JOHN Hunter Hospital's emergency department is buckling under a "perfect storm" of challenges, with staff warning that it's only a matter of time before something goes tragically wrong.
The warning comes after an elderly man died of natural causes while on a stretcher in a hospital corridor on Saturday. Doctors and nurses say they fear they will miss something, or someone, if they don't get the staff, beds, and resources needed to manage an increasingly "overwhelmed beyond capacity" ED.
The NSW Ambulance service and the local health district have said the man passed away as a result of the "natural course" of his illness - and that conflating the busy ED with his death would be inaccurate. But a doctor at the hospital has told the Newcastle Herald that having patients cared for in "overflow" in a hallway while waiting for a bed to become available was "unsafe" regardless.
Hunter New England Health denies staff on the ground attempted to escalate concerns about staffing and capacity levels to an "internal emergency" - or a code yellow - on Saturday, arguing the ED was only marginally busier than usual.
But staff say if the decision were up to them, not management, an internal emergency would have been called not just on Saturday but "a bunch of times" since January.
Internal emergencies have been called in other local health districts when a department or facility reached a point where it was "over capacity"; where there was no surging or "flexing" capability; and when there were inadequate staffing levels.
They said the hospital opens beds to surge its capacity when required, which is typically during the busy winter flu season. But the hospital had enacted its "crisis" plan and opened its remaining beds in January.
"There are no more beds to open, and we're only at the start of flu season," a doctor said. "Resources are overwhelmed, often. How are we going to do this until September?"
The Herald has seen a series of increasingly desperate messages from shift managers calling for staff to cover nursing shortages at the hospital on Saturday.
But both doctors and nurses at the hospital have said staffing issues are just the beginning. They said there was increased demand on the hospital caused by COVID-19 and influenza.
There was also a significantly larger number of children presenting to the ED with mild respiratory symptoms - a trend they say has been exacerbated by general practices refusing to see patients with a cough or fever.
"There are a lot of children being sent to the ED with minor cold and flu symptoms that could absolutely be managed by a GP," a doctor said. "But among those fairly 'well' children, there are also some really sick ones that we worry will get lost in the melee."
The doctor said they were terrified of making the wrong call on the floor, and what the consequences would be if a very sick child was left waiting in the ED for hours.
Nursing staff said patients had told them they'd had trouble getting in to see a GP at all. A nurse, who is not permitted to speak to the media, said the reduction in services at GP Access After Hours clinics had also added to the pressure on the ED.
She spoke to The Herald because she was terrified the unrelenting pressure on the department could lead to "tragic consequences" if they missed someone, or something important, because they were so stretched.
"Mistakes are bound to happen when everyone is under that much pressure," she said. She added that waiting times in the ED had "blown out", and ambulances were always there waiting with more patients to offload.
Saturday was described by another nurse at the hospital as "horrific". Ambulances had been lined up at the hospital for most of the day, and "many" people waited "at least" five hours before getting a bed at the hospital on the weekend.
The NSW Nurses and Midwives Association (NSWNMA) said the current "crisis" could not continue.
"ED nurses are being pushed to keep picking up staffing shortages or 'making do' while working short-staffed," NSWNMA's John Hunter and John Hunter Children's Hospital branch secretary, Rachel Hughes, said. "As it is, ED staff are completely stressed by the conditions they are constantly working in. Our patients and their loved ones put their trust in us to care for them safely, and when we don't have the resources we need to do that, terrible things can happen."
She called for ratios of one nurse to three patients on every shift in the ED.
"It is becoming extremely unsafe for our patients and the community we are desperately trying to support, and despite our continued pleas, this government still won't listen to us."
Ms Hughes challenged state politicians who had shown reluctance to support the association's claims for safer staffing levels to "come and spend a few hours" in the ED.
Leanne Johnson, the executive general manager of John Hunter Hospital, said it was "well equipped" to treat a significant number of complex cases while not compromising patient care.
"This past weekend was no different," she said.
Ms Johnson said the hospital saw a "small increase" in emergency presentations over the weekend, and staff continued to manage presentations and hospital capacity within normal process. She said at "no point" had John Hunter Hospital needed to call an "internal disaster" this year.
"Like all hospitals, there has been increases in activity, including paediatric presentations, and the team manages this through short-term escalation plans - this includes temporarily opening surge beds and flexing staff up and down in response to demand," she said.
Ms Johnson said while overall the hospital had "slightly higher than average activity" on Saturday, they were seeing increased presentations for higher acuity issues such as chest pain, acute respiratory infections, traumas, fractures and wounds across all days, not just on weekends.
"I can assure the community that patients who present to the ED, either via ambulance or in-person, are prioritised to ensure those with the most urgent conditions are treated first - and those in need of urgent medical attention will continue to receive appropriate care and should present to John Hunter Hospital's ED or call Triple Zero," she said.
Despite being one of the busiest emergency departments in the state, John Hunter Hospital continued to be one of the highest performing facilities in transferring care of patients from NSW Ambulance to the emergency department.
"According to the latest Bureau of Health Information Quarterly Report, John Hunter Hospital transferred more than 89 per cent of patients within the 30 minute benchmark, well above the state average," she said.
"Sadly, we can confirm the recent death of a patient within the John Hunter Hospital emergency department, which was related to the natural course of their illness.
"I acknowledge this is a difficult time for this patient's family, and offer them our sincere condolences."
