‘Overloaded and dysfunctional’: doctors reveal crisis in Australian emergency departments

·5 min read
<span>Photograph: Julian Claxton/Alamy</span>
Photograph: Julian Claxton/Alamy

An emergency department patient with a broken neck ended up slumping to the floor while waiting to be seen, and a patient requiring urgent surgery for a fractured pelvis and internal bleeding waited four hours just for an assessment.

These are some of the recent stories emergency department doctors have revealed to Guardian Australia as they describe an overwhelmed public hospital system where patients are being harmed due to delays in care.

On Monday, the Australasian College for Emergency Medicine (ACEM) published a piece in the Medical Journal of Australia saying these “tragic stories accentuate the need for change”, and that emergency department health workers were burning out while waiting for reform.

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“It’s hard to be part of that system and to talk about it when you’re exhausted already from working extra shifts,” the president of the Western Australian branch of the Australian Medical Association, Dr Andrew Miller, said.

“Just this week, in a major public emergency department, there were heart attack patients connected to monitors in hallways. At another hospital, a major maternity hospital, staff had to commission an operating theatre that is no longer used because there was nowhere else to do the surgery, despite there being no proper scrubbing facilities.

“Emergency staff are having to make a judgment about who to spend their time on and if their judgment is wrong, through no fault of their own, and disaster occurs, then that’s a personal trauma for them so it’s very difficult to talk about.”

Miller now works in the private system and said he was able to speak out because of this – and his high-profile position within the AMA. The stories are being told to him by emergency staff in the public health system who cannot speak out due to fear of retribution.

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“It’s also very difficult when you see someone die in front of you or you see someone have a stroke and it’s not treated properly, or you see someone have a heart attack and they’re being connected to a monitor in a hallway,” Miller said. “It’s hard to be part of that system, and talk about it, when you’re exhausted already from working extra shifts and you know there will be repercussions for speaking out.”

The ACEM said there was “clear evidence” that emergency department overcrowding is associated with preventable morbidity and mortality.

Emergency physicians have spoken up about this for many years, but responses have been inadequate,” the MJA piece said. It was co-authored by the ACEM president, president-elect, and immediate past president.

“The system has become increasingly overloaded, fragmented and dysfunctional.”

An emergency physician with 25 years experience told Guardian Australia at his major tertiary hospital staff were constantly seeing “very sick people stuck in waiting rooms”.

“All of these things have happened in the past two or three months. We had a patient who basically collapsed recently with neck fractures in the emergency department.

There should be no penalty for anybody who works in public health for raising the alarm, and the public should be outraged that they are being silenced

“There are things going on all the time in our emergency departments that are unconscionable. Things that make staff feel they’re not able to do their jobs properly, that are unsafe for patients. I’ve been doing the job for 25 years but it’s still soul-destroying, especially to junior staff.

“I recently saw a patient with a fractured pelvis, and major bleeding going on … and it was only at the end of the shift I went to go and see them because I thought it was going to be an easy case and I’d have time. And then I realised it was someone with major trauma who should have ideally been seen within 10 minutes.

“All those systems like the initial assessment break down when you’ve got emergency departments run like this. Almost all state governments have been delusional about the capacity available. And they keep on hoping that somehow, as if by magic, people will be seen faster and stay for shorter periods.

The factors leading to overcrowding and lack of staff are complex, the doctors said, and while exacerbated by Covid-19, the issues existed long before the pandemic. Poor community services and support, a lack of adequately trained and resourced staff in aged care, hospital staff shortages, and funding that focuses on beds without providing staff for them have all contributed.

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Miller said governments would not take the issue seriously until staff could speak freely about what was occurring.

“You’ve got to give power back to the people who actually give the care,” he said.

“There are two ways you can do that. One is, you have to give them freedom of speech. There should be no penalty for anybody who works in public health for raising the alarm and the public should be outraged that they are being silenced.

“They’re not allowed to send an email warning of risk to their board, they have to send it to their next-in-line boss, or they’ll be disciplined for communicating up the chain, let alone telling the public.

“Secondly, they’ve got to have equal power with management, because management are not the ones who are caring for the patient. Management become slaves to the budget and to KPIs.

“It’s not just about funding, because you can hose money onto a fire and that doesn’t put the fire out.”

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