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Those changes, aimed at easing lengthy waiting times for patients, could result in some services relocating within the building.
While any redevelopment work would not happen immediately, work was needed so the emergency department (ED) could function until the opening of the new Dunedin Hospital, Mr Fleming said.
``The facility needs work.
``We have plans for that, but we need to find viable, sustainable solutions first ... It needs to be a facility to last the next eight to 10 years, and it is very clear that our ED in its current configuration will not meet that.
``We are trying to identify viable solutions, within a constrained space . . . and I personally want this to happen as quickly as it can.''
Measures already taken included adding extra beds in winter and freeing up acute areas for initial assessment units.
More would be done to ensure the SDHB hit the Ministry of Health target of 95% of patients being admitted, discharged or transferred from an emergency department within six hours, Mr Fleming said.
That target was not been met by the SDHB in any of the four quarters of 2017-18.
Solving issues with the department might take some time, but there were two substantial projects the SDHB was undertaking to relieve pressure in emergency, Mr Fleming said: implementing its primary and community health strategy, and investing in ``valuing patient time''.
``A number of patients are waiting in beds because we haven't streamlined our resourcing and our care planning and our activity, so we are investing in those two initiatives - both of them should help ED, but they are not an investment in ED per se.''
That would mean the SDHB spending money tagged for deficit reduction, but which was of greater use being spent on the long-term health of the community, Mr Fleming said.
``We also have an absolute intention of redeveloping the existing day surgical unit to expand ED and relocate the internal medical assessment unit, but we have still to find a sustainable solution to rehousing them.''
Measures planned for next quarter included implementing a new national programme designed to streamline care of cardiac patients, work with inpatient teams to improve flow through the department, and trying to improve patient flow throughout the hospital, as it was believed practices elsewhere in the complex were contributing to issues in emergency.