The reception area at Dunedin Hospital Emergency
Department. Photo by Gerard O'Brien.
Any suggestion that Dunedin Hospital's emergency
department cannot work efficiently because it has too many
patients misses the point, emergency specialist Dr Tim Kerruish
says.
Dr Keruish, who is the clinical leader for the pilot project
charged with improving the patient flow through the
department, said reference to too many non-urgent patients
and the possibility of not treating some of them are
distractions.
Most of the people who came to the department did not become
in-patients, but even if they were turned away, there would
still be a problem of access to in-patient beds, he said.
He was commenting on an Otago Daily Times report of
concerns raised in the board's district annual plan about the
hospital's ability to meet Minister of Health Tony Ryall's
target that most patients should be admitted, discharged or
transferred from emergency departments within six hours of
their arrival.
The board said it would be difficult to meet this target
because of the high level of non-emergency attendances.
The problem was compounded by in-patient bed shortages
because there were not enough community hospital-level beds
for the elderly.
The plan also raised concerns about the size of the
department and staffing levels.
Dr Kerruish said doubling the size of the department would
not necessarily work.
He referred to a situation in a big hospital in the United
States where a 100-bed emergency department had doubled in
size because it was always blocked.
The situation actually worsened, because nothing else in that
hospital had changed.
Dr Kerruish said an emergency department that operated well
was an indicator of a well-run hospital.
The six-hour target should involve the patient spending no
more than three hours in the department, two hours for the
hospital medical team to see them and decide whether they
would be admitted, and one hour to find a bed.
The emergency department was "really good" at processing
patients within its three hours, but the delays occurred
after that.
An eight-bed "short-stayer" facility for those people with
conditions such as back pain or kidney stones, whose stay
might need to be between three and 23 hours, would help the
department function more efficiently.
Many other hospitals had them next to their emergency
department, and staff worked between the two.
At present, such patients often ended up on beds in
corridors.
He was keen to see the work begun in the department - which
used the lean thinking methods of the Toyota vehicle company
to identify waste and make improvements - extended beyond the
emergency department.
Until that happened, only limited gains could be made.
Some work has begun on this, with the support of the hospital
advisory committee.
Dr Kerruish said it would be a matter of staff sitting down
and working out over about three days, what the problems were
and how they could be fixed.
There would not be one answer, but a whole lot of small
solutions which would improve the way patients travelled
through the hospital, he said.
It would be only when there was engagement with the programme
right across the organisation that hospital-wide improvements
would result, he said.
elspeth.mclean@odt.co.nz
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