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    Simon Torvaldsen

    Whilst I greatly sympathise with my colleagues working under stress in ED, all the solutions presented are around demand management – more resources, more staff, etc. Adequate staffing is certainly a reasonable aim we all support.
    However, there was not one mention of looking to reduce that demand. As a GP, it is my patients who end up in ED, for various reasons. Many of these are preventable, with the right systems in place. And I take my responsibility to keep patients out of ED seriously. So part of the solution Is to resource and empower GP. Adequate rebates for the longer consults these people require, access to allied health staff, systems to support quality care etc. Give me too the support I need and some of these patients won’t end up overloading your ED. The time has come to stop looking at these problems in isolation and having a narrow, siloed approach to solving them. Having more hospital specialists alone won’t solve the problem, it is only one part of the solution.

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    1. 1.1
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      Crankyhawk

      A local issue we have is the lack of real time transparency for GP referrals to outpatients. There is no acknowledgement of the referral and no expected time frame (eg up to a year for neurology for example). Then the GP gets frustrated, doesn’t know if referral is received then sends the patient to ED. Where we often then contact the specialist and get the advice. Then it becomes “well going to ED worked better than outpatients, May as well do that”

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  2. 2
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    JWard

    This ‘cri de coeur’ invites the highest attention to resourcing primary health care. There is no doubt that a significant percentage of presentations to these swamped EDs arise because of the maldistribution of GPs and the fraying of primary health care as a co-ordinated, evidence-based system to keep people away from hospital. If there is a shortfall in capacity in the primary health care system, where else do people go?? A primary health care plan is being developed and should address the shortcomings of the previous national primary health care plan, otherwise it’s just more ‘ground hog day’ for everyone. No more short-term programs. Fund primary health care to its full potential. Then staff in ED departments will be able to breathe.

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  3. 3
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    David

    I’m an ED consultant in a regional hospital. I have a lot of respect for Simon’s position on these issues and I thank him for his advocacy over the last couple of years as ACEM president. I think that both the article and the comments afterwards are in danger of obscuring the real issues that plague EDs across the country.

    To me the basic problem in emergency departments is not outdated models of care or the employment conditions of senior doctors, although I agree with Simon’s points. I also don’t think the issue is a lack of access to primary care. Good primary care can improve people’s chronic disease and quality of life. It can prevent some hospital admissions, but the biggest increase in hospital admissions I’ve seen in the last five years is in category 2 patients – those who are quite unwell and need to be seen in ten minutes – in the over 85 age group. A good GP can’t stop the ageing process and sooner or later all of us will get old and sick, and many of us will come to ED, no matter how good our primary care is.

    The patients who clog up my ED every single day need a hospital bed, or a mental health bed, but we are constantly told that the solution is to work smarter, to do more with less, to divert people from hospital. Patients are told not to go to the emergency department for minor illnesses, after hours services are put in place, we’ve got nurse navigators and discharge planners and GEDI aged care nurses. It seems like government and hospital administrators will do literally anything to convince people that it’s a crisis that we can think and design our way out of.

    In reality the solution to the problems in emergency departments could not be simpler. We need more physical beds and more doctors and nurses to staff them. We need them every day of the year. There are very few major problems in my ED that would not be solved by opening 40 new medical beds, and very few major problems that could be solved by anything else.

    I know beds are boring. They represent bug chunks of recurrent spending that gets maybe one news headline and is then forgotten. They aren’t smart and innovative. But we don’t need smart and innovative, we need boring and expensive.

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  4. 4
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    Matt

    Agree with David.
    This is a piece written 10yrs ago by Jeremy Sammut.
    Worth reading.

    https://www.cis.org.au/app/uploads/2015/07/pm99.pdf?

    Health reform requires bold political leadership and vision to action the boring and expensive solutions that lay waiting.
    We don’t need more Commissions, Reports, PWC Reviews or “pieces of work”. We definitely do not need more managers.
    Just action.

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