Tasmanian Health Service pushes ahead with controversial hospital overcrowding protocol

Posted by
Patients could end up sitting in a chair holding a hand bell in order make way for a sicker patient.

Patients in the Royal Hobart Hospital (RHH) will be left to wait in chairs or on a trolley in meeting rooms, dining rooms and corridors and given a hand bell to call nurses in an effort to combat overcrowding.

Key points

  • The protocol suggests 20 areas of the hospital that will be used to accommodate patients in chairs 
  • Labor says the protocol is inappropriate in a first world health system
  • The State Government says “over-capacity” protocols are used safely in other jurisdictions

The ABC can reveal the Tasmanian Health Service (THS) will push ahead with its controversial plans to free up beds at the overcrowded hospital by moving patients considered fit for discharge to chairs.

In a memo sent to staff on Tuesday, the THS confirmed it had made minor changes to the controversial draft over capacity protocol (OCP), which was released in September and questioned by Prime Minister Scott Morrison.

“The original intent of the protocol is unchanged,” the staff memo stated. 

The protocol suggested 20 areas of the hospital that will be used to accommodate patients in chairs instead of beds.

These include meeting rooms, sitting rooms, family rooms, patient activity rooms and multipurpose rooms, and a corridor which could also cater for a patient in a trolley. 

Patients to use hand bell to signal staff

The THS has also followed through with its plan to give patients in chairs or on a trolley a hand bell to signal to staff.

“Staff must ensure a patient receiving care in the over-capacity area … [is] informed of how to call for staff assistance eg [by using] a hand bell,” the protocol states.

Patient being wheeled down a corridor at Royal Hobart Hospital.

It said staff should only move adult patients out of beds and into the over capacity areas, adding they must be:

“Clinically stable and confirmed discharge/transfer, able to transfer and sit in a chair, nil or less than four litres of oxygen per minute via nasal prongs, no cognition issues, and able to communicate and do not require isolation.”

Medical staff tend to patients

Triggers for activating the protocol include: when there is no resuscitation capacity in the emergency department (ED), 15 or more patients waiting for a bed in the ED and three or more ambulances unable to offload for 30 minutes or more.

The RHH has been operating at its highest escalation level, level four, often on multiple days a week, with some staff describing the situation as “the new normal”.

The document said the protocol was necessary to free up beds in hospital wards at the RHH to relieve pressure on the ED.

“In the context of the hospital operating with a deteriorating escalation status, the THS needs to operate differently,” it said.

“The Over Capacity Protocol acts as a safety valve to provide hospital space for acutely when the functioning of the ED is compromised.”

‘Things have got worse’: Labor

Opposition health spokeswoman Sarah Lovell said the news was concerning. 

”The bottom line is that [doctors and nurses] have been forced into this position where they need to make decisions about patient care in a far less-than-ideal situation because of chronic underfunding of our health system,” she said.

Ms Lovell said the millions of dollars of underfunding of the state’s health system by the current Government meant health workers are forced to put patients in places that are not set up to provide adequate patient care. 

She said while the protocol is not unheard of in Australia, it is inappropriate in a first world health system.

”It is really concerning that we’re not even into the flu season yet and we’re already talking about over capacity protocols,” she said.

“Nothing has changed and in fact things have gotten worse.”

‘Experts consulted over protocol’: State Government 

RHH executive Clinical Director Craig Quarmby said the protocol was supported by emergency physicians.

“As part of the consultation process conducted around the over capacity protocol, it was deemed important that all patients have access to a means of alerting staff should they need assistance, bearing in mind that these patients are awaiting discharge,” he said.

Ambulance ramping at the Royal Hobart Hospital

“We are trying to develop methods that improve the efficiency of patient discharge so that people who need the bed are not kept waiting any longer than they need to, which ultimately leads to better patient outcomes.”

Health Minister Michael Ferguson said the Government had listened to expert clinicians to determine the best way to care for patients.

“While over capacity protocols are used safely and effectively in other jurisdictions, the Government does not believe this is a silver bullet by any means and will continue to work on longer term solutions for managing increasing demand for acute health services,” he said.

Mr Ferguson said while more capacity is being built in the hospital’s new K block, it is important patient care is delivered within the RHH’s current physical capacity. 

Royal Hobart Hospital Emergency Department