Red News Readers,
Thirty plus years experience as a nurse in the health system tells me that you have to look at causes behind the rising waiting times in emergency departments. Access block is the main problem, too few beds for too many people, too few staff, especially experienced staff, for the beds that are open. The NSW health system has been over-rationalised, and now there is an reluctance or an inability to open more beds.
But why are there too many people in emergency departments? I think it is because emergency departments are the most accessible and affordable portal into the health system. It is a very fortunate citizen these days who can find a GP who bulk bills. Medical specialist fees are skyrocketing. GPs often only open in daylight hours, and do not home visit, unless they have an after hours locum service, most of whom charge a fortune. There is almost nowhere else to go if you have a dental emergency after hours. There are many citizens who see emergency departments as the place to present with all sorts of health problems which could be dealt with by a GP, if they could get in to see a GP. I have heard of patients ringing GPs for a semi urgent matter and been told the waiting list is 4 weeks. So they present at emergency department. The problem is access to the health system, not just access to emergency departments.
Hospitals struggle with emergencies
Kate Benson Medical Reporter, smh
January 2, 2009
ALMOST one in three people are waiting more than eight hours in emergency departments for a bed, the highest in 18 months, but doctors say the true figures are much worse as hospitals struggle with a surge in the number of patients and a lack of staff, beds and funding.
NSW Health figures, released yesterday after the Opposition health spokeswoman, Jillian Skinner, submitted a freedom of information request, show that 29 per cent of people are waiting more than eight hours for a bed, known as access block, up from 19 per cent six months ago, but the figures failed to reveal that some patients could wait up to five days, the president of the Australasian College of Emergency Medicine, Sally McCarthy, said yesterday.
"A patient is only counted when they have been waiting for eight hours or more for a bed, but you can have people waiting for days and days in the emergency department," she said.
"There are plenty of cases where management will move a person out of the department when they have been waiting for 7½ hours to avoid them being counted as an access block statistic, while someone who has been waiting more than eight hours could be overlooked and left for days because they have already been counted anyway."
About 17 per cent of people who present with imminently life-threatening conditions (triage 2 category) are not being seen within the required 10 minutes and 32 per cent of those with potentially life-threatening conditions (category 3) are not being seen within the necessary 30 minutes, up from 15 per cent and 30 per cent 18 months ago. The number of patients not being seen on time in categories four and five remain the same.
There were 153,897 people seen in emergency departments between June and September, up from 137,117 in June 2007, with most of the increase in the middle and lower triage categories.
"Bed numbers have not changed in 10 years but we are seeing about 40 per cent more patients through our emergency departments," Dr McCarthy said.
"It is very bad for the proper functioning of any emergency department because once we have 10 per cent of patients not being moved out to a bed, it starts to create problems. We have no space to see new cases, ambulances are delayed, patients get poor treatment and it has been well documented that mortality rates go up."
Mrs Skinner said: "They are the worst emergency department figures I have seen in my 13 years in the job. No wonder the Government tried to hide them. The Garling inquiry was told that stressed ED staff need more doctors, experienced nurses and beds in wards but nothing has been done."