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It’s July, we must be surprised by demand at the Emergency Department

johnboy 22 July 2010 22

Katy Gallagher is doing her annual performance of surprise at winter demand on hospital emergency departments:

The Minister for Health, Ms. Katy Gallagher said that our emergency departments provided record levels of access to care during the 2009-10 financial year- with 106,775 people attending for treatment over the 12 months.

“This was five percent above the 101,914 people who attended our Emergency Departments over the previous year and nine percent up on the year before that,” she said.

“Despite this considerable increase in presentations, waiting times at our emergency departments improved over the last financial year- with 62.8 percent of all people seen on time over the year, compared with 60.3 percent for the previous year.

During July 2009, which saw our greatest emergency department presentations due to the global outbreak of H1N1 influenza, an average of 159 people sought treatment daily at the TCH Emergency Department.

For the first two weeks of July this year, the average number of daily presentations to TCH has risen to 164- rising as high as 190 presentations on some days. Calvary Emergency Department has also experienced sustained increases in presentations recently.

So the nurses clinic next door is yet to have a major impact then.

Growing population with increasingly fewer GP options. Who’d have thunk that would lead to increased demand on the hospital?


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22 Responses to It’s July, we must be surprised by demand at the Emergency Department
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gun street girl gun street girl 11:49 am 23 Jul 10

sepi said :

So the problem is lack of staffed beds within the hospital, to admit Emergency patients, then what is the hold up on those – is it the increased staffing, or physical space for extra beds, or just funding in general? They certainly seem to be making new buildings at the hospital all the time.

To have a bed open, you need to staff it, which is costly. New buildings – whilst nice and shiny and vote winning (viz: Queanbeyan Hospital) – don’t look after the person in the bed – nurses, doctors, allied health staff et al do. I really do recommend reading the following article – it does sum it up quite nicely:

http://www.impactednurse.com/?p=1323

sepi sepi 11:35 am 23 Jul 10

I wasn’t criticising either – being surprised is not the same as slagging off.

It is a bit of a concern though that 10 or 20 extra people over 24 hours can cause overcrowding in emergency. It seems that if we had a serious car accident, bus crash, or even serious gastro in a whole school class, then our hospital would be totally unable to cope with 30 patients all at once.

So the problem is lack of staffed beds within the hospital, to admit Emergency patients, then what is the hold up on those – is it the increased staffing, or physical space for extra beds, or just funding in general? They certainly seem to be making new buildings at the hospital all the time.

Time for a new hospital altogether maybe – in Gungahlin

Ian Ian 11:27 am 23 Jul 10

sb14 said :

Good to hear you don’t consider these unmanagable figures Ian and Sepi. Because the time and resources put into to working up from scratch and caring for critically ill patients is comparable to the daily load inflicted upon your local medical clinic. I’m sure the good doctors and nurses at the TCH ED will be grateful for your pointing out where they are going wrong. No doubt they is just too much sitting about or such.

I was not claiming the doctors and nurses aren’t handling the workload because they are slack, rather that the numbers seem quite manageable for a hospital with the simple application of the right resources and processes.

justin heywood justin heywood 11:02 am 23 Jul 10

gun street girl said :

Nooooo! Please, why do we keep believing Katy’s excuses? Colds, grazes and cuts AREN’T the reason why the ED is overflowing! That is not where the crisis lies, and should not be our main target in fixing the problem!

I suspect that you might be a bit closer to the problem than us poor punters waiting in the ED. What do you think could be a solution?

gun street girl gun street girl 10:48 am 23 Jul 10

dvaey said :

Well, please do inform us what the reason is?

I alluded to it in my first and third posts to this thread. The ED isn’t overcrowded, the hospital is. In a very simple nutshell – without more inpatient beds, the ED will continue to be the overflow valve of the hospital. Katy keeps feeding the public the warm, fuzzy idea that if we only made sure GP type patients were catered for, the problem would go away… and you guys are falling for it hook, line and sinker. With the fear of attracting more unwanted attention to impactednurse, there has been an awful lot of attention drawn to this issue already by people within the industry, but they *still* don’t get it, and it’s frustrating as hell. Click on the link below to read more:

http://www.impactednurse.com/?cat=4

dvaey dvaey 10:24 am 23 Jul 10

gun street girl said :

Maybe if the nurses at the walk-in centre were allowed to prescribe antibiotics, it would take a big load off ED to handle all the cold/flu patients.

Nooooo! Please, why do we keep believing Katy’s excuses? Colds, grazes and cuts AREN’T the reason why the ED is overflowing! That is not where the crisis lies, and should not be our main target in fixing the problem!

Well, please do inform us what the reason is? Ive been there a couple of times this year, and a majority of people seem to come in with the same things, sick kids, cuts and minor burns, etc. While I dont pretend to know the medical history of every patient, from my experience almost everytime Ive been to ED, it was for stuff needing immediate treatment (so cant wait for a GP appt), but was not worth taking the ED staff away from life-threatening cases.

sb14 said :

Good to hear you don’t consider these unmanagable figures Ian and Sepi. Because the time and resources put into to working up from scratch and caring for critically ill patients is comparable to the daily load inflicted upon your local medical clinic. I’m sure the good doctors and nurses at the TCH ED will be grateful for your pointing out where they are going wrong.

I think you answered your own questions there. Why are the numbers unmanagable? Because theyre being squeezed for time and resources. The doctors and nurses dont need anyone pointing out that the problems are a lack of resources (and staffing) and too much overtime. The figures arent unmanagable by the department, theyre simply unmanagable with the current resources theyve been given by management and government.

Thumper Thumper 9:24 am 23 Jul 10

Ah, wasn’t it refreshing to hear Katy on TV last night spewing excuses left right and centre for why the situation exists.

