Patiently waiting: Inside an overcrowded hospital emergency department
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Patiently waiting: Inside an overcrowded hospital emergency department

Lines that regularly go out the hospital's front door. Staff scared to take responsibility for triage in overcrowded conditions. Patients stuck on trolleys as ambulances are ramped. Another Code Yellow called. This is the emergency inside a Perth emergency department.

“Sorry about the wait. There’s no room.”

Time and time again nurses and other hospital staff apologise to people who are clearly sick or in pain.

It is a Monday afternoon in the emergency department at Sir Charles Gairdner Hospital and staff are evidently used to apologising for the department being well over capacity.

WAtoday visited the Perth hospital 24 hours before reports emerged about an explosive email from SCGH director of emergency medicine Peter Allely outlining the major concerns he had about the hospital's ED.

He warned there would be "more avoidable deaths" in the coming months unless changes were made. He said there had been no increase in doctor and nurse numbers over the past decade, while patient numbers increased by 48 per cent since 2008.

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On Monday about 1pm the hospital recorded 62 patients in the ED, while 44 is capacity. Not long after we left they called a Code Yellow, signalling an internal emergency. While we were there, for not even three hours, a Code Black was called, a cry for security in response to a potentially dangerous situation.

Yet staff said it wasn't a particularly bad afternoon for the hospital. This was now the norm.

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At one point on Monday afternoon eight ambulances were ramped with their patients inside, two people were stuck on stretchers with ambulance officers waiting to be allowed through. They couldn't get in the door.

And they would be waiting a while. The department waiting room was packed, with the hordes of people never seeming to decrease in number.

There was a constant line of people who needed to stand and wait until they could talk to the triage nurse. It was 12 people deep at its worst, and six at its best. But this was not bad in comparison to the previous week. The line often went out the hospital's front door with patients standing outside on the path. People waiting outside until they could wait inside.

About 20 or so others were left sitting in the room, they had already been seen by one of the two triage nurses rostered on.

Too sick to stand

A wait in line often takes 40 minutes.

“This is bullshit! We’re all sick and can’t stand here waiting to see a doctor,” one man yelled, saying he had recently had brain surgery and needed help with his tumour which he said felt like it was “falling out” of his nose.

I’m in pain, we’re all in pain and we can’t sit down because we’ll lose our spot in the line

Patient

The distressed middle-aged man was now standing third in line.

He was flanked by several frail elderly people, one in a wheelchair and another using a walking stick, struggling to stand or even sit, they were in so much pain. One lady was leaning over a walker and another over a nearby chair just so they wouldn’t lose their place in the queue.

“I’m in pain, we’re all in pain and we can’t sit down because we’ll lose our spot in the line,” the man explained.

“Why are there only two windows open?

“I’m going to have to wait three hours. I already went to a doctor and was told to come to hospital so here I am. I’ve just had a tumour removed a week ago, and see this (pointing to his head), it’s hanging out of my nose.”

Ambulance ramping at Sir Charles Gairdner Hospital on Monday. At one point there were eight parked outside ED.

Ambulance ramping at Sir Charles Gairdner Hospital on Monday. At one point there were eight parked outside ED. Credit:Lauren Pilat

A young nurse approached the man as he stood in line trying to calm him down, asking him to lower his voice. Within minutes at least five additional nurses and four security guards were on-hand.

The staff’s quick action is understandable, with a recent increase in violence and aggression towards the hospital’s ED staff.

“I’m not going to hurt you or anyone, I’m not mad at you, I’m ashamed of the system,” the man explained, emotional at the situation he found himself in.

“This is the best hospital in Perth and look at it, we’re all going to have to wait for ages. It’s not on, we all pay our taxes.

“Why can’t you put another staff member on?”

Within about 10 minutes the man was taken to the second waiting room in a wheelchair by a nurse.

‘Is anyone waiting to see a doctor?’

The man’s outburst came after a female staff member addressed the people waiting in line by asking the somewhat absurd question: “Is anyone waiting to see a doctor?”

The staff member went on to consult with an elderly lady in a wheelchair at the front of the line, saying she was unable to take her through yet as they were too busy.

The elderly woman was forced to discuss her personal health concerns with the doctor in front of other waiting patients.

The same happened with several other patients; one a 78-year-old man who had to share his graphic health issues after a recent surgery in detail with a doctor who told him “there was not enough beds”.

When the elderly man was eventually taken through to the department, his wife was told she couldn’t come with him and would have to stay in the waiting room. There was no room for family who wished to support their unwell loved one.

Patients caring for patients

At one stage a woman entered the room shaking with tears streaming down her face from pain, confused about who to see and what to do. While she cried silent tears, the loud cries of another woman echoed around the room as her carer attempted to calm her.

A patient sitting down nursing her own wounded forearm assisted the woman shaking uncontrollably and walked her from the back of the line to the nurse’s window to get someone’s attention.

A male nurse saw to the convulsing woman before asking her to have a seat and wait for him to return. In the meantime a male patient left the back of the line to sit with the woman and console her. The nurse eventually returned and escorted the woman through to the department.

Meanwhile, an ambulance officer and several nurses were waiting with patients who had nobody with them for support.

Waiting room medicine - no privacy here

On several occasions nurses came out to assist patients, saying the hospital was at capacity and there was no room in the ED. Instead they were forced to consult with people in the waiting room.

On four separate occasions in the space of two-and-a-half hours nurses brought out a trolley with a blood pressure machine and thermometer, testing patients’ levels as they sat there.

One elderly patient in a wheelchair was given panadol while waiting to be taken in to the department to relieve her pain. The nurse said she’d have to administer the medicine in the waiting room because she was unable to give an estimated wait time of when she’d see a doctor.

At SCGH ‘waiting room medicine’ has become common practice.

Staff are reluctant to be responsible for triage under such stressful conditions, scared of being blamed if something goes wrong while they are struggling to cope with the overcrowding.

The staff’s concerns come after a death in the hospital’s waiting room two years ago was linked to inadequate staffing levels and ramping, as revealed by Dr Allely earlier this week.

Four Hour Rule

On the waiting room wall on Monday, under the Four Hour Rule poster - a government policy designed to ensure patients do not wait too long for treatment - is a sign showing the hospital met the rule 64 per cent of the time in the week ending March 3.

Introduced in WA hospitals in 2009 by the former government, the four hour rule’s aim is to have 98 per cent of ED patients seen and either admitted, discharged or transferred within four hours from time of triage.

On Monday, a SCGH nurse advised one patient visiting Perth from Melbourne, who had previously been taken through to the department, not to return to a “public hospital” in the future because they were far too busy.

Lauren is a casual reporter and producer for WAtoday.

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