Primum non nocere

There is an erudite weblog to help health care providers shorten waiting times and improve patient flow.

It would be nice to say that similar issues are not happening in Australia – but unfortunately we are not immune to catastrophic administrative policies which destroy hospital capacity and we too are seeing similar problems throughout Australia.

In Western Australia there are substantiated reports of patients dying in tertiary adult Emergency Departments, having been kept waiting for many hours. These cases never made it to the press – due in most part to the compassion and empathy with which the Emergency staff explained why the hospital system was suffering such problematic delays.

An example of a tragic incident involving an Australian ED is the death of a 30 year old man -who presented to the ED suffering ‘epigastric pain’ – he died following a cardiac arrest having been delayed for four hours in the ED waiting room. This is a tremendously sad incident, made all the more unpalatable by the typical political and bureaucratic response from administration and government. The typical response to such ‘incidents’ is that they are ‘not a system problem’; ‘are wholly unexpected’ and ‘unpredictable’.

Administrators say on the one hand that EDs are safe (despite being dangerously overcrowded) and openly praise the staff for their commitment; yet on the other hand ‘blame’ the same staff for making mistakes (without any evidence or real information) when situations arise as a result of overcrowding, access block and poor management.

Of course the people making these comments have no idea what actually happens in the Emergency Department or what really happened in the tragic cases outlined above. They simply tow the party line; cover their own political butts; plead ignorance to published and peer reviewed journal articles and seek solace in the Confederacy of Dunces.

In reality the evidence is plain to see, easy to read and possible to fix. But ‘head in the sand’ leadership persists – and we face the same metronomic attitudinal problem of treading water in the pullulating and growing megalopolis that is the Emergency Department

• Association between hospital overcrowding and mortality
  • Peter C Sprivulis, Julie-Ann Da Silva, Ian G Jacobs, Amanda R L Frazer and George A Jelinek
• Increase in patient mortality associated with ED overcrowding
  • Drew B Richardson
• Dying risk up 30% in Perth hospitals
• The deepening crisis
• Dear Potential Patient…

For those who work in our EDs the frustration is palpable; tolerance at an all time low and empathy has surrendered to obloquy. Patient assessments are done in the waiting rooms, triage areas and on ‘ramped‘ trolleys – and it is now routine to trawl these ‘holding zones’ to define those most seriously at risk of imminent harm. On a recent such ‘reconnaissance’ I managed to ‘redefine’ the spatial positioning of two patients, one with hyperkalaemia (>8) and ascending paralysis; and a second with progressive TEN. I now find it difficult to leave the front line of triage, my vantage point to the appendiceal neoplastic sprawl which now defines our ‘extended’ treatment area.

Yet, our reason for entering this profession was to care, to cure and to console – please afford me the opportunity of returning to this role and continue to adhere to the principle – Primum non nocere – above all do no harm.