With the election out of the way we can tell you just how bad the hospital is

I lived in Quebec for a couple of years… because most people there didn’t have a GP (at least the ones I knew!), they’d go to Emergency instead. Average Emergency waiting time was ~18 hours (no, really!) at the time; guys at work would take the day off to go to Emergency for their non-emergency conditions.

Wonder if education on initiatives like the walk-in clinic would help?

+1 MrNurseRatchet.

And Jeremy – I’ve heard sopranos on Fox News less shrill than you. ‘Shocking truths’ about ‘deceits perpetrated’, oh my!

Here’s hoping you’re never lied to by your own public servants and then go on to correct the record. (I don’t mean because it’d leave you floundering waste deep in double standards after this tirade. I mean I hope it never happens because it’d mean you were in government.)

Only heard good things about the ED; a friends’ son was admitted and treated extremely well, then re-admitted again as an emergency and dealt with superbly with the consultant giving out his home phone number for any further issues, day or night.
OK, they need to keep up the spending to catch up with other states and health is very expensive…it does look a little tatty in places so they have to expand and improve the existing….but these things take time don’t they?

MrNurseRatchet said :

In the ED’s defence (no, I’m not an employee there or a public servant in the health sector):

1) A sore throat you’ve had for the past 6 hours that you haven’t even bothered taking pain meds for is generally NOT an emergency
2) A cough that you’ve had for the past 8 weeks is generally NOT an emergency
3) The fact that you have chronic pain and haven’t bothered getting a primary GP to manage your issues doesn’t make the fact that you’ve run out of your pain meds an emergency
4) That painful sprained ankle that you’ve got that’s mildly swollen, not even bruised, for which you haven’t even bothered trying to ice or take any neurofen for? Nope. It’s not an emergency.
5) The fact that you’re a public sector employee and you’ve had a minor cold for the last 4 hours and would now like a medical certificate so you can have a week’s holiday on the south coast? No, I’m sorry cupcake, that’s not an emergency either.

“”(no, I’m not an employee there or a public servant in the health sector):””
Oh good, so just a run of the mill ALP staffer then?

I don’t accept that these sort of things consist of the majority or even a sizable minority of the of the cases that present.
When I was there last the sort of cases were:
-a woman who’d been bashed in the face repeatedly, and was understandably quite distressed.
-a family that had been in a minor-ish car accident, looked like a kid had a broken arm
-a guy who came in with the aid of a friend, with a wrapped up compound fracture to the leg
-quite a few mothers with sick infants.
-sick elderly people

@tetranitrate:

There is good evidence in the medical literature that ED overcrowding is associated with increased morbidity and mortality.

TCH ED is often overcrowded.

There is good evidence in the medical literature that something called access block is the major cause/determinant of ED overcrowding.

Access block is the inability to move patients who have already been diagnosed and treated _out_ of the ED to an appropriate inpatient ares (i.e. a ward).

Access block occurs because the available acute inpatient capacity of the hospital is insufficient to meet the needs of the population it is meant to provide for.

Thus:

Not enough beds in the rest of the hospital –> access block –> overcrowded ED –> people die unnecessarily / in excessive numbers.

This is well known, understood and documented within the medical profession. Convincing politicians of this in order to encourage policy decision that will actually fix the problem (i.e. creating more acute inpatient beds) rather than politically expedient “Look! I’m doing something! Really I am!” band-aid solutions… well, that’s another matter entirely.

@ mossrocket

I think you are a little bit confused regarding triage. TCH uses the Australasian Triage Scale (ATS) which sorts people into one of 5 categories based on an assessment of how time-critical your problem (or potential problem) is thought to be:

1 – Immediate (currently getting CPR, ongoing seizure, knife protruding from heart…)
2 – 10 minutes (chest pain, breathing difficulty, major trauma, strokes…)
3 – 30 minutes (fractures, abdominal pain, lots of other things…)
4 – 60 minutes (needs to be seen but not particularly time-critical for either Dx or Rx)
5 – 120 minutes (probably shouldn’t be in the ED)

Patients are traditionally seen more or less in order of their triage category, and on a first-come first-served basis within each category. This can be problematic if you are triaged as a Cat 3 or 4, but there is a steady stream of Cat 2 (or 3) patients that keep bumping you down the waiting list. In order to avoid this problem, senior nursing and medical staff within the ED tend to keep a very close eye on the list of patients in the department (including the waiting room, people on ambulance stretchers in the corridor, etc.) and will arrange to have people seen “out of order” if it is apparent that there is a clinical need to do so, and/or if some people have clearly been waiting too long to be seen. In particular, children are prioritised in this manner.

