That was the grim picture presented to the Southern District Health Board hospitals' advisory committee meeting yesterday by orthopaedic clinical leader David Gwynne-Jones in a presentation on access to the acute theatre.
Failure to do anything about the situation could mean significant clinical risk, he told the meeting.
If the hospital could not "sort out acutes" it did not "really deserve to call yourself a hospital".
While the hospital did well with the most urgent cases, those who should receive their operations within two hours, the situation for less urgent categories was a different story.
Only half of those who should wait no longer than eight hours for operations, which would include such conditions as appendicitis and fractures where the bone had pierced the skin, could get in to surgery in that time. Patients in that category made up about a third of all acute patients.
"Our acute patients often get poor service, being starved and delayed."
For those with hip factures, often "old ladies", the average wait was 42 hours, contrary to best practice which said they should be "done as soon as possible, definitely within 24 hours". The longer such patients were in bed the sicker they got.
The average wait for all acute operations was 26 hours, and in orthopaedics it was 34 hours.
Some patients might be required to fast two or three days in a row and then be told "at six o'clock" the theatre was too busy.
While the hospital has eight main operating theatres and two day surgery theatres (one of which he described as a broom cupboard), only one is designated as an acute theatre, even though about half of the surgery done at the hospital is classed as acute.
When the acute list "gets to crisis point", then elective surgery was cancelled.
Acute work was often done by unsupervised registrars out of hours, he told the meeting.
Mr Gwynne-Jones estimated an extra 1000 bed days were wasted a year by orthopaedic patients waiting for surgery, with more than 500 bed days in other specialties.
It was estimated that 30 to 35 extra hours of acute operating time a week was needed.
There had been no increase in acute theatre resources over the past 20 years, he said.
Reducing elective surgery was not an option as often surgery classed as elective, such as hip replacements, was urgent involving patients "crawling in on two crutches in pain". The hospital was "grossly under-providing electives" as well, but had no scope to increase them.
He suggested a second acute theatre on weekdays between 8am and 4pm, and doing evening and weekend lists. This would involve an extra consultant.
Mr Gwynne-Jones said the hospital was unusual in that it ran a single nursing shift from 8am to 4.30pm rather than two shifts, one finishing at 3.30pm and one at 5.30pm. Making the finishing time later could increase throughput by a third.
Nurse director Sharon Jones, part of the presentation team, said nurses were happy to do shift work but they were working to their full rostered hours now so there was not the flexibility.
Asked by board chairman Joe Butterfield what the constraint was to making improvements, both Mr Gwynne-Jones and Ms Jones said it was money.
Long term it was suggested Dunedin needed three more main operating theatres and four day surgery theatres of adequate size and standard.
A review of theatre capacity, both acute and elective, across the region was also needed.
Chief operating officer (Otago) Vivian Blake said the issues being raised were signalling that the hospital, after years of resource constraints, was getting to the point of no return.
Next month, the committee would receive the report of the group looking at how orthopaedic patients moved through the hospital and giving options for improvements.
SURGERY DEFINITIONS:
Acute surgery
• Urgent emergency surgery such as fractures, Caesareans.
• The time from assessment to theatre varies according to level of urgency.
• Times range from 2 hours to 48 hours.
Elective surgery
• Surgery where the surgery can take place more than seven days after initial assessment.
• Such as hip replacement or cancer surgery.
