Yes, but is it solvable? Yes, if we ask and answer the right questions, say experts.
I spent the first half of the week at the Health Innovation Community conference run by the AIDH in Brisbane. Apart from coming home with a mild case of conference cough and surviving a vaguely traumatic experience with a lukewarm thai green chicken curry, I learned a lot.
Best panel of the conference for mine came on day two – “Improving patient flow in our public hospitals”. And it was a cracking panel – Professor Clair Sullivan, director of UQ’s Digital Health Centre; Dr Justin Boyle, a researcher at CSIRO; Angie Nguyen Vu, general manager of the Emergency Medicine Foundation; and Dr Andrew Staib, an emergency physician and deputy director of emergency medicine at Princess Alexandra Hospital in Brisbane.
What do they have in common?
Apart from the fact that Professor Sullivan and Dr Staib are one of the more dynamic married couples I’ve ever met – combined IQ of about a billion – they are all coauthors on a piece of research that ought to be compulsory reading for all hospital administrators and public health policymakers in every state and territory in the country.
It’s called “Patient flow in emergency departments: a comprehensive umbrella review of solutions and challenges across the health system”, and you can find it here.
The Australasian College of Emergency Medicine describes access block as the number one, most important issue facing the healthcare system.
“Congestion-related morbidity and mortality is tragic,” said Dr Boyle on Tuesday.
He’s right. He’s also right when he said that ramping, bed block, access block – whatever you want to call it – is an easy media target, and therefore it is very often politicised.
That’s part of the reason why the Department of Health and Aged Care has been going to the urgent care clinics well over and over, with the line about it “reducing pressure on emergency departments”, and how “incredibly popular” UCCs are.
But as HSD reported earlier this week, UCCs have no impact on access block, or ambulance ramping. They are answering another question.
By the way, here is our full coverage of the HIC2024 conference:
- ‘Relieving ED pressure’: do we finally have the answer?
- Synthetic data: filling a gap
- EDs practicing ‘disaster medicine’ every day
- Patient safety in digital health. Are we there yet?
- Is our EMR ROI assessment model upside down?
- Not so much a single front door as a hallway
- EMRs will take a decade to show value
Meanwhile, Dr Staib’s assessment of what needs to be done couldn’t have been clearer. He hates the phrase “patient flow”, by the way.
“This is about hospital capacity,” he said.
“If you run a hospital super empty, patient flow just happens. If you run them at the levels that we tend to then you really need to do some stuff to keep people moving through that system.
“But that only works up to a certain point of capacity. And once you go over that hill, you’re not going to have movement and you are going to have access problems.”
That tipping point is generally agreed to be about 85% capacity.
So what’s the answer?
Dr Staib believes there is “plenty we can do” and that’s because, he says, there is “plenty of latent capacity” in our public hospitals right now.
“There is an enormous amount of latent capacity in acute hospital beds being occupied by people who don’t need a hospital care,” .
“It’s in the order of an extra 70,000 to 80,000 acute emergency episodes of care resulting in an admission a year,” he said.
“Another way to get your head around that is, my hospital for example, has just over 1000 acute beds. This morning 273 of those are occupied by people in a long stable maintenance state.
“And there are things that we can do around that at a hospital level, at a system administration level and at a policy level to deal with that, while people are trying to build new buildings.”
Another strategy would be to improve the provision of inpatient equivalent care, and that’s where digital health comes into its own.
“Digital health absolutely has to be the future,” said Professor Sullivan,
“One of the things that I would like to happen is that we acknowledge that this does require complex technological interventions.”
The bottom line, at least from the point of view of an outsider – a prospective patient, if you will – is that we’re spending a lot of money on UCCs and building new hospitals, when probably effective solutions exist now, within hospitals and within the digital health space.
It takes will to look at those solutions, however, rather than throwing money at the “easy”, “popular”, vote-winning strategies.
Viva la data. Check out the paper here.