‘Fit to sit’: You’re not ramped if asked to wait in hospital ED

Ambulance patients taken to Adelaide hospitals who are considered well enough to sit are being asked to wait inside emergency departments and are then not counted as being ramped, as overstretched hospitals run above official capacity.

Mar 22, 2023, updated Mar 22, 2023
An ambulance outside the Flinders Medical Centre. Photo: Tony Lewis/InDaily

An ambulance outside the Flinders Medical Centre. Photo: Tony Lewis/InDaily

Metropolitan Adelaide hospital emergency departments have an official capacity of 312 patients, but at 11am on Wednesday, SA Health’s dashboard showed 343 patients were waiting for a bed or had commenced treatment.

The bed-block was most evident at the Royal Adelaide Hospital, which has an official capacity of 69 patients, but at 11am was inundated with 85 patients either waiting for a bed or who had commenced treatment.

Five out of six metropolitan hospitals were listed on the dashboard as being “very busy”, with Flinders Medical Centre and the Queen Elizabeth Hospital declared at the highest-pressure rating “code white”.

The only metropolitan hospital listed at “normal” capacity was Modbury Hospital, but it had an average wait time of just under eight hours for non-critical cases at 9.30am.

Table: SA Health

SA Salaried Medical Officers Association (SASMOA) officials on Monday night inspected the Flinders Medical Centre emergency department, claiming it was in “gridlock” and backed up with “wall to wall patients into the night”, some of whom were forced to stand while they waited for a bed.

SASMOA chief industrial officer Bernadette Mulholland told InDaily yesterday that medical officers were currently under “enormous pressure” to treat patients and to clear ambulance ramps.

Latest data shows in February, ambulances spent 3036 hours – the equivalent of 126 days – stuck waiting outside Adelaide hospitals with patients due to a lack of available beds – a slight increase from 3018 hours in January.

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

SA Health chief executive Dr Robyn Lawrence told state parliament’s Budget and Finance Committee last week that SA Health used a protocol colloquially known as “fit to sit”, whereby patients who arrive at hospitals by ambulance are asked to wait inside emergency departments if they are deemed well enough to do so.

She said once patients enter an emergency department waiting room, they are no longer considered to be ramped.

“They are deemed under a clinical protocol as what we might colloquially call ‘fit to sit’ and they can wait in the waiting room,” she said.

“Just because you’ve called an ambulance doesn’t mean you’re the sickest person to arrive.

“In fact, frequently we have people who walk into the hospital who are more unwell and less able to sit in the waiting room than the person who has arrived in the ambulance.

“Patients in an ambulance are included in the ramping figures. When they enter the ED that clock stops.”

Asked if the “fit to sit” policy was being used to help reduce ramping hours, Lawrence said: “It’s being used as an appropriate mechanism to ensure those patients who need care receive it”.

“It’s common across the globe,” she said.

“I do not believe it’s impacting the statistics as these models have been used for many, many years.”

But Opposition leader David Speirs this morning said the Malinauskas Government “failed to mention” that the “fit to sit” policy was part of its plan to “fix the ramping crisis”.

He described the protocol as a “sham and a disgrace”, saying the government could be hiding the true extent of ambulance ramping in South Australia by shifting patients from ambulance ramps to emergency department waiting rooms.

An opposition spokesperson said the former Marshall Government did not have a policy called “fit to sit”. However, Health Minister Chris Picton claimed it was a “practice” under the former government.

InDaily in your inbox. The best local news every workday at lunch time.
By signing up, you agree to our User Agreement andPrivacy Policy & Cookie Statement. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

“This disgraceful tactic – calling into question the entire strategy around ramping reduction in South Australia – suggested that if a patient is able to sit upright in a chair they will be removed out of the ambulance truck and taken into the ED and kept there,” Speirs told reporters this morning.

“It doesn’t mean they won’t be in discomfort, it doesn’t mean their lives won’t be at risk, it doesn’t mean that they won’t be at risk of their health deteriorating.

“It is simply about getting people out of ambulance trucks and into emergency departments because we know that the clock stops in terms of counting ramping hours when the move from the truck to the emergency department (takes place).”

Speirs said he didn’t believe patients would receive the same level of care if they were transferred from an ambulance to a waiting room.

He conceded that the “fit to sit” model wouldn’t apply for patients with a serious medical condition as they would be less likely to be ramped in the first place.

“We had 114 people… this morning jammed into emergency departments waiting for care,” he said.

“If you are jammed into an emergency department and you are one of tens of people in some of those larger emergency departments, you are actually less likely to get good care than you would with paramedics paying attention to your personal needs in the back of an ambulance.

“It’s simply about the maths – it’s simply about driving down the number of hours on the ramp and pushing those into the ED so that the clock can be stopped.”

Picton claimed the “long-standing practice” was in place under the former Marshall Government .

He said the practice was not part of the government’s plan to “fix the ramping crisis”.

“As Dr Lawrence explained, it is a practice around the globe that some patients who are well enough arriving in ambulances will go into the waiting room,” he said.

“Are the Liberals seriously suggesting that they were wrong to have this occurring when they were in Government?

“Are the Liberals suggesting that there are no patients taken by ambulance who are clinically well enough to wait in the waiting room, after being triaged by clinicians? 

“This long standing practice that also happened under the Liberals is not our plan to fix the ramping crisis – that plan is our $2.4 billion investments in 550 beds and hundreds of extra doctors and nurses.”

InDaily contacted Mulholland for comment.

Local News Matters
Copyright © 2024 InDaily.
All rights reserved.