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'It isn't safe': Health system under siege as minister holds crisis talks

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Every Adelaide hospital emergency department was operating above capacity at the highest level “code white” last night, while the ambulance service sounded its own alarm over patient safety.

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The paramedics’ union says the ongoing impact of COVID, ramping and rising flu cases are smashing a network under siege, while the college for emergency medicine has declared “it isn’t safe”.

The nurses’ union says the health system is “on the brink of collapse”.

SA Health’s emergency department dashboard showed that at 8pm every single public hospital ED was at “code white” – the highest rating above capacity, meaning that the ED had all of its treatment rooms being used.

There were 137 patients still waiting to be seen, with 320 having commenced treatment.

The worst average wait time was at Lyell McEwin Hospital, at 216 minutes, followed by Flinders Medical Centre and Modbury Hospital both at 178 minutes.

SA Health’s emergency department dashboard.

It comes as Health Minister Chris Picton prepares to hold crisis talks this afternoon with emergency doctors from the Royal Adelaide Hospital and their union, after they began industrial action yesterday over bed-block.

The Government has said it knows the system is in crisis and wants to hear from doctors about short and long-term measures to ease the pressure.

Opposition health spokesperson Ashton Hurn said “the events of last night reflect a health system that is at breaking point, and what’s incredibly concerning is that it’s going to get worse”.

“We are just weeks away from COVID numbers exploding to 6000 cases per day – but Labor has no sense of urgency in preparing our system to cope,” she told InDaily.

Ambulance Employees Association (AEA) general secretary Leah Watkins said the SA Ambulance Service declared an “Opstat White” event last night – meaning “operational capacity, capability and/or resources are insufficient to maintain effective service delivery for high acuity cases” and “patient safety is directly affected”.

She said “Opstat White” levels had been declared 16 times in the month of June and again last night at 8.20pm.

“Last night’s Opstat White declaration was cited as being a result of a high number of pending Priority 2 cases, and ‘transfer of care delays’ ie ramping,” she told InDaily.

“The nature of the increasing demand of ambulance resources, the ongoing impact of COVID, the ongoing impact of ramping, and the rise in flu cases is placing even further strain on the Ambulance Service.”

Watkins said the ambulance service was failing to meet response times for a large number emergency cases.

“The significant investment in health and ambulance resources pledged by the Labor Government can’t come soon enough,” she said.

“The AEA has long taken the position of campaigning for patient and community safety. With this in the forefront of our minds, we encourage every eligible South Australian to ensure they are up to date with their COVID booster, and receive a current flu vaccination.

“It is the unfortunate reality that those needing an emergency ambulance may be facing significant delays, and we therefore encourage people to consider alternatives if safe to do so.

“We still encourage South Australians to call 000 if they feel they need to.”

Dr Michael Edmonds, SA faculty chair of the Australasian College for Emergency Medicine told InDaily: “It is now widely understood by stakeholders across health, including the government, that the health system in South Australia is in crisis and it isn’t safe, for either patients or staff.”

“The College recognises the commitment and resolve from the clinical workforce, government, and other stakeholders to collaboratively address the systemic issues that lead to access block, ambulance ramping, emergency department overcrowding, code whites, workforce issues and poorer outcomes for patients, including avoidable deaths,” he said.

“ACEM will hold the government accountable for the delivery of crucial fixes, and continues to offer clinician engagement in developing these solutions.”

Australian Nursing and Midwifery Federation state secretary Elizabeth Dabars told InDaily “after years of inaction and neglect, the new state government has inherited a health system on the brink of collapse”.

“Despite our urging, the previous government failed to address inpatient and sub-acute capacity,” she said.

“As a result, we have significant blockages in the health system with people trapped in the ED for days and weeks, or in an acute care bed they no longer need for weeks and months.

“This takes away the ability for people who have genuine acute care needs from accessing a bed and does nothing to fix ramping.

“The previous government also did not make any genuine effort to address workforce growth, only making a last ditch effort at the end to employ more graduates nurses and midwives that they then failed to support appropriately.

“The situation we now find ourselves in is entirely predictable and one we warned the former government about.”

Dabars said the new government had committed to growth in capacity with 300-plus extra beds and investment in new staff “but the immediate shortages of people with the required skills along with capacity in beds and services mean that these new investments are not working quickly enough to impact now or in the short term”.

“Nurses and midwives have been working 18 hour shifts, working short and have been fatigued and under resourced for a long time,” she said.

Picton told reporters today “we are absolutely concerned” about the state of the system.

“Clearly we are facing a really dangerous situation in terms of our hospital situation and our health services because we clearly don’t have the capacity in our system which hasn’t been there for a long time,” he said.

“We haven’t seen increasing numbers of beds and facilities available and we have now opened every possible bed that we can across the health system to cope with the demand that we are seeing.

“We are now refocusing our efforts to try to find any additional capacity that we can open in the health system.

“We are absolutely clearly concerned about what the situation is in terms of the capacity in our health system. And that’s why we’ve opened up over 200 beds since we came to government just a few months ago and that’s why we’re actively trying to find any additional capacity that we can to provide care to patients.”

In a statement, Picton told InDaily “we know that our public hospital EDs are incredibly busy at the moment with the normal winter ills, combined with COVID cases, and the flu”.

“We also know our hospitals are experiencing significant bed block due to patients waiting on places in aged care facilities and NDIS packages,” he said.

“The former government failed to invest in more capacity for the hospital system, and many of the issues we are facing are due to lack of beds and staff.

“This government is spending an extra $2.4 billion on the health system – which includes more beds, more doctors and more nurses.

“But this will take time and in the short term we have opened up more than 200 extra beds across the system to provide more capacity immediately and we are working with doctors on this issue.”

Picton said he was “looking forward” to meeting with the SA Salaried Medical Officers Association and ED doctors later this afternoon “to hear their proposed additional measures on how to combat the problems that we have inherited in the short term”.

“I meet with doctors across the system regularly and will continue to meet with them to understand their challenges and work with them on how to resolve these issues,” he said.

“As the Premier said yesterday we have opened every bed in the system already but if there are additional things we can do then we absolutely will.”

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