14 Aug 2015

111! Emergency depts call for help

7:16 am on 14 August 2015

Leaders in emergency medicine say they are facing record numbers of patient presentations and need more staff and funding to cope.

Wellington Hospital.

Wellington Hospital. Photo: RNZ / Diego Opatowski

Clinical leaders in emergency medicine at Auckland's busy Middlemore Hospital, and at Waikato, Wellington and Christchurch hospitals, says they expect to be busier in winter, but the growth in patients is now year round.

Board members at Wellington Hospital will hear from their chief executive today, that on one day in June, the department had the biggest number of patients presenting ever, at 173.

The department's clinical leader, Andre Cromhout, said that climbed to 180 in July, and so far this month the department has been seeing about 170 people a day.

Dr Cromhout said January was also busy, with 164 presentations a day on average, and 166 on average each day in February.

He wants a review of the demands facing hospital emergency departments, saying it made planning difficult.

"Every year the number of presentations, the number of people we deal with, and also the degree or acuity of the sickness increases. So every year we have to re-adapt, even though we do quite an extensive amount of pre-planning."

He said they cope most days, "but if this continues there will be a point where we're over-saturated and cannot continue."

Dr Cromhout urged patients to see their family doctor early on so there was less chance of a deterioration needing emergency attention.

In Waikato, chair of the New Zealand Faculty of the Australasian College for Emergency Medicine, emergency department head John Bonning, said July this year was more than 6 percent busier than July 2014.

He said many patients also had complex needs, and the emergency department had to manage, even if the rest of the hospital was full and it was hard to move patients into a bed on a ward. And he said it's not just a problem in winter these days.

Dr Bonning said a major effort to immunise people against flu this winter has reduced some sickness, but the pressures remained high for staff.

"They're struggling to do what they feel is a good job for their patients. Small things might get neglected, and you do what you absolutely have to do... occasionally people get everything they need, but not necessarily everything they want."

He said extra staff and extra money were both needed. "We need more specialists, we need more nurses, clinical nurse specialists we work with that see patients independently. But even healthcare assistants, radiographers. We need more acute geriatric care, for example."

He said any extra money would have to come from better spending decisions elsewhere in health, possibly including Pharmac "pulling back" on expensive drugs.

The head of the Christchurch Hospital Emergency Department, Scott Pearson, said busy days happened more frequently than they used to, and the ongoing high pressure was hard on staff.

He said it must increase the risk of mistakes being made. "I think you'll find around the country that emergency departments are starting to squeak, and they are all displaying evidence of increased risk and increased demand."

Dr Pearson says there needs to be "a deeper look at the demand on emergency departments. What is driving it and how we are going to resource that."

Busiest emergency dept in Australasia

Middlemore Hospital in south Auckland is home to the busiest emergency department in Australasia. Clinical head Vanessa Thornton said it saw 365 patients a day, many with complex needs.

"We always have a bit of a peak over winter ... but this year it has already been sustained over the past five weeks."

Dr Thornton said eventually delivering more care in the community - the Government's plan - should ease pressures on hospitals.

But, "it's a slow process to get to there so there's sort of an intermediate phase where hopefully these things will kick in in the community to start to be more proactive and improve care in the community."

She said mistakes occurred, but were very infrequent given the many hundreds who presented at emergency departments daily. She also said Middlemore Hospital's emergency department was in the process of recruiting staff.

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