The state government's elective surgery blitz has been condemned by Australia's peak body for emergency medicine, who says Tasmania's health system is struggling "beyond anything we have seen before".
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However, Health Minister Jeremy Rockliff maintains that "proper and appropriate" planning is under away to help deliver the important boost, as the government turns to the state's private hospitals to help take pressure off the public system.
The Australasian College for Emergency Medicine says years of neglect, underfunding and a lack of resources has left Tasmania's hospital system in a state of deep crisis where it can't function with existing workloads.
It's warned any increase in elective surgeries without "immediate and commensurate investment" to increase in-patient capacity will only make problems worse - including already dangerous ED bottlenecks.
With the worst access block in the country, ACEM Tasmania chairman Dr Juan Ascencio-Lane said doctors couldn't safely increase elective surgeries.
"While the government must deliver on their election promises, without an immediate increase in sustainable in-patient capacity across the hospital system, which includes completed staff hires, not just planned, the increase in elective surgery will put pressure on our acute health system that is already struggling beyond anything we have seen before," he said.
"Colleagues have told me of instances where recovery staff in theatres have had to care for patients, instead of the ICU, because the ICU did not have the staff or space to care for them.
"We cannot safely increase elective surgeries when the hospital system can't cope with the current workload."
As of May, more than 11,600 Tasmanians were on a waiting list for elective surgery across all categories.
An election promise, the state government has committed $156 million to deliver nearly 20,000 additional elective surgeries and more than 2300 extra endoscopies over the next four years.
While acknowledging efforts to recruit and train more staff, ACEM president Dr John Bonning said there was no place for a blitz anywhere in the healthcare system.
"Tasmania's emergency healthcare system is struggling worse than ever, and the government must explain how and where it will support the system to cope with an influx of patients from elective surgeries," he said.
"We should never see a 'blitz' in healthcare.
"Instead, we must plan carefully and develop a system that meets the needs of both emergency and elective patients and ensure equity between planned and emergency care."
A 2019 snapshot survey conducted by the college found Launceston General Hospital was the country's worst performing hospital for patient access block.
Access block occurs when admitted patients needing a hospital bed are delayed for more than eight hours from leaving the ED because of a lack of inpatient bed capacity.
In the lead up to this year's state election, the ACEM called for a whole-of-system focus to fix the "insidious systematic issues" plaguing the state's health system.
With the state continuing to experience the worst access block in Australia, it's warned the need for post-operative beds, including Intensive Care Unit admissions from elective surgeries, will cause the admission of ED patients needing a bed to be delayed even further.
Dr Bonning said it was unacceptable that Tasmanians were waiting so long for elective surgeries, but that progress without structure would only make a bad situation worse.
"Whilst patients awaiting elective procedures know who they are and eagerly await their turn, tomorrow's acute emergency patient who will need management in a Tasmanian ED does not yet know that they will need healthcare," he said.
"They do not yet know that they might be stuck on an ambulance ramp, that they might be stuck in an ED corridor waiting for admission, that they might suffer significant delays to their care at their hour of greatest need.
"This could be your parent, your child, your friend, or you. It is an equity issue. We cannot forget the acute patients."
The government has committed to employing an additional 280 full-time equivalent staff across the health system, with more than 180 expected to assist the elective surgery blitz.
Mr Rockliff said the government's elective surgery blitz was the state's largest ever boost, and included funding for the entire term of government, enabling more longer-term planning.
He said an implementation plan was underway, with surgical leaders within the Tasmanian Health Service and Health Department working together ahead of a statewide surgical and perioperative steering committee meeting this month.
"This record elective surgery blitz is extremely important, particularly after the disruption COVID-19 had," he said.
"We must always strive to do better because behind every number is a person waiting for care, and we are working hard so that more patients to get the surgery they need within the clinically recommended time."
The government has also turned to the state's private hospitals to help take pressure off the public system, including the purchase of theatre time and an escalation process to divert ambulances in periods of high demand.
Mr Rockliff said the government had written to major private hospitals to confirm the acceptance of immediate and longer-term initiatives, based on proposals put forward during a May roundtable.
"Representatives from Hobart Private Hospital, Calvary Healthcare, the North West Private Hospital and the Hobart Clinic presented proposals to improve patient flow and access to care and reduce waiting times for elective surgeries," he said.
"All the proposals were thoroughly reviewed by an expert panel and many of them have been selected for immediate funding with a number of longer-term proposals still being considered."
Successful proposals include:
- The purchase of theatre time/elective surgeries including endoscopy/gastroscopy and colonoscopy;
- An agreed escalation/overflow process to divert ambulances in periods of high demand;
- Private hospital liaison and flow nurses to transfer privately insured inpatients where clinically appropriate; and
- The purchase of Angiography Suite and Dialysis services.
Mr Rockliff said initiatives selected for immediate funding were expected to commence in the 2021-22 financial year.
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