More than 20 people have had elective surgery cancelled in the past 24 hours, extra ambulance crews have been brought in to try to transfer patients out more quickly, medical teaching rounds have been cancelled and senior staff are meeting every two hours to assess the overload.

But the Health Minister this morning revealed he was yet to speak to the hospital boss about the crisis.

The hospital yesterday declared a “major incident alert” triggering measures to ease overcrowding, as it was swamped with people seeking treatment.

It’s the second time in recent weeks such action has been taken at an Adelaide hospital – with Flinders Medical Centre doing the same last month.

Central Adelaide Local Health Network chief executive Lesley Dwyer said the RAH this morning remained “in a major incident… although it’s a slightly improved position but we want to make sure that we do not have ourselves becoming overwhelmed again”.

“Yesterday, we were in a position that we needed to ensure that our hospital was safe, that we needed to make sure that patients in the emergency department could not only be treated but then be transferred to an inpatient bed,” she told ABC Radio this morning.

“It’s very unusual for the Royal Adelaide to ever, ever call a major emergency.

“We know that often because we’re a major referral centre, that we have to be what we call a pressure valve for the system, so we didn’t take that decision lightly.”

She said the problem stemmed from a busy weekend.

“We’ve had a weekend where we’ve really started to struggle with the amount of patients that we had in our ED, where we didn’t have enough inpatient beds coming up,” she said.

“We did all of the things that normally do which is often using the Queen Elizabeth to what we call smooth ambulance activity; tried to make sure we increased our discharges but didn’t manage to get on top of it.

“As I say, it’s not a decision that we took lightly.

“We took that decision based on the clinical advice of our treating practitioners.”

She said 12 people had had elective surgery cancelled yesterday, another 10 today and more radiology work was being done “to make sure that nobody was waiting for scans such as CT scans, MRIs”.

Nurses said the situation at the RAH was symptomatic of “an entire public health system in crisis”.

“Even with this measure put in place, we had nearly 90 people waiting for a bed across metropolitan hospitals this morning,” said Australian Nursing and Midwifery Federation state secretary Elizabeth Dabars.

“This is an appalling number. South Australians are having to endure excessive wait times when they are in need of care.

“Almost all hospitals across this state are repeatedly running beyond capacity, reducing the ability to be able to manage spikes in demand.”

Emergency doctors also said it was a sign of a widespread problem.

“Major pressures in emergency departments are a near constant as a result of ongoing systemic issues across the state’s healthcare system,” said Australasian College for Emergency Medicine state faculty deputy chair Dr Michael Edmonds.

“The emergency medicine workforce is increasingly frustrated and distressed as a result of this unsustainable situation that continues to place patients at risk.

“This is a completely unacceptable way to deliver healthcare and South Australians deserve better.”

Edmonds said the current problems were a result of system-wide factors leading to delays in admitting sick and seriously injured patients from emergency departments to inpatient beds for more definitive care, and were not due to “patients who should have gone to a GP instead”.

“The government needs to step up, with genuine solutions – beds, staffing resources, system fixes – to address South Australia’s acute hospital access crisis,” he said.

Dwyer said she hoped the RAH’s internal emergency code would not need to be extended beyond today.

“It would be really unusual for us not to be able to correct our position by today but as I say every two hours we are looking at what we are doing, we have got all of our clinical leaders and our clinical staff all focused on the same thing, which is every patient in our hospitals needs to have a plan about what is happening for them,” she said.

Dwyer said the hospital needed “more options” for where to discharge patients for “ongoing support”.

She said she had not spoken to Health Minister Stephen Wade about the crisis but that SA Health chief executive Chris McGowan was “aware of what’s happening, his team are wrapping around us saying ‘what is it you need?’ and we’re expecting that when we ask for something that it is done”.

Wade this morning told reporters he’d had conversations with his departmental team about the crisis and expected to speak to Dwyer about it “this week”.

“What we saw over the last week in particular was an increase in category one and two – about a six per cent increase in our two most urgent emergency presentations,” he said.

“They are the categories most likely to need inpatient care.

“There was an unexpectedly low number of patient discharges and that led to pressure right across the system.”

He said RAH management “stood up a major incident yesterday because they needed a whole of hospital response”.

“Often the emergency department is if you like buffeted by different elements of inflow and outflow,” he said.

“What the RAH did yesterday was say we’ve got real pressure on our emergency department, we need a whole of hospital response, we need a whole of network response and that’s what a major incident is about.”

Opposition health spokesman Chris Picton said it was “gross negligence that Stephen Wade didn’t even pick up the phone to the CEO of our state’s largest hospital during the middle of an ‘internal disaster’”.

“What is the point of having this Health Minister if he’s not going to do anything when we have a health system in crisis and patients suffering?” he said.

“There’s 22 patients waiting even longer in pain today because their operations were cancelled, yet Stephen Wade couldn’t even pick up the phone to the hospital boss.

“The Marshall Government appears keen to blame anything and everything – coronavirus, federal government, former governments – everything except their own cuts and mismanagement.

“We desperately need the Liberals’ cuts to stop in our hospitals, the corporate liquidators to be shown the door and for the Government to finally listen to clinicians about investments needed to address the crisis.”