Emergency physician Peter Jones tells Michael Morrah how preventing access block will reduce ED wait times. Video / Ben Dickens
Auckland Hospital emergency physician Peter Jones says the lack of beds for patients at New Zealand’s hospitals is the worst it’s been.
He supports the Government’s ED targets but says hospitals are “nowhere near” meeting the goal of 95% of patients being admitted or discharged within six hours.
A man told the Herald he waited for 12 hours at Middlemore ED before getting a bed on a ward.
An Auckland man told the Herald he waited at Middlemore Hospital’s emergency department (ED) with an irregular heartbeat for almost 12 hours before being admitted to a bed on a ward.
A senior emergency physician has warned bed block, which causes waits like this in the country’s hospitals, is the “worst it’s ever been” and is causing EDs to become crowded and unsafe.
Peter Jones works at Auckland City Hospital’s emergency department and also advises Health New Zealand on emergency department wait time targets.
Emergency departments become overwhelmed when hospitals experience what’s known as access block – when there are not enough beds on wards for patients which leads to extended waits in ED cubicles and overwhelmed waiting rooms.
“I think it’s probably the worst it’s ever been, but this is not a sudden thing. This has been creeping up for the last 10 years.”
Peter Jones is an emergency medicine physician and an adviser to Health New Zealand. Photo / Ben Dickens
Jones, who did PhD research on emergency department overcrowding, said access block is the “creator of a busy ED” and increases the chance of death. However, he emphasised the risk of dying because of delayed care was small.
“We know that there is potential preventable mortality if we get flow through our hospital system better.”
The Government has introduced various health targets, including a plan aimed at ensuring 95% of patients are either admitted to a ward, discharged, or transferred to another hospital within six hours of arriving at an ED.
Jones is supportive of ED targets but is at odds with figures pushed by the Government, saying research shows admitting 80% of patients within six hours is what’s “achievable”.
“I don’t think we need to achieve it [95% within six hours], personally, for the people that are admitted to a hospital. There’s evidence showing that if we can get to about 80%, that’s probably the inflection point.”
Health Minister Shane Reti acknowledged the 95% target was “ambitious”.
“They will be hard to achieve but they need to be done, and we need to get started on them after years of neglect at the expense of pet projects by the previous Government,” he said.
Jones said New Zealand is “nowhere near” meeting the targets and what’s required is a concerted effort to improve the processing of acute patients who make up 85% of all patients at hospitals. Acute patients are those who unexpectedly need hospital care. For example, someone who breaks their ankle or has a heart attack.
He said in the past decade hospitals “lost sight of the ball” when it came to targets – an issue exacerbated by the Covid-19 pandemic. He believes there is merit to having targets even if there isn’t any additional money to get the results.
He says a “heavy-handed, top-down” approach from management won’t work and efficiencies need to be driven by clinicians.
Auckland Hospital has been running at a high occupancy rate for several months. Photo / Ben Dickens
Jones believes it’ll take up to a year before waiting times at EDs start to improve and even then, it won’t be a “seismic shift”.
“None of this is a quick fix. I am hoping over the next six to 12 months we’ll start to see an upswing in the curve in terms of our ability to complete the patients' journey in the ED within six hours.”
Official information provides an insight into how consistently overrun New Zealand’s main hospitals, and staff, have become.
At North Shore Hospital in October this year, 100% of shifts surveyed were worked when the hospital had an occupancy rate of more than 90%.
Staff at Palmerston North, Rotorua and Hawke’s Bay hospitals were also significantly under pressure during the same period, with all hospitals in the high 90% range.
Wellington Hospital operated at the same high capacity for 86% of the time and 68% of shifts worked at Middlemore Hospital in October were when the hospital had an occupancy rate of more than 90%.
‘Really shocking’ 12-hour ED wait
A man who visited Middlemore Hospital in October says he waited 12 hours before being admitted to a bed on a ward. Photo / Ben Dickens.
An Auckland man told by his doctor to go to Middlemore Hospital’s ED because he had an irregular heartbeat said he waited almost 12 hours before being admitted to a bed on a ward.
The 68-year-old, who asked not to be named, went into atrial fibrillation – a condition which often causes a rapid or irregular heart rate – and told the Herald he was appalled by the wait when he arrived at Middlemore’s ED in early October.
“The nurse told me that there were patients waiting there [in the waiting room] from last night. I was taken aback by that comment. How could patients be waiting there from last night?”
He said he was told it was because of a lack of beds.
“I arrived there shortly after 12.30pm and then I got a bed around 12.30am. It’s really shocking. Surely, they could improve quite a lot. I told them that I hadn’t eaten all day and was really, really tired. But because there were no beds, they said they couldn’t do much.”
