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Top doctor warns about ‘avoidable deaths’ at Sir Charles Gairdner Hospital as admissions soar

Email Sir Charles Gairdner Hospital emergency chief warns of 'avoidable deaths' due to staff shortages By Nicolas Perpitch

Updated March 12, 2019 20:06:48

Sir Charles Gairdner hospital emergency Photo: Sir Charles Gairdner Hospital is considered one of Australia's leading tertiary hospitals. (ABC News: Andrew O'Connor) Map: Perth 6000

An "increasingly unsafe work environment" in Sir Charles Gairdner Hospital's (SCGH) emergency department will lead to more "avoidable deaths" as winter approaches, one of the medical facility's most senior staff has predicted.

Key points:

  • Peter Allely claims patient numbers have soared, but staff numbers have stagnated
  • A death nearly two years ago was linked to inadequate staffing, Dr Allely claims
  • The WA Government says the patient-staff ratio at SCGH is similar to other WA hospitals

The director of emergency medicine at SCGH, Peter Allely, has emailed the executive and other heads of departments at the hospital to voice the concerns of senior emergency department staff.

In the email, Dr Allely said there had been an almost 50 per cent increase in patient numbers, but almost no increase in doctors since 2008.

The WA Government rejects the claim.

"As winter approaches there will be more avoidable deaths in our department in the coming months unless changes are made," Dr Allely said.

Death 'linked to inadequate staffing'

Dr Allely claimed the department was built to handle 54,000 patients each year, but was on target to see more than 74,000 this year — a 48-per-cent increase since 2008.

He said over the same 11 years, the number of full-time equivalent consultant doctors had not increased from 18, the number of full-time equivalent resident medical officers had remained static at 24, and the number of registrars had increased by two, to 24.

The number of nurses had not gone up since 2008 either, apart from boosts during winter, Dr Allely wrote.

"We're not sure if any other department in the hospital has delivered a 48 per cent increase in productivity with no investment," he said.

"We are very concerned that financial pressures on exec are so extreme that recommendations following significant clinical incidents are being ignored (including a death in our department now nearly two years ago that was linked to inadequate staffing).

"Benchmarking against other similar units has consistently shown we are amongst the least resourced large tertiary EDs (emergency departments) in the country."

The North Metropolitan Health Service said activity at SCGH's emergency department had in fact increased by 39 per cent since 2008, and clinical staffing had also risen to meet this demand.

The service's chief executive Robyn Lawrence said compared to 2008, there were currently 20 more doctors and 28 more nurses employed in the ED.

Doctors in surgical gear performing an operation. Photo: There has been almost no increase in the number of doctors at the hospital, Dr Allely claims. (Unsplash: Natanael Melchor)

But Dr Allely argued business cases to enable the hospital to reach safe staffing levels had been submitted repeatedly over the last two years, but had not progressed.

The relentless pressure of under-staffing, combined with the violence and aggression emergency department staff had to contend with from some patients, meant burnout was "huge with multiple OSH [occupational health and safety] referrals for mental health concerns".

"Nursing staff are frightened and feel that they may lose their registration while working or team-leading at triage because it is so unsafe," Dr Allely said.

"Our department is too small for the numbers we are seeing. Triage is not large enough to allow adequate clerical or nursing numbers (even if we had them) to process patients in a timely fashion resulting in a queue of patients out of the door to the front of hospital every day.

"Ramping is consistently higher than in previous years."

The more than 600-bed tertiary and teaching hospital is vying for federal funding for a behavioural assessment unit, for psychologically-disturbed patients who do not have a bed in a locked facility.

This would ease some of the pressure and risks in the emergency department, but Dr Allely said the hospital's executive needed to meet with emergency department staff to agree on a long-term plan to match their ever-increasing patient numbers.

"We would propose that a percentage increase in staffing proportional to our increase in activity gets budgeted automatically every year without the need for the repeated construction and reconstruction of business cases ad infinitum," he said.

In the meantime, the doctors want the issues of understaffing and the "inadequacy" of the emergency department triage area be placed on the hospital risk register.

Patient and staff safety is number one priority: Government

WA Health Minister Roger Cook released a statement disputing Dr Allely's claims.

Mr Cook said the increase in activity in the hospital's emergency department had been met with a proportionate increase of clinical staffing.

"The patient-staff ratio at the emergency department Sir Charles Gairdner Hospital is similar to that at other WA hospitals," he said.

A picture of Roger Cook in blue tie speaking into microphones outside the ABC Perth office. April 17, 2018 Photo: Roger Cook disagrees with many of Dr Allely's claims about staffing at SCGH. (ABC News)

"In the last month, there has been an increase in ED activity at SCGH, predominantly in Triage Category 4 and Triage Category 5. While some of these patients should be attending the ED, some are patients who should attend their GP for treatment.

"Patient and staff safety is our number one priority and we recognise the physical constraints in the department, as well as the minimal triage space in the main ED.

"We will continue to engage with our emergency department workforce about potential modifications to the unit's design."

'This is a cry for help'

Australian Medical Association state president Omar Khorshid said the situation at the hospital had been ignored by successive governments, and he agreed that more patients would die due to a lack of resources if nothing was done.

"This is a cry for help from one of our largest hospitals and is a clear demonstration that a crisis point has been reached," he said.

"To have experienced an almost 50 per cent increase in ED attendances since 2008 with no increase in staffing numbers is a sad indictment of how governments have turned a blind eye to this issue."

A head and shoulders shot of a man with dark hair in a shirt and jacket outside an office. Photo: Omar Khorshid says staffing problems at the hospital have reached crisis point. (ABC News: Alisha O'Flaherty)

Dr Korshid said there had been a cut in real terms in funding for hospitals in the last budget, and the next budget was an opportunity for the McGowan Government to substantially increase health funding.

"There will be an increase in avoidable deaths if the current Government doesn't act immediately to increase staffing and other resources to cope with this dire situation," he said.

Topics: health, doctors-and-medical-professionals, healthcare-facilities, perth-6000, wa

First posted March 12, 2019 09:03:12

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