Blog
President’s Blog: Public hospital system needs an out
Friday February 10, 2023
Exit block has become a big problem. Patients requiring transition to a nursing home or to appropriate disability accommodation, when previously they had lived at home, are staying much longer in an acute hospital setting than is medically necessary. This results in bed block, which then clogs up wards like orthopaedics, general medicine, rehab beds, the stroke unit… which leads to delays in patients being admitted from the ED and the associated inherent dangers in that.
― AMA Member
Sound familiar? As described in Hospital exit block: A symptom of a sick health system, the latest AMA report as part of the Clear the Hospital Logjam campaign: Hospital exit block: a symptom of a sick system | Australian Medical Association (ama.com.au)
‘Exit block’ is a term commonly used to describe the situation when patients receiving hospital inpatient care are medically able to be discharged but have no safe destination. The most common reasons for this are that people’s care needs have changed during their hospital admission, and they are now waiting for appropriate aged care (such as a place in a residential aged care facility or a home care package at the right level), or for disability care (often related to National Disability Insurance Scheme (NDIS) funding).
Exit block is a symptom of a healthcare system that is struggling to meet community demand for health and social services, however it has a significant impact on hospital logjams. Exit block means there are less beds for inpatient services, which ultimately results in increased waiting times for ambulance services, emergency department services, and essential elective surgeries.
The evidence is mounting on just how far behind the Australian healthcare system is falling in catering to the needs of the community. A recent Western Australian snapshot was telling.
WA had its worst ever ambulance ramping for January in the month just past. At more than 4,700 ramped hours, it’s a 26 per cent increase on the figures from January 2022.
The end of January also provided us with analysis from the Federal AMA that indicated that seven of the eight worst performing hospitals in Australia for Category 3 (urgent) emergency department presentations were from WA.
Of the 26 hospitals analysed in WA, none of them met all the clinically recommended timeframes.
Elective surgery waitlists have gone up by 80 per cent compared to a year ago.
Prime Minister Anthony Albanese was recently here to announce expressions of interest for seven Urgent Care Clinics in the State: in Perth, Joondalup, Rockingham, Murdoch, Midland, Bunbury and Broome.
He said the measure was designed to take the pressure off emergency departments. But I pointed out that we have already had similar trials with GP super clinics and St John’s care clinics that failed to have any impact on emergency department outcomes.
“The walking wounded patients that these clinics would see are fast tracked through EDs and therefore do not occupy beds, do not cause access block and do not cause ramping,” I warned.
“The unintended consequences of these urgent care clinics could paradoxically see the closure of some general practices nearby these locations.”
Put the right measures in place and there is the opportunity to reap the rewards. AMA analysis reveals that addressing exit block could save an eye-watering $811.6 million to $2.17 billion a year.
The AMA is calling on governments to work together to refine the current arrangements around transitioning people out of inpatient wards into appropriate care, and implement targeted solutions to address exit block.
The National Disability Insurance Scheme (NDIS) provides some evidence of how to improve the situation. In June 2022, the Minister for the NDIS announced a new agreement with state and territory governments to improve the hospital discharge process for NDIS-eligible patients.
As described in the report:
Before the operational plan was implemented in June 2022, there were 1,433 NDIS-eligible patients in public hospitals waiting to be discharged, with patients waiting around 160 days — over five months — for appropriate supports to be put in place through the NDIS so they could leave hospital. Of these 1,433 patients, 44 per cent had a discharge plan in place. These 1,433 NDIS-eligible patients cost the health system an estimated $253.8 to $679.4 million in the 160 days they were waiting to be discharged.
In the latest reporting period (November 2022), there were 1,224 NDIS-eligible patients in public hospitals waiting to be discharged (including 131 in WA, with 59 with a discharge plan and 72 without), with patients now waiting only 36 days — just over one month — for appropriate NDIS supports. These 1,224 NDIS-eligible patients cost the health system an estimated $48.8 to $130.6 million in the 36 days they were waiting to be discharged. Of these 1,224 patients, 59 per cent had a discharge plan in place.
By reducing the number of days NDIS-eligible patients are waiting to be discharged, the operational plan has resulted in an estimated saving of $205.0 to $548.8 million since it was implemented. Assuming the operational plan continues to be effective at reducing the number of days an NDIS-eligible patient waits for discharge (i.e. no days waiting for discharge), the health system would have saved an estimated $495.0 million to $1.32 billion annually.
There’s nothing quite like having a plan and acting with intent to achieve a realistic end.
As I said in relation to the dire outcomes shown in our own public hospital system:
“We call on the McGowan Government to develop a coherent, collaborative and comprehensive plan to turn around the health system.
“If the McGowan Government is spending enough on health, and in the right places, why is WA setting all these undesirable health records?”
Let’s find an exit strategy from these poor outcomes and stick to it.
