Emergency departments are overcrowded and patients wait for hours or drop out. What’s going on?


Around 25,000 people visit hospital emergency departments across Australia every day. Many of them report waiting hours to be seen. Some give up and leave, only to see their condition deteriorate.

The ‘ambulance ramp’ – where ambulances line up outside hospitals to deliver patients – has become more common and means some people wait long periods of time before even getting to the emergency room.

Of the 8.8 million emergency department presentations each year, one in three people wait more than four hours to be treated and admitted to a ward for further care, or to be discharged.

Our fragile public health system and its staff need urgent attention before emergency services can recover.

Not a new problem

Demand for urgent hospital care is increasing across Australia, putting prolonged pressure on acute care services provided by emergency departments. But demand has grown over decades, not months.

According to the Australian Institute of Health and Welfare, the number of people presenting to public emergencies increased by 3.2% on average each year from 2014 to 2019, mainly due to an aging population that is experiencing more complex health issues.

Perhaps surprisingly – and despite the ups and downs in some cities over shorter periods – overall demand for emergency services declined during the peak COVID period as people opted to stay home. house or were in confinement. Volumes have only recently returned to normal levels.

Two key issues keep people from getting emergency care.

First, the public health system is already at full capacity, so even small increases in demand bring it to a standstill.

Second, with more and more staff unable to work due to illness, including COVID infection, burnout and now the flu, there are not enough staff to care for patients.

Read more: Hospital emergency departments are under intense pressure. What you need to know before you go

No slack in the system

Emergency services are on a mission to prepare for the unexpected, whether it’s an increase in COVID infections or mass injuries from natural disasters, large-scale accidents or a terrorist attack.

The surge amplifies when the event also affects staff or health facilities, reducing care capacity as demand increases. We are currently facing an early outbreak of influenza, with rates approaching what is typically seen in late June.

Systems can cope with unexpected events by allowing “slack” or maintaining excess capacity in normal times. Unfortunately, our health care systems have been stripped of excess capacity. Cuts in the name of efficiency have been implemented by successive governments, without fully measuring the implications on the supply of health care when needed.

Read more: Reimbursement for private health insurance has cost taxpayers $100 billion and benefits only some. Should we scrap it?

Working harder has a cost

During COVID, additional capacity has been created by ambulance and hospital staff working faster and longer. In the longer term, this results in burnout.

Because burnout is harder to see than ramp ambulances, it’s less likely to make the evening news – but it’s a more critical and complex issue.

Around 20,000 Australian nurses left the profession in 2021, many citing stress and abuse suffered at work.

About 8% of paramedics suffer from post-traumatic stress disorder, double the average for Australian workers. Almost a third are diagnosed with depression.

Read more: Bad for patients, bad for paramedics: Ambulance surge is a symptom of a distressed healthcare system

Just add beds?

Adding “more beds” seems like a practical solution – but hospital beds depend on staff (especially nurses) to care for the patients in them.

Addressing hospital staff shortages is less straightforward. There is a long lead time to train additional nurses and we cannot rely solely on importing them from abroad. New Zealand is already worried that we will take many of its nurses to help our aged care sector and other countries are competing for qualified hospital staff.

In an attempt to ease the pressure, governments want to divert people with less serious illnesses or injuries from emergency departments to urgent care centers or 24-hour GPs. This can improve access to care for some patients, but this may not significantly reduce the demand for urgency. Data from New South Wales shows surprisingly few people went to the emergency room when they could have seen a GP.

Improve throughput

The long-term solution to emergency service blockages is to increase throughput.

Imagine the hospital as a bathtub and the patients as the water flowing in the bathtub. Increasing the size of the bath is a temporary solution. If you can’t turn off the tap, it will fill up quickly. We need to work on the drainage system – increasing the size of the drain and unclogging clogged pipes.

Hospitals have a duty to take care to discharge patients in a safe environment. To speed up hospital discharges, we need greater community capacity to house people with disabilities, people with mental health issues who need assisted care, older people who can no longer live on their own without assistance, and the -shelter.

Addressing the shortage of health workers is a complex process.
Getty/Lisa Maree Williams

Working with patients

Processes often follow a “one size fits all” model, but patients have varying preferences and needs. Some groups have more complex needs, which means they may spend more time in the emergency department.

We know, for example, that emergency services perform less well for older people with multiple health conditions, people with disabilities or mental health issues, people who are Aboriginal and/or Torres Strait Islander, or diverse cultural and linguistic backgrounds.

We are about to embark on a project with three major hospitals in Sydney. We will work with patients, clinicians and community groups to co-design improvements to emergency care and reduce wait times. Examples could include strengthening links between GPs and the emergency department, and greater use of technology to streamline care pathways and help patients navigate the journey.

For now, everyone can help reduce the stress of emergency services by taking better care of their health, addressing issues early with their GP and taking advantage of vaccination programs such as COVID and flu. .


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