September 18, 2008

More to It Than More Bed Space

There were claims last week overcrowding and delays in hospital emergency departments were as big a killers as road crashes in New Zealand. For the record, 422 died as a result of road smashes in 2007.

The claim came from the Australasian College for Emergency Medicine which, at a convention in Melbourne, called for a 15 per cent boost to the number of emergency beds in New Zealand. It made the same call for Australia, claiming the death toll there was 1500 a year and argued the major cause of "access block" to emergency departments was the fact that more people were going to the counter and there were not enough beds for them. The assessment almost coincided with Labour releasing National's health policy. National is proposing to throw $100 million across the board at health, according to a leaked document. It has also indicated it will not attempt another restructure of the health system.

More beds and more money will help, but as some health boards can testify after extending their own emergency departments, they are not cure-alls. More beds will inevitably lead to more demand for them - that is human nature. The answer on both sides of the Tasman is found in how health care providers communicate, how quickly patients are assessed and how the beds which are available are used.

The view of Australian Federal Health Minister Nicola Roxon is that her Government has to "get smarter" to reduce the number of deaths arising from overcrowding in public hospitals. She told the convention her Government knew their hospitals were under enormous strain, but that a one-off cash injection would not fix the issue. Her view that "we have to get smarter and that does require a big re- think of the system as a whole" is shared by administrators on this side of the ditch. At Christchurch Hospital, general manager Mark Leggett says they are full only two or three times a year and "to say that simply increasing the number of beds is the answer to improving patient flow and outcomes would be to seriously underestimate the complexity of the issues involved". Prime Minister Helen Clark had earlier dismissed the college's figures, saying they were plucked out of mid-air and extrapolated from an Australian study.

A document this week provided some of the lateral thinking required. The draft New Zealand Ambulance Strategy suggests more people could be treated at home rather than be dropped off at an emergency centre. Wellington Free Ambulance said extending the role of the paramedic could reduce the number of people it takes to emergency rooms by 28,000 a year.

In the Waikato vast sums are being spent on upgrades at Hamilton's Waikato Hospital and at Thames, but there is no expectation it alone will cure overcrowding. The upgrade at Waikato Hospital's emergency department will more than double its capacity in some areas, but if those beds are not used efficiently, the health board knows it will simply have problems on a grander scale.

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