Emergency departments overwhelmed by patients, not meeting targets

Palmerston North Hospital, where emergency department patients are waiting longer than ever to be admitted or sent home. Photo / File

District Health Boards around the country are struggling more than ever to meet the Ministry of Health's target of getting 95 per cent of patients through emergency departments in six hours.

MidCentral DHB reported just 82 per cent of patients over the six months to the end of June were admitted or discharged within the target time. For the same period last year, it was 89.5 per cent.

MidCentral DHB spokeswoman Lyn Horgan said an increase in the number of people presenting at the Palmerston North Hospital emergency department was partly to blame.

"The predicted presentation rate to any ED is expected to increase by 1 per cent every year; this year there has been a 4 per cent increase for MidCentral."

Renovation work in the hospital had also had an impact, she said.

"The temporary renovation work currently in progress in the ED has had a significant impact upon patient flow. This work has meant that there is limited space in ED, adding to the congestion and the ability to move patients around the department."

Despite attempts by the hospital and primary health to encourage people to go to GPs first, some people were still going to the emergency department when they didn't have to, Horgan said.

At Auckland City Hospital, 12 per cent of patients this year were in ED for more than six hours, as well as one in 10 patients in Northland, Hawke's Bay, Whanganui and Counties-Manukau.

Auckland DHB Chief Medical Officer Margaret Wilsher said population increases and more patients were the problem.

"Over the last six months Auckland City Hospital's adult emergency department saw a high number of presentations overall, and we also experienced surges in presentations where a large number of patients came through our ED doors in short periods of time.

"We are also experiencing challenges relating to a growing and ageing population, meaning that we are seeing an increase in the number of patients who have more complex care requirements."

The result listed for the target in the ADHB's annual report for 2016/17 was 94 per cent. It was 93 per cent in quarter 4 last year.

In Northland, 10 per cent of patients at both Whangarei and Kaitaia emergency departments were waiting more than six hours to be admitted to a ward or discharged during the past six months.

The number has grown as winter set in; 87 per cent of patients got through ED in less than six hours in the six weeks to June 30.

Over the 2016/17 financial year, Northland District Health Board reported 92.7 per cent of patients admitted/discharged in less than six hours.

NDHB spokesman Neil Beney said an increased number of patients was one of the factors affecting the time spent in ED.

"In Whangarei this has resulted in a 5 per cent increase in the number of people coming to ED and a 14 per cent increase in the complexity of [cases] in the medical wards.

"At times we meet the target within the current resources. However, this is outweighed by the days we don't."

Patients are spending longer in Whangarei Hospital's emergency department. Photo / File

Hawke's Bay Hospital achieved the target in 89.7 per cent of cases in the past six months.

DHB spokesman Dr Colin Hutchin said this was largely because of an increase in patients.

"Hawke's Bay Hospital has also seen an increase in patient demand from about 40,000 patients presenting in 2012/13 to 46,000 in 2017/18.

"This not only impacts on the department's ability to see patients within a six-hour time frame target, but reflects a busy hospital working to manage the flow of patients."

The DHBs' achievements in relation to MOH targets were not publicly reported from August 2017 until this month.

Health Minister David Clark said in June new targets were being established.

Clark told the Herald the emergency department target of six hours would be retained at least until any recommendations came back from clinicians who were developing the new measures.

Counties-Manukau DHB reported a result of 88 per cent in June, and 90 per cent over the six months to June.

Spokeswoman Vanessa Thornton said this was simply because of an increase in patient numbers.

"This is due to an increase in demand for ED services which impacts on the flows across the hospital.

"A piece of work is being initiated that will examine the problems and enable solutions."

Counties-Manukau DHB also had a high number of its beds occupied - an average of 98 per cent at 7am.

Whanganui DHB's spokesman blamed complexity and increased volume for its fall in the number of patients being admitted or discharged in the desired time frame.

"We have increased radiology services during unsocial hours to assist with patient flow. This was identified as a pressure point historically.

"We always strive to deliver the best possible service which includes meeting the target."

Whanganui met the 95 per cent target in 2016/17, but fell in the first quarter of 2017/18 to 91.4 per cent.

The MidCentral DHB had been trialling programmes to help patient flow and renovation work to create new triage rooms would help, Horgan said.

Taranaki, Capital & Coast, Wairarapa, Bay of Plenty, Southern and Hutt Valley boards also failed to meet the 95 per cent target. Waikato has not yet responded to an Official Information Act request.