23 November 2015

ACT still has longest emergency department wait times

| Ellen Harvey
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The Australian Institute of Health and Welfare’s Emergency Department Care 2014-15 report was released today and shows that ACT residents typically wait twice as long as the national average for emergency department care.

From the media release:

“The Australian Institute of Health and Welfare’s (AIHW) Emergency Department Care 2014-15 report released today has the median emergency department waiting time in the ACT at 37 minutes. Nationally it is 18 minutes,” Leader of the Opposition and Shadow Minister for Health Jeremy Hanson said.

“We also have the lowest percentage of patients seen on time at a lowly 59 percent. Across the border in NSW that figure is 81 percent while the national average is 74 percent.

“Furthermore, the report highlights that despite the fact the ACT has experienced a lower than national average increase in presentations over the last five years at 3.7 percent, we are still performing a lot worse than other jurisdictions that have coped with higher demand. Nationally the average increase in demand was 4.5 percent.”

Thoughts, Riot?

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Interestingly mixed results in ER. My own experience has been pretty negative. Only there in emergencies.
First was to take a young relative with a suspected fractured jaw from the soccer field. A very determined person (no label or uniform, so not sure if it was trainee nurse, a doctor or what), tried twice to take blood unsuccessfully. It was so painful, the young person clenched teeth to stop from yelling out & apparently turned a crack into a fracture.
When the person came in for a third try I said NO – get someone with more experience. Give them their due, they did. But the inter-staff conversation had been along the lines that the first person would just keep at it till she got the vein! I considered it outrageous treatment of a patient.
The second visit was with an attempted suicide. She’d done her homework & was not messing about – she wanted out of here. After 12 hours I watched the machinery register lower & lower numbers & got someone’s attention. “It’s ok, the machine’s not working properly”. Three minutes later she’s being resusitated & I’m being offered a cup of tea?! No thanks. I’m not leaving her side after this! When she got to a ward, they tried to discharge her into my care (& responsibility) 24hours after she had been resusitated, while she was still saying “let me out so I can complete the job”.
This little camper wasn’t happy.

Last time it was with someone whose Dr had wrongly prescribed medication. As a result, the patient was in deep & serious with severe & increasing neurological, renal & liver problems. A very allert GP was on to it instantly & sent said patient with a letter to ER. They were waiting, admitted & transferred to ICU for 3 days then to a ward for 4 days. Medical care good, but other care totally absent – patient couldn’t stand, but was not assisted with any personal care (wash, hair, teeth, feeding, bedmake), and ward was not clean, even to rubbish on floor.

I cannot help but wonder if the transfer of nurse education to universities is part of the problem. Not necessarily that a higher level of education may not in some ways be appropriate, but that the process & repercussions were not well enough thought through.
When nurses were hospital trained, they provide a major input to the staffing of the hospital. In so doing, they became very experienced at patient care, not just diagnostics & machinery. Now when a trainee is on the ward, it seems to take up more staff time, rather than add to the staff:patient ratios.

Maybe we need to go back and rethink how our medical services are going to work, without an apprentice system. Anyone else given any thought to this?

I’ve been three times to ER. The first time I was brought in by ambulance after passing out from a post-operative bleed. I woke in a large pool of blood . I waited three hours to see a doctor, but at least I got a bed in ER. I think there were others waiting in the corridor. Due to blood loss they struggled to put in a drip. Twenty eight hours later I was transferred to a bed in a ward. By this time I had developed a headache from lack of sleep due to the activity in ER and the man in the next cubicle snoring LOUDLY.
The next time I went in for a minor ailment, because I was due to fly overseas the next day and couldn’t get in to see my doctor. There was only one other person in ER that day and I got a quick and a good examination.
The third time I thought I might be having heart problems (fortunately I wasn’t and my heart was okay) and I was treated seriously.
So, mixed results for me.

wildturkeycanoe12:58 pm 20 Nov 15

Acton said :

The cause (I suspect) is that each time there is a boost to medical funding the salary rates go up so there is never any improvement to servicing times.

I would like to know how many doctors there actually are at the hospital ED. Every time I’ve been there it looks like there is only one or two docs doing the rounds in the area after triage and they aren’t in a particular hurry, having plenty of time to chat about things [not medical related] with the nursing staff. Yes, more doctors are needed to get things done about the waiting times. Where are they all? Probably delaying completing their studies due to the exorbitant costs involved and working a couple of part time jobs to save up for the next year’s tuition. Surely that is the reason we see that 90% of the doctors are not Australian born nor have done their medical degrees here. Walk into the Ginninderra Medical practice and tell me I’m wrong.

