'Patients first' the mantra of ED service

The Ministry of Health is publishing DHB national league tables widely. This week, health reporter Martin Johnston is delving into how the boards perform in six target areas, starting with emergency departments

When Auckland Hospital's new emergency department opened in 2003, its clinical director, Peter Freeman, promised to quit if patients were ever left waiting in corridors to be admitted to a ward.

"Unfortunately, about 18 months later there was a busy day, systems failed and we had to have patients in the corridor," Dr Freeman, the vice-president of the Australasian College of Emergency Medicine, recalled yesterday.

He quit and is now clinical director of Wellington Hospital's ED.

But his dramatic gesture has strengthened the stand of his Auckland successor, Tim Parke, against leaving patients in corridors and the concept is now embedded in the hospital's culture.

And it underlies, although is not written into, the Government's new health target on emergency departments - that 95 per cent of patients be admitted to a ward, discharged or transferred within six hours. It is also widely accepted in New Zealand emergency medicine, although some EDs still reluctantly employ the practice.

Counties Manukau District Health Board is top of the seven northern DHBs for performance on the target for July to September, the first quarter under the Government's new, slimmed-down health targets. It ranked ninth nationally of the 21 DHBs, achieving six hours for 89 per cent of patients, which was highest for the DHBs with big hospitals.

Counties has subsequently achieved the target, capping off more than a year's work throughout Middlemore Hospital to improve the flow of patients.

Waikato and Waitemata, however, took the two last places respectively in the national rankings.

Waitemata's chief operating officer, Graham Dyer, said the key was to have a well-staffed ED, enough inpatient beds and streamlined processes for managing patients.

"Our new Lakeview development at North Shore Hospital - already funded, under construction and due for completion in 2011 - includes a completely redesigned emergency department and separate 50-bed assessment and diagnostic unit which will help address these issues and the increasing demands caused by our growing population," he said.

Auckland City Hospital, too, wants to increase bed numbers - by around 300 - but other blocks that have been identified nationally include the delays in gaining approval each time a patient moves between departments, and the tendency for specialists not to do ward rounds at weekends, which can delay the discharge of some patients.

It is expected to take up to two years for all public hospitals to meet the target.

The importance of fixing whole-of-hospital "gridlock" was highlighted by college research last year that indicated that the consequential ED blockages lead to around 400 deaths a year in New Zealand.

They are attributed to factors such as delays in starting antibiotics for pneumonia, delayed heart-attack care and patients on trolleys in corridors simply being overlooked. This followed the terrible overcrowding in 2007 at North Shore Hospital.

Emergency specialists got the Health Ministry's ear while the National Party, which had campaigned on reducing ED delays, was on the way to the Beehive. Backed by a taskforce of clinicians and officials, Health Minister Tony Ryall implemented the new ED target in May.