The Australasian College for Emergency Medicine (ACEM; the College) is calling for greater cooperation and coordination between state/territory and federal governments to fix the acute hospital access crisis placing patients at risk across Australia.
The call comes as Australian health ministers have increasingly acknowledged the extreme pressures being faced by emergency departments (EDs) and hospitals across the country, ahead of their next national meeting prior to the June National Cabinet meeting.
ACEM President Dr John Bonning said major systemic issues that have been building for years are causing the current crisis, manifesting in serious bottlenecks in emergency departments Australia-wide.
“This crisis is caused by systemic issues and pressures that have been growing for years. These issues are causing sick and seriously injured patients to face major delays in being admitted to hospital inpatient beds or other healthcare services following their initial treatment and assessment in EDs,” said Dr Bonning.
“This is not a new problem. Presentation numbers have continued to climb steadily for the past decade, and systems are failing to meet that ongoing demand. This has been predictable and should have been planned for.
“The current crisis is not caused by patients presenting to EDs who ‘should have seen their GPs instead’, as such patients require relatively few ED resources and do not require admission to hospital. Overwhelmingly, the dangerous bottlenecks EDs are experiencing are because of system-wide resourcing, staffing and procedural issues leading to delays for our sickest patients needing admission to hospital.
“This is a dangerous situation which increases the likelihood of worse patient outcomes, including death.
“These are complex problems, requiring some complex solutions. Part of the solution is ensuring there are enough properly resourced and staffed inpatient beds. However, the whole system must be taken into account. This should include a focus on workforce sustainability and extending out-of-office hours access to other hospital services and specialties, including advanced diagnostics.”
National Cabinet also needs to look at the governance and funding arrangements between state and federal governments, in particular fee-for-service models, and improved Residential Aged Care Facility (RACF) access to telehealth support and hospital-delivered clinical support in the RACF environment, 24 hours per day.
ACEM also stresses that the systemic solutions needed must focus not only on improving flow into and through emergency departments, but out of them into the hospital as well. Better data will be key to understanding where resources need to be targeted to make this happen. The College has developed Hospital Access Targets, based on the best available evidence around hospital access block, which will support governments to do this. Several hospitals and jurisdictions are in the process of establishing trials of these targets.
“The College acknowledges a range of recent commitments from some jurisdictional health system leaders as part of efforts to alleviate some pressures,” said Dr Bonning.
“While in some instances, these may make some difference, this situation is bigger than any one state or territory. Greater, more coordinated commitments from jurisdictions and the federal government are required to fix these issues. These problems are too urgent and there can be no more cost or blame shifting. Nation-wide, we need to see coordinated commitments to fix the system, and the embracing of firm targets to reduce the dangerous hospital access block, ED crowding and ambulance ramping, that are now universal issues.
“As a College we are eager to see a coordinated and collaborative national effort across jurisdictions to help ensure people are getting the right care, from the right professionals, at the right time. Within this current crisis there is an opportunity for visionary, reformist and genuine improvements to Australia’s hospitals and health systems, and the College is eager to work with all governments to achieve the improvements Australians need and deserve.”
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