Lismore doctors at breaking point
DOCTORS at the Lismore Base Hospital are so overworked that patients are being put at risk, an internal hospital memo obtained by The Northern Star warns .
Written by the hospital’s Acting Director of Medical Services, Dr Sharon Miskell, the leaked memo says the hospital’s four permanent registrars are working more than 60 hours a week in overtime.
So dire is the lack of doctors that a casual fifth registrar recently worked 43 hours between 5pm on a Friday to 8am the following Monday with only 14 hours’ sleep.
She has since refused to work at the hospital again, saying she ‘was unsafe on the Sunday’.
While applauding the hospital’s registrars for their dedication and commitment, Dr Miskell warned the ‘situation is not sustainable’.
“The daily hours the medical registrars are working are unsafe, and a risk to patient care and safety,” the memo says.
It cites a fatigue study by the Australian and New Zealand College of Anaesthetists, which found that after 17 hours of ‘sustained wakefulness’, a doctor’s performance was impaired to the same degree as one with a blood- alcohol level of 0.05 per cent.
“The four (permanent) registrars have regularly worked daily hours of 12 to 20 hours, on weekdays and weekends, when they are on-call and also not on-call,” the memo says.
“They have advised that they have great difficulty leaving the hospital because of the constancy of admissions through the emergency department, which is evidenced by their overtime/call-back claims, which are predominantly for unrostered overtime.”
Over a four-week period the four registrars were forced to work a combined 649 hours in overtime, in addition to their 1440 rostered hours.
Dr Miskell said unless the problem was quickly resolved Lismore Base could lose its accreditation as a teaching hospital, which would mean four junior doctors would no longer be rotated for training from Sydney to Lismore.
Lismore Base Hospital general manager Brett Thompson said hospital management had advertised for a full-time fifth registrar.
In her memo, Dr Miskell said a sixth permanent registrar was needed to fill the night shift and allow registrars to leave the hospital at the end of their shift.
Mr Thompson said, in the meantime, the hospital was considering introducing a 10pm rule.
This is where the on-call registrar is not called in after that time and patients are assessed by senior staff in the busy emergency department, and either go to ward or remain in emergency.
Mr Thompson said the hospital was seeking feedback from doctors on the adoption of a 10pm rule.
However, according to an email by one specialist doctor, which has also been obtained by this newspaper, admitting patients directly to wards before they are assessed by a registrar would lead to ‘mistakes’.
“Admitting patients directly to the ward without discussion with the on-call medical team leads to poor work-up and mistakes, and this will only get worse with pressure from Kev- in Rudd to empty A&E (accident and emergency) departments to keep waiting times down,” the leaked email says.
“Keeping these patients in the A&E department does ensure a more thorough work-up and review, but as you point out, this is not an option when things get busy.”
Ambulance officers have previously told The Northern Star that their response times to emergency calls are being compromised because they cannot leave the hospital until after the patient they just delivered has been admitted.
Both Dr Miskell’s memo and the specialist argue that the pressure doctors are placed under is making it difficult to recruit more medical staff.
“Having a sixth (registrar) position will only solve the problem if it is filled, and two locums (casual doctors) may therefore need to be employed at any one time to restore LBH’s reputation as a desirable place for more permanent applicants,” the email said.