Short ED wait poor measure of hospital health

Although I work close to the now infamous Royal North Shore Hospital, I’ve never advised a patient to vomit so they’d get past triage, as other local GPs admit to in today’s Australian. However, I do routinely recommend patients not “be too stoic” at the triage desk, so the extent of their discomfort is obvious.
As well, I often wait until the patient has left the surgery before ringing the admitting officer to avoid the grilling designed to make me change my mind about the patient’s need for hospital assessment. And more than once, I’ve resorted to asking a particularly resistant admitting officer what they’d do if we were talking about their mother or father.
But although last week’s case of an unfortunate woman delivering a live fetus in the toilet at the hospital has created thousands of column inches and a war of words between politicians, over-stretched hospitals are not just a North Shore Hospital problem, or limited to NSW.
So in some ways, the federal government’s new plan to fix the hospital crisis by forcing states to appoint hospital boards is appealing. So far, it smacks a bit of “policy on the run” and a return to the past, but any move to put the needs of patients before bureaucrats and their financial targets deserves serious consideration.
However, serious questions emerge. For a start, the health system is not just about hospitals, and it’s not clear the proposed move would address the current disconnect between primary and secondary care. Intuitively, the plan also risks severing established and useful networks between hospitals, and between hospital and community based services.
As well, the plan is being sold not as a federal, but a local, takeover of hospitals, with “local people grabbing power”, according to a federal source quoted in the Australian, which makes this local doctor nervous.
Understandably, local communities don’t take a big picture view of the health system, but are concerned about what’s available in their own patch.
As doctors and voters, we need to watch this one closely, and remind ourselves and our elected representatives that there’s more to an efficient and caring health system than a short wait in the ED.

Tragic tale with many victims

“Doctor too tired for golf ball victim”, “Doctor fears he was too tired at hospital”, “Flaws in care of girl hit by golf ball” – headlines referring to the tragic case of Vanessa Anderson, who died in Sydney’s Royal North Shore Hospital during a seizure two days after being hit by a golf ball.
With the inquest into the 16 year-old’s death in progress, the accusations have been flying thick and fast. If the newspaper reports are correct the case is another symptom of a system in trouble.
According to the Sydney Morning Herald, the court has heard that “Vanessa’s CT scan went missing; doctors and nurses failed to keep appropriate notes; a nurse did not tell anyone when Vanessa could not move and suffered memory loss a few hours before her death; and doctors involved in the case failed to tell each other when they changed her drugs”.
Furthermore, a postmortem revealed four times the therapeutic level of codeine in her blood and high levels of Endone, the paper said.
But perhaps the most telling report was a tiny newspaper report which claimed administrators had been warned the neurosurgical ward would be three doctors short at the time of Vanessa’s admission. I’m not sure what options the bureaucrats had to make ensure patient safety, but it sounds as if an unreasonable burden fell to a female intern on her eleventh neurosurgical shift.
She’s had her name and photo in the papers. She’s admitted making mistakes and she’s expressed her sympathy to the parents.
When I googled the case, the top entry made me cry.
It was Vanessa’s death notice:
Vanessa Anderson
Suddenly, late of Hornsby Heights.
Beautiful and cherished daughter of Michelle and Warren, loving sister of Amanda and Nathan. …
11.9.1989 - 8.11.2005 "Ness your legend"
Vanessa was just three days older than my own son, and I imagine her parents’ lives will never be the same.
Life, too, will have changed for those involved in her care.
And without wanting to preempt the coroner’s findings, it seems to me the system is largely made up o good people doing their best in a system that feels increasingly as if it’s going off the rails.