Entry may be limited: ambulance or referral

Another potentially controversial proposal to limit entry to Dunedin Hospital's stretched emergency department is being considered by the Otago District Health Board.

It would restrict access to those arriving by ambulance or referred by their general practitioner.

In a report to go before the board today chief executive Brian Rousseau says the new proposal would have "very clear advantages" over the suggestion of having a GP clinic at the hospital to vet patients.

On-site development would not be required and therefore it could be implemented more quickly, Mr Rousseau said.

For some years the board has been concerned about the numbers attending the emergency department, particularly those with conditions which could be treated elsewhere.

Total numbers have dropped from more than 40,000 in 2002-2003 to 36,976 last financial year (although that figure was about 900 more than the previous year).

The proposal for a GP clinic at the hospital, where patients would pay, and which would deal with those arriving without referral from a GP or in an ambulance was not well received by the public or the Association of Salaried Medical Specialists when promoted in 2006.

It was also considered there could be legal difficulties involved in having an outside-operated GP clinic within a public hospital.

Mr Rousseau said restricting access to those GP-referred or arriving by ambulance was done successfully at Dunstan Hospital and the Taranaki District Health Board had recently introduced a variation of this at Hawera Hospital.

Under the Taranaki proposal patients who did not have urgent conditions were referred back to their GPs.

The information in Mr Rousseau's report on the new suggestion did not cover how the department might deal with patients who did not meet the criteria, whether the department would continue to provide 11.30 pm to 8 am cover for most of the city's GPs (excluding the Mornington Health Centre), and the possibility of extra pressure being put on ambulance services which are not funded to deliver patients to GPs or the Dunedin Urgent Doctors and Accident Centre.

The board will be asked to note his report and that management are exploring the options with a view to developing a recommendation for a board decision as soon as possible.

Mr Rousseau's report says if nothing was done, the increasing pressure in the department would eventually result in clinical safety and physical capacity issues.

This was reinforced by regular reporting from head staff in the emergency department that services were stretched and that the "facility and staffing are already at the limits of safe service delivery".

Allocating more staff to the area was an option he did not recommend.

During the past five years more senior nurses and specialist staff had been working in the department, but the issues remained.

Over that time the number of triage 4 and 5 cases (those patients who should be seen within an hour and two hours respectively) had declined by a total of about 9000, but there had been an increase of about 3000 patients in the triage 2 category ( those who should be seen within 10 minutes).

Mr Rousseau said patients in the triage 2 category would generally be much more "resource-intensive" than those in the 4 and 5 categories.


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