9 Aug 2019
A lack of action on hospital capacity to address significant ambulance ramping and overcrowding at Cairns Hospital continues to place patients and staff at risk, with urgent measures now required to improve the situation, says the Australasian College for Emergency Medicine.
ACEM President Dr Simon Judkins said the issues, now at crisis point, at Cairns Hospital Emergency Department have been repeatedly raised with hospital management and Queensland Health and the response to date has been a case of ‘too little, too late’.
“The situation in Cairns is at a critical point where patient and staff safety is seriously compromised, and serious action is now required,” said Dr Judkins.
“We visited Cairns late last year and it was acknowledged then that the hospital was struggling to manage the demand. Not enough has been done since, and that is a cause for alarm, given the dangers.
“One of the concerns is the way that Code Yellow, which the hospital ED was in for much of last week, has become a normalised way for the hospital to operate. That actually means that it’s a disaster situation because Code Yellow means it cannot meet public demand for health services. People don’t appreciate the risks for patients and staff in a hospital with a Code Yellow.
“When a hospital is running at full demand, all that pressure is focused on the front door and we see the dire situation with ambulances ramping up in front. It puts staff under enormous pressure. Of equal concern is that it means ambulances are unable to respond to people in the community who need help.
“The ongoing capacity issues represent an increased threat to patient safety, including a heightened risk of medical errors, delays to treatment, and tying up ambulance resources. This all could have been avoided by long term planning and investment.
“While the hospital’s management may point to a spike in presentations during winter, the reality is demand in the Cairns Emergency Department has been steadily increasing over many years. Winter happens every year, and these emergency presentations are neither unprecedented nor unexpected.
“While the response to date appears to have comprised small investments in beds and staff, it strikes us as a case of too little, too late.
“It’s certainly not enough for a long term solution, and the priority must now be on alleviating the burden on the Emergency Department to a level that is actually manageable.
“It’s not just a matter of investing in infrastructure, beds and staff, but about how the whole hospital is run. The whole-of-hospital response needs to look at how the inpatient units operate and how they manage flow through the wards to help free up Emergency Department capacity.
“We must ensure that the sick and unstable patients who turn up on a daily basis get the treatment they need, and that pressure on staff is relieved. I would expect significant improvements to be in train when ACEM and Australian Medical Association (AMA) Queensland representatives return to Cairns later this month.”
AMA Queensland President Dr Dilip Dhupelia said public hospitals were first port of call for the sickest of patients and it was crucial that public hospitals had the beds, staffing and resources to provide timely treatment to all who need it.
Dr Dhupelia said AMA Queensland and ACEM had recommended numerous ways to help improve patient access and help manage doctors’ workloads at Cairns Hospital and now call upon the executive and Queensland Health to ensure the following:
- Open 10 beds in Cairns Hospital that are staffed and equipped to manage acute admissions, not just low acuity patients. These must be distinct from the beds being purchased at Cairns Private Hospital.
- Intervention from the Director General to support the hospital’s executive in complying with and implementing current hospital systems - particularly around managing Code Yellow, enforcing discharge arrangements and inter-hospital transfer policy.
- Commitment to system/culture change within the hospital to make it safer into the future.
- Commitment to resourcing these initiatives in the short, medium and long term.
“Cairns Hospital and Health Services and the State Government need to immediately implement solutions to ensure patients are treated and admitted in a timely manner,” Dr Dhupelia said.
“Any problems with hospital access that could affect patient safety must be addressed immediately.”
ACEM is the peak body for emergency medicine in Australia and New Zealand, responsible for training emergency physicians and advancement of professional standards. www.acem.org.au
AMA Queensland is the peak body representing all Queensland doctors and medical students. AMA Queensland exists to promote and protect the professional interests of doctors and the health care needs of patients and communities.
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Published: 9 Aug 2019