This inquiry focuses on elderly patients in a major metropolitan hospital. It examines complaints involving five patients whose reported experiences mirrored numerous complaints received by the Health and Disability Commissioner (HDC) about North Shore Hospital in 2007.
Key Results
Although four of the five patients died, there is no evidence that treatment injuries or lapses in care caused their death. But in significant ways Waitemata DHB‘s care for all five patients breached the Code of Health and Disability Services Consumers‘ Rights (the Code). They suffered delays in care and deficiencies in communication with them and their families. The failings were not the fault of individual staff but the result of systemic issues, overcrowding, and pressures on staff. In such an environment, non-urgent care is often given low priority as staff focus on the bare essentials in an effort to keep patients safe. That happened at North Shore Hospital. Although the standard of medical care was largely reasonable, the nursing care was not. The nurses did not have time to care.
Waitemata DHB is not the only district health board with pressure on its acute services and an overcrowded hospital causing problems in the emergency department. Similar issues have been highlighted in four other recent HDC investigations.Nor is Waitemata alone in being critically short of Resident Medical Officers (junior doctors) and nurses — though its recruitment problems have doubtless been exacerbated by the well known difficulties at North Shore Hospital. These challenges are not unique to Waitemata DHB, nor to New Zealand.
The public accepts that at busy times hospital services will be stretched and that patients must be prioritised according to their needs. What is harder to accept is that crowded, uncomfortable, and unsanitary conditions should be commonplace in a modern hospital.5 All hospital patients, especially acutely unwell senior citizens, deserve clean facilities, comfortable waiting areas, and responsive services. A lack of hygiene and long waits in uncomfortable conditions are an affront to patient dignity and a breach of legal rights.
Overcrowding has been described as the most serious problem and most avoidable cause of harm facing hospital systems. It largely results from hospital access block (―bed block‖), when patients remain in the emergency department awaiting suitable inpatient beds. The causes of overcrowding, and the primary solutions, lie outside the ED. A whole-of-hospital approach is needed. Concerted action to tackle this endemic problem is essential both at Waitemata DHB and nationally.9