‘Wild West’: Frontline ED clinicians have given their candid views on what daily life looks like in SA’s hospitals

ED clinicians have given their raw view of life on the frontline of hospital emergency department work amid record ramping and overcapacity.

Dangerously clogged corridors, patients jumping queues to cut ramping numbers, an emergency department (ED) literally packed to the roof — welcome to the “Wild West” of hospital care, unveiled by disgusted doctors.

Fatigued ED clinicians have opened up on their punishing workloads, candidly telling about the “chaos” they are dealing with — and what they see as lack of support from managers.

From pressure to have less serious ambulance arrivals jump queues in order to cut ramping numbers to patients being left on trolleys in corridors blocking safe access, multiple recent inspections have revealed the raw edge of ED work.

The workplace inspections by their union representatives, allowed under laws where there is a risk of workplace danger, shines a spotlight into the EDs from the clinicians’ perspective — and it is not pretty.

SA Salaried Medical Officers Association chief industrial officer Bernadette Mulholland has conducted several inspections of EDs in recent months after calls from doctors worried about employee safety.

SASMOA chief industrial officer, Bernadette Mulholland has conducted several inspections. Picture: Matt Loxton

Her reports sent to SafeWork SA include one in March of Flinders Medical Centre after management declared a Code Yellow — an internal emergency — which doctors said was done without enough consultation “giving rise to potential harm to patients attending the FMC ED and to doctors working in the department.”

One doctor questioned the declaration, saying: “they have been saying the same thing for a decade, we have faced ramping for a decade, we are unclear why the administration is now declaring a disaster for what is no different.”

The doctor went on to say, “and they wonder why there is disillusionment now when suddenly the administration is declaring a disaster, focusing on ramping when this is no different to the last 10 years.”

Clinicians were concerned management was using the Code Yellow “inappropriately to modify changes in the FMC ED without engagement or consultation.”

“For example, beds in the corridor, prioritising ramped patients to off load these patients rather than ensuring care to the sickest patients, and cancellation of training,” the report notes.

The union rep was advised by medical staff of the “deteriorating morale and culture in the FMC ED.”

Clinicians warned that the FMC ED is now “inherently unsafe” for patients and staff.

When Ms Mulholland arrived she found “there were paramedics on the roof top of FMC ED in the car park and two ambulances. There were eight ambulances at the entrance of the FMC ED.”

Ambulances ramping out the front of the Flinders Medical Centre emergency department.

Her report to SafeWork SA notes: “There was an ongoing lack of resources to care for patients in the FMC ED and pressure from the hospital on which patients should be prioritised – those on the ramp or those in the waiting room – doctors raised concern that their professional judgement was not being supported and acknowledgment that the sickest patients should be seen first – this was leading to concern and psychosocial risks to the workers which had been ongoing for months.”

A management representative said the sickest patients need to be seen first and that “this is a decision of the clinicians,” the report states.

Ms Mulholland was told by medical staff that management continued to provide corridor care in the access and egress of the FMC ED “even though the executive had agreed a few days earlier that corridor care would not continue due to safety risks.”

Doctors said there was no line of sight for these patients and the use of the beds in the corridor was “clinically unsafe”.

Medical staff said a “patient waiting in the corridor had suffered a deterioration in their care while waiting in the corridor and the usage of the beds and acuity of the patients in the beds was unsafe.”

Ambulances entering the Royal Adelaide Hospital RAH. Picture: Brenton Edwards

Staff stated administration were placing “undefined patients” in these beds which meant “critical incidences for patients in these beds had happened and care was compromised.”

“It has been like this forever, and we have had enough,” one clinician said.

A separate report quoted FMC clinicians as feeling “defeated” as management allegedly chides them for not working hard enough.

That report, from last September, notes when the union rep arrived for the inspection “ there was an abundance of patients in the waiting room, ramping, moral injury, doctor fatigue, and stress arising from significant safety issues that led to an inability for doctors to perform their role to the standard expected of a doctor and which was impacting on clinicians ability to provide the care to seriously unwell patients within the appropriate times.”

Ms Mulholland records: “I spoke to a doctor who referred to the situation as ‘chaos’. There was an eight hour wait time, 18 patients waiting to be seen.

“One doctor stated they felt ‘defeated’. That many of their colleagues were physically sick and that in their view work was a major contributing factor.”

She noted in her report it was “obvious to everyone that staff in the ED were tired and burnt out and that clinicians in the ED had moved to simply doing what was needed to be done to

survive.”

When Bernadette Mulholland arrived she found “there were paramedics on the roof top of FMC ED in the car park and two ambulances”. Picture: MATT LOXTON

“Worst I’ve ever seen it in the ED,” on RAH clinician said.

ED clinicians with accrued leave entitlements said they could not take a break because the ED was short of senior doctors, “we are just tired” and “if we take leave, we are letting the team down and SALHN won’t backfill.”

Doctors say they were told by management “they are not working hard enough.”

Ms Mulholland’s report states she was advised doctors were worried about the night registrars, particularly in the FMC ED West area which was now known as “the wild west” due to lack of senior leaders at night.

“The doctors stated they go home knowing the roster is not covered the next day and the pressures on the ED and this is causing stress and anxiety because they know they cannot leave their colleagues and then they worry and can’t get to sleep. The rosters were punishing.”

A separate union inspection of the Royal Adelaide Hospital last October 3 over alleged breaches of workplace safety found 19 mental health patients waiting for a bed — one had been in the ED for 101 hours, another for 91 hours and the next for 78 hours.

“Of the 19 mental health patients, 15 of these patients had been in the RAH ED greater than 24 hours,” Ms Mulholland’s report states,

“All together there were 82 patients in the RAH ED (official capacity 69) seeking care. There were no beds available in the hospital.”

RAH clinicians described the situation as “awful, the worst I have seen it in the ED.”

The union reps asked management what was being done for the wellbeing of ED staff and were told management “thought it pointless and would appear tokenistic if they checked in on the staff …(there were) no solutions for the psychosocial impact on doctors because of the

environment in the RAH ED.”