Emergency departments not designed to deal with the number of patients they now see are sagging under the weight of serious over-occupancy
A third of patients who visited Wellington Hospital's emergency department this year spent at least some time waiting in a bed in the corridors, new data shows.
At some stage during virtually every single day since the start of the year, the ED has reached or surpassed 90 percent capacity, Te Whatu Ora Wellington's interim lead on hospital and specialist services Jamie Duncan said.
"As with other emergency departments across the motu, Te Pae Tiaki Wellington ED continues to regularly experience high volumes of presentations from patients with increasingly complex conditions and acuity," he said.
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The department averages 175 patients a day, with some days exceeding 200.
A briefing to Health Minister Ayesha Verrall from the start of the year, released to Newsroom under the Official Information Act, shows one in four people presenting to the ED spent some time in the corridor in the final three months of 2022. Duncan provided updated figures for 2023 so far, which show the situation has worsened.
"The time that an ED patient waits to see a doctor is complex. People coming to ED are assessed on arrival and prioritised by clinical and acuity need, not by order of presentation. This means some people may wait longer than expected to see a doctor. High occupancy across the hospital also means patients may sometimes wait longer in ED for a bed to become available on a ward," he said.
"Due to demand and capacity constraints, some may wait in beds in corridors in the ED clinical space – around one in three patients over the past six months – for a matter of minutes or hours, depending on fluctuating occupancy both in ED and our wards."
In addition, just 44 to 51 percent of ED patients were admitted, transferred or discharged within six hours – falling well short of the 95 percent target.
Duncan said all patients receive support and treatment, like pain relief or x-rays, while waiting to see a doctor.
The briefing said the department wasn't designed to deal with the numbers of patients it now sees. Presentations have increased by 60 percent since the facility was commissioned in 2001.
"Capacity has not increased in line with demand," officials wrote.
Surges in demand can be addressed through a range of measures, Duncan said.
"During periods of particularly high demand and occupancy we have the ability to call in additional staff, open additional clinical areas, utilise telehealth services, and referring people to their GP if they do not have urgent needs. We also have an existing arrangement that may see us refer some patients to the Wellington Accident & Urgent Medical Centre where clinically-appropriate and cover the cost of the consultation. All decisions are made by clinicians with patient safety as the key priority."
Verrall told Newsroom the pressures facing emergency departments are not new and are consistent with annual winter surges.
"I visit the front line regularly and I know sorting ED wait times is one of Te Whatu Ora’s top priority. To ease ED pressures this Government is undertaking a range of measures. Some of these include training 100 more GPs every year, better primary health services in local communities, and rolling out telehealth and digital tools to make it easier for people to reach out for help," she said.
"The winter plan announced earlier this year included 24 initiatives to enable people to get the health care they needed closer to home, such as the minor ailments scheme, hospital in the home services, increased access to radiology services in the community and community rapid response tools to lessen hospital admissions for our most vulnerable people."
Kate Allan, the chair of the New Zealand branch of the Australasian College of Emergency Medicine, said patients have never had to wait so long for healthcare.
"The issues in the health system that lead to these pressures are inherently complex and have built up over decades. It will take time to determine the impacts of the Government’s health reforms to address these pressures," she said.
Immediate measures like workforce planning and targeted investment to increase bed capacity could go some way to alleviating over-occupancy she said.
