North Shore Hospital report - New Zealand Doctor

Opinion 07HDC21742Subsequent adviceDr Aradagh reviewed Waitemata DHB‘s response relating to ECC services and provided thefollowing comment:―Under the heading ‗1.1 ECC‘ there is a description of some of the changes being made to theEmergency Care Centre including the appointment of a Clinical Director and newdevelopments to be opened in 2011. These developments are excellent and Waitemata DHBshould be congratulated for them.Under the heading ‗3 Emergency Care Centre‘ and the subheading ‗3.1 Special Features ofNorth Shore Hospital ECC‘ it is stated that I ‗may not have recognised the implications of thefact that North Shore Hospital‘s ECC provides both an ED and an Assessment and DiagnosticUnit (ADU) function for acutely referred patients,‘ then suggests that the ED function ismostly limited to non-referred patients and that my recommendations are only relevant to theED (non-referred) function of the ECC. These comments cause me some disquiet. First, theyare wrong in every respect but worse, they suggest a persisting mindset that contributed to theED Clinical Director being unable to influence how referred patients in the ECC weremanaged. The artificial separation of ‗emergency medicine‘ patients (over which the ClinicalDirector had influence) and ‗non-emergency medicine‘ patients (over which the ClinicalDirector had no influence) was a significant contributor to the problem.‗Streaming‘ referred patients (particularly patients referred to General Medical services) to aseparate unit dedicated to this task is good for patients and is an important part of the solutionto Emergency Department overcrowding. However, during the time relevant to the review(and still) both referred and non referred patients were cared for in the same space by thesame nurses. If referred patients are in this space (and it doesn‘t matter if it is called an ED oran ECC) then they become part of that space‘s workload.‖April 2009 131