Packed-out and understaff emergency departments are the latest part of the nation’s healthcare system to be ringing alarm bells, according to a major new report.
Performances have deteriorated in the overwhelming majority of categories over the last 12 years, such as wait times, and this trend can vary enormously depending on the state or territory in question.
In order to assess the performance of hospital emergency departments, statistics are recorded on what proportion of patients are seen on time as defined by government guidelines and the severity of an individual patient’s condition.
There are five categories, each of which has a different benchmark in terms of acceptable wait times.
Triage 1 – Resuscitation: Treatment required immediately. Defined as clinical care commencing within 2 minutes of presenting.
Triage 2 – Emergency: Treatment required within 10 minutes
Triage 3 – Urgent: Treatment required within 30 minutes
Triage 4 – Semi-urgent: Treatment required within 60 minutes
Triage 5 – Non-urgent: Treatment recommended within 120 minutes
According to the latest figures from the federal government’s Institute of Health and Welfare, patients presenting with a resuscitation level condition are seen on time approximately 100 per cent of the time.
In terms of conditions deemed an emergency, its here that things start to go downhill.
When records began in 2011-12, 80 per cent of patients were treated within 10 minutes.
But in the latest figures, which cover 2022-23, this had fallen to 64 per cent.
For patients in the urgent category, 66 per cent of patients were treated on time in 2011-12. This has since fallen to 58 per cent, after peaking in 2013-14 at 70 per cent of patients.
For the significantly less serious semi-urgent and non-urgent categories, the deterioration has been much more minimal, with the proportion of semi-urgent cases being treated on time down by 2 percentage points to 68 per cent and those with non-urgent cases down 1 percentage point to 88 per cent.
State by state
Of all the cases deemed Triage level 1 (Resuscitation), 100 per cent were treated on time in 2022-23 in Victoria, New South Wales, Queensland and Tasmania, with the notable exceptions of Western Australia and South Australia, where the figure was 99 per cent.
While the starting point in 2011-12 for Triage level 2 (Emergency) cases left all of the states in broadly the same ballpark, with 75 per cent to 83 per cent of patients considered an emergency seen on time, since then outcomes have diverged dramatically.
While all states have seen a significant deterioration, Tasmania, South Australia and Victoria in particular have seen the proportion of patients seen on time drop the most dramatically.
In South Australia, the proportion of patients seen on time has seen the largest decline of any of the states down by 35 per cent points.
Tasmania and Victoria round out the bottom three, with the proportion of patients being seen on time down 28 per cent points and 26 per cent points respectively.
At the other end of the spectrum, New South Wales its numbers drop by seven per cent, followed by Western Australia, down nine per cent.
When it comes to Triage level 3 (Urgent) cases, the news is equally concerning.
The starting point for all the states is much worse than it is for patients with more serious conditions, with the proportion of patients seen on time in 2011-2012 ranging from 52 per cent in WA to 72 per cent in Victoria.
On this metric, the largest decline in the proportion of patients seen on time occurred in South Australia, Western Australia and Tasmania, down 31 percentage points, 20 percentage points and 20 percentage points respectively.
At the other end of the spectrum, the best performers relative to their 2011-12 figures were Queensland down one per cent and NSW down two per cent.
The Weight Of Additional Demand
When looking at the sheer growth in the number of patients needing to be treated, it swiftly becomes unsurprising that the nation’s hospital emergency departments are struggling to cope with all the additional demand.
By category of severity the largest expansion in patients requiring care occurred in Triage Level 2 (Emergency), with the number of patients requiring this type of care in 2022-24 up 120 per cent vs. 2011-12. However, in the last 12 years all three of the most severe categories have seen the relative number of patients rise dramatically.
From neglected health conditions during the pandemic to an ageing and rapidly expanding population, the nation’s hospital emergency departments face an uphill battle to keep up with the growing demand placed on them by the public.
With population growth set to continue to grow at one of the fastest rates in the developed world and the increased care requirements of ageing demographics already baked into the nation’s future, without a major change in policy and/or funding, the nation’s hospitals appear set to remain in a highly challenging position.
As millions of Australians each year will attest, the nurses, doctors and other healthcare workers are doing their absolute best to provide quality care to the public under increasingly difficult conditions.
Ultimately, the trends seen in patient outcomes and the broader demand for emergency level care are extremely concerning.
If not adequately addressed by policymakers at a state, territory and federal level, the quality and timeliness of care may end up suffering.