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Too many Dunedin Hospital patients receiving treatment in wards not suited to their condition may be a major contributor to longer stays in the emergency department, chief operating officer Vivian Blake said.
She told the Southern District Health board's November meeting she believed if this issue was solved, it would remove 80% of the barriers to improving access for patients from the emergency department.
The hospital's lack of progress towards achieving the Ministry of Health target that 95% of patients should spend no longer than six hours in the emergency department has drawn criticism recently, some of it from senior clinical staff.
While the hospital has a variety of projects planned or in progress designed to address the issue, the latest information on the waiting times for September shows 70.34% of patients met the target time.
Speaking after the meeting, Mrs Blake said the problem she had referred to was known as "medical outliers", patients with medical conditions who were occupying beds meant for surgical patients.
This meant these patients were not receiving treatment from nursing staff who specialised in their conditions, and often this resulted in a longer hospital stay for them, meaning fewer beds were available for new patients.
Mrs Blake said the situation also meant specialists spent more time doing ward rounds because their patients were distributed around various wards.
There was also sometimes "duplication of effort" where tests might be repeated.
"There are a whole lot of reasons outliers are not a good idea."
The latest hospitals' advisory committee report to the board shows that in September the number of bed days medical patients spent in surgical wards was 183, almost 30 days more than last year's figure.
The target number of days was 30.
Mrs Blake said the mix of beds provided in the hospital had not altered to accommodate the changing profile of patients who were living longer, but eventually arriving at the hospital with complex conditions.
The effect of changing the mix of the available beds is one of the scenarios which will be tested in the computer modelling expected to start soon.
The hospital's operations manager, Megan Boivin, said the number of surgical beds the hospital staffed varied between 100 and 129, and less than that at Christmas time.
The number of beds designated and staffed for medical patients was 108.
This did not vary much, apart from Christmas and in times when the hospital was involved in controlling an infection outbreak.
Mrs Blake said 13 hypotheses would be tested, using available data from the hospital, to see what might make a difference to patient stays in the emergency department.
While she believed the hospital did need a short-stay unit or its equivalent, similar to other hospitals, it was important to test this need with the modelling.
In Taranaki, where it had also been assumed there was a need for a short-stay unit, the modelling did not identify that as the best option.
"Given our financial situation, to go in without validation would be very unwise," she told the board.