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"Perfect storm": doctors missing in crowded ED

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The doctors’ union says Noarlunga Hospital is reviewing its nighttime roster following an incident where its emergency department was left without any available doctors.

A medical officer told union inspectors last month that doctors had to attend a violent incident on the hospital’s mental health ward – Morier Ward – and another incident involving resuscitation during one night shift. This left only nurses, allied health professionals and administration staff available to attend patients in the overcrowded ED.

“The situation was the perfect storm – no medical attendance was available for the crowded ED (and) we were just lucky no adverse event happened,” one doctor said.

“The ED was full, triage area was full, resus (resuscitation) patient came in, and a code black in the Morier Ward …

“It’s scary, we were just lucky on this night, but if it’s not (considered) dangerous on nights for us and the patients, I’m not sure what then is considered dangerous.”

“This sort of near miss situation arises about once every three months but it did not happen at all before.

“At nights we are expected to cover the rest of the hospital medically and if this happens we do not have the staff to be able to cover the patient load in the hospital.

“… it is no longer necessarily a safe or predictable environment.”

The South Australian Salaried Medical Officers’ Association (SASMOA) inspected Noarlunga Hospital twice last month.

The hospital uses the beleaguered electronic health records system, the Enterprise Patient Administration System (EPAS), the rollout of which was suspended in June following safety warnings from doctors.

READ MORE: E-health system caused “rage attacks”, patient risks

Doctors told inspectors they were resorting to taking patient notes on paper towel during emergencies, because EPAS was too slow to use safely.

“In my view, the new EPAS system is not quicker (than the former, paper-based system) and it is much easier to make errors,” one medical officer said.

“For example, I would not use it for resus. We use paper towel, write it up and then punch it in.

“… the system EPAS uses is completely the opposite of our current national medication system.”

Another doctor said: “I was excited about EPAS. I love technology, I grew up in the age of technology and use it all the time, but EPAS is overwhelming, cumbersome, it generates more paper than previously, still takes up enormous amounts of time … and it is still not safe”.

“I am so disappointed with the way EPAS has gone.”

In August, InDaily reported that emergency department waiting times for Noarlunga Hospital had not been published for months.

A doctor told the inspectors: “Noarlunga Hospital was suspended on the (public emergency department waiting times) dashboard when EPAS was introduced but it is now operational, so not sure why we are not being displayed and are not available to the public”.

Doctors also said senior staff were extremely overworked at the hospital.

“The same senior staff are used too often – they become ‘punch drunk’ as they don’t get appropriate time off,” a doctor said.

“Staff sick leave within the ED has increased in the alst few months – one medical officer will call in sick per day.

“… recently there were four medical officers off on the same shift.

“There is no backfill for sick leave of medical officers. Locums are called in for relief for junior medical officers, but consultants are called back in.”

SASMOA has been called out by doctors to inspect hospitals across the state over the past three months, revealing claims that patients have died, mental health patients have been held for days in emergency and safety has been compromised because of severe emergency department overcrowding.

Several of the complaints made by Noarlunga hospital doctors echoed complaints made by doctors from hospitals in previous inspections.

Noarlunga Hospital doctors said that mental health patients were being held in windowless cubicles in the emergency department for several days:

“The other week a mental health patient had waited in the Emergency department for seven days” one said.

“It is not proper or appropriate care for these patients. They stay in the cubicles 24/7.

“This should be anything but what we experience in the provision of health care.”

“For days we watch them deteriorate and they need to go to a proper bed,” said another.

One doctor said mental health patients “should be admitted to a bed in the ward and ownership of these patients and their care is form this mental health unit”.

“…we don’t have the expertise at the emergency department.”

Doctors also said chemical restraint was being increasingly used to treat acute psychiatric patients.

“In the emergency department, we have to use a custodial model verses a therapeutical model for patients that present with mental health issues,” a doctor said.

“For days we watch them deteriorate and they need to go to a proper bed,” said another.

SASMOA has given the report to SafeWork SA, accusing the South Adelaide Local Health Network of several breaches of the Work Health and Safety Act.

SA Health released a statement to InDaily this morning saying work is being done to ensure the safety of the hospital’s staff and patients.

“The doctors and nurses at Noarlunga Hospital work extremely hard, and we’ve been working with them to make sure their safety, and the safety of our patients, is always prioritised,” the statement reads.

“There is a robust governance structure, and a number of committees, that reviews and monitors Work Health & Safety performance.”

Consultation is underway on the State Government’s “Transforming Health” discussion paper, released last month, which recommends that health services be consolidated in more specialised hospitals in order to reduce waiting times and rationalise resources.

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