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Elderly Most Likely to Have Long ED Stays November 15, 2010 New Zealand
Dr. John Chambers / Photo: Otago Daily
Times Elderly
patients are the most likely to be having long stays in "Anyone who
thinks that the patients lying around the corridor of the ED for hours are
young drunks or others there as a result of their risky lifestyle is
ill-informed," he said. Dr Chambers yesterday
said he had undertaken analysis of patient figures because he suspected
the hospital was failing the elderly. His figures for the
three months to the end of October showed nearly 61% of the 281 eldest
patients, those aged between 90 and 99, were having stays beyond the
target of six hours. Generally, the older
patients were, the higher the chance they had of not being treated and
discharged or transferred to a ward within the target time. While in some ways
this was logical as elderly patients were more complex and it could take a
long time to sort out whether they should be admitted or sent home, the
figures were still quite shocking, he said. Most of the elderly he
referred to would be people who had become acutely ill or had fallen over
"and frequently both". If patients had
complex needs which took time to assess then they should be accommodated
in places with "proper beds and toilets", not left on beds in
corridors. Elderly people would
be coming to the emergency department in greater numbers in the future and
they deserved a timely service just as much as younger folk, he said. In terms of age
groups, the highest proportion of people who turned up over the three
months to the end of October were in the 20- to 29-year-old group (3414),
but only 13.9% of them had stays longer than six hours, compared with 52%
of the 1298 80 to 89-year-olds. Under the Ministry of
Health targets the ED stay for 95% of all patients is six hours at most,
but in recent months about 70% have met this time. Dr Chambers has
recently spoken out about the lack of progress towards the target, and his
concern the hospital will not meet it without a short stay unit or an
assessment and planning unit. He said last week he
was pleased registered nurses in the department had added their support to
his recently published views and those of Dr Tim Kerruish, who led the
project to introduce "lean thinking" methods in 2008. A letter signed by 40
ED nurses and two doctors, sent to the Otago Daily Times, said the
department had made many changes to improve the patient's journey, but it
was now a challenge for the rest of the hospital to make further gains to
improve timely admission for acute patients. The group stated it
strongly supported the implementation of an assessment and planning unit
and a short stay unit, where patients could be observed if their stay was
longer than the six-hour target. Dr Chambers said the
nurses' letter reflected the fact staff were "rather impatient to see
that transformed into action". He acknowledged there
had been a temporary increase in nursing allocation for the department,
something which followed concerns raised by nurses. A five-yearly review of the department has recently been carried out by a Counties Manukau District Health Board assessor, and Dr Chambers said he was keen to see what it said. More Information on US Health Issues
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