The waiting time at Woden ED is much longer than the reported 37 minutes and is probably the time one waits to get assessed or triaged, not actually treated. In my experience at least two hours is the waiting time for treatment at Woden. The problem is not the people attending or trivial ailments, because Canberra does not have a higher proportion of “wimps and drunks” than other areas and higher AC T incomes suggest payment avoidance is not a prime motivation for ED attendance. Where else can you take an elderly parent with a detached catheter, or a daughter who splits her skull on a trampoline or a son who breaks a leg or a neighbour with a chainsaw gash? These accidents always seem to happen on the weekend. You go to the Woden ED and wait and wait and wait. This is despite us all paying more each year in medical insurance and rates – supposedly to improve hospitals. I have received better and faster medical treatment for minor emergencies overseas so this situation in Canberra is sub-standard. The cause (I suspect) is that each time there is a boost to medical funding the salary rates go up so there is never any improvement to servicing times.

wildturkeycanoe said :

watto23 said :

Meanwhile the nurse walk in centers have been empty the two time I went there.

Same here, I went there one night around 10:30 expecting to not get home until the wee hours but found the place abandoned. .

I’ve been twice. No wait either time.

Emergency on the other hand is always chockablock full of idiots and scroungers who should just go and see their doctor.

wildturkeycanoe6:42 am 20 Nov 15

watto23 said :

Meanwhile the nurse walk in centers have been empty the two time I went there.

Same here, I went there one night around 10:30 expecting to not get home until the wee hours but found the place abandoned. When I found the staff had to check the computer [internet?] for a remedy to my ailment, it probably isn’t surprising that more people bypass this clinic and go straight to ER where they would get sent anyway. I think anything more than a band-aid and that would be the outcome.
As for the GP clinics, yes there are a few bulk billing doctors around [only one that I know of in Belconnen and no longer bulk billed in Woden] but waiting periods of up to 3 hours on a semi-busy day mean a lot end up simply going to the hospital instead. That and when you factor in the “standard” of service the bulk billed centers offer, people would rather wait 5 hours to get proper care.
Then you look at some of the paid clinics and I’m not surprised people go to the hospital for everyday complaints. I was going to sign up for the local medical Co-op, but after being told I wouldn’t be able to get an appointment anywhere in their Canberra clinics for at least a week, gave up the notion and accepted I’ll have to sit around the bulk billed lounge instead. Who needs to book ahead a week or two for an acute condition they don’t know they are going to have? It might be fine for regular prescriptions and check ups but when you are really in need of attention, the hospital may inevitably be your only port of call.
Another reason for going to the ED would simply be money. $60 for a consult, plus another $30 for a normal course of medications would be too much for many people on small incomes. Sure, concession card holders get discounts, but not all low income earners get that benefit, especially the ones who are working poor. If you were making $18/hour, a 40 hour week would pay rent and leave a doctor’s visit equivalent for food. You cannot afford to get sick on that.

No one goes to Emergency for fun. Using Occam’s Razor and my personal experiences, I just think it’s it is chronically understaffed.
On more than one occasion while there with my daughter I have had to draw staff’s attention to others in serious trouble. One poor lady who had had a nasty fall off her bike went into shock before my eyes and I had to go and ‘bug’ someone behind the counter. Another time a fellow in the queue was clearly having a heart attack. There needs to be someone monitoring the waiting room.

Well, I think that the ACT Government should be commended for saving scarce budget $ by not reducing waiting times.

After all, we have repeatedly heard from a poster on RiotAct that where there are Trams, obesity is greatly reduced and general health of the populace improves. Also, that there will be a great many less less cars on the roads, hence presumably, less accidents.. The ACT Gov’t confirms this.

Obviously, the current waiting times thing is a transient situation. There will be less demand on the hospital after the Tram starts so the waiting time stats will improve.

So, in fact this report actually proves that the ACT Government can be effective at forward planning !

All hail the Tram !!!!!!!

If we are going to compare waiting times we first have to define what is an “emergency” because a lot of Canberrans are wimps and drunks.
Also, the notion that it is “free” attracts a lot of people who are simply too miserable to pay the Medicare/GP fee gap.
There is now a privately run bulk billed home GP service which is excellent according to friends I know who have used it.
I think they do a pretty good job overall. If you are really crook you will get urgent attention. The wimps and drunks can wait a bit longer.

I would love to see the percentages of what people in the ACT attend emergency for. Based on when I’ve been there it seems a lot of people use them for things like the flu to avoid paying for a doctor. Meanwhile the nurse walk in centres have been empty the two time I went there. However in lieu of some facts I’m happy to be shown its not people attending emergency for reasons that are borderline at best.

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