A FORMER President of the Australasian College of Emergency Medicine has described the current state of Australia’s emergency medicine sector as “the worst I have seen in my 30 years”.
Dr Simon Judkins, an emergency physician and the Immediate Past President of ACEM, wrote in InSight+, the weekly online news magazine of the Medical Journal of Australia, that emergency medicine in Australia was “in a dire state”.
“The acute parts of the health care system (EDs and ambulance services) are spending part of most days in “Code Yellow” – a perpetual state of crisis escalation,” Dr Judkins wrote.
“Ambulance arrivals are up, and ramping is at record numbers, hitting the headlines across the country.
“Admission times to wards have blown out to record lows (admitted National Emergency Admission Times [NEAT] in many hospitals is below 10%), with the number of patients staying days increasing substantially.
“Some EDs, to my knowledge, have reported having upwards of 40–50 patients waiting for admission at the start of the day, expecting to see another 300 arrivals.
“’Waiting room medicine’ is the norm, with patients waiting 7–8 hours to be seen.”
Before COVID-19 hit, Dr Judkins was already warning that there was “no surge capacity” in the emergency medicine sector.
“In order to prepare for the anticipated COVID-19 surge, elective surgery was cancelled,” he wrote.
“The homeless were housed. We moved to telemedicine. We went into lockdown. We saw a drop in infectious diseases of all sorts. Other presentations – trauma, acute myocardial infarction and stroke – declined.
“But now, emergency medicine in Australia is in a dire state.
“Anecdotally, mental health presentations to EDs have increased, the adolescent and young adult cohort in particular, and the inpatient areas are full.
“Paediatric presentations have rebounded, higher than ever, but accessing GPs is difficult, with many trying to balance multiple competing demands, including the on/off again COVID-19 vaccination program, a lack of funding and resources.
“So EDs are the destination for many concerned parents.
“I can see our ICUs bursting, with critical care patients spending longer in much needed resuscitation spaces, with the next resuscitation happening in a hallway, on an ambulance trolley.”
Dr Judkins described emergency departments as “the canary in the coal mine of system failure”.
“EDs have become the pivot point of system failure,” he wrote.
“Whether it be mental health care, drug and alcohol care, homelessness, underfunded or inefficient outpatient clinics, lack of hospital capacity, all roads will eventually lead to the ED.
“We need to remember the lessons of COVID-19: that our systems of health, welfare and public health are fundamentally linked – a failure in one will inevitably lead to more ED presentations, longer waits and less safe emergency departments, for all of us.
“Currently, our system is failing many who need it to be better.
“The solution is not bigger canaries, but a collaboration from all parts of the system, from GPs, through EDs to inpatient care and beyond, to ensure we all understand the risks patients are facing and work to rebuild a better system for all in a post-COVID-19 world.”
Dr Judkins’ article is free to access at:
https://insightplus.mja.com.au/2021/14/ed-overcrowding-under-resourcing-worst-in-30-years/
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- Cate Swannell