Record wait times, more sick patients: NSW’s health crisis laid bare

Sydney Morning Herald, 6 September 2023

Patients are waiting longer than ever before in the state’s emergency departments, while hospitals and paramedics are treating record numbers with the most life-threatening conditions.

The latest hospital data for April to June 2023, released on Wednesday, reveals 43 per cent of patients spent more than four hours between arriving at a public emergency department and leaving, the highest proportion since records began.

That is partly due to an increase in the number of patients needing urgent care, with NSW Ambulance responding to a record number of life-threatening cases and a 12.4 per cent increase in patients requiring resuscitation across the state’s emergency departments.

Here are three key take-outs from the latest Bureau of Health Information quarterly report.
Patients are spending longer in emergency than ever before

A record number of the most seriously ill patients overwhelmed the state’s emergency departments in the three months to June, limiting the ability of nurses and doctors to treat those with less urgent conditions.

Emergency staff scrambled to resuscitate 6385 “triage 1” patients, 700 more than the same three-month period last year, while juggling an additional 117,949 “triage 2″ patients needing treatment within 10 minutes of presenting.

Triage 1 patients present to hospital critically ill, they may be in cardiac arrest, have trouble breathing or suffering major trauma from a car accident, and they may be unconscious. Triage 2 patients may present with serious chest pain, severe fractures or very severe pain.

Australasian College of Emergency Medicine president Dr Clare Skinner said the influx of complex cases was preventing emergency staff from attending to other minor injuries and ailments.

“We’re going to bend over backwards to make sure that category one patient receives the care they need because it’s life-threatening,” she said. “But it means that the other patients in the emergency department suffer longer waits because staff are diverted to that critical patient in the [resuscitation] room.”

The two most urgent categories account for 17 per cent of all presentations but have a disproportionate impact on emergency staff, Skinner said.

“Just imagine working in a system where you’re seeing critical patient after critical patient with no time to debrief or decompress,” she said. “That’s putting an enormous amount of pressure on our senior doctors and nurses.”

The bureau presents data only and does not interrogate the reasons behind the steady increase in the number of people presenting to hospital with urgent care needs. The incline is not COVID-related, but continues the increase that was being witnessed pre-pandemic.
Paramedics are responding to more seriously ill patients than ever before

The increasing severity can also be seen in ambulance data. The 13,525 patients falling into the “highest priority P1A” category (for the most life-threatening conditions needing an ambulance within 10 minutes) is the highest of any three-month period on record.

Of those highest-priority patients, 64 per cent were seen within the 10-minute benchmark, an improvement on last year.

The overall number of ambulance callouts hit 357,491 between April and June, another all-time high, and a continuation of the upward trend of the last decade.

NSW Health Acting Deputy Secretary Joanne Edwards said she was confident in the ability of emergency staff to deal with the increasing severity of cases, although she conceded it was frustrating for the community experiencing increased wait times.

“The thing that we need to really remember and focus on the emergency department is geared towards ensuring care is provided to the most critically ill,” she said. “It’s a bit of a juggle that we always have to work through.”

Despite dealing with more cases than ever before, paramedic response times improved in the past year. For the highest-priority cases, the median response time dropped from 9.1 to 8.3 minutes.

Edwards said NSW Health was constantly monitoring ambulance performance to ensure the system was “as prepared as it possibly can be”.

Patients are staying in hospital longer
The average length of hospital stay has increased 12.5 per cent since before the pandemic to 6.3 days.

There were 483,500 admissions for the quarter, higher than early 2022 but similar to the numbers the public health system experienced pre-pandemic.

BHI chief executive Diane Watson said patients diagnosed with COVID-19 during their admission stayed twice as long in hospital on average as other patients, while those discharged to residential aged care stayed even longer.

“For the small cohort of patients who received a COVID-19 diagnosis and were discharged to residential aged care, the average length of stay increased further,” she said.
Health Minister Ryan Park acknowledged the health system was “facing great pressure and significant strain” and said there were “no quick fixes.”

“It will take time to address these challenges,” he told the Herald.

“It is encouraging to see the NSW Health workforce enjoy a net increase in the April to June quarter, and this will be further boosted by our roll-out of 1200 nurses and midwives to achieve safe staffing levels.”

Health Services Union secretary Gerard Hayes said the special commission of inquiry into health spending would help diagnose issues within the system and could not come quick enough.

“You can’t just look at ambulance ramping and think you can fix the problem, it’s a whole health issue,” he said.