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Emergency room crisis hits Royal Adelaide Hospital


Several patients were held in the Royal Adelaide Hospital’s emergency department for five days straight in an “extreme” overcrowding crisis late last week, InDaily can reveal.

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It is understood that by Thursday afternoon last week, three mental health patients had been languishing in the Royal Adelaide Hospital’s emergency department for five days running.

Five more mental health patients had been in the ED for three days and one had been there for four days.

The situation was “the most extreme I have seen in quite a while”, said South Australian councillor for the Australasian College for Emergency Medicine Dr Thiru Govindan, who is also a consultant emergency physician at the RAH.

He told InDaily about 25 mental health patients were stuck in the emergency department that afternoon, waiting on psychiatric beds in the hospital which were occupied.

The overcrowded emergency room was declared “unsafe” when the ED – which has 58 designated treatment spaces – contained about 75 patients, he said.

According to SA Health, seven patients had to wait for treatment in ambulances outside the hospital that afternoon – a practise colloquially known as “ramping”.

The longest wait in an ambulance was just over an hour.

SA Health would not reveal how many ‘code black’ incidents – threats to staff and patient safety requiring the intervention of security officers – occurred in the ED that afternoon.

Govindan said that some mental health patients had to be accommodated in medical cubicles in the ED, after the four mental health cubicles became occupied.

Medical cubicles pose dangers to patients suffering psychosis because unlike mental health cubicles – containing little more than a mattress – medical cubicles contain electrical wiring, hoses and equipment.

Govindan said some of the mental health patients who had been waiting for unacceptable periods in the ED were transferred to physical health wards – a practise he said he had never seen, having worked at the RAH since 2003.

“That is a crisis response for the hospital,” he said.

He said while the emergency department was “well-equipped” to deal with mental health patients suffering psychosis initially, the environment only served to worsen a patient’s condition after several hours.

Govindan said the 24/7 lighting and noise of an emergency room makes it “very unsuitable for mental health patients”.

“If they’re left in the ED, that exacerbates their condition,” he said.

Chief Executive Officer of the Central Adelaide Local Health Network Julia Squire confirmed that, “on Thursday March 10, the Royal Adelaide Hospital experienced a surge in emergency department presentations, including an unusually high number of mental health patients”.

“During this period of high activity, all mental health patients were cared for by specially trained mental health nurses,” Squire said.

“We know there is more work to be done, and our hard working staff do all they can to provide quality care especially during periods of high demand.”

Two years ago, Health Minister Jack Snelling set a target for his department that no mental health patient should wait more than 24 hours in a South Australian emergency department by January 2016.

The State Government has since achieved some long-term improvements to waiting times for mental health patients.

Last month InDaily reported that the number of mental health patients languishing for days in South Australian EDs had steeply declined.

And the average waiting time for mental health patients in EDs reduced from nearly 16 hours in late 2014 to eight hours by the end of 2015.

In the Central Adelaide Local Health Network, the average length of stay was 13.5 hours in July 2013, but reduced to 8.6 in January 2016.

“While there has been a dramatic decrease in emergency department wait times for mental health patients over the past six months, more needs to be done,” Minister for Mental Health Leesa Vlahos told InDaily this morning. 

“I have made it clear that one person waiting longer than 24 hours in our emergency department is too many.”

Last week’s experience at the RAH demonstrates the Government is far from meeting its target.

And the overcrowding at the RAH ED was worse this Tuesday, when the emergency department was crammed with about 90 patients, Govindan said.

He said the college was concerned by the “state-wide problem” of overcrowding in emergency departments, but that it had become particularly severe at the RAH.

He said SA Health was listening to the concerns and taking them seriously.

Mental Health Coalition Executive Director Geoff Harris that the state and Commonwealth governments were neglecting mental health programs that helped prevent patients arriving in emergency rooms in the first place.

“Whilst the focus in the media is on emergency and acute [mental health] beds, a number of the most innovative reforms of the last five years have either lost funding or will cease operating at the end of June this year,” Harris told InDaily.

“Programs such as intensive home-based support have had highly positive evaluations but have not been funded to continue.

“The intensive home-based support program was independently evaluated … [showing] it was highly effective in assisting people to gain a positive quality of life and reduce their use of emergency and acute care beds.

“The evaluators stated that if the program had continued it would have more than paid for itself in cost offsets generated by reduced use of emergency and acute care beds.”

He said another program, Crisis Respite, was facing the chop.

“Crisis Respite is a community-based option that appears to be very effective, is highly regarded by the people who have needed to use and is currently being evaluated,” Harris said.

“To date 40% of entries to this service have come directly from emergency or short stay units.

“… it won’t matter what the evaluation finds as there appears to be no interest from the Commonwealth or the state to continue to fund it.”

He said the programs, jointly funded by the state and federal government, were “well supported by evidence and aims to assist people to reduce their use of crisis services such as emergency and acute care”.

“We know what the robust solutions are to reducing the crisis in ED and acute care long term and helping people severely impacted by mental illness to lead better lives.

“What we don’t know is who cares enough to fund it.”


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