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With the election out of the way we can tell you just how bad the hospital is

By 30 November 2012 22

The Liberals’ Jeremy Hanson is brandishing with some relish the newly released Canberra Hospital emergency department waiting times once the fraudulent data tampering is taken out of the frame:

ACT Health Minister Katy Gallagher was forced today to table the shocking truth about the deceit perpetrated on Canberrans in regard to how long they are waiting in their emergency departments.

“Canberrans knew that over the last few years that they were waiting longer than ever in the emergency department for treatment,” ACT Shadow Health Minister Jeremy Hanson said today.

“Now it has been confirmed that they are waiting far longer than we thought, and far longer than anywhere else in the country.

Ms Gallagher was forced to correct thousands of patient records after widespread manipulation of data by a senior Health official was revealed earlier this year. This incorrect data on waiting times was used in a number of reports and statements by the Minister, and was revealed to be based on falsified records.

“These corrected reports show that Canberrans presenting to their emergency department for urgent or semi-urgent treatment have less than a 50 per cent chance of being seen within a clinically appropriate time.”

“Under this Health Minister, we have seen one of the greatest deceits in ACT history, and I will continue to hold her to account on this failing system. The release today of the corrected waiting times confirms that Ms Gallagher cannot be trusted to manage Canberra’s health system,” Mr Hanson concluded.

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22 Responses to With the election out of the way we can tell you just how bad the hospital is
#1
mossrocket1:32 pm, 30 Nov 12

I recently had the misfortune to spend an amount of time in the Canberra Hospital Emergency Department.

When we inquired as to when we would be looked after, we were told that triage was now done on a first come first serve basis – and not on urgency of the condition – something I found to be quite alarming.

I then noticed that everyone waiting was redirected away from the admission windows straight to the entrance doors, where staff would let people in people – all without proper triage…

I wonder if this is to further distort the waiting times – as there was no record of when a person entered the Emergency Dept – the first record was entered after the person entered the ward……..

#2
cmdwedge1:40 pm, 30 Nov 12

I eagerly await the Team Katy apologists.

#3
Tetranitrate5:38 pm, 30 Nov 12

@mossrocket
I’ve had the misfortune of visiting emergency at Canberra hospital a few times over the past year – once for myself and several times (over the course of a very long week) for a close friend.
As you mention, the triage procedure is absolutely shocking. In a sense first come-first serve actually makes sense, but in normal circumstances you’re waiting no more than a couple of minutes to be triaged, not hours. There’s not any other sort of procedure they can realistically follow for triaging since until you’ve actually assessed a patient you can’t really make much of a determination of how serious each case is.
Calvary is not nearly this bad – you can still end up waiting for hours depending on what’s happening of course, but at least they’re fairly prompt in triaging (in my experience).

It’s only a matter of time before someone dies of a stroke, heart attack or similar time-critical ailment at the Canberra Hospital as a direct result of the state of the emergency room, assuming it hasn’t happened already.

#4
MrNurseRatchet7:52 am, 01 Dec 12

In the ED’s defence (no, I’m not an employee there or a public servant in the health sector):

1) A sore throat you’ve had for the past 6 hours that you haven’t even bothered taking pain meds for is generally NOT an emergency
2) A cough that you’ve had for the past 8 weeks is generally NOT an emergency
3) The fact that you have chronic pain and haven’t bothered getting a primary GP to manage your issues doesn’t make the fact that you’ve run out of your pain meds an emergency
4) That painful sprained ankle that you’ve got that’s mildly swollen, not even bruised, for which you haven’t even bothered trying to ice or take any neurofen for? Nope. It’s not an emergency.
5) The fact that you’re a public sector employee and you’ve had a minor cold for the last 4 hours and would now like a medical certificate so you can have a week’s holiday on the south coast? No, I’m sorry cupcake, that’s not an emergency either.

The list goes on and on. I’ve sat in an ED with a deep laceration (down to the tendon) to my finger and have watched (and listened) to the above complaints that plague our EDs in Canberra. Until Canberrans actually LEARN what an emergency is, we will continue to have ED waiting times that are out of control.

#5
Antagonist8:54 am, 01 Dec 12

Canberrans don’t care, Jezza. Just look at how voters made sure Katy was held to account at the election. [/sarcasm]

#6
steveu10:19 am, 01 Dec 12

Tetranitrate said :

It’s only a matter of time before someone dies of a stroke, heart attack or similar time-critical ailment at the Canberra Hospital as a direct result of the state of the emergency room, assuming it hasn’t happened already.

Agreed. Then they may do something. People literally died due to lack of beds in the adult mental health facility, and this did motivate them to put some more resources into this area.

