North Shore Hospital report - New Zealand Doctor

Health and Disability CommissionerSimilarly, but to a lesser extent, staffing and workload issues, and outdated systems,clearly impacted on some of the medical care in these cases. There were delays inmedical review and definitive treatment, and poor co-ordination of care.I find that in relation to the services provided to Mrs B and Mr D on ward 11, and MrsC and Mrs E on ward 10, Waitemata DHB breached Rights 4(1) and 4(3) of the Code.In relation to the communication with, and information provided to, Mrs B and Mr D(and their families) the DHB breached Rights 5(1) and 6(1)(a) of the Code. In relationto the standard of hygiene and lack of basic amenities on ward 10 during Mrs E‘s stay,the DHB breached Rights 1(1), 3 and 4(1) of the Code.IMPROVEMENTSWaitemata DHB accepts that ―a number of its systems did not support North ShoreHospital‘s staff to provide the level of service it would wish to deliver to thecommunity and that the care provided to the five patients was not of an appropriatestandard [and] sincerely regret[s] this‖.Since 2007, many changes have occurred at Waitemata DHB to better support staff,improve systems and processes for the delivery of good quality patient care, andprovide necessary facilities and resources. Many of the changes, such as the boost instaff numbers and beds, and plans for capital expansion, have already beenacknowledged in this report.The DHB has advised that other changes include the following: Acute and emergency care processes will be completely reformed when theLakeview extension opens in 2011. In the meantime, the ED and assessment anddiagnostic functions are being developed as distinct organisational entities withtheir own leadership, but sharing responsibility for the governance of the ECC. AnECC governance committee is proposed. The Clinical Director of EmergencyMedicine has responsibility for all clinical activity within the emergencydepartment function of the ECC. A clinical director is being given explicitresponsibility for the activities of the acute admitting specialties in ECC. A quality improvement programme, ―Whai Manaaki‖, has been introduced in ECCto improve the patient journey. Additionally, three discharge co-ordinators havebeen appointed to make arrangements for patients with complex care needs.Nursing support has been enhanced with additional healthcare assistants recruited. The DHB is evaluating the Primary Care Options programme established in 2004to assist GPs to provide care in the community rather than referring patients toECC. It is also planning to increase the opening hours of selected General Practicesin high needs areas. The need for a formal clinical governance structure across the DHB has beenrecognised and is being progressed.68April 2009