New state measures may cause hospitals to struggle

Date:Feb 06, 2012

New federal government targets have been implemented  that require a number of state hospitals to pick up the pace of emergency admissions and patient processing.

Having come into effect on January 1, many medical facilities in NSW are now committed to increasing the number of patients seen within four hours.

In 2012, the state government set the target at 69 per cent - with the eventual aim of being able to see to 90 per cent of admissions within the time limit by 2015.

The new targets are aimed at producing procedural changes that will reduce waiting-room times by either admitting patients to an appropriate ward for treatment or administering care to more minor cases at speed to allow them to be discharged.

However, the dual focus of high-care and simple cases in the four-hour time limit has been described by the NSW faculty chairman of the Australasian College for Emergency Medicine Richard Paoloni as being difficult, as it does not allow for rapid changes to entrenched procedures.

Paolini told the Sydney Morning Herald on February 6 that data from "a number of hospitals" suggested the focus should remain on process and culture for long lasting improvements.

"Reorganisation and culture change are where we need to spend the effort," said Paolini.

"If we change the processes the target will follow."

As an example, Paolini suggested new classes of medical technicians could take on procedures such as bandage application and drip insertion to help speed up some areas, taking the pressure of more advanced personnel to perform other more complex tasks.

While a combined total of $169.4 million has been made available to the NSW government to begin implementing the necessary changes required by the four-hour target, a further $63.6 million is only to be provided if the state's hospitals meet the new annual guidelines.

In addition, a recent study posted in the Australian Journal of Medicine has found that the number of deaths in four Perth hospitals has decreased since the requirement has been put into place - while also noting that there were several inefficiencies that played an important role in lowering the mortality rates.

One particular observation was that emergency departments that did away with nursing triage could put their staff to better use initiating treatments in the wards, rather than forcing patients to be delayed by assessing techniques.

However it also noted that these measures were quite extreme and may not be practicable by all facilities.

The report stated: "There is a real risk that, just as evidence appears that the four-hour rule may be beneficial for patients, the demands on the ED (emergency department) may be so overwhelming that it is not achievable."

The increased pressure put on staff could understandably result in so-called sentinel events and misdiagnosis, the victims of which may require the services of a medical negligence lawyer



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