I empathise with the ED staff, and MrNurseRatchet has some valid points IMHO. On the surface there seems to be a shortage of Drs. in Canberra, and less that bulk bill. I never realised that Canberra was such an attractive place to live for Drs, I presume not enough money in the region so they all want to head to Sydney instead.

#7
snoopydoc10:40 am, 01 Dec 12

@ mossrocket

I think you are a little bit confused regarding triage. TCH uses the Australasian Triage Scale (ATS) which sorts people into one of 5 categories based on an assessment of how time-critical your problem (or potential problem) is thought to be:

1 – Immediate (currently getting CPR, ongoing seizure, knife protruding from heart…)
2 – 10 minutes (chest pain, breathing difficulty, major trauma, strokes…)
3 – 30 minutes (fractures, abdominal pain, lots of other things…)
4 – 60 minutes (needs to be seen but not particularly time-critical for either Dx or Rx)
5 – 120 minutes (probably shouldn’t be in the ED)

Patients are traditionally seen more or less in order of their triage category, and on a first-come first-served basis within each category. This can be problematic if you are triaged as a Cat 3 or 4, but there is a steady stream of Cat 2 (or 3) patients that keep bumping you down the waiting list. In order to avoid this problem, senior nursing and medical staff within the ED tend to keep a very close eye on the list of patients in the department (including the waiting room, people on ambulance stretchers in the corridor, etc.) and will arrange to have people seen “out of order” if it is apparent that there is a clinical need to do so, and/or if some people have clearly been waiting too long to be seen. In particular, children are prioritised in this manner.

In other parts of the world, a more coarse triage system is applied, essentially “Now/soon” or “Later”, to group patients into those who clearly (or probably/possibly) have a serious urgent threat to their life, limb or health, and the rest, who may well require medical attention, but not in nearly so time-critical a manner.

A hybrid of these two systems (the ATS and the “now/later” model) has recently been considered at TCH based on the following guidelines: People are triaged as per the ATS into one of 5 categories. Cat 1 & 2 patients are seen urgently. Cat 3 and 4 (+/- 5) patients are seen based on the order of their arrival / their waiting time (i.e. first-come first-served) in order to see if this reduces overall (and therefore average) waiting times, compared to strictly adhering to the ATS category priority system (which, as mentioned above, we depart from on an ad hoc basis according to senior assesment of clinical need, anyway).

This is likely the basis of your concerns about triage, mossrocket. It is important to understand, however, that in much the same way that we don’t blindly stick to ATS category priorities when deciding who to see next, we also certainly don’t robotically see the less urgent patients purely in first-come first-served order, either. Constant revision and re-assessment occurs (indeed, your ATS category can, and often does, change based on re-assessment by triage staff, even while still stuck in the waiting room).

Regarding “letting people in without proper triage”. Um, no. We don’t do that. Unless you are literally dying in front of us, no-one makes it into the department without being triaged properly.

As to records of when a person enters the department, there is definitely always a record of that, at the time of triage, which may well be a long time before you come into the department proper.

#8
snoopydoc10:54 am, 01 Dec 12

@tetranitrate:

There is good evidence in the medical literature that ED overcrowding is associated with increased morbidity and mortality.

TCH ED is often overcrowded.

There is good evidence in the medical literature that something called access block is the major cause/determinant of ED overcrowding.

Access block is the inability to move patients who have already been diagnosed and treated _out_ of the ED to an appropriate inpatient ares (i.e. a ward).

Access block occurs because the available acute inpatient capacity of the hospital is insufficient to meet the needs of the population it is meant to provide for.

Thus:

Not enough beds in the rest of the hospital –> access block –> overcrowded ED –> people die unnecessarily / in excessive numbers.

This is well known, understood and documented within the medical profession. Convincing politicians of this in order to encourage policy decision that will actually fix the problem (i.e. creating more acute inpatient beds) rather than politically expedient “Look! I’m doing something! Really I am!” band-aid solutions… well, that’s another matter entirely.

#9
Tetranitrate1:56 pm, 01 Dec 12

MrNurseRatchet said :

In the ED’s defence (no, I’m not an employee there or a public servant in the health sector):

1) A sore throat you’ve had for the past 6 hours that you haven’t even bothered taking pain meds for is generally NOT an emergency
2) A cough that you’ve had for the past 8 weeks is generally NOT an emergency
3) The fact that you have chronic pain and haven’t bothered getting a primary GP to manage your issues doesn’t make the fact that you’ve run out of your pain meds an emergency
4) That painful sprained ankle that you’ve got that’s mildly swollen, not even bruised, for which you haven’t even bothered trying to ice or take any neurofen for? Nope. It’s not an emergency.
5) The fact that you’re a public sector employee and you’ve had a minor cold for the last 4 hours and would now like a medical certificate so you can have a week’s holiday on the south coast? No, I’m sorry cupcake, that’s not an emergency either.

