A group of emergency department medicos today took the unusual step of speaking out to voice their concerns, declaring they’re at their “wits’ end” over a shortage of treatment spaces and medical under-staffing.
They say the WCH paediatric emergency department has just 19 treatment spaces when it should have 32 according to national guidelines and interstate comparisons.
They also say there’s a shortage of 10 full-time training medical officers compared to the average of comparative interstate hospitals.
“Executive are placing all of the clinical risk on the clinicians by leaving the department massively understaffed,” WCH emergency department doctor Davinder Gill said.
“Clinicians are stretched beyond their limit.
“Patients shouldn’t be subjected to this risk.”
The concerned doctors say the situation is “untenable” and are calling on the WCH Board to intervene and “fix the situation before it’s too late”.
Fearing repeated pleas from their union have fallen on deaf ears, they want the Premier to step up and offer a solution.
“It is a testament to the dedication and hard work of the Emergency Department staff that there are not more adverse events,” Gill said.
“But the risk is high and errors do occur.”
The doctors say the WCH has the worst record in the nation for missing the “four hour discharge target” for patients as well as the worst “did not wait” record of any similar hospital in the country.
They say nearly one in ten patients who attend the WCH paediatric emergency department do not even wait to be seen.
Gill said he and his colleagues have “no confidence that current management understand the seriousness of the issue”.
He called on the Board to “intervene urgently on behalf of the state’s children and families before there are more adverse events and the system fails completely”.
Gill said the ED was under-sized and understaffed “on all comparative measures, and the results are now there for everyone to see every day and every night”.
“Many patients wait more than four hours, some even up to eight hours to be seen,” he said.
“Almost nine per cent of patients don’t even wait to be seen.
“Key performance indicators are the worst in the country.
“The situation has been deteriorating for years and has been continuously neglected by hospital management.”
Gill said to reach the activity-based national average, the WCH needs 10 extra doctors and 13 more treatment spaces.
“In other words, if this hospital was in any other state, it would have 10 additional doctors and 13 additional treatment spaces,” he said.
“The Hospital Executive have approved some temporary staffing to deal with COVID, as have all of the hospitals Australia-wide, but this is unrelated to the systemic understaffing and extreme patient risks.”
SA Salaried Medical Officers Association chief industrial officer Bernadette Mulholland said the WCH ED was “in crisis”.
“The doctors have knocked management’s door down with warnings and proactive suggestions and are at their wits’ end,” she said.
“They are simply not being listened to by management.”
Mulholland said measures put in place by hospital management to try and help the situation – including virtual triage assessment and GP liaison – have “missed the mark and are wasting tax-payers’ money”.
The doctors’ concerns come amid growing fears the state would not cope with a local outbreak of COVID-19.
Dr John Bonning, president of the Australasian College for Emergency Medicine, told ABC Radio Adelaide this morning that despite having no COVID outbreak, SA was one of the worst performing states in the nation for hospital overcrowding and ambulance ramping.
“South Australia (is) right up there with the worst performers unfortunately at this stage,” he said.
“It has to be said Tasmania and Western Australia are the other relatively COVID-free states (and) are also struggling but certainly Adelaide has been a bad performer on this.”
Bonning said it “it’s not really clear why”.
“This is about acute hospital capacity for patients who come in in emergencies, it’s predictable and the states I have mentioned seem to be the poor performers in terms of planning for these emergency patients,” he said.
“It’s not some peri-pandemic blip and we would be seriously worried if/when COVID hits your states.”
His comments echo concerns voiced by the Ambulance Employees Association and SASMOA, in response to comments this week from the outgoing chief of the SA Ambulance Service, David Place, that SA would be “well placed” to cope with a large COVID outbreak such as that now experienced by New South Wales, despite record ramping outside Adelaide hospitals.
Demand on the Royal Adelaide and Queen Elizabeth hospitals was so high yesterday, it triggered an internal “major incident alert” as staff struggled to cope with the pressure on EDs.
It has forced some planned surgeries to be cancelled and has left health officials scrambling to secure more inpatient beds in the public system and at private hospitals.
Premier Steven Marshall this morning told reporters “we obviously are always reviewing the resources that we have in SA Health”.
“If there are specific issues that need to be addressed then we’re happy to look at them, but I have absolute confidence in the management of the… Women’s and Children’s Local Health Network and also, of course, in their board,” he said.
Marshall said the government had already “significantly expanded the capacity at the Women’s and Children’s Hospital in response to the coronavirus”.
“We have announced a brand new Women’s and Children’s Hospital in South Australia co-located with the Royal Adelaide Hospital, but more than that we have committed more than $50 million to keeping the existing facilities at the very high level that they need to be,” he said.
“We’re not going to let them go to wrack and ruin… we’re continuing to invest.
“We now have more doctors, more nurses, more beds, more ambulance officers and a much, much larger budget than when we came to government.”
Health Minister Stephen Wade said “pandemic plans” were put in place at a state level early in the pandemic “and we continue to review these plans as the pandemic evolves”.
“We remain ready to respond in the instance we have a surge in demand related to an outbreak,” he said.
Wade said SA was “not alone” in experiencing high levels of emergency department demand in recent months.
“Crowded EDs, record ramping and long waits for ambulances have been seen across the country, including Queensland, Western Australia, Tasmania, New South Wales and Victoria throughout this year,” he said.
“Even in the absence of local outbreaks, hospitals across the nation have experienced increased pressure as a result of the pandemic, most recently highlighted by the record levels of ramping being experienced in Western Australia right now.
“COVID-19 protocols are vital for our safety but they do significantly increase the time it takes to treat people in EDs. Delays are related to the infection control, the use of isolation rooms and reducing the interaction of possible COVID-19 and non-COVID-19 cases.”
Wade said that during the recent Modbury cluster “we saw the importance of maintaining these protocols in keeping the state safe”.
“As hospitals across the nation are experiencing increased pressure, the Marshall Liberal Government is investing $7.4 billion in health services to fix the problem, at the same time delivering a massive $3 billion hospital build program,” he said.
“There are more doctors, nurses and ambulance staff employed in South Australia than ever before.
“The independent Auditor-General’s figures show that there has been a net increase of more than 1000 frontline health staff since the 2018 election.
“Each year, the total number of frontline health staff has increased under the Marshall Government and we will continue to invest in our health system going forward.”
In a statement, the Women’s and Children’s Health Network said it was committed to “delivering the highest level of care to our patients, and every child who presents to our Emergency Department will receive the treatment they need”.
“While our hospital has experienced increased demand in recent months, a number of measures and resources have been implemented to meet the needs of all our patients,” the statement said.
“The Paediatric Emergency Department (PED) has introduced a range of new positions to help improve flow and quality of care, including the GP Liaison Consultant, additional social worker, ED and mental health positions and additional medical staff.
“Our PED pods currently offer nine additional treatment spaces during the busiest time of day and we are continuously working with clinicians to develop ways to improve patient flow through the PED.
“We thank our staff for always working hard to provide the best possible care and services for our patients and the community.”
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