While ambulance ramping is a well understood and highly visible symptom of our overwhelmed hospital system, dedicated clinicians revealed their deep concerns about what is happening inside our EDs.
On Monday 22 September 2025, the Royal Adelaide Hospital (RAH) had 70 admitted inpatients waiting in the ED for an available ward bed. The RAH ED has 68 treatment spaces in total, meaning that every space was already occupied by patients who had been assessed and required admission but could not be moved to a ward. As a result, there were no treatment spaces left for anyone arriving and requiring emergency care.
The numbers on this day – and most days – are much too high. But what really matters is the people behind the numbers, left waiting for the emergency care they urgently need.
This is not safe, it is not acceptable, and the people of South Australia deserve better.
Australasian College for Emergency Medicine (ACEM; the College) President-Elect Dr Peter Allely said this bed block, which has been worsened by the number of hospital beds occupied by patients awaiting aged care placements, had effectively left staff with finding ways to treat the approximately 250 emergency patients the RAH can expect to arrive on any given day, and created a serious patient safety risk.
“We’re familiar with ramping and the visual of ambulances lining up to offload. But in the ED, those lines of ambulances become lines of patients in waiting rooms, cubicles, and down corridors. Still waiting, still bottlenecked, but just hidden from the public eye,” Dr Allely said.
“This is a safety issue. EDs are always open for emergencies, but when they’re used for inpatient care, it limits doctors and staff from treating people with life-threatening conditions.”
“We aren’t aware of this level of access block having happened at another tertiary hospital. But the concerns about the sheer number of patients we’ve seen stuck in the ED are from the coalface – from experienced ED physicians with decades of experience who saw no other option but to highlight this urgent situation,” he said.
Dr Allely acknowledged the Malinauskas Government’s recent investment in up to 120 new step-down beds to ease aged care pressure on South Australian hospitals but said more was needed.
“We need to get serious about addressing the huge number of inpatient beds being occupied by patients who are unable to access places in aged care facilities,” he said. “We are talking hundreds of people here in South Australia, who are essentially in limbo. This isn’t good for the system, and it’s not fair to these people.
“We know this is an issue that the Malinauskas Government has been focused on, with a number of critical investments already made, but we need to see more action from both the Federal and the state Governments on this front.”
“We’re seeing stays of well over 24 hours happening all the time, which is simply unacceptable. Despite this situation we encourage anybody experiencing serious or life-threatening symptoms to seek urgent care at the ED. If you are sick, you will always receive care at the ED,” Dr Allely said.
“ACEM will continue to work with all levels of government and healthcare stakeholders to enhance our EDs so that they not only continue to provide high-quality emergency care for people who need it, but also ensure they are admitted to hospital as quickly as possible. It’s what the people of South Australia deserve.”