Steady rise in long hospital stays reflects ‘struggling system’

The Victorian Agency for Health Information (VAHI) defines length of stay as ‘the period of time between when a patient arrives and departs from an emergency department [ED]’.
 
Latest figures from the VAHI show that, over a three-month period in 2019 in Victoria, 409 patients stayed in a hospital ED for longer than 24 hours – a sharp increase from 170 patients over the same length of time in 2018.
 
Length of stays of less than four hours during the same quarter in 2019 was 63%, a slight decrease from 67% in the previous year.
 
An overall steady rise from the last quarter in 2018 to the last quarter in 2019 shows that more hospital-admitted patients are outstaying 24 hours.
 
Given the state-wide target of patients staying in an ED for longer than 24 hours is 0%, this substantial increase is concerning, according to Australasian College for Emergency Medicine (ACEM) President Dr John Bonning.
 
‘One patient waiting in the ED for 24 hours or longer is too many, so to have a blowout of this magnitude is very concerning. It represents an unacceptable risk to patient safety,’ Dr Bonning said.
 
Overcrowding of hospital EDs is an increasing issue of focus, with calls to divert non-urgent presentations to general practice and increased primary care funding to upgrade the situation.
 
The Australian Institute of Health and Welfare (AIHW) reported a 4.2% increase of nationwide ED presentations in 2018–19 (8.4 million) from the previous year. The same 12-month period saw close to four million non-urgent or semi-urgent ED presentations that could have been managed in a primary care setting.
 
The Productivity Commission’s 2019 report on government services showed that expenditure on general practice was $375 per person per year, with the number for hospitals considerably higher at $2606.
 
Dr Bonning underlines the need for major systemic improvements to address issues in EDs and better distribution of funding across Australia.
 
‘[Long ED stays] reflect a system struggling to meet the demands of some of our most vulnerable sick and injured patients requiring admission to hospital, and particularly those experiencing mental health crisis,’ he said.
 
‘It is also well established that overcrowded and access-blocked EDs – an inability to admit a patient for over eight hours – increase the risk of harm to patients.’
 
The ACEM calls for a ‘whole-of-system’ solution, taking into account that population growth, increased chronic disease burden, ageing populations, and reduced access to primary care are placing ‘huge pressure’ on hospital EDs, Dr Bonning said.
 
‘As this pressure continues to build, the reality is that increases in resourcing have not kept up with demand,’ he said.
 
The RACGP’s Vision for general practice and a sustainable healthcare system aligns with recommendations to conduct targeted research on how better use of general practice services can reduce ED presentations, hospital overcrowding and overall health expenditure. The college’s pre-budget submission 2020–21 called for implementation to support the Vision.
 
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emergency department hospitals overcrowding Victoria