PerthNorg

The Real Healthcare Crisis Part 1

OF late there is a story every other day about the health care system in Western Australia in mainstream media. Everyone has seen the same pool photographs of ambulances queuing outside one of the three big emergency departments, or read the figures on wait lists for elective surgery. Both of these issues are credible and need urgent attention, however, there is a big white elephant in the room that NO ONE outside the industry is talking about, and NO ONE inside the industry is willing to acknowledge. That is the disarray and dangerous practices that occur on a daily basis in our private hospitals.

That is all about to change. All of the stories over the coming weeks will highlight various issues within the health care system as it stands in WA. All of the stories will be based in fact from personal interactions with Nursing and Medical staff in both public and private institutions here in Perth.

When things go wrong with your surgery where would you rather be public or private? If you thought you would be better off in a major private hospital, think again. The following case study will highlight this issue.

Mrs Smith (not her real name) is 69 years of age and requires a Total Knee Reconstruction, in the public system, on a waiting list this could take many months so she opts to go to one of the many well known private hospitals in Perth, (they are all run pretty much the same way). Post operatively at about 11pm on Friday night she suddenly has difficulty breathing and the nurse responsible for Mrs Smith activates the MET (Medical Emergency Team), as any responsible nurse would in either the public or private sector. The people who respond are a Level 1 or 2 Nurse with a critical care background (either Coronary Care or Intensive Care) and a resident medical officer (quite often with less than 3 years experience post graduation) and the level 3 Hospital nurse manager who could have a critical care background but often does not.

It is decided the patient requires urgent imaging and blood tests to ascertain the cause of her sudden deterioration. Most private facilities need to send their bloods for testing offsite after business hours in a "taxi" (and we all know how easy it is to get one of those on a Friday night), a radiographer needs to attend from home to take the x-ray. Average time for blood results is 2 - 3 hours, and for images is 1 - 2 hours.

After this information is at hand there is a need for a Computerized Topography Pulmonary Angiogram (CTPA), a regular test to exclude or confirm a blood clot in the lungs or Pulmonary Embolisim (PE, commonly known as cabin class syndrome after the media latched onto this problem in long haul passengers), another radiographer and a radiologist now need to be called into warm up the machine and do the procedure and review the scan. Approximately 2 hours after this call a diagnosis is available.

The patient is found to have a PE and treatment is commenced at 3am to correct this and the patient is placed in Coronary Care for close monitoring. The patient survives this time. From initial emergency call activating the MET team till treatment is approximately 5 hours which is very rapid for the average private hospital in Australia.

Lets say Mrs Smith is uninsured and waits to have her operation at one of the big public hospitals here in Perth. She has the same complication and the response is this:

Ward nurse again activates the MET team, however it now consists of a level 3 Clinical Nurse Specialist who has a minimum of 5 years critical care experience, a senior training Registrar (ie a doctor with more than 3 -5 years post graduate experience training to be a specialist),and a level 3 Nurse manager of varying experience. The team follows the same steps here as in the private hospital with some clear differences.

The blood tests are processed on site as a priority giving results in 30 - 45 minutes, radiographers are onsite at 24 hours a day and therefore x-ray images are ready in about 15 minutes, CT technicians are available and the CTPA is completed while the radiologist is en route from home to review the scan. The patient is moved to the Respiratory High Dependency Unit, and once it is determined that there is a PE treatment is commenced at about 12.30am, average time from the emergency at 11pm on Friday night till treatment would be 1 - 1.5 hours.

Same patient, same problem;

Private, less experienced medical staff onsite (with senior medical staff at home, if they can be reached) and about 5 hours till correct treatment post diagnosis. Public, More experienced staff onsite and only 1 -1.5 hours till correct treatment post diagnosis

truthwillout