Around 25,000 people visit hospital emergency departments across Australia each day. Many of them report waiting hours for an appointment. Some hand over and leave, only for his or her condition to worsen.
‘Ambulance arrival’ – queuing ambulances outside hospitals at hand over patients – has change into increasingly common and means some people wait an extended time before they even get there.
With 8.8 million reported to emergency departments every year, one in three people wait longer than 4 hours to be treated and admitted to a ward for further care or discharge.
Our fragile public health system and its staff require urgent attention before emergency departments can recuperate.
This isn’t a brand new problem
The demand for urgent hospital care is increasing across Australia, placing long-term pressure on acute care services provided by emergency departments. But demand has been rising for a long time, not months.
According to Australian Institute of Health and Welfarethe number of individuals presenting to public emergency departments increased by a mean of three.2% per 12 months between 2014 and 2019, mainly attributable to an aging population that experiences more complex health problems.
Perhaps surprisingly – despite ups and downs in some cities over shorter periods – the general demand for emergency departments reduced throughout the height of the pandemic when people selected to remain at home or were in lockdown. Volumes have only recently returned to normal levels.
Two key issues make it difficult for people to get assist in an emergency.
First, the general public healthcare system is already underutilized, so even a small increase in demand causes congestion.
Secondly, with increasing numbers of staff unable to work attributable to illness, including Covid infection, burnout and now flu, there may be a shortage of staff to look after patients.
No slack within the system
Emergency departments are within the business of preparing for the unexpected, whether it is a surge in COVID infections, mass injuries from natural disasters, large-scale accidents, or a terrorist attack.
The surge intensifies when the event also impacts health care staff or facilities, taking away care capability as demand increases. We are currently experiencing an early surge in influenza cases with rates much like those typically seen late in life. June.
Systems deal with unexpected events by allowing “slack” or maintaining excess capability during normal times. Unfortunately, our healthcare systems have been over capacityd. Successive governments have made cuts within the name of efficiency without fully appreciating the results on the provision of health care in times of need.
Working harder comes at a price
During the Covid-19 epidemic, ambulance and hospital staff worked faster and longer to supply additional capability. In the long term, this ends in burnout.
Because burnout is harder to identify than ambulances within the driveway, it’s less more likely to appear on the evening news – but it surely is a more critical and sophisticated issue.
Around 20,000 Australian nurses left the career in 2021, many cite him stress and harassment he suffered at work.
About 8% of paramedics suffer from post-traumatic stress disorder, twice the common amongst Australian employees. Nearly a 3rd were diagnosed with depression.
Just add beds?
Adding “more beds” looks like a practical solution, but hospital beds rely upon staff (especially nurses) to look after the patients in them.
Solving the issue of staff shortages in hospitals is tougher. The training of additional nurses takes an extended time and we cannot rely solely on importing them from abroad. New Zealand is already frightened that we’ll take away a lot of its nurses elderly care sector and other countries compete for qualified hospital staff.
In an try to ease the pressure, governments need to divert individuals with less serious illnesses or injuries from emergency departments to urgent care centers or 24-hour primary care physicians. This may improve access to look after some patients, but may not significantly reduce the necessity for emergency care. New South Wales data shows that surprisingly few people attended emergencies, regardless that they might have gone to their GP.
Improved flow
The long-term solution to emergency department blockages is to extend capability.
Imagine the hospital as a tub and the patients as water flowing into the tub. Increasing the dimensions of the tub is a brief solution. If you possibly can’t turn off the faucet, it should replenish quickly. We must work on the drainage system – increase the dimensions of the drain and unblock clogged pipes.
Hospitals have an obligation to make every effort to discharge patients to a secure environment. To speed up discharges from hospital, we’d like more opportunities to supply accommodation for individuals with disabilities, individuals with mental health conditions who need support, older individuals who can not live alone without help, and people who find themselves homeless.
Getty/Lisa Maree Williams
Working with patients
Processes often follow a “one size fits all” model, but patients vary of their preferences and wishes. Some groups have more complex needs, which suggests they could spend longer within the emergency department.
We know, for instance, that emergency departments perform worse for older individuals with multiple health conditions, individuals with disabilities or mental illness, people who find themselves Aboriginal and/or Torres Strait Islander, or from a culturally and linguistically diverse background.
We are about to set off for approx design with three major hospitals in Sydney. We will work with patients, doctors and community groups to collaboratively develop improvements to emergency care and reduce wait times. Examples include strengthening links between GPs and the emergency department and the greater use of technology to streamline care pathways and make it easier for patients to navigate your entire journey.
For now, everyone can assist ease the stress in emergency departments by taking higher care of their health, addressing concerns early with their GP and benefiting from vaccination programs resembling Covid and flu.
