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Alarm sounds over emergency department staff shortages

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Lyell McEwin Hospital doctors claim management is stonewalling requests to urgently recruit more staff after emergency department presentations rose by at least 25 per cent in six years.

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Hospital medicos have written to Health Minister Chris Picton urging him to intervene, warning the problem will worsen when the hospital’s redevelopment is completed next year.

The doctors’ union says the ED will grow from 54 treatment spaces to 77, but there are concerns there won’t be enough clinicians to staff it.

SA Salaried Medical Officers Association chief industrial officer Bernadette Mulholland told InDaily the ED is now inundated with 200 to 210 patients each day, compared to 160 in 2016 – an increase of 25 to 30 per cent.

“What we are not seeing is a commensurate increase in the clinical staff and the space and the additional capacity to complement that actual increase in patient presentations and demand,” Mulholland said.

“When the new development is open we’ll certainly have the additional cubicle space but at this stage we don’t have the clinical FTE to support those additional presentations.

“You can’t open 77 cubicles without the required essential staff to go with it.”

Mulholland said the ability to recruit adequately-skilled medicos would take extra time in a workforce plagued by fatigue and staff shortages across the board.

“With doctors you actually need about six months lead-in time to recruit to these positions,” she said.

“And really we should start to be recruiting for trainee doctors for next year in about four weeks’ time.”

Mulholand said COVID had also made it difficult to bring staff in from overseas.

She accused hospital administrators of blocking business cases outlining the required levels of additional staff.

“The NALHN SA Health executive seems to minimise and discount the issues that have been raised by the profession, by the medical officers, and that in itself raises issues of culture and the disconnect between clinicians and the administration,” she said.

Mulholland said until the problem was addressed, patients would continue to suffer, like 92-year-old Maureen Wortley, who was forced to wait two hours in the cold in her dressing gown outside the ED earlier this week.

“As clinicians they all know they can’t get everything they want but you actually need some tools to be able to provide that timely patient care,” she said.

“There’s a disconnect between the administrators who control the finances and the clinicians who provide the care to the patients and the community.

“Until there’s a preparedness by the administration to do that – to loosen some of that control – then we are going to continue to see these repetitive issues and crises in our health system.”

Dr David Pope, a senior clinician at the Lyell McEwin and immediate past president of SASMOA, said there were staff shortages across the board in Adelaide’s hospitals but the Lyell McEwin was the worst affected.

“We can’t come anywhere to meeting the demand of patients,” he said.

“We are always at least one shift behind. People are waiting 12 to 14 hours to see a doctor because we just simply don’t have the doctors.”

Dr Michael Edmonds, SA faculty chair of the Australasian College for Emergency Medicine and an emergency doctor at the Royal Adelaide Hospital, said the pressure across Adelaide EDs was “terrible at the moment”.

“The situation is becoming untenable with staffing shortages,” he said.

“There’s no immediate hope of improvement and they’re all recognising that winter is coming, the flu is making a comeback this year, COVID is still going around strong and we’ve still got the worst access block we’ve seen in years,” he said.

“It’s going to be a terrible situation in the next few months.”

Health Minister Chris Picton said he would meet with clinicians “to hear about those concerns and what we can do to try to improve the situation for them to be able to best treat patients”.

“I understand there are significant concerns about staffing at the Lyell McEwin and at other hospitals,” he told InDaily.

“This is why we were elected with a plan to increase the number of doctors and nurses across the system and also to properly develop workforce planning for the system which hasn’t been in place previously.

“We’ve got a health system that’s under pressure, under-resourced.

“A key element of our health system is our staff – our doctors and nurses. They have been working flat chat during the last two years during the pandemic and clearly there are key elements of the system including the Lyell McEwin where there are additional staffing needs.”

Picton said the State Government was “now working through implementing our election commitments to boost staffing right across the health system including the Lyell McEwin”.

In a statement, a spokesperson for the Northern Adelaide Local Health Network said the Lyell McEwin had “recently experienced periods of high demand” but insisted “as is the case whenever it is busy, all patients presenting to our emergency departments (EDs) are prioritised according to their clinical needs”.

“NALHN has continued to recruit and increase medical staffing in the LMH ED with an additional 8 FTE in this last financial year,” the spokesperson said.

“As we work though developing a new ED Model of Care, medical officer staffing for the LMH ED is currently being reviewed.

“Our hospitals are also staffed in line with the Nursing Midwifery Enterprise Agreement and we prioritise our workforce planning to ensure the wellbeing of our staff.”

The spokesperson said “behind the scenes, work is occurring around improvement of employee wellbeing across NALHN”.

“We thank our staff for always working hard to provide the best possible care for our patients,” the spokesperson said.

SA Health says the $58 million Lyell McEwin upgrade is being completed in a staged approach with the entire redevelopment due to open in January next year, increasing ED capacity to 72 treatment spaces.

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