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Hospitals in red: 71 ER patients waiting for beds in Middlemore

All Black avoids court appearance, how builders work around GIB shortages and the government is called out for overspending on the latest New Zealand Herald headlines. Video / NZ Herald

Hospitals have reached “a level of panic” with 71 patients waiting for beds in the Middlemore emergency department overnight and warnings from doctors that delays will lead to deaths.

Top ER doctor John Bonning told the Herald that hospitals across the country were seeing “record delays and record numbers of patients”.

“Middlemore Hospital had its biggest day ever” on Tuesday night, he said.

Emails leaked to the Herald by another doctor showed the South Auckland Emergency Department had seen more than 420 patients for the second night in a row this week, normally they see 300, moving the hospital to the code red, which the doctor said basically meant “a level of panic.”

Bonning said it was time for Health Minister Andrew Little to show leadership and advised him to reintroduce waiting time targets in hospitals.

“A patient who arrives in an emergency department with a 10% blockade, which means that if you have 100 patients and 10 have been there for more than eight hours, they are 10% more likely to die over the next seven days,” Bonning said.

“There is a very real impact for people who are waiting.”

The best ER doctor John Bonning.  Photo / Provided
The best ER doctor John Bonning. Photo / Provided

The unnamed doctor said the minister needed to recognize the country was going through a hospital crisis and that staff needed to be paid better so they wouldn’t have to leave the profession they love.

Little told the Herald as hospitals were under pressure, “like they were every winter,” they were coping.

“A few months ago hospitals were preparing for a flu season that was expected to be bigger than the last two years and for this reason they expected to get planned care, most hospitals were able to do that,” did he declare.

The minister said he had not seen any data showing hospitals were hitting record levels of delays and patient referrals.

“It would be interesting if he (Bonning) provided it, because he’s been known to say things like that without backing it up with data.”

He said he would not reintroduce ER wait time targets as this previously meant DHBs were manipulating the system which meant many patients had a negative experience as they were not allowed in to the emergency room if they had already reached the threshold.

“Previously hospitals were punished if they didn’t meet targets and that just starved them of resources, now we use those metrics to understand what’s going on and then intervene with management resources, for example […] more resources to stop the bed block.”

The doctors’ warnings came after the Herald leaked an email that was sent by Manukau District Health Board management to staff on Wednesday morning saying “the hospital remained red with a full hospital, an emergency department and 71 patients waiting for a bed”.

“Staff for the afternoon and night seem critical […] overnight the hospital was bypassed by North Shore Hospital for a few hours which was very helpful. Waitakere and ADHB were under the same pressure as we were,” the email said.

Health Minister Andrew Little said our hospitals are not at crisis point, but are under significant pressure.  Picture/File
Health Minister Andrew Little said our hospitals are not at crisis point, but are under significant pressure. Picture/File

The doctor who leaked the email asked not to be identified as staff received a ‘stern email from the chief medical officer’ after a previous Herald story about a woman with typhoid fever forced to sleep in his vehicle to the parking lot of Middlemore Hospital due to shortage of beds. But the doctor said the pressure on hospitals was “extremely concerning”.

“I think red is like the panic level basically […] every time you deviate from optimal care in a timely manner, you increase the risk of complications resulting from delays, and that includes patient death,” he said.

The doctor said hospitals operating above capacity also meant doctors seeing patients had to rush and could miss things, “everything about their care slows down”.

“You might not start treatment in time, tests or scans might not be done in time, you might stay in hospital longer, put yourself at risk of infections or other complications, doctors don’t have time to explain anything to the patient or their families,” the doctor said.

“Doctors tour the wards until 7-8pm (from 8am), which is terrifying. The ward tours should be finished before lunch.”

Bonning echoed the anonymous doctor’s comments, adding “the problem isn’t just which patients should see their GP, it’s really sick patients who need to be admitted”.

He said the massive influx was due to a combination of factors.

“Every year the demand increases by 3-4% depending on population growth (without more hospital resources), winter illnesses are worse this year because we have not been exposed to the flu virus for two years, so people are getting sicker, Covid is not the cause but it adds stress, departments need to be reorganized and the workforce is the main issue… we have had nurse resignations across the system and staff illnesses,” Bonning said.

“It’s (the problem) showing up in the emergency services, but it’s system-wide.”

Bonning said those numbers at Middlemore Hospital were repeated across the country.

“I am aware that smaller hospitals are struggling, Wellington, Palmerston North, Dunedin, Southern have gone code black which usually means hospitals have reached crisis point.”

Bonning said: “It’s the worst winter ever and we’re only a few days away, and it’s been a pretty mild winter to be honest.”

Covid isn't the cause, but it's adding to stress, according to the best ER doctor.  Picture/file
Covid isn’t the cause, but it’s adding to stress, according to the best ER doctor. Picture/File

“People wait six, seven, eight hours just to be seen by a doctor in the emergency room. We select the sickest and we triage people, people go to resuscitation rooms etc., but people wait in the hallways .”

Counties Manukau Health acting CEO Dr Pete Watson said Middlemore Hospital was under ‘abnormally high’ pressure for this time of year with both high occupancy and many patient presentations to emergencies.

“Middlemore emergency department presentations last week were 17% higher than last year, and we saw a significant increase in flu and respiratory illnesses,” Watson said.

He said they were expecting a tough winter season and were in the process of recruiting additional manpower and coordinating patients across the region would help them manage the increased demand for their services.

“We are at full capacity and expect this to continue through the winter months. […] Any members of our community who need emergency medical care in the Manukau Counties Health Region will receive it,” Watson said.

Auckland DHB Director of Patient Management Services Alex Pimm said their hospitals were very busy with many people with acute respiratory illnesses.

“While not unexpected in the winter, we have started to see the impact of winter respiratory disease earlier than usual.”

Pimm said adult emergency department presentations each day on average in May compared to April were up 7%.

“Overall, we are also seeing more complex cases come to our emergency services. We recognize that there can sometimes be longer waits than we would like and are aware of the impact this has. about the patients and their whānau.”

Auckland DHB was anticipating a difficult winter which included the postponement of planned procedures when hospitals were very busy to ensure we had sufficient capacity for critically ill patients.

“We never take the decision to postpone scheduled procedures or surgeries lightly,” Pimm said.

The DHBs wanted to encourage everyone to get a flu shot this year to help protect against four different strains of the virus and reduce the need for hospitalization.

Flu shots are free for Maori and Pacific people aged 55 and over, all 65 and over, pregnant women and people with certain underlying health conditions.

Waitematā DHB sent a statement to the Herald saying Waitakere Hospital was busy but expected at this time of year and they had good systems in place to deal with surges.

“Sometimes we have large groups of people presenting to our emergency departments, but the safety of our patients and all staff is paramount. The public can be confident that people in need of hospital care or other health services will always receive the right level of support,” the statement read.

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