20 May 2012

Please don't wander into the Emergency Department pleads the Chief Minister

20 May 2012 | johnboy

Chief Minister Gallagher is asking Canberrans to stop making her emergency department numbers even worse by coming in for non-emergencies.

Instead she suggests these alternatives:

— Community Pharmacist – your local pharmacist is qualified to give you expert advice on many health issues;

— healthdirect – call 24 hours a day seven days a week on 1800 022 222 for free expert advice and reassurance;

— Walk-in-Centre – for one-off treatment of minor illness and injuries for those over the age of two, see a specialist nurse seven days a week from 7am until 11pm, at Canberra Hospital;

— GP surgery – for ongoing comprehensive health care for everyone, including those with acute problems, children under two years and those who have complex medical problems, your GP is your best option; and

— CALMS – 1300 422 567, the call centre is open weeknights from 6pm and all day weekends and public holidays, with CALMS clinics open from 8pm.

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snoopydoc8:52 pm 22 May 12

Health Direct (the phone advice line) is necessarily risk-averse. It is exceptionally difficult to adequately assess the nature, extent, and potential risks of a patient’s condition over the phone. Despite the wonders of the information technology age, actually laying eyes and hands on a patient is still far and away the best, most accurate and safest way to figure out what the hell is going on with you and make a sensible and safe decision about what needs to be done about it.

The Walk-In Clinic is _very_ good at sorting out minor/simple problems, however there are two things worth keeping in mind. Firstly, it is staffed by nurses. They are very experienced, senior nurses, with specialised extra skills and training in a wide range of practice, however they are still limited by very specific and rigid operating guidelines. Secondly, these guidelines are there for a reason, predominantly that what _you_ might consider minor and/or simple and what health care practitioners consider minor and/or simple can be (and often are) two _very_ different things.

Patients presenting with minor complaints that are not really appropriate for the Emergency Department do, indeed, clog up the works a little bit. However, it’s worth keeping in mind that in fact this group of patients doesn’t actually inhibit the provision of acute/critical care to those patients who _do_ have “proper” emergency conditions to any significant extent. It makes the waiting room a hell of a lot more full, and it results in a higher number of people giving up after a long wait and leaving (interestingly, this is one of the statistics that excites and frightens politicians the most, but which is of minimal importance in terms of actual bad outcomes for the public, or the functioning of an emergency department).

Clinics aimed at relieving the demand created by minor ailments do not reduce the number of presentations to, or workload of, emergency departments, but they _are_ a very good way for politicians to be seen to be doing something active to address the problem without actually addressing the underlying more relevant causes of emergency department overloading and dysfunction. Providing more acute inpatient hospital beds (what we actually need) just isn’t as publicly noticeable or sexy as building a shiny new clinic. Such clinics _are_ very useful, however, and almost certainly reduce the demand for “regular” GP appointments for minor injuries and ailments.

The CALMS after-hours GP service is excellent, and information about them can be found here:

http://www.calms.net.au/site/index.cfm?display=26182

One previous commentator complained that there is a broken path to the fee structure. The website above clearly indicates that the maximum out of pocket expense will be $35. If the CALMS doctor thinks you need ED assessment or treatment, they will send you to ED, with a detailed referral letter and they will also have discussed your case with a senior ED doctor before you get there. Unfortunately, this does not mean you get to “jump the queue”, and you will still be triaged, just like everybody else. (Incidentally, arriving by ambulance is also not a ticket to bypass triage).

The causes of long ED waits, overcrowding and inefficiencies are many… but too many people presenting with minor “non-emergency” problems is not a major player.

supamum1:23 pm 22 May 12

katkat said :

Every time I’ve called Health Direct they’ve told me to go to the ER, and most of my friends (who have called) have had the same experience. That line seems to be driving up numbers at the ER rather than reducing them.

Same for me, with my children. They alway say we recommend you see a doctor in the next 4 hours…. Ok so its 10pm guess we’ll have to go to the hospital.

BimboGeek8:23 am 22 May 12

Just to point out that there is a bit of culture gap at work here. Some of you are trying not to cause a nuisance and staying away from EDs even when quite sick or injured.

They are more concerned with grannie drops, princesses with grazed knees, panicked hypochondriacs and other genuinely minor problems that can seem major to the helpless idiot suffering them.

In Britain the “don’t come in unless you are dying” culture was so ingrained in some people that they had to run ads going “actually these things are emergencies, come in please!”

miz7:46 am 22 May 12

It would really help Emergency if the Walk in Centre could treat a broader range of ailments. Eg, it can treat a UTI, but if you have any back pain whatsoever, that ‘could’ be a kidney infection, and up you must go to Emergency. This sort of thing is just plain silly.

Mr Evil10:51 pm 21 May 12

For God’s sake, people – Katy just wants all you selfish, whinging, ungrateful bastards to stop getting sick and injured: is that really too much to ask in this day and age????

And while we’re at it – isn’t it time you all got back to the salt mines, you bloody lazy bludgers!

Gerry-Built10:39 pm 21 May 12

of course, Katy’s answer of having someone doctor the books (see what I did there?), has been discovered; so it’s time to throw it in the user’s hands… “If you people only used it less, it wouldn’t get so much use”…

socialnode110:18 pm 21 May 12

I used the walk in clinic tonight for the first time and was actually surprised at how quickly we were seen to.

