[The Conversation]

Ambulance Ramping Is A Signal The Health System Is Floundering. Solutions Need To Extend Beyond Eds​

Health-care systems across Australia are buckling in the wake of COVID waves and the flu season. Pictures of ambulances piling up outside hospitals have become commonplace in the media. Known as “ramping”, it’s the canary in the coalmine of a health system.

As a major symptom of a health system under stress, state governments across Australia are investing unprecedented amounts into ambulance services, emergency departments (EDs) and hospitals. South Australia has committed to an increased recruitment of 350 new paramedics. Likewise, New South Wales has committed to 1,850 extra paramedics.

Victoria, meanwhile, has committed an additional A$162 millionfor system-wide solutions to counter paramedic wait times, on top of the A$12 billion already committed to the wider health system. This could begin to alleviate the system pressures that lead to ambulance ramping.


But what happens when the paramedics return yet again to ED with another patient? Will they simply end up ramped again?

We also need to consider better care in the community – and paramedics could play a role in this too.

Smoother transfers and discharges​

The Victorian government initiative is based on a similar modelused in Leeds, in the United Kingdom, which has resulted in decreased ramping times. The Leeds model has seen only 4.9% of paramedic attendances to ED having ramping delays over 30 minutes, compared to the UK average of 21%.

The model focuses on transferring the patient from the paramedic to the ED staff, discharging patients from hospital and coordinating the patient’s care in the community.

The aim is to improve patient flow in and out of the hospital. For patients requiring a hospital bed, they are admitted. For those not requiring admission, they are discharged home in a timely manner. Discharge coordinators will assist this process, coordinating the care patients need after an ED or hospital stay out in the community and in their homes.

The discharge process is complex. Often a well-done discharge is the difference between a patient returning to the community healthily versus a re-presentation to the hospital due to actual or perceived worsening of their condition.

However, patients often feel rushed when discharged from hospital and ill prepared to return home. Staff feel pressure to get patients discharged and out of beds to allow the next patient in.

The adoption of the Leeds model in Victoria aims to increase the flow in and out of the hospital. While this will get patients off ambulance stretchers, it may further exacerbate the feelings of being rushed.

A good discharge reduces the likelihood of a patient returning to hospital. Shutterstock​

Discharge and transitional care services, which aim to guide patients from their time in hospital to living back at home, tend to be disconnected and misunderstood by the wider health service. We must overcome these disconnections if the proposed model is going to have success.

Otherwise, new initiatives may decrease ramping at the ED, but this may come at a cost to the most vulnerable of patients in our community, if they feel they’re discharged too soon, are unable to cope and end up going back to hospital.

Paramedics can provide care in the community, too​

Poor access to primary care services, such as being able to see a GP and a lack of community services, are problems across the globe. This has led to the use of paramedics in non-traditional roles in the UK, Canada, the United States, Finland and Ireland. Here, paramedics are used in emergency departments, in primary care practice and in outreach community services. Paramedics working in these non-traditional roles are collectively known as community paramedics.

In Australia, paramedics are university educated and professionally registered, which maintains a high workforce standard. Paramedics can work independently within the community and are well situated to supplement or complement community services and primary care. Yet 80% of paramedics in Australia work solely in ambulance services.

Paramedics can work independently in the community but most in Australia work within ambulance services. Diego Fedele/AAP​

State governments should consider new models of care, such as the introduction of community paramedics to support primary care services and other sectors across the health care system.

With further training, paramedics in Australia could be used beyond ambulance services. This could include working alongside other health professionals in emergency departments, supporting GPs and in hospital discharge teams. With a surplus of paramedic students graduating, there is a ready-made workforce ready to assist the wider health care system.

Community paramedicine programs overseas have resulted inimproved patient health outcomes and quality of life, and have been found to be economically beneficial.

A Canadian report found community paramedics saved the health-care system $29 million by keeping the 2,300 patients involved in the study healthy and avoiding hospital. Most importantly, patients had positive experiences of having their care delivered in their home.

However, not all patients wish to have their care delivered in their home or community. One report found 2.2% of patients refused to be treated by community paramedics.

