Perth Children's Hospital was a "disaster waiting to happen" just days before a seven-year-old girl died of sepsis after having to wait almost two hours for treatment, an inquest into her death has heard.
Aishwarya Aswath was carried into Perth's flagship paediatric hospital by her father at 5:32pm on April 3 last year.
She was triaged as a low-priority patient and only admitted at 7:30pm after waiting two hours.
About 50 minutes later her heart had stopped beating and doctors began CPR, which could not save her life.
Nurses' union chief executive Mark Olsen said he received emails from staff at the hospital in late March — just weeks before Aishwarya was admitted — flagging that nurses were being left responsible for 40 to 60 patients at a time amid chronic staff shortages.
Staff 'weren't being listened to'
"What struck me was it was a disaster waiting to happen … and they weren't being listened to," he said.
Part of an email read to the court said staff were taking increased sick leave due to stress and burnout.
"Nursing staff are asked to do double and extra shifts on most days and absent staff are regularly left unreplaced," Mr Olson read.
Mr Olson said conditions had been eroded over decades, which meant when COVID-19 struck, senior nurses were more inclined to take comparatively less stressful jobs in vaccination clinics, "decimating" the pool of casual staff hospitals could usually draw on.
At one point the hospital's lawyer, Carolyn Thatcher SC, questioned the relevance of Mr Olson's evidence, but coroner Sarah Linton allowed it.
"It's become very clear to me in this inquest one of the reasons nurses were run off their feet [was because they were] doing too many jobs for one person to do in a safe and sensible way," the coroner said.
"Staffing is one of the key issues.
'Why does it take a death?'
"It seems to me to suggest … there was a problem that could be fixed.
"It raises the issue of why does it take a death?"
Mr Olson said the WA government could have done more to incentivise senior nurses to return to the hospital floor during the high demand in COVID-19 clinics.
He also spoke of the merits of minimum nurse-to-patient ratios compared to the current WA Health Department system of nursing hours per patient day (NHPPD), which Mr Olson said used a very opaque formula.
"The reason we prefer patient ratios is that they are transparent, you can see exactly what it is … you can't hide a deficit," he said.
One nurse for nine patients
The inquest earlier heard from one of the nurses working the night Aishwarya died that the patient ratio had been one nurse to every nine patients that night.
Mr Olson also said the health department had developed a policy of not replacing the first person who called in sick.
The night Aishwarya died there were two nursing staff off sick, while a third became ill during their shift and left.
PCH emergency department co-director of nursing Susan Baker told the court the two nurses who called in sick the night Aishwarya died were replaced with casual staff, while the one who went off sick was not, but on the understanding there was an extra person on that night who could fill in.
She also said that since the department had hired more staff, current levels worked out to 1:4 nurses to patients using the WA Health Department's preferred staffing model.
Moves to increase staff numbers
The inquest has heard that in April 2020 patient presentations fell dramatically, but in April 2021 – when Aishwarya came to the ED — it was coming off an unprecedented rise in patient numbers.
Ms Baker said the ED environment was very dynamic, which made it difficult to predict staffing requirements.
She outlined steps the hospital had taken between November 2020 to July 2021 to recruit more staff when it became apparent there was an unprecedented number of patients presenting at the hospital beyond the usual winter spike.
The steps included recruiting more junior staff straight out of university, implementing more graduate training positions, and approaching retired and part-time nurses to do more work.
It also slashed the wait times for the recruitment process, which she described as "lengthy and frustrating", getting the average number of days taken to employ someone down from 123 to 35.
The inquest continues.
