Figures released under the Official Information Act showed patients going through the ED system between January and June this year averaged about 3500 a month, while processing patients in under six hours peaked at 64.4% in February and crashed to a low of 58.1% in June.
The Otago Daily Times requested the figures off the back of a flood of complaints from readers about the state of the ED.
Stories included waiting 17 hours to be seen, patients being treated in the hallway and generally "Third World" conditions.
ED former head Dr John Chambers said the figures did not surprise him, and were indicative of some facets in the department that were not working properly.
"The performance is in the 60% range, which is more than 10% worse than the national average. This is well below the milestone for evidence of change."
Performance in any month or day did not correlate with numbers of patients going through the system, Dr Chambers said.
"The month with the lowest number presenting [June] had the worst performance.
"Performance more likely correlates with complexity of illness, age and morbidity.
"These factors may apply hospital-wide in any given month, with complex cases occupying inpatient beds and blocking access for ED patients awaiting a bed upstairs."
Many of the issues were long-standing, Dr Chambers said.
"Staffing may be an issue due to unfilled vacancies and staff sickness at times meaning inpatient beds are effectively closed.
"Dunedin Hospital has plenty of beds, but without nurses they cannot function: our most wintery months, July and August, are unlikely to be any better."
Ministry responses always focused on increasing business and winter pressures, but the system was performing poorly year round, he said.
"Many millions are being spent on wishful thinking about alternatives to ED, but it all comes down to staffing and resources within the ED and acute hospital wards with managerial pressure and support day-on-day, seven-days-a-week to improve throughput."
The government has a target of 95% of patients processed within six hours by 2030, but Dr Chambers felt the target was so far out as to be meaningless.
"It could actively hold progress back if [nationally] marginal improvements are seen, and very modest milestones reached."
Dunedin Labour MP Rachel Brooking said the government could choose to ease pressure on hospitals by helping people with the cost of a doctor’s visit and letting hospitals hire the staff they needed.
"[Prime Minister Christopher] Luxon’s hiring freeze, underfunding and rising health costs are all piling pressure on to our emergency departments.
"Cutting and delaying hospital builds will only make this problem worse in the future.
"Health cuts have made it harder and more expensive to see a doctor or nurse."
Health Minister Simeon Brown stressed the majority of patients across the country, including at Dunedin Hospital, were admitted, discharged or transferred from emergency departments within the government’s six-hour target.
"While progress has been made, there is more work to do to reach the goal of 95% of patients meeting the target by 2030, and strengthening our workforce is a key part of that effort.
"To support this, I recently announced that Health New Zealand [Te Whatu Ora] is funding an additional $20 million for ED staffing across the country. This investment will enable faster care for patients and relieve pressure on hospitals such as Dunedin."
Health New Zealand attempted to put a positive spin on the matter, saying it was committed to achieving the shorter stays in ED target by 2030.
"Our focus remains on improving patient flow through emergency departments, hospital wards and back into the community.
"We are working closely with community providers to ensure patients can be safely cared for after discharge, helping to prevent unnecessary ED visits."
Reducing pressure on emergency departments was a key priority, a Health New Zealand spokeswoman said.
"Recent government initiatives include expanded 24/7 online doctor and urgent care services, as well as a strengthened primary care workforce to retain and grow community doctors and nurses.
"By caring for more people in the community, we can help keep EDs available for those who truly need hospital-level care."
