Clinical leader of the "6 Hours - It Matters!" project Mike Hunter cited a case where an elderly man recounted being examined nine times. The man concerned had "an interesting condition", but he was exhausted after the experience.
There were times when questions did have to be asked more than once and examinations repeated, but this was "too much", he said last week.
The hospital is working towards introducing a more generic admission service which involves developing some clear guidelines for use by general practitioners about the referral of patients who need to be in hospital, but do not need acute care.
Mr Hunter said any such system which could eventually refer such patients directly to the relevant ward needed for them to be safe.
In a hospital with many sub-specialtie, where patients best belonged was not always straightforward, and it was important not to lose the benefit of specialty and sub-specialty input.
Mr Hunter and his management counterpart on the project, chief operating officer (Otago) Vivian Blake, said while Dunedin Hospital had come under some criticism for the time it is taking to improve emergency department waiting times, hasty changes were not the answer.
Mr Hunter said while there had been some improvement in the percentage of patients meeting the six-hour stay targets, some of those gains might be down to people paying increased attention to the difficulties, rather than a permanent fix. Whole-of-system improvements would take longer to introduce.
Mrs Blake agreed, saying the hospital did not want to achieve the target for a couple of months and then find it dropping back because sustainable changes had not been introduced.
Changes had to be "systemic and sustainable".
Mr Hunter said the hospital could meet the target by "gaming", moving patients in and out of the department, but that would not improve patient or staff experience.
The board has agreed to extend the contract of the facilitator on the "Putting the Patient First" project designed to improve patients' journeys through Dunedin Hospital services. Allan Cumming had been employed until the end of this year originally, but his contract will run for another year.
Mrs Blake said he was providing much data analysis about what was causing breaches of the six-hour target and then working with people to help them identify what the problems were so they could then find solutions.
Mr Hunter said first impressions of what a problem was often were not backed up when the situation was analysed.
Also, a major problem could mask something happening further "down the chain".
Mr Hunter said he felt there was a growing realisation that "striving towards the target" was not just about pleasing the Minister of Health Tony Ryall or the Government, but about using the target to improve the whole of a patient's journey through the hospital.
