Ministerial Briefing & Mind Map - Essay Example

?MIND MAP SUMMARY Shortage of Ambulance because most of them are ramped outside the emergency department waiting for patients to be given medical care. Lack of coverage which means if an ambulance is paged it cannot visit another patient. Shortage of beds in hospitals and delays in attending other patients. Furthermore, resources are choked up Due to the backlog problem which means so many patients are waiting outside there will be lack of resources. As well as lack of crew members as most of the paramedics are helping the people ramped outside hospitals and shortage of medical staff is a critical issue. Ramping increases daily shift and sleep deprivation as the staff has to work for 24 to 48 hours without sleep. It increases frustration; hence, there is an increase in physical and verbal violence. Increase in stress level as waiting time can stretch up to hours. Death of patients due to delay in medical care and patient’s treatment is affected. Both ambulance service and hospitals are getting affected because of ramping. The Government need to provide extra funding to hospital for beds and resources. Health care plans have to be discussed further by government officials. Unions are discussing this problem with Government officials as the health of staff and patient is both at risk. Patients are moved to other hospitals. But, ramping has a domino effect. The other hospitals will now face the similar problem as they would not be able to cater to other patients due to lack of space. Paramedics and ambulance officers cannot take usual breaks between works. The officers are not allowed to go until instructed.They have to work long working hours which affects their productivity. MINUTES forming ENCLOSURE to File X Reg X TO THE OFFICE OF THE MINISTER FOR HEALTH AND AGEING RE RESPONSE TO RAMPING MEDIA ARTICLE PURPOSE The purpose of the memorandum is to provide health minister with a tentative solution for the problem of ramping. The solution can be further analyzed by the health minister and government officials and to find a suitable decision. This brief focuses on the issues of ramping in Adelaide, South Australia. In Flinders Medical Center, the problem of ramping is growing which was mentioned in the article. It is believed that if the Government: Provide funds to hospitals to increase the number of beds and expand the emergency department Build camps within the vicinity of hospitals to shift patients from ambulances Ensure that the patients are shifted from emergency department to in patient wards without delay. Hire more crew members the problem can be reduced to some extent. These solutions are further discussed in the recommendation section. Also, the costing of these policies is discussed in the cost section. This will enable Government to curb the problem of ramping. SUMMARY OF ISSUES Ramping is caused when there are not enough beds in the hospitals to cater to the patients. Thus, the patients have to wait in ambulances for medical care. However, this has a domino effect. The ambulances are full of patients; thus if paged cannot attend other patients. The other patients die unattended. Also, ramping increases the level of stress. There is an increase in daily shift due to extra working hours. This leads to exhaustion, burnout and sleep deprivation. The patients’ family members’ stress level also increases. BACKGROUND According to Australian Institute of Health and Welfare (AIHW, 2011) in 2009-10, 8.6 million people were hospitalized; 7.4 million were injured from accidents and were admitted in emergency department and 70% were attended in recommended timings set according to the triage category. However, percentage of people attended on time has to be increased to 80% for category 3 patients, 90% for category 2 and 100% for category 1 patients. 70% patients were seen on time; however, the remaining 30% had to wait in ramps to be attended by the doctor. In 2011-12, the quarterly statistics for March showed that 6000 patients were admitted in Flinders Medical Center. Overall, in Adelaide there were 27,481 admissions. (Australia, n.d.) Moreover, there were 15,778 presentations to Flinders Medical Center and 11,330 in Noarlunga Hospital in the quarter ended on March 2012. Overall, there were 89,593 presentations in Adelaide. (Australia, n.d.) According to the Government of South Australia, the patients are moved from emergency department to in-patient ward within 2, 4 or 8 hours. Only 31.8% were moved to in patient ward within 2 hours compared to the target of above 70%. (Australia, n.d.) An article published in Australian center of independent journalism, states that ramping is the small part of the serious problem. Three years ago a man was in cardiac arrest and was brought to Sunshine Coast but there was not enough space so he was taken to another hospital but he died on the way. The problem of ramping is all across Australia but its severity is different in different states and hospitals. (Anon., 2011) According to the AMA analysis of the Australia’s public hospital system, in South Australia 61% category 3 patient were seen on time compared to the national target on 80% and 89% of category 2 patient were seen on time compared to the target of 91% during 2009-10. (AMA, 2011) Moreover, according to the media release by Hamilton, SA Ambulance Service is unable to cater to the category 1 emergency calls. Most of the officers and ambulances are catering to ramped patients; thus, enough crewed ambulances are not available to attend other emergency calls. The Ambulance Employee Association confirmed that this is a growing concern and there were not enough crew members with appropriate resources to see the patients on time. It is quoted from the article that “The ambulance service overstretch underlines the problems with ramping at Flinders Medical Centre and diversions from other hospitals around Adelaide.” (Hamilton, 2012) ADVICE FROM OTHERS According to the response from the AEA and its members, they will not tolerate ramping. They believed that measures should be taken to avoid it. If ramping continues, then they might impose a ban or limitation to protect the members of the society. They want