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Not meeting increasing demand: crisis in hospital emergency departments

Report from RNZ
Hospitals across the country have reached crisis point, with several emergency departments at capacity. People are being treated in corridors, increasing numbers of staff are reporting burnout and wait times are becoming longer.

Capital & Coast DHB said Wellington Hospital had an emergency department that was too small to meet the increasing acute demand. There were not enough inpatient beds across the hospital, it said.

A Wellington GP, who did not want to be identified, said the emergency department struggles were symptomatic of the struggles the whole health system is facing. “There’s no beds, referrals that we’re sending through are being declined. Even when patients are in the system and they’ve been seen by a specialist they’re not followed up with it. Referrals for imaging aren’t getting done on time. If they do get listed for surgery they wait months and months.” But she said the situation hadn’t come out of the blue – and had been building for months. “At least the past year, but particularly the past six months, it’s getting worse and worse.”

In the past 48 hours, Dunedin Hospital and Whangārei Hospital have reached capacity, asking people to keep ED for emergencies only.

Now, medical practitioners say it is a nationwide problem that, without support, is going to get worse.

Australasian College for Emergency Medicine president Dr John Bonning said the emergency department was where the stress was most visible, but the whole system was under increasing pressure.

“Patients are stuck. They’re in corridors. They’re spending six, eight, 12 hours in the emergency department where we’re forced to try and provide them longitudinal care,” Dr Bonning said.

Some ED shifts were functioning with only two thirds of their normal number of nurses.

“So it’s about the sickest and most injured patients not being able to be admitted to the ward and us trying to look after them whilst we wait for those ward beds to become available.”

It was easier to outline the hospitals that did not have a major problem than to name the ones that did, he said.

“Virtually everyone I have spoken to has issues with this. We’ve had the biggest January and February on record.”

College of Emergency Nurses chair Sue Stebbings said the crisis point had been building for years.

“Some of the main challenges are for nurses continuing to manage with increased numbers of patients presenting while they’re working with short staffing,” Stebbings said.

“Sometimes the space isn’t available so corridor spaces are being used in many departments. There’s not enough staff to open up the new areas where new departments have been built and also the challenge of continuing to care for patients while they wait for transfers to wards, often for prolonged periods of time.”

Emergency nurses were often battling a constant fatigue from the increased demands when they just wanted to provide the best care possible, she said.

“It’s quite distressing when that’s not possible. They’re overwhelmed … there can be delays to care so if someone needs pain relief medication, they have to sometimes juggle that need with something else, and while they want to do things as quickly as possible, that’s also distressing for nurses.”
‘Tsunami of patients’

New Zealand Medical Association chair Dr Kate Baddock said the issue did not start with emergency departments, that was just where it was most visible.

GPs were being overwhelmed with increased workloads, not enough doctors, more patients, and not enough support, she said.

That was leading more people to go to EDs as they faced waiting times of up to four weeks.

“So we’ve got a chronic problem exacerbated by an acute problem relating to getting enough doctors … and then we’ve got people delaying being seen because of Covid and associated issues around access,” Dr Baddock said.

“You’ve ended up with this tsunami of patients needing to be seen.”

She wants the government to free up the stream of international doctors coming into Aotearoa.

Dunedin Hospital declared a code black yesterday after reaching capacity.

At one point, 18 patients were stuck in the Emergency Department awaiting a bed with only three available in the wards.

Southern DHB chief medical officer Nigel Millar said there was sufficient capacity in the wards to receive patients now.

Waitematā DHB reported considerable congestion in both North Shore and Waitākere Hospitals, where they consistently saw more than the daily average of 150 presentations per hospital between October and December.

Today, Whangārei Hospital put out a call for people to stay away from the ED unless it was an emergency. The department was at capacity. On Tuesday and Wednesday, 246 people arrived at the ED – on the same days last year, there were 138 patients.

Northland DHB’s Surgical and Support Services manager Mark McGinley said many hospital beds were full and that was having an impact on inpatient admissions.

Dr Bonning is meeting with Health Minister Andrew Little tomorrow to call for more support for a system under mounting pressure. Without support, he said, they were at a crisis point with a possible harsh winter on the way.

5 comments:

  1. D'Esterre, 27. March 2021, 12:22

    “Capital & Coast DHB said Wellington Hospital had an emergency department that was too small to meet the increasing acute demand. There were not enough inpatient beds across the hospital, it said.” When that hospital was being built, many of us said it was too small, including the numbers of parks, given that older patients (who disproportionately use services) must perforce use their cars. And we were ignored. Now the chickens have come home to roost.

    It seems that the space problem has combined with lack of staff to create the current imbroglio. The health system here tottered along when the borders were open; now they’re closed, with all the consequences of that. And the increase in demand has nothing to do with the coronavirus.

     
  2. michael, 27. March 2021, 17:27

    The massive rebuild in 2009 to meet Wellington’s future needs has clearly failed. And yet WCC (and the government) is insisting that thousands more people be housed in the city without any thought about things like this. As the population rapidly increases, where is the space, planning and funding for the extra hospital beds, aged care and day care facilities, schools, medical centres etc to service the massive increase? And let’s not even talk about the infrastructure. It is madness!

     
  3. Mike Mellor, 31. March 2021, 13:32

    Interesting comments, but unfortunately having little relevance to the problem and not asking a key, unanswered question – what is causing this increased demand?

    It’s nothing to do with the number of car parks (I’d rather the hospital prioritised beds, a core activity, than parks), and “older patients…must perforce use their cars” is clearly not the case, since older people are just as capable of using taxis etc as anybody else. The popularity of the SuperGold card shows that they’re pretty capable of catching the bus, too, and beyond retirement age the older that people get the less likely they are to have a driving licence, or a car.

    Neither are “WCC (and the government)…insisting that thousands more people be housed in the city”, as this is yet to happen, and is just making room for those who want to live here.

    So what is causing this increase in demand?

     
  4. Claire, 31. March 2021, 16:03

    Mike: try the backlog from covid lock down. Also lack of staff coming into the country.

     
  5. D'Esterre, 4. April 2021, 16:05

    Mike Mellor: … “what is causing this increased demand?” I’d assumed that everybody would have worked this out. Here’s my take: it’s a consequence of the desperate poverty in a significant subsection of NZ society: poverty which has been exacerbated by the issues associated with the pandemic, though not caused by the virus itself.

    “It’s nothing to do with the number of car parks…” I observed that lack of parking is an additional problem, along with the hospital being too small. As was pointed out at the time it was designed. Those of us who’ve attempted to find parking there – and been unable to get a bed allocated – can attest to this.

    “….older people are just as capable of using taxis etc as anybody else. The popularity of the SuperGold card shows that they’re pretty capable of catching the bus…” I’m delighted for you that you have the physical mobility – and the spare time – to use the buses. A drive around a jammed hospital carpark suggests that lots of patients and visitors can’t or won’t do likewise. Many of them will be OAPs with mobility problems: many others will be parents with small children, people with disabilities, commuters from the suburbs. Ordinary people, in other words. Let’s not get into the issue of people on fixed incomes having to pay for transport.

    Neither are “WCC (and the government)…insisting that thousands more people be housed in the city”… Wasn’t that exactly what the draft spatial plan was about? It’s certainly what the government intends. And has ordered WCC to make provision for, whether or not the city has the infrastructure.

     

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