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An easy solution to the ED ‘crisis’

By rescuedg - 12 September 2012 20

STOP GOING!

I was listening to Ross Solly hammer the Director-General of Health this morning on the radio and some of the feedback from listeners is a clear indication of why the ED in The Canberra Hospital is under such stress. People who cannot be in need of emergency treatment are showing up in droves. The ABC is reporting that an average of 182 people per day are showing up just at the ED in the Canberra hospital.

GPs exist for a reason – to diagnose and treat illness and injury that does not require immediate emergency attention. They are also much much easier to access than people seem to think. I called the GP in O’connor last week, they had spots all that day. The GP in Lyneham is advertising for business. I know that recently Andrew Leigh did a list on his website of all the GPs on the Northside who were taking new bookings and who bulk-bill. When I went to the GP in O’connor they did the medicare rebate on the spot – so only $30 out of pocket for a full appointment where the Dr was in no rush to get me out the door. In the past I have been to the Phillip Medical Centre and always been seen within a couple of hours without an appointment.

I’ve also been to the Walk-in Centre a couple of times and never waited more than half an hour. The nurses there will tell you what is wrong with you and refer you on, if necessary, to a GP or to the ED – if it is something that are not able/allowed to treat.

Tl;DR the ED is for emergencies, if you are not in immediate need there are a lot of other options.

What’s Your opinion?


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20 Responses to
An easy solution to the ED ‘crisis’
snoopydoc 8:51 pm 13 Sep 12

Inappropriate “non-emergency” patients presenting to ED are a fact of life, but are actually in the minority. The vast majority of patients we see do indeed have at least moderately urgent problems that either need to be seen in a timely manner (e.g. at least the same day), and while others might not be quite so urgent from a clinical outcome perspective, there are a number of patients seen each day for whom being seen sooner is, for want of a better word, “nicer” (e.g. more convenient logistically for them and/or their family, allowing earlier return to work or at least definite planning in that regard, or more timely access to other medical services that will definitely be necessary on an outpatient basis in their near future).

There are definite gains to be made in efficiency within any emergency department, however, as some commentators have rightly pointed out, the elephant in the room is the phenomenon of access block. Unfortunately, only so much can be achieved by shuffling the deck chairs on the Titanic, when there simply aren’t enough lifeboats to go around.

In the case of emergency department overcrowding and prolonged waiting times, the lifeboats are essentially the acute inpatient hospital beds. There are not enough of them per capita. Indeed, over the last decade or two, the number of acute hospital beds per capita has something like _halved_. For a growing population. A growing, aging population. With more, and more complex, health problems. Problems that require more interaction with the health care system, not less. Problems that require longer stays in hospital, not shorter ones.

Measures such as directing funding and resources into the other end of the blocked pipe – sub-acute services such as aged care, “step-down” beds, rehabilitation beds, community based services and so on – absolutely have merit and will help but, unfortunately, these efforts alone are and will not in the forseeable future be enough to have any significant impact on the current access block problem in anything approaching a timely manner.

There are not enough acute inpatient beds to service the current, let alone the projected, health care needs of the population.

People wait hours to be seen in ED because we are physically full. Our beds are full. The recliner chairs designated for acute care are full. The random spaces in our plaster room, and our corridors are full of the walking (or not quite walking) wounded. The corridors themselves are full of beds with patients who should be somewhere else, either in a proper acute care bed space in the emergency department or, more usually, elsewhere in the hospital.

We are well staffed. We are interested in seeing sick and injured patients. We signed up for it. It’s our job. Some days we even enjoy it. Those are usually the days where we aren’t spending half our work day shuffling patients and beds around in a frenzy of damage control, and apologising to every patient we see about the long wait, or the crappy spot they’ve been plonked in for the past hours. We _want_ to see you. Especially if you are _properly_ sick or broken… because… okay, critical care doctors are just a bit weird that way… but I digress.

We are full because the _hospital_ is full. We have nowhere to send the patients we have already seen, diagnosed, and treated, who need to be admitted to hospital (which as in most large urban hospitals is roughly 30% of the punters who come through the door). These patients continue to occupy beds in the ED. Which means we can’t put new patients, from ambulance stretchers, or the waiting room, into those beds to be assessed, diagnosed and treated in turn.

In the past several years there has been a crescendo of increasingly frenzied activity revolving around increasing the efficiency of patient flow through the ED and the hospital at large, and both clinical and administrative staff currently spend a _lot_ of time and effort trying to optimise these processes within the resource constraints imposed upon us.

But it’s damn hard to keep everyone afloat when you only have half the lifeboats you know you need.

snoopydoc 8:22 pm 13 Sep 12

@ pink little birdie:

TCH ED has had a short stay / observation ward for a few years now. Our particular version has 9 beds and is known as the EMU.

Calvary ED has a similar area known as the CDU.

pink little birdie 9:44 am 13 Sep 12

This isn’t Canberra example but I think it works well for the maybe need to be admitted cases.

