ramping – Michmutters
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Australia

Fixing weekend discharge key to improving capacity at South Australia’s hospitals

A senior doctor at Adelaide’s biggest hospital says the health system is under “siege” and pinpoints Mondays as the busiest day.

SA’s struggling health system was again in focus this week due to the death of a 47-year-old man while he waited for an ambulance in suburban Adelaide on Monday.

Problems around ramped ambulances, overcrowded emergency departments and full inpatient hospital beds, trouble doctors and nurses on any day of the week.

But each Monday a perfect storm of complications aligns, cranking up pressure on health staff and patients.

So, what makes Monday the busiest day in SA’s hospitals, and what can be done about it?

Headshot of Dr Peter Subramaniam at an Adelaide hospital
Dr Peter Subramaniam says having fewer doctors working and community services unavailable on weekends leads to lower discharge rates.(ABC News: Ethan Rix)

A weekend hangover

As medical lead of the surgery program at the Royal Adelaide Hospital and chair of the Australian Medical Association Council, Peter Subramaniam knows South Australia’s health system well.

He says it is under “siege”.

“The system is under pressure and there is a significant demand and our capacity to meet that demand is not working,” Dr Subramaniam said.

The qualified vascular surgeon pinpointed Mondays as the busiest days for hospitals.

“You can see from the data we have that ours are lower on the weekend compared to weekdays,” he discharge said.

“So that contributes to the log jam that occurs on a Monday.”

A masked nurse adjusts their blue plastic glove in an operation room.
Experts say more resources are needed every day of the week, including weekends.(Rawpixel: Chanikarn Thongsupa)

Dr Subramaniam said fewer doctors working to patients over the weekend had an impact discharge.

“Most acute care hospitals operate on reduced staffing,” he said.

But that’s not the only thing bringing down discharge numbers.

“We rely heavily on community services to be available and accessible over weekends and often that’s difficult to organize,” Dr Subramaniam said.

“You might need a rehab bed or a step-down bed or a community nursing service to be able to manage the patient once they’re discharged.

“Once we’ve discharged the patients, they need to go somewhere.”

Elizabeth Dabars stands outside a hospital in Adelaide
Elizabeth Dabars says a criteria-led discharge policy was never fully implemented.(ABC News: Michael Clements)

monday blues

Chief executive of the Australian Nursing and Midwifery Association’s SA branch Elizabeth Dabars said the “absence of senior clinicians” on the weekend was driving up ramping times.

Professor Dabars wants to see nurses, allied health professionals and junior doctors able to discharge more acute patients under something called criteria-led discharge (CLD).

“It’s a win for the people wanting to go home and it’s a win for the broader community who would have better access to hospital beds,” the qualified nurse said.

CLD has been hotly debated for decades and was a policy directive issued by SA Health in 2019.

A car drives past an emergency department building
The state’s emergency departments have been under extreme pressure.(ABCNews)

Professor Dabars said it was never fully implemented.

“That has not really seriously been put in place and that is a blocker to people being discharged,” she said.

“It doesn’t actually make sense for it not to be enabled.”

But the former president of the South Australian Salaried Medical Officers Association, Dr David Pope, said the number of patients that would fit the CLD criteria was small.

“Item [CLD] works quite well in some areas but I defy anyone to go around and find patients sitting around in the hospital for want of a doctor to come in on a Monday morning,” Dr Pope said.

“That just doesn’t happen.”

Headshot of Doctor David Pope
David Pope says elective surgery admissions make Mondays busier than other days.(ABC News: Ethan Rix)

He said a crowded start to the week was a side effect of elective surgery.

“That worse effect on a Monday is purely a function of when elective surgery patients arrive,” he said.

The doctor said the idea that senior clinicians were unwilling to provide care on weekends was damaging to an already stretched workforce.

“Doctors are in the hospitals 24/7, so if there’s a need for a doctor to be in the hospital they will be there if they exist,” he said.

