North Shore Hospital report - New Zealand Doctor

Health and Disability Commissionergeneral practitioners and A & M Clinics. Such an influx is unlikely to go away (especially inthe winter months) and efforts must be made to reduce the non-emergency admissions to theECC.This can be done in two ways:i) Enhancing primary care, and increasing numbers of patients that can be handled in thecommunity. I am not sure of what WDHB is doing in respect to primary care options, butthis has been successful at CMDHB and ADHB and should be encouraged if not alreadyin place.ii)Demand Splitting: This involves taking non-emergency (Triage 3–5) patients referred toinpatient services out of ED, and bypassing them into an admission ward. As far as I amaware a plan for an 80+ Admission Ward had been approved by the Board and will bebuilt, hopefully in the near future. This will alleviate the pressure on the ECC but will notnecessarily negate the need to build more capacity in the major hospital in the future.As far as I am aware, the Emergency Department at WDHB is the only department in NewZealand that does not have absolute leadership of the Emergency Department facility. Likeinpatient departments it is just a user of the system. This has left an enormous leadershipvacuum, and a strong recommendation would be to place the ECC under EmergencyDepartment leadership immediately, 103 with the inpatient services continuing to utilise theservices as before. This may bring about a considerable improvement in many facets ofemergency care performance.It is interesting to note that as long as four years ago the clinical leaders were constantlyoutlining to the Board the need for more beds to cope with the predicted increase in patientworkloads. This concern seems to have been ignored up until recently, perhaps motivated bysome unfavourable clinical events.This delay in forward planning has left the clinical staff in an intolerable situation, hoping tocope as best they can in a facility not capable of sustaining such volumes. Medical andnursing staff continue to work under extreme pressure.Of all aspects of performance that has most impinged on ability to provide appropriatestandards of care the Board should perhaps be held the most accountable.103 Dr Henley clarified that when he refers to leadership in ECC, he means someone who has overallcontrol of how things are managed in the department; he does not mean that the medicalcare/management of the medical patients should be carried out by ED specialists.142April 2009