EMERGENCY doctors have slammed as misguided, expensive and "dangerous" a proposal that patients who do not need attention within 30 minutes not be taken through overloaded emergency departments.
The first statewide report on NSW public hospitals has recommended that only patients in the urgent triage categories one, two and three (to be seen within 30 minutes) should be treated in emergency and the rest be channelled through a so-called patient care centre.
Commissioner Peter Garling, SC, said in his report that patients in category four (to be seen within an hour) and five (two hours) could be seen by general doctors at patient care centres to be set up at all hospitals and funded by the Federal Government.
It potentially means that patients with such conditions as open wounds, broken limbs, appendicitis or those experiencing miscarriage will not be seen by an emergency specialist.
"In my view, if it is all right for you to wait for an hour or more to be seen in an emergency department then you probably didn't need to be seen by an emergency specialist. Many other well qualified doctors can help you," Mr Garling said.
But emergency doctors said it was often the patients in categories four and five who were sent by GPs to be seen by a specialist, and up to 25 per cent of them were eventually admitted to hospital.
The NSW chairman of the Australasian College for Emergency Medicine, Tony Joseph, said "it was a pity" Mr Garling had not taken the advice of the college on relieving emergency overload by attracting more doctors to the profession and providing more beds.
"It seems that he hasn't taken any advice at all on the submissions that the college made to him … I wonder if he has read it?"
Dr Joseph said patient care centres were an expensive option because they would create a parallel system to emergency which would compete for resources such as radiology and pathology and need their own medical and nursing staff.
"It will increase the time [to treat patients] and may increase representations and increase the ordering of tests."
Dr Joseph said it was a way of taking the "pressure off the Government" so it did not have to resource emergency departments.
Dr Clare Skinner, an emergency registrar at Royal North Shore Hospital, said it was the only "weak point" of the report and described it as "short-sighted" and "dangerous".
"The evidence is that it's not the less urgent cases that create the workload," she said.
Dr Garry Nieuwkamp, the director of Wyong Hospital's emergency department, said the proposal was fundamentally flawed.
"You could have a triage category one that is a sudden emergency but the illness in fact ends up being treatable and you're out of the hospital the same day, whereas the person who comes in as triage category four who has a slight temperature and is 80 years old and then ends up in the ICU because of what seemed like an insignificant illness is actually quite seriously ill and dies two days later," Dr Nieuwkamp said.
"Anyone who's been a director of an emergency department knows that that group of people are the ones [who] are the greatest risk for misdiagnosis, and although they are a low triage category does not mean that they don't have serious problems that require an expert to review them," he said.