Seriously ill people are being put at grave risk in overcrowded emergency departments where paramedics are still regularly stuck in long queues, doctors say.
Nearly two years after the Labor party vowed to fix Victoria’s ambulance service, leaked data indicates there has been no improvement in ambulance “ramping” and that this month hundreds of patients waited longer than an hour to get into an emergency department while under the care of paramedics.
The queues are tying up paramedics when they should be free to respond to urgent cases. Doctors say the problem persists because hospitals are too full.
The leaked Ambulance Victoria data shows that during the first two weeks of September, there were 10 days when one in 10 patients arriving at Melbourne hospitals via ambulance were stuck in a queue for more than an hour because emergency department staff did not have enough resources to accept them.
The data also shows that depending on the day, between 69 and 85 per cent of patients were handed over to hospital staff by paramedics within 40 minutes. The government’s target is 90 per cent. During September last year, the overall result for the month was 82 per cent.
Despite Premier Daniel Andrews’ vow to improve ambulance response times, the proportion of urgent “code one” callers receiving an ambulance within 15 minutes has risen only marginally, from 74 per cent to 75 per cent, in the past two financial years.
A spokesman for the Victorian Emergency Physicians Association Dimitri Giannios said ever since the federal government last year cut its bonus funding for hospitals to admit 90 per cent of emergency patients within four hours, emergency departments had been getting increasingly swamped.
He said units were so busy that junior doctors were performing resuscitation on patients without the presence of senior clinicians – something that previously did not happen. Dr Giannios said crowds of people waiting for care can trigger agitation and violence, causing risks for patients and hospital workers.
“There are times when things get so chaotic and crazy, you wonder if you’ll get out alive,” said the doctor, who called for the government to fund more hospital beds and resources.
Last October, the state government told hospitals they could no longer go on ambulance bypass, whereby hospitals send out alerts telling paramedics to take non-emergency patients elsewhere when staff think they are dangerously full. The government scrapped the system, saying it contributed to ramping, took ambulances outside of their areas, and created ‘ripple effects’ where hospital emergency departments go on bypass, one after the other.
A year on, spokesman for the Australasian College for Emergency Medicine Simon Judkins said nothing much had changed.
The emergency physician said hospitals were still employing a “pseudo bypass” when they did not have enough beds, and that overcrowded departments continued to put people at risk of serious injury and death because staff were responsible for too many people.
“I think the feeling is that we’ve lost some direction… we need to create capacity,” he said.
“It’s dangerous for patients and it’s incredibly stressful for people working in that environment”.
Research conducted at Canberra Hospital last year found that older patients who waited in emergency departments for more than four hours to be transferred to a bed in a ward were more likely to die than patients who waited less than four hours.
Dr Judkins said hospitals needed to look at new ways to create space for more patients to move through the emergency department to wards for treatment. He suggested hospitals look at running more services on weekends, and appointing more full-time medical staff, rather than those who work part-time in private practice.
A spokesperson for the Minister for Health and Ambulance Services Jill Hennessy insisted ambulance response times and transfer times at hospitals were improving, but warned “there is still more work to do”.
The spokesperson said the state government had spent a record $16.47 billion on health this year, and that its $10 million Better Care Victoria fund was investing in innovative programs to improve Victorian hospitals.
“September is traditionally a busy month and we work closely with hospitals to do what we can to improve the management of patient arrivals in hospital emergency departments,” she said. “This includes distributing patients across hospitals to avoid multiple ambulances arriving at hospitals in a short period of time wherever practicable.”
A spokesperson for Ambulance Victoria said September was traditionally a busy month and that it was working to improve transfer times with hospitals.
“We were, and continue to be, supportive of the removal of ambulance bypass and it has had a positive impact on overall transfer times since its introduction last year,” he said.
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