Another example of the philosophy that nothing is impossible to those who don't have to do it…

The four-hour rule imposition would make sense only if it had been preceded by an analysis of what was required in order to meet the target at each facility followed by the provision of the necessary resources.

Is there any practical way of reversing the obligation? Lack of available beds for admissions is a major 'access block' to the efficient operation of emergency departments…

Why don't we hold hospital, social services and human relations bureaucrats and managers responsible – with costs and imposts – if they fail to move all appropriately assessed patients, unnecessarily occupying a hospital bed, to a nursing home facility within four days?

In some jurisdictions this would free up about 30% of hospital beds... It might even be more appropriate for the people occupying them. Not a cure for the problems identified in the article, but it would help.

The focus on nursing home type patients is a bit of a red herring.

A few decades ago, many of our public hospitals did have geriatric wards. However over the decades the number of available public hospital beds has decreased by more than 50%.

Geriatric wards have gone, as well as separate wards for men and women.

Typically the 4 hour waiting rule is like trying to fit a square peg into a round hole with a sledge hammer.

I fail to find much merit in the article or its summation. Comparative bench marking, would likely show too many chiefs and not enough Indians in ACT hospitals? As for bagging "interfering" paramedics, they are first on the scene, save many thousands of lives and possibly already have formed a probable diagnosis arrived at through decades of practical experience.
I can remember an occasion when a sharp eyed medic pointed to a single pulse from an artery; even as the medico was writing out the death certificate.
Don't bag paramedics, when a much better option is to use their often extensive and usually reliable practical experience. Better one should bag the intellectual arrogance that makes such offensive belittling possible?
Years ago and working as a medical officer for a remote mining company, I was astounded when a patient, with a perfectly reset leg/Tibia; had his leg re-broken and reset by a very junior Dr., who apparently resented that this service had already been perfectly performed on site by a less qualified person? [Well, he couldn't find the break and this sort of extremely arrogant action is too common, especially among very recent university graduates, with an over inflated view of their comparative value and standing?]
Even though he and I knew that we were many hours away and the quicker the injury was reduced the less permanent damage would ensue.
Let me conclude with this evocation, that we drop/sack/fire the bungling bureaucratic bean counting figure fudging control freaks? And then reintroduce or substitute team work; that simply focuses on the patient and best possible outcomes. Rhrosty.

I have found that many staff in emergency departments are not very hard working at all.

We are 25Km from 4 different ambulance stations. We are 25Km from a small hospital, & 50Km or so from 2 different large hospitals. We do not find ambulance service very prompt, so for 2 of my three heart attacks I have not bothered with them, & driven myself, & been driven by a neighbour for the later ones.

As the local coordinator for our rural watch, a card with my name & phone number is on the fridges of about a hundred homes. I am often the first call for folks needing help. I have therefor driven a number of people to hospital for help, as well as my own experiences.

I have found the service/help given depends on the problem. Cardiac problems get tremendous instantaneous service. Asama if bad enough gets pretty rapid treatment, if you shout loud enough to be noticed, but I have sat for hours with people with broken ribs, arms & legs, while medical staff near by, sat & discussed TV programs, & weekend trips.

One lady, in agony with a gallstone attack waited 2 hours for as much as a pain killer, & was sent home as soon as she could stand.

Yes I'm sure bureaucrats fudge figures, & should be charged with fraud, but please don't put imaginary halos on the emergency staff. Although a few may be angles, the halos would probably slip & choke many them.