Canberra Hospital: Even the Nurses say its crap

CALMS – Canberra After-hours LocuMS.

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.

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.

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.

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.

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’.

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

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

There is always the possibility that some minor ailments (sniffles, colds, basic sprains) will get looked at quickly. It may be possible to assess and treat the patient in fasttrack without requiring a full emergency bed, whilst more serious (although still not time critical) problems have no choice but to wait for a proper bed to free up.

A big problem that is only going to get worse is the number of elderly people in the hospitals. They come in from home where they were just getting by, have no nursing home to go to but can’t be discharged into their own care.

So has your family member received the treatment to get her on the mend in a timley and efficent matter? As for those being kicked out at the first sign of them being better, you really have to ask why they would want to be there if better? The 2am discharge sounds like a beat-up, there would be no admin staff at that hour to do that.

The emergency department in TCH is an absolute joke – I’ve lived in cities around Australia and it is much worse here than elsewhere. The typical wait is 3-4 hours or more. The nurses are often apathetic. Some of them seem poorly trained. Like the previous posters say, they’ll turf you out the door at the first opportunity, regardless of the hour. Clearly, something needs to be done!

skaboy12 – I agree, but people also need to determine whether their ailment is worth clogging up the hospital system for – there ARE some doctors out there who DO bulk bill those on health care cards etc. There is an entire medical centre in Belconnent and one in Tuggeranong that bulk bills everybody.

sepi -you say “And I don’t actually think there are that many people in casualty with a sniffle. Who would want to sit around for 7 hours with nothing much wrong?”

Incorrect. MANY people go to the hospital because they feel off colour, have the flu, or can’t get to or simply refuse to go to a doctor. My sister-in-law is a nurse and I have no reason to doubt her.

I know a lot of ex-nurses. They do not get paid enough. And their working conditions are not good.

But that doesn’t change the fact that Canberra hospitals seem to be always operating one step ahead of total disaster. And this is not a new situation. I think this is where Jon should put his surplus.

Just to clarify – is she spending time in the ED ward – or on the floor in the ED waiting room ?.

From an editorial point of view – there is a world of difference.

The ED has its own ward full of short stay beds. They are far removed from the ER waiting room, yes they are noisy, as emergencies happen 24/7 and no they will not turn off someones ECG or ventilator because you can not sleep. Its hospital, not a hotel. The staff are there to preserve life – not pamper. Sure its noisier, but I bet its a darn sight better than being somewhere else and not getting treated.

Mrs Danman works on ward in TCH – and she was admitted to the ER last year. She had to stay overnight in the ED ward as there was no beds on a ward.

Oh and being a private patient in a public hospital means only one thing. Your choice of doctor.

You can not make demands followed up by “I am a private patient” – trust me its been said before and scoffed at as many times.

Perhaps more incentives to become a health professional is what we need?
Better pay, better funding, better conditions, better negotiated EBA’s… I dunno… What I do know is that for all the funk ups that the government do to the health industry there are about 3 dozen health professionals that I know who are on the front line who cop the shit from mostly families, but often patients on a daily basis for something they have no control over.

Who in their right mind would want to work in an environment like that – no matter what industry ?

Mrs Danman has been threatened with physical violence, punched, kicked in the neck, scratched and verbally abused, ad all for what? A pittance…..Yet she still loves her job….Hospitals need more people like that….

A little over a year ago, the nurses at Canberra ED took their issues to Katy Gallagher – she came to meetings at the hospital and talked with the nurses about how things could be improved. Unfortunately, things have not improved since then.

Long gone are the days where people could stay overnight in ED to recouperate a little – if you’re well enough, they will turf you as soon as look at you. It is not that they don’t care, but they need the beds too much.

A friend was told she was going home from maternity on Sunday night. On Saturday they asked her if she needed painkillers, and when she said no, they asked her to go home! She had no way of getting there, as everything had been planned for the next day. It seems like the answer is to always accept the drugs!

And I don’t actually think there are that many people in casualty with a sniffle. Who would want to sit around for 7 hours with nothing much wrong?

CanberraResident, If the government did something to get more doctors bulk billing then people wouldn’t need to go to th hospital with the flu. Those people may not able to afford the $55 to go to the doctor, of which you get $30 back. $25 is a lot of money to a lot of people and and its only going to get worse with KRudd running the show.

Try having a severe asthma attack and seeing people with coughs and sniffles being looked after first!

“Please let us know if you are experiencing difficulties breathing” my arse!

skidbladnir, your case certainly doesn’t fall into this category, but if people out there would stop clogging up the hospital system with sniffly noses, and upset stomachs, then perhaps the hospital would be in better shape.

I took my 2 year old to Calvary a few weeks ago – very high temperature persisted for 2-3 days and wasn’t getting any better, so at 2am off we went, only to find a whole bunch of not very sick people sitting in the Calvary waiting room. A cough here, a sniffle there. No suspected heart attacks by the looks of things, no severe lacerations, and no pregnant women waiting to deliver. Just a whole bunch of flu victims. I waited 7 hours before my 2 year old was attended to. So much for friggin triage! DISGUSTING!

I wish people wouldn’t always blame the Government on hospital inefficiencies – we all know that Katy Gallagher is a garbage Minister for Health, but let’s take a bit of responsibility ourselves shall we? Do you really need to go to casualty with your snotty nose when a regular GP or a good lie-down will do the same? There sre still some practices that will bulk bill, and it’s likely the wait won’t be 7 hours.

A friend had a recent stay in Woden. A problem was diagnosed, treated, and healing commenced. At about 11pm he was woken and asked if pain killers were required. He replied in the negative. At that, the Doctor asked if he could call his wife to come and pick him up, there and then! He explained that his wife had spent the last 20 hours at his bedside, and rather than coming to collect him, would be catching up on some well earned sleep.

Not to be foiled, at 2AM(!) the same Doctor returned, waking him again, and requesting he sign forms to permit his discharge.

Something is very wrong with a system that needs to exert such pressure to gain an empty bed.

Hospitals in the ACT are no good when they are busy. Which seems to be about a third of the time.

I don’t know what can be done about it.