“”(no, I’m not an employee there or a public servant in the health sector):”"
Oh good, so just a run of the mill ALP staffer then?

I don’t accept that these sort of things consist of the majority or even a sizable minority of the of the cases that present.
When I was there last the sort of cases were:
-a woman who’d been bashed in the face repeatedly, and was understandably quite distressed.
-a family that had been in a minor-ish car accident, looked like a kid had a broken arm
-a guy who came in with the aid of a friend, with a wrapped up compound fracture to the leg
-quite a few mothers with sick infants.
-sick elderly people

#10
JimCharles5:30 pm, 01 Dec 12

Only heard good things about the ED; a friends’ son was admitted and treated extremely well, then re-admitted again as an emergency and dealt with superbly with the consultant giving out his home phone number for any further issues, day or night.
OK, they need to keep up the spending to catch up with other states and health is very expensive…it does look a little tatty in places so they have to expand and improve the existing….but these things take time don’t they?

#11
Woody Mann-Caruso6:59 pm, 01 Dec 12

+1 MrNurseRatchet.

And Jeremy – I’ve heard sopranos on Fox News less shrill than you. ‘Shocking truths’ about ‘deceits perpetrated’, oh my!

Here’s hoping you’re never lied to by your own public servants and then go on to correct the record. (I don’t mean because it’d leave you floundering waste deep in double standards after this tirade. I mean I hope it never happens because it’d mean you were in government.)

#12
Minz10:36 am, 02 Dec 12

I lived in Quebec for a couple of years… because most people there didn’t have a GP (at least the ones I knew!), they’d go to Emergency instead. Average Emergency waiting time was ~18 hours (no, really!) at the time; guys at work would take the day off to go to Emergency for their non-emergency conditions.

Wonder if education on initiatives like the walk-in clinic would help?

#13
stillflying4:43 pm, 02 Dec 12

Minz said :

I lived in Quebec for a couple of years… because most people there didn’t have a GP (at least the ones I knew!), they’d go to Emergency instead. Average Emergency waiting time was ~18 hours (no, really!) at the time; guys at work would take the day off to go to Emergency for their non-emergency conditions.

Wonder if education on initiatives like the walk-in clinic would help?

I doubt it. Why do you think the nurse walk in clinic was established? I once saw someone sitting across from me at the hospital there for the flu. This olderish man had a small fever running, he didn’t look too bad but you bet he was moaning and groaning and carrying on like that would help someone get to him faster. Someone mentioned the nurse walk in clinic and his response was “I’d rather see someone who knows what they’re doing, a Doctor.”

#14
Tetranitrate8:35 pm, 02 Dec 12

snoopydoc said :

@tetranitrate:

There is good evidence in the medical literature that ED overcrowding is associated with increased morbidity and mortality.

TCH ED is often overcrowded.

There is good evidence in the medical literature that something called access block is the major cause/determinant of ED overcrowding.

Access block is the inability to move patients who have already been diagnosed and treated _out_ of the ED to an appropriate inpatient ares (i.e. a ward).

Access block occurs because the available acute inpatient capacity of the hospital is insufficient to meet the needs of the population it is meant to provide for.

Thus:

Not enough beds in the rest of the hospital –> access block –> overcrowded ED –> people die unnecessarily / in excessive numbers.

This is well known, understood and documented within the medical profession. Convincing politicians of this in order to encourage policy decision that will actually fix the problem (i.e. creating more acute inpatient beds) rather than politically expedient “Look! I’m doing something! Really I am!” band-aid solutions… well, that’s another matter entirely.

Yeah I’m aware that this is the root of the problem, and I’ve never seen TCH *not* overcrowded.

Your post responding to mossrocket doesn’t really address the bulk of his/her concern though – it isn’t about the waiting times post-triage, it’s the amount of time it takes BEFORE triage that’s really shocking and up until that point doctors on duty don’t have the information necessary to make determinations about who needs to be seen first. Personally I’ve never noticed this issue at Calvary, but the times I’ve been to TCH I’ve noticed that it seems to take an inordinate amount of time before people are actually triaged.
This is a bigger deal than people simply needing to wait in the emergency room for hours on end as at least doctors have a general awareness of what’s going on with them once they’ve been triaged.

#15
Tetranitrate8:38 pm, 02 Dec 12

JimCharles said :

but these things take time don’t they?

Excellent point, after all they’ve only had 11 years.

#16
DrKoresh11:12 pm, 02 Dec 12

Tetranitrate said :

Yeah I’m aware that this is the root of the problem, and I’ve never seen TCH *not* overcrowded.

