The New Zealand emergency care needs an overhaul as the hospital system is in a crisis. Hospitals are crowded and the patients have to wait in the ambulance or get treatment in the hospital corridors.
Such a situation would turn to a disaster if these hospitals have to respond to a real crisis situation like an earthquake.
On Sunday, ambulances were used as makeshift emergency rooms at North Shore Hospital as the emergency department struggled to cope with an influx of patients. Wellington Hospital staff regularly had to open concertina wall dividers - designed to expand the department for mass casualties in natural disasters - to accommodate more patients.
At 5pm yesterday, Wellington Hospital's emergency department had 41 patients for its 21 cubicles. Seven patients were waiting for ward beds - one of whom had been there for 10 hours - and 15 were waiting to be seen.
A college survey of Australian hospitals, published last week, found that caring for patients who could not be sent to overcrowded wards soaked up about 40 per cent of emergency department workloads. Dr Freeman said New Zealand hospitals had the same problem, though there was no national data. He and colleagues at other emergency departments were considering conducting a similar survey this month.
Dr Freeman said patients were waiting unacceptable lengths of time for emergency department treatment. This was not conducive to good care.
While everyone in hospitals had to be part of the solution, changes had to come from higher management. There is a need for a good flow of patients through the hospital for the emergency care to function properly. District health boards needed to make patient flow and bed management a core focus.
Ministry of Health principal medical adviser David Galler, who is also an intensive care specialist at Middlemore Hospital, said there was no dispute that emergency departments were under a lot of pressure.He agreed the problem needed to be addressed in a holistic manner - saying it should be tackled before the patient even reached the emergency department, by increasing access and use of primary health care services.
Dr Galler said it was likely to recommend the ministry give assistance to district health boards wanting to overhaul patient flows. A new quality improvement committee, established this year, was looking at issues of overcrowding, and was due to make a recommendation to the Health Minister soon.