28 Aug 2019
The Australasian College for Emergency Medicine (ACEM) and Australian Medical Association (AMA) Queensland are calling for a greater focus on resourcing and implementing measures to address the capacity, ambulance ramping and overcrowding crisis at Cairns Hospital.
Following crisis talks today, management has committed by Monday, to providing clear short, medium and long term plans and timeframes in response to issues repeatedly raised by staff, including operational and infrastructure issues.
Management has also committed to lay out their plans to staff and work on the longer-term issues to improve culture within the hospital.
ACEM President Dr Simon Judkins said the discussions were welcome, but measures to address the crisis were needed immediately, with a greater focus on implementation and resourcing rather than planning.
“The view from doctors on the ground is that the hospital is broken and that real change is required now. “The hospital executive and hospital clinical leaders need to be accountable for implementing that change,” said Dr Judkins.
“For too long we have been raising concerns that staff and patient safety has been compromised as a result of failures to manage demand.
“We must see an easing of pressures that have meant Code Yellow – which the health service is placed under during disaster situations when it struggles to meet public demand – has become a normalised way for the hospital to operate.
“This is about ensuring the increasing number of patients who present to the Cairns Emergency Department each and every day receive the care and treatment they urgently require; that pressure is relieved on staff so they can continue delivering the critical care which the far north Queensland community relies on; and that ambulances and paramedics are freed up to continue responding to members of the community in need.
“We’ve offered solutions. We need a whole-of hospital response that addresses how the inpatient units operate and how they manage flow through the wards to help free up ED capacity, and that the accountability of Hospital Management is strengthened.
“While we’ll see what management is proposing on Monday, we will be escalating our concerns to the Queensland Health Minister if the response once again proves to be a case of ‘too little, too late’.”
AMA Queensland President Dr Dilip Dhupelia welcomed the commitments to work on system/culture change within the hospital but warned the hospital desperately needed short-term fixes to deliver extra hospital beds and cut waiting times.
Implementing culture change to improve patient safety into the future is critical,” said Dr Dhupelia.
“However, culture change takes time and patients need health care today.
“The priority must be on immediately alleviating the burden on the Hospital’s Emergency Department to a level that is actually manageable,” he said.
To address the crisis at Cairns Hospital ACEM and AMA Queensland have urged management to immediately adopt the following actions to provide some short term relief:
- 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.
- Enforcement of the existing inter-hospital transfer policy to enable stable patients who are being transferred from another hospital to be assigned directly to the appropriate ward, without going through the Emergency Department.
To address the underlying systemic issues, ACEM and AMA Queensland have also urged Cairns Hospital to adopt the following actions:
- Strengthen accountability of the hospital executive and the medical leadership for effective management of inpatient capacity through the current ‘Access to Care’ project. This should include mandatory reporting of 12 and 24 hour ED waits to the CEO and the Queensland Health Minister respectively.
- Ensure that the hospital has capacity to admit patients from the ED as part of a proactive plan for each forward 72 hour period.
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Published: 28 Aug 2019