Bid to ease Christchurch Hospital workload

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Some ambulance patients are being treated by nurses and others redirected to GPs as health managers try to stem skyrocketing attendances at Christchurch Hospital's emergency department (ED).

Patient numbers at the department have exceeded 7000 a month three times this financial year – an average of more than 225 a day.

They are the highest monthly totals the department has recorded. Total numbers are 5 per cent up on the previous year.

Ninety per cent of patients leave the department within six hours, compared with a Government target of 95 per cent.

Initiatives to reduce ED numbers include a telephone triage service and an ambulance treatment and referral project to direct non-urgent cases away from the department.

An alternative low-cost clinic is being considered as part of the Canterbury District Health Board's facilities plan.

ED specialist Scott Pearson said the rise in patient numbers was "unsustainable".

The flow-on to other areas of the hospital was a problem, with some patients waiting hours for a bed in a general medical or cardiology ward, he said.

"We are acutely aware of this and we know we can't just keep adding doctors and nurses and in another year have the same issue," Pearson said.

"We have got to look at whether there are certain patient groups that if they had services in the community, could be managed in the community safely."

Cost was a barrier for some people using community services. A subsidy system was being investigated, and a report was due before the board by April 17, Pearson said.

St John Ambulance district operations manager Tony Dowell said St John was using nurses from its acute demand co-ordination service to respond to low-priority calls in Christchurch.

The nurses assessed patients and provided treatment or referral to a hospital or primary care clinic.

Since the trial started on February 5, nurses had attended 32 incidents, of which 62 per cent were managed in the community rather than taken to the ED. Examples included people with migraines or blocked catheters.

St John had also started using ambulance crews to assess patients and refer them to the acute co-ordination service, rather than take them to hospital, he said.

As at February 11, 35 patients had been referred to the service and all were managed in the community, Dowell said.

The triage phone service already operates in rural areas, with patients assessed by a nurse on whether they should stay at home or go to an after-hours clinic or the ED. It is now being introduced across Canterbury.

Selecting patients

Visits to Timaru Hospital's emergency department have fallen 19 per cent since a scheme was introduced to send non-emergency patients elsewhere.

For the past four months, people arriving at the department have been assessed by a triage nurse at reception and, if they are deemed non-emergency, directed to a GP or after-hours service.

Last August, 1639 people attended the department, compared with 1323 last month.

More than 100 people were turned away in the scheme's first month, November, and 105 last month.

The South Canterbury District Health Board has also used a telephone triage system similar to that being introduced across Canterbury.

A board spokeswoman said people being redirected included those with sprains, minor cuts and colds.

Emergency medicine consultant Dr Joe Harris said the project meant less pressure on staff.

Anyone who insisted on being seen was allowed to stay, but they could have a significant wait, and the board worked with patients who said they could not afford a GP. No children were redirected, he said.

- © Fairfax NZ News