The move comes as new access block survey data confirms that Tasmania’s two largest hospital EDs, Hobart and Launceston, recorded the worst results in all of Australia for patient access block and 24 hour wait times.
This is the result of patient flow blockages that originate in the management of inpatient capacity, and are therefore beyond the ED’s control. Access block occurs when a patient has a length of stay in an ED of longer than eight hours because of the lack of inpatient capacity to accept admissions.
ACEM President Dr Simon Judkins said: “ED overcrowding, 24 hour long waits and ambulance ramping are proxy indicators for preventable deaths and harm to patient health. The worse these factors are, the greater the risks to patients.”
ACEM’s data reveals that when the point-in-time access block snapshot survey was taken in June 2019, the Royal Hobart Hospital (RHH) had 13 (50%) access-blocked patients out of 26 being treated and six waiting for over 24 hours. This made RHH the second worst performing hospital in the country, with the state’s second largest hospital Launceston General Hospital (LGH) being the worst performing.
In September, the situation at RHH had deteriorated markedly from June, with 20 (57%) access-blocked patients out of 35 awaiting treatment, and seven patients staying more than 24 hours.
This deterioration is concerning, not just because the ‘Access Solutions’ meeting was convened in June to resolve the crisis by improving patient flow, but because of the Ministerial statement (30 September) that improvements were driving better patient flow at RHH.
ACEM Tasmania Faculty Chair Dr Marielle Ruigrok said: “Compliance with the principles for timely, quality care that were agreed to in the Access Solutions Action Plan need to be evident in a reduced rate of access block and 24-hour waits at both Royal Hobart Hospital and Launceston General Hospital.”
Tasmania needs a state-wide strategy because ACEM data shows that the system failures include LGH.
In the first survey of 2019, RHH and LGH had 13 and 17 access-blocked patients respectively, compared to the national hospital mean of five.
In late 2019, RHH and LGH had 20 and 13 access-blocked patients respectively, compared to the national hospital mean of nine.
Dr Judkins said: “Numerous reports in recent years show longstanding cultural issues affecting whole of hospital performance. Given the situation is now as desperate as it is, it is in the interests of all Tasmanians that the Government invests in cultural change and leadership programs to resolve these issues.”
"It may also be time to explore who is in those leadership positions and if they are, in fact, the right people to oversee these vital pieces of work and culture change."
Furthermore, trend data shows the proportion of access-blocked patients waiting longer than 24 hours in Tasmania has ranged from 130% to 520% higher than national levels between 2015-2019.
“It’s time for the Health Minister to embrace a standard which ensures no patients are left waiting 24 hours or longer in EDs, and when it does happen, to ask for explanations and solutions, addressing how it will be avoided in the future," said Dr Judkins.
“Public reporting on 24 hour waits is necessary to drive improvement and keep EDs safe for all Tasmanians.”
ACEM is looking forward to meeting with the Minister for Health on Friday 15 November to discuss these results and understand the plan for immediate actions to improve patient flow and end 24 hour waits at both the Hobart and Launceston 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
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