4 NEWS
4 NEWS
11 APRIL 2025 ausdoc. com. au
SPECIAL REPORT
PHOTO: AAP
Are‘ lazy doctors’ to blame for ED deaths?
Dr Megan Brooks.
The true story of ambulance ramping and its tragedies.
Paul Smith Editor
DR Megan Brooks fronted a parliamentary select committee last month.
Her testimony, which took about 45 minutes, was about the spectacle of patients in the midst of an acute health crisis stuck in the back of an ambulance a few metres from medical care.
That the physical distances are so small yet the ED so distant explains the media and political obsession, particularly when things go wrong and someone dies.
However, Dr Brooks, the former director of the ED at the Royal Adelaide Hospital( RAH), went before MPs to offer a deeper insight into the realities that would be almost comic if the consequences were not so tragic.
What follows is an account familiar to many doctors working in a system where each day, every day involves a flirtation with catastrophe that each day, every day you manage to dodge.
Except, of course, until the day you do not.
Resus 2 or 2C786?
Her story starts in 2017 having just been appointed director and tasked with moving the ED into Adelaide’ s newly built $ 2.7 billion tertiary hospital.
“ We spent a lot of time looking at the design of the ED and trying to give feedback that it wasn’ t going to work very well,” she told the MPs.
“ The actual functional layout of the ED wasn’ t one that was going to make it easy, particularly for us to retain line of sight for patients.
“ Similarly, having three walls and a door on all the cubicles, while that was brilliant during COVID, meant we had to staff the ED in ways very different from a traditional ED where you have what’ s called a fishbowl that’ s up in an elevated position so clinicians [ can see into ] all the cubicles.
“ What we had in the design of the new RAH was, in fact, the very opposite of that.”
She told the committee that at the time of the big move, there was a belief within the Central Adelaide Local Health Network,
the network which managed the hospital, that there would be direct admissions to the wards, an easy way of getting patients in and then out of ED.
As a result, the triage process was renamed by staff as the‘ quick look’, Dr Brooks said, because“ apparently we were only going to need to have a quick look at many of our patients and they would just be automatically going through to the ward”.
“ Even up until 3 September 2017, which is the day before we moved to the new hospital, I was being told:‘ No, no, there’ ll be [ a ]‘ quick look’; people will just move up to the ward.’
“ I was always asking how that would happen, because I didn’ t see any process or protocols. I [ also ] didn’ t know how we were going to get the patients entered into the electronic medical record( EMR) system.
“ Time after time we, as clinicians, were saying,‘ How is this supposed to work?’”
She said the first month was one of the most difficult professional times of her life, even as an ED clinician who was on the front line of the COVID-19 pandemic.
“ We had to start using the EMR on the first day, and I don’ t know of any other group of clinicians that were asked to move into an entirely new building and use an entirely new EMR on the first day.“ So we slept in that building. We had sleeping bags in our offices, and we stayed and we slept in that building just so we could make sure that our patients were safe.”
‘ I would be told:‘ You can’ t change the number because someone might want to change the light bulb in 10 years’ time.’
She said even the way the rooms were numbered in the new ED became a trigger for major headaches and delayed care.
“ They were numbered with wayfinding numbers, so it was‘ 2C786’ instead of something sensible like‘ Resus 2’.
“ Cubicle 1 wasn’ t next to cubicle 2, next to cubicle 3.
“ So when an emergency bell was pushed, on the overhead we would have 2C786 and something else and we would all be grappling to grab our little map to try to work out where our colleague had pressed the emergency bell because we didn’ t have normal sequential numbering.”
She said she spent hours arguing the case with management to secure permission to renumber the cubicles so staff could find people when they were really unwell.
“ We clinicians … couldn’ t even find the sick person … But I would be told:‘ You can’ t change the number because someone might want to change the light bulb in that room in 10 years’ time.’
“ I would say,‘ Well, I would quite like to find your relative if they are dying.’”
This battle to number the cubicles sequentially took almost a year, she said.
“ But it is only in recent years that we have been able to take down the laminated plastic temporary signage because we were not even allowed to stick things on the wall.”
‘ You’ re too expensive!’
Dr Brooks said her first months as director of the ED was a steep learning curve. She had only been an emergency physician for three years. But she got through, she says, with the support of her fellow clinicians as well as the nursing staff, particularly the hospital’ s lead nurse Dr Tina Jones( PhD).
But she told the MPs that she was soon being quizzed by managers over costs, or as she put it,“ being castigated for running an incredibly expensive service”.
It turned out that this was a result of the ED activity not being counted accurately by the managers.
The bean counters were meant to use the national weighted activity unit to document what the ED was doing, which was then measured against what was considered a national efficient price for that activity.
She said the system was so out of whack with clinical reality that her ED, the biggest in the state, was at one stage found by the accountants to be doing less activity than the ED at Mount Gambier Hospital, 400km away.