The last hours of Anne Pedler’s life were spent in an ambulance ramped outside Launceston general hospital because no bed was available for the 71-year-old.
Pedler arrived at the hospital at 12.45am on 6 August 2022 with a diagnosis of a pulmonary embolism – a sudden blockage of the vessels responsible for sending blood to the lungs. Despite being triaged as urgent, Pedler was still ramped at 8.30am – when she suffered cardiopulmonary arrest.
Peddler’s daughter, Stella Jennings, said she is kept awake at night wondering whether her mother might still be alive if things had gone differently.
The cause, she was later told by the hospital, was a delay in obtaining blood test results. “The tests were ordered but, as my mother was not an admitted patient, there was no one assigned to follow the results up.”
An anticoagulation medication for the pulmonary embolism was withheld pending the results. The coroner in Pedler’s case, Robert Webster, found the medication would have increased her chances of survival.
“It is reasonable to conclude the standard of medical treatment received by Mrs Pedler was heavily influenced by the fact that not only was there no bed available for her but there was also a lack of nursing staff on duty,” Webster wrote.
The time taken for patients to be transferred off an ambulance stretcher to a hospital emergency department is a key indicator of hospital performance. When an emergency department is at capacity and this transfer is delayed, it is known as “ambulance ramping”.
A new report from the Australian Medical Association has revealed people across the nation are spending more time waiting in ambulances as Australia experiences “unforeseen levels of ramping”.
Ramping also means that paramedics are unable to respond to subsequent ambulance callouts while they wait with the patient.
The peak medical body’s 2023 Ambulance Ramping Report Card, published today, has found no states or territories are meeting their performance targets, with data showing many are failing by more than 30%.
Queensland, New South Wales, Western Australia and South Australia all have a target of 90% of cases being transferred from the ambulance to the emergency department within 30 minutes. Other state and territory targets vary slightly.
According to the report, South Australia was one of the worst-performing states in 2021–22, with just 42.9% of patients transferred within 30 minutes.
In the same period, the report found 58.7% of patients in Queensland were transferred within 30 minutes. The 134,155 hours ambulances spent ramped outside the top 26 Queensland hospitals was an increase of 20% from 2020–21.
In Western Australia, the report found the number of ramped hours in 2022 was 66,384 – an increase of 26.6% compared with 2021, and 576.1% compared with 2017.
In Victoria, the target is 90% in 40 minutes. But in 2021–22 only 61.3% of patients were transferred within that time, representing an 11.4% deterioration on the previous year, and a 20.5% deterioration since 2018–2019.
In NSW 80.1% of patients were transferred within 30 minutes in 2021-22, an 8.9% deterioration compared to 2018–2019 when the state was only 1% off the 90% target.
The ACT and Tasmania were the only jurisdictions which recorded an improvement in 2021-22 compared with the previous year. But it is against a background in which “patient transfer performance however has been deteriorating for several years” and remains significantly lower than previous years, the report found.
The report was based on data provided by state and territory health and ambulance services. Measures used to report on ambulance ramping differ between states and territories, which makes it challenging to perform national comparisons and determine the scale of the problem at a national level, as the report acknowledges.
“Despite this, it is evident states and territories are falling short of their performance targets, and longitudinal data demonstrates that the time it takes to transfer a patient from the ambulance to the care of the hospital emergency department has been increasing overall year on year.”
The president of the AMA, Prof Steve Robson, said ambulance ramping was a symptom of hospital logjam, caused by a lack of public hospital capacity.
“Behind every number and every statistic, there is a harrowing personal tale of a patient forced to wait far too long just to be transferred from an ambulance to the ED,” Robson said.
