Seven hours before being seen – inside the shiny new Royal Adelaide Hospital

AS medical reporter, Brad Crouch has been shown through the new Royal Adelaide Hospital on numerous occasions. Here is how he saw it from the perspective of a carer for a patient in pain arriving at the ED.

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AS medical reporter for the Sunday Mail and The Advertiser , I have been shown through the new Royal Adelaide Hospital on numerous occasions as it was being built then opened, with officials telling me how wonderful it will be for patients.

Here is how I saw it from the perspective of a carer for a patient in pain arriving at the ED, an experience which occurred within the past month and, precipitated a report this week in The Advertiser showing our public hospital emergency department waiting times are the worst in the land – and aren’t getting any better.

 

The Royal Adelaide Hospital at night.

PATIENT has chest pains to a point she cannot lie down, is wheezing. Last time the person had the same symptoms it was a pulmonary embolism, a potentially fatal condition of blood clot in the lung – about 30 per cent of untreated cases die. The decision is made to go to hospital, I drive (legally) fast, rather than ring an ambulance – I’ve written so many stories about the SA Ambulance Service being under the pump I’d prefer to drive rather than risk a 000 call under these circumstances.

SA Ambulance Service have been under the pump dealing with large numbers of patients.

► 10.30pm Arrive at $2.3 billion new Royal Adelaide Hospital, park out the front of the ED and walk straight in, very smooth. Tell triage nurse the symptoms mirror a past episode and fear it is another pulmonary embolism, which did not seem to carry much weight. Personal details including very intimate details of a separate past treatment have to be told loudly to the nurse behind glass, while the man who arrived behind us listens with great interest. Didn’t expect glamour, but did hope for a measure of dignity.

Told to wait. Waiting room is pretty full – the room is relatively small, officials say because the new hospital will be so efficient there won’t be much waiting. We go down the corridor and find seats in front of a toilet. I was aware the hospital had been on Code White that day – more people seeking help in the ED than beds, so expected to wait – but also expect this might be a reasonably high priority condition.

► 11.30pm Wheezing is getting worse, but the only person patrolling the waiting room is a woman pushing a computer on a trolley who again asks personal details including address and mobile phone number, to the interest of anyone within earshot. SA Health is big on “privacy” yet personal details are asked in front of total strangers. Security is called to calm a woman loudly demanding staff ring the police integrity unit. Ambulances are treating patients in the carpark in what is known as “ramping” as there is no room in the ED.

► 12.30am We consider going to Wakefield Hospital, after a man who arrived after us with what appeared to be a sore arm is called through. Movement is painful so we decide to give it until 1am.

A chair in a emergency department cubicle.

► 12.45am Called into ED. It’s freezing cold, to the point patient has to ask for a blanket. I get a hard plastic chair in the shiny new cubicle but figure we won’t be here long. Nurses ask questions, take blood pressure, then a doctor arrives who quickly decides on a CT scan, based on the previous pulmonary embolism and current symptoms.

► 1.30am We’re hoping to be called for the CT scan soon. Patient is cold, scared and in pain.

► 2.30am We’re hoping to be called for the CT scan soon. Patient is cold, scared and in pain.

► 3.30am We’re hoping to be called for the CT scan soon. Patient is cold, scared and in pain.

The patient is tired but can’t get comfortable in the bed, and I’m stuck in possibly the world’s worst designed plastic chair, but sleep is not an option anyway as it is freezing cold. It’s also noisy. There are continuous loud announcements over the PA such as “cleaner to the resuscitation room”, and “orderly to room such-and such”. The PA system seems a weird, annoying way to communicate such mundane messages in this day and age. There are some odd chimes that keep going off, lots of people coming and going who generally take a curious look inside the cubicle as they pass. It’s also a workplace for many – so lots of chatting and laughing as happens in any workplace, which is lovely except when you are sick, scared and tired.

A visitor waiting area in the new RAH.

► 4.30am We’re hoping to be called for the CT scan soon. Patient is cold, scared and in pain. We’re in limbo but it feels closer to hell. The ED doc rings radiology to see what’s the hold up. “Oh, you’re next,” we are told. Don’t get your hopes up. Security is called to the ED which adds to the experience.

► 5am We’re hoping to be called for the CT scan soon. Patient is cold, scared and in pain.

► 5.20am A Code Black is called to the resuscitation room – staff being monstered by someone.

► 5.26am The patient is finally called for the CT scan. It feels like winning the lottery. I wonder why I drove so fast to the hospital, to arrive seven hours earlier. Patient is wheeled out. But they have to take two CT scans, with associated radiation dangers.

A private patient room at the new RAH.

► 6.30am Eight hours after arriving the CT scans are finally back and the ED doc hurries in. “Oh f..k,” say her eyes, but her actual voice says “I’m afraid it’s bad news”. She tells the patient she has not one, but multiple pulmonary embolisms in both lungs, and the reason her right side is so sore is part of that lung is dying from the clot.

Might have been nice to know the night before. In a $2.3 billion shiny new hospital.

We’re told the patient will be admitted, as blood thinning medication is commenced. Then told there are no beds available in the 800-bed new hospital, so we are stuck in ED, taking up space that someone else might have needed.

► 8am Taken to an inpatient room. And yes, the spacious single person room with ensuite and views is great, just like a motel, with a day bed instead of a hard plastic chair for a carer. But I don’t go to hospitals in an emergency situation for a vacation.

► Today The patient is home but has had to juggle medication due to negative side effects and will be on blood thinning mediction for life.

 

Adelaide by night - the new Royal Adelaide Hospital RAH, Tuesday, August 1, 2017. (AAP Image/Brenton Edwards)

THIS week I checked the situation at the RAH and saw that at 9.30am on Monday there were 26 people who had been in the ED who were waiting for beds – five had been waiting more than 24 hours, six between 12-24 hours.

SA has a target that patients presenting to a public hospital emergency department will be seen, treated, and either discharged or be admitted within four hours. But federal data shows SA hospitals are the worst in the land for seeing people in EDs on time, and it’s getting worse – just 64 per cent were seen in that time frame in 2016-17. The need to fix the ED gridlock we are seeing on a daily basis more crucial than ever. Otherwise, Transforming Health’s mantra of “Best Care. First Time. Every Time.” is just an empty slogan.