Nurse shortages are threatening to compromise the care given to seriously ill babies in the neonatal intensive care ward at Perth Children's Hospital (PCH), a series of leaked emails from management at the besieged facility suggest.
Emails seen by the ABC show the hospital is continuing to battle staff shortages in wards, intensive care units and in the emergency department as the number of sick children presenting to the hospital continues to engulf its capacity.
The emails were written in the same week an inquest into the death of seven-year-old Aishwarya Aswath in the emergency department at PCH was taking place.
Aishwarya died of sepsis in April last year on a night the ED was critically short-staffed, the inquest heard, after her parents' desperate pleas for help from staff went unanswered.
Intensive care short-staffed
The emails reveal the hospital appears to be battling similar staff shortages 16 months later, despite government assurances that the hospital has the staff it needs, and backs up warnings from doctors last week that the hospital is at crisis point.
"3B [neonatal intensive care] down one nurse overnight — high acuity and not covered for priority of pt [patient] need," one email reads.
"x4 vented babies covered by two nurses," — meaning there were just two nurses for four babies on ventilators on at least one night last week.
The normal staffing ratio is one nurse to one ventilated baby.
Ward 4B and the emergency department were also short-staffed the same night, according to the email, with 50 - 70 patients in the ED for most of the night and 12 still waiting for beds at the end of the shift.
"Over census beds used on 1B, 2A, 4A, 3C at 19pts" the email read — meaning 19 children needing beds were instead cared for in treatment rooms and other areas because there was not enough room for them in wards.
Not enough beds on wards
Two days earlier, another email said: "the hospital is in BLACK status with wards going over census (meaning children being given beds outside wards)."
Black means the hospital cannot take any more intensive care patients.
The email went on to say: "There are 12 ward overflow patients waiting to be allocated a bed in ED.
"I understand that everyone is busy, however can you please assist your teams and the wards to discharge patients as soon as possible."
An email sent from a nurse manager on August 25 described staffing as "very tight" with 15 nurses down, and begged nurses to volunteer for extra shifts.
The email offers double time to nurses willing to work an extra shift without the required break of 9.5 hours between shifts, listing five wards that were short-staffed as well as the emergency department.
Nurse describes 'disaster waiting to happen'
A nurse who did not wish to be identified told the ABC the situation was a "disaster waiting to happen".
She said the crisis in the hospital last week should have warranted the calling of a code yellow, an emergency management tool used for "infrastructure and other internal emergencies" when the hospital can no longer admit patients.
However, she believed this did not happen because management were "keen to keep the media eye off the drama" in the same week the inquest was taking place.
She said the shortage of staff was putting children's lives at risk.
"The hospital is worse than it's ever been," she said.
"Everyone is expecting another Aishwarya."
She said all available staff at the hospital were being asked to fill roster shortages in the emergency department, even nurses who had not worked in the ED or on wards for years, creating a dangerous situation.
"We are all getting asked to work extra shifts, overtime — even people like me, who haven't worked on the wards for sometimes decades.
"No one wants to work on the wards or in ED as we know it won't be safe and we are scared of losing our registration.
"Many of us haven't worked for years and the equipment and technology is completely different."
With experienced staff reluctant to pick up the requested shifts, the nurse said hospital managers were getting desperate.
"The skill mix is really junior. They employ anyone with a heartbeat effectively," she said.
"Lots of very junior staff and senior staff are leaving, or they're just so shattered from managing poor care constantly."
COVID-19 no longer a cover: Opposition
Opposition health spokeswoman Libby Mettam said the ongoing staff issues were 'deeply concerning', particularly given Aishwarya's case.
"It's concerning to hear that this level of crisis in our health system is the new normal," she said.
"It's now been over a year since Aishwarya tragically died at Perth Children's Hospital, and this feedback indicates very little has changed."
Ms Mettam said she believed the health system needed a 'circuit breaker', and renewed the opposition's calls for a Royal Commission into the system.
"What we need is to see the McGowan Government take responsibility for the crisis that's happened under their watch," she said.
"They've used scapegoats, deflected blame, and they no longer have COVID as a cover for these issues that have developed over the last five years."
High demand and unplanned leave causing shortages
The government did not respond to a query about staffing at the hospital, directing enquiries to the Child and Adolescent Health Service (CAHS).
CAHS Acting Chief Executive Valerie Jovanovic said PCH is currently experiencing high demand.
"Despite decreasing COVID-19 and influenza presentations, there has been an increase in respiratory synctial virus (RSV) presentations over the past few weeks," she said in a statement.
"This is resulting in an increase in admissions to the hospital and we are also seeing higher than normal levels of staff unplanned leave."
Ms Jovanovic said the hospital "responds swiftly" to manage fluctuations in staffing numbers, with support from a casual pool of nurses, NurseWest and existing staff working more hours.
"We are actively working to identify opportunities to increase the number of available nursing staff, including international and national recruitment opportunities," she said.
In the statement issued on Sunday, Ms Jovanovic also said Ward 3B — the neonatal intensive care ward — was "adequately staffed to its required nursing roster profile".
