DHS Victoria has notified Victorian hospitals of a new parliamentary inquiry:

The Legislative Council’s Standing Committee on Finance and Public Administration has resolved to inquire into and report on:

“The capacity of hospitals to meet demand, standards and quality of care, resourcing and access levels, and the accuracy and completeness of performance data for Victorian hospitals.”

The Age reported today on the submission to the inquiry by Victorian ED registrar Dr Andrew Buck whose allegations support a survey of Victorian ED directors by the ACEM which stated that hospital administrators were fudging computer data and admitting patients to “virtual wards” or “ghost wards”.

In other words, patients waiting long periods for an inpatient bed due to access block were allocated a Short Stay Unit bed on the computer system even though they were left on ED trolleys with their risk of bed sores and discomfort, not to mention the delay in definitive care by a dedicated nursing and medical team on the wards such as a stroke unit.

This practice is clearly not in the best interests of patients as KPI data will erroneously suggest everything is going well when it clearly is not, and thus means levels of poor patient care cannot be easily identified.

From my experience, doctors and nursing staff in the ED find such manipulation of data abhorrent, and it is a pity that hospital administrators appear to have been forced into such measures by government funding rules to retain a reasonable level of funding.

Fortunately, the Victorian government seems committed to increasing acute inpatient beds which hopefully will reduce the bed access block and ED overcrowding which is the prime issue in emergency departments at present.

The DHS annual report for 2007-2008 can be found here.

NSW health department looks like they may be requesting a “please explain” from doctors who admit patients to hospital with a diagnosis that can often be treated in the community such as pneumonia, UTI, DVT, etc.

See The Sydney Morning Herald article Dec 17th 2008.

NSW Health’s Acute Care Taskforce has identified 12 medical conditions, including pneumonia, bronchitis, urinary tract infections, chest pain and gastroenteritis.

Hmmm… chest pain Mx in the community for trial of death?

Sounds like the bureaucrats think we are lazy and irresponsibly unnecessarily adding to bed access block by admitting low risk patients.

Certainly there is a place for encouraging some of these patients to be treated in the community, but I would be surprised if most avenues to community treat appropriate patients are not already being tried.

At the end of the day, the patients we admit are almost always needed to have inpatient care either because they have a more severe form of the illness that warrants close medical or nursing care, or their social situation mandates it, or there is a lack of community support (unavailability of hospital in the home resources or availability of adequate GP follow up), or evening presentations where home care overnight becomes less safe.

Many EDs utilise their Short Stay Observation Unit for lower risk patients as long as hospital administration has not usurped this beds as interim care for patients needing inpatient care.

Creating more paperwork will just make us more frustrated and inefficient – the ED environment is already overloaded with bureaucratic processes that adversely impact ED staff efficiencies without demonstrably improving patient care, please don’t add more!

Sounds like just more political smoke screen to disguise the fact that there just are not enough acute hospital beds for the population and not enough community resources to allow community care.