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Patients face potentially lethal delays as hospitals struggle

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Emergency physicians have warned the public hospital system is at “breaking point”, with thousands of patients being forced to wait hours for a hospital bed, clogging emergency departments and preventing ambulances from unloading.

A survey by the Australasian College of Emergency Medicine of all the nation’s 121 accredited emergency departments has found that 70 per cent of emergency department patients are being delayed more than eight hours as they wait for beds in other parts of the hospital to become available, adding to evidence of enormous strain in the system.

The survey’s author, Associate Professor Drew Richardson, said the result highlighted the extent of the “access block” problem, when a dearth of free beds in the main body of a hospital prevents patients moving out of emergency. The knock-on effect is to clog the emergency department, which in turn means ambulances cannot unload patients.

“These figures…show that too many patients are waiting too long to receive the proper care,” A/Professor Richardson said. “They reflect a hospital system that is critically overburdened and that is putting patients into the firing line.”

More than half the hospitals in the survey reported that at least one patient had to wait for more than 12 hours for a bed, an outcome A/Professor Richardson said was “completely unacceptable”, and should be ringing alarm bells for health authorities across the country.

Evidence indicates that the longer patients are forced to wait in emergency, the worse their health outcome is likely to be. A Canberra Hospital study found that older patients forced to wait more than four hours for a ward bed were 51 per cent more likely to die than those who suffered shorter delays.

The survey’s results underline AMA warnings of an impending crisis in the public hospital system as a result of the Federal Government’s decision to rip $57 billion from its funding over the next 10 years.

The Federal Government has walked away from the National Health Reform Agreement with the states, cut incentive payments, dump activity-based funding and reduce indexation of its public hospital funding to inflation plus population growth.

AMA President Professor Brian Owler has warned the cuts will have a profound effect on the hospital system, warning that “public hospitals and their staff will be placed under enormous stress and pressure, and patients will be forced to wait longer for their treatment and care”.

“Rather than funding the necessary hospital capacity, the Commonwealth has withdrawn from its commitment to sustainable public hospital funding and its responsibility to meet an equal share of growth in public hospital costs,” Professor Owler said earlier this year. “Funding is clearly inadequate to achieve the capacity needed to meet the demands being placed on public hospitals.”

The AMA’s annual Public Hospital Report Card, released in April, showed that although there had been marginal improvement in public hospital performance against Government benchmarks, no State or Territory met the target to see 80 per cent of emergency department Category 3 urgent patients within clinically recommended triage times.

Professor Owler said access block was a particularly concerning issue.

He said that emergency departments were able to meet performance targets for patients who did not require admission to hospital.

“But when they have to be admitted, that is where performance suffers. That is an issue of the capacity of our public hospital system,” he said.

Professor Owler warned the system would be hit by “a perfect storm” when lower indexation funding arrangements kick in in 2017-18.

“This will lock in a totally inadequate base from which to index future funding for public hospitals,” he said. “State and Territory governments, many of which are already under enormous economic pressures, will be left with much greater responsibility for funding public hospital services. Performance against benchmarks will worsen and patients will suffer. Waiting lists will blow out.”

Adrian Rollins