Code Red – when care capacity was considered “critically reduced” – had jumped from 120% to more than 135%.
One emergency doctor, whom RNZ has agreed not to name, said it was “just moving the goal posts”.
“Code Red requires 135% overload. That means patients backing up into the waiting room and corridors, and ambulances backed up as well.”
The new ED alert system used colour-coded steps to trigger action to ease pressure, usually caused by a shortage of hospital beds or lack of staff.
Responses could include bringing in extra staff, discharging patients from ED or hospital wards, or even postponing elective procedures, when a hospital was completely gridlocked.
The Resident Doctors Association, which represents trainee specialists and junior doctors, said the new system appeared to have been rolled out “almost under the radar”.
National secretary Deborah Powell likened it to “applying wallpaper to a great hole”.
“I suspect this is just them trying to sanitise news. It makes no difference to occupancy, it’s just the optics of it. And it doesn’t help front-line staff.
“The fundamental problem [in ED] is insufficient beds and insufficient staff, which leads to high occupancy and reduced turnaround of patients – or worse, pushing patients out too early which, results in ‘bounce backs’.
“Pushing the limits out so we record less escalation is not diminishing the occupancy rates – it is simply hiding them a little more.”
The new system could even add to the pressure in ED because conditions had to be worse before there was a response, she said.
“As you climb through the escalation pathway, things kick into gear to try to free the system up.
“I don’t know if it is particularly effective because we’re just stuck. We don’t have enough beds and we don’t have enough staff.”
The Australasian College for Emergency Medicine did not have an official position on the new system.
However, its New Zealand chair, Dr Kate Allan, agreed EDs needed more resources, however that happened.
“We know that there are workforce issues at some of our rural hospitals, but all the emergency departments with which I’m in contact are under pressure with long wait-times and overcrowding.”
A senior consultant – who wished to remain anonymous – said getting national consistency could be helpful.
“It doesn’t matter whether it’s colour-coded green, pink or purple, as long as it recognises when there’s a threat to care and it triggers the necessary response. That’s the important thing.”
That doctor was hopeful that a new acute care advisory group within Health NZ would bring positive change.
A Te Whatu Ora spokesperson said the agency was in the process of improving the “sometimes disparate” data reporting systems used by former district health boards to make them nationally consistent.
The status of a hospital and ED was dynamic and its status could “change back and forth in minutes over the course of a 24-hour period”, she said.
“Hospitals are experienced at managing these changes and have processes in place to support this.
“Providing care to the local community remains our priority and to be clear, we never turn people away from EDs in any hospital across New Zealand when they need our care.”
Health NZ director of health targets Duncan Bliss said all districts were now using the national framework.
“The triggers for escalation are determined nationally and trigger levels set locally, ensuring hospitals can apply their own expertise and decision making.
“The aim is to ensure the best possible care for our patients, and best use of our dedicated kaimahi.”
New ED At A Glance system
- Green: under 88% capacity
- Yellow (moderate reduced care capacity): over 89%
- Amber (significantly reduced care capacity): over 108%
- Red (critically reduced care capacity): over 135% (or over 114% between 11pm and 7am)
Progressive actions include:
- Reviewing ED patients and moving patients who are stable and waiting for diagnostic results or to be discharged to waiting room or transit lounges.
- Offering telehealth or other referrals to less urgent patients
- Sending unstable patients to critical care beds
- Delaying non-emergency procedures
- Calling in staff
- Delaying ambulance handovers
- Hospital-wide escalation response – free up ward beds.
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