EDs ‘canary in coalmine’ of systemic issues in health

NEWS - eHealthNews.nz editor Rebecca McBeth

Overflowing Emergency Departments are the canary in the coalmine of major problems in health, and only by addressing the wider system will issues be resolved, the general  manager of the Australian Emergency Medicine Foundation (EMF) says.

Angie Nguyen Vu participated in a panel at the Health Informatics Conference (HIC2024) in Brisbane in August where she said research shows hospital mortality increases by 67 percent for patients waiting more than 12 hours in ED compared to those who wait six hours.

The panel discussed their involvement in and results of a recent study published in the BMC Health Services Research on patient flow in EDs.

“Ambulance ramping and ED overcrowding is just a symptom of what is happening in the whole health system,” said Nguyen Vu. 

“The ED is the canary where the symptom can be seen, but the coal mine is the whole system where the problem has to be solved.”

She advocated for a multi-faceted, data-driven approach and highlighted ongoing research efforts at the EMF to “systematically examine the magnitude of various factors leading to challenges to emergency access."

Clair Sullivan, director of the Queensland Digital Health Centre, distinguished between ED overcrowding, which is when there are too many people to treat in ED within the resources available, and access block, which is when people wait in the emergency department for more than eight hours to get into a patient bed.

She said these are often conflated, which is unhelpful as they require different solutions. Sullivan told the audience that hospitals could solve the issue of ED overcrowding without having any impact on access block as people who need to be admitted would still not be able to smoothly move through the facility.

She urged health leaders to be bold and brave in thinking about how to solve the problem of access block.

"We need to think of what we do as a complex adaptive system. To nudge a complex adaptive system into a high level of functioning, you actually need transformative change," Sullivan said.

ED doctor Andrew Staib said “every emergency department in Australia every day is practicing disaster medicine”. At just one hospital he works in, the excess mortality is 500 a year. 

“It is about having managed capacity in our hospitals and this study showed there is plenty of latent capacity in our hospitals at the moment,” said Staib.

Justin Boyle from the CSIRO Australian e-Health Research Centre was a lead investigator on the study. 

He said there has been a tsunami of healthcare demand over the past five years and the issue has become highly politicised, but the problems in hospitals are “not due to any inaction from a particular political party”.

Boyle said solutions need to be evidence based and remove opinions and conjecture from the conversation.

Potential solutions included; improving discharge processes and enhancing community care options to reduce unnecessary hospitalizations; leveraging health informatics and data analytics to better predict and manage bed demand; fostering better integration between hospitals, primary care, and community services; and investing in preventative care to reduce overall hospital demand.

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