Investment solely in the acute sector of our health system fails to recognise the inter-connectedness of all parts of the system. We must also invest in community services and primary care. Without system-wide investment, our health services will continue to fail.

This article was first published on The Conversation, and was written by Brendan Shannon Senior Lecturer in Paramedicine, Registered Paramedic from Monash University, Kelly-Ann Bowles Director of Research/Associate Professor - Paramedicine from Monash University

 

[riskydave]

I cannot for the life of me understand why politicians cannot see the problem or are just ignoring it. Are they so arrogant and self-obsessed with lining their own pockets that they just do not care or cannot see. This country is growing, not shrinking, we are going to need more hospitals more ambulances more fire trucks more schools more gaols more police as the population increases but they just seem intent on shrinking everything and cost cutting. How the hell is 8 Nuclear Subs going to help Australia, we were never a threat to anyone, no-one was going to attack us as we were never a threat, now we know we are!
That money could have solved our Ambulance and Hospital problem and a heap of other things along the way, but nope, lets waste it and give and give it to America. These politicians have really got to wake up and I am sorry, but I think the people of Australia have got to start having a look at what's going on instead of being a bunch of sheep and voting for the same people that their mothers and Father and Grandma and Grandpa did.
They won't help you anymore.
This county is a MESS, and no-one seems to care.

 

[Happymad]

My daughter phoned for a ambulance last week her husband was vomiting rolling in pain to be told we will get a paramedic to phone you after 20 min no phone call she put him in the car drove to nearest hospital
He has spent days in hospital with a very high white blood count,infection on his lungs and a gallbladder the system has gone to the dogs

 

[riskydave]

I think the public need to look p the Premiers email address and lets start ding a campaign, Pauline Hanson once said I think it was, "If nothing gets done, nothing gets done!!"

 

[Roscoe44]

Our Health system is the same as all other State run/used services. Successive governments have let all of the services that they are responsible for, to become run down to the point where they put band aids on them to keep them functioning albeit poorly. They then have the gall to say look at how we are improving the service.
I ask everyone to name just one State Government service that is functioning well, let alone is being run with a surge capacity and the silence is deafening.
We are supposed to be living in a first world country, but this has long gone and will never return until Governments get back to the basics of providing efficient well staffed and resourced services, instead of putting out press releases of how well they are doing. If the politicians actually listened to the staff who run these services under very poor conditions and who do a fantastic job given the circumstances, then we just might see a return to first world standards to which we pay for through our taxes and deserve.

 

[Vinylted]

It's broke and they ain't fixing it!

 

[I'm Mal]

Ambulance Ramping Is A Signal The Health System Is Floundering. Solutions Need To Extend Beyond Eds​

Health-care systems across Australia are buckling in the wake of COVID waves and the flu season. Pictures of ambulances piling up outside hospitals have become commonplace in the media. Known as “ramping”, it’s the canary in the coalmine of a health system.

As a major symptom of a health system under stress, state governments across Australia are investing unprecedented amounts into ambulance services, emergency departments (EDs) and hospitals. South Australia has committed to an increased recruitment of 350 new paramedics. Likewise, New South Wales has committed to 1,850 extra paramedics.

Victoria, meanwhile, has committed an additional A$162 millionfor system-wide solutions to counter paramedic wait times, on top of the A$12 billion already committed to the wider health system. This could begin to alleviate the system pressures that lead to ambulance ramping.


But what happens when the paramedics return yet again to ED with another patient? Will they simply end up ramped again?

We also need to consider better care in the community – and paramedics could play a role in this too.

Smoother transfers and discharges​

The Victorian government initiative is based on a similar modelused in Leeds, in the United Kingdom, which has resulted in decreased ramping times. The Leeds model has seen only 4.9% of paramedic attendances to ED having ramping delays over 30 minutes, compared to the UK average of 21%.

The model focuses on transferring the patient from the paramedic to the ED staff, discharging patients from hospital and coordinating the patient’s care in the community.

The aim is to improve patient flow in and out of the hospital. For patients requiring a hospital bed, they are admitted. For those not requiring admission, they are discharged home in a timely manner. Discharge coordinators will assist this process, coordinating the care patients need after an ED or hospital stay out in the community and in their homes.

