Jump to content
Sign in to follow this  
hulkster

Ramping. This cant be good.

Recommended Posts

https://www.abc.net.au/news/2019-06-17/ambulance-ramping-hits-10000-hours-at-hobart-hospital/11215264

 

How is ramping any good for anyone or any hospital. Been going on for years and we still have no fix for this fucken mess.

Paramedics are worth their weight in gold but how they put up with the conditions thrown at them is beyond me.  Same with ER doctors and nurses. 

The whole system is fucked with a huge dollar shaped dildo.

 

Couple of years ago i fell off a ladder and hurt my back . Had an ambo ride to the Launceston General Hospital and once there i has on a stretcher with the two Paramedics looking after me in a corridor outside the ER. They couldn't leave me until i was handed over, and it was a good 40 minutes till that happened. So, we had two paramedics and an Ambulance doing nothing because the hospital couldnt take me. I felt terrible tying them up but what could I do. I couldn't move.

 

Surely something has to be done, and fast.

Share this post


Link to post
Share on other sites

i have been that guy who got straight though triage, you dont want to be that person

 

yes, you had a serious injury and in a lot of pain, but you were not getting worse

 

 

many of the ER beds are taken up by people waiting for beds in the wards (that can take hours)

Edited by TheManFromPOST

Share this post


Link to post
Share on other sites
32 minutes ago, TheManFromPOST said:

 

 

yes, you had a serious injury and in a lot of pain, but you were not getting worse

 

 

many of the ER beds are taken up by people waiting for beds in the wards (that can take hours)

 When I said i feel terrible it wasnt because i was sore, it was because i was the reason 2 paramedics and an ambulance werent going anywhere.

Share this post


Link to post
Share on other sites

in ER you are still monitered closely, if it was not a paramadic, it would have been a nurse checking you every 10 minutes

Share this post


Link to post
Share on other sites

Related to cuts in health care by the current LNP government of like 450 million in Tassie

  • Like 1

Share this post


Link to post
Share on other sites

The media has made an ongoing complaint about ramping over  here in Adelaide and from video they present it does seem to be an issue.

 

Essentially Adelaide has two major hospitals but it also has an aging population which has led to their re-opening older hospitals that they had wanted to de-commission with the opening of the new RAH in particular.

 

Everyone experiences something different I  guess but we had my mother packed into an ambulance 13 times over the course of a couple of years and she was never ramped once. Where it could back up was in Emergency itself where she was held for often two reasons: There was not a bed available or she needed oxygen at a level that could only be supplied in ICU or Emergency.

 

Her lungs were failing, something she was in big denial over but on the wards they cannot supply more than, if I recall correctly, 4litres per minute, in ICU or Emergency they can go to 8.

 

I have no idea what happens above that, oxygen tent I suppose.

 

It's understandable, oxygen is or can be a fire risk, and no one wants a fire in a hospital.

 

My guess would be that the RAH is still refining its triage and volume of ICU which is totally understandable in a new facility with a changing external dynamic but the media loves to sensationalise.

 

I would not have a clue about the situation in Launceston but in SA and WA from personal experience Paras do not go with the patient as a general rule, it is the Ambulance crew, who are Para trained of course but both states keep a "roaming" team of paras who can respond then hand over once the Ambos arrive.

 

It is of course still not good enough, the Ambulance and crew are a combined very expensive and vital piece of kit that is being stalled on the ramp sometimes, but I do think they exaggerate it somewhat from our experiences. Possibly on weekends etc it could be more of an issue.

 

The thing is that it is not something that can be addressed overnight. The only way to take the pressure off the ramp is to have more capacity in the hospital and that takes time to build out and to train and provision more staff not to mention lots of funding.

 

Overall, and I am not addressing the Launceston situation,  in the end a small city, Adelaide is doing ok from what we saw - if there was a bottleneck it was at emergency sometimes caused by bed availability in the hospital but sometimes they simply did not want to move mother until she stabilised.

 

It's always a damned if you do or don't situation that the media loves to seize upon.

 

If there were excess capacity in the hospitals they would be calling that waste....

 

Cheers

 

 

 

 

 

Share this post


Link to post
Share on other sites
23 minutes ago, Leonid said:

 

Sorry, not true at all as far as I can tell.

Health spending has been going up steadily in all states and federal for the last 10y.

https://www.aihw.gov.au/getmedia/e8d37b7d-2b52-4662-a85f-01eb176f6844/aihw-hwe-74.pdf

 

Yeah quoting me document from 2016-2017 data published in 2018, I'm talking cuts made in 2019.

https://www.abc.net.au/news/2019-07-29/royal-hobart-hospital-budget-50m-cuts/11363310

Edited by Jeruselem
  • Like 1

Share this post


Link to post
Share on other sites

🙂

 

It's ok J, he can take a while to catch up sometimes    🙂

 

However the thing is any money allocated or not allocated to health always takes a time to percolate through the system - essentially its a game of prediction that they mostly get wrong.

