Victorian Emergency Departments at Breaking Point

Symptomatic of an Australian healthcare system pushed to breaking point, emergency departments in Victoria are buckling, clogged and understaffed. Ambulances wait in queues, ‘ramped’ for hours, staffing shortages abound, and patients are stranded. Medical leaders say the causes behind the crisis are foundational, only exacerbated by the pandemic.

Recent data from Victorian Health Services Performance showed that in the period January-March this year, a third of code 1 ambulance patients waited more than the target time for treatment. Code 1 indicates urgent ‘lights and sirens’ emergencies.

Ambulance Victoria’s Acting CEO Libby Murphy called the quarter the “busiest in Ambulance Victoria’s history,” with a surge of 93,234 code 1 incidents. EDs treated close to 2,000 more patients than in the previous quarter, while numbers of furloughed paramedics and nurses also soared. At the peak of COVID-related hospitalisations under Omicron, when 1,200 COVID patients were admitted each day, 5,000 hospital workers and 500 paramedics were furloughed daily.

The strain on EDs and ambulances has led to multiple preventable deaths across Victoria. Since last October, as many as 12 Victorians have died waiting for an ambulance. One such was 14-year-old Alisha Hussain, who died of an asthma attack while unable to get emergency care. Ambulance shortages have lasted for months, with many patients in critical conditions waiting at the doors of hospitals or in EDs for hours.

Victorian authorities are currently investigating the death of a 72-year-old man at a regional hospital who waited more than three hours for a bed. The man went into cardiac arrest in the ED bathrooms after waiting in an ambulance outside Bairfield hospital for three and a half hours.

In a statement, the hospital spokesperson said “At the time of the man’s arrival via ambulance, there were three other ambulances waiting. All nine emergency department cubicles were occupied at the time, in addition to our short stay unit cubicles.” 12 employees had called in sick that day, making up 18% of the hospital’s rostered direct clinical staff. Half of them had contracted COVID.

Though the hospital managed to cover for 10 of the 12 absentees, this meant closing five beds in other wards and resulted in a ‘patient flow blockage’. The Bairfield is a quintessential example of one of the deep-rooted causes of ED crisis levels. Patient flow blockages due to understaffing makes transferring patients out of EDs very difficult, creating wider clogging.

During the pandemic, staffing shortages have become a regular and critical occurrence. Healthcare workers, especially those on the front line, regularly catch COVID or are close contacts, forcing many into isolation. Beyond that, front line workers are becoming burnt out under the physical and moral fatigue the pandemic has wrought, leaving their jobs or retiring early.

The brutal working conditions and less-than-stellar wages are paltry incentives to stay on. And Victoria is far from alone: Queensland has the country’s worst ‘ramping’ rates and wage caps in NSW are pushing nurses to strike over and over.

Ahead of the upcoming election, AMA has been campaigning for 50-50 split between federal and state government spending on public hospitals.

Victoria’s budget, handed down last week, was heralded as health-centred, promising 7,000 new health workers and more funding. This is on top of April’s ‘COVID Catch-Up’ package – $1.5 billion of investments into the public health sector to try to ease pandemic strains.

But as CEO of the Victorian Healthcare Association, Tom Symondson, writes, “simply throwing money at the system won’t fix our core problem…While more infrastructure is always welcome, the main problem we have right now is workforce.”

Cover photo by Robert Linder on Unsplash.

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