More than 1500 patients were treated in corridors at Middlemore's ED in one month

Brian from Mount Roskill

More than 1500 patients were treated in corridors at Middlemore Hospital’s emergency department in just over a month.
A report obtained exclusively by the Herald also highlights 43 separate incidents of patient harm due to delayed care and staff shortages.
The report was escalated to national leaders at Health New Zealand Te Whatu Ora, but there were delays in acknowledging the issues.
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Clinicians’ efforts to secure funding for additional resources have so far been unsuccessful.
Patients are “suffering” and being put at risk with more than 1500 treated in corridors at Middlemore Hospital’s overcrowded emergency department in the space of just over a month, according to a report obtained exclusively by the Herald.
The report – written by clinicians – highlights an alarming number of serious failures in the 36 days between July 1 and August 5 last year, with staff saying politicians have ignored their plight.
“To say that the ship is sinking and no one is coming to help is an understatement,” one staff member wrote as part of feedback on emergency department (ED) overcrowding.
The “quality alert” review, obtained under the Official Information Act (OIA), details 43 separate incidents where patients were harmed because of poor quality and delayed care amid ED overcrowding and staff shortages in the middle of winter.
Reported ED overcrowding incidents does not show the old ladies who wet themselves in the corridors
Middlemore ED staff member
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“Our patients are being done an injustice and we’re not talking about it – not at the level it needs to be talked about. It’s not visible to our leaders, and as you will be very aware, it’s certainly not visible to our politicians,” the staff member continued.
Clinicians came up with a business case to boost resources before this winter – but funding has not yet been forthcoming.
Another ED staff member said patients being treated in corridors and other “non-clinical spaces” was having a “significant effect on the morbidity and mortality” of those they’re supposed to be helping.
“It [reported ED overcrowding incidents] does not show the old ladies who wet themselves in the corridors because there is nowhere else to go. It does not show the patients who had a poor experience of death when we could have shown them kindness and dignity when they took their final breath,” the staff member said.
The overcrowding between July 1 and August 5 last year was “predicted and likely to occur again”, the report warned.
The deficiencies identified included:
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1,536 patients received care in an inappropriate clinical space like a corridor.
Patients also received sub-optimal care in ambulance waiting areas, on plastic chairs in the waiting room, on the floor, and in their cars.
There were 1230 “excess bed days” which is the number of days patients languished in the ED before being admitted to a ward.
Only one in every 10 walk-in ED patients suffering a heart attack received appropriate medical intervention within the 90-minute KPI. However, nine out of 10 coming by ambulance were seen within recommended time frames.
1,043 patients including 660 adults and 383 children “did not wait” in the ED because of overcrowding and long wait times.
The report said occupancy rates are increasing by 2-3% every year at Middlemore.
The ED has 151 beds but there were at least 12 days last winter where more than 400 patients arrived in a single day.
While Counties has low presentation rates given its overall population, more than 50% of patients who do arrive at the ED are of high acuity with “severe illness or medical conditions,” the report said.
‘Very challenging for staff’
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Counties Manukau group director of operations Dr Vanessa Thornton was unable to say if this winter would be any different in terms of pressure on staff and patient load.
“There’s no doubt at times we will have patients in corridors,” she told the Herald.
Asked whether she understood why staff would say “the ship is sinking”, she said she did.
“I do sympathise with that because on some days it can be very challenging for staff, and it feels like they’re not getting the support that they need at the time.”
Thornton, who holds a management position but also works in the ED as an emergency physician, said treating people in corridors was “not a perfect clinical space” but was the only option when the ED was overrun.
She accepted patients were occasionally put at risk during busy periods.
“We don’t want patients in corridors. I don’t want patients in corridors. No one does. Part of the process of doing this review was to have a look at it and see what we would need to implement to prevent that,” she said.
‘Medical error’ amid staff shortages
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A review written by clinicians and obtained by the Herald has raised serious concerns about staff and patient safety at Middlemore Hospital's emergency department. Photo / Jason Dorday
A review written by clinicians and obtained by the Herald has raised serious concerns about staff and patient safety at Middlemore Hospital's emergency department. Photo / Jason Dorday
The Herald has analysed the 43 patient safety incidents reported during the 36-day period reviewed.
The report said “several” of the incidents are being investigated as “severity assessment code” one or two, meaning they’re the most serious adverse events which resulted in death or permanent loss of function.
In all cases, the ED was over capacity or in “code-red” and in at least 18 of the incidents the department was short-staffed.
“Multiple corridor patients, back-to-back resus patients and unexpected deaths,” one staff member noted next to one of the incidents.
During another incident staff noted they were “short staffed by two doctors, five registered nurses and three healthcare assistants.”
“Poor quality care” was noted as being relevant to all incidents, and in at least four incidents, iatrogenic harm was a contributing factor to patient harm meaning mistakes were made by staff during treatment or medical intervention.
Thornton said getting extra staff to plug gaps was difficult.
“If a quarter of the staff are sick on a day, it’s hard to replace [them]. It is challenging and it does put pressure on the staff,” she said.
She said the purpose of conducting the review was to improve the system.
‘Hoping’ for extra funding
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Efforts by clinicians to get extra funding to assist this winter have so far been unsuccessful.
Even before winter last year, a $3.6m proposal to boost staff numbers at Middlemore’s ED failed because there was “no mechanism to secure funding”, according to the report.
Thornton said the budget process is still under way and “we’re hoping” to get some money for that project which was referred to in the report as a new “fast track” model of care.
“We have obviously asked for more money acutely across the whole region because there’s demand everywhere,” she said.
Thornton said some improvements had been made to alleviate pressure, including establishing a new permanent 22-bed ward as an overflow for patients waiting in ED.
She said extra nurses from other departments, like intensive care, had been identified to help if required, and regional “load sharing” of ambulances would see patients diverted to other hospitals if Middlemore was unable to cope.
The report and its findings were endorsed by Counties Manukau health leaders including Thornton.
However, clinicians also recommended Health New Zealand Te Whatu Ora (HNZ) national bosses and the Health Minister be notified of the risks.
The Herald understands the review did find its way to HNZ’s national lead for quality and patient safety, Sarah Jackson, and the agency’s chief medical officer, Dame Helen Stokes-Lampard.
The Herald asked why no feedback on such serious issues had been provided by national clinical leaders.
A spokeswoman for HNZ said “there was a delay in acknowledging the report” at a national level but this didn’t prevent Middlemore Hospital from working on improvements.
The Herald’s OIA result suggested such escalation would not necessarily result in funding being approved.
“Funding allocation is progressed through dedicated channels and processes in HNZ rather than quality status reports sent to clinical leadership.”
Health Minister Simeon Brown did not answer direct questions about the report or the concerns of staff, nor did he say whether he was sent the report when it was written.
He blamed the previous Labour administration for “unacceptably long” ED wait times and said the Government reinstating health targets had seen an improvement in ED wait times.
“Much more work is needed to fix this challenge, and that is why we will continue to focus Health New Zealand on putting patients first and reducing wait times,” he said.
He also said funding for 24-hour urgent care services in Counties Manukau would also reduce pressure on Middlemore’s ED.
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