30 November 2011

Worst emergency department in the country?

30 November 2011 | johnboy

The Liberals’ Jeremy Hanson is having a good old whack at the increasingly hapless Katy Gallagher with new data from the Australian Institute of Health and Welfare on emergency department performance.

According to today’s AIHW report, the ACT now has both the worst elective surgery waiting times and the worst emergency department waiting times in the country. ACT Shadow Health Minister Jeremy Hanson said these disastrous outcomes have occurred due to Katy Gallagher’s inability to manage the health system effectively.

“Not only is the ACT’s average elective surgery waiting time of 76 days more than double the national average, we also now have the worst emergency department waiting times, with patients waiting almost twice as long as the national average and only 58 per cent of patients being seen on time,” Mr Hanson said today.

“Canberrans are waiting longer than any other jurisdiction because Katy Gallagher has been incapable of managing the $1 billion health system and these appalling results are simply not good enough.

“Behind these statistics are patients waiting longer than they should and often in pain.

But hey, they’ve got time to work on a new logo!

UPDATE: Chief Minister Gallagher has in turn announced that she’s come up with her own “Report Card” for the ED which shows “improvement”.

“I’m pleased to see the Report Card for August 2011 showing solid improvements in performance by the Canberra Hospital.

“The efforts of the Health Directorate are paying off with significant improvements in the proportion of patients seen within the targeted timeframe across categories 2, 3, 4 and 5,” the Chief Minister said.

The Report Card shows that 100 per cent of Category 1 patients are seen immediately and 88 per cent of Category 2 patients are seen within 10 minutes which is above the target.

“While there’s still more work to do in Categories 3 and 4, I’m pleased to see the proportion of Category 3 patients seen on time has risen from 44 to 64 per cent, and the proportion of Category 4 patients has increased from 42 to 57 per cent,” the Chief Minister said.

“The Report Card also shows 82 per cent of Category 5 presentations to Canberra Hospital are seen within recommended timeframes, which is also above the target.

“Significantly, these improvements at the Canberra Hospital have been made in the face of increasing presentations to the Emergency Department, with an additional 200 people seen during the year to August and more than a hundred additional admissions to hospital via the ED.”

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aidan9:23 am 01 Dec 11

For a bit of perspective, an American ED physician wrote about a sabbatical he had in a Tasmanian ED

http://lifeinthefastlane.com/2011/11/why-are-there-so-many-emergencies-here-this-is-an-er/

A real eye-opener. The USA health system is incredibly broken, but it shows how it is all integrated, and a lack of primary care leads to more presentations at ED at a more advanced stage of illness.

It is good to have some metrics measuring ED outcomes, but it is also stupid to ignore the fact that Canberra has a GP shortage, particularly those that bulk-bill.

matt312218:47 pm 30 Nov 11

Canberra Hospital is pretty good as far as hospitals go. But I have noticed that when I have been in the ED for whatever reason sometimes the receptionists there can get a bit cranky. And don’t DARE question the knowledge of the reception staff.

I went in the other day because I had received an electric shock at work (it happens sometimes.), mainly to get an ECG done. The reception nurse sat me down and started to type onto her computer about my status while dictating it out loud. “Patient has suffered electrocution on right hand, no exit wound”. I gently asked her to change what she had typed, electrocution to electric shock. Electrocution em-plies death by electric shock. “No it doesn’t” she snapped. Her tone caused people in the ED to look at turn around and look. Eventually I convinced her but she wasn’t happy.

Don’t dare question them.

Ian7:40 pm 30 Nov 11

So there’s a valuable lesson to our school children in this. If you don’t like the report card you got from the school principal, just invent your own and report your own grades. Cool.

TheDancingDjinn7:05 pm 30 Nov 11

grunge_hippy said :

KeenGolfer said :

A significant part of the issue with ED waiting times anywhere in the country would have to be the number of people who go to ED when they don’t need to. It’s called the “emergency” department for a reason.