I was very sick and taken to the hospital in Adelaide (6 am boxing day no doctors open). I was straight through to the emergency room (no one in the waiting room and I was sick). Doctors pretty quick on my case. (There was also only a couple other people in the emergency room) After a couple of hours they still weren’t sure if it was gastro or more serious. So they moved me to this “might need to be admitted but we still aren’t sure so we will move you to a short stay room and keep watching you but will free up a emergency bed for us” area It had say 6 beds.
We should get a system like that. Slightly less than accute care.
Making CALMS free might also help (GP After hours service at the hospital)

(and before anyone asks I was admitted and had surgery the next day so I did need to the emergency room)

KeenGolfer 7:44 am 13 Sep 12

Having used the Calvary ED twice in the last couple of years for genuine emergencies, I found we were seen to immediately and received excellent care. I like hopefuls idea although that has potential issues to overcome.

kakosi 2:01 am 13 Sep 12

I wonder what adding a few doctors to the walk-in clinic might do to the non-emergency presentations at the ED?

But I don’t believe it’s the non-emergency patients who hold up the ED (as they usually end up waiting for many hours outside in the waiting room) I believe it’s the lack of well-trained doctors and nurses available at the hospital that hold up the ED.

I’ve been there many times in the past 12 months and it’s always the same routine – get in quickly due to emergency situation and then wait for hours to see a doctor and then many more hours to get a hospital bed. Every part of our public hospitals is understaffed and underfunded.

The inadequate funding isn’t about current politics – it’s been like this under every colour of political leadership for many years.

The conclusion I’ve reached is that the majority of people assume they’ll never need to go to hospital and see paying extra taxes for healthcare as an imposition. They don’t vote for politicians who promise more funding to health.

Then they find themselves in the ED one night waiting hours to see a doctor and they can’t understand why the situation is so dreadful. They blame the government when the fact is they themselves are to blame.

sepi 10:26 pm 12 Sep 12

the news also says that more ED patients are having to be admitted to hospital than ever before, but don’t let the fact worry you.

‘We know year-on-year we’ve seen a 5 to 6 percentage increase in ED presentations over the last three to four years,” Dr Brown said.
”But along with that we’ve had an even higher percentage of people who are being admitted once they present to the ED

Read more: http://www.canberratimes.com.au/act-news/extra-beds-as-patients-surge-20120911-25qxp.html#ixzz26G2YLyjh

hopeful 3:57 pm 12 Sep 12

Here’s a possible solution – How about a system where the triage nurse gives anyone who presents with a “non-emergency” condition/problem a voucher to go to a doctor. Doctor then gets reimbursment from hospital – $70-$80 well spent. Anecdotal evidence suggests people turn up at the ED because they can’t afford a doctor not because they can’t get in (or haven’t tried!)

carnardly 3:23 pm 12 Sep 12

unfortunately it’s true.

Maybe if some of these younguns were shown what they look like in the wee small hours a small percentage might change their ways… either way, they often use resources like ambulances, triage staff, nurses and doctors who could be assisting others.

beejay76 2:56 pm 12 Sep 12

carnardly said :

off their face and have got spew and pi$$ stains all over their pretty going out frocks….

Thanks for that image, canardly! Noice….

carnardly 2:23 pm 12 Sep 12

Imagine if you could toss all the drunks, smack heads and party pill poppers on a friday or saturday night into the carpark to sleep them sleep themselves off, or cark it… while treating the others. The queue would reduce tremendously.

And unfortunately there are many selfish and thoughtless people that use up critical resources doing the same week after week after week…. It might be fun partying around town, but its not very classy when the hospital rings someone’s mum at 3 am to come and pick up a kid when they’re off their face and have got spew and pi$$ stains all over their pretty going out frocks….

Comic_and_Gamer_Nerd 1:02 pm 12 Sep 12

Guarantee that if ED started billing the filthy tight arse scumbags that use it as a free GP, a lot of time would be freed up.

rescuedg 12:25 pm 12 Sep 12

@peitlab, that is a really interesting point. However, it would be interesting to see how many of the 200 presentations on Sunday required hospitalisation or even emergency treatment?

Masquara 12:17 pm 12 Sep 12

Surely the crush in ED is a direct result of Katie Gallagher’s “South of France Holiday Friend” messing with the wait figures. If the wait times were “lessened”, then of course the hospital honchos charged with planning & strategy would have responded accordingly and not known what the actual emergency department needs were, staffing & response-wise. So Katie’s friend is the cause of the current problems – and it’s squarely Katie Gallagher’s ministerial responsibility. Take the rap, Katie!

peitab 12:14 pm 12 Sep 12

Much of the Australian research currently being done on EDs is now saying that GP-type patients are not the major cause of delays in the ED. Overwhelmingly the number one cause is still access block (i.e. access (or not) to an in-patient bed).

Many hospitals around Australia are in the process of redesigning their entire patient flow system to deal with access block. While ACT Health has announced that their redesigning their ED patient flow system (which is an excellent start), does anyone know if they’ve done a whole-of-hospital redesign?

beejay76 11:22 am 12 Sep 12

Indeed. I wonder how much the perception of the unavailability/ expense of GP care is simply ingrained now and people just assume they can’t get in, or can’t afford it?

In Gungahlin it was very hard to see a doctor, but in the last year or less at least three new clinics have opened up. I still have to wait if I want to see my particular GP, but if I just need one, anyone, I can generally get in same/ next day. If not, there’s always Gininderra or Phillip and the long wait…..

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