30 November 2011

Worst emergency department in the country?

| johnboy
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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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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.

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.

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.

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.

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.

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.

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.

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.

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.

grunge_hippy5:01 pm 30 Nov 11

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.

sb14 said :

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

I couldn’t give a rat’s how long it takes for my mildly sore big toe to be attended to on a Saturday night. And when that toe needs the ingrown nail removed I’m happy to wait that bit extra knowing that if I have a heart attack I will be attended to in a timely manner, be shipped to a fully functional and well staffed catheter lab following which there will be a bed for me in a cardiac care unit staffed by experienced nurses and well trained doctors.

Emergency dept waiting times and elective surgery lists capture nothing but bed block.

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

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.

I’ve also had the same experience . A family mum and 3 kiddies were in a and e
with Gastro! I felt like saying go to the walk in clinic if you must or better still go take your bowls and go to bed.Think about other people. A quick phone to Health direct could have avoided spreading their germs around a hospital.

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

I couldn’t give a rat’s how long it takes for my mildly sore big toe to be attended to on a Saturday night. And when that toe needs the ingrown nail removed I’m happy to wait that bit extra knowing that if I have a heart attack I will be attended to in a timely manner, be shipped to a fully functional and well staffed catheter lab following which there will be a bed for me in a cardiac care unit staffed by experienced nurses and well trained doctors.

Emergency dept waiting times and elective surgery lists capture nothing but bed block.

Sure we have the worst hospital waiting times in the country, but have you seen that multi-storey car-park at Canberra Hospital ! WOOOWEE what a hum-dinger.

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.

+1

It’s complicated by the paucity of GPs in town and, of those, the few who bulk bill. A few more Walk In Centres would certainly help, as would greater use of healthdirect (sic) Australia.

And yeah – our health services are understaffed and underfunded, but they still do an amazing job.

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.

I want to know what Jeremy Hanson is going to do about it.

No, seriously, has he ever said what needs to be done to fix it?

I went and looked up the Liberals’ health policy to see if there was anything and all I found was: “Thank you for taking interest in our policies. We are currently developing our 2012 election policies and they will be available here once released.”

laraeddy said :

Why is it far better to criticise our public services rather than acknowledge the great work they do on our behalf for the great majority of the time ?

News values.

I agree. We had 3 kids at the Birth Centre (TCH) and it was fantastic. Everyone was marvellous.

A couple of years ago I had a burst appendix, can’t say enough for all the professionals that helped me that day (Ambos, ED staff, Surgeon, Anaesthetist, Nurses, Ultrasound Tech). Frigging marvellous. I’d be dead without them. So Cheers!

rescuedg said:

“Wonder about patient outcomes, maybe we are waiting so long because we have the best treatment…?

Possibly not but its a nice idea.”

Heaven forbid we should ever say anything positive about our excellent public services, but I would like to chip something in from recent personal experience.

My partner and I recently went through the great sadness of a stillborn baby girl and, in my partner’s case, some fairly horrible follow-up complications. This all happened as public patients at the maternity part of Woden Valley Hospital.

Yes, they are horribly understaffed, and may have something else on their plates when you push the call button – but the professionalism, quality of care and genuine compassion we have experienced is nothing short of amazing. Just one example that comes to mind was a doctor calling by at the end of what had been a harrowing day for him, just to make sure that things had gone well with a procedure my partner had had that day – she wasn’t his patient at that stage, but we had got to know him through other things that had happened.

Certainly, the comparison between these people and some gum-flapping careerist pollie who wouldn’t know the front end of a stethoscope from the back end of a boil is pretty stark.

Interestingly (well, I think so), we did write a letter to the Crimes to try and publicly acknowledge the positive experience we had of WVH – it never got published, although a complaint about a letter taking a couple of days too long to get between two Canberra suburbs did get a run around the same time.

Why is it far better to criticise our public services rather than acknowledge the great work they do on our behalf for the great majority of the time ?

johnboy said :

aidan said :

“the increasingly hapless Katy Gallagher”

Really?

She published a media release this morning letting people know about Monday’s twitter community cabinet.

It sure looks like floundering from here.

Sounds like her staff stuffed up. I don’t get an impression of “floundering” at all. I think it takes more than a late press release or two to write off a Chief Minister.

Mostly I am thankful that I don’t have the always defensive-aggressive Stanhope on the telly. And not just his personal style, but the “you’re either wi’ us or a’gin us” mode of Governance.

aidan said :

“the increasingly hapless Katy Gallagher”

Really?

She published a media release this morning letting people know about Monday’s twitter community cabinet.

It sure looks like floundering from here.

You should probably be more specific than ‘worst ED in the country’. From my experience, care is good but waiting times are long. Perhaps ‘worst ED waiting times in the country’ is more appropriate?

“the increasingly hapless Katy Gallagher”

Really?

Wonder about patient outcomes, maybe we are waiting so long because we have the best treatment…?

Possibly not but its a nice idea.

Someone has to be in last place … are we so speshul that it can’t be us? Would be happy to speculate that the Cbr public is (a) relatively highly serviced in terms of occurrences per capita per annum, and (b) better able than most others to cope/find alternatives.

Maybe they need another ‘succesful ‘ twitter session.

They probably shouldn’t have blown up the old hospital.

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