06/08/2019 - 15:34

Auditor sheds light on ramping

06/08/2019 - 15:34


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A new report has challenged views on the effects of ambulance ramping on patient outcomes.

Auditor sheds light on ramping
The auditor general’s review acknowledges the need for improvement, but downplays the perceived risk to patients. Photo: Gabriel Oliveira

A new report has challenged views on the effects of ambulance ramping on patient outcomes.

Successive state governments have spent billions of dollars making Western Australia’s public hospitals among the nation’s best, albeit with some exceptions.

For example, the Fiona Stanley and Perth Children’s hospitals are showpieces. The Midland Hospital, which is outsourced to St John of God Health Care, is highly regarded, and many others are less than 20 years old or have had major refurbishments. 

Genuinely ageing institutions are Royal Perth Hospital and the King Edward Memorial Hospital for women, although it’s planned to shift this latter facility closer to the children’s hospital.

The rebuilding process was launched by former coalition premier Richard Court in the late 1990s, gathered pace under former Labor health minister Jim McGinty after a major health review in 2004, and has continued under Colin Barnett’s Liberal-National and Mark McGowan’s Labor governments. 

Yet the reputation of the hospital system is dragged down by one recurring challenge that health and transport boffins have been unable to resolve – ambulance ramping. It’s the sight of ambulances queued outside hospital emergency departments that provides perfect vision for television news bulletins to report criticism by groups such as the Australian Medical Association and the opposition of the day, highlighting alleged risks to patients from apparent delays in treatment.

These reports are usually followed by demands from the AMA for more hospital beds to be opened and other union calls for more staff to ensure patient safety. 

But a new report by the independent auditor general Caroline Spencer into the efficiency of ambulance services paints a different picture. While noting there is room for improvement, she downplays the perceived risk to patients.

Ms Spencer defined ramping as: “The practice of leaving ambulances parked outside hospitals while crew wait with patients for admission to a hospital emergency department (ED).” Her review assessed its impact on patients and other parts of the health system.

She notes that WA’s ambulance services are unique in that they are contracted out to St John Ambulance WA, which has provided services since 1922. This arrangement makes WA the only state where ambulances are not government operated. Relevant unions would like the services government owned, but their efforts to date have failed. 

The review found little evidence that lower priority patients affected by ramping suffered long-term health problems. 

“While it seems intuitively obvious that delays in treatment increase the likelihood of adverse outcomes, much depends on the nature of the condition that brought the patient to hospital,” Ms Spencer said. 

“Conditions that require hospital treatment may not pose any immediate threat to the patient’s general health, and urgent pain management is often delivered effectively by ambulance crews. If a patient’s condition deteriorates while being attended by ambulance crew, the priority level can be increased and the patient taken into the ED without further delay.”

The report also noted there was little evidence that ramping imposed significant costs on the health system, adding: “While some hospitals have incurred costs in managing the queue of patients waiting with ambulance crew, these costs appear minor in the context of the system as a whole.”

Ms Spencer’s findings will be of some comfort to the families of patients, and a blow to the campaigns run by the AMA and other unions. Nevertheless, having ambulances lined up outside EDs is not a good look. More work has to be done.

Beazley works the crowd

AS a former defence minister, Kim Beazley was quite at home in his role as governor at the recent centenary observance of the opening of the Honour Avenues in Kings Park, which commemorate the lives of WA servicemen killed in action overseas whose bodies never came home.

Mr Beazley put his notes to one side as he spoke of the strategic importance of Australia’s involvement in the world wars. And while noting the tragedy of so much loss of life, he also recognised the pain so many women – mothers, wives, girlfriends, sisters – endured because of the deaths, and the many survivors who returned physically or mentally damaged.

There was no quick exit after the formalities. The governor worked the crowd, discussing relevant issues. Don’t be surprised if there’s a move to cushion the current charge of about $400 to have a plaque for an eligible family member added to the 1,800 plaques already in the park.


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