The discharge process is complex. Often a well-done discharge is the difference between a patient returning to the community healthily versus a re-presentation to the hospital due to actual or perceived worsening of their condition.

However, patients often feel rushed when discharged from hospital and ill prepared to return home. Staff feel pressure to get patients discharged and out of beds to allow the next patient in.

The adoption of the Leeds model in Victoria aims to increase the flow in and out of the hospital. While this will get patients off ambulance stretchers, it may further exacerbate the feelings of being rushed.

View attachment 5976
A good discharge reduces the likelihood of a patient returning to hospital. Shutterstock​

Discharge and transitional care services, which aim to guide patients from their time in hospital to living back at home, tend to be disconnected and misunderstood by the wider health service. We must overcome these disconnections if the proposed model is going to have success.

Otherwise, new initiatives may decrease ramping at the ED, but this may come at a cost to the most vulnerable of patients in our community, if they feel they’re discharged too soon, are unable to cope and end up going back to hospital.

Paramedics can provide care in the community, too​

Poor access to primary care services, such as being able to see a GP and a lack of community services, are problems across the globe. This has led to the use of paramedics in non-traditional roles in the UK, Canada, the United States, Finland and Ireland. Here, paramedics are used in emergency departments, in primary care practice and in outreach community services. Paramedics working in these non-traditional roles are collectively known as community paramedics.

In Australia, paramedics are university educated and professionally registered, which maintains a high workforce standard. Paramedics can work independently within the community and are well situated to supplement or complement community services and primary care. Yet 80% of paramedics in Australia work solely in ambulance services.

View attachment 5975
Paramedics can work independently in the community but most in Australia work within ambulance services. Diego Fedele/AAP​

State governments should consider new models of care, such as the introduction of community paramedics to support primary care services and other sectors across the health care system.

With further training, paramedics in Australia could be used beyond ambulance services. This could include working alongside other health professionals in emergency departments, supporting GPs and in hospital discharge teams. With a surplus of paramedic students graduating, there is a ready-made workforce ready to assist the wider health care system.

Community paramedicine programs overseas have resulted inimproved patient health outcomes and quality of life, and have been found to be economically beneficial.

A Canadian report found community paramedics saved the health-care system $29 million by keeping the 2,300 patients involved in the study healthy and avoiding hospital. Most importantly, patients had positive experiences of having their care delivered in their home.

However, not all patients wish to have their care delivered in their home or community. One report found 2.2% of patients refused to be treated by community paramedics.

Investment solely in the acute sector of our health system fails to recognise the inter-connectedness of all parts of the system. We must also invest in community services and primary care. Without system-wide investment, our health services will continue to fail.

This article was first published on The Conversation, and was written by Brendan Shannon Senior Lecturer in Paramedicine, Registered Paramedic from Monash University, Kelly-Ann Bowles Director of Research/Associate Professor - Paramedicine from Monash University

In SA, ramping and the whole health sector is now the worst it has ever been. This is despite the campaign of lies by the current labor circus who repeatedly promised to fix it. The systemic demise began last time these clowns were in office and the current premier was health minister. He introduced an absurd scheme called transforming health. He also built the world's most expensive hospital that blew budget and time by 200% and still ended up substandard. When The Marshall Liberal Government came to power, they abolished transforming health, expanded hospitals, increased ambulances and staff and dramatically reduced ramping. The labour opposition claimed that The Government did nothing. Now the labour clowns are back in, they have claimed credit for the previous government achievements but downgraded services again, wasted money that they promised for health and sent the state backwards yet again.

 

[Ricci]

If I am so unwell that I need care I don't care if you are white, black, blue, green, spotted or striped. Nor do I care what your title may be, nurse, doctor, paramedic, whatever. My only thought is, is this person capable, do they have the knowledge required.

The system is broken, we need a new one. It's no use saying "but that's how it's always been done" as that fixes nothing. Some people have to stop being quite so precious about their titles and position and just work together towards the common goal.

 

[Penny4]

If I am so unwell that I need care I don't care if you are white, black, blue, green, spotted or striped. Nor do I care what your title may be, nurse, doctor, paramedic, whatever. My only thought is, is this person capable, do they have the knowledge required.

