Triple-0 dispatch flaws exposed but key targets hit for first time since 2020

The true state of Victoria’s healthcare system has been exposed in a new report, revealing how key targets for ambulances, surgery and emergency departments are being missed.

Ambulance Victoria is struggling with “workforce constraints”, the Department of Health has admitted, as new numbers show they failed to meet key response targets for urgent code 1 cases last financial year.

The Department of Health’s annual report, released last week, revealed health services had failed to meet key benchmarks across the ambulance service, elective surgery and emergency departments.

The data shows paramedics reached 62.8 per cent of urgent code 1 incidents within 15 minutes, falling short of their 85 per cent target.

“The result is lower than the target due to record-breaking demand and workforce constraints, which have compounded capacity issues already in the system,” the report states.

“Ambulance Victoria is deploying a range of strategies to optimise the availability of ambulance resources and stabilise performance.”

It comes as Victorian public hospitals missed their elective surgery target by more than 40,000 patients in the past financial year, despite the government’s promises for a record-breaking surgery blitz.

Victorian public hospitals missed their elective surgery target by more than 40,000 patients last financial year. Picture: iStock

The report shows 190,058 patients were admitted from the elective surgery waiting list in the last financial year, more than 17 per cent short of their 230,100 target.

Almost one in two patients who needed “semi-urgent” surgery waited more than 90 days, with only 55 per cent admitted in time. This was well short of their target of 83 per cent.

One in four patients waited more than a year for “non-urgent” or category three surgery, with the department missing their target of 95 per cent.

The only elective surgery category to meet its target was urgent, category one elective surgery, with 100 per cent of patients admitted within 30 days.

The report blames the shortfall on “workforce challenges, hospital pressures resulting from the Covid-19 pandemic and delays to capital projects” caused by supply challenges in the construction industry.

The report shows emergency departments continue to struggle with demand, with more than a third of patients not treated within the clinically recommended time.

Category one emergency patients – which refers to those who need resuscitation – were treated immediately in 100 per cent of cases.

Almost half (48 per cent) of all patients were in the emergency department for longer than four hours – a measure that reflects not just demand in the ED but difficulties transferring injured and ill patients to other hospital wards due to bed shortages.

Emergency Department waiting times continue to be an issue. Picture: AAP

The report says they missed treatment time targets because of “increased demand, patient complexity and supply constraints, which are placing significant and sustained pressure on emergency departments” alongside infection control measures slowing patient flow.

This number was even higher for those whose emergency was mental health related, with 60 per cent of all patients having to spend more than four hours in the ED, and 60.5 per cent waiting more than eight hours for a mental health bed.

The report says the “demand for inpatient bed-based services continues to exceed what the system can supply”.

“People presenting with complex and high-care needs require intensive care beds,” it says.

“Without access to these beds people require treatment in the emergency department or general ward until a bed is available.

“Bed closures at some services have also impact [sic] the result.”

Emergency department delays flowed through to paramedics, who were frequently stuck outside hospitals – instead of out on the road responding – to care for patients waiting to be admitted, with more than 38 per cent of patients waiting more than 40 minutes.

Ambulances were frequently stuck outside hospitals while waiting to transfer patients this past financial year. Picture: Luis Enrique Ascui

The report blames ramping times on “changes in patient complexity, longer treatment times and hospital patient flow”.

While issues such as workforce shortages hindered their ability to respond in time, the annual data does show patients continued to receive good care from paramedics.

More than 97 per cent of patients were “very satisfied or satisfied” with paramedics’ service while the agency met the key targets for transferring suspected stroke patients within the ‘golden hour’ of treatment and managing patients with severe pain.

Mental health services continued to be hit with “workforce, recruitment and retention issues”, which was blamed for the low number of (43 per cent) of mental health carers who reported positive experiences for seeking care.

Triple-Zero

Victoria’s triple-zero agency repeatedly took too long to dispatch ambulances — failing their target every month — last financial year, despite a major boost to call-answering times.

The Emergency Services Telecommunications Authority took more than two minutes and 30 seconds to dispatch an ambulance to one in five urgent calls, their latest annual report shows.

In the same period, call-takers answered more than 90 per cent of ambulance calls within 5 seconds.

The report, which blames factors including high numbers of inexperienced staff and ambulance availability, shows ESTA dispatched 79.7 per cent of Victoria’s code one events within 150 seconds – well short of their 90 per cent benchmark – and a 3.0 percentage point decrease compared to 21-22.

“This was influenced by a range of factors, including increased call processing times due to a new cohort of inexperienced CTD employees, more complex events requiring additional triage to establish the most appropriate event classification and AV operational capacity,” the report states.

This was the first annual report to capture the aftermath of a damning independent review into the agency, which was released in September 2022 and found 33 Victorians potentially died after triple-0 and ambulance delays.

The report says they were “actively” working on the recommendations and points to changes, such as a 25 per cent increase in frontline call takers and major improvements to call-answering times.

ESTA figures were released last week. Picture: Asanka Ratnayake

90 per cent or more of triple-0 ambulance calls were answered within 5 seconds in every single month bar one – July 2022 – in the past financial year.

“We worked hard to improve our service,” acting ESTA chair Mary Delahunty and chief executive Debra Abbott’s foreword states.

“In August 2022 we met our monthly ambulance call answer performance targets, the first time since November 2020.”

Emergency calls were up by 5.5 per cent compared to the 2020-21 pre-pandemic rate but the authority still met their annual call-answering targets for every agency bar SES.

They fell short by less than seven percentage points, answering 83.6 per cent of the agency’s emergency calls.

“Call activity to VICSES storm queue is extremely dynamic – bad weather usually sees call surge and the limited notice can drive monthly non-compliance,” the report states.

The report also reveals there were four “potentially high risk” adverse events reported to the independent regulator — in line with “pre Covid-19 levels” — and that more than one in five triple-0 ambulance call-taker trainees had left the year-long course.

More than 50 of the 231 employees enrolled in the ambulance call-taker training last financial year had their training cancelled, because they either failed the assessment or withdrew.

Dropout rates were lower for police (158 total trainees) and fire (51 total trainees), hovering at about 13 per cent, while cancellation rates for dispatcher training across all four agencies was low.