Tony Knott died at 82 years old while waiting to receive care at Middlemore Hospital's emergency department. Photo / Cameron Pitney
Prior to arriving at the ED, Knott waited 4.5 hours to be transferred from North Shore Hospital to Middlemore Hospital by ambulance. Coroner Amelia Steel said the delays were “relevant to the circumstances” of his death.
The man who went into atrial fibrillation and spent hours waiting at Middlemore’s ED said he didn’t think much had changed since Knott’s death.
“I understand that Tony’s death happened three years ago but the situation at Middlemore Hospital hasn’t improved at all. I want to back up the sentiments of Tony’s family.”
He said it was obvious how busy the hospital was once he got a bed.
“I saw patients in the corridor in the ward. I was waiting with my wife. There were people in chairs, and people coming in as new admissions. It was full.”
He was subsequently called by a manager at Middlemore who apologised.
Reti told the Herald the man’s experience at Middlemore’s ED is the “exact opposite” of what is expected.
“We have to continue to work on the basics to make sure we support staff, so they in turn can support the patients who need them.”
‘Very busy’ at Middlemore’s ED
Counties Manukau Health group director of operations Dr Vanessa Thornton, photographed in 2011. Photo / NZME
Middlemore Hospital emergency physician Vanessa Thornton said waiting 12 hours for a bed is not acceptable but stressed it becomes challenging for ED staff during a surge when lots of patients arrive at once.
“We try to focus on the sickest patients. Because we’re an emergency department, life-and-limb-threatening situations are our main core business which can result in longer wait times for those who are less urgent.”
She likened the ED targets as an “outcome measure” for the entire health system.
She said since Covid-19, people are less “dismissive” of illness and more inclined to seek healthcare, which has contributed to the system being overwhelmed.
Patients are seen in EDs based on their triage category which indicates a patient’s clinical urgency. A category one patient with an immediately life-threatening condition needs to be seen immediately, and those who arrive with an imminent life-threatening situation, classified as category two, should be seen within 10 minutes.
Asked whether EDs were meeting triage times, Jones told the Herald, “No is the short answer”. For immediately life-threatening situations, EDs did “really well”, but that wasn’t always the case for other categories, he said.
Thornton agreed saying “it can be difficult” to meet the needs of category two patients within the 10-minute guideline.
The emergency department at Middlemore Hospital. Photo / Ben Dickens
She said Middlemore’s ED team was “actively working” to improve wait times and were currently admitting or discharging 69% of patients within the six-hour target.
“We get daily updates on that to ensure that we try to move people through as quickly as possible and all the staff are committed to that, but it’s challenging for them.”
She hoped an extra ward set up to deal with high capacity during winter would remain open through summer.
Stranded in hospital for ‘weeks or months’
"You can’t just send someone who has complex needs to live on their own if they are not able to manage their activities of daily living.”
Jones said there were up to 30 different factors that can contribute to access block, ranging from the less obvious such as cleaning of beds on wards so they can be used by a new patient, to the more complex like high-needs older patients who can in some cases end up stranded in hospital.
The latter is an issue Jones said needs attention, noting that in some cases patients who can no longer live independently, and without family support, can end up waiting on a hospital ward for weeks or months before being discharged to a care facility.
“That is a problem. This can be weeks or months [in hospital] at the extreme. You can’t just send someone who has complex needs to live on their own if they are not able to manage their activities of daily living.”
Aged Care Association chief executive Tracey Martin says the country will be 12,000 residential care beds short over the next eight years. Photo: RNZ / Nate McKinnon
Aged Care Association chief executive Tracey Martin told the Herald the organisation was “unfortunately, not surprised” by Jones' concerns.
She said it was a “very frustrating” issue, and one she felt the Government had failed to engage on.
Martin said she’d offered to design a service and funding model to address issues with residential care in New Zealand but felt blocked by Associate Health Minister Casey Costello.
“We have, on a number of occasions, requested that Associate Minister Costello chair a Ministerial Taskforce with members of the continuum of care provision for older persons, such as home care, residential care and palliative care. Minister Costello has declined.”
Martin said the country will be 12,000 residential care beds short over the next eight years.
Costello told the Herald there are two reviews under way into the aged care sector which are investigating how to improve the system.
One involves considering revamped funding models for the sector and she expected options on this to be available “soon”.
Both reviews involved “extensive” engagement with the aged care sector and the public, she said.
Michael Morrah is a senior investigative reporter/team leader at the Herald. He won the best coverage of a major news event at the 2024 Voyager NZ Media Awards and has twice been named Reporter of the Year. He has been a broadcast journalist for 20 years and joined the Herald’s video team in July 2024.
