SA Health deadline for Royal Adelaide Hospital ED fix looms

A violent attack and crowded ED is putting more pressure on RAH staff despite a deadline to fix staff issues now less than 24 hours away.

The Royal Adelaide Hospital ED is still regularly handling more patients than capacity. Picture: Kelly Barnes

Conditions at the $2.7bn Royal Adelaide Hospital’s embattled emergency department have deteriorated since a SafeWork SA inspection which gave management a Tuesday deadline to improve working conditions for staff.

An inspection by the doctors’ union SA Salaried Medical Officers Association (SASMOA) after the SafeWork inspection found multiple alleged contraventions of health and safety laws with the ED “continuously blocked with admitted patients giving rise to ramping on the ambulance ramp and in the waiting room..”

Workers reported feeling “dejected”, “deflated”, and “fed up” and that since the SafeWork improvement notice was issued “nothing has changed”, and “things are worse.”

The inspection occurred last Tuesday - the night a doctor, nurse and security guard all needed medical treatment after a violent incident which resulted in a Kensington Park woman being charged with three counts of assault.

A clinician was injured at the RAH allegedly in an attack by a patient. Picture: NINE NEWS

The inspection found action by management after the SafeWork order “did not provide any meaningful relief to the workers. This is causing workers chronic distress, anxiety and psychosocial harm,” the SASMOA report states.

“Workers reported that ‘patient and doctor safety is now at risk’.”

The inspection began at 10.40am and found 84 patients in the ED with a capacity of 69.

There had been 13 patients in the ED greater than 24 hours; with some mental health patients waiting up to 97 hours for a mental health bed.

“There was one 89-year-old with Covid who waited 29 hours for a bed” the report states.

“There is insufficient beds in the hospital to support the number of patients coming to the RAH ED,” it says, noting management is aware of this and “nothing effective has

been done ... to address the issue giving rise to physical and psychosocial health and safety impacts on workers.”

Aftermath of an incident in the RAH ED. Picture: 7NEWS

The inspection also found workers reported not seeing security take immediate action while

assaults were occurring.

“This has contributed to the overall psychosocial safety impacts on staff and left them

feeling unsafe and unsupported in their workplace,” it states. “Workers reported ‘we are not just emotionally unsafe in our workplace, now we are also physically unsafe.”

Opposition leader David Speirs noted the health system is entering its fifth consecutive week of code yellow, triggering elective surgery bans, and there were almost 3800 hours of ambulance ramping in June.

“The sickening violence against doctors and nurses in our EDs is becoming a regular occurrence and it is unacceptable, especially when Peter Malinauskas promised he would fix the health system,” Mr Speirs said.

Since last week’s alleged assaults security in the ED has subsequently doubled, more duress alarms been provided and more mental health staff deployed.

The SafeWork inspection was prompted by an earlier inspection by the doctors’ union SASMOA which found staff were under such stress the situation was summed up by a doctor who told the union’s chief industrial officer Bernadette Mulholland: “Staff are f***ing broken.”

Ongoing refusal to comply with a SafeWork improvement notice could result in prosecution with the risk of a maximum $250,000 fine, however an initial failure to comply may incur a $3600 expiation notice.

If officials show they are making efforts to comply and reduce the risk of psychological harm to clinicians from an overloaded ED they may be given an extension.

A spokesman from SafeWork SA said inspectors had issued an improvement notice and requested additional information be provided by July 9, 2024.

“The improvement notice required the RAH to review, and if necessary, revise demand escalation control measures,” he said.

“SafeWork SA will review any documentation received to support compliance with the improvement notice and consider its response.

“Under certain circumstances, the Work Health and Safety Act allows for an extension of time to comply with an Improvement Notice.

“Improvement notices are a very commonly used tool by SafeWork SA in relation to work and health safety matters. SafeWork SA issues thousands of improvement notices each year across all industries in South Australia.”

Advocates including the Mental Health Coalition of SA and the Australian Nursing and Midwifery Federation state branch are calling for more community resources for intervention before mental health patients reach a crisis point needing emergency care.