Overhaul of after-hours care needed to help flooded emergency rooms

dr Melbourne GP Karen Price believes the days of 24-hour GP surgeries were probably over, but said adequate funding would allow medical centers to extend their opening hours.

“Most of the non-acute stuff that doesn’t need to be in the ER [likely happens] between 6 p.m. and 10 p.m. anyway,” Price said, adding that people waking up in the middle of the night with acute pain would likely need to go into an emergency.

Melbourne GP, Dr. KarenPrice.

Melbourne GP, Dr. KarenPrice.

It costs the taxpayer about $500 to $600 for each emergency room, but Dr. Price estimated that GPs could see patients outside of business hours for about a third or less of that amount.

The former president of the Royal Australian College of General Practitioners said families often need reassurance or advice on how to deal with sick children at home.

“People sometimes wait all day to see if little Johnny or little Ginny is doing better and then they don’t, so they worry. And they’re pretty sick, but they’re not sick [enough to need to go to a hospital].”

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Doctors also said that after nearly two years without many respiratory illnesses, people were more anxious and less confident about dealing with illnesses at home.

After-hours options for Victorians include visiting a pharmacist, calling a GP, visiting the Victorian virtual emergency department (via video conference) or calling the Nurse on Call, a 24-hour hotline and Advice given to patients or carers about their health concerns.

To fill the gaps in after-hours care, the Victorian Government has begun opening 25 new priority primary care centers staffed by GPs and nurses. Some of these are open in the evenings.

And the Albanian government has similarly pledged to open 50 emergency clinics across the country, including 10 in Victoria, open from 8am to 10pm, seven days a week.

Doctors, however, have criticized these initiatives as a patch, rather than a long-term solution: giving people better access to their regular GP practice and immediate access to other specialists.

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“Solutions developed in isolation from individual branches of the healthcare system can often be more expensive and confusing for patients who have to decide where to go, and we often don’t invest in the governance and data that allow us to see whether they’re really working for patients,” Whitelaw said.

Whitelaw supported moves to support more GPs opening after hours. Aside from that, she said it’s also valuable to have GPs manning medical advice hotline services like on-call nurses, as they offer treatments and prescriptions and could be less cautious in their advice on whether an ED visit is necessary be.

A pediatrician who works in an emergency room in Melbourne and is not authorized to speak publicly said it was common for patients using an on-call nurse to be told “to see a doctor within six hours,” which is afterwards can lead to confusion. hours

“Counseling is often very conservative and is designed not to miss a patient with a serious condition given the limitations of a phone consultation,” they said.

“I think the nurse on call is a really valuable service but it also has limitations … there will be certain symptoms or findings that they find that they are taught to tell the parents to take care of immediately, but.” sometimes this advice needs to take into account the availability of local resources… and the time of day.”

Healthdirect Australia, which operates an on-call nurse, said the majority of people have been advised to see a GP or “self-care”.

“This advice is achieved through a combination of evidence-based clinical guidelines used by the nurses, application of the nurses’ clinical experience and the caller’s individual situation, including the availability of the proposed healthcare provider,” said a spokeswoman.

The chief physician in the emergency department, Dr. Stephen Parnis said he was very critical of the introduction of nurses on call more than a decade ago and hadn’t seen good data on the impact it was having on emergency or general medicine presentations.

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“They have algorithms. That’s what nurses do. It’s on the phone, with no visual aids whatsoever, so it’s all very conservative.”

However, when asked if he would prefer to replace the on-call nurse, he said there may be improved ways to offer the service involving senior nurses and GPs now that many more people have access to video calls.

“When we do an initial assessment of a patient, a picture is worth a thousand words,” he said.

A Victorian Government spokeswoman said the primary care system was broken: “We will continue to lobby the Commonwealth to prioritize primary care reform so that Victorians do not feel that emergency rooms are their only choice for after-hours treatment. “

The President-elect of the Australasian College for Emergency Medicine, Dr. Stephen Gourley said the Commonwealth must immediately address and invest in federal responsibilities that have contributed to dangerous pressures in emergency departments, including Medicare, the NDIS and elder care.

“[Our] Members report that the system would run more smoothly if these three areas of federal responsibility were adequately resourced, patients who need beds were significantly less likely to be stuck in emergency rooms for days, and more people had access to the safe and timely care they have need,” he said.

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https://www.smh.com.au/national/victoria/after-hours-care-revamp-needed-to-help-swamped-emergency-departments-20230108-p5cb2d.html?ref=rss&utm_medium=rss&utm_source=rss_national Overhaul of after-hours care needed to help flooded emergency rooms

Callan Tansill

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