What will change?

The state government said it was looking to make criteria-led discharge “a regular part of hospital operations.”

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Categories
Australia

A grieving family says South Australia’s health system is broken after man’s death while waiting for ambulance

The family of a South Australian man who died while waiting for an ambulance on Monday night says the state’s health system is ‘broken’.

The 47-year-old father of two, Andrew, died from cardiac arrest on Monday evening in a Plympton car park, where he had pulled over and called an ambulance after experiencing chest pain.

At the request of the family, the ABC has decided not to publish a picture of him or use his last name.

His family remembers Andrew as a “much-loved” partner, friend, family man and colleague.

Nathan Hutchison, the brother of Andrew’s partner, read a statement on his behalf.

“My partner Andrew was my soul mate and loving father to our children, my heart has been torn in two and I feel broken,” the statement said.

man standing in vest with checkered shirt and glasses
Nathan Hutchison says the health system needs to be fixed. (ABCNews )

“He’s going to be deeply missed, but will always be remembered and very much loved.

“We are devastated he’s been taken so soon.”

Mr Hutchison said that the system needed to be fixed.

“It’s just devastating for us,” he said.

“It’s very hard to put it in words, clearly there’s a system that’s broken and needs to be fixed.

A divided road with palm trees in the median strip, along with directional signs.  Only one car is visible and its parked
The man suffering chest pain called triple-0 after pulling over on Anzac Highway at Plympton. (ABC NewsEvelyn Manfield )

“It’s tearing up my family. Fix the system.

“We do appreciate the work the first responders did when they arrived, and the community members did when they were there.”

Central Adelaide Local Health Network chief executive Lesley Dwyer described the “awful” incident as “an absolutely tragic outcome” and said a full investigation would take place.

TAFE SA chief executive David Coltman said Andrew had been a well-loved member of staff.

“[He] was a highly regarded manager at TAFE SA and we are deeply saddened by his sudden passing,” he said.

“TAFE SA is providing support to [his] colleagues during this difficult time and we extend our heartfelt condolences to [his] Familia.”

A woman with short brown hair wearing a beige scarf and a black top
Lesley Dwyer says discharging NDIS and aged care patients to free up hospital beds remains a priority.(ABCNews)

Acting Health Minister Tom Koutsantonis said the man’s death was “horrific” and said he would also want his elderly father to call him if he had a medical episode.

“I’ve got an elderly father and I say to him, ‘if something happens, call an ambulance and call me’,” he said.

“But that’s not the solution you’d expect in a first-world country.

“In a first-world country, we expect an ambulance to come on time when it’s [a] life-threatening situation.”

A man in a suit standing behind microphones with a road overpass behind him
Tom Koutsantonis urges the public to still call triple-0 in an emergency. (ABC News: Shari Hams)

Mr Koutsantonis said there had been a “whole-of-government” approach to address the health crisis, which included hiring more doctors and nurses, opening private beds, and moving aged care and NDIS patients out of hospital and into care.

“You gotta have faith. We still want people calling triple-0,” he said.

“In three months we’ve done a lot but in three months you can’t fix it.

“Right now there’s no-one in South Australia who’s thinking about this in political terms, they are thinking about in terms of ‘if I call an ambulance will it come in time to save my father, my mother, my child?'”

‘extreme pressure’

Ms Dwyer said the health system was “under extreme pressure on Monday afternoon with large numbers of triple-0 calls.”

“The hospitals themselves had come off a weekend where we’d been extremely busy,” she told ABC Radio Adelaide.

A white hospital building with blue and green windows, with green trees in front of it
Ambulance crews were ramped up at the Royal Adelaide Hospital for three hours on Monday, the union says.(ABC News: Che Chorley)

“And so you had two of the major metropolitan hospitals, being Flinders and the Royal Adelaide, that were really struggling to get people into the emergency department in a timely way to free up ambulances.”

