Moves to reclassify Royal Adelaide Hospital surgery patients may put some at risk, doctors warn
SA HEALTH is juggling the numbers of elective surgery patients at Royal Adelaide Hospital to push the most urgent patients who receive treatment in 30 days to a three-month window.
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SA HEALTH is juggling the numbers of elective surgery patients at Royal Adelaide Hospital to push the most urgent Category 1 patients to receive treatment in 30 days to Category 2, which has a three-month window.
The change is based on available dates for surgery rather than medical indicators, an internal memo reveals.
It follows a blowout in patients overdue for surgery, with more than 200 waiting beyond the clinically recommended time and a warning the hospital will have trouble meeting national targets. A shortage of anaesthetic staff at the RAH has caused repeated cancellation of elective surgery lists.
The staff reduction has triggered contingency moves, including deferring leave of remaining anaesthetists after the RAH’s elective surgery list topped 200 patients overdue for their surgery, according to a memo issued on April 27.
A subsequent memo from Clinical Director of Surgery Professor Guy Maddern stresses it is “absolutely crucial” Category 1 patients are given a surgery date within 24 hours of finalising the request for admission.
It says: “It is therefore realistic that all patients that have been assigned a surgery date beyond 30 days are reasonably clinically indicated to be assigned as a Category 2.
As such, I have directed the elective waiting list be revised and any patients who fit this criteria have their category amended.”
The new directive means a patient judged to be a Category 1 patient by their doctor and who cannot be listed within 30 days for reasons including workload and the surgeon’s availability, will be reclassified into a less-urgent category.
The SA Salaried Medical Officers Association (SASMOA) president Dr David Pope said the move had no clinical basis.
“It is being done for the sole purpose of meeting paper targets,” he said.
“There are safety risks — there are long waits in the less urgent categories and every day you wait past the period considered safe by your surgeon you’re at risk of an avoidable catastrophic health event.
“Surgeons make a very considered decision about what is a safe period — now they find the final decision is being overriden by an administrative process that puts them and the patients in an impossible situation.”
SASMOA intends to take up the matter with SA Health.
But Professor Guy Maddern, Clinical Director of Surgery at Central Adelaide Local Health Network, said the procedure was not uncommon.
“It is not at all unusual for there to be times when patients are re-categorised if a clinician deems there has been a misclassification or there is a change in the patient’s clinical condition.”