compliance from Flinders Medical Center without skepticism and want them to cease any sort of ramping. AEA said that FMC has changed its ambulance practice which has caused delays and ramping. Due to this practice, the public and patients are both at risk. According to the AEA’s response letter, Flinders Medical Center should provide Nursing, PSAs and Barouches to handle ambulance patients in a same way as in emergency department. FMC should have reasonable off stretcher time but it should depend on the patient’s condition. FMC should not move a patient to any other hospital unless a bed is arranged. The medical center should use AMU to have a flexible capacity during code whites. More beds should be arranged by government to increase FMC’s capacity. Ambulances that are paged for category 1 and 2 should be released quickly and the SAAS should keep a check on FMC. Also, the government should consider to give make an emergency department in Noarlunga to reduce the burden. Furthermore, patient’s discharge policy should be revised which is one of the main causes of ramping. In the AEA’s meeting with the Health CE’s, they recommended that the emergency department capacity should be increased across the Metro Area. The number of beds should be increased to cater more patients. Also, nurses, extended care paramedics should be utilized and awareness should be created to avoid going to hospitals. COSTING COMMENT In order to give psychological treatment to employees, doctors and paramedics, a psychologist can be hired to motivate them which will cost 5000 Australian dollars per month. However, in a hospital there is a psychologist. The team members can have a weekly session with him/her without any cost or the management can pay a lesser amount for the efforts. In order to measure the trend, a researcher will have to be hired. A part time researcher can be hired or a research student for 1000 Australian dollars. Furthermore, to create awareness, banners and television programs will have to be made. The awareness campaign might cost 2000 to 3000 Australian dollars depending on the type of banners and programs. To increase number of beds and expand emergency department 10000 to 15000 Australian dollars will be required. However, if government subsidizes, then FMC will be able to expand its facility. More nurses and general practitioner will have to be hired who can visit patients at home. Their fees will depend on the service they provide to the patient. To make a camp in the ramp area, 500 to 1000 Australian dollars will be required so that the patients can be shifted there. There will be an additional cost of stretchers to transfer and keep the patients in camp. It will cost 2000 Australian Dollars and the additional equipment will cost further 2000 Australian dollars. RECOMMENDATION It is recommended that: The patients who are treated in emergency department should be moved to general wards as soon as possible to reduce off-stretcher time. Also, the hospitals should set a maximum waiting time which should not be more than 20 minutes in the case of category 2 patients. Also, the employees and doctors should have psychological treatment to control level of stress. This will improve their efficiency and will reduce the amount of physical and verbal violence. Moreover, Flinders Medical Center should observe the trend of patients coming in and discharging. This will give an idea of average patients per days and the level of triage. Thus, Flinders can make bed arrangements accordingly. If too many patients are coming in, then feasibility of enlarging the emergency department should be taken in to consideration. The government should support Finders Medical Center by providing capital assistance to them to enlarge the facility. Also, awareness programs should be aired to create awareness among public. They should be guided about general check up and what measures can be taken to avoid hospital. Furthermore, nurses and general practitioners should set up camps where the public can get regular check up. Also, if the cases are of category 3 or not very serious, then general practitioners and nurses should be hired who can visit patients’ home and treat them so that bed space in hospital can be saved for critical patients. If the patients have recovered from critical condition then they should be discharged as soon as possible. A nurse practitioner should be sent instead of keeping them in hospital to monitor the progress. Also, there should be a camp in the ramp area where the patients can be shifted so that the ambulances are not occupied. This will enable ambulances to reach critical cases on time. WORKS CITED AIHW, 2011. Australia's hospital 2009-2010 at a glance. [Online] [Accessed 3 June 2012]. AMA, 2011. An AMA analysis of Australia’s public hospital system. [Online] Available at: http://www.google.com.pk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CF4QFjAB&url=http%3A%2F%2Fama.com.au%2Fsystem%2Ffiles%2Fnode%2F7291%2FAMA%2BPublic%2BHospital%2BReport%2BCard%2B2011.pdf&ei=96PIT9z_ApDorQe_htGZDg&usg=AFQjCNHhA4WdRVxlP2LYAw-RwmCW-qp0D Anon., 2011. Ambulance Ramping an Alarming Trend. [Online] Available at: http://www.reportageonline.com/2011/08/ambulance-ramping-an-alarming-trend/ Australia, G. o. S., n.d. Admissions from ED for public metropolitan hospitals by quarter. [Online] Available at: http://www.sahealth.sa.gov.au/wps/wcm/connect/1b13ff8043a5544a835ecbed1a914d95/ED+Admissions.pdf?MOD=AJPERES&CACHEID=1b13ff8043a5544a835ecbed1a914d95 Australia, G. o. S., n.d. ED presentations to public metropolitan hospitals by quarter. [Online] Available at: http://www.sahealth.sa.gov.au/wps/wcm/connect/85dc040043a552ad82cccaed1a914d95/ED+Presentations.pdf?MOD=AJPERES&CACHEID=85dc040043a552ad82cccaed1a914d95 Australia, G. o. S., n.d. Emergency department flow target data. [Online] Available at: http://www.sahealth.sa.gov.au/wps/wcm/connect/5b14648043a5508f8261caed1a914d95/smoed-flowtargetdatajan2012-Ops-20120404.pdf?MOD=AJPERES&CACHEID=5b14648043a5508f8261caed1a914d95 Hamilton, M., 2012. Ambulance System Overload. [Online] Available at: http://www.saliberal.org.au/Media/MediaReleases/tabid/79/articleType/ArticleView/articleId/423/Ambulance-system-overload.aspx Read More