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Eleven young Victorians have died and nine others have permanently lost function as serious failures in emergency departments become more frequent.
Workforce shortages and a pandemic-related increase in demand have been linked to critical delays in recognising and treating deteriorating children, including sepsis patients nearing collapse.
Dio Kemp was adored by her family. She died in November 2019.
The state’s hospital watchdog, Safer Care Victoria, has raised serious concerns about a shortfall of paediatric expertise among some doctors and nurses caring for children, saying it has become normal for clinicians to provide services to children “outside of their comfort zone”.
One emergency department manager said their unit saw 120,000 patients a year, yet it had no staff with speciality training in paediatrics after hours, while regional or rural centres were “more often” staffed by locum medical staff with only a few years’ experience.
“Access to resuscitation resources for deteriorating children can be delayed because of the number of unwell adults and the assumptions that the adults will be more unwell than children,” said a Safer Care Victoria white paper.
“ED staff are less familiar with children and even some senior staff prioritise seeing the adult patient with which they are more comfortable.
“All these factors reduce the perceived importance of the child and often leave the least experienced clinician to manage them.”
The revelations are detailed in two separate Safer Care Victoria reports, including a previously unpublished review examining the causes of serious adverse events in emergency departments involving children and young people from January 2017 to June last year.
The review was obtained by The Age under freedom-of-information legislation after Safer Care Victoria refused to release it.
The analysis confirmed a sharp escalation in the number of serious adverse paediatric events in 45 Victorian health services in the year to September 2022, across numerous hospital areas, including special care nurseries, birth centres and emergency departments.
Of the 21 deaths and severe instances of harm that occurred in emergency departments from 2017 until June last year, 10 involved sepsis, a life-threatening infection complication. Several cases involved testicular torsion (when the testicles’ blood supply is cut off), anaphylaxis, stroke, asthma, self-harm or myocarditis.
Eight of the sentinel events in emergency – regarded as “wholly preventable” and resulting in serious harm or death – occurred in just the first six months of 2022, compared with three in all of 2021 and three in all of 2020.
Eight of these 21 sentinel events involved babies aged up to one-year-old, six were in patients aged one to five, and seven were older children or teenagers aged up to 18 years.
A photo of Dio Kemp when she was unwell. Her death is subject to a coronial investigation.
The coroner is investigating several deaths, including three-year-old Dio Kemp, who died in 2019 of bacterial septicaemia following multiple visits to Monash Medical Centre.
Also under examination is the treatment of 19-month-old Diamond Creek boy Noah Souvatzis, who died in 2021 of meningitis after initially being sent home from Wangaratta Hospital emergency department.
Separately, the mother of Amrita Lanka, Satya Tarapureddi, said she resorted to asking the cleaners at Monash Children’s Hospital for help before her daughter’s death last year of myocarditis, an inflammation of the heart muscle.
The Victorian government has already announced several key reforms in response to the increase in sentinel events affecting children. That includes a statewide escalation scheme that worried parents can use if they feel their concerns are not being addressed.
Amrita Lanka died in hospital aged eight.Credit: Justin McManus
“At the centre of this reform is the families who have lost their children to a paediatric sentinel event – ongoing consultation with these parents and carers, as well as our health services, is critical to the program’s success ahead of implementation next year,” an Allan government spokeswoman said.
The Safer Care Victoria white paper published this month also suggested several other changes, including that every emergency department and urgent care centre that treats children has a dedicated paediatric waiting and treatment area, with dedicated staff with paediatric skills.
Australasian College for Emergency Medicine president-elect Dr Stephen Gourley said while the overwhelming majority of Victorian children treated by emergency department clinicians had positive outcomes, worrying workforce shortages continued, particularly affecting regional areas.
“EDs are trying desperately to manage roster gaps and often – especially in [rural, regional, and remote] areas – the solutions are locums, or no doctors at all, as is happening with concerning frequency in many areas of Victoria.”
The majority of Victorian emergency department patients are still waiting more than four hours for a bed and Gourley warned that funding cuts to health services means problems will continue to get worse without long-term solutions increasing capacity in hospitals, mental health, aged care and other forms of community care.
Australian Medical Association Victoria vice-president Dr Simon Judkins said some rural and regional emergency departments were reliant on junior or temporary “locum” doctors who didn’t have speciality emergency department training, let alone expertise in treating children.
For example, a doctor training to be an orthopaedic surgeon doing temporary locum work, with limited to no experience in paediatrics, might be the clinician looking after a sick child who arrived overnight.
Judkins, who commutes weekly from Melbourne to work at a regional ED, said the government needed to do more to incentivise senior doctors comfortable treating sick children with complicated medical histories to work in regional areas.
In many cases where young patients had come to harm, junior medical clinicians did not have access to a senior person to help them manage cases, leading to diagnosis delays.
“Currently in Victoria, there is a disconnect between the ‘accepted’ level of paediatric knowledge and capability with what the system requires to be safe,” the Safer Care white paper said.
“A safe system of care requires all clinicians caring for children to have a general set of paediatric skills, rather than accepting the status quo that providing services to children is often outside of their comfort zone, given that children comprise 30 per cent of medical caseloads.”
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