 

Cheers

 

 

Share this post


Link to post
Share on other sites
1 minute ago, Leonid said:

 

OK but now it's $50m, and out of forward budgets (which appear to be increasing year-on-year) - i.e money that is not committed yet?

 

 

 

It's still 50 million the hospital doesn't get now.

Share this post


Link to post
Share on other sites

And the document for 2017-2018 still seems to be showing the same data - slow & steady growth.

https://www.aihw.gov.au/getmedia/91e1dc31-b09a-41a2-bf9f-8deb2a3d7485/aihw-hwe-77-25092019.pdf.aspx

Just now, Jeruselem said:

 

It's still 50 million the hospital doesn't get now.

 

Yes but if today I say I'll give you $300m on January 1, and tomorrow I say I'll give you $250m on January 1, how much actual money have you lost?

 

I guess, succinctly put, what I'm saying is that every state and federal government in Australia has been increasing year-on-year spending on health to a greater or lesser degree, but in the last decade health spending across every wholesale metric appears to be going up.

 

So no-one is actually decreasing health spending.

Share this post


Link to post
Share on other sites

If the hospital budgeted based on the original forward estimates given the 2016-17 and 2017-18 numbers, they have a problem because the 2019 cuts were not budgeted.

Share this post


Link to post
Share on other sites
Just now, Jeruselem said:

If the hospital budgeted based on the original forward estimates given the 2016-17 and 2017-18 numbers, they have a problem because the 2019 cuts were not budgeted.

 

Then they can change their budget. I do so every month. It sucks, but that's part of business.

They still haven't lost any money as they didn't have it yet anyway.

Share this post


Link to post
Share on other sites
2 minutes ago, Leonid said:

 

Then they can change their budget. I do so every month. It sucks, but that's part of business.

They still haven't lost any money as they didn't have it yet anyway.

 

Well well they did change their budget ... it means more flipping ambulance ramping on top of the levels before.

Share this post


Link to post
Share on other sites
2 minutes ago, Jeruselem said:

Well well they did change their budget ... it means more flipping ambulance ramping on top of the levels before.

 

I get it. I don't disagree with the issue of ramping needing to be resolved... but it's not because of budget cuts.

 

As in, next year the hospital will have more money than they did this year, and likewise the year after next they'll have more money than next year.

 

That's just the way it has been for the last decade or so...

Edited by Leonid

Share this post


Link to post
Share on other sites
9 minutes ago, Leonid said:

 

I get it. I don't disagree with the issue of ramping needing to be resolved... but it's not because of budget cuts.

 

As in, next year the hospital will have more money than they did this year, and likewise the year after next they'll have more money than next year.

 

That's just the way it has been for the last decade or so...

 

I hope you're right about the funding but I wouldn't use past behavior as indicator especially with this economic downturn hitting property taxes which everyone is addicted to.

Share this post


Link to post
Share on other sites

And that’s true as well but you know governments can only spend what they earn so if revenue is down, so are budgets....

Share this post


Link to post
Share on other sites

to add a bit of coherence, the federal budget for health has less than fuck all to do with hospital management, which is a state responsibility, and the medicare funding of inpatient care is a mysterious beast even to hospital staff, who personally see not a cent

 

as such, no great amount of federal money (which sponsors the pbs, and medicare) sees the light of day in the public hospital system... so much so that on discharge from hospital, you get (if you are lucky) 3 days of ongoing medication which buys you enough time to visit a gp (if you are mobile and can get an appointment) to obtain further supplies, which will then be a federal problem, because , you know, that's who do medicare and (subsidised) drugs

 

wrt ramping, "exit block" in emergency means there are no open beds to process the meat that wagons deliver, nor staff to attend them in the never never betwixt transport (the ambulance), and a defined repository (a bed)

 

some get triaged to go and sit in the waiting area, because they aren't as sick as they think they might be (on the judgement of  hopefully senior and competent nurse... triage is not a doctor duty), having attempted to cue jump by taking a big wite bus to the back door rather than more public transport to the front entrance

 

long story shorter, if you can't have a place to be seen, you need to be parked somewhere safe, and ambulances are cheap - because they don't cost the hospital a thing, and while they are tied up in emergency baby sitting, they can't go and collect more meat

 

at this point, hospital go on bypass, meaning meat is delivered further afield, to spread the load, but the actual result is that places that are barely coping with their own meat supply are suddenly gifted with exotic flesh from out of area

 

not only does that mean the accrued details of regular attendees are not on hand (although the mhr will fix that in no time, if you believe that to be a truth), it means if they need to stay they are far from their support people, and can only be handed back to another hospital when there's a bed, oh, and when they are proven by requisite cultures (takes about 3 days) to prove they are not going to import multi-resistant germs between establishments

 

 

 

and as for adelaide ?  the new rah replaced a much larger establishment with a smaller bed number witout as many ancillary services, to serve an increasingly sick and numerous catchment

