Staff in the emergency department at South Australia’s Royal Adelaide Hospital (RAH) say they are experiencing challenges like never before. Data reveal the facility has admitted far more patients than total beds on the facility’s license. Dr. Peter Allely, President-Elect of the Australasian College for Emergency Medicine (ACEM), called attention to these shocking advances. He likes to think this would represent one of the biggest shifts in Australia’s healthcare landscape. He highlighted the impact of long boarding times in emergency departments, which can cause harmful patient events.
Dr. Allely explained that this is an extraordinary situation. For the first time, one of Australia’s most populous city’s large tertiary hospitals is out of capacity to admit patients into its emergency department. There his concerns about the potential risks from long emergency department stays were heard. He stressed that studies indicate patients are at significantly greater risk of death or other serious complications when they exceed eight hours in these settings.
The Reality of Overcrowding
In fact, just in recent days, RAH has felt a wave of patients, forcing them to overcrowd their Emergency Department with patients. According to Emma McCahon, a spokesperson for the hospital, “There were a large number of admitted patients in the emergency department in the RAH on that day.” Systemic issues with the grant program are compounding the problem. This has left patients waiting in ambulances outside hospitals as the facilities reach complete capacity.
Dr. Allely described the pressure on hospitals, stating, “You have people who are in need and it’s really difficult to do your job properly when you’ve got simply no space to see anybody.” He explained that staff at emergency departments prioritize timely discharges to manage patient flow effectively, but the continuous influx of patients strains available resources.
Similarly, when departments hit capacity, White said hospitals often have a plan in place to deal with that preferred procedure especially. “At the Royal Adelaide, when the emergency department is at capacity, we enact a whole of CALHN response to decompress the department,” McCahon added.
Strategies for Patient Care
In light of these persistent issues, emergency department teams have pursued a number of different strategies to keep care quality high. As Dr. Allely pointed out, patients are frequently moved to transit units to relieve stress on crowded emergency departments. This proactive approach not only ensures that the most critical cases get immediate attention, but works to improve overall patient flow.
The local community hospital has been extremely proactive with repatriating patients for care closer to home. They further provide programs such as Hospital in the Home, to alleviate pressures on hospital resources. Dr. Allely remarked on the importance of these efforts, stating, “If they were all where they should be, where they deserve to be, I suspect that the hospital overcrowding would disappear fairly quickly.”
In this context, McCahon reassured the public about the commitment of emergency staff, saying, “We provide safe medical care for every patient, even when our emergency departments are stretched, focusing on the sickest patients first.”
The Way Forward
In spite of their different approaches, both Dr. Allely and McCahon agreed on one thing—that systemic change is urgently needed within South Australia’s healthcare structure. The rising patient load on the residential aged care waiting list has compounded the hospitals’ crisis of crowding even more. “There’s something like 300 patients in South Australian hospitals waiting for residential aged care facility placement,” Dr. Allely pointed out.
He highlighted that tackling these systemic problems will be essential in doing what is needed to ensure positive patient outcomes and prevent unsafe overcrowding. “The Australasian College for Emergency Medicine believes that nobody should spend more than 12 hours in an emergency department,” he stated.
While RAH finds its way through this difficult terrain, healthcare workers are still committed to delivering high quality care. Dr. Allely concluded by emphasizing the flexibility and commitment of emergency staff: “Doctors and nurses that work in emergency departments are flexible and pragmatic, and whenever somebody comes in with an obvious life threat, we will find a way to look after them.”
