NSW Audit Office - Financial Reports – 2003 - Volume 2 – Review of Nepean Hospital Emergency Status
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NSW Audit Office - Financial Reports – 2003 - Volume 2 – Review of Nepean Hospital Emergency Status

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Review of Nepean Hospital Emergency Status BACKGROUND TO OUR REVIEW On 13 March 2003 the Shadow Minister for Health requested the Auditor-General to examine the emergency status coding of Nepean Hospital. Her concern was that emergency status data she had obtained from the Department of Health for each Sydney metropolitan hospital in October and November 2002 showed significantly lower ‘Code Red’ hours for Nepean Hospital than data she had obtained directly from Nepean’s Emergency Department. (See below for an explanation of ‘Code Red’.) We are reviewing this matter because the capacity of hospitals to cope with emergency patients is critical to the standard of patient care. If the systems measuring a hospital’s ability to cope with patient numbers are not robust, then inappropriate decisions may be made. KEY FINDINGS The data obtained by the Shadow Minister for Health directly from the Nepean Hospital Emergency Department is only a partial measure of the Hospital’s overall ability to handle emergency patients. We found a number of instances where the Ambulance Service records (and hence the Department of Health’s records) of Nepean Hospital’s status differed from the Hospital’s own records. We intend to carry out a wider review of the integrity of the systems for evaluating hospitals’ capacity to handle emergency patients. This review will examine whether a sample of larger hospitals correctly follow the Department of Health guidelines for ...

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Review of Nepean Hospital Emergency Status
BACKGROUND TO OUR REVIEW
On 13 March 2003 the Shadow Minister for Health requested the Auditor-General to examine the emergency status coding of Nepean Hospital. Her concern was that emergency status data she had obtained from the Department of Health for each Sydney metropolitan hospital in October and November 2002 showed significantly lower ‘Code Red’ hours for Nepean Hospital than data she had obtained directly from Nepean’s Emergency Department. (See below for an explanation of ‘Code Red’.)
We are reviewing this matter because the capacity of hospitals to cope with emergency patients is critical to the standard of patient care. If the systems measuring a hospital’s ability to cope with patient numbers are not robust, then inappropriate decisions may be made.
KEY FINDINGS The data obtained by the Shadow Minister for Health directly from the Nepean Hospital Emergency Department is only a partial measure of the Hospital’s overall ability to handle emergency patients. We found a number of instances where the Ambulance Service records (and hence the Department of Health’s records) of Nepean Hospital’s status differed from the Hospital’s own records. We intend to carry out a wider review of the integrity of the systems for evaluating hospitals’ capacity to handle emergency patients. This review will examine whether a sample of larger hospitals correctly follow the Department of Health guidelines for determining emergency codes and whether the systems appropriately record these codes.
DETAILED FINDINGS
The findings from our review were: a hospital’s ability to deal with emergency patients is assessed as Code Green (in effect, operating within capacity), Code Orange (nearing capacity limits) or Code Red (at or exceeding capacity limits). The Department of Health has issued guidelines to hospitals on how these codes should be assessed the codes have two main purposes: àto help hospitals recognise approaching capacity limits and take appropriate actions àto alert the Ambulance Service of a Code Orange or Code Red so that ambulance patients (other than those with life-threatening conditions) can be diverted to other hospitals the Ambulance Service records the code status advised to it by all hospitals on a continuing basis. The Service can ‘over-ride’ the status as advised by a hospital to a Code Red if an ambulance has been at the hospital for more than one hour and the hospital has been unable to accept the patient into the emergency department the Ambulance Service information is available online to the Department of Health so that it can co-ordinate action over a wider area
Auditor-General’s Report to Parliament 2003 Volume Two
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Review of Nepean Hospital Emergency Status
a hospital’s ability to handle emergency department patients at a particular time depends largely on the workload of the emergency department itself. However other factors also affect the hospital’s ability to handle emergency patients, such as the availability of beds in wards to which patients can be transferred. These factors (eg knowledge of inpatient beds shortly becoming available) will generally operate to give a less urgent coding than simply looking at the emergency department patient loads. We have not yet been able to verify whether the differences in the two sets of figures supplied to the Shadow Minister for Health are solely due to this differing scope
Code Red status often occurs when treated patients are unable to be allocated beds elsewhere in the hospital
all major metropolitan hospitals have a ‘Bed Manager’ whose role includes monitoring the capacity of the various parts of the hospital, particularly in regard to emergency patients. The Bed Manager uses information from the various parts of the hospital to recommend changes to the hospital’s code
Nepean Hospital’s Emergency Department has implemented its own system for measuring its workload. This system is managed by the Emergency Department staff who input data at regular intervals. This information is available to the Bed Manager to assist her in assessing the hospital’s overall ability to cope with emergency patients
the Department of Health’s Code Red emergency report for Nepean Hospital for October 2002 (compiled from the Ambulance Service data) contained nine instances of Code Red not recorded as such by Nepean Hospital. We have not yet examined if the Ambulance Service recorded these because of ambulances not being able to discharge patients
two October 2002 Code Red instances for Nepean Hospital in the Department of Health’s data were for substantially longer periods than recorded by Nepean Nepean Hospital recorded three Code Red instances in October 2002 which were not recorded by the Ambulance Service and advised to the Department of Health.
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 Auditor-General’s Reportto Parliament 2003 Volume Two