Long-term strategy urgently needed to avert hospital capacity crisis

The Australasian College for Emergency Medicine (ACEM) is calling for better co-operation between the Victorian and Commonwealth Governments, as well as the communication of a long-term strategy in relation to the treatment and ongoing care of aged care patients during the COVID-19 pandemic. It comes as some Melbourne hospitals and emergency departments (EDs) come under sustained and increasing pressure.

The College is deeply concerned that systemic and inter-governmental issues are contributing to situations in some hospitals where aged care patients who have presented to hospital for assessment and treatment are prevented from returning to their homes or other environments for ongoing treatment or care, following their treatment in hospital.

As acute inpatient hospital beds are increasingly full, the situation is creating dangerous capacity issues within some hospitals, including bed block (inability to admit patients) and dangerous ED overcrowding. Patients presenting to some of the city’s EDs, including those with COVID-19, and others with mental health needs, are facing waits of 24 hours or longer for admission to hospital from the ED. We have heard of waits up to 60 hours.

As hospitals become increasingly crowded, the risk of COVID 19 infection to both patients and staff increases. These are big red flags that the system is nearing capacity. This is in addition to workforce pressures as a result of COVID-19 infection, quarantining of staff deemed to be close contacts and fatigue.

ACEM President Dr John Bonning said as infection rates among healthcare workers remain of such concern, any situation which results in crowded emergency departments and hospital wards, and therefore heightened risk of infection transmission, needs to be better managed with a robust and timely response, which we are yet to see.

“Melbourne’s ED staff; and I’m sure many of our inpatient teams who are also working incredibly hard; feel stuck in the middle, due to the absence of a long-term strategy from the State and Commonwealth Governments,” said Dr Bonning.

“At the heart of this is ensuring that all patients who need care receive the level of care they need at the time they need it, in the best environment according to care needs. Transfer to hospital needs to be about acute care needs, and patients should also be discharged as soon as medical assessments deem it safe and appropriate to do so. Without a capacity plan these immediate issue have the potential to significantly escalate.

“Staff in hospital EDs and wards urgently need the reassurance that the Commonwealth and State Governments have a cooperative long-term strategy to address current and ongoing issues, to ensure patients receive the care they need, and that our hospitals and emergency department have the capacity to continue providing that care. This should include urgently looking at building better systems to allow EDs and hospitals under relatively less pressure to assist those under greater strain, and improving community aged care capacity and options for patients who do not need hospital-level care.

“This cannot be about blame and recriminations. It must be about openly and transparently working through the issues to find sustainable and effective solutions. The situation should also stand as a warning to all hospital and healthcare systems across Australia and New Zealand as we deal with the ongoing and fast moving COVID-19 threat.

“ACEM welcomes the opportunity to continue working with governments, departments and clinicians on the ground to help work through these very important issues.”

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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