The system is broken, we need a new one. It's no use saying "but that's how it's always been done" as that fixes nothing. Some people have to stop being quite so precious about their titles and position and just work together towards the common goal.

Exactly. How are you Ricci, have you had your op yet?

 

[Ricci]

Exactly. How are you Ricci, have you had your op yet?

Have appointment with the surgeon on Thursday when he lets me know how radical the surgery needs to be. It's taken all this time to get all the test results in,

 

[Penny4]

Have appointment with the surgeon on Thursday when he lets me know how radical the surgery needs to be. It's taken all this time to get all the test results in,

Been thinking of you. Sometimes those test results take time. These days, surgeons want all the info before surgery which is a good thing. Fingers crossed it's not too radical. x

 

[Luckyus]

Ambulance Ramping Is A Signal The Health System Is Floundering. Solutions Need To Extend Beyond Eds​

Health-care systems across Australia are buckling in the wake of COVID waves and the flu season. Pictures of ambulances piling up outside hospitals have become commonplace in the media. Known as “ramping”, it’s the canary in the coalmine of a health system.

As a major symptom of a health system under stress, state governments across Australia are investing unprecedented amounts into ambulance services, emergency departments (EDs) and hospitals. South Australia has committed to an increased recruitment of 350 new paramedics. Likewise, New South Wales has committed to 1,850 extra paramedics.

Victoria, meanwhile, has committed an additional A$162 millionfor system-wide solutions to counter paramedic wait times, on top of the A$12 billion already committed to the wider health system. This could begin to alleviate the system pressures that lead to ambulance ramping.


But what happens when the paramedics return yet again to ED with another patient? Will they simply end up ramped again?

We also need to consider better care in the community – and paramedics could play a role in this too.

Smoother transfers and discharges​

The Victorian government initiative is based on a similar modelused in Leeds, in the United Kingdom, which has resulted in decreased ramping times. The Leeds model has seen only 4.9% of paramedic attendances to ED having ramping delays over 30 minutes, compared to the UK average of 21%.

The model focuses on transferring the patient from the paramedic to the ED staff, discharging patients from hospital and coordinating the patient’s care in the community.

The aim is to improve patient flow in and out of the hospital. For patients requiring a hospital bed, they are admitted. For those not requiring admission, they are discharged home in a timely manner. Discharge coordinators will assist this process, coordinating the care patients need after an ED or hospital stay out in the community and in their homes.

The discharge process is complex. Often a well-done discharge is the difference between a patient returning to the community healthily versus a re-presentation to the hospital due to actual or perceived worsening of their condition.

However, patients often feel rushed when discharged from hospital and ill prepared to return home. Staff feel pressure to get patients discharged and out of beds to allow the next patient in.

The adoption of the Leeds model in Victoria aims to increase the flow in and out of the hospital. While this will get patients off ambulance stretchers, it may further exacerbate the feelings of being rushed.

View attachment 5976
A good discharge reduces the likelihood of a patient returning to hospital. Shutterstock​

Discharge and transitional care services, which aim to guide patients from their time in hospital to living back at home, tend to be disconnected and misunderstood by the wider health service. We must overcome these disconnections if the proposed model is going to have success.

Otherwise, new initiatives may decrease ramping at the ED, but this may come at a cost to the most vulnerable of patients in our community, if they feel they’re discharged too soon, are unable to cope and end up going back to hospital.

Paramedics can provide care in the community, too​

Poor access to primary care services, such as being able to see a GP and a lack of community services, are problems across the globe. This has led to the use of paramedics in non-traditional roles in the UK, Canada, the United States, Finland and Ireland. Here, paramedics are used in emergency departments, in primary care practice and in outreach community services. Paramedics working in these non-traditional roles are collectively known as community paramedics.

In Australia, paramedics are university educated and professionally registered, which maintains a high workforce standard. Paramedics can work independently within the community and are well situated to supplement or complement community services and primary care. Yet 80% of paramedics in Australia work solely in ambulance services.

View attachment 5975
Paramedics can work independently in the community but most in Australia work within ambulance services. Diego Fedele/AAP​

State governments should consider new models of care, such as the introduction of community paramedics to support primary care services and other sectors across the health care system.

