Overcrowding killing patients

A shortage of hospital beds is killing as many people every year as road accidents, emergency doctors say.

They are calling for a 15% increase in the number of beds to help solve the problem, following research that indicates hundreds die every year.

The Australasian College for Emergency Medicine is holding a conference in Melbourne on Friday to combat the crisis of overcrowding in hospital emergency departments, caused mainly by having too few inpatient beds.

An international review of studies on EDs, done for the college, finds that overcrowding and blocked access increases the risk of death 10 days later by 34%.

The review, by the University of New South Wales, calculates the excess death toll in Australia is similar to the annual road toll of about 1500.

Dr Tim Parke, clinical director of Auckland City Hospital's adults' emergency department, said yesterday the number of deaths in New Zealand probably matched its road toll too.

Typically, more than 400 people die on New Zealand roads each year.

A spokeswoman for Health Minister David Cunliffe said last night his ministry would look into the college's concerns and advise him.

" . . . this Government has undertaken the largest hospital building [including seven new hospitals] campaign in the country's history and made primary healthcare more accessible."

The ideal occupancy of inpatient wards is 85%, but many New Zealand hospitals often run at more than 90%, especially in winter. Waikato Hospital reached 109% last Monday.

The college says the core problem is lack of beds and a 15% increase is needed in Australia and New Zealand.

"Nationally, we would hope occupancy is 85%." Dr Parke said, "And if that means more beds, then so be it."

In the Auckland region, a 15% increase would add 315 beds to the current stock of about 2100.

New Zealand's public hospital beds have declined from 2.48 per 1000 people in 1988 to 1.56 in 2006 - largely through reduced lengths of stay and increased efficiencies like the sharp increase in day surgery.

When Auckland City Hospital opened in 2003, amalgamating four hospitals, doctors criticised the 7% reduction in beds. At about 1000 currently, it is still slightly below the 1062 before amalgamation.

Following its winter from hell last year, the Waitemata District Health Board will have added 68 beds by the end of this month and is planning for at least 300 more by 2013.

When hospitals are overcrowded, ED patients can wait many hours and, in one North Shore Hospital case reported last year by the The New Zealand Herald, four days, before being admitted to a ward or given surgery.

Overcrowded emergency departments lead to worse outcomes because of factors like delays in starting antibiotics for pneumonia, delayed heart-attack care and patients simply being overlooked because they are on a trolley in a corridor.

Auckland City Hospital no longer permits patients to wait in the ED's corridors because of this risk and the rest of the hospital agrees to help by putting patients in areas like day rooms.

The international review dismisses the idea that GP patients contribute to ED overcrowding and says: " . . . persistence of this belief is detrimental to finding real solutions".

It adds that the evidence is mixed on whether siting GP clinics in or beside hospitals reduces ED overcrowding.


Packed Hospitals

- The problem
• Overloaded hospital emergency departments.
• Estimated to be causing 400 preventable deaths a year.
• Overcrowded hospitals mean patients have to wait in the emergency department for an inpatient bed.

- The solution
• The Australasian College for Emergency Medicine wants a 15% transtasman increase in hospital bed numbers.

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