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Health – Emergency Departments

Dr Rosalie Woodruff MP

Dr Rosalie Woodruff MP  -  Monday, 6 June 2022

Tags: Emergency Department, Health

Dr WOODRUFF - Minister, an important measure of the performance of an emergency department is how many patients are being seen on time. You'd know when a patient arrives at the emergency department they're allocated a triage category based on their condition. Each category has a clinically recommended time frame for treatment and a national benchmark target for how many patients it's acceptable to see outside that time frame. Those targets are important for all the categories but they're particularly critical for category one patients, who are in an immediately life-threatening condition.

The standard set for category one is common sense. Every single patient in this category has to be seen and treated immediately when they arrive at an emergency department. Was that the case in Tasmania during the year of 2020-21 across each of our emergency departments?

Mr ROCKLIFF - We'll see if we can provide that information for you.

More broadly, in recent years our emergency departments in Tasmanian hospitals have experienced increasing pressure due to rising numbers of people presenting for care, especially at the Royal Hobart Hospital. This is caused by several issues, including a growing and ageing population, relatively high rates of chronic disease and an increase in patients with mental health issues presenting to EDs, although hopefully our PACER initiative will support some improvement in that.

In the first 10 months of 2021-22, there were 144 783 emergency department presentations statewide. If this trend continues, it is expected that in the full 2021-22 financial year, we'll have a similar total number of presentations to last year. We have seen substantial staffing increases in our emergency departments with a statewide increase in staffing of 4.4 per cent which amounts to some 24 full time equivalent staff over the first nine months of 2021-22 and this follows sizeable increases in recent years. In regard to COVID-19 of course extensive planning and investment in hospital capacity along with the extraordinary dedication and resilience of our health staff to ensure that our health system was able to manage the surge-cases in Tasmania.

Also, I want to acknowledge the COVID @ home program, which help us to -

Dr WOODRUFF - Sorry, minister, I am a bit confused, because I am not talking about any of this. I am asking about Category 1 patients, and was every single Category 1 patient seen on time at an emergency department in 2020-21? Straight question, I can put it on notice if you want.

Mr ROCKLIFF - We can provide that information for you, and while we are just finding information I just want to talk about our initiative to prepare our health system to manage demand. I mentioned this deliberate establishment of statewide access and flow program, strengthening collaboration with private hospitals, convening a health recruitment taskforce to review and improve recruitment across the public health system.

And so, if I look at the percentage of patients in each triage category - patients seen on time - on our dashboard we have Category 1 at 100 per cent for the last 13 months.

Dr WOODRUFF - Okay, is that right? The annual report for the department says that of triaged Category 1 patients - 98 per cent were seen immediately at the Mersey, 98.3 per cent of the time at the North West Regional, 99.6 per cent of the time at LGH and 99.9 per cent of the time at the Royal. Can you give me the total number of patients who presented with a life threatening condition who were not seen and treated immediately? And why is there a discrepancy between the annual report and the dashboard figures?

Mr ROCKLIFF - These figures are April 2021-April 2022. Category 1 - 100 per cent, I'm reading from that now.

Dr WOODRUFF - I asked for 2020-21, the whole year, not just one month.

Mr ROCKLIFF - We have the last quarter of 2021, so I'll get that information for you. We are now publishing this on a monthly basis.

Dr WOODRUFF - So, is there rounding happening on the dashboard? Because you can't round a number like being seen immediately because they are real people, real life threatening situations.

Ms MORGAN-WICKS - We are just referring to the public health dashboard which is published monthly which has the last 13 months. So, it is reporting at the moment from April 2021 through to April 2022. We just happen to drop off the last month as and when we report each new month. We will certainly have that data. I don't understand that it is a matter of rounding. I misinterpreted when you said for the year 2020-2021 and I went to latest one. So, my apologies.

Dr WOODRUFF - Thank you. I will put that in writing.

Minister, back to the secondary triage. Do have an estimate of how many of Ambulance Tasmania's secondary triage calls resulted in a diversion to an alternative service provider? And how does that figure compare to the target for the first year of the services operation?

Mr ROCKLIFF - I think I have that information at hand before. I believe that I did answer that. Excuse me if I hadn't but the scope of patients referred to secondary triage has expanded since its commencement and will expand further over time as more alternate medical care pathways are established.

Secondary triage commenced on 22 February 2021 and at May 2022 approximately 2140 Triple Zero calls had been successfully diverted from an emergency ambulance response. Of these cases approximately 50 per cent were in the south and 25 per cent in both the north and the north west. The implementation of the secondary triage service formed part of the 2018 commitment of the Government to invest $125 million into ambulance services.

The Police, Ambulance and Clinician Early Response, otherwise known as PACER team, is dispatched to mental health patients in the community experiencing crisis following by a secondary triage clinician. This service delivery model has assisted many mental health patients to get the care they need without needing to present to an ED and I have spoken on that a number of times. Is that the information you wanted around secondary triage?

Dr WOODRUFF - Yes, how many diversions have there been? Mr Webster said last year in Budget Estimates that the secondary triage goal was to reduce ambulance callout by 35 per cent or in real terms, by 16 000 calls a year. We are only halfway through the second year of this service, and understanding that, when do you expect that we will be able to reach those levels of 35 per cent diversion, 16 000 calls, and do you have intermediate targets? How are we tracking, basically?

Mr ROCKLIFF - Thanks, Dr Woodruff.

Mr WEBSTER - In referring to the 35 per cent, I was referring to the Victorian outcome and the full suite and so we are building our suite and it will take some years to do that. Switching on mental health was an important step this year. So far, we have had 2140 Triple Zero calls diverted in the 15 months. PACER is now running at about 30 diversions per day. Importantly, the majority of those, around 74 per cent actually, result in avoiding hospital for that cohort, which is the operative way to do that. So, as we build the cards, as Ambulance Tasmania call them, which are actually the conditions that are written up into cards, we would hope that eventually we will get close to what Victoria are doing. They have been going now for a number of years and have a very aggressive approach to it. We need to build our confidence in the system and also build the number of cards, as I said.

The major step for 2022 was building in PACER and as the Premier announced recently, the extension of that to the north west as a mental health emergency response - it won't exactly be PACER - is a really important step because that will grow our capacity and we grow that over the period as well. I would hate to put a time line on it, it's just that, use it as much as we can and build our confidence in it.