Hospital and staff under ongoing pressure

A Wairarapa Hospital clinical leader says resourcing pressures meant the emergency department [ED] “effectively closed” for a time earlier this week, although a Te Whatu Ora – Health New Zealand [HNZ] spokesperson has assured the Times-Age that patient care is a top priority for the organisation.

Norman Gray, the clinical head of Wairarapa Hospital ED, said while the doors of the ED had remained open earlier this week, there were no beds in the hospital for patients from the ED to be admitted to.

This put intense pressure on staff and resources within the ED, leading to long waits for new patient arrivals, with some forced to wait outside due to the constraints.

Gray, who is also Wairarapa Hospital’s delegate for the Association of Salaried Medical Specialists, said there did not seem to be an effective organisational response by HNZ to the resourcing and staff shortage problems at the hospital.

Kieran McCann, executive operations leader for HNZ Wairarapa, acknowledged there were workforce and other pressures, but said patient care was key.

“Wairarapa Hospital is not closed. Wairarapa Hospital ED is open 24 hours a day, seven days a week,” McCann told the Times-Age.

“At no stage do we close our doors to walk-in or ambulance patients. EDs are always busy environments. However, there are times when volumes are higher than usual, which can be exacerbated by various factors, including high occupancy across our hospitals, workforce shortages, and staff absences. This is something EDs across the country are experiencing at the moment.

“Our priority is always to ensure that patients are getting the best possible care and we want to reassure people that they will be seen and treated.”

Gray said people in the ED waiting room often have to wait many hours, and even outside the building when the waiting room is full.

He said HNZ is pushing responsibility for the staffing and other problems onto managers who have neither the executive power nor resources to remedy them.

“It all comes down to a lack of space and staff,” he said.

“The ED has about eight beds and an overflow area with four beds and that is pretty much full all the time. When the place is full, the staff have to scramble to accommodate new arrivals,” he said.

Gray thought the HNZ statement is an admission of failure, and an attempt to normalise the current situation.

“In effect, HNZ is admitting the problem. It shouldn’t be like this, and it didn’t use to be like this. The situation is that every day it’s getting harder and harder to admit people from the ED into the hospital. In the old days, you got discharged [from hospital] when you were well. Now you get discharged when you can walk,” Gray said.

The experiences of a recent patient reflect Gray’s observations. Masterton resident Richard Dahlberg was in Wairarapa Hospital for five days in mid-April. He praised the dedication of the hospital staff, who he described as excellent, but said they are overworked.

“The hospital is chocka. People were sitting outside at the ED on the steps it was so full,” he said.

“The staff are run ragged, and it’s just not fair. I don’t know how they put up with it. They work so hard. The staff put themselves at risk every day, I don’t know how they keep such a positive attitude. They all deserve a medal.”

Dahlberg thought the system needs more resourcing.

“It drives me nuts to see how our public health system is underfunded,” he said.

McCann provided further context explaining current ED and hospital pressures, while also praising the hospital staff.

“Like other emergency departments across the motu, the Wairarapa Hospital ED continues to experience growing demand for services from patients with increasing complexities and acuity. At the same time, high demand on services can exacerbate staffing pressures such as annual leave, general illness, and the need to care for dependents. These challenges are not new, and are not isolated to the Wairarapa,” McCann said.

“The amount of time that a person waits in ED – both before and after seeing a doctor – is complex. People coming to ED are assessed upon arrival and prioritised based on their clinical and acuity need, rather than by order of presentation. Our staff work extremely hard to assess, treat, and discharge or admit patients within a reasonable timeframe. High presentations and capacity constraints, however, mean that people assessed as less urgent following triage may wait longer than expected to see a doctor.

“All decisions around patient care are made on a case-by-case basis by experienced clinical staff, with patient safety at the heart of all decisions. Anyone in need of emergency-level care receives it, and people receive support and treatment – such as pain relief and X-ray – while waiting to see a doctor.

“Across the wider Wairarapa Hospital, we are also operating at a high rate of occupancy, which means that patients may wait slightly longer than expected in ED until a bed becomes available on a ward. Occupancy constantly fluctuates – from day to day, or even hour to hour – as patients are admitted and discharged.

“We are indebted to the hard work and dedication of our healthcare kaimahi – both in ED and throughout the hospital – who strive to ensure that patients are cared for and supported,” McCann said.

“We recognise, however, that it can be frustrating for people waiting in ED to be referred on or sent home, and we empathise with anyone who experiences this.”