Issue 5 / 2 August 2010

Last week, the Prime Minister announced pre-election funding for new medical and nursing positions to train young doctors and nurses in Emergency Medicine.

Although not strictly “new money” (these funds were allocated in the May federal budget), as AMA President Andrew Pesce said, it is a welcome measure but it must be accompanied by a suite of hospital-wide solutions to the problem of overcrowded emergency departments (EDs).

As I explained in a previous blog, ED overcrowding is not about patients with simple problems who could go to their GPs – these cases are relatively easily and cheaply managed.

There are three key issues that need to be addressed to improve patient flow and cut overcrowding, all of which need to be managed concurrently to free up our EDs for swift management of new patients. These include access block, adequate trained staff and policy back-up.

We know from local research that long delays in bed placement affect patient morbidity and mortality, quite apart from blocking access for new patients and making ED an intolerable workplace for staff.

While we also know that the main solution is the provision of adequate numbers of acute beds, this is not enough. We need an adequate supply of trained ED staff to safely assess and treat the arriving patients and discharge or admit them to the appropriate team.

In this era of sub-specialisation, inpatient units prefer patients who fit nicely into their chosen sub-specialty. Registrars do their best to “deflect” the complex patients with comorbidities from their teams.

Unfortunately, this model conflicts with the increasing number of complex elderly patients who need inpatient treatment. In this situation, it is the ED doctor who acts as patient advocate, having to negotiate care for them.

This brings me to the second and third main arms of patient flow strategy – the importance of having adequate numbers of trained ED staff, and giving them the policy back-up to do their jobs effectively.

Many readers might not have been working in hospitals while the specialty of emergency medicine was developing. In the past, junior doctors did initial “clerking”, and inpatient registrars made decisions about admission or discharge.

This approach is no longer effective in today’s acute hospitals.

For EDs to function adequately, both nursing and medical staff have to be purpose-trained; there must be an effective ratio of senior to junior medical staff; and there must be enough staff with the wisdom and confidence to advocate effectively for patients.

Many readers will remember their ED time as a great learning experience. There is no doubt that it still is, but the patients and regulators of today also expect a safe and effective service.

Without an important boost in resources, appropriate policies and an adequate bed base, our current EDs might just choke. Let’s hope the resuscitation team is ready to deliver before the pulse fades.

Dr Sue Ieraci is a specialist Emergency Physician with 25 years’ experience in the public hospital system. Her particular interests include policy development and health system design, and she has held roles in medical regulation and management. In addition to her emergency department work, Sue runs the health system consultancy SI-napse.

One thought on “Sue Ieraci: Will Gillard’s cash injection resuscitate our emergency departments soon enough?

  1. Peter Arnold says:

    Great stuff, Sue! But where are they going to find enough young people to learn nursing? Not to mention the university courses which remove all those willing hands from the ward for years – while these young women in nurse training approximate child-bearing age.

    The introduction of university training for nurses might have satisfied some intellectual aspirations, but its effects on nurse numbers has been devastating. We depend now so largely on foreign-trained (or untrained) young women, often with poor English.

    So by whom will the patients in any proposed additional beds be nursed? I encourage any friends going into hospital nowadays to have a relative with them at all times – to minimise ‘adverse outcomes’.

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