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Canberra Hospital: Even the Nurses say its crap

Skidbladnir 12 March 2008 33

Over the Long Weekend, I had the fortune of attending The Canberra Hospital due to a family member being involved in a head-on collision with a lunatic driver (wrong lane, speeding, child in the passenger seat), who arrived at TCH by ambulance.
We were told to wait and once they had arrived and been assessed, we would be let in to see them.
We hung around for almost three hours after the family member’s arrival before the nurses inside the Emergency ward realised that we were still waiting to see them, we were told “Sorry, there’s been a bit of a rush on”.
So we waited to see nurses and doctors, and after impossibly slow action on seeing to a broken arm, hand, foot, and leg, possible internal injuries were finally ruled out 12 hours later.
Having been told that once a bed on another ward became available she would be moved, I went home at 3am, because I had to get to work in four hours.

Its now been over three days since arrival and yet still, she is occupying space on the Emergency Room because a bed has not become available in the Hospital proper, and has not slept without assistance as the ER is nothing but busy doctors and nurses and humans on diagnostic machinery.
Apparently not even claiming private helath care can help, as there are also no beds available there.
Nor are there any other beds available at John James Hospital in Deakin, and they cannot put her into Calvary.

One friendly nurse was quite happy to tell me that this kind of delay and short staffing is not uncommon, and that the bed shortage is much more than just statistics on the news, but nothing more than talk seems to have happened.

Anyone know the Jacqui Burke Health Hotline thing, so we can ram a greased pole up Katy Gallagher and get her back on doing her job of BEING RESPONSIBLE FOR HEALTH CARE?

According to this statement from Katy “Don’t blame the Minister, its my Department’s fault” Gallagher herself, the numbers of hospital beds in the ACT are set to decrease next year.

By the end of 2007–08… …will have a capacity of over 800 hospital beds on average, an increase of 24 per cent on the number of beds available in 2001–02 (670).

Based on current estimates… …it is anticipated that the ACT public hospital system will have access to just under 800 beds on average by the end of 2008-09.


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33 Responses to Canberra Hospital: Even the Nurses say its crap
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Skidbladnir Skidbladnir 10:40 am 18 Mar 08

Update, after spending four days in the ER, got finally admitted to a bed for a night, and home the next afternoon.
But not without finally spotting a cracked sternum and two ribs about two hours before discharge.
And forgetting to assign the proper equipment needed.

But the nurses themselves were wonderful people, who deserve at least whatever they’re getting paid now. And a holiday.

VicePope VicePope 11:44 am 17 Mar 08

ps to previous. A 24 hour bulkbilling practice onsite or near would get the emergency wait down enormously.

VicePope VicePope 11:42 am 17 Mar 08

Recent experience. Very long wait in Emergency, despite the patient (whom I was accompanying) being agreed to be very sick. Lack of beds, apparently. Eventually got in, and spent close to a day in there before being moved to a ward.

I don’t think the patient would have any concerns or complaints about the quality of medical care. Appropriate practitioners at all times, reasonably frequent monitoring. Hard working doctors and nurses who did not seem to stop. Good medical result achieved in good time.

Two adverse comments. First, the system seems to be over-clericalised to an unhealthy level – the number of clerks is extraordinary and their work practices seem sometimes a bit self-serving. For example, it may be better to do the discharge thing by having a clerk come to the patient, rather than queuing masses of patients on comfy chairs watching clerks talk to each other. Second, as one who rants a bit about privacy, I see there’s an obvious problem with personal stuff being said and done in public areas like the emergency waiting room and the discharge lounge. I could hear (because the clerks called out rather than walking five metres) details of procedures and practitioners.

thetruth thetruth 10:43 pm 13 Mar 08

I said during the election and I’ll say it again … THINGS WILL NOT GET BETTER UNTIL THE COMMUNITY HOLD THE PERSON (OR PEOPLE) RESPONSIBLE FOR HEALTH RESPONSIBLE THAT IS THE TERRITORY GOVERNMENT.

Just say Stanhope fix it or we will boot you out… simple if you allow it to be the Feds are not paying enough blah blah then you allow folks to blame other and not be responsible – that in turn allows Stanhope to pay $750K for the GDE sculpture while saying Howard wasn’t paying enough for health!!!! Isn’t it Stanhope not doing the job he was charge to do and playing silly buggers with your health dollars – why would you give him more, when he spends so much on crap like that.

