South Australia Minister for Health and Wellbeing Stephen Wade

Years Of Ramping Undermines Best Practice Ambulance Care

Victor P Taffa

Marshall Government has acted promptly to address care issues in the SA Ambulance Service (SAAS) after a report which shows that years of ramping and organisational problems have undermined best practice ambulance care.

Marshall Government has accepted all 14 recommendations of an independent review in to a cluster of adverse incidents involving SAAS paramedics and ambulance officers.

Report commissioned by SAAS Chief Executive Officer, David Place, examined an unexplained rise in adverse incidents that occurred between October and December 2018 that raised issues of clinical management of patients.

While the review was underway, SAAS took a range of immediate actions to enhance good patient care. In particular, SAAS policy was changed to increase clinical reviews and authorisation before a decision is made not to transport a patient.

Independent reviewer Associate Professor Peter Hibbert explored whether there were any common or systemic factors involved in the 17 incidents, which included 9 deaths. All 9 deaths have been reported to the State Coroner.

Minister for Health and Wellbeing Stephen Wade today released the report in full.

“Findings of the report are incredibly concerning, the report finds that, in some cases, unsafe care is associated with an under appreciation by ambulance officers of the clinical risk posed to patients.” Minister Wade said.

“There was a lack of response to abnormal observations and to clinical and historical risks. The report also criticised a preoccupation with meeting non-clinical targets as key performance indicators, and shortcomings in clinical supervision.”

“While on the evidence before me, ramping has not caused these adverse incidents, the report highlights that ramping affects the decision-making of crews as they may be less inclined to transport patients to hospital than they should be.” Minister Wade said.

“Ramping not only has a direct impact in terms of delaying care and tying up ambulance resources, the report highlights its indirect impacts such as undermining clinical management of patients.”

“Poor clinical management will lead to adverse impacts whether ramping is occurring on the day or not.”

“Report makes clear that ramping and its impact have been building for a number of years and the practices at SAAS have developed over many years.” Minister Wade said.

“This report highlights the importance of addressing ramping and the situation in our hospitals calmly and responsibly.”

“We don’t want community members failing to call for help when they need it or paramedics trying to second-guess the hospital response.”

“Mentality of pursuing thin key performance indicators which focus on efficiency (like ambulance response times) rather than the quality of patient care must change, patient care must be at the forefront of everything we do.” Minister Wade said.

“We need to empower our ambulance officers and team leaders with the tools they need to provide the best possible care for patients.”

“Marshall Liberal Government has called out ramping as being unacceptable. Rather than let ramping fester like the former Labor Government did, we are committed to stamping it out.”

“Less than 2 weeks ago, our central hospitals held a Summit to Stop Ramping with promising early signs. But we know there’s a long way to go and more needs to be done.” Minister Wade said.

David Place, who was appointed as CEO of SAAS in December, said he is committed to ensuring that all paramedics and ambulance officers receive the support they need to consistently deliver the very highest standards of patient care.

“When I became aware of an increase in the number of incidents and that there were questions to answer about the clinical management of patients in these cases, I immediately sought an investigation into each case and commissioned Professor Hibbert to develop his report to see whether there were any core issues at play.” Mr. Place said.

“Report and our commitment to implementing all 14 of its recommendations is important because it will strengthen our internal culture and lead to better patient outcomes. We have already put in place a series of measures to ensure there is additional rigour in our decision making and I am pleased that improvements can be seen.”

Work to implement the recommendations is underway and will be overseen by a number of safety and quality experts, including the Health Complaints Commissioner.

Professor Hibbert has agreed to continue to work with SAAS to develop a work plan to further enhance the changes implemented to date.

SAAS crews respond to approximately 300,000 patients every year, often in difficult circumstances.

 

Abbreviations:

SA                   South Australia