The number of Australians experiencing lengthy waits in hospital emergency departments for admission to a ward is about three times the target set by emergency medicine specialists, according to a new report.
The Australasian College for Emergency Medicine (ACEM) said patient safety was at risk and emergency departments were filling up with vulnerable people who might not need medical attention, but had nowhere else to go.
A huge proportion of these people are elderly Australians, particularly those with dementia.
“Things are deteriorating … we’re really struggling with capacity to deal with this demand,” president of the ACEM and director of Alice Springs emergency department Dr Stephen Gourley said.
The ACEM would like to see no more than 10 per cent of patients who need to be admitted to hospital spend over eight hours waiting in emergency departments, but their annual report shows in major cities 31 per cent are waiting longer than that.
In regional areas it’s 32 per cent and in remote areas 23 per cent.
Data analysed by the ACEM found it took 15 hours and 36 minutes before 90 per cent of people who required admission at a metro hospital were all sent to a ward.
Dr Gourley said patients were being put in unsafe situations.
“There’s a safe period of time to be in the emergency department and then we need to get you into the wards … and research shows the longer people wait for a bed the higher the rates of morbidity are and even mortality goes up.”
He said the data, which covers 293 hospitals, showed people with mental-health related presentations were spending the longest in emergency departments.
“These are people who have really serious mental health issues and emergency departments are noisy, the lights never go off so being stuck in that environment for days is really not ok,” Dr Gourley said.
“I’ve got examples of people waiting five or six days in the emergency department for a bed to become available.”
Waiting in emergency for brain surgery
Even those with urgent medical complaints are sometimes enduring lengthy waits.
Wayne Jones presented to Perth’s Sir Charles Gairdner Hospital last year after his doctor told him he needed emergency brain surgery to have a tumour removed.
Mr Jones had limited mobility on the right-hand side of his body due to the large tumour, but he had to stand in the emergency department waiting room for almost five hours with crutches he had brought from home.
“It was a disaster,” the 60-year-old said.
“Chairs were absolutely scarce and people were everywhere and there was no offer of a wheelchair.”
He was eventually admitted and three days later his tumour was removed in a five-hour operation. Over his 10 days in recovery he was repeatedly moved between wards as the hospital reached capacity.
“Most mornings they would say over the loudspeaker that it was code yellow, meaning the hospital was full. People were in the halls, concertina blinds were put around them because there weren’t any rooms free.”
He felt he would be better off at home so self-discharged against medical advice.
“I knew hospitals were struggling but it’s not until you’re there that you get a sniff of just how bad things are.”
Sir Charles Gairdner Hospital has been contacted for comment.
What causes bed block?
Long emergency wait times are influenced by how quickly a hospital can safely discharge patients to make room for those coming in.
But when patients end up in hospital because community-based services can’t accommodate them — not because they are sick — the discharging process can be long and complicated.
Dr Gourley said more dementia patients were being brought into emergency departments because aged care facilities had shut high-need dementia units or didn’t have appropriately trained staff to manage “behaviours of concern”, which can include agitation and wandering.
“Elderly people get pushed to the hospital because there’s nowhere else for them to go and they get stuck there for a prolonged period of time, and that can be months, or in some cases up to a year.
“Right now 20 per cent of acute care beds are taken up by people waiting for appropriate aged care.”
The federal government has promised 35 specialist dementia care units around the country by 2023. So far 16 are operational with a further 10 to open this year.
One emergency department worker at a major Melbourne hospital, who didn’t want to be named, said she’d noticed an increase in the number of National Disability Insurance Scheme (NDIS) participants presenting to ED due to funding issues.
“I had a gentleman who was quite genuinely dumped at the emergency department by one of his support workers because his funding had run out. He was really upset as he didn’t have a medical concern but still had to be admitted.”
The health worker said she often had NDIS supported accommodation providers refusing to take back a participant after a hospital stay which meant they were stuck in hospital.
These bottlenecks at the back door mean people can’t get in the front door of the hospital, says Andrew Partington, a health economist who works at the National Health and Medical Research Council and Flinders University.
He said hospitals were commonly the “piggy in the middle” forced to remedy failings within primary care or aged care.
“That means if you can’t get a spot in aged care you might be looked after in an incredibly high-cost environment … which is a horribly inefficient way of picking up the slack.”
The number of patients in regional NSW awaiting discharge to an aged-care facility nearly tripled between December 2021 and June 2022, research has shown.
A spokesperson for the Department of Health said delayed hospital discharge of older people was a complex issue and the government was investing in a new scheme this year called the Hospital to Aged Care Dementia Support Program.
It will launch in Adelaide and Hobart soon, with 11 other locations around the country to follow.
Services aplenty but staff in short supply
Governments are attempting to tackle bed block with new initiatives.
Most states and territories have their own versions of “hospital in the home” programs which reduce the length of a hospital stay, or prevent admission altogether, by having medical professionals visit patients at home.
In addition, the federal government has invested in 87 urgent care clinics meaning people can be treated for some illnesses and injuries out-of-hours instead of presenting to an emergency department.
There’s also 45 Medicare Mental Health Centres nation-wide with extended hours where adults can seek help from mental health professionals for free, which may reduce emergency department visits.
Mr Partington said these initiatives were helpful, but he’s worried about staffing as not only are there shortages in health but Australia is expected to have a shortfall of 110,000 aged care workers by 2030.
“It’s sad because we’ve known these pressures were coming for a long time, we’ve had good demographic modelling to tell us we should expect this,” Mr Partington said.
Dr Gourley said workforce shortages were making health care a less appealing career.
“The pressure on the system right now is reaching a point where people can’t really work full time … or stress means they leave the front lines completely.
“In major cities vacancies for emergency medicine specialists are at 50 per cent, in regional and rural areas, that number increases to 75 per cent.”
Editor’s note 17/01/2025: Due to a misinterpretation of the data supplied by The Australasian College for Emergency Medicine (ACEM), an earlier version of this story contained factually incorrect details. The article stated that 90 per cent of people waiting in emergency departments for hospital admission had waited between 12 and 16 hours. This is not correct. The relevant data from ACEM shows the number of patients waiting in emergency departments is in fact three times the target set by the ACEM, or 31 per cent of people waiting longer than eight hours.
