Hospital filled to capacity

Dr Nigel Millar."It sounds a bit drastic, but we were quite concerned." Photo: ODT files

An at-capacity Dunedin Hospital issued an emergency plea as it struggled to keep up with demand yesterday.

After 18 patients were stuck in the emergency department (ED) early yesterday waiting for an inpatient bed when only three were available, the Southern District Health Board (SDHB) issued a "code black" from the hospital’s new and untested escalation plan.

It asked the public to go to their GPs or use the after-hours service and keep the ED for emergencies only.

SDHB chief medical officer Nigel Millar said during the critical period yesterday the longest wait in ED for an inpatient bed had been 12 hours.

Patients were waiting up to seven hours to be seen within ED, Dr Millar said.

The hospital’s intensive care unit was also at capacity and there was a high volume of patients awaiting surgery for urgent operations during the code black.

The alert level at code black was the highest among a colour-coded system progressing from green, to yellow, orange, red and finally black that was being trialled at present.

Code black was reserved for "extremely unusual circumstances".

It was downgraded to yellow at 6pm.

"It sounds a bit drastic, but we were quite concerned," he said.

Over the long weekend not as many patients were discharged as the hospital had forecast, and there was a high volume of patients awaiting urgent surgery, he said.

When it was as full as it was now, there was increased demand on all parts of the hospital, from patients awaiting urgent surgery or patients requiring urgent diagnostic tests, to staff supporting discharges.

Hiring more nurses to move patients through different stages at the hospital would help ease the pressure, but that was only a parallel issue and one where some progress had already been made, he said.

An all-of-hospital approach to remove existing delays in the flow of patients through the hospital was required.

An emergency operations team with dedicated time to help the flow of patients through the hospital put in place during the code black helped frontline staff improve the situation yesterday, Dr Millar said.

Early this month, health board chairman Pete Hodgson said the task force in place to deal with the hospital’s patient flow issues "cannot fail".

During yesterday’s code black, he would not comment on whether the task force in charge of finding a solution was failing, nor on criticisms of the SDHB.

"I really don’t mind the accountability, but I am not about to make grand and sweeping conclusions in the middle of a pretty serious event with many people waiting in ED right now for a bed," he said.

Issuing a code black allowed a consistent and co-ordinated response, SDHB chief executive Chris Fleming said.

The task force of senior staff he created at the start of this year came after so-called bed block was blamed for ballooning surgery wait lists at the hospital.

Mr Fleming said at the time long-stay patients were a particular focus.

A recent check had found of 271 beds in Dunedin Hospital, 85 (31%) were being used by people who had stayed five nights or longer.

Of those, 45 patients had stayed more than 10 nights at the hospital, and 18 people had stayed more than 20 nights, Mr Fleming said.

hamish.maclean@odt.co.nz