With further training, paramedics in Australia could be used beyond ambulance services. This could include working alongside other health professionals in emergency departments, supporting GPs and in hospital discharge teams. With a surplus of paramedic students graduating, there is a ready-made workforce ready to assist the wider health care system.

Community paramedicine programs overseas have resulted inimproved patient health outcomes and quality of life, and have been found to be economically beneficial.

A Canadian report found community paramedics saved the health-care system $29 million by keeping the 2,300 patients involved in the study healthy and avoiding hospital. Most importantly, patients had positive experiences of having their care delivered in their home.

However, not all patients wish to have their care delivered in their home or community. One report found 2.2% of patients refused to be treated by community paramedics.

Investment solely in the acute sector of our health system fails to recognise the inter-connectedness of all parts of the system. We must also invest in community services and primary care. Without system-wide investment, our health services will continue to fail.

This article was first published on The Conversation, and was written by Brendan Shannon Senior Lecturer in Paramedicine, Registered Paramedic from Monash University, Kelly-Ann Bowles Director of Research/Associate Professor - Paramedicine from Monash University

Dues to various medical incidences I have had the misfortune to have called on the services of the Victorian Ambulance Service and have experienced this ramping on a number of occasions this occurs, however only for a very short time and depending also on what day of the week the occurrence. As a consequence has nothing but a high regard for the professionalism of all Ambulance staff in Victoria. Same as all Hospital staff in these awkward times.

 

[Luckyus]

State governments should be demanding that the Federal government instead of swanning off around the world being a general prat!! He should in Canberra taking the lead in fixing this problem that continues to threaten the very existence of the Medicare System or is this a hidden agenda of some kind, like not very subtle attacks on personal superannuation.

 

[Lynjw]

Ambulance Ramping Is A Signal The Health System Is Floundering. Solutions Need To Extend Beyond Eds​

Health-care systems across Australia are buckling in the wake of COVID waves and the flu season. Pictures of ambulances piling up outside hospitals have become commonplace in the media. Known as “ramping”, it’s the canary in the coalmine of a health system.

As a major symptom of a health system under stress, state governments across Australia are investing unprecedented amounts into ambulance services, emergency departments (EDs) and hospitals. South Australia has committed to an increased recruitment of 350 new paramedics. Likewise, New South Wales has committed to 1,850 extra paramedics.

Victoria, meanwhile, has committed an additional A$162 millionfor system-wide solutions to counter paramedic wait times, on top of the A$12 billion already committed to the wider health system. This could begin to alleviate the system pressures that lead to ambulance ramping.


But what happens when the paramedics return yet again to ED with another patient? Will they simply end up ramped again?

We also need to consider better care in the community – and paramedics could play a role in this too.

Smoother transfers and discharges​

The Victorian government initiative is based on a similar modelused in Leeds, in the United Kingdom, which has resulted in decreased ramping times. The Leeds model has seen only 4.9% of paramedic attendances to ED having ramping delays over 30 minutes, compared to the UK average of 21%.

The model focuses on transferring the patient from the paramedic to the ED staff, discharging patients from hospital and coordinating the patient’s care in the community.

The aim is to improve patient flow in and out of the hospital. For patients requiring a hospital bed, they are admitted. For those not requiring admission, they are discharged home in a timely manner. Discharge coordinators will assist this process, coordinating the care patients need after an ED or hospital stay out in the community and in their homes.

The discharge process is complex. Often a well-done discharge is the difference between a patient returning to the community healthily versus a re-presentation to the hospital due to actual or perceived worsening of their condition.

However, patients often feel rushed when discharged from hospital and ill prepared to return home. Staff feel pressure to get patients discharged and out of beds to allow the next patient in.

The adoption of the Leeds model in Victoria aims to increase the flow in and out of the hospital. While this will get patients off ambulance stretchers, it may further exacerbate the feelings of being rushed.

View attachment 5976
A good discharge reduces the likelihood of a patient returning to hospital. Shutterstock​

Discharge and transitional care services, which aim to guide patients from their time in hospital to living back at home, tend to be disconnected and misunderstood by the wider health service. We must overcome these disconnections if the proposed model is going to have success.