VOTE HIM OUT – AND THEN HOLD THE LIBS RESPONSIBLE IF THEY STUFF UP VOTE THEM OUT – the pollies will soon work it out

nyssa76 nyssa76 6:36 pm 13 Mar 08

If things have really gone pear-shaped and you should be in hospital the doctor organises and admission, bypassing the shlurks coughing and sniffing in A&E.

Ingee, last year, despite the severe asthma attack (like barely breathing). I had my doctor’s nurse take me to TCH, he called ahead and she had a letter.

I was STILL left in A&E for over 5hrs with a broken heating thingy (you know the one above the sliding doors to keep out the cold) in the middle of June.

Their solution? “Just keep using your ventolin dear”

It’s kinda sad when you have to use it three times on the way to the bathroom (and back) and walk past people who bloody well shouldn’t be there.

MrMagoo MrMagoo 4:45 pm 13 Mar 08

1800 whinging old cow, oh hang on a minute that’s Jacqui’s home number

Thumper Thumper 1:58 pm 13 Mar 08

Note to self, use preview button…

‘Are’…

Thumper Thumper 1:58 pm 13 Mar 08

Is there that many hours in a week 🙂

gun street girl gun street girl 12:00 pm 13 Mar 08

I guess we could all just work harder. That’s what Boxer the horse said before he was carted off to the knackery in Animal Farm, wasn’t it? I only worked 90 hours last week – I am sure I could work harder. 😉

Mr Evil Mr Evil 11:58 am 13 Mar 08

Katy’s only part-time: she doesn’t have time to worry about this stuff.

Not that there’s anything wrong anyway. Katy is always right: 300 000+ Canberrans are wrong.

gun street girl gun street girl 11:36 am 13 Mar 08

Asking the bosses to come in at 10pm every evening [i]is[/i] asking them to work more! Registrars at the moment bear the burden of shift work already – a move towards adopting shift work for all and sundry (including bosses) would prompt a mass exodus (and TCH is already struggling to recruit – unsurprisingly). Without all health care workers (including allied health, the imaging department etc etc) working shift work, moving the medics into a shiftwork pattern won’t fly, because we need our colleagues to do their bit to facilitate admission, treatment and discharge (I think we’re probably agreed on that point).

An aside on the logistics of shift work: it’s hellishly difficult to staff, in that you’d need to at least treble your recruitment of medical officers. TCH’s ICU and ED have a massive amount of staff when you compare them to ward units. They need those staff in order to cover for days wherein staff are on ‘recovery’ after evenings or nights, as well as to work holidays and weekends (which are usually understaffed elsewhere). At the moment, we are struggling to recruit medical officers to cover the hospital as it runs now!

virgil99 virgil99 11:22 am 13 Mar 08

Gun street girl, your comments are quite correct. unfortunately, there are teams where weekend reviews never occur. The suggestion is for the whole hospital to move this way, not just the busy medical registrars. For example, there are units where on a weekday, there maybe 3 consultants and 3 registrars in the hospital for 60 odd patients, while on a weekend there is a single consultant round of 2 hours or so.
Why can the whole thing not move to a shiftwortk pattern to even up the cover. Why cant there be an evening consultant round at 10pm of all the new admissions to ensure safe and appropriate management. Not asking people to work more, just differently. ED’s and ICU’s dont run for just 40 hours per week. Patients turn up at all times but the management is so much different based on the day, or the hour.
Compare the evenness of admissions and discharges for paediatrics and the medical teams. Paeds runs 7 days, most medical teams run 5. Not blaming the doctors alone, more the whole system, including the allied health staff etc that you mention above.

Danman Danman 10:50 am 13 Mar 08

CALMS – Canberra After-hours LocuMS.

gun street girl gun street girl 10:45 am 13 Mar 08

Virgil, just a few comments on ‘making teams review ward patients on the weekend’:
Firstly, this would require more medical staff, and better working conditions for those of us who work after hour shifts (compared to the crap conditions offered presently). We’re understaffed already, and those of us on the ground are already flogged to death. The whole idea of a ‘twenty four hour a day, seven days a week’ hospital only floats if you can staff it (and retain those staff!), and pay for it too.

Secondly, many units already review their patients over the weekend. I can think of five medical units off the top of my head which roster registrar cover on the floor over the weekend. Other units have consultant rounds on the weekend on an informal basis. In my experience, weekend discharges are still problematic in that allied health services are not available, so that arranging reviews with them, as well as putting discharge services into place, can be logistically impossible.

Thirdly, discharge into aged care facilities on the weekend is often difficult or discouraged, given that they tend to work in an understaffed capacity over these times. Often it’s safer for the patient, and better for continuity of care, to stay until Monday, so we can discharge them into the care of nursing staff who simply aren’t there on the weekends.

