Call to prioritise action as emergency department demand again reaches crisis point

Categories: Public Sector News

The ANMF (SA Branch) is deeply concerned by the continuing activity levels experienced in our metropolitan emergency departments.

In a statement to media released today, ANMF (SA Branch) CEO/Secretary Adj Associate Professor Elizabeth Dabars AM said:

“In the past couple of weeks, we have seen attendance at emergency departments and ramping of ambulances once again reach crisis point.”

“Mental health presentations continue to be significant contributors to the spike in demand despite the relocation of mental health beds from Glenside to the RAH.

“The ANMF (SA Branch) is continuing to closely monitor demand at major metropolitan hospitals and regularly engage with nursing staff, Local Health Networks and the Health Minister to identify other measures to alleviate the pressure.

“However, implementing the longer-term measures (detailed below) recommended to the Minister last year to start addressing the issue needs to remain a critical focus for the State Government.

“At this time, there has been little progress in improving patient flow or in addressing the blocks to discharge identified as key requirements for emergency department ramping to be resolved.

“While we welcome the ‘End ramping’ workshop to be held next week led by the Central Adelaide Local Health Network, we are aware SA Health is also holding a workshop to further focus on the issue. This is a forum we would expect to be engaged in, along with the other key stakeholders representing the hundreds of extremely tired staff who are being affected by this issue on a daily basis.”


  1. Increase sub‐acute and post‐acute care capacity by:
    1. creating alternative capacity for disability clients awaiting placement/packages; and
    2. creating alternative capacity for older people awaiting aged care packages/placements/requiring further convalescence.
  2. Improve flow through the hospital and maintain bed availability for expected ED admission requirements by:
    1. creating escalation points for (doctor/nurse) review of discharge for patients in hospital on a daily basis where capacity may not meet the demand expected from the ED and elective loads for the day ahead;
    2. creating a mini ‘code yellow’ system to maintain availability on daily basis. There is the continuing problem of the lack of availability of senior clinical (medical and nursing) out of hours to lead decision making. Things still get noticeably worse out of hours and on weekends.
    3. ensuring that any consultant/medical review of admissions from the ED are undertaken within the targeted time. Perhaps reserve beds in nominated wards that can act as assessment, confirmation capacity rather than holding in the ED (to deal with situation where consultant reviews are delaying the transfer of patients assessed within the ED as admissions to inpatient units).
    4. creating a space for discharged patients awaiting pick-up and no longer requiring care and supervision.
    5. increasing the ‘pull capacity’ of Metropolitan Referral Unit and Royal District Nursing Service. RDNS have been in the RAH for the last week but have limited capacity to take patients. The packages should be made more flexible and individualised – particularly around Activities of Daily Living and basic care supports.
  3. Increasing mental health service capacity including:
    1. Addressing issues of toxicology/substance abuse;
    2. Investigating the increased forensic load;
    3. Addressing issues of workforce supply;
    4. Increasing availability of and access to beds, subject to recruitment of sufficient staff and planning;
    5. Fast-tracking community team reforms (outlined in Deloittes and related reports that are now at least 18 months old) that will increase community capacity and incentives for attraction and retention into those roles. This will enhance capacity to assess, treat and sustain consumers in the community to reduce presentations to EDs.
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