An emergency medicine conference opening in Sydney tomorrow (Monday) will hear about the need to reduce “unacceptable” waiting times for people presenting to emergency departments with mental health problems.
The 34th annual scientific meeting of the Australasian College for Emergency Medicine (ACEM) will also put the spotlight on access block more generally, as well as gender equality and inclusive workplaces. Profession Gillian Triggs will deliver the ACEM Foundation Lecture: Health Care for Australia’s vulnerable populations; how we can do better?
Sadly, patients presenting to emergency departments with mental health concerns have unacceptable lengths of stay following triage and assessment. The emergency department is inappropriate for the ongoing care of this patient group.
The highly stimulating emergency department environment and design can contribute to further distress and agitation which may increase the risk of behavioural disturbance.”
The conference themes are ‘Impossible is just a perspective’ and ‘Getting the balance right’, and discussions will cover policy, clinical governance and oversight, principles and practice standards, leading evidence, best practice, and patient and community expectations. (See beneath this post for selfies and snaps from pre-conference workshops.)
Sally McCarthy writes:
Emergency departments in Australia and New Zealand are the front door to the health system for those who are acutely unwell or injured. Many of us have waited anxiously in an emergency department late at night with a sick child or with someone who has suffered an acute injury, which may be minor or life threatening. Emergency departments treat all patients based on the severity of the presenting problem rather than socio-economic or health insurance status.
Demand for care in emergency departments reflects changes in the health system and the broader community. If funding for mental health services is reduced, for example, emergency departments are likely to see more mental health patients, or if there is a drug epidemic such as “ice”, we will see more “ice” or other drug users. In the recent winter, many patients were suffering from the effects of the flu which varied from mild to seriously life threatening. On busy weekends, a significant number of patients seen in emergency departments will be affected by alcohol.
Demand for healthcare in Australasia continues to grow. And, like many other countries, Australia and New Zealand’s populations are ageing and living with chronic diseases and cancer, which can be managed by modern medicine. The increase in the prevalence of chronic diseases, and the invariable complications of both the diseases and treatment, have added to the demand on acute care resources which are often only able to be provided in emergency deepartments.
Emergency Medicine physicians usually work only in emergency departments and provide specialist supervision and care seven days per week. They have specialist skills both in resuscitation and diagnosis in the acute phase of illness and injury, as well as a diverse set of procedural and technical skills. They are also deeply committed to the work involved in emergency care and in providing timely, appropriate and high quality care to all of our patients.
From tomorrow (20 November), over 800 members of our College, the Australasian College for Emergency Medicine (ACEM), will meet in Sydney at the Annual Scientific Meeting. Many topics and relevant research in areas relevant to Emergency Medicine will be discussed, such as advances in resuscitation and management of clinical conditions, emergency department design and function, and the treatment of some groups of patients such as mental health patients and illicit drug users.
Focus on access block
There will also be discussion about one of the biggest challenges facing emergency departments, which is “overcrowding”. This phenomenon is also known “access block” and it occurs when patients who are to be admitted to hospital stay in the emergency department for long periods because there aren’t enough available beds on the wards for these patients.
Access block leads to increasing pressure on emergency department staff and long waits for patient and undermines the quality of care that we can provide. Evidence consistently demonstrates that access block leads to increased risk of complications, medical and drug errors, death and increased costs to the health care system.
Access block has historically been seen as ‘an emergency department only problem’; however, it is symptomatic of a health system in crisis where inpatient capacity cannot meet demand. Hence, access block requires a “whole of system” response.
ACEM believes strategies must be adopted to improve the flow of patients into and through hospitals. These include hospitals identifying system-wide process solutions that are tailored to their local needs and the realistic setting of targets for whole of hospital performance.
If you can prevent people coming to the emergency department in the first place, by preventing illness and injury, even better. It is unfair for the patients who use emergency departments and for the staff who work in them to have so much of the pressure in the health system directed at this one point.
Long waits for vulnerable patients
One of the most vulnerable groups to be caught up in this predicament are patients presenting with mental health issues.
ACEM’s policy position is to treat all patients presenting to the emergency department with an acute mental illness with the same dignity and respect afforded to patients presenting with any other condition requiring emergency medical care.
Sadly, patients presenting to emergency departments with mental health concerns have unacceptable lengths of stay following triage and assessment. The emergency department is inappropriate for the ongoing care of this patient group. The highly stimulating emergency department environment and design can contribute to further distress and agitation which may increase the risk of behavioural disturbance.
Data from ACEM’s 2016 Annual Site Census suggest that of all mental health presentations to the emergency department, the majority wait more than eight hours following assessment for an inpatient admission. ACEM is currently piloting research in emergency departments to estimate the prevalence of mental health access block.
Preliminary data suggests that approximately one-third of patients with an acute mental illness wait more than eight hours in the emergency department, with some of these patients waiting much longer.
ACEM believes there are a number of strategies that can be adopted to address these issues, including identifying care pathways in hospitals and the community.
The development of innovative service models that provide access to emergency care for mental health patients, along with safe assessment rooms and improving the safety of staffing models, emergency department design, adequacy of facilities and bed capacity, are measures governments can adopt so patients presenting to the emergency department with acute mental illness receive the best possible care.
Responding to aggression and violence
The increased use of crystal methamphetamine, or “ice”, results in patients affected by this drug presenting to emergency departments and often they are acutely psychotic. Their care can present a number of challenges to the function of emergency departments, including the safety of staff, the patients and carers.
Experienced hospital security personnel with excellent communication skills, an aptitude for learning, and a positive ‘customer service attitude’ are an important emergency department resource to prevent and respond to aggression and violence.
As a member-based organisation, it is incumbent on ACEM to look after those on the frontline of emergency care. We acknowledge emergency physicians and emergency medicine trainees in Australia and New Zealand are confronting these issues while experiencing emotional exhaustion, and a diminished sense of personal accomplishment and even burnout.
ACEM has an ongoing commitment to improve the working lives of the emergency medicine workforce through its membership support, policy and advocacy and education.
Patient care is at the heart of emergency medicine. Emergency physicians and emergency medicine trainees who are enjoying a sustained and satisfying career will be more able to meet the needs of their Australian and New Zealand patients.
It’s this vision of optimal patient care being delivered by a sustainable emergency medicine workforce that is driving ACEM’s efforts in this area.
• Associate Professor Sally McCarthy is Chair of the ACEM ASM 2017 Organising Committee. A senior specialist emergency physician at the Prince of Wales Hospital in Sydney, she is a former ACEM President.
ACEM is the peak body for emergency medicine in Australia and New Zealand, responsible for the training and education of emergency physicians and advancement of professional standards in emergency medicine.
Selfies and snaps from pre-conference workshops