Wellington emergency department posing ‘significant risk to patient safety’, doctors warn

Overcrowding and inadequate staffing at Wellington’s emergency department is “dangerous” and posing an “ongoing significant risk” to patient safety, a group of local junior doctors has warned.

The risk is particularly high during overnight shifts, the resident medical officers wrote in the July 13 letter, which was anonymously provided to the Herald.

Capital & Coast District Health Board officials have received the letter and are working to address the issues, chief medical officer John Tait told the Herald in a statement.

“High demand in ED is not a Wellington-specific issue and is being seen around the country,” Tait said. “Like all DHBs, we continually look at how we can best manage demand and ensure that patients and staff remain safe.”

A Wellington Hospital emergency department doctor, who spoke to the Herald on the condition of anonymity, described the heartbreak in seeing patients wait more than 24 hours before being shifted from ED to a ward.

“It is soul-destroying working a shift,” he said.

“It feels like you’re firefighting, you’re running from one disaster to the next.

“It’s now at the point that we’re running out of corridor space to put people.”

The doctor said extra space for patients was sometimes available, but could not be opened because there was not adequate staffing levels to do so.

His concerns were echoed by the resident doctors’ letter which said prolonged wait times had become commonplace at Te Pae Tiaki/Wellington Emergency Department, with waits often exceeding six hours.

“The department is almost always overloaded,” the letter stated. “Patients are having to be nursed in corridors.”

The crowded waiting room “poses another substantial risk” and was “particularly unfair to our nursing colleagues at triage”, the group said.

The doctors also criticised the DHB for its handling of unexpected absences, which they said has led to recent instances in which “staffing has fallen below what we would consider safe”.

It will only get worse, the doctors predicted, as staff followed Covid-19 guidelines and stayed home for symptoms that might not have resulted in sick days in the past.

The DHB acknowledged it has been under strain in recent months.

“Te Pae Tiaki Wellington ED has been seeing high presentation numbers with increasing acuity and is full for more than two-thirds of each day,” Tait said.

“This has been occurring since March, and a marked recent increase in patients with respiratory illnesses presenting and being admitted to the hospital has increased demand during July.”

The demand had resulted in extra pressure on staff, he said.

“Our ongoing work to manage demand and keep our staff safe continues and we are in the process of implementing a number of measures, including a tested and monitored procedure to ensure safe clinical staffing during periods of exceptional demand, to ensure ED has access to Security Orderly support during these periods, and we are reviewing ED’s visitor policy to prevent overcrowding by visitors and support people and to mitigate overcrowding if prevention is unsuccessful.”

Tait said health officials are also working to improve patient flow across hospitals, bed configuration and better use of spaces.

“We will undertake additional investment in 2021/22, and are also investing in services in the community — enabling people to remain well and access the services they need closer to home thereby reducing their need for hospital-level care.”

The Wellington ED doctor said Tait’s response was “predictable” and simply another rendition of what was communicated to staff on a regular basis.

The letter has surfaced as the nursing union continues contract negotiations with the Government, with safe staffing levels having been a major sticking point.

“Members have been clear from the beginning that their safety at work and the safety of their patients is a priority, and that is where they most deserve certainty,” lead advocate David Wait said earlier.

“Better pay will make nursing more attractive, but it is not clear how the DHBs will be held accountable if they do not provide safe staffing. Nurses don’t want more vague promises that the problem will be fixed in the future — which is what we have received once again.”

Health Minister Andrew Little acknowledged yesterday that work has been slow implementing Care Capacity Demand Management, a scheme announced three years ago to solve safe staffing concerns. But he also criticised the nurses’ vote to reject the latest offer, setting the stage for more strikes later this month and in September.

“The health system is already under pressure from a global pandemic and the winter flu season,” Little said, adding that the strikes would be “hugely disruptive to public health services, and to the people who need them”.

In the Wellington doctors’ letter, written before the latest nurse negotiations breakdown, they lamented the recent departure of experienced and senior nursing staff.

“We want to be able to offer to help/support our nursing colleagues and we fully support them in their efforts to raise safety concerns and improve care for our patients,” they said.

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