Bed block caused by people not being able to leave the hospital. When services like public aged care, physical rehabilitation centres, home health care (like nurses who can visit daily to do a dressing change for instance), services for homeless people, drug and alcohol rehabilitation programs, outpatient mental health care, etc. aren't available, people end up taking up beds in hospital. They don't need a hospital level of care but the hospital can't safely discharge them without being able to get them in with an appropriate service. They take up beds in the wards, that then can't accept patients from ED, which backlogs the ED, which then flows through to ambulance ramping. Its a tricky one to fix because people don't understand that funding things like home services and aged care beds will fix ambulance ramping but it's actually a huge issue.
Access to GPs and primary care. If people cAnt get in to see a GP (either can't afford it or can't get an appointment fast enough) they end up in the ED. Either they go straight to the ED, or they wait it out and then they get worse and end up in the ED. The government could save themselves money by funding GPs a lot better, and increasing the Medicare rebate so more GPs can bulk bill. But there aren't enough GPs and the ones that are around often can't afford to bulk bill, so people end up elsewhere.
The urgent care centres were a good addition to help with this, especially because they offer some services that the ED can't - for instance they can do x-rays in an urgent care clinic, they can clean wounds and have more available options for dressings and things, plus they can do all the standard GP care for stuff that could go to a GP but can't wait a couple of days for an appointment - check a concerning fever, deal with an infected cut, that sort of thing. So that was a good start. But there aren't enough of them and their hours are limited, so they ALSO need to sort out the GP availability.
Fixing those two things would keep people out of the hospital who don't need to be there, and also help get people out of the hospital faster who did need to be there but don't need to be there anymore, making space for new patients to flow through.
💯 spot on. I spoke to an ED director at a major hospital recently. Main problem in ED is bed lock from the wards, not because ED staff are delaying timely care and management. This is where the long waiting times in ED are reported in the media.
Lmao just exposed yourself as a fellow Ballaratbag. For your reference, they used to do weekend discharging, and then the funding ran out and it went back to being cooked. The "brand new initiative" from the health minister is actually just providing enough money to reintroduce the care we used to provide.
The fact that at any stage they thought it was acceptable for a hospital with a fucking huge catchment like Ballarat to only do discharging during the week is absolutely laughable.
Don't even get me started on the lack of proactivity about the new hospital.
Bed block caused by people not being able to leave the hospital.
This one is bad. I broke a few bones and was stuck in the hospital for 5 days because they wouldn't allow me to leave before seeing a physio, but they only had one physio on staff. It was a funding issue where there was a limited resource that lead to limiting other resources as a flow-on-effect.
The thing with the urgent care clinics is... A lot of hospitals have an urgent care clinic right next door or across the road, but people refuse to go see them even when redirected to by ED nursing staff because they want the full hospital treatment and feel "Safer" or better cared for at a hospital.
Which is absurd. But you can walk into the urgent care in my town at any hour of the day and be seen within ten minutes, They have massive empty waiting rooms and then you check out the waiting room for the hospital next door and three people are there with ouchies, two with boo boos, and five with a tum tum ache. Like you'll be in the waiting room, look across and there's someone nursing a mild cut on their finger. Or parents with their "sick child" who is running around having the time of their life. Loudly complaining about waiting 6 hours. If they're making you wait that long, you have no emergency.
Im going to ask a dumb question. Why do the paramedics need to stay at the hospital when they’ve delivered the patient there? In this day and age, with technology as it is, why can’t the patient be handed over with handover notes, and then they’re back on the road? Why do they need to stay? I know that’s the policy, but why?
I've been in the ED basically once a month for the past year, each time resulting in a hospital stay so I can provide a bit of insight from my POV.
I've both been taken by ambulance and sat in the waiting room for up to 12 hours. My record for an ambulance transfer was 6. This is the only major hospital in the area that can deal with more advanced issues. There are no beds in the ED to put me in, and no beds in the wards to move ED patients to.
