No more code red


Hospitals trial new ambulance delivery system

A new system of allocating ambulances to Sydney hospitals has entered its second month of operation.

The system is designed to spread ambulance arrivals across appropriate hospitals in a more even, systematic way.

The aim is to allow ambulances to bring the right patient to the right hospital the first time round, avoiding secondary transfers of patients. It is also supposed to prevent ‘clustering’ of ambulances, particularly for smaller emergency departments.

Under the new system EDs no longer have the right to signal ‘code red’, media reporting of which has embarrassed the NSW government.

Using an on-board GPS-system, ambulance crews decide which hospital to deliver patients to, based on factors such as:

  • Patient’s clinical condition and acuity.
  • Estimated ambulance arrival time.
  • The types of services available at each hospital. 
  • A hospital’s emergency department load recently delivered by ambulance.

Each Sydney hospital’s ED is allocated a ‘diversion threshold level’ ranging from three patients for smaller hospitals to five for main hospitals. The figure represents the number of patients an ED can take per hour.

Ambulances may override the threshold in life-threatening cases and for P4 trauma patients.

Shane Jackson, an NUM at St George Hospital ED has been using the new system since it came into operation in early June.

He said the diversion threshold is calculated over an hour from the time each ambulance arrives.

‘For example if five cars turned up at 9 am this morning then in theory we won’t get any more cars until after 10 am,’ Shane explained.

‘However If we can’t offload all five cars in that hour, our threshold still comes back to zero at 10 am.

‘So the threshold is five per hour continuously every hour, despite what difficulties we might encounter after the ambulance arrives.

‘Under the old system we were able to say, “Help we’re in trouble, can we go red?” Now the emphasis is on higher management to deal with problems, but the ED is still stuck in the middle.’
Shane said it is too early to say whether the new system is an improvement.

‘We have had some very rough days recently, but we’re not sure whether the increase in presentations is due to winter or the new system, or a combination of both,’ he said.

He pointed out that the allocated threshold takes no account of non-ambulance arrivals.

Another feature of the new system is the ambulance status board, a web-based program available at all EDs.

The board gives EDs access to real-time information on ambulance arrivals and their status, and pending prescheduled ambulance bookings.

Shane said one drawback of the new ambulance status board is that it is specific to each hospital.

‘We used to have access to information for the whole area health service, so we could plan the day around what everyone else was doing. Under the previous system we at least knew which hospitals were in trouble and which weren’t, and what we could expect.’