Royal Hobart Hospital considers opening intensive chair unit amid overcrowding woes

OVERCROWDING at the Royal Hobart Hospital is so severe that health officials are planning to put patients in alcoves and storerooms — and given a hand bell to call if they need help.

Dr Craig Quarmby, executive clinical director at the Royal Hobart Hospital, talking to reporters on Monday. Picture: NIKKI DAVIS-JONES

OVERCROWDING at the Royal Hobart Hospital is so severe that health officials are planning to put patients in alcoves and storerooms — and given a hand bell to call if they need help.

A proposed Over Capacity Protocol, seen by the Mercury, lists areas staff might consider moving patients to when the hospital is full and the emergency department is struggling to cope with demand.

The draft document, written by the hospital’s executive clinical director last week, notes: “In the context of the hospital operating with a deteriorating escalation status the THS needs to operate differently.”

“This protocol describes the mandated actions necessary when the Emergency Department (ED), as the main point of entry for emergency admissions, has more patients than it can safely care for,” the document states.

DOCUMENT EXTRACTS “Unlike many departments, the ED is unable to cap demand when all available patient care spaces are occupied. The risk of serious incidents happening not only increases with every additional patient that arrives over and above capacity, but this is concentrated in one geographical area. “The Over Capacity Protocol acts as safety valve to provide hospital space for acutely admitted patients when the functioning of the ED is being compromised.” “An over capacity space is an area that is used to accommodate an additional patient/s that is over the opened number of beds on that ward. An over capacity space does not require additional staff.” “Staff must ensure a patient receiving care in the over capacity space area must be informed of how to call staff for assistance using a hand bell.” “Be mindful of the fact that when staff are hungry, tired, thirsty and stressed that this inevitably can lead to reduced performance and at worst could lead to injury or increased incidents.”

The document identifies alcoves off corridors, a waiting bay, a family room, a store room and a gym as places to put patients.

It is to be put into action during busy periods within weeks.

“Staff must ensure a patient receiving care in the over capacity space area must be:

informed of how to call staff for assistance using a hand bell,” it says in part.

The hospital is struggling to cope with a surge in demand and has been operating at the highest level of its escalation plan.

A Government spokeswoman said the “storeroom” described in the documents was actually a large room with an ensuite, which was temporarily being used for storage.

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Patients have been forced sleep on the floor of the emergency department after waiting three days for admission to the psychiatric ward.

Delays have become so bad that reclining seats and trolleys were mobilised to cope with people waiting overnight.

The document tells staff to find people who are about to depart from the hospital who can be moved.

“Ward rounds/huddles should be held each morning … (they) will identify the definite discharges and known transfers for the day.

“It is from these definite discharges and transfers that the patients will be identified to vacate their beds if needed.”

The protocol provides a script for nursing staff to read to patients who are being turfed from their beds.

A patient waiting for treatment at the Royal Hobart Hospital makes a bed on the floor.

“Please be assured this is a short term measure,” they are instructed to say.

“Your safety remains our priority and you will continue to receive the care you need, while we work to relocate/transfer/discharge you.”

RHH executive clinical director Craig Quarmby said the document had been circulated for discussion.

“Over-capacity protocols are commonly used by large hospitals to manage high demand,” Dr Quarmby said.

“The proposed RHH protocol draws on the experience and protocols of other hospitals around Australia and overseas.

“The measures under discussion are for strictly identified patients who are ready for discharge or transfer from the RHH.

“Instead of these patients waiting in beds for completion of their discharge process — for example awaiting medicines or a family member to collect them — these well patients are moved out of the beds so they become available for sick patients in ED.

“The patients will be in sight of staff and will have a bell to attract attention in case they need any assistance.”

Labor Health spokeswoman Sarah Lovell speaking to reporters about mental health patients having to sleep on the floor of the Royal Hobart Hospital. Picture: LUKE BOWDEN

Labor’s health spokeswoman Sarah Lovell said the document was a testament to the crisis in the state’s health system.

“The fact that they are even considering making a change like this is horrifying and just highlights the absolute crisis in the hospital system and the fact that the Minister (Michael Ferguson) is not responding,” she said.

“He’s not got a plan to fix this. He’s not got a plan to improve things at all.

“But clearly it’s worse than people even realise. this is this protocol is reminiscent of something you would see when there’s some kind of natural disaster or some kind of state emergency — looking for any vacant space to put people and give them a bell to ring.”