❓ A parliamentary question regarding the effectiveness of the four-hour rule in Perth hospitals, followed by a ministerial response highlighting its success in reducing mortality rates and praising hospital staff.
AnsweredQoN 3Legislative Assembly
QuestionView source ↗
HOSPITAL
MORTALITY RATES — FOUR-HOUR RULE
3. Mr A.P. JACOB to the Minister for Health:
I noted in a newspaper article this month that the Medical Journal of Australia published
research findings that an estimated 267 lives were saved at three Perth
hospitals in 2010–11 because of the four-hour rule. This research
paints a very different picture of the four-hour rule from that put forward by
the opposition, which is of a system that has failed. Can the minister please
clarify whether the four-hour rule is saving lives in Perth, as claimed in the Medical Journal of Australia ?
MORTALITY RATES — FOUR-HOUR RULE
3. Mr A.P. JACOB to the Minister for Health:
I noted in a newspaper article this month that the Medical Journal of Australia published
research findings that an estimated 267 lives were saved at three Perth
hospitals in 2010–11 because of the four-hour rule. This research
paints a very different picture of the four-hour rule from that put forward by
the opposition, which is of a system that has failed. Can the minister please
clarify whether the four-hour rule is saving lives in Perth, as claimed in the Medical Journal of Australia ?
AnswerView source ↗
It was an excellent article by Dr
Gary Geelhoed, who is a former president of the Australian Medical Association,
as many members would know, and Nicholas de Klerk, who looked at all the
emergency department data and mortality figures for our hospitals. As I have
said in the house before, there was a strong suggestion that the changes that
we put in place would result in a significant drop in mortality rates, and I am
very pleased that that has indeed occurred. It made sense that it would occur
because in the early 2000s, Dr Sprivulus from Fremantle Hospital wrote a report
that said that each year about 120 people died in our tertiary hospitals as a
result of delays in accessing a bed in a hospital. The prolonged eight-hour
wait under the former government was reaching between 40 and 50 per cent of
cases. Dr Sprivulus said that every year 120 people were dying. Behind that
figure was a huge number of people having increased morbidity. Morbidity means
that if a person has an injured leg, the leg might be saved or it could be lost
without the right treatment. The loss of the leg is an increase in the
morbidity rate if the treatment was inadequate. There were about another 800
cases of morbidity behind the figure of 120 patients who were dying. We
predicted that when we brought in the four-hour rule, it would significantly
reduce the eight-hour ED waiting times—the figure has decreased from 40
to 50 per cent to 10 or 15 per cent—and that there would be a
subsequent reduction in mortality rates. Indeed, that is what has occurred. The
study undertaken by Dr Geelhoed showed 80 fewer deaths in our tertiary
hospitals this year compared with last year. When we factor into that the 10
per cent increase in demand in hospitals, the fact that the figure of 120 came
from the early 2000s, and what the graph would have shown with the increase in
demand and how many more people we would have expected to die in our hospitals,
it means a total of 267 lives have been saved as a result of the introduction
of the four-hour rule.
It has been a fantastic outcome; I
had great pleasure, I have to say, in presenting a copy of the report to the
new federal health minister, to continue the federal government's
encouragement of all the other states and territories that now have to follow
Western Australia's lead as part of the federal–state agreements
on health, and its introduction of the same system into all the other states
and territories.
Mr
B.J. Grylls : Leading the way.
Dr
K.D. HAMES : Absolutely, as usual.
I expect to see a similar reduction in mortality in those
other states and territories as they get their figures down. We went from being
the worst in Australia for eight-hour waits under the former Labor government,
to now being easily the best in Australia. We are already well ahead of the new
federal targets that have been set for the four-hour rule program across
Australia. It is a fantastic outcome, and I want to congratulate all the
hospital staff and the full range of people looking after patients. This was
not just a problem for emergency departments, wards, doctors or nurses; it was
a problem across the system, and changes had to be made across the system to
turn around the ship that is the health system, and totally change the way that
it operates. It has been a hard road, and the hospital system has put in a huge
effort to achieve this outcome. I want to congratulate it on this fantastic
outcome.
Gary Geelhoed, who is a former president of the Australian Medical Association,
as many members would know, and Nicholas de Klerk, who looked at all the
emergency department data and mortality figures for our hospitals. As I have
said in the house before, there was a strong suggestion that the changes that
we put in place would result in a significant drop in mortality rates, and I am
very pleased that that has indeed occurred. It made sense that it would occur
because in the early 2000s, Dr Sprivulus from Fremantle Hospital wrote a report
that said that each year about 120 people died in our tertiary hospitals as a
result of delays in accessing a bed in a hospital. The prolonged eight-hour
wait under the former government was reaching between 40 and 50 per cent of
cases. Dr Sprivulus said that every year 120 people were dying. Behind that
figure was a huge number of people having increased morbidity. Morbidity means
that if a person has an injured leg, the leg might be saved or it could be lost
without the right treatment. The loss of the leg is an increase in the
morbidity rate if the treatment was inadequate. There were about another 800
cases of morbidity behind the figure of 120 patients who were dying. We
predicted that when we brought in the four-hour rule, it would significantly
reduce the eight-hour ED waiting times—the figure has decreased from 40
to 50 per cent to 10 or 15 per cent—and that there would be a
subsequent reduction in mortality rates. Indeed, that is what has occurred. The
study undertaken by Dr Geelhoed showed 80 fewer deaths in our tertiary
hospitals this year compared with last year. When we factor into that the 10
per cent increase in demand in hospitals, the fact that the figure of 120 came
from the early 2000s, and what the graph would have shown with the increase in
demand and how many more people we would have expected to die in our hospitals,
it means a total of 267 lives have been saved as a result of the introduction
of the four-hour rule.
It has been a fantastic outcome; I
had great pleasure, I have to say, in presenting a copy of the report to the
new federal health minister, to continue the federal government's
encouragement of all the other states and territories that now have to follow
Western Australia's lead as part of the federal–state agreements
on health, and its introduction of the same system into all the other states
and territories.
Mr
B.J. Grylls : Leading the way.
Dr
K.D. HAMES : Absolutely, as usual.
I expect to see a similar reduction in mortality in those
other states and territories as they get their figures down. We went from being
the worst in Australia for eight-hour waits under the former Labor government,
to now being easily the best in Australia. We are already well ahead of the new
federal targets that have been set for the four-hour rule program across
Australia. It is a fantastic outcome, and I want to congratulate all the
hospital staff and the full range of people looking after patients. This was
not just a problem for emergency departments, wards, doctors or nurses; it was
a problem across the system, and changes had to be made across the system to
turn around the ship that is the health system, and totally change the way that
it operates. It has been a hard road, and the hospital system has put in a huge
effort to achieve this outcome. I want to congratulate it on this fantastic
outcome.
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