PerthNorg

The Real Healthcare Crisis Part 3B

Within the Western Australian Health sector there are several very dirty and offensive words that all Emergency Department staff are counselled against using in public or in private. I am going to give them all plenty of air now and let my fellow Cit J's decide if I have 'acted imporoperly' in sharing this information here.

Bed Block, this is the term used to describe what is possibly the largest contributing factor to our current crisis within the hospital system and is only going to get worse. The reason for bed Block is one of mathematics, there is only so many beds available for patients on each ward within the hospital system, once this number is reached the rest of the patients who need admitting spend between hours and days (yes, there is a patient over 90 who is on their 4th day) in the Emergency Department waiting for someone else to be well enough for discharge home before they can be moved to the ward.

In a modern Australia with world class healthcare available how does this happen? The simple answer is there is not enough hospital beds, and/or not enough nursing staff for the wards, and/or not enough places in nursing homes. Each side of politics will blame the other, then both state parties will blame the Federal government of the day. To a small degree they are accurate their is not enough hospital beds or nursing staff and there is not enough Gerentology places available in Perth and it's surrounds, but lets look at the bigger picture.

I will use the QEII complex (Sir Charles Gairdener Hospital) as an example but it APPLIES to most of the hospitals of Perth. When I arrived in Perth, Mr Court and the Liberal party were in power. While in Government for reasons that I could not find except possibly financial expedience, at QEII two 35 bed gerontology wards were closed and converted to office space, also two 35 bed respiratory wards were closed and amalgamated into one 28 bed ward. I have been reliably informed that 3 months before I arrived there was infact four 35 bed respitatory wards at this hospital. It was about this time that the demise of the public health system in Perth began. When you consider this occured at the majority of hospitals in Perth and its surrounds the current shortages were inevitable. Then came the Labor victory and Mr Gallop followed by our current premier Mr Carpenter, who have failed to acknowledge and or reverse this trend of closing beds in hospitals, and blaming the Federal Government for our health system woes. The curent administration has implemented some stratergies to increase the number of beds available recently, however the net result is that there are still less beds available now then when they came to power.

This is situation is now complicated by an agreement several years ago with nurses related to 'nurse:patient ratios' which often sees wards with empty beds due to the lack of nursing staff while patients languish in Emergency Departments (ratios don't seem to apply to ED???). I wholly commend nurses for this action as it is about patient safety, and the long term survivabilty of nurses.

So, what happens when there are patients in the ED who have been admittted but can't be found a bed on the ward? This lucky group of patients and it could easily be you, your child, brother, parent, grandparent etc etc.... they get to remain on an ED trolley which is about 50 cm wide, 180cm long on a 2cm thick vinyl mattress (for ease of cleaning). The net effect is that there is now less space in the department for doctors and nurses to assess the new patients who arrive, remember the long wait times mentioned in previous posts, this is where that chain begins. Each of the three big hospitals have enough space to have roughly 30 patients at any one time on a trolley, given that on a perceived 'quiet day' there is atleast 20 patients being assessed at anytime in the 24 hour period. Once Bed Block starts you can see how this will not be enough to cope. This brings us to:

Ramping, you are seriously unwell, so sick you decide against driving to hospital or getting a loved one to take you, you call St Johns Ambulance, and when relief is in sight you have made it to the hospital and the magic doors that only work for an ambulance slide open and ...... you are suddenly placed in a cue with several other patients on ambulance trolleys waiting. On any given day in Perth there are a number of ambulances caught in this predicament. Every couple of months on a slow news day the 'West' will send a photographer to one of the big hospitals and make a story out of what is now a daily occurence. At the time of writing this there are ambulances ramped at 4 emergency departments. As I have previously commented on, people are routinely triaged from an ambulance trolley to the waiting room when possible to free up space within the department and the ambulance crews, however when this is not possible and the crews are ramped there is a flow on effect of decreasing the ability of St Johns to respond to emergencies in the community.

The Emergency Department is full, you have several patients being cared for by ambulance staff on their trolley's being ramped, what next? The dirtiest word of them all:

Bypass, this occurs when there is absolutely no space and NO more ambulances are allowed to arrive at the Emergency Department, it DOES NOT mean the general public are unable to walk through the door to be triaged and eventually seen. Thanks to a wonderful website that can only be accessed by Health Department computers and St John's ( http://edsv/Statistics.aspx?code/ALL  ) I can see that currently no hospitals are on bypass even though 7 departments are more than 20% over their maximum occupancy as recommended by the health department itself, however I can see that 4 hospitals have at some stage been on bypass for a total of almost 7 hours today.

Currently there are over 350 patients either being assessed or are admitted and awaiting a bed in Perths' Emergency Departments. Today over 1100 patients have presented to see a doctor and there is still several hours before the count restarts from zero at midnight.

There is no magic solution to the crisis I have detailed and the issues surrounding Emergency Departments is just one fo the many our Health system today faces. The purpose of my writing these posts is not to embaress one or other of the political parties state or federal, nor is it to annoy anyone within the Health Depaertment. I want to highlight what it is to work in this environment day after day, I want the public to understand that the emergency staff are not just sitting around drinking coffee laughing and carrying on as they do on the popular television dramas while you languish in pain in a waiting room.

As a member of the public there is one thing that you can do that will make our working lives in these departments more bearable, just say "thank you" when we do finally get to you.