North Shore Hospital report - New Zealand Doctor

Opinion 07HDC21742―Over the winter months comparing 2005 and 2006 there was a 32% increase inthe number of patients in Emergency Care Centre at midnight. There is anincreasing length of stay in the ECC at NSH waiting for an inpatient bed.Although there are 11% more attendances there are 30% more patients in thedepartment at any time of day compared to last year. These are increasingsymptoms of bed block.‖In March 2007, the General Manager for Adult Services presented a business case forprogramme budgeting and marginal analysis (PBMA) 50 to the Board for approval.The Board Chair stated that the Board recognised the importance of this and urgentlyresponded by allocating $4.861 million for additional beds and $2.048 million for theexpansion of the HDU. This funded: 20 additional beds at Waitakere Hospital (opened in July 2008) investment in key ECC staffing roles implementation of a Bed Capacity Management programme a feasibility study for a 40-bed Acute Assessment Unit at North Shore Hospital projects to minimise inappropriate use of inpatient beds six additional HDU beds.On 11 July 2007, the Board convened a special meeting to urgently consider a capitalrequest for additional beds at North Shore Hospital, to resolve the worseningovercrowding in the ECC. Managers were asked to prepare and present business casesas quickly as possible. They were instructed to be ―bold and innovative‖ inconsidering short-term solutions and to bring an options paper to the Board thefollowing week for endorsement.On 17 July, the General Manager for Adult Services‘ options paper, ―Strategies formanaging a shortage of acute inpatient beds at NSH‖, was presented to the Board. Thepaper acknowledged the commitments already made by the Board to improveservices, but indicated that ―things were not adequate‖ to deal with the significantacute inpatient demand, which was clearly resulting in ongoing delays in ECC. Thepaper recommended a number of options, including a proposal that a 50-bed shortstayunit be commissioned, and a business case be developed for a tower block atNorth Shore Hospital for use from 2011.When the Board met again on 29 August 2007, the Chief Executive and FinanceOfficer provided an update on progress of the proposed measures. The Board stressedthe importance of management having specific plans in place to deal with the regularand predictable winter pressures on ECC and medical beds. Although there were someplans in place, the Board recognised that further planning was needed to managepressures over the next two to three years, prior to the completion of the Lakeviewextension (the Acute Assessment Unit). The Board indicated that this ―might require astronger focus on clinical planning and work design, which might require someexternal expertise‖.50PBMA is a process that helps decision-makers maximise the impact of healthcare resources on thehealth needs of a local population.April 2009 33