Emergency In Emergency, Australia

Main Category: Primary Care / General Practice
Also Included In: Medical Students / Training
Article Date: 23 Sep 2007 - 17:00 PDT

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Media reports of a crisis in NSW public hospital emergency departments are indicative of a bigger nation-wide problem, according to the AMA.

Emergency Physician representative on the AMA Federal Council, Dr David Mountain, said that until recently all Australian governments have ignored the medical workforce, particularly medical training.

Dr Mountain said everybody has suddenly realised there is a shortage of doctors and decided to increase student numbers, but you cannot train a new medical workforce overnight.

"The problems we are seeing in emergency departments in NSW are occurring in other branches of medicine and in all States and Territories," Dr Mountain said.

"The shortage of staff leads to extreme working conditions in emergency departments, which discourages young doctors from going into emergency physician training.

"The overall bed occupancy rate in public hospitals is contributing to the problems.

"To ensure that patients presenting to emergency departments can be given a bed within a reasonable time of needing one, hospitals should run at 85 per cent bed occupancy. To do this, we need more beds.

"More beds will enable patients to flow through emergency departments in a more timely manner.

"But the reality is that many of our big teaching hospitals are running at between 95 per cent and 100 per cent occupancy, and some are even running at more than 100 per cent.

"Patients get stuck in emergency departments and in corridors and have to be managed by emergency staff in sub optimal conditions when they should be in a bed on a ward.

"It is demoralising for emergency physicians to come back for their next shift to find a patient still on a trolley," Dr Mountain said.

Nationally, only 65 per cent of category 3 (urgent) emergency cases are seen within 30 minutes.

There has been a 36 per cent increase between 2004 and 2007 in the number of patients affected by access block and overcrowding. This category is defined as a patient in need of admission but who cannot be admitted for eight hours or more.

In NSW, emergency departments at all levels have been over-stressed and under-resourced for a long time.

Emergency department staff feel that the NSW Department of Health has ignored the problem and done nothing to support senior emergency staff or provide training opportunities for junior staff. As a result, neither senior nor junior emergency physicians are being attracted to work in the public system, causing serious workforce problems, especially in outer metropolitan and country areas.

AMA Federal Councillor and doctor-in-training in emergency medicine, Dr Alex Markwell, said all governments should learn from the NSW crisis and should support the training programs and put in place incentives to keep senior emergency physicians in the public system.

"There needs to be greater flexibility in rostering arrangements with a better balance of teaching and non-clinical time for senior staff," Dr Markwell said.

"We need a greater investment in training the next generation of emergency physicians so that patients aren't left waiting on trolleys for the quality care they need.

"Governments must also be discouraged from pursuing plans to use less-qualified doctors or nurse practitioners to staff emergency departments rather than addressing the real problem, which is a lack of trained emergency specialists," Dr Markwell said.

http://www.ama.com.au