Lastly, many patients and their families resist the idea of going home on the weekend (as strange as that might seem). It’s amazing how often we become a babysitting service for families who just can’t possibly cope with having their elderly Mum or Dad go home on the weekend.

virgil99 virgil99 10:30 am 13 Mar 08

Loads of reasons for this sort of stuff. As a general rule, the staff in ED are trying their best to get you seen. But at times, there may be up to 20 patients in the ED waiting for a bed on the ward. Thats in a 24 bed ED. Simple maths says that leaves 4 beds to see the new patients.
What are the causes? Theres a few.
Beds – Although more beds are valuable, more efficient use of the beds is the clear requirement. The hospital needs to aim for 85-90% occupancy, which will give you room to account for fluctuations. When the pollies talk about beds at TCH, be aware that they count the day surgery beds, the day-case oncology beds, the paediatric day surgery beds in their numbers. These are not available for acute care overnight.
Lots of people with “sniffles” do come to ED, but they are not a major load.
They clog up the waiting room, but generally only take a few minutes to see, the real problem is the admitted patients waiting for space.
Things that can be done include – running the hospital 24 hours (ie support services, full imaging, social work support etc). Making teams review ward patients on the weekend would make a huge difference, figures show you are half as likely to get discharged on a weekend as during the week!! Better access to outpatient investigation to stop the patients who spend days in hospital waiting for an MRI, or an echo (ultrasound of heart).
In the case mentioned above, there will have been beds available in the private hospitals, but the surgeons will not be prepared to have a trauma patient under them there. Private hospitals are run for the convenience of the doctors….not the patients.
More nursing home beds. As a rule there are usually between 30 and 45 patients on the ward in TCH / Calvary combined who are not having acute care, but are waiting for nursing homes.
As to the paeds question, Calvary is perfectly capable of assesing and treating the majority of children…If they need admission they will need to be transferred to TCH.
On the CAMHS issue, while getting seen in the community is a good plan, CAHMS are not able to arrange “direct admission”, these patients still need to come via the emergency department.
So, more beds, and more efficient use of beds. Biggest issue for opening beds is lack of nursing staff, not lack of funds. The funds are available.

Ingeegoodbee Ingeegoodbee 9:26 am 13 Mar 08

It would seem highly unusual for a two year old to not receive attention almost immediately but perhaps the triage nurse was fairly comfortable that it was just a fever, who knows.

Here’s what we do. We use CAHMS which has a house call facility, a doctor comes to you, usually within about an hour and attends to who ever is sick. It costs $120 but you get a fair crack of that back at Medicare, around 50% anyway. If they can manage whatever is wrong at the time they do, even giving you enough drugs to get you through to when the pharmacist opens in the morning. If things have really gone pear-shaped and you should be in hospital the doctor organises and admission, bypassing the shlurks coughing and sniffing in A&E.

gun street girl gun street girl 9:14 am 13 Mar 08

Correction, JC: there are a few admin staff on overnight (the night ward clerk, for one), but they are not needed to physically discharge a patient. To illustrate: patients ‘discharge’ themselves overnight by dying from time to time; the medical staff handle the paperwork, and it’s filed later by admin. The main thing preventing a midnight discharge is the difficulty in dispensing discharge meds. For the record, it is not policy to discharge (living!) patients at obscene hours – in fact, we have a tendency to keep them in overnight so we can push them out at a more reasonable hour (which consequently leads to more people sleeping downstairs in the ED while they wait for those beds to be vacated).

Captainwhorebags: you’re right on the money.

Skidbladnir Skidbladnir 9:12 am 13 Mar 08

The only Emergency room I’ve seen her in so far is the “follow the red line” into the huge room with the nurses station at the centre of it.

While she’s doing much better than initially, she still can’t get seen to by the actual care she needs until she’s in an actual bed.
Today makes day four in that room, but there’s an old woman in the next bed who was already there for two days before we arrived, and she’s still there too.

Spending a week in an Emergency Room bed is pushing the limit of the term ’emergency’.

VYBerlinaV8_the_one_they_all_copy VYBerlinaV8_the_one_they_all_copy 8:45 am 13 Mar 08

Go to Queanbeyan Hospital – service is better, faster and the place is a lot quieter.

Special G Special G 8:16 am 13 Mar 08

Don’t bother taking your 2 year old to Calvary – no paediatrician on duty there. They have to call TCH for advice.

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