There has been a recorded increase in paediatric sentinel events reported in emergency departments (EDs) in Victoria, post COVID-19. This is due to a complex and interconnected range of factors, but there is insufficient research to understand this in its entirety, or to determine whether treatment at specialist hospitals, or by specialised practitioners, could have altered the outcomes. Despite the best efforts of medical staff, there are – and will always be – negative patient outcomes in every age group.
Emergency physicians are highly trained generalists who can identify and treat a wide range of healthcare needs, for people of all ages. The FACEM Training Program is appropriate for a generalist speciality. The Program was updated in 2022, and has a bigger focus on paediatrics, including work-based assessments specifically relating to paediatric emergency medicine (PEM). This includes the involvement of trainees in high-acuity cases with supervision, and the ability to complete other training requirements on paediatric patients. ACEM is also investigating the development of ACEM Continuing Professional Development (CPD) pathways that can support FACEMs to further develop their skills in the emergency care of children.
ACEM supports having paediatric leads in emergency departments. These are FACEMs with an interest in paediatrics and/or paediatric emergency medicine, that can improve local clinical guidelines, and support education and training in paediatrics.
A service that provides ED clinicians with the ability to seek timely advice and support for paediatric patients from specialised centres is also vital. However, while virtual care can enhance and support current health offerings, it is not a replacement for “doctors on the ground”. Virtual care can also exacerbate workforce shortages in some areas.
In Victoria, as in most places in the world, the healthcare workforce is increasingly insufficient to meet the needs of a growing population with complex health needs. This is being experienced across the state, but is more severe in rural, regional, and remote areas (RRR). In some RRR areas, emergency departments are the only places for patients to receive care, and it is essential that the public are supported and educated to trust the care they will receive in these facilities.
Due to workforce shortages, EDs are trying desperately to manage roster gaps and often – especially in RRR areas – the solutions are locums, or no doctors at all, as is happening with concerning frequency in many areas of Victoria.
Access block is a significant cause of issues in the acute health system, and leads to overcrowding, longer wait times, staff burnout and shortages, and poorer patient outcomes, including avoidable patient deterioration and preventable deaths. Funding cuts to health services means problems will continue to get worse. The solutions are to address systemic issues by increasing capacity in hospitals, mental health, aged care and other forms of community care, and by improving patient flow out of EDs. Most crucially, the healthcare workforce must be rebuilt and supported to enjoy healthy, sustainable careers.
The College encourages caregivers of children who require urgent healthcare to continue to present to their local emergency department.
(Statement attiributable to ACEM President-Elect, Dr Stephen Gourley)
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.nz
ACEM Media Manager, Melissa Howard [email protected] +61 427 621 857