Major fixes needed to address broken hospital systems

The issues and distressing cases resulting from overcrowding in Australian hospitals highlighted on the 7.30 program (22/01/20) are unacceptable and demonstrate the major problems plaguing the country’s healthcare systems, says the Australasian College for Emergency Medicine (ACEM).

ACEM President Dr John Bonning said the issues raised, including patients stuck waiting and receiving treatment in the back of ambulances because emergency departments (EDs) are full (often because the hospital itself could not accommodate admitted patients from the ED), and the prevalence of long and unsafe waits of 24 hours and longer for mental health patients, reflect the experiences of ED staff across Australia and New Zealand.

“This is deeply distressing, completely unacceptable and major fixes are needed,” said Dr Bonning.

Data from the Australian Institute of Health and Welfare show EDs, hospitals and healthcare systems are under more pressure than ever. This is due to factors including population growth, increased chronic disease burden, lack of access to the provision of appropriate acute and mental healthcare and other factors.

As ED presentations have increased each year, so have the number of admissions from the ED into the hospital, yet the number of available staffed beds has decreased. This causes longer wait times in the ED for admission into hospital, which leads to the inability to provide care to patients waiting to access the ED.

Across Australia, most admitted patients are now waiting in the ED up to 11 hours and 43 minutes before being admitted into a ward in the hospital, with 10% waiting even longer. Across all states, Tasmania has the worst admitted patient wait times, with most patients waiting in the ED for up to 22 hours and 44 minutes, and 10% even longer, when agreed access targets in Australia are four hours and in New Zealand are six hours. This significantly affects the ability of EDs to function as they are supposed to, looking after the constant influx of sick and injured patients.

ACEM’s most recent access block snapshot survey found that ED patients waiting for an inpatient bed contributed to almost 35% of the ED workload across Australia, causing a knock-on effect that leads to longer waiting times to receive treatment (due to admitted patients taking up space in the ED), and subsequently more patients leaving the ED at their own risk.

Since 2014-15, the number of patients who chose not to wait in the ED for treatment and left at their own risk has increased by 36% across Australia. The reality is that resourcing increases have not been commensurate with demand.

“When an emergency department is overcrowded, as so many are, this is well known to increase risk of harm and death for patients, as pressure increases on staff who can struggle to care for overflow patients,” said Dr Bonning.

“Cases of ambulance ramping and ED overcrowding such as those referenced in last night’s report, and others under investigation, add further weight to this.

“Such high demand can also contribute to ambulance ramping; when the ED is so overcrowded, a patient is unable to be taken off an ambulance stretcher, and in some cases remains in the ambulance at the door of the hospital due to lack of a space in the emergency department. This problem is also compounded by the fact that arrivals by ambulance (per 1,000 population) have increased by 13% since 2014-15; the greatest increase of all arrival modes.”

Mental health patients are also continuing to face dangerously long waits in hospital emergency departments. An ACEM mental health access block snapshot survey has shown nearly one third of patients with an acute mental illness waiting more than eight hours in emergency departments, and some for much longer. Meanwhile, ACEM’s The Long Wait report found people presenting with acute mental and behavioural conditions were less likely to be seen within appropriate timeframes compared to other patients.

Dr Bonning said major commitments are needed to address the serious and systemic issues.

“Resourcing is a factor but there are also major systemic issues at play, such as the need to better manage hospital inpatient flows and beds, and the need for additional and improved primary care in the community,” said Dr Bonning.

“At the moment we are letting down too many Australians who are seeking timely treatment from emergency departments. We need governments to resource emergency departments properly but also to ensure there are sufficient inpatient beds, so that there are pathways out of the ED. This is a whole of health system issue involving flow of patients from the community through ED into hospital then being discharged back out into the community when they are well enough.

“Medical and executive leaders in hospital and health systems must also be accountable for ensuring that beds are managed as efficiently as possible. Ultimately the community suffers from insufficient resourcing and inefficient practices, and this is unacceptable.

“In order to improve accountability, one measure ACEM continues to call for is for all states and territories to embrace a national standard of mandatory reporting of 12 and 24 hour ED waits for mental health patients to hospital CEOs and Health Ministers respectively.”

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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