However, ACEM is extremely concerned that this budget reveals the government’s continuing failure to understand, and address, the systemic issues that lead to dangerous bottlenecks in emergency departments (EDs) and ambulance ramping.
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. This creates ‘access block’ in EDs.
Access block is the single most serious issue facing emergency departments and the major contributor to ED overcrowding. It occurs when a patient waits for over eight hours to be admitted from the ED into an inpatient ward in the hospital. It significantly impacts on patients, causing delays in assessment and treatment, increased risk of exposure to error, increased length of stay in hospital and worse health outcomes – including increased inpatient mortality.
Access block affects over 50% of patients in SA’s emergency departments and it is dangerous: new patients presenting to an ED have a 10% greater chance of dying within seven days of admission when more than 10% of ED patients are access blocked. People in SA who are access blocked are also twice as likely to wait over 24 hours for a bed than the Australian average.
The hospital access crisis is caused by whole-of-health system issues and fixing them will require whole-of-health-system solutions.
This should include a focus on implementing a 7-day hospital service model, with improved out-of-office hours access to hospital services including advanced diagnostics, as well as senior decision makers in inpatient units. An increase in hospital inpatient bed numbers is also required: admitted patients need ward beds to go to and bigger EDs will not fix that problem.
ACEM South Australian Chair, Dr Mark Morphett said, ‘The budget offers no genuine solutions to the hospital access crisis. The government must stop and actually listen to the clinicians and patients experiencing this crisis every single day then develop and implement genuine solutions to address the systemic issues that cause dangerous access block.’
‘The main causes of access block and ramping are delays in admitting patients needing further care from EDs to inpatient hospital beds or other care options. We need clear pathways, not only into EDs, but out as well.’
‘Fixing access block also requires an urgent focus on workforce sustainability. Staff are burnt out and leaving the profession in droves. This must be addressed urgently.’
ACEM President Dr John Bonning said, ‘Emergency doctors have had enough. The lives of South Australians are being put at risk by a failure to address, and find solutions for, the systemic issues creating ambulance ramping and dangerous bottle necks in EDs. There have been enough excuses and dabbling in small fixes. The health system in South Australia is in crisis and it needs help now.’
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