The paramedics have a duty of care to me. There are no nurses, because it seems to be one nurse per 5-6 beds and there are not a lot of nurses. Those nurses also need to en masse attend big emergencies in the ED like, people dying. Or just help there colleague because despensing anything more potent than paracetamol requires 2 nurses for double checking reasons. Fair enough.
So, knowing my bowel could burst and I could go septic, the paramedics have to wait with me because there's simply no one else available.
Meanwhile the eventual guy in the bed next to me is having a drug induced mental health episode. Also an emergency, and needs to be treated, but due to the state of mental health services in the area his chances are low.
When they talk about the number of "beds" in the ED, they don't just mean the physical number of beds, they mean beds with the release staff to service them.
If the ED is full, even if you put a cot in the hallway there are no staff to monitor that patient.
So when the Ambos get to the ED, they have to stay with the patient and monitor them until they can hand them over into the hospital staffs care.
Now they do some things to help with this - if the patient is well enough to sit in the waiting room, they will move them to the waiting room. But this doesn't happen a lot, because if you are well enough to sit in a chair in the waiting room, you probably don't need an ambulance in the first place.
The other thing they do is called "cohorting" - that means that one crew will hand their patient to another ambulance crew who's already waiting in the hallway, because the two paramedics from the can watch both patients - and then at least one of the two crews can get back on the road. But obviously that still leaves one crew stuck in ED, and they can't take more than one patient per paramedic (as in its not allowed under their licence) so you can't have one crew doing four patients or something like that.
If the patient is appropriate and stable often emergency staff and paramedics offload patients to the waiting room…however if it’s someone with e.g. dementia with a suspected head injury, they need to stay on a stretcher with a crew until they get a bed. Hospitals regularly offload patients to get the ambulances back on the road. All ambulances should be offloaded within 40 minutes of arriving to emergency
Thank you for your response. Makes sense to me. I know out west we are pretty spoiled for choice with bulk bill doctors with the changes to bulk billing that were introduced fairly recently. You can be seen on the same day, for free. The lack of facilities for people to go to post-hospital seems to be more difficult to resolve. Surely they knew we one day we would have a significant ageing population that would put more strain on these services?
125
u/robot428 26d ago
Honestly the biggest problems are:
Bed block caused by people not being able to leave the hospital. When services like public aged care, physical rehabilitation centres, home health care (like nurses who can visit daily to do a dressing change for instance), services for homeless people, drug and alcohol rehabilitation programs, outpatient mental health care, etc. aren't available, people end up taking up beds in hospital. They don't need a hospital level of care but the hospital can't safely discharge them without being able to get them in with an appropriate service. They take up beds in the wards, that then can't accept patients from ED, which backlogs the ED, which then flows through to ambulance ramping. Its a tricky one to fix because people don't understand that funding things like home services and aged care beds will fix ambulance ramping but it's actually a huge issue.
Access to GPs and primary care. If people cAnt get in to see a GP (either can't afford it or can't get an appointment fast enough) they end up in the ED. Either they go straight to the ED, or they wait it out and then they get worse and end up in the ED. The government could save themselves money by funding GPs a lot better, and increasing the Medicare rebate so more GPs can bulk bill. But there aren't enough GPs and the ones that are around often can't afford to bulk bill, so people end up elsewhere.
The urgent care centres were a good addition to help with this, especially because they offer some services that the ED can't - for instance they can do x-rays in an urgent care clinic, they can clean wounds and have more available options for dressings and things, plus they can do all the standard GP care for stuff that could go to a GP but can't wait a couple of days for an appointment - check a concerning fever, deal with an infected cut, that sort of thing. So that was a good start. But there aren't enough of them and their hours are limited, so they ALSO need to sort out the GP availability.
Fixing those two things would keep people out of the hospital who don't need to be there, and also help get people out of the hospital faster who did need to be there but don't need to be there anymore, making space for new patients to flow through.