North Shore Hospital report - New Zealand Doctor

Health and Disability CommissionerOpinionGeneral commentsThe common contributions to the cases subject to this investigation are ECC overcrowdingand a generally overwhelmed acute care system at North Shore Hospital.As more patients, who should be in ward beds, accumulate in the ECC the less care each canbe afforded, so patient dissatisfaction and clinical risk compound. Good medical and nursingstaff (and I have no doubt that the staff at North Shore Hospital are good) will prioritise theirinterventions so that patient safety is preserved as best it can be. Non-essential aspects ofmedical and nursing care may be sacrificed simply to keep patients safe. Patients, and theirrelatives, who experience delays, crowding, and less attention than they would like, will bedissatisfied. The complaints under investigation reflect this.As patients accumulate it is the nursing resource that is stretched most. Eventually the safetyof patients is compromised as the patient load exceeds the capacity to observe them. At NorthShore Hospital (and at many others) the ECC bears the burden of patient dissatisfaction andincreased risk despite the significant contribution from things outside the ECC‘s authority(inefficient admission processes, lack of admitting rights, and difficult access to ward bedsbecause of high hospital occupancy rates, etc).It is my opinion that the concerns raised about the standard of care delivered by ECC havelegitimacy, but it is an injustice that the staff of ECC must defend themselves when theyappear to have worked well and hard against overwhelming odds. It must be particularlyfrustrating for ECC staff that they find themselves under this scrutiny after submissions tothose who might have been able to improve matters were not embraced.Specific AdviceIn relation to this discussion, and after examination of the information provided to me, I haveformed the following opinions:1. [Ms A] (and her partner) received discharge care below an acceptable standard.2. All of the patients under investigation received delays in care — less interaction thanthey (or the family) would have liked, and perceived deficiencies in communication.The delays are documented. The deficiencies in care and communication remainperceptions and are debated in the information provided. I suspect there is legitimacyin these perceptions, but I cannot identify any definite episodes of substandard care inthis respect.3. The substandard discharge care provided to [Ms A], the delays in care, and any realor perceived deficiencies in care or communication, do not appear to be due tofailings of any of the clinical staff, but rather to do with the context in which theywere working.4. An overwhelmed acute care service (specifically ECC overcrowding and anoverwhelmed acute General Medicine service) was the principal reason for thedeficiencies observed.5. Waitemata DHB had been made aware that acute care services at North ShoreHospital were overwhelmed and suggestions for increased capacity had not beenaccepted. It is my opinion that the failure to respond to the state of acute care at NorthShore Hospital, including the dismissal of specific requests for increased capacity,represents a failure to ensure services of an adequate standard.6. Concerns about overwhelmed acute care services in the hospitals of New Zealand,and ED overcrowding specifically, have been brought to the attention of the Ministry128April 2009