Nursing Staff-to-Patient Ratio Guidelines to be Implemented at Perth Children’s Hospital
Perth Children’s Hospital (PCH) is set to implement new nursing staff-to-patient ratio guidelines in its emergency department next month. The move comes after a coronial inquest into the death of seven-year-old Aishwarya Aswath, who died of sepsis while waiting almost two hours to be admitted to the hospital, found that she may have lived if she had received care sooner. Deputy coroner Sarah Linton recommended mandating a 1:4 nursing staff-to-patient ratio in all public hospitals, as advocated by the Australian Nursing Federation. The government has committed to implementing a 1:3 staff-to-patient ratio in PCH’s emergency department on July 17.
While Aishwarya’s parents have welcomed the announcement, they believe it is only a small part of what needs to happen to avoid future tragedies. Aswath Chavittupara, Aishwarya’s father, said, “This is just one of the things that we were fighting for. There’s a lot more changes that need to happen.”
Staffing Struggles and Concerns
The Australian Nursing Federation (ANF) and Australian Medical Association’s (AMA) WA branch have raised questions about how the government intends to implement patient ratios amid staffing struggles. ANF state secretary Janet Reah said, “What they actually need is a robust casual pool that is trained to work in that ED to draw upon when there is unexpected staff sickness, or there’s a rush of patients coming in that need care.” She added, “I can’t see how nurses and midwives would be happy with this announcement. They still have the same impossible workload that they had six months ago.”
AMA WA President Michael Page said an ad-hoc approach to implementing the ratios would strain other departments. “We think overall it’s a good thing for patient care and patient safety, but we are concerned about staffing levels,” he said. “The potential downside of mandatory staffing ratios is that it draws staff from other clinical areas which then may find themselves short.” Both were also alarmed there did not seem to be any measures to enforce the guidelines, and the fact they were only being implemented at one hospital emergency department. “We have no more than a promise of a guideline in one department,” Ms Reah said.
Premier Roger Cook said the measures were a small step before expansion across the state. “We’re not going to let the perfect get in the way of the good. We want to make sure that we can start to implement [the ratios] to the child and adolescent health services, with a view to then extend that right across our health system,” he said. “There will be very clear guidelines to rostering, and managing of our wards, that we want to see a nurse-to-patient ratio consistent with these new guidelines from July.”
Calls for a Royal Commission
Aishwarya’s parents also criticised the time it has taken to begin implementing ratios after their daughter died in April 2021, and repeated calls for a royal commission into WA’s health system. “The most important factor is, why did it take two years to happen?” Mr Chavittupara said. “A royal commission will look into all the aspects; the funding, the resources, and all [those] factors.”
Conclusion
The implementation of nursing staff-to-patient ratio guidelines at Perth Children’s Hospital’s emergency department is a small step towards improving patient care and safety. However, concerns have been raised about staffing struggles and the lack of measures to enforce the guidelines. Aishwarya’s parents have called for a royal commission into WA’s health system to address the funding and resource issues that may have contributed to their daughter’s death. It remains to be seen how the government will address these concerns and ensure that the new guidelines are effectively implemented.