ED under pressure well before winter hits

Health workers are worried Christchurch Hospital’s emergency department (ED) is already under pressure and may be forced to close to some patients during winter’s peak.

A recent Canterbury District Health Board (CDHB) report warned more than 56,000 patients were expected at ED this year, up 1100 compared to 2017.

CDHB older person’s health general manager Dan Coward said strategies to reduce patient numbers in 2017 had worked and the DHB was preparing to implement them again this winter.

The plans included increasing the role of GPs, the 24 Hour Surgery and community nursing, recruiting more staff ahead of winter, postponing staff training, and promoting staff wellness including flu vaccinations.

Preparations are under way to add another 20 beds at Burwood Hospital before winter hits.

Specialist staff are stationed at Christchurch Hospital to speed up assessment of older patients and, if necessary, transfer them to the older person’s health unit at Burwood Hospital.

Paramedics are also expected to provide treatment in people’s homes or take them to their GP or the 24 Hour Surgery to help reduce unnecessary ED presentations.

One paramedic, who did not want to be named, said ED had already reached capacity months out from winter. Some GPs did not accept acute patients referred from paramedics as they believed hospital treatment was necessary or they were too busy to fit in an urgent appointment.

About half the patients he tried to refer to GPs ended up being taken to hospital.

He said ED was overloaded with patients five to six times a week, forcing patients to wait on trolleys in the corridor.

Last year, Canterbury paramedics were advised to transfer only critically ill patients to ED on at least two occasions.

Christchurch Hospital had not been forced to close to non-critical patients, like hospitals in Auckland and Australia did routinely, but the paramedic said he would not be surprised if it had to this winter.

Age Concern Canterbury chief executive Simon Templeton said he was concerned about the impact of this year’s flu strain, which had caused deaths overseas, and the ability of services to cope with increased demand.

The CDHB’s strategy of keeping people well at home was good when it worked, but there was a risk patients could miss out on necessary hospital treatment, he said. ‘‘It’s something that needs to be front of mind of people planning the services and sometimes it can be those unforseen consequences of decision-making.’’

St John national patient pathways manager Kris Gagliardi said staff followed clear clinical guidelines to make decisions about treatment.

‘‘Part of our job is to try and reduce the work load [at ED] but our clinical guidelines are very clear – that if the patient needs to go to hospital they are taken there.’’

In the year to date, 62 per cent of people who called an ambulance in Canterbury were taken to ED, 2.6 per cent were taken to a GP or after-hours clinic, 3 per cent were given advice by phone or referred to a GP or nurse, and 18 per cent were treated in their own home. Paramedics were increasingly working as primary care providers rather than ambulance drivers, Gagliardi said.

NZ Nursing Organisation organiser Danielle Davies said union members were concerned about staff shortages and had requested a meeting with senior management at the CDHB to discuss recruitment plans for winter. Nurses wanted to be able to continue their professional development and opposed a freeze on training over winter.