The State Government has welcomed findings of an independent review which investigated competing claims of inappropriate patient prioritisation at hospitals.
The Government has also committed to implementing the five recommendations made in the review.
The independent review found no evidence to support claims that clinicians are being directed to offload patients ramped in ambulances ahead of sicker patients waiting in emergency departments, nor that deaths had occurred as a result.
Likewise, the review found no evidence to support opposing claims that waiting room patients are inappropriately prioritised over those in ambulances.
The review identified a trend for waiting room patients to be seen more quickly than those conveyed by ambulance – noting the causes of this trend would require further investigation.
The review was conducted by two highly experienced doctors – former Royal Adelaide Hospital trauma specialist and 2009 South Australian of the Year Dr Bill Griggs, and nationally respected doctor and SA Commissioner for Excellence and Innovation in Health Professor Keith McNeil.
The review was ordered immediately by Health Minister Chris Picton after SA Salaried Medical Officers Association President Dr David Pope made concerning comments on 7 December that hospital administrators were directing clinicians to offload ambulance patients over those with higher clinical priorities in the waiting room – and that this led to patient deaths.
Last week, following the death of a patient who waited 10 hours for an ambulance during a night of high ramping, the Ambulance Employees Association made counter claims – that waiting room patients are being prioritised into the ED over patients ramped in ambulances and that this is putting the community at risk by leaving ambulances delayed in responding.
Given these two starkly differing accounts, the Government asked the independent reviewers to expand their scope to look at both unions’ claims.
Delivered to Government yesterday, the review states:
“No evidence was found to support Dr Pope’s contentions that patients had died (nor could we find any evidence of overt harm occurring to any patient) as a result of any instructions given by hospital administrators to offload ambulance patients as a priority over waiting room patients of known greater (or even of similar) clinical need.
Furthermore… there is no evidence that patients conveyed to hospital by ambulance are given treatment priority over those in the ED waiting room.
Likewise, the case of a patient death cited by the AEA could not be definitively linked to the clinically inappropriate prioritisation of waiting room patients over ambulance patients, although over the past 12 months, data shows that there is a trend for non-ambulance arrivals at EDs to been seen more quickly than those conveyed by ambulance.”
“We could find no evidence that ED staff had been directed to give lower priority patients in ambulances priority over higher triage category waiting room patients, and likewise, could find no definitive evidence of the counterfactual situation…”
“We found absolutely no evidence that practices had been enacted, or that data was being manipulated, to present a more palatable view of the ambulance ramping situation.”
The report includes data of the waiting times to be seen (in minutes) for ambulance and non-ambulance (i.e. waiting room) arrivals at major metropolitan emergency departments:
There is a clear and consistent SA Health policy – in place for many years including under the former Marshall Liberal Government – that states patients in ambulances may be prioritised over those in the waiting room if they have been triaged as “an equal category”, in order to allow ambulances to get to other emergencies in the community.
The Government has accepted in full the five recommendations made by the reviewers, including strengthening the wording of that policy, and ensuring that senior ED clinicians on each shift have responsibility for oversight of the relative risk of the waiting room, the ambulance ramp and the community response to Triple Zero calls.
A working group, chaired by Professor McNeil and including clinicians nominated by the ambulance, doctors’ and nurses’ unions, will be commissioned to oversee the implementation of the recommendations.
In 2022, the Government ended a legal direction issued under the former Liberal Government requiring the state’s hospital CEOs to offload all ambulance patients within an hour regardless of acuity of other patients waiting in EDs – an order which Dr Pope condemned at the time as “extraordinary” and “gaslighting” staff.
The Malinauskas Government’s focus remains on fixing the ramping crisis by creating more capacity in our hospital system – with 550 additional doctors, nurses, ambos and allied health staff already employed, and more than 150 additional public hospital beds coming online this year.
A copy of the independent review can be found here.
As put by Peter Malinauskas
Our doctors, nurses and ambos do extraordinary work everyday, making life and death decisions.
From the day we took office, my Government’s focus has been on enacting policies which support our medical staff to save lives –more staff, more ambulances, and more beds.
I thank the reviewers for their thoughtful recommendations to further assist our clinicians to ensure patients get the best, most timely care – whether they be in a waiting room, an ambulance, or in the community.
As put by Chris Picton
I welcome the outcome of this report and the data analysis and recommendations that have been provided.
SA Health has for many years had a policy regarding triaging and supporting where clinically appropriate offloading ambulances. That policy will now be strengthened as recommended in this review.
The past week has been a solemn reminder of the need for ambulances to be released from hospitals to respond to urgent cases in the community.
We know one of the key ways to reduce ramping is to open more staffed beds and create more capacity within our hospitals – which is exactly what we are doing.
This will help both our ambulances to respond more quickly to community cases, as well as faster responses to patients in the emergency waiting rooms.
We have accepted all five recommendations made by the reviewers and will now get to work on implementing them together with our clinicians.
