Dr. Peter Allely, the President-elect of the Australasian College for Emergency Medicine, has recently sounded the alarm over crises in Western Australia’s emergency departments. He goes on to call their present state a “disaster scenario.” His comments come as worries over patient safety grow. He calls out this “unhealthy fixation” on optimizing metrics, arguing it leads healthcare systems to focus on numbers rather than real patient outcomes.
In a recent media interview, Dr. Allely stated that there’s absolutely no question about the need for reform in the health department. He defended that political time frames are constraining innovation. Otherwise, he cautioned, things are going to get worse. This is all the more crucial as WA’s rapidly ageing population puts increasing pressure on EMS.
Given these concerns, Dr. Allely stressed that more hospital capacity is needed. He stated that the state is currently “10 to 15 years behind where we need to be” regarding hospital infrastructure. Since 2021, WA hospitals have opened 900 new, wholly unregulated beds. He says this is not enough to address the systemic issues that are still lingering.
Current State of Emergency Departments
Dr Allely recently described the current state of emergency departments as the worst in 18 years. He described a concerning shift away from traditional triage processes to a rapid “sieving and sorting” method akin to disaster management protocols. This modification has led to patients without immediate life threats sitting unattended in waiting areas.
“We’ve almost moved, on some days, from the traditional triage process of seeing people by order of priority to almost like a disaster situation where … we are triaging but in some respects, we’re not, we’re just sieving and sorting like you would in a disaster situation.” – Dr. Peter Allely
Dr Allely said her greatest concern was for the patients who might seem stable but might worsen as they wait for treatment. He pointed to a very scary reality. Patients without clear immediate life threats are left to wait until, sometimes, very serious health issues present themselves.
“But it’s the group that aren’t immediate life threats, aren’t obvious immediate life threats, you’re getting put in our waiting room, that frighten us the most, because they might reveal themselves as having something horrible wrong with them while they’re sitting in our waiting room.” – Dr. Peter Allely
Emergency departments are already under extreme pressure as they continue to struggle with the crushing, unsustainable burden of an ageing population. Dr. Allely underscores this shift as a key driver behind today’s crisis and an important emerging factor. In doing so he warned that if we do not act now, these pressures will be even greater.
Call for Investment and Reform
Dr. Allely called for immediate investment in hospital capacity and preventative health measures. The governor pointed out that 900 new beds have been opened in the last few years. This progress is not enough, given the increasing number of patients and the level of care that is now required.
“We’ve increased the number of beds since 2021 by 900. That’s the equivalent of building a whole new tertiary hospital in just the last four years.” – Dr. Peter Allely
He stressed the critical importance of new care models. These models can help alleviate the strain on emergency departments by increasing community-based healthcare resources and expanding access to primary care services. This would not only relieve current service demands, but allow providers to address underlying health concerns before they become emergencies.
Health policy researcher Clare Mullen, in agreement with Dr. Allely’s sentiments, emphasized the importance of making strategic investment in preventative health. She pointed out that political cycles make these kinds of investments difficult because of how long it takes for them to pay off.
“The challenge with prioritising investment in prevention is, frankly, the political cycle.” – Clare Mullen
Mullen spoke to the challenge in that governments are often reluctant to invest in efforts with long-term outcomes. He acknowledged what’s been a challenge for any administration—committing funds today for benefits that won’t be realized for decades.
Future Risks and Recommendations
Dr. Allely cautioned that the consequences could be catastrophic without immediate systemic change. He made the bold prediction that ramping hours would soon exceed 10,000 hours. This increase may increase risk and lead to negative outcomes, even among patients receiving the most intensive type of emergency care.
“You will see ramping figures over 10,000 hours in the very near future, and you will see increased risk and increased bad outcomes in the emergency department.” – Dr. Peter Allely
Mullen underscored personal experiences where patients have been put in perilous circumstances as a result of lack of oversight in waiting rooms. She described a shocking incident with a dementia patient who had a fall after being left in an unsupervised waiting area.
“And then bad outcomes are happening, like the patient who suffers from dementia who comes in on an ambulance and gets put in a waiting room, even though they’re not safe to be put there, and then has a fall and injures themselves.” – Clare Mullen
Dr. Allely burned the last round to emphasize the call for immediate action to reduce risks in EDs.
“The risk in our waiting rooms, in particular in the emergency departments, is just rising and rising and rising.” – Dr. Peter Allely
