Statement on ambulance ramping at Women’s and Children’s Hospital

The College urges hospital executives and the South Australian government to take immediate steps to make sure women and children in need of acute medical care do not have to experience dangerous waits – before tragedy occurs.

The College has repeatedly raised significant concerns around patient safety and systemic issues in South Australia’s health system. The College has previously raised concerns with SA Health about unpublicised reports of ramping at the WCH and were informed that it had not, in fact, occurred.

The reports from Tuesday night indicate that the WCH has clearly now joined other emergency departments (EDs) in Adelaide in suffering from ambulance ramping. This first ever acknowledged incident of ambulance ramping at WCH demonstrates that, despite reassurances from the government, the healthcare system is failing to meet the needs of South Australians. It also demonstrates a clear disconnect between the bureaucrats and policy makers, and the reality of our health system.

Following tragic incidents in children’s hospitals in other states of Australia, emergency doctors are anxious that without immediate action to fix the issues that lead to ramping a similar tragedy could occur in South Australia.

ACEM is also greatly concerned that if these problems are not solved immediately the arrival of COVID-19 into South Australia will push an already overwhelmed health system over the edge. Despite numerous announcements from Premier Marshall, there has been no appreciable change in frontline health systems that are already beyond capacity.

Even without COVID-19, South Australia is experiencing an acute hospital access crisis, with dangerous access block – a result of systemic staffing and capacity issues creating delays in patients being admitted from EDs to inpatient beds – leading to extreme ED crowding, ambulance ramping and concerns for patient safety and staff wellbeing. The College has previously expressed our frustration and despair at the inability and reluctance of SA Health to address this issue to effect sustained and meaningful improvement.

Access block is dangerous for patients and staff and leads to poorer patient health outcomes, longer hospital stays, increased errors in care, and an increased chance of death. It is one of the biggest causes of workplace stress for emergency healthcare workers and it contributes to staff burnout.

Fixing ambulance ramping will require a whole-of-system response to address the dangerous problem of access block. Access block occurs when there are not enough staffed inpatient beds or community care options for people to access care following initial care in the ED. To simply state EDs should stop ramping as an action, as directed by the SA Health chief executive yesterday, is to ignore the antecedents to this practice and the exhaustive advice from experts and clinicians – and will undoubtedly lead to patient harm.

Emergency healthcare workers work hard to deliver the best possible patient care. But they cannot do this without the support of government and hospital executives, who are in charge of our healthcare systems and responsible for providing in-patient beds and hiring staff.

Governments and hospital executives are obligated to ensure that hospitals and the public health system are properly supported and administered to deliver the safest possible healthcare to the community.

In order to address ambulance ramping, the College urges the SA Government to significantly increase investment into the public health system in ways that will reduce access block. This should include the addition of at least 200 fully staffed hospital beds and 130 fully staffed psychiatric beds across South Australia, allocated according to operational need.

Hospital Access Targets (HATs) should also be implemented state-wide. ACEM welcomes the announcement of new sub-acute beds, and urges the SA Government to trial, review and/or implement access block solutions such as direct admissions, discharge lounges and access to diagnostics outside business hours.

ACEM calls upon the premier and SA health to genuinely engage with ACEM and other clinical stakeholders to address the ongoing issue of access block and the realities of SA’s COVID-19 preparedness.

ACEM South Australian Faculty Chair Dr Michael Edmonds said, “No one requiring emergency care should experience ramping or other delays to acute care – especially children.”

“Many of us will need emergency care in their lives and everyone deserves, and should expect, timely access to the best possible care.”

Dr Edmonds said, “Delays in care, such as from access block and ramping, lead to poorer patient health outcomes, longer hospital stays, increased errors in care, and an increased chance of death. Long waits for an ambulance and for a bed in hospital are becoming the norm. But it is not the quality of care we should be accepting as normal. No one needing care should get stuck waiting. “

“That our hospitals are unable to meet the needs of South Australia before we even begin to see the impact of COVID-19 in South Australia is mind-boggling. Our emergency clinicians live and work in fear of how bad this situation may become. Despite this, the community should feel reassured that our emergency departments will continue doing everything we can to ensure emergency care needs are met as best as possible.”

Dr Edmonds said, “To ensure everyone gets the healthcare they need when they need it, we, Australia’s peak body for emergency doctors, urge South Australians to demand sustainably staffed additional inpatient bed capacity and immediate and long-term solutions and plans to address the dangerous access block and ambulance ramping being experienced in hospitals.”

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