John Malham, patient, The Buloke Times
Recently I spent two weeks in a semi-major regional hospital that caters for its town population of twenty thousand and the surrounding areas 70 thousand population.
I had no intention of writing this article but having witnessed the forceful nature of the hospital’s discharge team, I began taking notes and interviewing people involved in all aspects of the hospital’s running.
The Discharge Team seemed to be ruled by the motto, “patients home as soon as possible above the patients welfare needs”. I felt obliged to let the public know what I was experiencing.
Patients in my belief, and also some of the staff, were being released too soon and in one case it nearly led to a death. Matt fell four metres when a roof collapsed and sustained seven broken ribs and a punctured lung. After one day in emergency and two in ICU he was moved into my ward.
He spent two days there in agony but was told to ring his wife to pick him up and take him home. This amazed me as it did several of the staff, but he was discharged regardless. Having been advised by myself and staff his wife took him to their local hospital where he was immediately transferred by ambulance to the Ballarat Hospital. They confirmed his original injuries but also that he had a lung full of blood with continual bleeding into said organ. He was released seven days later, lucky to be alive. One of his paramedics on the trip to Ballarat advised him that if he had been at the original accident he would have arranged an air lift to Melbourne.
Other patients I observed to be discharged too early, included Russell who had severe stomach pain but was released without a diagnosis. After these incidents I took a total negative attitude towards the discharge process and decided to delve deeper to find out if the rest of the hospital was similarly run. A huge can of worms was soon discovered!
Interviews
Inside the hospital I interviewed the doctors, nurses, visitors, orderlies, receptionists, canteen staff, cleaning and emergency staff. Havingan adversity to sleep and a smoking habit, I spent many hours outside of the hospital where I spoke to police, security guards, addicts, emergency patients, paramedics and transport drivers such as St John of God and Flying Doctor service employees.
Having spoken and questioned all involved I concluded that the Discharge Team was not only to blame, the whole health system that enveloped this hospital was broken. From when being picked up by an ambulance to self admitting you should be warned to “enter at your own risk”.
The town has only four GPs with a two-week waiting list. The knock on effect was that a huge deluge of patients visitied emergency with minor injuries 24 hours a day. Some of these patients were waiting hours to be seen. The only people spoken to, who were reasonably happy at work were the gardeners, receptionists, canteen staff and food providers because they knew both their start and finish times. Orderlies were also generally happy because they were similar, but occassionally had to work extra and their shift times were not very far in advance causing difficulty planning. The ward nurses were in the same boat, but sometimes had to pull double shifts due to staff shortages.
The supervisor of security advised that he was severely understaffed and had pleaded with administrators for years without a positive response. This led to increased danger to his staff from violence while dealing with drunks, addicts and the mentally ill.
Ramping
This shortage also led to police attending to oversee patients, emergency staff also faced danger from these patients as well as a lack of room and beds that led to the corridoring and bedding of patients on the paramedics’ and transports’ stretchers. This led to one of the major problems, ramping.
Paramedics and transporters I spoke with advised being ramped up to eight hours was not unusual.
Paramedics advised they work varying shifts, four days on/four off, five days on/five off and eight days on plus on call for 24 hours/eight off. Transporters work four days on four off, five days on five off, 12 hour shifts. Having worked shift work myself, I belive that twelve hour shifts are too long. Both paramedics and transporters know their starting time but no idea when they will finish, the only guarantee is that it won’t be after 12 hours. One female paramedic was at the end of her fourth day shift, she had already worked sixty-six hours of which 16 were ramped.
Normal occurrence
This was a normal occurance for all I interviewed.
I witnessed one example where a patient had to be transported to the Royal Melbourne Hospital. A transport vehicle with hours to spare and an ambulance sat outside the hospital. The transporter was available to go but the paramedics had, after woking their normal shift, been called back for another four hours, thus disallowing them from continuing. The transporter needed a paramedic or two new paramedics were required for the ambulance after five and a half hours. Two new paramedics were found and the patient travelled to Melbourne. Meanwhile, two vehicles sat idle.
During my cigarette breaks I saw up to seven vehicles waiting to either unload or pick up in a bay that catered for two.
My personal experience of this inefficient system was being transported from my small country town to this hospital by a vehicle and two paramedicas from Melbourne. Then upon my transfer to Ballarat, being taken by two transporters, also from Melbourne, six hours later than the due pickup time.
Questions
One question I posed to paramedics is, “what happens if you arrive at high risk situation?” They replied thatpolice are called to attend, then three options are considered; chemical restraint, physical restraint by way of strapping down the patient, or police accompaniment in the vehicle.
Something that worried me, and please excuse my sexism, but having been attacked myself by two individuals on ice, I asked what happens if you pick up an unconcious person who suddenly awakens and becomes violent, especially if the paramedics are both female? The response was … press the alarm that contacts the police, exiting and locking the vehicle quickly and hope you make it out safely. In my opinion this is an unsafe practice but one I don’t have an answer to.
Requirements
Having questioned everyone involved at this stage, except administrators, below are the major requirements needed:
- Larger hospitals, more nurses, more beds, more doctors – both in the hospitals and GPs.
- More paramedics. There are many qualified in the community but unable to be hired due to financial constraints.
- More vehicles, although they are useless without more staff.
- Above all, more money injected into the health system so the above can be realised.
- Less bureaucrats and management leading to streamlining of the system.
- Return financial control back to the health department rather than major hospitals who tend to keep most of it themselves rather than dispersing it where needed.
With one day to go before my transfer, I was lucky enough to come across three administrators who cared about their hospital. Much to my surprise I wasn’t duck shoved or told I would have to talk to a Department of Health spokesperson. Later that afternoon I had an hour meeting with the Communication Manager who spoke to me openly. I gave him a list of questions which he promised to answer and email me. As I originally feared, someone up the chain found out, obviously felt threatened and closed it down. I was given a number to contact at DH and upon contact I gave my name and enquiry. I was told to hang on, then duly hung up on.
The higher up the tree you climb the more you encounter scared, useless, incompetent idiots.
Finally, it is obvious to me that the health system, like all government-run systems such as education and the elderly, is stuffed, and until a huge injection of funds is implemented by the powers that be, things will only get worse. Don’t hold your breath.
This article appeared in The Buloke Times, 26 July 2024.