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Patients are still dying unnecessarily

Patients still dying unnecessarily, so access block under the microscope yet again at emergency medicine conference

While politicians and health bureaucrats continue to pay lip service to finding solutions to access block and overcrowding, very little has been achieved, the annual scientific meeting of the Australasian College for Emergency Medicine (ACEM) will be told.

The conference will be held at the National Convention Centre in Canberra November 22-25.

Even though politicians and health departments have been shown the facts and even though patients are still dying while waiting for beds, there has been no significant improvement in access block in Australia or New Zealand.

Access block is defined by ACEM as “the situation where patients are unable to gain access to appropriate hospital beds within a reasonable amount of time, no greater than eight hours”.

Emergency department (ED) overcrowding is defined as “the situation where ED function is impeded by the number of patients waiting to be seen, undergoing assessment and treatment, or waiting for departure, exceeding the physical or staffing capacity of the department”.

In a conference session at 1.30-3.00 pm on Monday November 22, Associate Professor Drew Richardson, chair of road trauma and emergency at Australian National University Medical School will present the latest Australian access block and overcrowding data, while Dr Peter Jones, director of emergency research at Auckland City Hospital, will present the first-ever New Zealand data.

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According to Professor Richardson, "Caring for patients whose emergency treatment has finished but for whom no inpatient bed is available continues to make up about 30% of all ED workload nationwide.”

A study in May this year found that, of 77 Australian accredited EDs surveyed, 73% were experiencing access block.

"Three-quarters of the patients waiting for inpatient beds were experiencing access block, that is, they had been in ED more than 8 hours."

"The situation was worst in urban district hospitals and best in paediatric hospitals.

“In tertiary hospitals, Queensland had most overcrowding and least access block, with 4.0 access block patients out of 57.3 under treatment and 16 waiting to be seen,” Professor Richardson said.

“Western Australia performed worst, with 13.3 access block patients out of 39.0 but with only 6.7 waiting.

“Nationwide, 62 patients had been in the ED more than 24 hours, the longest over 60 hours since an inpatient bed had been requested.”

"Unfortunately the level of access block nationwide increased between May and September, even in hospitals that had introduced a "4-hour rule"

At the conference, Professor Richardson will release for the first time new data from a study in September.

Access block continues to be a problem in tertiary hospitals in New Zealand, and contributes significantly to the ability of these hospitals to meet the “Shorter Stays in ED” target, Dr Jones will tell the conference.

“Data collected in May and August of all 27 hospitals in New Zealand was the same as in previous surveys conducted in Australia.

“The study found that access block was seen more in tertiary than secondary hospitals (64% compared with 23%), and that no hospitals with access block were able to meet the Shorter Stays in ED target of 95% discharged or admitted within six hours.”

Dr Jones says the next step is to research the effects of the introduction of the target on outcomes other than the target itself and to look at what different hospitals have done to introduce the target. Such research has just begun in New Zealand, with Dr Jones co-leading the project.


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