And yet at no stage did she even hint at a solution.

Speaking of which, what has happened to Federal ALP’s great hospital take over?

gun street girl gun street girl 9:02 am 23 Jul 10

dvaey said :

I suspect that the reduction in the number of GPs and also the reduction in people wanting to fork over $60 for a prescription in these financial times, would account for the extra 3% going to see a free doctor at ED. Maybe if the nurses at the walk-in centre were allowed to prescribe antibiotics, it would take a big load off ED to handle all the cold/flu patients.

Nooooo! Please, why do we keep believing Katy’s excuses? Colds, grazes and cuts AREN’T the reason why the ED is overflowing! That is not where the crisis lies, and should not be our main target in fixing the problem!

sb14 sb14 12:12 am 23 Jul 10

Good to hear you don’t consider these unmanagable figures Ian and Sepi. Because the time and resources put into to working up from scratch and caring for critically ill patients is comparable to the daily load inflicted upon your local medical clinic. I’m sure the good doctors and nurses at the TCH ED will be grateful for your pointing out where they are going wrong. No doubt they is just too much sitting about or such.

dvaey dvaey 11:28 pm 22 Jul 10

BimboGeek said :

ACT’s current population growth rate is 1.8% so there’s a fair whack unaccounted for.

The media release mentions that people with less serious problems should go somewhere else….

I took a family member to ED recently, due to a chest infection and most of the doctors at the family doctors were on holidays and the rest were booked out a week in advance.

I suspect that the reduction in the number of GPs and also the reduction in people wanting to fork over $60 for a prescription in these financial times, would account for the extra 3% going to see a free doctor at ED. Maybe if the nurses at the walk-in centre were allowed to prescribe antibiotics, it would take a big load off ED to handle all the cold/flu patients.

virgil99 virgil99 9:25 pm 22 Jul 10

These are not GP patients. This is everything from a splinter to a massively injured trauma patient. For example, an intern (1st year doctor)in ED will see between 4 and 6/7 patients per shift max……
Simple maths……TCH ED has approximately 40 treatment spaces total including resuscitation area, paeds, observation ward etc…..
At any times there are up to 25 patients who have been seen, sorted, and waiting for a bed on the wards………So 15 spaces left to see the 160-180 patients per day…..Hence delays…..
The other issue is the multiple queues……Wait to see the triage nurse, then wait for a bed inside,then wait for a doctor to see you, then wait for the senior doctor to see you, then wait for X/Ray, blood test, result of treatment, then wait for a doctor from an inpatient team to see, then wait for them to talk to their boss for a decision…..THEN…..wait for a bed…….Not very efficient…….
“GP-type patients” – NOt really an issue…….They present, they wait for a while, once seen they ususally take 5-10 minutes to sort out.

gun street girl gun street girl 8:23 pm 22 Jul 10

With respect Ian, you’re probably under-estimating what it takes to see a real ED patient (as opposed to a GP casemix), let alone the process that goes beyond the initial contact with ED staff to admit them to the hospital.

Ian Ian 7:44 pm 22 Jul 10

#9 Pork Hunt – I think the 106,775 might be for TCH + Calvary. So its something like 159 at TCH, and 132 at Calvary. Still those don’t strike me as volumes that would cause the sort of grief to manage that they seem to.

Pork Hunt Pork Hunt 6:04 pm 22 Jul 10

Ian said :

I was surprised to hear numbers like 159 per day – doesn’t strike me as being a particularly large or difficult volume of patients to have to deal with, unless they’re trying to run it on one doctor or something.

106775 people divided by 365 = 292.5

gun street girl gun street girl 2:21 pm 22 Jul 10

Ian said :

I was surprised to hear numbers like 159 per day – doesn’t strike me as being a particularly large or difficult volume of patients to have to deal with, unless they’re trying to run it on one doctor or something.

…Or if the vast majority of the beds designed for ED patients are occupied by already admitted patients who are waiting for a bed on the ward. It’s difficult to see those volumes of patients if there’s no flow through to the wards. Once you start having to see them in the corridors, it becomes even more labour intensive and inefficient (let alone undignified for the patient and plain dangerous).

Woody Mann-Caruso Woody Mann-Caruso 2:11 pm 22 Jul 10

Thanks GSG. 100K+ attendances is still wow.

I’m curious about the averages. They says 159 was a big deal and 190 was a peak, but 106,775 attendances divided by 365 days is 292 per day. Where do the other 100 – 150 per day fit in?

sepi sepi 12:47 pm 22 Jul 10

I was surprised that 159 in a day (24 hours?) is an excessive amount of patients too. My medical centre would see more than that.

It is such a shame the new nurse clinic won’t see kids under 2. The only times I have ever been to casualty are with sick babies/toddlers. They always seem to get sick after hours, and advice from the 24 hour health line seems to be very conservative for under twos, and they always seem to recommend taking them to a dr straight away.

Ian Ian 12:40 pm 22 Jul 10

I was surprised to hear numbers like 159 per day – doesn’t strike me as being a particularly large or difficult volume of patients to have to deal with, unless they’re trying to run it on one doctor or something.

gun street girl gun street girl 12:08 pm 22 Jul 10

@Woody: it’d be blanket attendances, rather than unique individuals.

BimboGeek BimboGeek 11:51 am 22 Jul 10

ACT’s current population growth rate is 1.8% so there’s a fair whack unaccounted for.

The media release mentions that people with less serious problems should go somewhere else but she doesn’t provide any relevant statistics to even support the implied claim that hospital EDs are swamped with problems that can be treated at your local pharmacy.

Another case of politicians blaming the population for failures in policy?

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