I’ve had to go to Calvary ED for various reasons and if you do have a genuine emergency type situation you’re always seen to very quickly in my experience.

agreed. but after forking out over $70 to go to the doctor this week, I can see why people rock up to the ED instead of going to their GP. Some people dont have that kind of money. I know I was struggling on an off pay week and with no health care card to bulk bill. Plus I have to go back again tomorrow because he only gave me 2 days off when I am still not well and need an extension and/or drugs this time to fix the problem.

In order to fix the waiting times in the ED, we need more bulk billing clinics and more doctors.

People with health care cards do not get bulk billed, the price just goes down to $55 – which is still pretty expensive for pensioners. they get it free at the walk in’s – and others pay $30.

sb146:32 pm 30 Nov 11

Jethro said :

sb14 said :

Absolutely and the finger needs to be pointed squarely at the Federal Government there. Standard Consultation Medicare rebate for a GP is $34. They have businesses to run with significant overheads and most cannot survive solely on the rebate – hence no bulk billing.

I’m all for public hospitals and whatnot. However, should we really expect the government to fully fund every trip every person in Australia makes to the GP?

What an entitlement culture we have.

No but I guess given the choice of forking out cash for a GP or a free all-inclusive service at the local hospital, most people will opt for the latter which clutters the waiting room and blows out waiting times for Cat 4s and 5s (which is what the media likes to present, and people like to complain about). Charging people to come to the ED will discourage them but runs the risk of discouraging people who actually should be presenting.

Some people actually can’t afford the asking price at the local GP. Raising the rebate will at least allow GPs to meet those people half way.

Jethro5:58 pm 30 Nov 11

sb14 said :

Absolutely and the finger needs to be pointed squarely at the Federal Government there. Standard Consultation Medicare rebate for a GP is $34. They have businesses to run with significant overheads and most cannot survive solely on the rebate – hence no bulk billing.

I’m all for public hospitals and whatnot. However, should we really expect the government to fully fund every trip every person in Australia makes to the GP?

What an entitlement culture we have.

cranky5:56 pm 30 Nov 11

Had a major lower back meltdown about a year ago. Totally out of the blue. Attended ED to be given a couple of tablets. No help at all.

Virtually paralysed by the pain, stuggled to see an osteo about 5 days later, who took one look and phoned TCH ED to book me in. Attended TCH ED, and sat, and waited, for over 5 hours.

I was going downhill fast, and called wifey to come in and offer moral support. Then recieved a call from the osteo, who was gobsmacked that I was still waiting. He called ED again, at the same time as wife approached the desk. This time, some notice was taken, and I was wheeled in behind the scenes.

I could not believe the amount of work going on in the ED ‘ward’. It was chockers, with some very peculiar ‘issues’ being addressed by an incredibly competent group.

It may have taken 6 hours to get there, and this was probably too long, but the care and attention once through the door was incredible.

I ended up in there for a bit over 2 weeks, so it wasn’t a sniffle or ingrowing toenail.

sb145:39 pm 30 Nov 11

grunge_hippy said :

In order to fix the waiting times in the ED, we need more bulk billing clinics and more doctors.

Absolutely and the finger needs to be pointed squarely at the Federal Government there. Standard Consultation Medicare rebate for a GP is $34. They have businesses to run with significant overheads and most cannot survive solely on the rebate – hence no bulk billing. There have been no significant increases in the rebate by the Commonwealth Government for decades as far as I’m aware.

sb145:26 pm 30 Nov 11

Mumbucks said :

That’s assuming they’re not on holidays or playing golf!

Nice stereotype. Doctors work bloody hard.

When are we going to move past using emergency dept and elective surgery waiting times as a measure of a hospital’s worth?

When Gallagher fixes it, rather than the opposite, which is happening at present.

You miss my point. These are not good measures of how a hospital works. By focussing on this we neglect such things as adequete training of staff and adequete and up to date equipment.

gooterz5:04 pm 30 Nov 11

One has to wonder how much the numbers effect the ordering of patients.

If you wanted to just increase the stats and not care about much else you just treat any patients that are about to go past the limit.
Once they blow the required time for the category then they wont be treated for a long time as they use that chance to treat someone who is still within their time!

Just having a system of pass fail will likely lead to this effect espically when you have to bring the numbers up.

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