‘Escalation’ plan bid to unclog EDs

Covid-19 has greatly reduced demand at Dunedin Hospital’s emergency department - volumes in June...
Covid-19 has greatly reduced demand at Dunedin Hospital’s emergency department - volumes in June were down 10% on the previous year, and 7% down in July - but the SDHB expects normal service to resume. Photo: ODT files
In a bid to unclog its slow-moving emergency departments, the Southern District Health Board is developing an "escalation" plan to try to improve patient flow.

Dr NIgel Millar. Photo: ODT files
Dr NIgel Millar. Photo: ODT files
Emergency departments in all New Zealand hospitals are meant to achieve 95% of patients being admitted, discharged or transferred within six hours of arrival, but very few manage this. The most recent data on the Ministry of Health website showed just three met the target.

Covid-19 has greatly reduced demand at Dunedin Hospital’s emergency department - volumes in June were down 10% on the previous year, and 7% down in July - but the SDHB expects normal service to resume.

"Despite lower volumes in July, the total numbers admitted on to the ward increased from 926 to 958 year on year (3%)," SDHB chief executive Chris Fleming said in a report to be considered tomorrow.

"That is reflected somewhat in the busyness pressure that has been reported back to us by the inpatient teams during July and subsequently into August."

In Southland, ED patients in July were within 1% of usual, but an error in collating statistics meant the board did not know how many of those patients had been admitted, Mr Fleming said.

The age of people arriving at ED had been rising year on year, and was now on average 43, a figure the board wanted to do more research on, he said.

The escalation plan, to be presented by chief medical officer Nigel Millar, was intended to provide a systematic approach to recognising and fixing delays in patient flow through the hospital system.

"Dunedin Hospital emergency department has frequent episodes of overcrowding that create practical obstructions to care, risk and distress to patients and families," Dr Millar said.

"An overcrowded ED does not necessarily mean that the problem lies within that service. It is just that this is the point in the system where a flow problem becomes visible."

The whole hospital needed to be involved to recognise potential delays and their impact.

The plan would have the emergency department issue a "yellow alert" if it started to experience delays, which would result in doctors being brought in to see unassessed patients, discharges speeded up and an audit of potentially available beds made.

The alert scale went from orange and red stages to black - a critical situation which would result in an emergency response team being called out and the SDHB chief executive and board chairman being notified.

"It would be easy for such a programme to be seen as a blame process, when in fact staff are working to the best of their ability in a complex and constrained system that needs continuous improvement," Dr Millar said.

 

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