Currently, healthcare workers in WA who are close contacts of COVID-19 cases but are testing negative on RATs and have no symptoms, are permitted to provide clinical services. However, in practise, they must request and receive approval to work from their individual healthcare facility via often excessively lengthy and complex processes.
ACEM members have reported that, for healthcare workers in some WA EDs, this process can require approval from a hierarchy of five or six decision-makers and take up to six hours.
This is sometimes preventing healthy staff, who wish to provide clinical care, from working in a dangerously understaffed health system. The College believes that the risks to patients due to staff shortages are more significant than the risks they face by being treated by a clinician who is testing negative to COVID-19 and has no symptoms, who is providing clinical services while following infection control protocols and who is using full personal protective equipment (PPE).
The College is calling for these chains of approval to be immediately revised and simplified and for greater clarity in where the responsibility for this decision-making lies. ACEM believes that heads of EDs are the most appropriately placed to be making these complex health decisions that balance workforce capacity with risk of COVID-19 exposure and that they should immediately be empowered and supported to do so, in accordance with consistent state-wide principles developed in partnership with public health, infection control, and occupational health and safety experts.
ACEM WA Faculty Chair Dr Peter Allely said, "We must empower the people who are leading on the frontline – who are the best placed to balance health risks and to make these decisions swiftly – to ensure safer levels of staffing and safer EDs for patients and staff."
"In some WA EDs, if I was a COVID-19 close contact but tested negative on a RAT and had no symptoms and I wanted to work, I would need to email the head of my ED. That's where it should end. But currently the process requires them to then email the person above them for their approval, who needs to email the person above them for their approval, and so on, until it gets all the way to the head of the hospital or health service."
"This overly time-consuming process is hindering extremely time-poor clinicians from working in a system that urgently needs them."
"This is not about having staff working while sick. This is about staff who are perfectly well, and wanting to work, and who are allowed to work, but being hindered in doing so because of an absence of consistent workforce management advice."
There are well-publicised workforce issues in Western Australia, as elsewhere in Australia. The existing workforce is spread thin due to increasing demand and hospital overcrowding, large numbers of exhausted staff needing leave or leaving the workforce entirely, border restrictions and COVID-19 infections. There are no reserves in the workforce for situations like this, so large sections of the workforce are critically understaffed. This is dangerous for staff and for patients and can lead to worse outcomes, including death. This issue affects the entire healthcare system with rural, regional and remote areas experiencing the impacts most significantly.
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
