Questions over Flinders revamp as doctors condemn piecemeal solutions

An expansion of the Flinders Medical Centre Emergency Department will see the hospital’s overall bed capacity reduce, according to an SA Health blueprint – with doctors warning the Marshall Government must tackle “whole-of-health system issues” rather than “simply making space for more people to be treated in EDs”.

May 13, 2021, updated May 13, 2021
Ambulance ramping at Flinders Medical Centre last year. Photo: Ambulance Employees Association

Ambulance ramping at Flinders Medical Centre last year. Photo: Ambulance Employees Association

Health Minister Stephen Wade today opened a new Flinders paediatric ED – part of a broader Southern Health Expansion Plan announced last year.

“This Emergency Department is the busiest ED in the state – under our redevelopment it will also be the biggest,” Wade told reporters today.

“At the end of this development there’ll be up to 30 additional treatment bays, the balance of the 30 will be in place by the end of July.”

But documents detailing that expansion, dated July last year, detail a complex realignment of beds throughout the Southern Adelaide Local Health Network, with the Flinders ED’s expansion offset by a reduction of beds elsewhere in FMC.

A flowchart suggests the new ED will have 12 extra treatment spaces, with a further 12 added to an Emergency Extended Care Unit. However, the existing Acute Medical Ward, located adjacent the current ED, will go from 30 beds to zero.

The chart suggests 16 of those beds will be ‘relocated’ to a general ward at Noarlunga Hospital.

In a statement, the Southern Adelaide Local Health Network told InDaily the expansion plan was “creating more capacity” across the overall network, “through a number of service moves to create more treatment spaces and capacity”.

The statement reiterated that “there is an overall increase in capacity of the Flinders Medical Centre Emergency Department by up to 30 more emergency treatment spaces” – the 24 new beds plus “the capacity to flex up to an additional six spaces”.

“There is also a new refurbished paediatric unit, a new resus bay and additional Emergency Department Cubicles,” SALHN said.

“A 24-bed Medical ward has been created at Noarlunga Hospital so that people in the south can get care closer to home.

“Importantly, as part of [the plan], SALHN has commissioned an additional 12 beds at the Specialised Advanced Dementia Unit and is in the process of opening up to 18 beds at the Neurobehavioral Unit at the Repat Health Precinct.

“Overall, there is increased treatment spaces across SALHN.”

It did not specifically address whether there would be fewer overall beds at FMC.

Opposition Health spokesman Chris Picton said it was “unfathomable that this supposed upgrade is resulting in fewer overall beds than what was there before”.

“How does closing more beds than you are opening result in any better care for patients who can’t find a bed? The Government is robbing Peter to pay Paul in this upgrade which will leave overall the hospital short-changed,” he said.

It comes as the Australasian College for Emergency Medicine called on the Marshall Government to “offer genuine and systemic improvements to address the state’s acute hospital access crisis”, arguing EDs remain “under immense pressure while the Government focuses primarily on reannouncements of previous plans to expand emergency department capacity”.

The College’s SA Faculty Chair Dr Mark Morphett said in a statement: “Government responses to the escalating crisis have continually fallen short of addressing the root systemic causes of the dangerous bottlenecks being experienced in South Australian EDs.”

“Whole-of-health system issues are the problem, and it is these systemic issues which need to be addressed,” he said.

“Simply making space for more people to be treated in EDs will do little to address the real causes, which, overwhelmingly, are delays in admitting patients needing further care from EDs to inpatient hospital beds or other care options.

“We need clear pathways, not only into EDs, but out as well.”

Morphett said SA “urgently needs solutions which take a whole-of-system approach”.

“This should include a focus on workforce sustainability and improving out-of-office hours access to other hospital services and specialities, including advanced diagnostics,” he said.

Morphett, who works at the Flinders ED, did not respond to questions about the specific situation at FMC.

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Flinders has been at the forefront of the state’s ramping crisis, with the Ambulance Union claiming last week its ED was on a “Code Yellow”, representing an “internal disaster”.

SA Health denied that at the time, but SALHN Clinical Director of Emergency Services Dr Andrew Blyth said today “that was probably because staff were so busy actually trying to manage the situation that they didn’t formally notify the switchboard to call [a code yellow]”.

He said whether the situation was designated a Code Yellow or not was “largely irrelevant in a way”, given “the entire response of what we’d call a Code Yellow was actually happening in the ED”.

“The system’s been under great stress, and this isn’t something unique to SA,” he said.

“We’ve had quite significant increase in demand, and that demand flows right into the hospital… we’ve had a particular surge in presentations in mainly the older age group, who have significant co-morbidities and often require more time [in hospital], so are much more likely to get admitted.”

He said the “high stress” was “landing on the system at a time when we actually are in the middle of a redevelopment aimed at trying to alleviate some of the stress”.

He suggested the ramping phenomenon required a hospital-wide solution, saying the stress was “right down to the ‘back door’ of the hospital, with patients accessing facilities like NDIS, nursing homes etc”.

Picton argued the major cause of ramping is ‘bed block’, “where patients get stuck in the emergency waiting for a bed [so] cutting the overall number of beds at Flinders will only make that worse”.

In a statement, Wade told InDaily: “It is unbelievable that Labor would seek to comment on the South Health Expansion Plan.”

“Labor’s Transforming Health disaster saw the Repat closed and massive downgrades to suburban hospitals across Adelaide,” he said.

“Our expansion of the Southern Health Network includes opening beds at Noarlunga Hospital and the Repat – which Labor closed – and will give people in the southern suburbs access to more services and better health care, closer to home.”

Nursing union boss Elizabeth Dabars told InDaily she was primarily concerned with seeing an increase in beds system-wide, but that there were concerns about the re-designation of the FMC Acute Medical Unit – which could affect staffing levels for the equivalent beds at Noarlunga, as well as the types of patients treated.

She said the union was “relatively supportive” of services such as orthopaedics transferring to Noarlunga, but called for an increase of at least 30 to 40 mental health beds and a greater emphasis on community and out-of-hospital strategies.

“The point still stands that across the board there are not enough beds in the current environment,” she said.

“Having a small increase in the absence of prevention and discharge strategies is still not going to be enough – you’re not going to achieve the result you need or want in any event.

“Clearly there are simply not enough beds in the system and this is demonstrated by the large and increasing number of code yellow and code whites being called on a weekly, if not daily, basis.”

She said the southern expansion was “effectively redistributing what they have permission to use – but shuffling the beds does not deal with the issue of there simply not being enough beds in total”.

“It’s analogous to shifting the deck chairs on the titanic,” she said.

“More beds must be opened urgently… we know there are 30 to 50 people awaiting beds in EDs across metro SA on a daily basis.

“We need the Minister and Government to step up, provide leadership and be accountable for the state of our health system, which is currently in crisis”.

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