12 May 2016 | Capacity issues at Middlemore Hospital have led the DHB to request GPs call ahead if they are sending patients to the emergency department.

A new telephone service to be answered by a senior medical officer from 8am until 2am and then a senior registrar from 2am until 8am has been put in place, Counties Manukau Health senior communications advisor Diane Abad-Vergara told New Zealand Doctor in a written statement.

The hospital has been at full capacity five days this year.

Using phones a smart idea

Manurewa GP Bruce Arroll approves of the plan, saying if hospitals had more doctors carrying pagers or mobile phones, it would be a good thing.

Hospital consultants carrying mobile phones is starting to make a real difference for his practice, where talking to someone at the hospital and getting advice can mean no referral is needed.

It is a smart idea to have senior medical staff, instead of junior, on the end of the phone, Dr Arroll says, as they are more confident with the decisions needed to keep people out of hospital.

Urgent care clinics could help ease the strain

Medical director of Takanini Care and Counties Care A & M clinics, William Kim, says Middlemore Hospital being at capacity means he and his staff are more conscientious about their referrals.

When Middlemore is especially busy, Dr Kim says the phone lines to hospital registrars and consultants can get overwhelmed and he may have to call several times to get advice.

If, in some cases, GPs were to send their patients to an urgent care clinic, instead of ED, it would relieve pressure on both the hospital and on the phone lines, he says.

High occupancy in March and April

Across March and April, the hospital has sent five urgent notices to primary care warning of high occupancy levels.

High occupancy rates apply to medical, surgical, gynaecology and burns adult wards, which is where general patients can be placed. Beds in paediatrics, women’s health and mental health cannot be used for general patients, Ms Abad-Vegara says.

The hospital has unexpected spikes from time to time, and has well defined contingency plans to respond to them, including decanting patients to other areas, she says.

Referrals to be reviewed

The urgent notices ask GPs to review all referrals to help manage short-term demand in the hospital’s ED. And the notices are having an impact, Ms Abad-Vegara says.

“It brings the issues to the top of mind on the day, reminds them (primary care) of various options, and gets them to have another look at their referrals. It also updates them on work Counties Manukau Health is undertaking to address demand.”

Avoidable presentations

It is widely acknowledged, Ms Abad-Vegara says, that improving patient care and reducing ED delays is achieved by focussing on the whole patient journey, including primary care.

A guide for patients, called “Are you in the right place?” will be launched next week to help patients and families understand where to present.

Republished with permission of New Zealand Doctor. To subscribe to go

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