Hundreds spend 24 hours at ED
Hundreds of people are spending 24 hours or longer in emergency departments each month, suggesting a staggering level of dysfunction across the health system which poses a serious risk to patients.
Figures obtained by National’s health spokesman Dr Shane Reti shows 594 people waited 24 hours in an emergency department in August, up from 160 last August – a number getting progressively worse each month.
Clinicians have for more than a year warned of an ED crisis fuelled by staffing shortages, increased demand and too-small departments, leading to worse outcomes for patients.
College of Emergency Nurses spokeswoman Sue Stebbeings, said the situation was only worsening. ’’We are speaking out because we are aware the risk is increasing,’’ she said.
Dr Kate Allan, Australasian College of Emergency Medicine Aotearoa faculty chairperson, said the figures were ‘‘worrying’’ and reflected system-wide issues which are decades in the making.
‘‘These significant pressures being experienced across the country’s healthcare system are making it increasingly challenging for emergency department staff to admit patients requiring further care into hospital inpatient beds, leading to longer ED waits following initial treatment and assessment,’’ she said.
The stark warning follows a spate of high-profile deaths including, a pregnant woman who died after a delayed admission to ICU in Palmerston North, a 4-year-old who died from a throat infection in Wellington, a woman who died after leaving Middlemore Hospital emergency department because of long waits, and a patient who presented to a busy Christchurch ED, left and later died in ICU. It also comes as hospitals clear a backlog of more than 30,000 surgical procedures.
The scarcity of beds delays people being admitted to wards from the emergency department, slowing assessments and treatments and increasing the likelihood of an error, clinicians say.
It also lengthens the patient’s overall stay in hospital and is tied to worse health outcomes – including death.
Reti, who has worked as a GP, said the figures were a sign of a system under immense stress, and undermined Health Minister Andrew Little’s pledges to end the postcode lottery of care through centralising health bureaucracy and abolishing district health boards. ‘‘EDs are a snapshot of the system,’’ he explained. ‘‘It is a disaster waiting to happen.’’
The data related to people who spent time in ED until they were discharged or admitted to a ward,
during which they would be under observation and may in some cases have started treatment whilst waiting for a bed.
Reti has called for emergency department wait times targets, set up under National but replaced with health system indicators, to be publicly reported again.
Dr John Bonning, in his former role as president of the Australasian College for Emergency Medicine, had also said the target – to admit, discharge or transfer 95 per cent of ED patients within six hours – should be publicly reported. Little on Saturday said there was an 11% vacancy across the health sector – a figure which would total 9000 doctors, nurses and other workers, and is about double where it usually sits. However, there had been an overall increase in nurses, he said.
In May, then-immigration Minister Kris Faafoi announced a number of immigration changes, including putting nurses on a two-tier ‘green list’ but the Labour Government has faced consistent pressure from the Opposition to move foreign nurses to the fast-tracked residency scheme, instead of the two-year work to residency scheme.
Reti reiterated calls for the immigration settings to be changed for nurses, and said the changes had come too late in the piece.
Dr Pete Watson, the national medical director of Te Whatu Ora – Health New Zealand said the agency which replaced district health boards was training more clinicians.
‘‘We are boosting nursing numbers by doubling the number of nurse practitioners trained each year from 50 to 100,’’ he said in Parliament on Saturday.