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Emergency doctors urge DHBs, Minister to commit to action

Thursday 27 August 2019

Emergency doctors urge DHBs, Minister to commit to action to address crisis in overcrowding in EDs

The issues of overcrowding and long waiting times for patients at Palmerston North Hospital’s Emergency Department and the devastating stress for staff, as reported in the news, are occurring across New Zealand’s Emergency Departments (ED), says Dr John Bonning, President-Elect of the Australasian College for Emergency Medicine (ACEM).

“Emergency Departments are the barometer of acute access to the health system with more than a million patients accessing EDs around the country each year. It’s the front door, and what we’re seeing is dire straits in many medium to large hospital Emergency Departments.

“It’s absolutely critical that District Health Boards reinforce the importance of the Shorter Stays in Emergency Departments (SSED) initiative to support better outcomes for patients. The key to achieving this is improving access to care for admitted patients.

“We stress that the issue of overcrowding cannot be fixed by the Emergency Department alone. It requires a whole of hospital approach that puts the patient at the centre.

“When capacity issues mean a patient can’t be moved from the ED to an inpatient bed, we have a distressing situation of access block where patients are not admitted to a hospital ward in an appropriately timely fashion.

“Emergency Department staff then have to look after patients who have had their acute issues attended to and have been stabilised, alongside the continuous stream of newly presenting acute patients.

“With this comes a complexity of cases, especially among the very old and the very young, with pressures to make critical medical decisions, alongside managing patient and staff safety. Other issues such as patients affected by alcohol, violence and other abusive situations also arise and threaten people in ED.

“Over the past four years, performance against the SSED target measure has fallen away drastically across the country. Yet, we have compelling evidence that this target measure improves patient outcomes right across the health system.

“When patients are forced to wait eight hours or more for a bed, we will continue to see access block throughout the hospital. It shows up as crowding in the ED, patients on beds or trolleys in corridors, or ambulances ramped outside the ED because beds or space are not available.

“It’s a dire situation for patients, their whānau, as well as staff, to be facing in very busy Emergency Departments with very sick and seriously injured patients.
“For example, in July this year for the first time, Waikato Hospital’s Emergency Department received more than 300 patients in a 24 hour period.

“These patients are invariably seen by emergency doctors soon after arrival and are stabilised, but then they can often wait many hours to be admitted. Sometimes, for example, patients with mental health and addiction issues, can spend over 24 to 48 hours waiting for a definitive mental health assessment and admission from the Emergency Department.

“People presenting to the ED with a mental health crisis suffer the most because they can have very long and inappropriate lengths of stay.”


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