Ambulance ramping cases have been described as the “canaries in the healthcare coalmine”, with escalating pressures on hospitals exposed by delays in the transfer of patients into emergency departments.
In some instances, ambulances are “ramped” for hours outside hospitals, waiting for available beds, and the crisis is expected to continue as Australia’s population ages and multimorbidities rise.
But digital advance care planning can help to alleviate the problem by preventing unnecessary hospitalisations and ensuring patients’ end-of-life care choices are respected, including wishes to not endure life-extending interventions.
“Solutions do exist,” an editorial on ambulance ramping in The Lancet Healthy Longevity claimed, “For example, in the Netherlands, greater investment in palliative care has led to more people being able to die at home or in specialist institutions than in hospital; a crucial metric, as hospital use is highest in the last year of life.”
Within efforts nationally to minimise the growing pressures on hospitals, digital advance care planning provides an essential voice for patients who would otherwise be taken to emergency departments.
“Digital advance care plans allows carers, paramedics, emergency department clinicians and loved ones to urgently access patients’ end-of-life preferences, even when they are unresponsive,” founder and CEO of Touchstone Life Care Dr Merran Cooper said.
“They lower the amount of unnecessary and unwanted hospital care that is provided to people who actually want to have a gentle death in a place they prefer.”
Data from Touchstone Life Care’s digital advance care planning system, which is used by more than 40 aged care providers, indicates that many people hope to avoid hospitals and drastic medical interventions in their last days:
For CPR after a catastrophic event such as stroke, major deterioration, illness or operation:
- 40.64% said they only want CPR if it is expected they will have their minimum quality of life
- 49.12% said they do not want CPR
- 10.24% said they do want to receive CPR regardless of quality of life.
If they have a terminal condition, respondents said they would prefer to receive care:
- Where it is easiest for my family and loved ones to be with me: 43.88%
- At home: 30.58%
- In a hospital or similar: 17.63%
- Other: 7.91%. (The other responses focus on preferring palliative care at home until it becomes too burdensome for the family or when nurses deem it necessary to go to hospital. Some emphasise a desire to not rely on others or a refusal of life-extending interventions when the outcome is poor quality of life.)
However, in the absence of mandatory and widespread digital advance care planning, people are routinely transported to under pressure hospitals, contributing to the ambulance ramping crisis.
Canaries in the healthcare coalmine
The AMA’s 2023 Ambulance Ramping Report Card examined the “grim” situation, with then president of the doctors’ lobby, Professor Steve Robson, claiming it should be sobering reading for health ministers across the country.
“Behind every number and every statistic, there is a harrowing personal tale of a patient forced to wait far too long just to be transferred from an ambulance to the ED,” Professor Robson said.
“This issue continues to dominate news headlines every day. Patients, doctors, paramedics and hospital staff all deserve decisive action from governments to address ramping, ED overcrowding and hospital logjams.”
According to the report card, South Australia was one of the worst performing states, with 42.9 per cent of patients transferred within 30 minutes in 2021–22. Less than 60 per cent of Queensland patients were transferred within 30 minutes.
As well as adding to the logjams, a number of people have also died while waiting in ramped ambulances. In May 2024, the Brisbane Times reported paramedics had repeatedly raised the alarm about the condition of a man who had waited for hours on an ambulance stretcher at a Queensland hospital before he suffered a heart attack and died. In April 2024, the ABC reported on an inquest into three unrelated deaths of South Australians affected by ambulance ramping, including one man who had waited in an ambulance for five hours.
The Rural Doctors Association of Victoria warned in September 2024 the problem was systemic, particularly at smaller regional hospitals in the state.
“Predominantly, it’s just that there’s no beds,” president-elect Louise Manning told the ABC. “When you’ve got no beds in ED because you’ve got patients waiting to go to the acute beds in other parts of the hospital, but then you have got people sitting in acute beds that are unable to be discharged … it has a flow-on effect everywhere else.”
This not only results in longer waits for patients needing urgent care but also leaves fewer ambulances available for other emergencies.
Solutions do exist
As a former emergency medical doctor, Touchstone’s Merran Cooper says the systemic deployment of digital advance care planning would be a significant improvement from the current practice.
“Advance care directives must be readily accessible and up-to-date to be effective, something many current systems are not able to support,” Dr Cooper said.
“Across much of Australia, advance care directives still depend on outdated systems, such as paper forms or static PDFs that require manual checks and uploads. Some processes even rely on staff to verify whether an advance care directive is complete and signed before uploading it, and, if it isn’t, that directive may never make it into the hospital or ambulance systems.
“Over the past few years, Australia has made significant strides in digitising healthcare systems. Now it is time to introduce an interoperable digital standard for advance care directives to help ease the burden on our hospitals and ambulance services – and to also make sure patients’ care wishes are heard.”
About Touchstone
Touchstone Life Care provides a comprehensive digital advance care planning platform that integrates with clinical systems and provides one-click compliance, with reports easily downloadable for accreditation purposes.
Book a demonstration to discover why residential aged care and home care providers are adopting digital advance care planning.
