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AN EMERGENCY medicine physician says patients throughout Australia are still dying unnecessarily as they wait in emergency departments (EDs) for a hospital bed.
The accusation is based on a nationwide ED snapshot taken in September that showed three-quarters of hospitals had access block.
Associate Professor Drew Richardson, chair of road trauma and emergency medicine at Australian National University Medical School, said even though politicians and health departments had been shown the facts and patients were still dying while waiting for beds, there had been no significant improvement in access block in the past year.
Access block is defined by the Australasian College for Emergency Medicine (ACEM) as the situation where patients are unable to gain access to appropriate hospital beds within a reasonable time, which is defined as no greater than 8 hours.
Professor Richardson is due to present the latest Australian data on access block and overcrowding in emergency departments today (22 November) at the ACEM annual scientific meeting in Canberra.
Two snapshots were taken this year, at 10am on one Monday in May and one in September, in the EDs of 77 and 76 accredited hospitals respectively across Australia.
The September data showed 77% of patients who needed a bed waited more than 8 hours.
The proportion had remained unchanged in the past 2 years, Professor Richardson said.
The data showed 2107 people were under treatment (27.7 per ED) while 545 patients were in the waiting room (7.2 per ED).
Of the 2107 under treatment, 735 were waiting for beds (9.7 per ED). Of those waiting for beds, 570 had been waiting for more than 8 hours (7.5 per ED) and 96 had been waiting for more than 24 hours (1.2 per ED).
The May study found that 73% of patients needing a bed had waited more than 8 hours.
Nationwide, 62 patients had been in the ED for more than 24 hours, the longest being more than 60 hours since an inpatient bed had been requested.
Release of the data follows a report issued last week by the Australian Medical Association that showed there had been little improvement in public hospital capacity and performance despite significant extra federal funding as part of the National Healthcare Agreement.
Professor Richardson co-authored an article in the MJA last year that said at least 1500 deaths each year in Australia, similar to the road toll, could be attributed to ED overcrowding.(1)
Professor Richardson told MJA InSight before the ACEM conference that the value placed on emergency as opposed to elective admissions needed to be reviewed.
“If you could get all the people waiting for nursing home beds out and shorten the length of stay for elective surgery, and reduce the admissions under physicians that are done for investigations of people who aren’t actually sick at the time, then there would be more available beds without increasing the bed stock,” he said.
“It is clear we have got the balance wrong in terms of the facilities we are providing for emergency patients.”
Study co-author Dr Peter Jones, director of emergency research at Auckland City Hospital in New Zealand, said the whole health system needed to change to run 7 days a week for both elective and acute patients.
“This will require a major paradigm shift for hospital specialists,” Dr Jones said.
“This is potentially causing great harm to patients and the need for change is urgent.
“I am not sure what more motivation politicians need.”
1. Med J Aust 2009; 190: 369-374.
Posted 22 November 2010
A large part of the problem in my area is the loss of mobile x-ray 4 years ago because the update to new digital radiology and the poor rebate meant private radiologists were not able to underwrite the service. As a result elderly people are being transported at great cost and inconvenience to a public A&E just for plain x-rays – often for medicolegal reasons.This often results in the person suffering deterioration in their physical/or mental health tying up beds.
“If you could get all the people waiting for nursing home beds out —–“. It is distressing to read that acute hospitals are still suffering due to past government actions in running down the buffer of beds that previously existed in secondary care. Also a focus on getting patients INTO nursing homes should be redirected into getting them well enough to stay out where possible. This means active consultations in the patient’s home and systems of comprehensive care and rehabilitation in the community. Nursing home admission should be only a carefully chosen option for anyone, either in hospital or at home. It should not be a means of clearing beds for the next acute admission, but I suspect this is often the case.
This article confirms what we all know – that access block is real and has not changed over the last years.
The problem is that there simply are not enough beds, neither on the wards nor in the nursing homes, and that an increasingly elderly population have a high incidence of co-morbidities which makes early discharge impractical.
One patient of mine who was in ICU for legionella pneumonia recounted to me his discussion with a senior official in the NSW Dept of Health who happened to be a friend of his. He had not been able to leave ICU because of lack of beds on the wards. The DoH official had left us a message: “Tell them to try harder”.
We are already trying so hard that there is nothing left to try with. Try as we might, we cannot create beds from nothing.
The real problems behind access block need to be addressed. Blaming the messenger is a poor substitute for intelligent management.