Patients becoming ‘invalids’ while waiting
People who use Southland Hospital are living longer, many are living in poverty and the population the hospital serves has grown by 29% in the past 15 years.
These are some of the reasons why the hospital is struggling to cope, researchers have found.
Independent consultants Sapere were asked to conduct a clinical needs analysis to understand why surgeries were being postponed and why the emergency department was experiencing ‘‘unprecedented demand’’.
A draft version of the report – which was requested by Southland-based District Health Board members Terry King, Kaye Crowther and Lesley Soper – will be presented to the board tomorrow, with the final version expected to guide future plans for the hospital.
The report says that as a secondary hospital, Southland Hospital serves 151,000 people living in Invercargill, the Southland District, the Gore District and Queenstown-Lakes – but this number has grown from 117,210 people in 2006.
Although it does not provide numbers, the report says pockets of Invercargill and the Gore district reach four or five on the Index of Multiple Deprivation (on a scale of one to five), while large swathes of the Southland district are on level three.
GPs told researchers they were dealing with more complex patients – driven by an ageing population – but managing with the same resources and in many cases, fewer staff.
This meant that consultations took longer, or they were seeing fewer patients, leading to ‘‘an unenrolled population that some report is the highest level they’ve experienced in many years.’’
This means patients are visiting Southland Hospital’s emergency department instead, with one senior clinician telling researchers about 5000 visits a year could be avoided if people could access a GP.
People are also visiting the ED because they have to wait too long for an appointment with a GP, or they can’t afford to see an after-hours GP, the report says.
The impact of ageing is being seen by the department too, with more complex ailments, or patients on lots of medications, for example.
Obesity adds to the time it takes to treat patients, the report says, taking much longer to insert an IV line or needing image guidance, for example.
Patients are sometimes spending up to eight days in the ED because there are no beds available on the wards.
Often, this is because older patients are waiting for a bed in an aged care facility or because a shortage of staff means patients have to wait to see a physiotherapist, for example, before they can be discharged.
‘‘The sense from the medical department is that, of 38 patients on the medical ward at any one time, around six to eight might be waiting for placement,’’ the report says.
Aged residential care providers are closing beds when they do not have enough registered nurses and a shortage of home and community support workers means discharging younger patients to their homes is not always possible.
Surgical teams are also spending more time in the theatre with operations on older patients – some in their 90s – taking longer.
Surgeries are being postponed because of staff shortages and the hospital is now doing almost no non-malignant cancer work, the report says.
‘‘Elective surgical levels are lower than appropriate storing up trouble for the future.’’
Unlike other district hospitals, Southland Hospital handles complex trauma surgeries – but it only has one acute theatre that operates until 7 or 8pm.
This means fewer joint replacement surgeries can take place with the orthopaedic department reporting fewer shoulder surgeries and patients becoming ‘‘invalids with arthritic hips and knees’’.
‘‘Patients are so severe they, we were told, could not walk even 50 metres,’’ the report says.
Staffing challenges are experienced throughout the hospital, and a lack of physical space makes it difficult for clinicians to offer catch up clinics to get through waiting lists.
Sapere will present a finalised version of its clinical needs analysis for Southland at the Southern DHB’s June board – it’s last before the national health reforms come into effect.