Your post responding to mossrocket doesn’t really address the bulk of his/her concern though – it isn’t about the waiting times post-triage, it’s the amount of time it takes BEFORE triage that’s really shocking and up until that point doctors on duty don’t have the information necessary to make determinations about who needs to be seen first. Personally I’ve never noticed this issue at Calvary, but the times I’ve been to TCH I’ve noticed that it seems to take an inordinate amount of time before people are actually triaged.
This is a bigger deal than people simply needing to wait in the emergency room for hours on end as at least doctors have a general awareness of what’s going on with them once they’ve been triaged.

I think that the people waiting to be triaged are most likely obviously not in need of immediate or urgent medical care, and that is why they are being left to wait. Unless you are a healthcare professional or well-versed in it’s practice and can enlighten me?

As for the comment about the lack of beds in suitable wards? That seems spot on to me. When I broke my femur last year I think I was seen and dealt with by doctors in emergency almost immediately, but I was put into the renal ward for 2 days before they could get me a bed in the orthopedic ward.

This year the wifey had to go to emergency for chronic pain being caused by some as yet undiagnosed ailment. She was waiting for several hours in the ED before she was give a “bed”. Her bed was two chairs pushed together in a corner. Because she wasn’t in a normal bed she was largely ignored by nurses and spent about 18 hours there with TCH doing sweet lump-all for her.

#17
Tetranitrate9:42 am, 03 Dec 12

DrKoresh said :

I think that the people waiting to be triaged are most likely obviously not in need of immediate or urgent medical care, and that is why they are being left to wait.

Determining whether someone is need of immediate or urgent medical care IS triage.

#18
watto2310:05 am, 03 Dec 12

My experience in emergency is alot of people go there with things that could be treated by a GP. Of course on weekends GP’s cost more money. I went to emergaency with what turned out to be a broken shoulder. They had a huge queue (mostly people who did not need to be there), I said i was in pain potential break etc. after 2 hours I politely said I might go find a GP, so off i went to a place in Phillip. Just as busy, but eventually got xrayed and diagnosed with a break. Problem is the treatment etc was pretty average and 6 weeks later ended up needing to see an orthopaedic surgeon. Cost me money even on private healthcare.

So IMO the issue is costs for many people. Emergency is free and post emergency treatment is free. Then for someone like myself on private healthcare. If I choose to use it it costs me money versus no costand clogging up the queues and waiting times for beds etc.

You can throw as much money as youi like at emergency and hospitals, but you won’t fix the root of the problem which is costs for non public hospital care.

#19
Evil_Kitten4:27 pm, 03 Dec 12

Well I had a great experience at the ED at TCH – I must be the only one! I saw the nurse (a lovely guy called Steve I think) within 10 mins and then was only back in the waiting room for about 15 mins before the doctor saw me.

I might add that the waiting room was quite full, and I was lower down on the emergency scale at a category 4. Not sure why I got so lucky?

#20
PantsMan8:46 am, 14 Dec 12

Nice FOI dump here: http://www.cmd.act.gov.au/__data/assets/pdf_file/0010/396766/FOI12-97_-_Concerns_raised_regarding_ED_data_2009-2012.pdf

Suppose the election is now over to FOI decision makers can now start compying with the law.

#21
pink little birdie9:37 am, 14 Dec 12

Ironically just past the canberra Hospital department is CALMS. They are only $20 ($90) more expensive than the regular dr ($70).
Though last time I was there I had a 9:30pm appointment and saw a dr at 11.30. (for gastro – not quite emergengy level but still needed to see a dr.

#22
crackerpants10:03 am, 14 Dec 12

pink little birdie said :

Ironically just past the canberra Hospital department is CALMS. They are only $20 ($90) more expensive than the regular dr ($70).
Though last time I was there I had a 9:30pm appointment and saw a dr at 11.30. (for gastro – not quite emergengy level but still needed to see a dr.

CALMS is an excellent service and I’ve used it twice with the littlies…but have been sent from there to ED both times. Yes it costs, but I’m happy to pay for the reassurance that we *should* be in ED, with all the trials and tribulations that that entails. HealthDirect is another great after hours service, but again, have often been advised to go to ED. The walk in clinic is an option now that both kids are aged over 2.

The ED has got more crowded and more disgusting each time I’ve been there – or so it seems to me. Trying to get a wee sample from a 4 year old in the one and only toilet in the ED ward, when there is poo smeared on the floor from the previous occupant, has left me sincerely wishing for a private ED in Canberra. My most recent experience, at 19 weeks, by myself and pretty scared, I couldn’t even get a seat – just belligerent stares from people “saving” seats for their friends. I scored a plastic kid’s stool eventually. Not a big deal, but not fun at the time either, and I’d happily pay for a more agreeable ED experience.

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