ED crowding is unethical in a COVID-19 world

The Australasian College for Emergency Medicine (ACEM) is warning of escalating risks to patient safety and lives as crowding makes a dangerous return to Australian and New Zealand emergency departments (EDs) despite the COVID-19 threat reducing but remaining present.

At the height of coronavirus lockdowns there was a downturn in ED attendances and admissions due to reduced presentations, systemic improvements as well as most elective surgery stopping, which freed up hospital beds. As COVID-19 restrictions ease and presentation numbers return to normal, emergency doctors are reporting life-threatening crowding issues and access block in EDs are back with a vengeance, even before hospital bed capacity has returned to expected levels.

Crowding has been reported in all jurisdictions but is particularly bad in Tasmania, the Northern Territory, South Australia, New Zealand and Victoria.

“Evidence overwhelmingly tells us that that ED crowding increases the risk of harm and death to patients,” said ACEM President Dr John Bonning.

“COVID adds new dangers. We need to continue with extra infection control measures such as divided clinical teams and areas in EDs, spatial distancing and PPE for the foreseeable future, and must also consider the additional time required for coronavirus testing, as well as bedspace needed for additional assessments.

“Crowded EDs and hospitals are the ideal environment for COVID-19 to spread undetected and threaten our healthcare system, staff and patients. Allowing ED crowding to continue is untenable and unethical.

“Crowding in EDs is caused by hospitals being full and admitted patients being left in the ED for extended periods blocking beds needed for newly arriving patients with serious illness and injury (termed access block). It is not caused by ‘GP type’ patients.

“We have seen unprecedented collaboration and clinical engagement to manage the pandemic, and this must be harnessed for once in a generation reform to our health system. This is a whole of system problem requiring whole of health system responses. Resourcing is one factor but there are also systemic issues, such as the need to better manage hospital inpatient flows, beds and discharges which need to be resolved. Other measures which need to be considered include: new time-based access measures or targets for ED care; improved health system staffing profiles; developed models of virtual care and more timely access to both primary and outpatient care.

“Leaders and decision makers at all levels need to take responsibility, and everybody involved in our healthcare systems needs to be involved in finding solutions. Failing to act now not only risks patient lives but threatens to create an entirely new public health crisis.

“ACEM looks forward to sharing solutions with governments, health system leaders and the community to help improve the situation.”

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

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