Access block taking its toll in lives

The annual number of deaths attributable to access block and emergency department overcrowding in hospitals is similar to the number who die on the nation’s roads.

One of the articles on this subject in the current Medical Journal of Australia describes the problem as ‘a blight on our hospitals and the community’. Professor of the Department of Emergency Medicine at the University of Western Australia, Daniel Fatovich, said research had shown an annual 20 to 30 percent excess mortality rate because of access block and emergency department overcrowding.

“This equates to at least 80 deaths per million population, a figure that is similar to the road toll,” Professor Fatovich said.

Access block refers to the inability to admit emergency patients to a ward in a timely fashion, and Professor Fatovich said Australia is at the forefront of research into the problem.

Director of Trauma ( Emergency) at Royal North Shore Hospital and The University of Sydney, Dr Tony Joseph, said solutions include an immediate increase in the number of acute hospital beds, and improved coordination and increased capacity to manage medical patients with complex conditions in the community, outside acute public hospitals.

“Improved hospital processes (such as sending admitted patients to a designated area until a ward bed becomes available, planning discharges for earlier in the day and spreading elective surgery across the week), and better standardisation of treatment within emergency departments, could also be part of the solution,” Dr Joseph said.

Another article warns against falling for myths in the debate.

Chair of Road Trauma and Emergency Medicine at the Australian National University’s Medical School, Professor Drew Richardson, said a range of popular solutions are not backed by evidence.

“For example, the solutions lie outside the emergency department. Changes to ED structure and function do not address the underlying causes or major adverse effects of overcrowding,” Professor Richardson said.

“There is no evidence that telephone advice lines or co-located after hours GP services assist in reducing ED workloads. Additional GP services, even bulk-billing services near hospitals, does not significantly decrease ED workload either in theory or in practice.

“It is vital to know what really does and does not cause access block, and to avoid perpetuating the myths that abound in this area of the policy debate.

“The fundamental issue is the availability of inpatient beds,” Dr Richardson said.

^{The statements or opinions that are expressed in the MJA reflect the views of the authors and do not represent the official policy of the AMA unless that is so stated.}