KEY POINTS:
Hospitals are leaving patients in ambulances to cope with an overcrowded emergency department, according to a new report which recommends banning the practice.
"[The practice] is not endorsed by any group in the health sector," says the report, written by health officials and doctors for Health Minister Tony Ryall.
"... it slows time to treatment for the patient, leaves the patient in the care of unregistered practitioners - paramedics - for longer than appropriate, and has been shown to have negative health outcomes."
Mr Ryall yesterday released the report, which states New Zealand's EDs face problems of overcrowding, long patient stays, treatment of patients in corridors, and long waits for assessment and treatment.
The minister has previously stated support for firm waiting time targets but without stating how many hours. He is now calling for public and health-sector submissions on the report over the next fortnight and expects the Cabinet will make decisions within weeks.
He said he would not impose financial penalties on district health boards that failed to meet the targets as that could disadvantage patients, but he would encourage boards to write the targets into their chief executives' performance contracts.
Emergency medicine specialists estimate that leaving patients waiting too long in their departments - of which the main cause is overcrowded hospital wards - leads to around 400 deaths a year in New Zealand.
The Australasian College of Emergency Medicine last year called for a 15 per cent increase in hospital bed numbers on both sides of the Tasman to alleviate the problem.
Hospital overcrowding regularly hits the headlines. Some patients at North Shore Hospital, which has subsequently added beds, have had to wait days in the emergency department for admission to a ward, bringing criticism from the Health and Disability Commissioner last year.
The report to Mr Ryall records significant waiting time improvements at British emergency departments after the National Health Service in 2000 imposed a "radical" target of four hours from arrival to admission, transfer or discharge.
This is now achieved for more than 97 per cent of patients, although there was some "gaming" by leaving patients in ambulances.
The report says New Zealand's model of emergency medicine takes more time and the four-hour target may have shifted some clinical work from EDs to further inside British hospital targets.
A New Zealand ministry snapshot last February found that up to 20 per cent of patients spent more than eight hours in the emergency department. At large emergency departments, the average is 5 hours.
RECOMMENDATIONS
* A health target of a maximum of six hours for ED patients, from arrival to ward admission, transfer or discharge.
* A ban on leaving patients in ED corridors.
* A requirement for hospitals to write formal overcrowding plans that shift patients into areas like whanau rooms on wards, rather than leaving the problem mainly to EDs.