There were maybe 6 people ahead of us and including filling in paperwork we were in and out in about an hour.
There was 5 people who came in after us and 3 sent direct to ED.

Lighting and parking is an absolute shocker though, I’m easily freaked out at the best of times but walking back to the carpark was so scary!

I’ll definately use it again for simple ailments had I have gone to our drs tonight it would have cost $140 ($70 x 2) and I would have likely spent the same amount of time to be told the samething.

nyssa19769:09 pm 21 May 12

I hobbled into A&E in Feb 2011 with a suspected broken ankle. After 6-8 hours, I was told it was fractured and sent home with my own crutches and a crepe bandage.

11 days later I was chasing the Fracture Clinic and was told ‘they shouldn’t have sent you home in a crepe bandage’. Once in the Fracture Clinic I saw a poster for how to protect the exact break I had in my ankle.

No MRI was ordered.

I wore a boot, the bone healed and I went into an ankle brace.

I spent 3 months walking on torn ligaments (high pain threshold) before an MRI and surgeon recommended, in July, to Comcare (workplace injury to begin with) to have my surgery paid for which ‘fixed’ the ligaments near my ankle.

I’m still in pain almost a year later, even after surgery and physio. I could possibly have another surgery on it. I still hold TCH accountable for sending me home without following procedure and just telling me to ‘rest’ it and to ‘not walk on it so much’.

And then there’s the time they left me in a cold waiting room with a major asthma attack that kept me in the hospital for FIVE days……

Katy has no bloody idea what the rest of us have to go through just to get seen for ‘real’ emergencies e.g. not a cold or vomiting.

Genie6:18 pm 21 May 12

I’ve said it before and I’ll say it again….

The emergency departments need to scrap the whole “Triage Nurse” and have a “Triage DOCTOR”

That way anyone presenting to the ED, has their up to 5min consultation with the doctor, and they can be directed to go home, be sent to the x-ray department (coz there is nothing worse than sitting around for 4 hours to spend 30seconds with a doctor saying they need an x-ray) or sent out to the waiting room for treatment.

I don’t know if it would increase numbers given they can see a doctor first up.. but it can evict plenty of non-urgent patients out of the waiting room.

mezza7612:11 pm 21 May 12

EvanJames said :

Getting medical care for accidents and injuries is quite challenging actually. We had a relative with a serious hand injury, left a rather large chunk of their hand hanging, and it proved quite difficult finding an alternative to Casualty.

Couldn’t work out what CALMS was or how you accessed it. Getting an appointment with a GP same day, you’re kidding right? The walk-in centre info seemed to discourage anything serious or possibly needing antibiotics (I thought they could prescribe? The info inferred that they couldn’t) … we searched the ‘net for info about a casualty-style clinic that you pay for (fair enough) but came up blank.

Relative had a 5+ hour wait in Casualty. And was then booked in for urgent plastic surgery on the hand the next day (despite being a weekend).

CALMS is essentially just an out-of-hours GP service. While from memory it wasn’t cheap ($70 I think) they are usually easy to access – just ring up and make an appointment after hours.

The Walk-In Centre is just nurse practioners – they cant and wont perscribe anything. Anything other than a cut or a sniffly nose and you’re on to the ED. Frustrating in some respects but that’s the separation between GPs and Nurse practioners for you.

As an aside – did you know that most GPs have ’emergency’ slots available for well…emergencies? If it isn’t life threatening (although from what you describe the ED would have been my first pick) – try ringing a few GPs and decribe that its an emergency. In most cases they ‘should’ drop everything and see you straight away. Ive been bumped a few times at the GPs for emergencies (ie. kid v glass door) so they are definitely an option during business hours.

That’s my public health education duty for the day.

dtc11:29 am 21 May 12

So this entire thing seems to be based on weekend admissions. As a father of two children under the age of 3, let’s look at these alternatives that Katy mentions.

Of course, government policy is all about your specific situation and why you are so special. If the emergency depts were clogged with sick 2yr olds, then your complaint would be valid.

Underlaying all of this debate is funding and, guess what: GPs are paid through Medicare (and your contribution) and Medicare comes from the Federal Govt.

However, hospitals are funded by the states (of course, most state funding is routed via the Cth, but its up to the state to spend it as the state sees fit)

So if the hospitals can push more people to GPs, then its cheaper for the state and more expensive for the Cth.

This used to be the reason why GP clinics could not be co-located on hospital grounds (it may still be, I am not sure if the legislation has changed). It was so emergency (state) departments couldnt shovel whole batches of people onto nearby (Cth funded) GPs.

The current ALP govt has been pushing very strongly to take over all health funding, with large bribes to the states etc. However, for various reasons (Libs controlling the states, states not wanting to give up areas of power, issues over who is actually best to run health care at ground level etc), this hasnt gone very far. Its a recognised issue, but without any obvious solution.

So, yes, there are practical reasons why you should go to your GP rather than emergency if you can. There are also funding reasons why the ACT govt wants you to do this.

Oh, and btw, there are large bribes (um, ‘assistance payments’) available to GPs to work in Canberra, expand their clinics etc, plus considerable Cth funding in development of ‘super clinics’. Unfortunately, there just arent enough GPs to go around (some might blame the whole Medicare number debacle of the Howard govt, some might blame the control over numbers by doctors, any number of reasons). Depending on your philosophical view, this is just how the market operates or is something the govt (Cth and/or state) should work harder on (for example – higher Medicare payment for GPs if they see people on the weekend?)

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