Bone surgery list at Auckland Hospital still growing, says Twaddle

By REBECCA WALSH, health reporter

Six months after the opening of New Zealand's most high-tech hospital even more patients are waiting too long for bone surgery, a report has found.

Outspoken orthopaedic surgeon Bruce Twaddle incurred the wrath of hospital chiefs last year when he questioned the number of beds and resources in the new Auckland City Hospital and suggested patient care could be compromised.

Last night he revealed the situation was getting worse, not better.

Hospital management have acknowledged there are "legitimate and reasonable concerns" but expect the pressure to ease in June when orthopaedic services around the region are reorganised.

Mr Twaddle, director of orthopaedic trauma, said the latest report, one in a series monitoring surgery delays among five specific types of orthopaedic fractures, showed the workload was increasing.

The orthopaedic ward had 50 beds but regularly had 70 patients a day. That meant 20 people were being cared for in other wards, raising concerns about their orthopaedic care.

Last October 15 per cent of orthopaedic patients were treated in non-orthopaedic wards compared with 30 per cent now.

Mr Twaddle said that although the situation was likely to change in June when North Shore Hospital started taking acute patients, "on the flipside" Auckland would have to take over acute and elective services for the central Auckland region.

"From our point of view, the data that we have used suggests we are struggling to service our present needs and we have real concerns about having the resources to deal with electives when they start in June."

The report found that complication rates were 13 per cent higher than at a similar period last year.

"That's a reflection we are not able to treat people as well as we want and they are suffering more complications and requiring further treatment," said Mr Twaddle.

Between 10 to 34 per cent more people with urgent fractures, such as open fractures, were not being operated on within the recommended clinical guideline of the day of admission.

For less urgent cases, such as ankle fractures, the figures were 40 to 60 per cent worse in most cases.

"We are struggling to keep up with the urgent ones and getting worse at anything that is not that urgent," Mr Twaddle said.

"A significant number of patients are not dealt with in a clinically acceptable and timely fashion."

Mr Twaddle said Auckland City Hospital was a tertiary trauma hospital which meant it dealt with serious cases from around the city. Those patients took the most time and resources and he was concerned that had not been adequately taken into account.

He wanted hospital management to admit there was a problem, "so we can try and get a way to solve it".

In a statement , Auckland City Hospital general manager Dr Nigel Murray said Mr Twaddle and his colleagues had "some legitimate and reasonable concerns", which all parties were keen to resolve.

"In the past six months we have put in an extra $400,000 in staffing resources and five extra theatre sessions, and the big question for us is why this doesn't appear to have made an impact," he said.

Dr Murray said Auckland City Hospital expected a significant easing of pressure when North Shore Hospital began to look after its own acute patients as part of a plan to redistribute elective and acute patients more equitably across the region.

Auckland handles nearly all acute surgery for Auckland City, the North Shore and Waitakere. But he said Auckland was poorly serviced for major joint operations compared with the rest of the country.

"All DHBs in the metro area simply have to get better. It also requires more funding so that the DHBs can do more operations. We're pleased that the Government is presently looking at this," he said.

Mr Twaddle said it was vital more resources were made available. He wanted money for elective surgery ringfenced and run as a separate unit, rather than put into a general theatre or anaesthetic budget.