North Shore Hospital report - New Zealand Doctor

Health and Disability Commissionerwould mean that patients waiting in ECC for these tests could have decisions madeabout their care more quickly and be moved on or discharged. Throughput would alsobe improved if they could get hospital occupancy below 90%. However, there is asense of ―business case inertia‖ at North Shore Hospital.The ECC Charge Nurse Manager stated that the discharge process starts too late andis very slow. The organisation knows, in general terms, the busiest days and times andwhen patients are due to be sent home. If these days and times were identified andplanned for in advance, using predictive models, the discharge process would be moreproactive and efficient.The ECC Unit Manager advised that the relationship between ECC and the wards iscritical, especially when there is an urgent need for beds. It is unsatisfactory that thisrelationship is frequently ―personality dependent‖.ECC staffingThe Acting Clinical Director believes that more staff are needed in ECC until theprocesses are fixed. In December 2007, he presented a case to management for morestaff, but was told there was no money for further staff and she was to findefficiencies. 53The ECC Charge Nurse Manager noted that there have been a number of submissionsover the years for more staff and more beds in ECC, but there was no response until2007 when an increase in nursing hours of 11.6 FTE was allocated. In her view, thiswas the first time that the Board really acknowledged staff shortages. 54 It has beenimpossible to recruit enough nurses to fill this allocation. Negative publicity about theproblems at the hospital has made recruitment more difficult.An ECC registered nurse explained that nursing performance is limited by staffinglevels. When the department is overcrowded, the nurses become task focused. Thereis limited opportunity for an in-depth overview of patients and no time to read theclinical notes. Team Nursing is ―fine‖ if the workload is reasonable, but the modelfails when there are too many patients and not enough nurses. In these circumstances,it is impossible to know the patients well enough to cover for other nurses, and unsafe.The ECC registered nurse said it is also ―awful‖ for patients to constantly havedifferent nurses caring for them.The ECC registered nurse advised that the Monitoring Zone of ECC has only eightbeds with monitoring equipment for patients who are acutely unwell. They try to keepone or two spaces free in case other emergencies come in. Sending a patient throughto the Acute Zone, when stabilised, frees up a bed. However, there are occasions53 WDHB responded, ―[The Acting Clinical Director] submitted a proposal to the then [GeneralManager of Adult Health Services] in December 2007, for possible inclusion in the Adult HealthServices‘ bid for funding through Waitemata‘s PBMA process. It was agreed that [the Acting ClinicalDirector‘s] proposal did not meet the criteria for funding under the PBMA as it sought investment ininfrastructure. Funding for additional staff was instead to be considered as part of the general budgetingprocess for Adult Health Services. As a result [his] submission was not put to the Board.‖54 WDHB stated that the ECC Charge Nurse Manager‘s impression that there have been no staffingincreases in ECC does not tally with the clear increases in staffing since 2005.36April 2009