SA Best MLC Frank Pangallo said he was unsure what a government inquiry would achieve “because we all know where it’s going wrong.”

“The system is broken and more people are likely to die unless something happens,” he said.

Mr Pangallo said Andrew’s death was a “tragedy, and most likely was an avoidable one”.

“We’re likely to see instances like this again,” he said.

“Waiting times have blown out to unacceptable levels.”

A man sitting behind a microphone points.  There is a bottle of water next to him and a name tag
Frank Pangallo wrote to Health Minister Chris Picton last week about a different patient.(ABC News: Lincoln Rothall)

Mr Pangallo said he wrote to Health Minister Chris Picton last week about a different patient who had waited two hours for an ambulance after suffering a heart attack.

“There was another tragedy that was averted,” he said.

Mr Pangallo said his office had been told by a member of the public yesterday that a taxi had been dispatched when a triple-0 call was made.

“A family member had called for an ambulance and it wasn’t considered a high priority so a taxi was dispatched,” he said.

“I’ve heard of this happening previously as well.”

Plan alternative options, says union

SA Ambulance Employees Association secretary Leah Watkins said yesterday that South Australians should consider planning alternative options in the event of lengthy ambulance delays.

SA Ambulance Employees Association secretary Leah Watkins.
Leah Watkins says South Australians should prepare a plan for what to do in the event of a lengthy ambulance delay.(ABCNews)

“In the vast majority, people are calling triple-0 because they’re in a point of crisis and they have no other option and they should still do that if they do feel the need,” she said.

“But the ambulance service and the health system is completely overwhelmed at the moment and so if they are concerned that there is going to be a delay for them, to get help early.

“If you’re home alone, call a neighbor or a friend just to let them know what’s going on so that there’s perhaps someone that could come over and wait with you or someone that can drive you to hospital yourself.

Lesley Dwyer said while “there was nothing wrong” with Ms Watkins’ advice, “people should not be frightened of ringing” triple-0, and it should be the “first port of call” in an emergency.

“We’d certainly not advocate people hopping in a car or a taxi if they thought they had a life-threatening condition or one that was going to deteriorate on the way,” she said.

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Categories
Australia

Launceston General Hospital patient dies after being ramped for more than nine hours

The death of a woman in her 70s who was ramped and waiting to be admitted to a Tasmanian hospital’s emergency department for more than nine hours is “totally unacceptable” and shows the state’s health system is crumbling, a union says.

The union that represents paramedics in Tasmania said the woman was taken to the Launceston General Hospital about midnight on Friday night, and died at about 9am on Saturday.

“The patient had been ramped for nine hours at the time when they passed away, and they were still in an inappropriate setting and had not been allocated a bed at that time,” said Robbie Moore from the Health and Community Services Union (HACSU) .

“This is a very sad situation that just demonstrates how bad our health system is, that we couldn’t have a bed available for a patient who clearly needed medical assistance, and shows that ambulance ramping is out of control and patients’ lives are being put at risk.”

Ambulance ramping happens when hospital emergency departments are full and cannot admit new patients.

Paramedics care for the patients they have transported in an area of ​​the hospital outside of the emergency department.

Mr Moore said the patient received care from emergency department staff while they were waiting for an ED bed to become available, and was also cared for by ambulance paramedics.

“A patient being ramped for nine hours is totally unacceptable, and demonstrates that we are letting down the Tasmanian community,” he said.

“Unfortunately this is not an isolated incident … we’re unfortunately aware of several other incidents where patients have been unable to get a bed and passed away on the ramp.”

Nursing staff ‘distraught’ at conditions in LGH emergency department

The Australian Nursing and Midwifery Federation’s Tasmanian secretary Emily Shepherd said on the night the woman was brought to the hospital, the LGH’s emergency department was full, with 20 patients waiting to be admitted to beds in other parts of the hospital, about 50 people in the ED waiting room, and seven ambulances ramped up.

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