KEY POINTS:
South Auckland's newest health leader, fresh from Britain, has a plan to end the problem of many patients having to wait hours for treatment at busy emergency departments.
Geraint Martin, chief executive of the Counties Manukau District Health Board since December 4, came to New Zealand with a pedigree in senior management at the National Health Service.
He said yesterday that the NHS had ended long waits for patients with minor or moderate injuries or illness by introducing a system called "see-and-treat".
A self-professed specialist in change management, Mr Geraint, who is 44, said he had started talks with Middlemore Hospital clinicians and "wants changes in place before the winter", but did not want to simply impose a "wheeze-bang idea" from overseas.
He defined the essential elements of see-and-treat as:
* Dividing emergency departments into two work streams: one for patients with the most urgent needs, such as victims of serious car crashes, and the other for those with less serious conditions.
* Creating systems to ensure the necessary x-rays and other tests were arranged soon after a patient's arrival.
* Establishing "strong connections" to hospital wards, so patients who needed to be admitted flowed through smoothly.
Mr Geraint did not know if Middlemore's ED would need more staff to implement such a system, but said that in Britain it had reduced waiting times dramatically "for no extra money".
The clinical director of Auckland City Hospital's emergency department, Dr Tim Parke, who is from Britain, said EDs there had a higher proportion of patients with minor to moderate conditions.
"When you've got that volume of patients with minor or non-life-threatening things, clearly it makes sense to develop systems to target resources at them."
See-and-treat meant different things to different people, Dr Parke said. At first, it involved emergency medicine consultant doctors treating the most minor conditions to get these patients treated quickly.
It worked, but took the most experienced staff away from where their skills might be needed most, in resuscitation or treating the critically injured.
"See-and-treat has come to mean ... a system where minor [conditions] were streamed differently and dealt with largely by experienced, skilled nursing staff."
