suicidal thoughts or issues related to addiction to alcohol and other drugs.
So, let’s take an average patient on an average night. She is an 88-year-old woman who has fallen at home and broken her hip. This is what her experience would likely be: the ambulance may be tied up with other callouts or stuck queuing outside an ED so it will take some time to arrive. Paramedics will eventually arrive and administer pain relief, lift her on a stretcher and take her to hospital.
Because the emergency department and all the beds in hospital are full, the paramedics won’t be able to settle her in a bed in the ED for assessment and treatment. Instead, she’ll have to wait in the back of the ambulance with the paramedics, or the paramedics will put her on a stretcher and carry her inside where they will all wait, with other patients and paramedic crews, in a hospital corridor. There is no space for her carers to come inside to support her.
In the corridor, surrounded by other people, we will ask her questions, listen to her chest and examine her for other injuries – like an associated head injury, or internal bleeding. We should feel down her spine, but we can’t do that while she is strapped on the stretcher.
It is difficult and morale-crushing for everyone involved, and it is fundamentally unsafe. In the chaos, it is too easy to miss important signs of a serious health problem. If something serious is missed by frontline healthcare workers, this can damage them, professionally and emotionally.
This is not caused by any single person, stakeholder, organisation, or issue. Paramedics and emergency staff want to provide timely, safe, and dignified treatment. I know that hospital executives and governments also want to support the provision of safe and effective care.
This is happening because the health system is in crisis. This is happening because there are too many sick and injured patients requiring complex care, and not enough of the right staff and resources at the right place and right time to meet patient needs in the right timeframe.
The ED is full of people whose emergency care is completed but they can't go to the wards. In turn, the hospital wards are full of people who don’t need to be there anymore. They have finished hospital care and they need to be discharged home or into residential community care – but this care isn’t available to them, or there are no appointments for months, or the processes are so difficult to navigate that it’s extremely hard to coordinate.
However, these problems can be treated. We know how. And so do the politicians of New South Wales. In 2022, after we gave evidence, the inquiry committee went away and crafted a final report.
In it, was a prescription for change: 12 recommendations. These 12 recommendations – 12 treatments – when implemented, will help give all people in NSW access to the care they need, when and where they need it.
What would this look like? The 88-year-old woman who has fallen at home and broken her hip calls an ambulance, and it arrives quickly.
Paramedics administer pain relief medications, lift her on a stretcher and take her to hospital. She is brought into the ED, where she is immediately transferred into a hospital bed and made comfortable, with her carers beside her. Paramedics give a brief handover to ED staff. The ambulance is rapidly despatched back on the road to help other people in need.
Nurses and doctors, in a coordinated way, give pain relief, organise x-rays, and plan a timely orthopaedic procedure to fix the hip. The surgery is performed within a day or two, and after an appropriate amount of acute recovery time in the orthopaedic ward, she is discharged. Leaving a hospital bed empty for a patient who needs it, she is returned home, and community-based care is easily arranged.
This is what it should look like. We know what to do to make this a reality. And so does the NSW parliament – it wrote the script. The next NSW government must immediately implement the 12 recommendations outlined in the final report of the Impact of ambulance ramping and access block on the operation of hospital emergency departments in New South Wales.
NSW has waited long enough.
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
ACEM Media and Communications Manager Melissa Howard [email protected] + 61 427 621 857