ED a long way short of targets: clinicians

Dunedin Hospital’s emergency department is a long way from meeting its performance targets despite WorkSafe New Zealand lifting a ‘‘please improve’’ order, clinicians say.

Emergency departments are meant to achieve a Ministry of Health target that 95% of patients are seen within six hours: few hospitals nationally meet that mark and Dunedin Hospital seldom has in recent years.

That and a range of safety concerns due to high patient numbers, more seriously ill patients coming to the ED and serious short-staffing issues prompted the departmental health and safety officer to place a provisional improvement notice (Pin) on the hospital in July last year.

That, by law, required the Southern District Health Board to begin working on rectifying the issues within eight working days, and senior management has been working with clinicians since on possible improvements.

A report to be considered by the board’s hospital advisory committee tomorrow said that although the Pin had been removed following separate meetings between ED staff, the SDHB, and WorkSafe, much more remained to be done.

More staffing, including a proposed third registrar on night shifts, was still to be confirmed and the outcome of an exercise which assessed staffing levels against other emergency departments was unknown.

WorkSafe had also urged management and clinicians to improve communication, implement better systems for reporting and managing risk, and create a position in Dunedin Hospital to specifically manage patient flow.

In the past fortnight the SDHB has been the subject of two highly critical reports by the Health and Disability Commissioner concerning care of patients who later died and who spent part of their time in hospital in an SDHB emergency department.

Both cases were referred to the director of proceedings for possible further legal action.

Emergency department staff are scheduled to make a presentation to the committee tomorrow, which highlights a 19% drop in the department’s performance in the past five years and suggests possible ways to improve it.

In 2015 Dunedin Hospital hit its 90% seen-within-six-hours target 93% of the time, but by last year that had slumped to 75%, ED clinical director Richard Stephenson and charge nurse manager Janet Andrews said.

Patient numbers had remained static at a daily average of 126, but admission rates had increased 31% and patients were sicker, had more complex complaints and needed more staff resources to care for them properly, the clinicians said.

This was affecting ED patients due to an overload of patients, and the whole hospital was being affected by bed block, in part because of delays in admitting patients.

The clinicians also highlighted increased risk to patients at most stages of their journey through the ED system, most notably while being triaged for entry to the department and while waiting to be allocated a bed on a ward.

More nurses and health care assistants were being allocated to each shift and a more efficient bed allocation system being introduced, but an extra registrar, an extra senior medical officer and more administration staff were also needed, the clinicians said.

They also warned that as Covid-19 moved toward becoming ``the new normal’’ that it was vital that the performance of the emergency department improve.


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