Union takes WCH management to employment tribunal as doctors say they’re at their ‘at wits’ end’ over understaffing

The nursing union has moved against the management of the Women’s and Children’s Hospital, saying it is dangerous for staff and patients.

The doctors’ union says the Women’s and Children’s Hospital is not safe and the nurses’ union is taking management to the Employment Tribunal.

Both unions spoke out on Wednesday. But as the statements were being made, just six patients were being treated in the 26-capacity ED, with three waiting and an average wait of 20 minutes.

The union focus on the WCH follows drama at other hospitals this week, with the Royal Adelaide Hospital and Queen Elizabeth Hospital declaring internal emergencies as demand overwhelmed capacity.

SA Salaried Medical Officers Association chief industrial officer Bernadette Mulholland said the WCH had too few clinicians, not enough treatment spaces and average waiting times well above national averages “putting children’s safety at risk”.

The outside of the Women's and Children's Hospital in North Adelaide.

“The paediatric ED at the Women’s and Children’s is in crisis,” she said.

“The doctors have knocked management’s door down with warnings and proactive suggestions and are at their wits’ end.

“They are simply not being listened to by management.”

WCH ED clinician Dr Davinder Gill said: “The ED is both undersized and understaffed on all comparative measures.

“If this hospital was in any other state, it would have 10 additional doctors and 13 additional treatment spaces.”

Australian Nursing and Midwifery Federation state secretary Adjunct Associate Professor Elizabeth Dabars said members had reported longstanding issues with ED staffing “which have created dangerous conditions for WCH patients and staff alike”.

The union is seeking orders in the tribunal to increase staffing, including a base staffing requirement of one nurse to three patients at all times.

Hospital officials released a statement saying: “Every child who presents to our ED will receive the treatment they need.

“While our hospital has experienced increased demand in recent months, a number of measures and resources have been implemented to meet the needs of all our patients.

“The Paediatric Emergency Department (PED) has introduced a range of new positions to help improve flow and quality of care, including the GP Liaison Consultant, additional social worker, ED and mental health positions and additional medical staff.

“Our PED pods currently offer nine additional treatment spaces during the busiest time of day and we are continuously working with clinicians to develop ways to improve patient flow through the PED.”

NEW VIRTUAL ED OPENS AT WCH

It comes as sick children can now see paediatric emergency doctors and nurses at the Hospital without actually visiting the hospital, thanks to its new Child and Adolescent Virtual Urgent Care Service.

The video consultation is the latest effort to unclog emergency departments and comes as the Royal Adelaide Hospital and Queen Elizabeth Hospital also remain in a declared internal emergency due to overwhelming demand, and the new ED at Flinders Medical Centre has failed to end ramping.

The WCH service started this week for children in metropolitan Adelaide aged one to 18 and allows a consultation over a device with a camera such as a smartphone for non life-threatening conditions including minor injuries, allergies, ear pain, fever, rashes and mental health issues.

The waiting time depends on the child’s condition and how many people are using the service – a “virtual waiting room” puts patients in a queue

It can also refer families to facilities close to their home if the child needs services such as X-rays or blood tests.

An emergency nurse will initially assess the child and if the nurse decides the child needs to speak with a doctor the family will be placed back in the virtual waiting room until the doctor is free. They may also be referred to another healthcare service.

The service is available seven days a week from 1pm to 8.30pm.

You can visit the virtual site HERE.

‘MAJOR INCIDENT’ ALERT FOR RAH AND QEH, NEW FLINDERS ED OVERUN

The “major incident” alert at the RAH and QEH, which includes cancelling elective surgery and moving patients to private hospitals, comes as Flinders Medical Centre faces ongoing ambulance ramping despite its $8.5m new emergency department opening last Thursday as the biggest in the state.

It is the third month in a row the RAH has declared such an internal emergency, while FMC had one in May.

Executive Director, Operations, of the Central Adelaide Local Health Network Brendan Docherty said the RAH and QEH had experienced a high level of emergency demand over the past 72 hours.

“We have initiated a major incident alert to assist the network to manage this demand in a co-ordinated manner and to ensure we are operating in a safe environment,” he told staff on Tuesday.

“Our focus over the next 12-24 hours is to secure additional inpatient bed capacity – public and private – additional community capacity and support for our patients. This will assist us to appropriately move patients from the emergency departments.”

The Network Incident Command Centre is co-ordinating resources to help emergency patients to the appropriate services and is meeting every three hours to review progress.

All available clinical staff have been ordered to attend ward rounds and meetings to review all patients to speed discharge where appropriate.

They are being asked to consider any community based options or alternative care pathways, including treating patients in their own homes.

The declaration came as the Ambulance Employees Association reported shortages of ambulances in the Adelaide Hills and Fleurieu Peninsula.

Opposition health spokesman Chris Picton said the government promised months ago that ramping would be fixed “almost immediately.”

“This declaration shows that the system is completely overwhelmed and the care of patients is at risk because of a lack of resources,” he said.

“Steven Marshall’s supposed fix was his project at Flinders Medical Centre which saw 30 inpatient beds closed and replaced with 30 emergency beds. That clearly hasn’t worked.

Meanwhile, despite its new emergency department opening last week, Flinders Medical Centre was on Code White on Monday night – treating more people than its official capacity – as ambulances lined up in its carpark waiting to hand over patients.

At 9.30am on Tuesday it was still on Code Red, treating 69 people in its new $8.5m 74-capacity ED, and the average waiting time to be seen was 188 minutes.

There were also 40 people stuck in the ED who had been treated but were waiting for an appropriate bed, including 12 who had been waiting between 12 and 24 hours.

While the government had pointed to the opening as a major step to ease ramping, the Ambulance Employees Association and SA Salaried Medical Officers Association have seized on the situation as evidence more resources are needed.

The AEA said cases ramped at FMC on Monday night included an elderly patient who on the ramp for seven hours, and 15 emergency calls had no ambulances available.

“This is not a system coping, this is a system collapsing,” it said in a statement.

An elderly patient ramped for 7-hours at FMC. Crews unable to transport to RAH without prior authorisation. 15 emergencies in the community last night with no ambulance to send.

This is not a system coping, this is a system collapsing.#saparli#stoprampinghttps://t.co/3DT75V8Oj4

— Ambulance Employees Association (SA) (@aeasa1981) August 30, 2021

SASMOA noted the situation was the same across the city on Monday night, with all public hospitals operating above their official ED capacity.

Government officials say ramping is a national phenomenon and has been exacerbated by Covid-related protocols in hospitals.

All Metro EDs in white. No beds, not enough clinicians - we know beds have decreased and patient presentations increased - could this get any worse? #TimetoCarepic.twitter.com/yVRlGBpCtt

— SASMOA (@sasmoa4doctors) August 30, 2021

Meanwhile, more than 600 people were put in taxis after ringing triple-0 for an ambulance from January to May – and paramedics asked for the system to be expanded after being fed up with being called to cases which were not genuine emergencies.

Parliament’s Budget and Finance committee was told on Monday that on-road paramedics can now call a cab, as can call centre paramedics, for non-urgent patients — but a paramedic always assesses the situation to ensure a taxpayer-funded taxi is a better alternative than tying up a paramedic crew.

The State Government and SA Health has been asked for comment.

Originally published as Union takes WCH management to employment tribunal as doctors say they’re at their ‘at wits’ end’ over understaffing