 

they did the same here with northern beaches - the brilliant private / public arrangement that proved so bad at port macquarie that it eventually reverted to public, so they're trying again here where i am

 

they send their pathology off site (that's efficient in emergencies) , amongst other rather bizarre logistical issues, because... you know, the private system is always good at increasing efficiencies and lowering costs

 

 

 

tldr :  ramping will cease when hell freezes over in a warming climate

 

 

  • Like 2

Share this post


Link to post
Share on other sites

additional info :

 

if hospitals fail to meet targets for processing meat, their budgets are cut

 

because obviously, if you lack sufficient resources, you will be more efficient with less and the problem will be resolved

 

 

meantime, the cost of special treatments and medication rise as each new option becomes available, and becomes considered "appropriate"

 

 

old and sick people get treated beyond reasonable likelihood of roi, because pushy relatives want "everything possible done", and in the sanitised world of eternal youth, no-one ever dies unless doctors are the reason... because disease isn't i guess

 

 

anyway, i ran away into general practice because at least i have some control, and the possibility of co-ordinating useful timely care for people i curate like a collector

 

meantime, the e.r. is chockers with ice-crazed types who aren't admissible as psych issues (if there was an acute bed anyway), and too fucked up for the police to take away, but can absolutely take up a bed (and numerous minders, nedical and otherwise) for significant hours / days

 

 

the system is broke, but there ain't a clear fix

 

 

  • Like 1

Share this post


Link to post
Share on other sites

Well here in the NT, we had only one real hospital (the private and public hospital) in same building. We have the Palmerston one now built but they probably ramp excess ... back to Darwin. Yay

Yes there's hospitals in Tennant creek, Gove Katherine and Alice Springs as well but they don't have near the facilities of Royal Darwin Hospital.

Edited by Jeruselem
  • Like 1

Share this post


Link to post
Share on other sites
1 hour ago, scruffy1 said:

the system is broke, but there ain't a clear fix

 

We need pollies to stop passing the buck and institute proper reform, along with adequate funding, which maybe could be found if they stop handing out useless tax cuts to high rollers and so on, but that'd require a media landscape that would hold them to account, which would require at the very least significant reform to media ownership laws. 

 

Nothing happens unless lots of people get the shits pretty hard, and there's a pretty effective system in place to ensure only a few people get the shits about anything, no matter how atrocious. 

 

So, you know, we're totally screwed. In regard to anything and everything. 

Share this post


Link to post
Share on other sites

in health the wedge is the state versus federal responsibilities - both of whom show no generosity or co-operation

 

my best anecdote to demonstrate :

 

as a gp, i get supplied on request with "free" drugs for emergency use in my doctor's bag, some of which are quite costly (to the system; free to me)

they get supplied in fixed quantities that bear little relationship to likely use pattern, but there is no wriggle room - want any, you get 10 as default, even if you might only ever use one in the shelf life

 

most often these are not used, but need to be on hand in case

 

i suggested to the local hospital (where i was also working at that stage) that it would be sensible to bring in my stock when it was close to expiry (a few months' remaining) and exchange it for newer stock, as the old stuff would get utilised in emergency before it could go out of date

 

i was happy to swap for lesser quantities, because, well, that's what would be enough in reality rather than the defined arbitrary amounts

 

 

no go

 

federal law prevents me from doing so, as it is supplied for my use as a gp, and thus i must throw it out unused; can't even donate it for overseas use in countries where the use by date is less concerning than the total unavailability of basic useful stuff, because the contract for supply to the feds stipulates any such disposal would interfere with international marketing agreements - bad for business to give free redundant out-of-date stock to places that will never afford supplies anyway

 

the suspicion is the exporting like so might encourage less scrupulous people to sell stock overseas (like patients are noted to do with common stuff got here under pbs, to send to their distant family - stuff as mundane as panadol, but other less otc (over the counter) items too

 

here's the monthly allowables - https://www.pbs.gov.au/browse/doctorsbag

 

note it's max quantities, but find a pharmacy to dispense a singe ampoule of anything, and i'll fall over dead from surprise, the pharmacy guild know how to make $

 

 

and so it goes

  • Like 2
  • Sad 1

Share this post


Link to post
Share on other sites
2 hours ago, scruffy1 said:

 

long story shorter, if you can't have a place to be seen, you need to be parked somewhere safe, and ambulances are cheap - because they don't cost the hospital a thing, and while they are tied up in emergency baby sitting, they can't go and collect more meat

In which case @hulkster should do his best ( if he is ever unfortunate enough ) next time to just concentrate on his own well being which is probably not so well given he's lying on an ambulance gurney ( sp? )  again. And the paramedics need to just deal with it too

Share this post


Link to post
Share on other sites

Regarding budgets, even if it increases from year to year it in no way indicates if it increases in line with demand increase, and if the budget has always been insufficient it is just a lame game of catch up where budgets may be forever falling behind demand..

  • Like 2

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
Sign in to follow this  

×