Six Hours
Health Minister Tony Ryall will set a maximum patient waiting time limit of 6 hours in hospital emergency department waiting rooms. This seems to me a fairly weak commitment considering that the UK set and met a commitment for a maximum waiting time of 4 hours. I rather suspect that Ryall is not keen to commit the resources needed to reduce waiting times.
- Reducing the number of minor complaints that present to the ED. This is simply not going to happen while after-hours GP care is expensive and ED care is free. Until the differential between after-hours care and ED care is reduced, people will sit and wait – and complain.
- Increasing ED staffing levels. There will be no reduction in waiting times while the emergency departments remain hopelessly understaffed. The dumb thing is that for 10 years we have had well-researched guidelines for optimal staffing levels in the ED – 1 doctor per patient per hour and 1 Nurse FTE per 1000 annual patient throughput. There isn’t a single ED in the country with staffing levels even approaching that.
- More Ward beds. Patients are hanging around in EDs waiting for surgery because there are insufficient ward beds. I have already argued that some of this is due to poor discharge processes. However there has been a very foolish tendency to reduce hospital size when rebuilding and no attempt has been made to increase bed numbers despite the increase in population. This happen in both National and Labour governments, so I am not expecting much change with change of government.
- More theatres, and theatre staff – including surgeons. There is still substantial delay in people getting their urgent surgery (let alone elective surgery). This is the only area of the four I have mentioned where National shows any commitment to resolve the resource issues.
The original triage system set the target for Category 5 (the least urgent) patients as “90% will be seen within two hours”. None of the large emergency departments have ever reached that target and most are falling further away from that every day. Six hours, to me, seems very under-ambitious.
Additional:
DPF also blogs on this over at Kiwiblog. Interesting combination of astute observations and complete cluelessness in the comments. I’ll leave you to decide which is which 
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Nov 25 08 12:39 pm
This is hard because you do not want people going without treatment because they cannot afford it, but you cannot have ED’s clogged with people who are better off taking a codral and going to bed (sleep is very good for healing).
Perhaps providing a service where minor complaints are seen to by a nurse or a medic is the way to go…
What do you think?
(Dont forget, there are also people, like myself, who are the opposite, in thinking that they do not want to waste a doctors time and will only go there if they are on their deathbed, regardless of how much a service costs)
Nov 25 08 12:47 pm
Millsy: Nurse practitioners would be the way to go eventually. However, the current problem is that there is already a gross shortage of nurses, so tying one up dealing to minor ailments is not helpful. In practice, nurse initiated treatment is a common feature of rural hospitals (where the nurse is jack-of-all-trades anyway and the workload is lighter)
Nov 25 08 1:12 pm
I dont have a problem with nurse practitioners…as long as they have more than 3 years training at the local polytech (with a higher level of entrance criteria).
Do you think that DHB’s should take over the role of nursing training again? Or should their be a more intensive level of polytechnic nurse training (4 year degree for example)
Nov 25 08 3:36 pm
Millsy: My feeling is that nurse practitioners need a proper post grad course, rather that a DHB run affair. You really want a rigorously standardized qualification.
Nov 25 08 4:18 pm
I have no doubt about that, I guess what I am saying is that whether such a course would be better run at a polytechnic or a university.
When a medical professional sees to me, I want them to actually know more about what they are doing then they do about the treaty of Waitangi. As someone who leans right-ward (if ever so slightly), you should have such concerns.
Nov 25 08 8:58 pm
Completely OT MacDoc, but what are your thoughts on the new generic substitute for Losec that Pharmac is inflicting us on it? Is it worth paying the extra for the real McCoy?
Seems to be reasonably equivalent. Not had any complaints from patients so far.
Nov 26 08 8:25 am
Why not charge patients a fee if they turn up at hospitals and it is not an accident or emergency?
Nov 26 08 9:33 am
Bodger: The problem with that is the nurse is not trained to diagnose but trained to triage. Thus a child with abdominal pain may have appendicitis (and thus be a legitimate emergency) but still be a triage category 4 (semi-urgent).
This means that the extra fee you are proposing can only be determined by the doctor retrospectively, after making a diagnosis. This would cause all sorts of strains on the doctor-patient relationship once the patients learn the new system. I expect a number of doctors to “up” their diagnosis to make it sound like an emergency. This will undoubtably cause confusion and, possibly, misdiagnosis (imagine presenting with a cold four times in a row and being labelled “bronchitis” each time – four episodes of bronchitis in a row is much more alarming than four colds and will lead to a lot of unnecessary investigation)
I can also guarantee a sudden flurry of complaints. The biggest generator of complaints was the old part charge for ED services – and that was not a retrospective fee.
Nov 27 08 10:02 pm
I am struggling here Doc. Why would a doctor care about the Doctor/patient relationship in a situation where he is unlikely to ever see the patient again? Similarly I suspect that the complaints process will be a huge issue initially, but once the public realise that the free lunch is over, the number of people arriving at hospital with non emergencies will diminish. However I will bow to your better judgement in this regard.
Nov 27 08 10:52 pm
Bodger:
Asking the doctor to determine whether a patient should pay or not can be very destructive even in short-term relationships. I can guarantee that some patients will attempt to argue about their diagnosis (some already do, for different reasons). Some will purposefully beef up their symptoms to be classified “urgent” – leading to unnecessary tests and treatment. I already know of several patients who claim to have chest pain when they clearly don’t, just to get seen faster.
The biggest problem is that most non-urgent problems seem urgent to patients. To be sure, some patients come into the ED with obvious nonsense, but most of them have some sort of valid concern, even if it is not an emergency. For instance, most hot kids are non-urgent (colds, flu and similar viruses), but a very small percentage have sepsis, meningitis etc.If you discourage the non-urgents, it won’t be long before someone does not bring in a really sick kid. Money is always a dangerous barrier in medicine.