Over­loaded city clin­ics turn away am­bu­lances

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Am­bu­lances are be­ing turned away from city med­i­cal clin­ics, putting fur­ther pres­sure on Waikato Hos­pi­tal’s strained emer­gency depart­ment.

And the lack of beds at the ED is so dire, peo­ple are be­ing forced to stay in – and tie up – am­bu­lances out­side as they wait for a space to free up.

Pa­tients have also been put into hos­pi­tal cor­ri­dors be­cause of over­crowd­ing.

Long wait­ing times and full med­i­cal clin­ics around Hamil­ton are see­ing those prac­tices bump pa­tients off to the hos­pi­tal’s ED – even when pa­tients’ con­di­tions are less than se­ri­ous.

The Waikato DHB was briefed on the de­vel­op­ment on Wed­nes­day – one se­nior health boss called it a ‘‘sig­nif­i­cant is­sue’’.

Waikato’s ED has been stretched to the limit this win­ter.

In July 10, the hos­pi­tal’s ED treated a record 297 pa­tients, while on May 23, the depart­ment was tipped into over­load, prompt­ing elec­tive surg­eries that weren’t can­cer-re­lated or emer­gen­cy­type to be resched­uled.

DHB di­rec­tor of hos­pi­tal ser­vices Brett Para­dine said the city’s med­i­cal clin­ics had started turn­ing away am­bu­lance pa­tients due to long wait­ing times.

Hamil­ton’s An­gle­sea Clinic had also in­formed the hos­pi­tal it wouldn’t ac­cept redi­rected pa­tients from the ED when the clinic had a four-hour pa­tient wait.

‘‘We know de­mand grows over time, but this has been a par­tic­u­larly dif­fi­cult win­ter,’’ Para­dine said.

‘‘St John is see­ing record lev­els. They have had the high­est lev­els of call­outs here in the Waikato, with a 16 per cent in­crease last month com­pared to the same month the pre­vi­ous year.

‘‘The is­sue about peo­ple be­ing redi­rected from pri­mary care to the emer­gency depart­ment is a sig­nif­i­cant is­sue for the DHB.’’

Para­dine said de­liv­er­ing pre­ven­ta­tive care through the pri­mary care sec­tor is the best way to re­duce de­mand on the hos­pi­tal’s ED.

Anec­do­tal ev­i­dence sug­gests peo­ple come to the ED be­cause they strug­gle to ac­cess or af­ford pri­mary health­care. They also know they will re­ceive good qual­ity care at the hos­pi­tal.

How­ever, Para­dine said most of those turn­ing up to the depart­ment were in need of ur­gent care.

‘‘We know de­mand grows over time, but this has been a par­tic­u­larly dif­fi­cult win­ter.’’

DHB di­rec­tor of hos­pi­tal ser­vices Brett Para­dine

‘‘The feed­back I’ve had from the clin­i­cal di­rec­tor in the emer­gency depart­ment and a num­ber of clin­i­cians I’ve spo­ken to there [is that] most of the peo­ple who are com­ing up to the emer­gency depart­ment do ac­tu­ally need to be there.’’

In re­ply, Waikato DHB chair­man Bob Sim­cock said he as­sumed pri­mary care providers were re­quired to de­liver a 24-hour ser­vice.

‘‘At the mo­ment it seems to be that when they de­fer back to us, they’re re­fus­ing that obli­ga­tion,’’ Sim­cock said.

DHB di­rec­tor of strat­egy and fund­ing Julie Wil­son said med­i­cal clin­ics had ex­pe­ri­enced high lev­els of staff sick­ness, putting them un­der fur­ther pres­sure.

A pri­mary com­mu­nity care work­shop has been sched­uled to look at mak­ing the sec­tor sus­tain­able, Wil­son said.

Mean­while, Para­dine said ini­tia­tives to in­crease ED staffing lev­els had led to four ex­tra se­nior doc­tors em­ployed.

The emer­gency depart­ment has yet to reach its full nurs­ing quota due to res­ig­na­tions. A fur­ther re­cruit­ment pro­gramme is needed to fill those va­can­cies.

Since last July, more than 20 nurses have re­signed from the emer­gency depart­ment, many cit­ing stress.

Waikato Hos­pi­tal ED is also un­der pres­sure, with am­bu­lances some­times re­quired to hold peo­ple out­side un­til a space frees up in­side.

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