KEY POINTS:
South Auckland's most seriously ill patients are being triaged quicker than ever before as a nurse-efficiency scheme revolutionises Middlemore Hospital's emergency department.
The department is expected to meet all triage benchmarks in the next few weeks, for the first time in its history.
The result has come from a New Zealand-first staff efficiency drive implemented at the hospital early this year and featured in the Herald in March.
The scheme is based on a management technique developed by the world's biggest carmaker, Japanese giant Toyota.
Initially confined to a handful of wards, the scheme's dramatic success has spread as it is systematically rolled out hospital-wide.
The emergency department has been involved for less than five weeks, but has already reported staggering improvements.
Each department nurse now has an extra hour and a half, per shift, of spare time previously spent on inefficient tasks such as searching for supplies and equipment.
The extra time is now being spent seeing more patients, and spending more time at patients' bedsides.
The department's goal of having patients either admitted or discharged within six hours has leapt from a 35 per cent success rate a few months ago to higher than 70 per cent. That rate is still climbing, and is expected to meet the department's goal of 90 per cent.
Triage times are coming down rapidly, and two rooms previously used for storage have now been emptied and freed for other uses.
In the next week patients at the department will see a further improvement, as a series of cards, invented by the nurses, begin to appear on their cubicles.
The cards will tell the patients which doctor is attached to them, what foods they are allowed to eat, when they are next to be seen and when they are expected to be discharged.
The department's clinical head, Dr Bhavani Peddini, said the improvements were all geared towards increasing nurses' contact with patients.
"The patients want to be seen. They want to be treated promptly. So we've decreased waste and increased patient time, and we're processing more patients, faster."
General manager for quality improvement Allan Cumming said the areas of the hospital to benefit from the scheme had reported on average about one hour, per nurse, per shift, being freed up.
The scheme's $250,000 cost was forecast to save the hospital $1 million in its first year, although that was "a very conservative" figure, he said.
Its success had been so extensive, departments previously not earmarked for the scheme were now lining up to implement it, he said.
A national pilot of the programme at nine of the country's health boards is also set to start on July 1, with Counties Manukau District Health Board being the trial leader.
Mr Cumming admitted the improvements seemed simple. But previously nurses had been solely focused on caring for patients, he said. They had not been given the time, encouragement or authority to look at their environment and change it to make it more efficient.
"We're saying, look, you're the best people to look after that environment. And we're going to let you. We're not going to interfere. It's being nurse driven, not management driven. It's about management stepping back."
