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As we hold our breath wondering about the reach of Covid-19 into southern parts of the country this summer, it is not encouraging to hear of the short-staffing of Dunedin Hospital’s intensive care unit (ICU) and the ongoing issues with patient flow.
This week we learned some beds at the ICU and the high dependency unit (HDU) are going unused because there are not enough nurses to staff them. Also, some elective surgery has had to be cancelled to leave ICU and HDU beds available for any acute patients who might turn up.
Then, a fortnight ago , the hospital almost struck gridlock, what is known as "Code Black" when the hospital is full and patients need to be discharged so new patients can enter.
For years there have been a steady stream of projects and initiatives to address the issue of patient flow, but none of them appear to have made much impact. The increasing complexity of presenting patients’ conditions and short-staffing are ongoing issues which contribute to the problem, and neither can be magically changed.
It is understandable board chairman Pete Hodgson expressed some frustration with the recent near Code Black event given the situation, as he said, that there was no Covid-19 in the city, no seasonal flu, no bad weather, no long weekend and no crashes, any of which might put the hospital under pressure.
Southern District Health Board is not alone in having ICU staffing problems, and the Covid-19 pandemic has highlighted the general shortage of nurses.
Last month, the New Zealand Nurses Organisation pointed out that each of the three Auckland DHBs had 300 to 400 vacancies and staff were so stretched patient care was at risk.
Staffing shortages in Southern are not confined to Dunedin Hospital either. Some beds in Southland Hospital’s medical ward had to be closed most days in October because of nursing shortages. Midwifery vacancies were described by SDHB chief executive Chris Fleming as "an extreme risk" in his latest report to the board, with only about half of the positions filled in Dunedin and 17.3% in Southland and registered nurses being required to lend support.
Since the pandemic began there has been concern about the limited number of ICU beds in the country, with our ICU staffed beds per capita considerably lower than those in Australia.
But this was an issue before the pandemic too, something which successive governments have not adequately addressed. It has been reported that in 2018, 17% of planned surgery was cancelled because there were no ICU beds available.
Trying to make sense of the numbers of beds available for seriously ill patients is difficult, and Health Minister Andrew Little’s claims the 289 ICU and HDU beds could be ramped up to 550 under the "surge" scenario and that 1400 surge nurses are being trained, have been challenged.
Mr Little recently announced funding for some new ICU beds at several hospitals, but it will be at least six months before they are ready and there are already questions around staffing them. (In Dunedin, the long-awaited and much-delayed stage 2 of the ICU upgrade is still not open because of issues with the ventilation system.)
The adequacy of plans for surge capacity, where surge nurses with limited extra training, are brought in to help under supervision from an ICU-experienced nurse and patients might be housed in spaces not normally used for intensive care, has been questioned.
Of course, if those surge nurses are required, they will have to come from elsewhere in hospitals.
Everyone will be hoping that high vaccination rates will mean the worst-case Covid-19 scenario for 9000 cases a week in the Southern area, with 40 people in hospital, does not become a reality.
There does not seem to be much stretch left in the SDHB rubber band.