Patients are facing dangerously long waits of almost three hours above what is recommended before being admitted through WA hospital emergency departments (ED), a damning report has revealed.
The report found only 20 per cent of hospitals accredited by the Australian College of Emergency Medicine (ACEM) met minimum senior staffing recommendations.
ACEM WA faculty chair Peter Allely said studies from the United Kingdom and New Zealand showed emergency department overcrowding was claiming lives every year.
"We know scientifically, as a fact now, that people die in overcrowded emergency departments," Dr Allely said.
"We know that for every 72 people that spend longer than eight hours in an emergency department there will be one excess and preventable death.
"It works out to a lot of people in WA."
Waiting 11 hours to be admitted
The ACEM report, State of Emergency, found 90 per cent of patients admitted to Western Australian hospitals after attending an ED were waiting more than eight hours.
Of all ED presentations, 25 per cent required hospital admission.
It took an average of almost 11 hours for those patients to be admitted across all hospital types.
Metropolitan hospitals performed the worst, taking an average of 12 hours and four minutes for 90 per cent of patients to move through the ED and be admitted.
But major tertiary hospitals also missed the target with an average of 10 hours and 27 minutes to clear ED.
"The reasons are multi-factorial … but the number one reason is a lack of beds," Dr Allely said.
"There has been a culture of inadequate bed numbers in WA for a couple of decades now, and it's catching up on us unfortunately."
Patients at regional hospitals fared better but were still on average waiting nine hours.
Only 43 per cent of patients were admitted within four hours, a decrease from the previous five years.
However from 2016-17 to 2020-21, 80 per cent of those who were discharged without needing to be admitted were done so within four hours, meeting the ACEM recommendations.
More mental health patients
The report also found overall presentations to emergency departments increased 11 per cent between 2016-17 to 2020-21, while the population only grew 10 per cent.
Mental health presentations to EDs increased from 86 per day in 2016-17 increased to 106 per day in 2020-21.
In 2020-21 mental health made up four per cent of all ED presentations.
Five per cent of all people coming to emergency departments either did not wait for treatment or left at their own risk in 2020-21, a 39 per cent increase from 2016-17.
Dr Allely said the declining performance in WA's emergency departments over the past five years was concerning.
"We're really struggling to adequately staff emergency departments, especially in the outer metro and regional areas," he said.
The McGowan government has invested $252 million into ED reform and opened 483 new hospital beds within 18 months.
However, Dr Allely said it would take some time to work out whether this was enough to halt the declining performance.
He said more work needed to be done to also free up existing beds in the system.
"About 25 per cent of patients in hospital at any one time don't need to be in hospital, they can be cared for in residential aged care facilities or with improved community services, especially in regards to mental health," he said.
"We're hopeful that we're heading in the right direction, but I guess the proof will be in the pudding over the next couple of years."
In her introduction to the report, ACEM president Clare Skinner said it was no secret the acute health care system was in a state of emergency.
"Emergency department overcrowding, ambulance ramping, overly long waits for care, burnt out healthcare workers leaving the sector, and adverse outcomes for patients – including avoidable deterioration and sometimes death – are becoming 'normal'," it said.
"Let me be clear: This absolutely isn't normal, nor safe – but it can be fixed."
The nurses union said the revelations are not surprising.
Australian Nurses Federation WA secretary Janet Reah said she's particularly worried about mental health patients being left sometimes days in emergency before a bed becomes available.
"There's no rest, it's noisy, they get upset, obviously, and it exacerbates the problems they already have that they're seeking help for," she said.
Government defends record
WA Health Minister Amber Jade Sanderson said Western Australia was facing workforce pressures in the context of global shortages and the pandemic, that were being felt around the world.
"Despite this, we have had successes recruiting healthcare workers and between January 2022 and May 2022 the clinical workforce grew by 1,107 nurses and midwives (FTE) and 412 medical practitioners (FTE)," Ms Sanderson said.
"We are undertaking a workforce campaign that includes recruiting overseas healthcare workers and upskilling the WA workforce and all graduate midwives are offered employment in WA hospitals.
She said a functioning primary care system, including disability and aged care, was critical to reducing pressure on emergency departments.
She pointed to the considerable investment in bringing new emergency beds online.
AMA wants to see a plan
But AMA President Mark Duncan-Smith said this still failed to bring WA up to the national average of beds per head of population.
He called on the government to develop a plan to address the shortfall
"It's time the doctors and nurses of this state didn't have to fight ramping and bed block with one arm tied behind their back," he said.
In a report, the AMA last year called for 612 new public hospital beds on top of those already pledged, which they say will bring WA into line with the national average.
"This chronic shortage of hospital beds in WA has led to growing waiting lists for access to elective surgery, overcrowded emergency departments unable to cope with expected demand and unacceptable delays in access to emergency care," that report read.
"Bed shortages result in an increased risk to workforce wellbeing and cause avoidable patient deterioration and death."
Editor's note: This story initially reported between 1,500 and 2,000 deaths in WA were attributable to overcrowding in emergency rooms each year. That figure was calculated by extrapolating from large studies from the United Kingdom and New Zealand published in peer-reviewed journals. However, there has been no research in Western Australia that conclusively proves these figures are directly applicable to the West Australian population. As such, we have removed that specific figure from our coverage.
