Staffing ratios needed for stretched emergency departments

NSW emergency departments (ED) are under more pressure than ever before, with a record number of attendances across the state, reinforcing the need for safe nurse-to-patient ratios to be rolled out urgently.

According to the latest Bureau of Health Information (BHI) report, there were 810,201 ED attendances in the January to March quarter, up 5.2% compared to the same quarter in 2023. Concerningly, more than 74,000 patients left the ED before completing treatment, which is almost 17% more than the same time last year.

The volume of critically ill patients presenting to EDs also grew during the first quarter of the year, with a record 6,677 triage category 1 (resuscitation) patients (up 13.9%) and a record 123,935 triage category 2 (emergency) patients (up 9.1%).

NSW Nurses and Midwives’ Association (NSWNMA) General Secretary, Shaye Candish, said staff were dealing with complex clinical care and increased workloads as patient numbers surged.

“These figures show EDs across the state are being pushed well beyond their limits and this is having a severe impact on the staff and patients,” said Ms Candish.

“It’s disappointing only 56% of patients were discharged from ED’s within the recommended four hours, which is the lowest number since 2010. This reflects the sheer volume of patients presenting to public hospitals, coupled with the issue of bed block, and the challenging conditions our members work in, often while chronically understaffed.

“Royal North Shore, Royal Prince Alfred, Liverpool and John Hunter hospitals continue to see the highest number of presentations. Wyong Hospital had a 6.9% increase in ED attendances, while Nepean Hospital was up 8.7% and Blacktown ED rose by 10.5%.

“Regionally, there was an increase in ED patients attending Coffs Harbour Health Campus (up 9%), Singleton (up 9.9%), Forbes (up 13.1%), Moree (up 6.7%), Cooma (up 4.8%) and Bega’s South East Regional Hospital (up 6.6%) compared to 2023 levels.

“The BHI data also shows 51,149 elective surgeries were performed, which is down 6.6% on the same quarter in 2023. While more than 3,400 patients were stuck on the waiting list longer than is clinically recommended.”

NSWNMA Assistant General Secretary, Michael Whaites, said the latest hospital figures were deeply concerning, particularly in EDs.

“This data highlights how critical safe nurse-to-patient ratios are for public hospitals. The NSWNMA has been instrumental in getting ratios rolled out for the first time in NSW, as we’ve seen at Royal North Shore and Liverpool hospitals. This will go a long way in dealing with this demand, but we need to ensure all clinical areas get this benefit,” said Mr Whaites.

“These record figures are indicative of the workload pressures nurses and midwives face daily across the public health system. The Treasurer must allocate further funding to the Safe Staffing policy in the upcoming and subsequent state budgets, to ensure ratios are implemented across all wards and units in all public hospitals.

“This includes improvements to maternity once a review of Birthrate Plus® is complete. Given 16,439 babies were born during the last quarter, up 3.7% on the same period last year, we need to ensure our midwives are able to care for women and babies in a work environment that is safe.”

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