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Dangerous ED crowding cannot be blamed on 'GP-type' patients alone - ACEM

Fuseworks Media
Fuseworks Media

The Australasian College for Emergency Medicine (ACEM; the College) has concerns about media reports today suggesting patients unable to access GP appointments are the major cause of dangerous crowding and capacity issues facing New Zealand emergency departments (EDs).

The College is a strong supporter of more funding and better access to primary care as part of a well-balanced health system that helps people better manage their health. The healthcare system must provide the care that is needed, when and where it is needed, and access to GPs is a very important part of this mix.

However, ACEM President Dr John Bonning said to attribute crowding and access block within EDs to ‘GP-type’ patients alone fails to acknowledge and address the true causes of these major and urgent issues.

"While GP-type patients may contribute somewhat to crowding in ED waiting rooms, generally these patients tend to present with minor ailments, which are relatively quick to resolve, and do not require admission to hospital. Overwhelmingly, the major issue contributing to emergency department crowding is an inability to admit acutely unwell or injured patients to hospital wards when their initial care in the ED is complete," said Dr Bonning.

"This leads to access block, whereby a patient spends longer than eight hours in the ED from their time of arrival to being admitted to a ward, transferred to another hospital or discharged. Access block adversely impacts all aspects of the acute healthcare system. It is often linked to increased patient harm, prevents others from receiving the care they need and contributes to longer hospital lengths of stays and even to worse patient mortality.

"It affects all parts of the healthcare system, not just patients stuck on beds in the ED. It has also been shown to adversely affect care and even worsen mortality in new patients arriving at an access blocked (overcrowded) ED, as well as elective patients not even in the ED. Whilst primarily it is patients who are affected, access block also negatively impacts on the overall wellbeing of ED staff. All of this adds unnecessary burden and costs to the healthcare system, resources that can be utilised elsewhere."

In 2009, Shorter Stays in Emergency Department (SSED) targets were introduced, requiring 95% of patients to be admitted, transferred or discharged from the ED within six hours.

By 2015, most EDs came close to achieving the SSED targets, but recent performances show that these have deteriorated back to levels last seen in 2009 before the introduction of the targets.

"While access measures such as SSED targets are designed to improve access block in EDs, it must be made abundantly clear that they require a whole of health system approach, with District Health Boards - not just EDs - all held to account,’ said Dr Bonning.

"This is far more complex than simply attributing crowding to GP-type patients. This is about serious system and capacity shortcomings leading to these issues, which is why systemic solutions are required. Finding these requires buy-in and commitment at every level of our healthcare system."

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