Volume 192 - Issue 6
Whole-of-hospital response to admission access block: the need for a clinical revolution
Authors: Biswadev Mitra, Peter A Cameron and Pieter De Villiers Smit
Med J Aust 2010; 192 (6): 354-356. || doi: 10.5694/j.1326-5377.2010.tb03540.x
Published online: 15 March 2010
Published online: 15 March 2010
To the Editor: We read with interest Walters and Dawson’s call for a clinical revolution to tackle access block1 and are heartened by the interest shown by general physicians in a problem that primarily affects the emergency department (ED). The efficient management of admitted medical patients is paramount to patient flow within the hospital, and “buy-in” from general physicians is essential.
When considering any new model of care, it is important to note that longer patient assessments in ED by emergency doctors has a relatively small effect on access block; the claim that the length of assessments is a significant factor in access block has been established as a “myth” by investigators who have mapped process times.2 Therefore, it is unlikely that substituting one workforce of acute physicians for another would make any difference to overall patient flow through the ED. On the contrary, it is likely to be associated with increased costs3 and adverse effects on the emergency medicine labour supply.4
In addition, the ability and willingness of the general physician workforce to implement and sustain the newer role of “acute physician” is unknown. The root cause of access block lies in ward-bed shortages, ward processes and community capacity, which should be solved by improved flow processes across the continuum of care.
Access block will not be solved by a second tier of acute physicians duplicating the role of emergency physicians. However, there are many aspects of Walters and Dawson’s model of change that would improve patient flow, in particular: improved rostering of medical staff; improved access to pathology and radiology services; and, perhaps, specific retraining of medical staff in the efficient discharge of inpatients. These aspects should be rigorously explored as we strive together to tackle access block.
References
- Walters EH, Dawson DJ. Whole-of-hospital response to admission access block: the need for a clinical revolution. Med J Aust 2009; 191: 561-563.
- Richardson DB, Mountain D. Myths versus facts in emergency department overcrowding and hospital access block. Med J Aust 2009; 190: 369-374. 0_pgfId-2016420
- Folland S, Goodman A, Stano M. The economics of health and health care. 4th ed. New Jersey: Prentice Hall, 2003. 0_pgfId-2010444
- Mork AK. Factor substitution, rational expectations, and the effects of commodity price shocks on employment and investment. Econ Inq 1985; 23: 507-523. 0_CBBJJIFG