A new order to cancel non-urgent elective surgery has infuriated clinicians

As the health system buckles under near-relentless pressure a new order to cancel non-urgent elective surgery has been issued, as the $2.7bn RAH faces state and federal safety inspections.

SA Health’s code yellow internal emergency may be lifted but doctors have been ordered to cancel some non-urgent elective surgery as the embattled system strains under huge demand and record ambulance ramping.

The order with the note “effective immediately” to clinicians in the Central Adelaide Local Health Network (CALHN) on Wednesday infuriated doctors who say management is “lying” to the public about the resumption of elective surgery.

“It is outrageous and the waiting lists just keep getting worse,” one clinician told The Advertiser.

“The clear lie about the code yellow frustrates us all.”

Under the order staff are only allowed to operate on category 1 patients, and urgent category 2 patients who are given an exemption.

Day surgery cases can proceed but if they are changed to requiring an overnight stay as part of their pre-operative check they must be cancelled.

Doctors have been ordered to review their patient lists and cancel as required, and to lodge a reason why any urgent category 2 patients deserve an exemption.

The order comes as federal investigators check the $2.7bn Royal Adelaide Hospital to see if it is maintaining acceptable quality and safety standards — an inspection labelled a “farce” by clinicians.

Central Adelaide Local Health Network Chief Executive Officer, Dr Emma McCahon thanked staff who “continue to triage and treat patients presenting for urgent care appropriately.”

“Following the standdown of the code yellow, each Local Health Network has been directed to manage their elective surgery numbers in accordance with their available bed capacity, preserving capacity to meet emergency demand,” Dr McCahon said. “To make sure those presenting with urgent needs can be cared for, only Category 1 and urgent Category 2 surgeries are taking place, as well as day procedures as these don’t require an in-patient bed. This is being reviewed daily and we are directly contacting affected non-urgent category two and three patients to reschedule them in order of priority.

SA Health’s code yellow internal emergency may be lifted but doctors have been ordered to cancel some non-urgent elective surgery. Picture: NewsWire / Kelly Barnes

Australian Commission on Safety and Quality in Health Care inspectors are checking the RAH against standards designed to protect the public from harm and to improve the quality of health services.

However, clinicians claim management had warning of the “surprise” check months ago.

“Management are very focused on ticking the boxes and making sure all paperwork is in order when it comes to the eight healthcare standards for accreditation,” one said.

“The elephant in the room is that a hospital network where ramping and staffing shortages is a constant and staff burnout is high and morale is at an all-time low, is a very unsafe place for patients.”

CALHN chief executive Dr Emma McCahon rejected the claim saying all hospitals go through accreditation inspections “every three to four years.”

“As our last assessment was in 2021, we have been expecting and preparing for assessment for some time,” she said. “As is usual practise, we were given short notice on Thursday that an assessment would be occurring from Monday to Friday this week.”

The RAH faces a separate SafeWork SA order to improve conditions in its emergency department where the relentless heavy workload is taking a psychological toll on clinicians.

The SafeWork notice to improve work, health and safety management systems in the ED was issued on June 9 after an inspection found work health and safety laws being violated.

Ramping levels are at record levels. Picture: NewsWire / Kelly Barnes

While a subsequent inspection found its recommendations being followed, SafeWork issued another improvement notice in July — as ramping hit record levels of 5539 hours.

Management had until August 9 to comply but this was extended to this Friday to allow the hospital to complete staff consultations.

The situation in the embattled ED has reached a point one clinician summed it up by telling union representatives “Staff are f...ing broken.”

At 7am on Thursday, RAH clinicians were treating 76 people in its 69 capacity ED with an average wait of more than three hours to be seen.

Tweet of SA Labor saying it will fix ramping in November 2021

There are now 22,136 patients on the elective surgery waiting list “ready for surgery”, including 4554 listed as overdue.

SA Health says 951 patients had their elective surgery postponed due to the code yellow which ran from May 30 to August 16.

Officials and Health Minister Chris Picton say the code yellow was lifted as many measures — including buying private hospital beds to deal with demand — are now “embedded” in the system.