This media release was issued on 28.09.2017 and posted on the ACEM website on 3.07.2018

The peak body for emergency medicine in Australia and New Zealand has proposed a number of solutions to help to improve patient care and reduce the current pressure on emergency departments.

The call for action comes as new figures show a worrying increase across Australia in the number of admitted patients waiting more than eight hours in emergency departments before being transferred to hospital ward beds - widely referred to as “access block”.

Australasian College for Emergency Medicine (ACEM) President Professor Tony Lawler said: “The greatest challenge faced by Australian and New Zealand’s emergency departments is access block. Patients staying longer in the emergency department, because there aren’t beds on the wards for them to go to, leads to emergency department overcrowding and impacts negatively on the provision of care to our patients.

“Evidence consistently demonstrates that access block leads to increased risk of complications, errors, death and increased costs to the health care system.

“Access block also causes ambulance congestion outside hospitals as they wait to hand over seriously ill or injured patients – known as ambulance ramping.”

Professor Lawler said the College called for the implementation of a number of strategies to improve the flow of admitted patients from the emergency department to hospital wards, and to improve patient outcomes.

“There needs to be increased public hospital funding and capacity by increasing the number of available beds, to keep better pace with population growth and the growing demand for public hospital services,” he said.

“The implementation of evidence-based approaches and protocols for dealing with overcapacity, in line with international best practice, is needed to spread any excess demand more evenly throughout a hospital, rather than concentrating the majority of the clinical risk in our already overstretched Emergency departments. Governments and administrators must work with hospital clinical staff on these measures to ensure their effectiveness.”

Other strategies include:

  • Hospitals should identify system-wide process solutions that are tailored to their local needs. These should consider how patients travel through a hospital, and address factors preventing a timely and clinically appropriate patient journey through the hospital e.g. inpatient discharge processes, extending service availability beyond traditional business hours, a better balance of full-time versus visiting medical officer specialists.
  • Set realistic targets for hospital performance developed by State Governments in conjunction with hospitals, clinicians and consumers. These targets should promote optimum patient care and minimise the potential for unintended consequences.
  • Increase funding for EDs to meet growing demand for care and allow flexibility in finding arrangements to accommodate unexpected increases in demand, for example, due to an unusually severe flu season.

Professor Lawler added: “Emergency department staff care deeply for the health and wellbeing of their patients. Everybody who enters an emergency department deserves the opportunity to experience quality care, in a timely manner and with the greatest chance of positive outcomes.”

2017 Access Block Point Prevalence Survey

Researchers took a snapshot of emergency departments on Monday August 28, with 120 Australian emergency departments reporting on the patients present at the time. It found 21% of patients who need to be admitted to hospital had to wait over eight hours for a bed, with some patients waiting more than 24 hours.

106 patients from 31 hospitals were classified as having a dangerously long emergency department waiting time of more than 24 hours, with the worst performing hospital having nine such cases. Eight hospitals reported patients who had been in the emergency department for more than 48 hours and five reported patients staying more than 60 hours.

Overall, demand nationwide was higher than ever before with a record 17,848 patients presenting to an emergency department, 3805 (21%) of whom required admission to the hospital after receiving emergency treatment.

Professor Lawler said: “With emergency department overcrowding figures worsening or remaining at a substandard level, this survey reinforces the day-to-day experience of many emergency doctors, which is that our hospitals nationwide are overburdened. This leads to increasing staff stress and burn-out. However, the worst aspect of this is that patients are being put at risk and that is not acceptable.”

Download the 2017 Access Block Point Prevalence Survey

This media release was issued on 28.09.2017 and posted on the ACEM website on 3.07.2018