‘Wall to wall patients’ in crowded hospital ED

UPDATED: SA Health has axed the co-chairs of a taskforce set up to address the state’s ambulance ramping crisis, prompting Opposition claims the group has been shut down amid a medical union claim that Flinders Medical Centre was in “gridlock'” last night.

Mar 21, 2023, updated Mar 21, 2023
Photos: Tony Lewis/InDaily

Photos: Tony Lewis/InDaily

South Australian Salaried Medical Officers Association (SASMOA) officials last night inspected the Flinders Medical Centre emergency department after it was declared at “code white” – the highest rating above capacity – meaning that the ED had all of its treatment rooms being used.

The union warned there were “wall to wall patients into the night” at the ED, with some patients forced to stand while they waited for a bed.

“When we got called in there were 108 patients in or traversing through that emergency department and the back of the hospital – the gen meds and sub-specialities – was completely full,” SASMOA chief industrial officer Bernadette Mulholland told InDaily this morning.

“Quite clearly it was really distressing.

“Sometimes you go in and you see that there is a loosening up of the beds or there is the ability to get that flow, but the whole hospital and system was in gridlock.

“It was really difficult for both the emergency department and the general medicine at the back of house where the patients stay to really find a short-term solution.”

Leaving FMC ED after inspection – wall to wall patients into the night – more beds and more staff is the key outcome for this crisis – burn out and moral injury for staff needs to be treated – winter demand around the corner the clock is ticking @SAHealth

— SASMOA (@sasmoa4doctors) March 20, 2023

At 9am this morning, Flinders Medical Centre’s ED was declared at “code red” – meaning five per cent of its treatment rooms were available – but at 11am it returned to “code white” with an average wait time of 157 minutes, or just under three hours.

Mulholland said the situation was worrying as hospitals brace for a surge in demand over winter.

“There is significant acuity in the patients that are presenting – these are people that really do need to come to the emergency department and the hospital and really do need to be treated as quickly as possible,” she said.

“That puts enormous pressure on the clinicians that are there and at the same time, they’re receiving messages saying: ‘Clear the ramp, clear the ramp’.

“I’ve watched them in the last week and their faces are just so worn down and they’re just looking for some hope.”

Table: SA Health

In a statement, SA Health said the Flinders Medical Centre ED experienced high demand yesterday afternoon, with “many very sick people needing care, arriving in person and by ambulance”.

“We work across the system and with our union partners to respond to surges in demand. We were able to overcome the peak pressure by around midnight last night,” they said.

“People who present to our ED are always prioritised according to their clinical need, with high acuity cases seen first.

“The past few weeks in particular have been very busy with people presenting to hospital who are very sick and require a high level of care, including in our ICU.

“We thank the community for their patience and for understanding that our staff are doing their very best. We thank our incredible staff for their outstanding commitment to caring for patients and for working together to keep people safe, particularly during periods of very high demand for services.”

Meanwhile, the Opposition has accused SA Health of “shutting down” a taskforce set up by the state government in August last year to address the ambulance ramping crisis.

The taskforce was asked to come up with recommendations to reduce the time ambulances spend stuck waiting outside hospital emergency departments with patients due to a lack of beds.

SA Health chief executive Dr Robyn Lawrence told parliament’s Budget and Finance Committee on Wednesday that the two co-chairs of the taskforce, Shane Solomon and Tony Sherbon, were no longing leading the unit following a department restructure at the end of last year.

She said the taskforce had since merged into SA Health’s “core executive group”, which was chaired by herself.

“There is no point just talking about the task force,” Lawrence told the committee.

“The task force now… is integrated into my executive committee.”

Ambulances outside Flinders Medical Centre. Photo: Tony Lewis/InDaily

Lawrence said the executive committee meets monthly to discuss ramping and it continued to provide updates to Health Minister Chris Picton.

She denied that the change was “grey or vague”, arguing that it made sense for her to have oversight over ramping as it was part of her “core business”.

“It’s part of what we do every single day and therefore we have built it into our core processes, as opposed to having a continual side-arm over here that’s doing the business,” she said.

“We have reorientated our health executive, which includes the LHN (Local Health Network) CEOS and my department team, to be the leadership team of healthcare.

“I want them focussed on the key big issues, and therefore we have now structured our executive meetings to be that, so we have one executive meeting a month completely focussed on the ramping issue.”

Labor MLC and the party’s former state secretary Reggie Martin asked Lawrence during Wednesday’s committee meeting whether the taskforce “actually exists how it originally existed”.

“I am a bit confused,” he said.

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Lawrence responded: “It’s essentially changed into part of our executive structure, with a complete focus on ramping and acute demand”.

“The terms of reference – a lot of them are carried over exactly the same,” she said.

“The people in attendance, apart from the external members, are exactly the same. They were the same people sitting around the room.

“For all intents and purposes, its outcomes and its terms of reference will be essentially the same.”

But the Opposition’s health spokesperson Ashton Hurn said the task force had been “shut down”.

“For the past 12 months, the now-disbanded ramping taskforce has been hearing evidence and making recommendations that have been kept secret from South Australians,” she said.

“For months we have called on Labor to front up and publicly release all of the recommendations from the taskforce, but so far they’ve refused.

“Labor promised to fix ramping and that’s what South Australians voted for, but the unfortunate reality is that (Premier) Peter Malinauskas has overseen the worst 10 months of ramping in state history.”

Lawrence told InDaily in a statement this afternoon that the ramping taskforce “continues to set the strategies which will reduce ramping in our hospitals”.

“Since the start of the year, the taskforce has been integrated into my executive committee with a complete focus on tackling ramping and acute demand,” she said.

“The core terms of reference, participants and work program continue in this new format.

“This makes sure our actions across the department and Local Health Networks are completely aligned on addressing ramping as our top priority.”

Mulholland welcomed the change, saying it made sense to have the most senior person at SA Health to oversee ambulance ramping.

“They are, after all, accountable and responsible at the end of the day for the strategy and the administration,” she said.

“We need the administration to step up and be accountable and responsible for their decisions.”

Latest ramping data shows ambulances spent 3036 hours – the equivalent of 126 days – ramped outside hospitals in February – a slight increase from 3018 hours in January.

However, February’s figure is markedly lower than the high of 3838 hours in June.

State parliament will be asked to legislate ambulance response times and require the government to report against those targets under a bill proposed by the Greens.

The legislation will be introduced this week.

“Ending the ramping crisis was the centrepiece of Labor’s election campaign, yet one year on ambulances are still spending far too long stuck outside hospitals,” Greens SA health spokesperson Robert Simms said.

“Without clear, legislated targets it’s impossible to measure success and ensure that our health system is getting the resources it needs.”

But on Monday, Health Minister Chris Picton said the latest SA Ambulance data showed that inroads were being made into improving response times.

Picton said there had been a rise in meeting priority one response times from 47 per cent in January 2022 to 63 per cent last month, above the stated target.

Priority two response times were also met in 53 per cent of cases last month, compared with 36 per cent at the beginning of last year.

– with AAP

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