South Australia's biggest public hospital has been operating above capacity at the highest pressure rating, with workers told to delay non-urgent tasks to deal with an influx of patients leading into winter.
An email sent to Royal Adelaide Hospital staff yesterday afternoon and obtained by the ABC states the CBD hospital was declared at "level-three demand escalation" — also known as "code white" — meaning it was operating above its official capacity.
The hospital remains at that level.
In Tuesday's email, Central Adelaide Local Health Network (CALHN) operations and performance interim director Matthew Tuk asked staff to help move patients from the emergency department to inpatient beds.
"Our network has been experiencing continued high demand from patient presentations over the past few days," he wrote.
"All non-clinical non-essential activities for the next 24 to 48 hours should be rescheduled to allow all clinicians to focus on patients, interventions and flow."
It comes as the hospital struggles to reach an SA Health target to discharge 30 per cent of patients by 10am, while overcrowding and ambulance ramping causes hours-long waits at its emergency department.
Hospital in 'crisis', doctors union says
CALHN declared a code white at the Royal Adelaide Hospital (RAH) one day after the SA Salaried Medical Officers Association (SASMOA) conducted a safety inspection of the hospital.
SASMOA chief industrial officer Bernadette Mulholland said the level-three pressure rating meant the number of patients presenting to the hospital outweighed the number of available beds.
"The hospital is in crisis," she said.
"We've seen a surge in presentations and a surge in demand over the past two weeks.
"They have been consistently, on and off over that period of time, in code white for long periods of time, which puts enormous pressure on that particular hospital."
Ms Mulholland said the hospital blockage had resulted in one mental health patient waiting for more than 70 hours in the emergency department.
She said the number of mental health presentations had surged, alongside influenza and other respiratory infection cases.
Health Services Union SA branch secretary Billy Elrick said allied health worker shortages also contributed to code white declarations, with delays in diagnostics and treatment forcing patients to endure lengthy wait times.
"The ongoing understaffing crisis is placing these workers under extreme pressure as they provide essential services with limited resources," he said.
Mr Tuk wrote in his email to staff that CALHN's operations command centre had taken control of managing bed availability at the RAH.
He also asked staff to "utilise additional inpatient bed capacity" through private hospitals.
"Medical leads, heads of unit and nurse unit managers have been contacted separately to this email and asked to assist," he wrote.
Hospital struggles to reach patient discharge target
SA Health earlier this month conducted a one-week review of the health system to find out how to improve patient flow through public hospitals.
The "Focus Week" initiative ran from May 15 to 21 and was modelled on the "Perfect Week" used for several years by the UK's National Health Service.
During the week, staff had their administration tasks reduced, to give them time to focus on how patients flowed through the system.
One of the Focus Week targets was for hospitals to discharge 30 per cent of patients by 10am and 50 per cent of patients by 12pm.
But in an email to staff on May 19 – also obtained by the ABC — CALHN CEO Lesley Dwyer said the network was struggling to reach the target.
"In case you are wondering, across Australia, on average 30 per cent of patients are discharged in the public system before 10am, so it did have some evidence of where we could get to," she wrote.
"However, despite our effort we have not seen much of an uplift, and across CALHN it is stubbornly sitting at 8.21 per cent by 10am and 28.4 per cent by 12pm!!
"How frustrating, and so we've sent out a survey to try and identify these barriers."
In a statement, CALHN said the RAH is "experiencing a high number" of emergency department patients.
"In order to alleviate some of the demand, we have been working with out-of-hospital services such as My Home Hospital and Priority Care Centres, private hospital providers, regional hospitals to safely repatriate patients closer to home, and our SA Virtual Care Centre to facilitate virtual care where appropriate," it said.
"As always, our patients are treated according to clinical need with the sickest patients being treated first."
The health network said it always aims to discharge patients earlier in the day provided a doctor has decided it is clinically safe to do so.
"We involve our staff in changes at our hospitals and welcome their feedback to new initiatives," it said.
Premier briefed on hospital woes
Premier Peter Malinauskas said he received a briefing on the situation at the RAH yesterday.
He said the hospital had been under a "sustained period of pressure for a while", with demand spiking during the past week.
"What's interesting to learn is whether or not those demand spikes speak to another trend, or whether it's a spike we expect to abate," he said.
Health Minister Chris Picton said there had been a significant number of people in the RAH emergency department waiting for inpatient beds, with the hospital taking "appropriate" action to address the issue.
He said patient discharge targets were one tool used to measure hospital performance.
"It is an important metric that hospitals around the country look at, but it's not the be all and end all," he said.
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