eMJA: Access block: problems and progress

To the Editor: The series of articles concerning access block1 indicates that access block is a major health issue in this country. It is remarkable that, despite all these efforts to avoid admissions and reduce inpatient length of stay, only a few occasions of brief success at reducing ambulance diversions were described, and only one case of reducing access block (Royal Melbourne Hospital).

We contend that it is now time to increase available beds. In several cases, the association between worsening access block and closure of beds was noted (Australian Capital Territory, Queen Elizabeth Hospital, Royal Perth Hospital). Available data show a steady reduction in hospital beds per thousand population in Australia, from 3.3 in 1995–96 to 2.8 in 1999–2000,2 a decrease of more than 11%.

Keeping inpatient occupancy below a threshold percentage is important to controlling access block.3,4

Reducing occupancy by increasing available beds is the logical recommendation.

Richardson DB, Ruffin RE, Hooper JK, at al. Responses to access block in Australia. Med J Aust 2003; 178: 103-111. <PubMed><eMJA full text>
Australian Institute of Health and Welfare. Australian Hospital Statistics 1999–00. Canberra: AIHW, 2001. Available at: http://www.aihw.gov.au/publications/hse/ahs99-00/index.html (accessed Mar 2003).
Bagust A, Place M, Posnett JW. Dynamics of bed use in accommodating emergency admissions: stochastic simulation model. BMJ 1999; 319: 155-158. <PubMed>
Forster AJ, Steill I, Wells G, et al. The effect of hospital occupancy on emergency department length of stay and patient disposition. Acad Emerg Med 2003 10; 127-133.

(Received 3 Apr 2003, accepted 14 Apr 2003)

Emergency Department, Ryde District Hospital, Eastwood, NSW.

Peter A Roberts, MB BS, FACEM, Area Director, Emergency Medicine. Northern Sydney Area Health Service; Paul A Cunningham, MB BS, FACEM, Director, Emergency Medicine.

Correspondence: Dr P A Roberts, Emergency Department, Ryde District Hospital, Denistone Road, Eastwood, NSW 2122. probertsATdoh.health.nsw.gov.au

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