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Most patients wait over four hours in Royal Adelaide emergency

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EXCLUSIVE | More than half the people who arrived at the Royal Adelaide Hospital’s emergency department last year waited four hours or more for admission, new SA Health data shows.

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In the 12 months to July this year, 43,799 of the people who turned up at the RAH emergency department spent at least four hours there before being admitted or discharged.

That’s 52 per cent of the 83,535 patients that arrived at the ED in 2018-19. SA Health says the figures represent a 5 per cent improvement on the previous year.

Some of the patients stayed, or were held, in the emergency department for extreme periods:

Previous reporting by InDaily has shown patients with mental health conditions are often left – or detained – in the emergency department the longest, waiting for a bed in the Royal Adelaide Hospital’s psychiatric ward – although this data does not specify patient conditions.

Bronwyn Masters, the Central Adelaide Local Health Network executive director of operations, told InDaily the hospital always strived to do better, and that SA Health had established home hospital programs and priority care centres in its efforts to improve the situation.

Masters said the hospital had experienced a 7.1 per cent increase in the number of presentations to the Royal Adelaide Hospital emergency department in 2018-19.

Despite this increase in presentations, we had a 5 per cent improvement in the percentage of patients seen and treated within the National Emergency Access Target (NEAT) compared to the previous 12 months,” she said.

“Our clinical staff work hard to provide the highest possible quality care for our patients who are constantly under the care of clinicians despite any prolonged waits. As always, patients with the most urgent needs are prioritised for treatment.”

The South Australian Government signed on to the National Emergency Access Target – which aims for 90 per cent of patients who present to the ED to be either admitted or discharged within four hours – in 2011, aiming to meet it by 2013.

Most major hospitals across the state and the country have also failed to meet the target.

But the average performance of hospitals around Australia – 66 per cent of patients admitted within four hours – far exceeds that of the Royal Adelaide Hospital. Some hospitals, such as the Albert Hospital in Victoria, have come close to meeting it.

The target is important because some research (here and here) suggests it reduces deaths among patients.

But that finding remains scientifically controversial – and some view it as placing unreasonable pressure on medical staff to push patients through the hospital system quickly, potentially encouraging them to discharge patients too soon to make way for new patients.

SA Health stresses that patients waiting in the RAH ED can be receiving active care and treatment before admission – but there is no detail on the seriousness of the conditions patients had while they waited four hours or more in the Royal Adelaide Hospital ED in 2018-19.

Earlier data provides some context.

The Australian Institute of Health and Welfare has published data comparing similar hospitals across the country over the past several years.

The RAH boasts a perfect record in the immediate treatment of patients requiring instant resuscitation, according to the data (which you can find in full here).

Table: Australian Institute of Health and Welfare

However, less than one-third of patients who arrived at the RAH ED needing treatment within 10 minutes received it in 2017-18.

Table: Australian Institute of Health and Welfare

The RAH’s performance was poorer than comparable hospitals for patients in several categories in 2017-18.

Urgent (requires treatment within 30 minutes)

Semi-urgent (requires treatment within 60 minutes)

Non-urgent (treatment recommended within 120 minutes)

This month, InDaily published a series of harrowing accounts from staff within the Royal Adelaide Hospital, illustrating the human impact of extreme waiting times in the emergency department during the first year of the new Royal Adelaide Hospital’s operations.

The incident reports described patients suffering malnutrition, days-long sleep deprivation and extreme periods of time shackled to a bed without specialist mental health treatment, and without access to a toilet or shower.

The incidents described in those reports very likely breach the United Nations Convention on the Rights of People with Disabilities, vice-president of Australian Lawyers for Human Rights Natalie Wade told InDaily at the time.

Most of the patients who waited the longest, according to those incident reports, were there for mental health conditions.

Geoff Harris of the Mental Health Coalition said at the time: “There is no other way to describe this, other than appalling.”

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