Secret code: nurses question why Code Yellow not called as RHH emergency department overrun

The nurses union say the Department of Health failed to formally declare a “Code Yellow” at the Royal Hobart Hospital during a chaotic period in which a patient was ramped for 19 hours, but the department say the claims are “false”.

New Minister for Health Guy Barnett at the Royal Hobart Hospital. Picture: Nikki Davis-Jones

The nurses union says the Health Department’s failure to formally declare a “Code Yellow” at the Royal Hobart Hospital is misleading the public about the severity of the current week-long crisis.

But the Health Department say that the claims from the union are “false”, and “at no point over the past week was it determined that a code yellow was required and no request to the department to discuss a code yellow was made”.

The hospital has been struggling with a surge in demand and a staff shortage which has seen the emergency department fill to overflowing and elective surgeries being cancelled for lack of beds.

But staff are puzzled why they are being told to follow many of the protocols applicable under a Code Yellow — an internal disaster affecting service delivery — when a Code Yellow has not been formally declared.

Code Yellows have been declared at the Royal several times in recent years — but the Department of Health says not at all during the last week.

The hospital is operating at level four of a separate four-level escalation scale.

Previous level four escalations have been described as “potentially catastrophic overload” accompanied by “increased risk of dying”.

Australian Nursing and Midwifery Federation state secretary Emily Shepherd said her members felt the Health Department wasn’t being fully transparent.

“They were told that they needed to follow the Code Yellow protocol,” she said.

“So they were doing all the things that needed to be done, including ramping up additional beds and those sorts of things.

Text received by a hospital staff at the Royal Hobart Hospital. Picture: Supplied.

“Normally with a code and whether you talk about code blue (medical emergency) or code black (security threat), there would be a hospital-wide announcement — but it wasn’t announced through the PA system.

“Members feel that gives the rest of the hospital an understanding about what the challenges are dealing with in the emergency department and perhaps then they might also take a bit of priority action in their areas.

“They really felt that a public announcement around the code together would have actually really assisted because getting people to consider whether there might be another appropriate avenue for seeking care.

“Not being fully transparent about it — and not just within the hospital but with the community — is really devaluing the point of having a Code Yellow when its designed to address the issue.

A response was sought from the Department of Health but none was received by deadline.

Health Minister Guy Barnett was questioned about the level four escalation yesterday.

“That’s clearly an operational matter for the Royal Hobart Hospital,” he said.

“It’s how they manage the bed block and concerns and challenges that they have at the Royal Hobart Hospital.

“So it is a matter that is serious. It’s being handled in a professional way by the Royal Hobart Hospital.”

The latest figures on the state’s health dashboard were released on Friday.

They show 7833 people on the elective surgery waiting list in July, down from 7896 the month before and 9019 the year before.

The figures showed 66 per cent of patients were being seen on time, up from 61 per cent a year before and the number of people on the outpatient waiting list was stable at 56,386.

Labor health spokeswoman Sarah Lovell said the state’s heath system continued to generate bad news stories.

“The health system is another example of a basic service that this government can’t get right,” she said.

“They’ve had 10 years to fix the health system, or to do something that will improve people’s access to health services,”

“I understand things at the Royal at the moment are very dire but the Royal is struggling every day.

“A normal day at the Royal Hobart Hospital is a very tough day for patients and staff and I was really concerned to hear the health minister in one of his first interviews, talking about bed block and access to the emergency department and not really grasping the real cause of that problem.”

On Saturday, the Department of Health’s secretary Katherine Morgan-Wicks said the hospital did not meet the threshold for a code yellow and that the claims from the nurses union were untrue.

“At no point over the past week was it determined that a code yellow was required and no request to the department to discuss a code yellow was made,” Ms Morgan-Wicks said.

“The claim the Health Department ‘failed’ to call a code yellow at the Royal Hobart Hospital is false.”

She said that on Saturday morning, the hospital had dropped to escalation level 3.

“The department has been working in close contact with our hospital chief executives to monitor access and patient flow through our services and assist with statewide movement as required to ensure all available public and private beds have been fully utilized.

“Hospitals have established escalation management protocols for managing patient flow, and these protocols are reviewed regularly by clinicians and the Department throughout each day.

“A code yellow was last called at the Royal Hobart Hospital in December in a COVID peak with hundreds of staff absences on planned and unplanned leave. While the hospitals and our ambulance service have managed significant demand this week, the RHH did not reach the escalation threshold for code yellow.”

Greens leader Dr Rosalie Woodruff on Saturday said it looked like a “deliberate strategy” for the government to not declare a code yellow.

“We are concerned that staff are working to code yellow protocols. There’s clearly intense pressure but the minister hasn’t made that statement to the public,” she said.

“We want to understand how it could be that staff are being told to work to code yellow protocols and the Secretary of the department is saying that’s not the situation.”

Labor spokeswoman on health Anita Dow said the state government had no intention of fixing Tasmania’s health system.

“Ambulance ramping, the worst bed block in the country, a reliance on agency nurses and locums, emergency departments at capacity, coupled with staff burnout and shortages are all symptoms of a health system in crisis and a Government that’s run out of ideas,” she said.

Health Minister Guy Barnett denied claims about the RHH operating under a code yellow.

“The government trusts our clinicians to make the right call for our hospitals,” he said.

Originally published as Secret code: nurses question why Code Yellow not called as RHH emergency department overrun