Frontline Adelaide doctors’ grim warning on plan to update ambulance policy

A planned change for how hospitals take patients from ambulance has left stunned doctors furious, warning sick people “will die and staff will leave”.

The public hospital doctors’ union has bluntly rejected the state government’s planned updated ambulance transport policy – covering ramping – with a grim warning from its members that “patients will die”.

There also are renewed claims management are ordering ambulance arrivals to be prioritised over sicker patients in crowded waiting rooms.

The government says the updated policy simply clarifies existing rules, while Opposition health spokeswoman Ashton Hurn dubbed it a “dump and run” policy allowing ambulances to offload patients faster – in turn lowering politically sensitive ramping figures but adding to clogged corridors in hospitals.

Unlike the existing policy, the planned updated policy states: “Patients must be triaged upon arrival to ED at which point the hospital assumes overall responsibility for patient care.”

The SA Salaried Medical Officers Association (SASMOA) has written an 11-page letter to SA Heath chief executive Dr Robyn Lawrence raising numerous concerns and stating: “We cannot support this policy in its current form.”

SASMOA chief industrial officer Bernadette Mulholland says definitions about clinical care have been changed and raises multiple questions over who bears legal responsibility for patients.

The letter warns the public will be encouraged to call an ambulance if they believe they will get priority treatment on arrival.

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

Opposition health spokeswoman Ashton Hurn has dubbed it a “dump and run” policy. Picture: NCA NewsWire / Naomi Jellicoe

The letter includes savage feedback from frontline doctors such as:

“PATIENTS will die and staff will leave.”

“WE are not staffed to provide this care. If the RAH accepted clinical responsibility at triage as indicated in the document there would be unattended patients in invisible spots in the ED getting no care or indeed no monitoring.”

“INAPPROPRIATE focus on ambulance ramping rather than addressing the root cause of the problem.”

“THIS document fails to reflect the realities of the ED, does little to recognise, and fails to address well documented causes of ambulance ramping (access block and overcrowding) and inappropriately places the burden of responsibility on emergency department staff.”

SASMOA says the new policy is “aspirational” but warns: “To make the document mandatory, knowing the transfers of patients cannot occur safely or at all within the stipulated period, made it hazardous.

“SASMOA is concerned that the policy … is simply a tool to hide or deflect from this failure.”

The letter quotes doctors saying they are under pressure from administrators, such as “inappropriately forcing a clinical action and subverting appropriate decisions made by experienced ED clinicians. The continued pressure and political decision making places patients (and ED clinicians) at significant risk.”

ED doctors also warn the updated policy “allows no room for clinical decision making on priority of patients. A low-priority patient in an ambulance would take precedence over a high-priority, long-waiting patient in the waiting room. This is contrary to the basic principles of ED management.”

SA Health chief executive Dr Robyn Lawrence said there were no changes being made to existing transfer of care protocols, but thanked SASMOA for providing advice.

“The Ambulance Transport and Handover Policy does not relate to transfer of care, as this process remains unchanged,” she said.

“The policy will detail who has legal responsibility for which patients, at which time, and in which location. This policy clarifies that transfer of legal responsibility occurs at triage.

The consultation period is currently underway and SA Health will review all feedback.”

Originally published as Frontline Adelaide doctors’ grim warning on plan to update ambulance policy