KEY POINTS:
Patients waiting in ambulances for beds and receiving treatment in corridors are two symptoms of a hospital system in crisis, health industry representatives say.
And they say an overall approach to the problem is needed, improving processes from primary care to hospital discharge.
On Sunday, ambulances were used as makeshift emergency rooms at North Shore Hospital as the emergency department struggled to cope with an influx of patients.
A survey by the Australasian College of Emergency Medicine showed levels of access to beds in Australian emergency departments was steadily deteriorating.
Patients were often waiting up to eight hours for a bed, and emergency department staff spent about 40 per cent of their time caring for patients who should have been moved to wards too full to take them.
One of two New Zealand college representatives, Dr Peter Freeman, said the situation was mirrored in New Zealand, where he said many hospitals were operating in crisis mode and would struggle to cope if a major disaster occurred.
Dr Freeman said patients were waiting unacceptable lengths of time for emergency department treatment.
The problem was happening all over the country, and doctors and nurses were being forced to work in environments which were not conducive to good care.
"No patient should be treated in a corridor," he said.
"It is totally unacceptable and yet it is happening all the time."
Dr Freeman said good patient flow through the hospital was vital.
While everyone in hospitals had to be part of the solution, changes had to come from higher management.
Doctors and nurses could work as patients' advocates, raising the issues, but because of the inter-departmental nature of the problem the necessary changes in process had to come from a senior level.
Bed management was typically delegated down to departmental managers, who struggled because it needed an overall approach.
"None of the emergency departments are getting any quieter. If we don't do something, the situation will be a whole lot worse next year."
Ministry of Health principal medical adviser David Galler, who is also an intensive care specialist at Middlemore Hospital, said there was no dispute that emergency departments were under a lot of pressure.
He agreed the problem needed to be addressed in a holistic manner - saying it should be tackled before the patient even reached the emergency department, by increasing access and use of primary health care services.
There was a steadily increasing demand on acute services, and health services had not changed sufficiently to cope with that.
The level of demand for acute services was partly seasonal, and was also affected by the overall health of the population.
The access and use of primary services also had an effect - patients used emergency departments when they could not go to their GP, whether because of cost, distance, or the time of day.
A new quality improvement committee, established this year, was looking at issues of overcrowding, and was due to make a recommendation to the Health Minister soon.
Dr Galler said it was likely to recommend the ministry give assistance to district health boards wanting to overhaul patient flows.
- NZPA