Otherwise, new initiatives may decrease ramping at the ED, but this may come at a cost to the most vulnerable of patients in our community, if they feel they’re discharged too soon, are unable to cope and end up going back to hospital.

Paramedics can provide care in the community, too​

Poor access to primary care services, such as being able to see a GP and a lack of community services, are problems across the globe. This has led to the use of paramedics in non-traditional roles in the UK, Canada, the United States, Finland and Ireland. Here, paramedics are used in emergency departments, in primary care practice and in outreach community services. Paramedics working in these non-traditional roles are collectively known as community paramedics.

In Australia, paramedics are university educated and professionally registered, which maintains a high workforce standard. Paramedics can work independently within the community and are well situated to supplement or complement community services and primary care. Yet 80% of paramedics in Australia work solely in ambulance services.

View attachment 5975
Paramedics can work independently in the community but most in Australia work within ambulance services. Diego Fedele/AAP​

State governments should consider new models of care, such as the introduction of community paramedics to support primary care services and other sectors across the health care system.

With further training, paramedics in Australia could be used beyond ambulance services. This could include working alongside other health professionals in emergency departments, supporting GPs and in hospital discharge teams. With a surplus of paramedic students graduating, there is a ready-made workforce ready to assist the wider health care system.

Community paramedicine programs overseas have resulted inimproved patient health outcomes and quality of life, and have been found to be economically beneficial.

A Canadian report found community paramedics saved the health-care system $29 million by keeping the 2,300 patients involved in the study healthy and avoiding hospital. Most importantly, patients had positive experiences of having their care delivered in their home.

However, not all patients wish to have their care delivered in their home or community. One report found 2.2% of patients refused to be treated by community paramedics.

Investment solely in the acute sector of our health system fails to recognise the inter-connectedness of all parts of the system. We must also invest in community services and primary care. Without system-wide investment, our health services will continue to fail.

This article was first published on The Conversation, and was written by Brendan Shannon Senior Lecturer in Paramedicine, Registered Paramedic from Monash University, Kelly-Ann Bowles Director of Research/Associate Professor - Paramedicine from Monash University

Great idea to have properly trained paramedic working in the community to help patients heal at home in non serious situations and keep the hospitals for those serious cases snd decrease wait times for beds.

 

[Luckyus]

Have appointment with the surgeon on Thursday when he lets me know how radical the surgery needs to be. It's taken all this time to get all the test results in,

I hope that there is nothing major in store for you Ricci

 

[Mancub1967]

I cannot for the life of me understand why politicians cannot see the problem or are just ignoring it. Are they so arrogant and self-obsessed with lining their own pockets that they just do not care or cannot see. This country is growing, not shrinking, we are going to need more hospitals more ambulances more fire trucks more schools more gaols more police as the population increases but they just seem intent on shrinking everything and cost cutting. How the hell is 8 Nuclear Subs going to help Australia, we were never a threat to anyone, no-one was going to attack us as we were never a threat, now we know we are!
That money could have solved our Ambulance and Hospital problem and a heap of other things along the way, but nope, lets waste it and give and give it to America. These politicians have really got to wake up and I am sorry, but I think the people of Australia have got to start having a look at what's going on instead of being a bunch of sheep and voting for the same people that their mothers and Father and Grandma and Grandpa did.
They won't help you anymore.
This county is a MESS, and no-one seems to care.

As an X Paramedic I understand peoples frustration regarding ambulance response times, the problem of ramping is not new, it is a world wide problem not just Australia, the population is ageing and we sre short of Doctors, Nurses, and Paramedics, many medical practices have shut down, the LNP during their time in government made the situation worse by freezing the Medicare rebate for Doctors, the situation was never addressed hence why many Doctors left private practice, we are desperately short of GPs now, our A&E departments have had to cope with this problem, governments are recruiting but there is a world wide shortage of Doctors, Nurses, and Paramedics, all State governments are recruiting the best they can, also there are more people training to fill these voids. As for the comment regarding the Subs, defence matters and is complex, people would be angry with our government if we had no deterrent.