SA hospitals grapple with ‘unprecedented’ access block as elective surgeries cancelled

South Australia’s emergency departments are dealing with “surges on top of surges” of patients ahead of winter, the doctors’ union says, as SA Health cancels elective surgeries to cope with demand on the hospital system.

May 31, 2024, updated May 31, 2024
Ramping outside the Royal Adelaide Hospital ED on Thursday night. Photo: Thomas Kelsall/InDaily.

Ramping outside the Royal Adelaide Hospital ED on Thursday night. Photo: Thomas Kelsall/InDaily.

SA Health CEO Robyn Lawrence said today all category two and three elective surgeries would be paused for “approximately a week” under a system-wide code yellow declaration, with only category one and paediatric urgent category 2 surgeries to continue.

The internal code yellow places the SA Health system into an emergency management framework to free up beds, with regional patients returning to country hospitals and patients receiving care at home where possible.

Lawrence said she was anticipating nine elective surgeries to be cancelled today, with the measures to be reviewed daily.

“These are surgeries which aren’t as urgent as category one surgeries,” she told ABC Radio Adelaide this morning.

“They can include things like joint replacements, gallbladder surgery, those sorts of things which we know patients won’t typically deteriorate rapidly with.”

Lawrence said hospital networks had opened all available hospital beds and “maximised” out-of-hospital care options, but the level of demand required further action to free up beds.

She said there were more than 140 patients in hospital with COVID-19 and the flu, with metropolitan hospitals reporting around 270 staff are off work with COVID.

“Compared to this time last year, we have 200 more admitted patients in our system,” Lawrence said.

“That’s a medium-sized hospital of patients that we are fitting in our system compared to last year at the same time.”

At a press conference later this morning, Lawrence would not rule out patients having to receive treatment in hospital corridors.

“This is the worst I’ve seen [waiting times] in South Australia since I’ve been here,” she said.

SA Health’s emergency department dashboard showed that at 4.30pm on Thursday every public hospital ED was at “code white” – the highest rating above capacity, with the number of patients in ED greater than or equal to 125 per cent of total beds.

By 8am at the Royal Adelaide Hospital, 69 patients had spent more than eight hours in the ED, including 17 mental health patients.

Ambulances outside the Royal Adelaide Hospital ED last night. Photo: Thomas Kelsall/InDaily.

The average time for a non-critical patient to be assessed at the RAH ED was 5.25 hours this morning. Non-critical patients at the Flinders Medical Centre were also facing a five-hour wait.

According to the emergency department dashboard, 33 patients at the RAH have waited in the ED longer than the recommended time.

The RAH remains at code white this morning as does the Flinders Medical Centre, Modbury Hospital, and Queen Elizabeth Hospital.

South Australian Salaried Medical Officers Association (SASMOA) chief industrial officer Bernadette Mulholland said hospital staff were dealing with “surges on top of surges”.

“That’s the crazy life that we’re actually living in at the moment,” she said.

“And then to be able to take some pressure off the system, we then have to halt elective surgery, and that creates more problems in the system itself.

“We feel like sometimes that we’re on this wheel that’s just going round and round.”

Mulholland said demand has been growing across the hospital system over the last six weeks leading to “unprecedented levels of access block at all of our major emergency departments”.

“Slowly that’s evolved into what we’re actually seeing now, which is a pretty big crisis in our health systems, in our hospitals,” she said.

Mulholland also said the winter months would be “pretty tough for the clinicians, for the patients and the community”.

She said it would be distressing to see rising numbers of patients presenting to hospitals with higher acuity combined with the absence of medical staff suffering from COVID and flu.

Bernadette Mulholland

SASMOA chief industrial officer Bernadette Mulholland. Photo: Tony Lewis/InDaily

There have been 2394 new cases of COVID-19 reported in South Australia over the last seven days, an increase from 1907 the previous week, and 1529 the week before.

“I don’t think we can say any more that this is just a winter surge – these surges are now continually happening no matter what month, no matter what season,” Mulholland said.

Dr Michael Edmonds, an emergency physician based in South Australia and chair of the SA faculty board of the Australasian College for Emergency Medicine, said the high demand on the hospital system today “was not a huge difference” compared to previous weeks.

Edmonds said delays in discharging patients to aged care, NDIS and mental health facilities had contributed to hospital access block.

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“The difficulties we have is that the hospitals are just getting fuller and fuller,” Edmonds said.

“Most of the hospitals have been at full occupancy for weeks and months.

“And I think the difficulties are being that all the kind of issues are compounding [and] we are having more trouble getting people out, people are having a longer length of stay.”

Edmonds also raised concerns about the number of mental health patients waiting for a bed in South Australia’s emergency departments.

“The emergency department is not a therapeutic environment for patients with mental health problems; they come at a very vulnerable time and when they’re often in distress and need a good therapeutic environment around them,” Edmonds said.

“The emergency departments just don’t provide that – we have 24-hour movement, noise, light. There’s no opportunity to rest.

“There are risks – if you put anyone into a small cubicle for 24 hours they become dissatisfied with that situation and some people have less ability to control their emotions… and there’s a risk of violence towards staff and other patients.”

The problems across the state’s health system this week have put renewed focus on the Malinauskas Labor Government’s pre-election promise to “fix the ramping crisis” by investing billions of dollars into healthcare funding.

Ambulance ramping, the time spent by ambulances outside public hospital emergency departments waiting to discharge patients, has soared to record levels under Labor, although the percentage of ambulances responding to callouts on time has consistently improved.

An ambulance leaving the Royal Adelaide Hospital on Thursday. Photo: Thomas Kelsall/InDaily.

Health Minister Chris Picton said the state government would continue to make healthcare a priority.

“There will continue to be further investments made to making sure that our health system has additional capacity to meet these demands,” Picton told reporters today.

“We clearly know that there are hundreds of extra beds that are needed across the system, that’s why we are doing exactly that.

“Would I like all of those beds to be available yesterday? Of course I would. But it does take time to build additional beds.

“We’ve been able to put on additional ambos, additional crews, additional trucks, because it takes less time to do so.

“And it’s had a material impact in terms of South Australians getting an ambulance on time.”

Opposition leader David Speirs said South Australia’s public hospitals were in a “dangerous pattern” of overload.

“Peter Malinauskas promised to ‘fix ramping’, but our hospitals have never been so overloaded and on five consecutive days this week not a single bed was free for sick South Australians in need,” Speirs said.

“To see this chaos in the week before winter is alarming because the cold weather is yet to hit and we know, when it does, even more demand will be placed on our hospitals and frontline healthcare workers.

“This is a dangerous pattern which compromises patient safety, and places huge amounts of pressure on doctors and nurses, so where is Peter Malinauskas’ plan to keep beds free?”

-Additional reporting by Isabella Kelly 

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