Latest data from the Victorian Agency for Health Information on the number of patients staying longer than 24 hours in emergency departments (EDs) paints a concerning picture of hospital and health systems under increasing pressure, says the Australasian College for Emergency Medicine (ACEM).
The shows that during October to December in 2019, 409 patients stayed in EDs for more than 24 hours. This represents a more than doubling of the 170 patients who experienced stays longer than 24 hours in the same quarter in 2018.
The increase is all the more concerning considering the target for patients staying longer than 24 hours in the ED is zero, and Victoria has previously had relatively low rates of 24-hour stays in the national context.
While there was a slight increase in the October to December 2019 quarter in the percentage of patients staying less than four hours in EDs compared to the previous three months, at just over 63%, this still fell well short of the 81% target.
ACEM President Dr John Bonning said the concerning blowout in 24-hour stays reflected issues faced in hospitals across Australia and New Zealand, and major systemic fixes were needed.
“One patient waiting in the emergency department for 24 hours or longer is too many, so to have a blowout of this magnitude is very concerning. It represents an unacceptable risk to patient safety,” said Dr Bonning.
“It reflects a system struggling to meet the demands of some of our most vulnerable sick and injured patients requiring admission to hospital, and particularly those experiencing mental health crisis. It is also well established that overcrowded and access blocked EDs (access block being an inability to admit a patient for over eight hours) increase the risk of harm to patients.
“Experience tells us that patients in mental health crisis are disproportionately represented in terms of dangerously long waits in EDs, which highlights the urgency of the government’s commitment to implement measures such as those identified by the interim report of the Royal Commission into Victoria’s Mental Health System.
“Whole-of-system solutions are needed, including increasing the number of available acute mental health beds, as well as easier and improved access to out of hours mental health services and support. There is a need to build capacity, focussing on the integration of primary and community based mental health care with hospital services.
“Across Australia and New Zealand we are seeing situations where population growth, aging populations, increased chronic disease burden, reduced access to primary care, particularly out of hours, and a lack of access to provision of appropriate acute and mental healthcare, as well as other factors, are placing huge pressure on hospital emergency departments.
“As this pressure continues to build, the reality is that increases in resourcing have not kept up with demand.
“Resourcing is one factor but there are also systemic issues that need to be resolved, such as the need to better manage hospital inpatient flows and beds, and the need for additional and improved primary care in the community. At the moment too many patients and staff are being let down.
“Medical and executive leaders in hospital and health systems must be accountable for ensuring that beds are managed as efficiently as possible. Ultimately the community suffers from insufficient resourcing and inefficient practices, and this is unacceptable.”
Background
ACEM is the peak body for emergency medicine in Australia and New Zealand, responsible for training emergency physicians and advancement of professional standards.
