Royal Adelaide Hospital ED on ‘code white’ as SafeWork SA deadline looms

The emergency room in the state’s flagship hospital was over-capacity again on Wednesday morning.

Bosses of the Royal Adelaide Hospital hope they can meet a July 9 deadline to improve their besieged emergency department enough to reduce psychological risks for harried staff or face a $250,000 fine but the picture was bleak on Wednesday morning.

At 7.30am the hospital’s ED was over-capacity and on code white with clinicians treating 76 patients in its 69-capacity ED, 19 people waiting or due to arrive, and an average four hour wait to be seen — which was faster than Flinders Medical Centre where arrivals faced an average eight hour wait.

SafeWork issued the intervention order to improve after its inspectors found work health and safety laws being violated as demand escalated without adequate measures to minimise risks to workers’ psychological health and safety.

Their inspection was prompted by an inspection by the SA Salaried Medical Officers Association (SASMOA) which found ample evidence of clinicians being “burnt out and fed up.”

This included one doctor who told SASMOA chief industrial officer Bernadette Mulholland: “Staff are f … ing broken.”

Central Adelaide Local Health Network — which runs the $2.7bn RAH — chief executive Dr Emma McCahon said she wants to improve patients flow through the ED and the entire hospital to ease pressure.

She also said treating people at home was crucial to easing the demand at the hospital door.

Ambulances ramped at Royal Adelaide Hosptial on Wednesday morning as the ED burst at the seams. Picture: RoyVPhotography

“This solution isn’t just in the emergency department,” she said.

“The solution is right through the whole system, both the hospital system and the community.”

Speaking on radio FIVEAA said she was confident the RAH administration could meet the deadline to ease relentless pressure on clinicians.

“We’ve been asked to produce evidence that we have things in place to improve the system and look after ourselves,” she said.

“And I’m confident that we will have the evidence to present back to SafeWork to show that they’re working really closely with our clinicians to improve and continue to improve and make their workplace better.”

However, SASMOA’s Ms Mulholland said burnt out clinicians are leaving to become locums, with less stress and more certain hours.

A Central Adelaide Local Health Network statement on SafeWork’s intervention order says: “The safety of our staff and patients is our priority.

“We take all concerns regarding staff safety and wellbeing seriously and thoroughly investigate any incidents raised.

“Following a site inspection by SASMOA, SafeWork SA visited the RAH and after issuing an improvement notice, we are working collaboratively with SafeworkSA to ensure we are providing a workplace that is safe for both staff and patients.”

SafeWork gives RAH July deadline to avoid fine

The $2.7bn Royal Adelaide Hospital has until July 9 to fix problems causing psychological risks to clinicians at its embattled emergency department or face fines of up to $250,000.

An intervention order by SafeWork SA follows an inspection of the site last week, triggered by a separate inspection by the SA Salaried Medical Officers Association which was submitted to the work safety watchdog.

That inspection was summed up by one doctor who told the SASMOA inspectors: “Staff are f … ing broken.”

The SafeWork inspectors found work health and safety laws being violated as demand escalated without adequate measures to minimise risks to workers’ psychological health and safety.

Despite the order there looks to be little respite for ED workers as winter demand ramps up.

At 4pm on Tuesday every metropolitan public hospital ED was on Code White — treating more patients than their official capacity — and the system had run out of beds with clinicians treating 348 patients despite a combined ED bed capacity of 317.

At the RAH, ED clinicians had commenced treating 79 patients in the 69-capacity ED, with 36 patients waiting to be seen or expected to arrive shortly.

Australian Medical Association state president Dr John Williams said SafeWork SA’s intervention must be a “wake-up call about the risk to frontline doctors and the crisis across the entire public hospital system.”

AMA (SA) president Dr John Williams. Picture: AMA

SASMOA chief industrial officer, Bernadette Mulholland. Picture: Matt Loxton

We’ve known for a long time that frontline doctors are bearing the daily brunt of the health crisis,” he said.

“Now it’s clear they’re being placed at personal risk and forced to work in unsafe conditions. “That’s bad for them and it should be worrying for their patients.

“Doctors at almost every level, in general practice and in emergency departments and inpatient care, are drowning under the workload.

Bed capacity is severely lacking and ramping is almost seen as standard procedure.

The worrying thing is, we’re only one month into winter. There’s a very real chance that the existing pressures on our doctors will grow in the weeks and months ahead.”

SASMOA chief industrial officer Bernadette Mulholland has told The Advertiser ED clinicians are getting burnt out.

“In my view it’s the worst I have ever seen in our hospital system,” she said.

“There has been years of pressure on clinicians in EDs and it is the same thing day in, day out, just relentless pressure.”

The state government plans to open 330 extra hospital beds by the end of next year, however in the short term the system remains on Code Yellow internal emergency with non-urgent multi-day elective surgery still cancelled.

There are now 21,503 people listed on the elective waiting list as ready for surgery including 4261 listed as overdue.