The ED saw 270 patients on Saturday and 263 on Sunday. Normally it deals with 240 to 245 on those days.
"There are 106 people in the ED now," Dr Thornton said at mid-afternoon yesterday. "That's a very heavy load for this time of day. We try to keep it less than 90."
The hospital had also been hit by an increase in staff absence due to sickness, "which just increases the stress in terms of staffing for increased workloads".
Middlemore's ED has been a strong performer on the Government's target to discharge, admit or transfer 95 per cent of patients within six hours.
But Dr Thornton said it missed the target on Sunday because of "bed block" - the unavailability of beds on wards to send ED patients to because of high occupancy.
She said the cold weather had contributed to the increased number of patients. It was associated with an increase in the number of patients with respiratory infections, including influenza.
National surveillance by the Institute of Environmental Science and Research indicates the flu rate is only slightly above the wintertime "baseline". The latest ESR estimate, for the week to August 7, put the rate at little more than one-third of the rate at this time last year, and one-sixth of that in July 2010 when the swine flu pandemic peaked.
The Waitemata District Health Board had the highest flu rate in the week ending August 7.
Waitemata's chief medical officer, Dr Andrew Brant, said yesterday the number of patients coming to the North Shore and Waitakere Hospital EDs had increased during winter, to a combined daily total that regularly exceeded 200. "Although busy, we are coping well with the volumes, thanks to significant investments in staffing and new facilities ..."
The DHB met the six-hour ED target for the week to Sunday.
Hospital occupancy yesterday was at 90 per cent for North Shore, and 85 per cent for Waitakere.
At Auckland DHB hospitals yesterday, occupancy ranged between 82 and 92 per cent and the children's and adults' EDs met or exceeded the six-hour target over the weekend.