Dunedin Hospital will find it hard to meet the Minister of Health's expectation that patients should spend no longer than six hours in emergency departments, because it is still dealing with too many non-urgent cases, the Otago District Health Board says.
About a quarter of patients visiting the department have a stay longer than six hours, according to the board's recently-approved district annual plan.
Mr Ryall's target states that patients should be admitted, discharged or transferred from emergency departments within six hours of their arrival.
While the board has consistently treated the most urgent cases immediately, it has had trouble meeting the required treatment times for the next two triage categories.
This situation was compounded by a shortage of hospital beds due to a lack of community hospital-level care beds for the elderly, the board said in its annual plan.
That shortage meant it was unable to discharge elderly patients back into the community.
The board has been concerned for a while about the number of patients attending the department with conditions which could be treated elsewhere.
In the annual plan, the board suggests patient numbers could be reduced by further community education or by introducing criteria which would mean "some patients are not assessed".
The department was not built to accommodate the number of patients attending, and monthly attendances were about 850 above the target of 2500, the plan said.
Figures from the board, covering February to July this year, show that in most months patient numbers had fallen slightly from last year's figures, apart from March, which has traditionally been a busy month.
The biggest reduction of patients was in triage categories three and four.
The plan said the department had 21 beds, but its patient count indicated it should have 33.
Also, the number of senior doctors working in the department was about half that recommended by the Australasian College of Emergency Medicine for the number of patients seen.
A fast track process for the least serious cases (triage categories four and five) was introduced, but staffing constraints meant it could only run for four hours a day during the week.
It stopped briefly during the swine flu outbreak because of a shortage of space resulting from a need to isolate some patients, but the process has been restarted.
The improvements to waiting times for those in triage categories four and five, however, had not had any impact on those in categories two and three.
The six-hour target would mean patients would have to move faster from the department into other areas.
This would be difficult on "after hours" shifts when staffing was reduced, because staff whose presence might be required in the emergency department would also be needed elsewhere in the hospital, the plan said.
The department was part of a pilot programme last year which introduced lean thinking methods, similar to those used by the Toyota company, to reduce waste and improve efficiency.
Some gain were made, but it became clear other parts of the hospital would have be involved as well if the programme was to be effective.
Preliminary work has begun on extending the programme to other areas.
Committee chairman Richard Thomson has emphasised the need for this process to be driven by staff.