In other parts of the world, a more coarse triage system is applied, essentially “Now/soon” or “Later”, to group patients into those who clearly (or probably/possibly) have a serious urgent threat to their life, limb or health, and the rest, who may well require medical attention, but not in nearly so time-critical a manner.

A hybrid of these two systems (the ATS and the “now/later” model) has recently been considered at TCH based on the following guidelines: People are triaged as per the ATS into one of 5 categories. Cat 1 & 2 patients are seen urgently. Cat 3 and 4 (+/- 5) patients are seen based on the order of their arrival / their waiting time (i.e. first-come first-served) in order to see if this reduces overall (and therefore average) waiting times, compared to strictly adhering to the ATS category priority system (which, as mentioned above, we depart from on an ad hoc basis according to senior assesment of clinical need, anyway).

This is likely the basis of your concerns about triage, mossrocket. It is important to understand, however, that in much the same way that we don’t blindly stick to ATS category priorities when deciding who to see next, we also certainly don’t robotically see the less urgent patients purely in first-come first-served order, either. Constant revision and re-assessment occurs (indeed, your ATS category can, and often does, change based on re-assessment by triage staff, even while still stuck in the waiting room).

Regarding “letting people in without proper triage”. Um, no. We don’t do that. Unless you are literally dying in front of us, no-one makes it into the department without being triaged properly.

As to records of when a person enters the department, there is definitely always a record of that, at the time of triage, which may well be a long time before you come into the department proper.

Tetranitrate said :

It’s only a matter of time before someone dies of a stroke, heart attack or similar time-critical ailment at the Canberra Hospital as a direct result of the state of the emergency room, assuming it hasn’t happened already.

Agreed. Then they may do something. People literally died due to lack of beds in the adult mental health facility, and this did motivate them to put some more resources into this area.

I empathise with the ED staff, and MrNurseRatchet has some valid points IMHO. On the surface there seems to be a shortage of Drs. in Canberra, and less that bulk bill. I never realised that Canberra was such an attractive place to live for Drs, I presume not enough money in the region so they all want to head to Sydney instead.

Canberrans don’t care, Jezza. Just look at how voters made sure Katy was held to account at the election. [/sarcasm]

In the ED’s defence (no, I’m not an employee there or a public servant in the health sector):

1) A sore throat you’ve had for the past 6 hours that you haven’t even bothered taking pain meds for is generally NOT an emergency
2) A cough that you’ve had for the past 8 weeks is generally NOT an emergency
3) The fact that you have chronic pain and haven’t bothered getting a primary GP to manage your issues doesn’t make the fact that you’ve run out of your pain meds an emergency
4) That painful sprained ankle that you’ve got that’s mildly swollen, not even bruised, for which you haven’t even bothered trying to ice or take any neurofen for? Nope. It’s not an emergency.
5) The fact that you’re a public sector employee and you’ve had a minor cold for the last 4 hours and would now like a medical certificate so you can have a week’s holiday on the south coast? No, I’m sorry cupcake, that’s not an emergency either.

The list goes on and on. I’ve sat in an ED with a deep laceration (down to the tendon) to my finger and have watched (and listened) to the above complaints that plague our EDs in Canberra. Until Canberrans actually LEARN what an emergency is, we will continue to have ED waiting times that are out of control.

@mossrocket
I’ve had the misfortune of visiting emergency at Canberra hospital a few times over the past year – once for myself and several times (over the course of a very long week) for a close friend.
As you mention, the triage procedure is absolutely shocking. In a sense first come-first serve actually makes sense, but in normal circumstances you’re waiting no more than a couple of minutes to be triaged, not hours. There’s not any other sort of procedure they can realistically follow for triaging since until you’ve actually assessed a patient you can’t really make much of a determination of how serious each case is.
Calvary is not nearly this bad – you can still end up waiting for hours depending on what’s happening of course, but at least they’re fairly prompt in triaging (in my experience).

It’s only a matter of time before someone dies of a stroke, heart attack or similar time-critical ailment at the Canberra Hospital as a direct result of the state of the emergency room, assuming it hasn’t happened already.

I eagerly await the Team Katy apologists.

I recently had the misfortune to spend an amount of time in the Canberra Hospital Emergency Department.

When we inquired as to when we would be looked after, we were told that triage was now done on a first come first serve basis – and not on urgency of the condition – something I found to be quite alarming.

I then noticed that everyone waiting was redirected away from the admission windows straight to the entrance doors, where staff would let people in people – all without proper triage…

I wonder if this is to further distort the waiting times – as there was no record of when a person entered the Emergency Dept – the first record was entered after the person entered the ward……..