PerthNorg

The Real Healthcare Crisis Part 3A

There is a major crisis looming in Western Australia and it is going to be bigger and have further reaching impacts than anyone on either side of the political divide are currently willing to acknowledge publicly.

Anyone who has ever visited an Emergency Department either as a patient or as a carer/friend/relative will know that on arrival you are directed to the 'Triage Nurse'. This highly skilled and experienced nurse gets to spend approx 5 min talking to you and then based on how you have answered their questions, empirical data such as heart rate etc and a big chunk of intuition you will be given a 'Triage Score'. How quickly you progress through to be seen by a Doctor is largely dependant on this number that appears next to your name.

Australia, like most countries across the globe uses a 1 - 5 'Triage score'. 1 being most urgent and 5 the least. To score a 1 you will need to have no heart beat, and or not breathing, and or have multiple injuries that in essence mean that unless an entire team of staff immediately begin working on you, you will die. These are the patients that commonly appear on shows like ER.

A score of 2 is when you are actually having a heart attack as you arrive in the department, or you have just been cut from the wreck that was once your car, or perhaps you are having an anaphylactic reaction to that Chinese meal that was not supposed to have any MSG in it. This score equates to you being likely to die or lose the permanent use of a limb or eyesight if your not treated within 10 minutes of arriving.

A score of 3 is for those in severe and intractable pain, either from falling down several flights of stairs, or maybe your car is still 'sort of recognisable' but your legs are not. Maybe you are unable to move because of an acute appendicitis, or your having trouble breathing because your asthma is playing up. If you scored a 3 you will possibly lose your life, eyesight or limb if not attended to by a doctor within 30 minutes of arrival.

A score of 4 is for those sporting injuries, you know the ones, your playing your favourite sport (watching the footy) and as you reach for that next beer you fall and twist your knee or injure your shoulder, maybe you have had a pain in your abdomen for the past few days and finally decide to see the GP, she sent you for and x-ray and then onto hospital because you have a bowel obstruction, or perhaps a big night out ended in you getting into a fight and now you need some stitches to patch up your face. A score of 4 entitles you to hopefully be seen by a Dr within 60 minutes of arriving.

A score of 5 is for EVERYTHING else, coughs, colds, flu's, sprains, strains, pain you have had for a week and not been to your GP about etc etc etc. As a rule a score of 5 entitles you to a minimum of 2 hours waiting, occasionally you will be seen sooner than that, but more often you will have to wait 4 - 6 before a Doctor can see you.

Why have I detailed this system here for you?

My logic is two-fold really, firstly so you can understand why the staff in the Department sometimes lack sympathy for your aches and pains that you have done nothing about for a week or more until the wee hours of the morning, and they are nearing the end of a 10 - 15 hour night shift. Or why when you start swearing and abusing the staff about having to wait for an hour to have your foot x-rayed and to see the doctor, the foot you hurt on the local dance floor while drunk, security will appear and gently escort you out the door. It is well known that an Emergency Nurse or Doctor, is verbally abused almost every day they attend work, and that there is either the threat of physical violence or an actual assault every week in one of Perth's metropolitan departments.

Secondly, is too highlight the looming crisis I mentioned earlier. For the past few months the average waiting time for a patient with a score of 3 has been between 100 and 110 minutes, more than double what is internationally recognised as acceptable. It is only because the nursing staff are willing to care for patients in corridors and on chairs, regularly assessing them and keeping the most senior medical staff on duty abreast of any sudden changes in these patients condition and the sheer force of will, or good luck that none of these people have died.

I can assure you that those of us in the Departments are doing everything we can to prevent this from happening. Unfortunately, however I personally can only see this issue getting worse especially given that the Fiona Stanley and new Swan Districts Hospitals are still some 5 to 8 years away. I will elaborate on why in my opinion this is going to get alot worse in my next post.