SA government releases findings into independent review of hospital emergency department ramping

A much-anticipated independent review into hospital emergency departments has rejected claims some patients are wrongly given priority to improve ramping statistics.

A review into whether ramped ambulance patients are being given priority over sicker waiting room patients in emergency departments to free up ambulances – leading to deaths – has found “no evidence” it occurs.

It also found no evidence to support opposing claims that waiting room patients are inappropriately prioritised over ambulance patients, or that bureaucrats are pressuring clinicians to treat less urgent cases as higher priorities.

Nor was there evidence to support claims clinicians are being pressured to offload ramped patients ahead of sicker ED waiting room patients.

However, it acknowledged a “trend” to see waiting room patients faster.

Premier Peter Malinauskas welcomed the report and said all five recommendations would be implemented, adding he “read the report with a degree of relief”.

On December 7, Health Minister Chris Picton announced an independent review by 2009 South Australian of the Year Associate Professor Bill Griggs and Commissioner on Excellence and Innovation in Health Keith McNeil.

It was sparked by comments by SA Salaried Medical Officers Association president Dr David Pope in The Advertiser that clinicians were being “intimidated” into giving ramped ambulance patients priority over sicker patients in the waiting room, resulting in deaths.

Since then, a SASMOA survey of ED clinicians strongly backed Dr Pope’s view that clinicians are being coerced by bureaucrats into giving higher priority to ramped ambulance patients.

Dr David Pope, president of the SA Salaried Medical Officers Association. Picture: Sarah Reed

However, the report found no evidence of such pressure, with Dr Griggs noting such matters may be a matter of perception in a high-stress environment where clinicians are focused on treating the patients they can see.

“One of the things we found is evidence of people feeling stress,” he said.

The review examined data for 2023 and also interviewed numerous staff for evidence of any deaths caused by patients leapfrogging queues but found none.

Both Dr Griggs and Prof McNeil noted such cases would be “etched in the memory, etched in the soul” of clinicians.

They also investigated a death cited by Dr Pope but found no evidence it was linked to higher priority cases forced to wait so ramped ambulances could be freed.

Following the death of 54-year-old disabled man Eddie at Hectorville after waiting 10 hours for an ambulance on December 27, the ambulance union released a statement noting there was significant ambulance ramping that day leading to delays in getting to calls.

“AEA members have reported that on this night, and others, waiting room patients were prioritised into the Emergency Department over patients in ramped ambulances, leading to

some crews being ramped and unable to respond for over seven hours,” a union statement said.

However, the review found no evidence to support the claim waiting room patients were being prioritised on that day.

At a press conference on Thursday to release the review Mr Malinauskas said his office had made contact with Eddie’s family offering them the opportunity to talk with him if they wished.

54-year-old Hectorville man Eddie who died waiting for an ambulance 10 hours after a triple-0 call was first made.

The review states:

NO evidence was found to support Dr Pope’s contentions that patients had died (nor could we find any evidence of overt harm occurring to any patients) as a result of any instructions given by hospital administrators to offload ambulance patients as a priority over waiting room patients of known greater (or even similar) clinical need;

THERE is no evidence patients conveyed to hospital by ambulance are given treatment priority over those in the ED waiting room;

LIKEWISE the case of a patient death cited by the AEA could not be definitively linked to the clinical inappropriate prioritising of waiting room patients over ambulance patients, although over the past 12 months data shows there is a trend for non-ambulance arrivals at EDs to be seen more quickly than those conveyed by ambulance;

WE found absolutely no evidence that practices had been enacted, or that data was being manipulated, to present a more palatable view of the ambulance ramping situation.

Opposition health spokeswoman Ashton Hurn said she did not think the report would give the average person any confidence there is no pressure in the health system.

She criticised the narrow terms of reference of the review and said it was “a joke” so few clinicians — about 20 — were directly interviewed.

“Where there is smoke there is fire,” she said. “There are claims and counter claims from the doctors association and the ambulance union … and the government has released a report saying ‘there’s nothing to see here’.”

Opposition Leader David Speirs and health spokeswoman Ashton Hurn with Eddie’s uncle Steve and aunt Brenda. Picture: Ben Clark

SA Health’s protocol is that a ramped ambulance patient should be treated ahead of a waiting room patient who is triaged at the same priority level.

Eddie’s aunt Brenda and uncle Steven blame Eddie’s death on Premier Peter Malinauskas’ “failure” to fix ramping, while the government notes it is investing heavily in more ambulances, paramedics, hospital beds, doctors and nurses.