The Royal Hobart Hospital (RHH) says it has revised its escalation protocols amid complaints from staff that attempts to ease worsening bed shortages through the use of emergency codes are being ignored by management.
But the nurses union says it is yet to see the details of the new measures.
On Monday, the hospital’s emergency department (ED) was at triple its capacity – with 75 patients waiting.
Requests by RHH staff to use emergency codes were again rejected by senior management, the Labor Opposition revealed in State Parliament on Wednesday.
ED staff attempted to call a “code yellow” emergency code on three occasions because it could not manage patient flow, but were denied.
Code yellow denotes an “internal emergency”, which RHH defines as:
“… an event that impacts the facility and may be caused by an internal or external event which may adversely affect service delivery and/or safety of persons and requires a significant and coordinated response. Possible situations include failure of electricity supply, medical gases, water supply, waste disposal systems, information and communications systems, structural damage or incidents involving hazardous substances.”
Revised codes to help deal with overload are ‘imminent’, the health minister said. (ABC News)
The hospital management said it was not required because there was still bed capacity.
Neroli Ellis, from the Nursing and Midwifery Federation, said clinical risk should be included in the code yellow definition in lieu of updated RHH protocols.
“We saw a refusal from the state-wide chief operating officer and the CEO of the hospital to let the code yellow run and improve patient care,” Ms Ellis said.
“The risk was there, this is a risk to patient care and it’s not being upheld.
“For that to be refused by senior management – it’s very distressing that clinical risks are not being identified and respected.”
Ms Ellis said RHH was constantly on its highest escalation code, and the only option to escalate it further was to call a code yellow.
New emergency protocols ‘imminent’, Minister says
The hospital’s group clinical director Wendy Rowell said for the past four months the RHH had been reviewing its patient flow escalation protocols which allow resources to be increased in periods of high demand.
Patients have been waiting inside ambulances parked outside due to a lack of beds. (ABC News: Sam Ikin)
“The RHH’s Emergency Department director has designed revised protocols, and staff are currently being consulted on these revised measures, which will hopefully assist in managing higher demand levels,” she said.
Ms Ellis said it was the first she had heard of the revised measures and the consultation with staff.
Health Minister Michael Ferguson told ABC Radio Hobart the use of a code yellow was not appropriate to manage patient flow problems.
Mr Ferguson said the revised protocols would ease the pressure on staff and described their implementation as “imminently coming to fruition”.
“I will always stand by our staff who are deserving of effective escalation policies.”
Lack of action ‘causing patients harm’, AMA says
The Australian Medical Association (AMA) renewed its criticisms that the Tasmanian health system’s bureaucratic structure “wasn’t functional”.
“To not address the level of access block is causing our patients harm and it needs to be taken seriously from the administration level and all levels,” the AMA’s Stuart Day said.
“Our emergency departments spend more time at the highest level of escalation because of lack of access to the hospital than they do at any other level.
“When a hospital is at its highest level of escalation, (with) patients in the emergency department and others who need treatment urgently, there’s nowhere to put those (overflow) patients.
“There needs to be a further response than what is currently offered.”
Last week, the Government announced it would spend $658 million to fund extra beds and staff across Tasmania, after prolonged criticism over treatment failures.