Photo: RNZ
Health New Zealand has scrapped the highest Code Black alert used by some emergency departments to show when they are critically overcrowded or understaffed.
The agency said its new ED At A Glance system was about getting a “nationally consistent” approach – but some doctors suspected it was intended to make conditions look better than they really were.
Crowded EDs had been hitting Code Black when they reached more than 145 percent of maximum occupancy.
Internal documents seen by RNZ showed that alert was gone and the thresholds for other levels had been pushed higher.
Code Red – when care capacity was considered “critically reduced” – had jumped from 120 percent to over 135 percent.
One emergency doctor, whom RNZ has agreed not to name, said it was “just moving the goal posts”.
“Code Red requires 135 percent overload. That means patients backing up into the waiting room and corridors, and ambulances backed up as well.”
The new ED alert system used colour-coded steps to trigger action to ease pressure, usually caused by a shortage of hospital beds or lack of staff.
Responses could include bringing in extra staff, discharging patients from ED or hospital wards, or even postponing elective procedures, when a hospital was completely gridlocked.
The Resident Doctors Association, which represents trainee specialists and junior doctors, said the new system appeared to have been rolled out “almost under the radar”.
National secretary Deborah Powell likened it to “applying wallpaper to a great hole”.
“I suspect this is just them trying to sanitise news. It makes no difference to occupancy, it’s just the optics of it. And it doesn’t help front-line staff.
“The fundamental problem [in ED] is insufficient beds and insufficient staff, which leads to high occupancy and reduced turnaround of patients – or worse, pushing patients out too early which, results in ‘bounce backs’.
“Pushing the limits out so we record less escalation is not diminishing the occupancy rates – it is simply hiding them a little more.”
The new system could even add to the pressure in ED because conditions had to be worse before there was a response, she said.
“As you climb through the escalation pathway, things kick into gear to try to free the system up.
“I don’t know if it is particularly effective because we’re just stuck. We don’t have enough beds and we don’t have enough staff.”
The Australasian College for Emergency Medicine did not have an official position on the new system.
However, its New Zealand chair, Dr Kate Allan, agreed EDs needed more resources, however that happened.
“We know that there are workforce issues at some of our rural hospitals, but all the emergency departments with which I’m in contact are under pressure with long wait-times and overcrowding.”
A senior consultant – who wished to remain anonymous – said getting national consistency could be helpful.
“It doesn’t matter whether it’s colour-coded green, pink or purple, as long as it recognises when there’s a threat to care and it triggers the necessary response. That’s the important thing.”
That doctor was hopeful that a new acute care advisory group within Health NZ would bring positive change.
A Te Whatu Ora spokesperson said the agency was in the process of improving the “sometimes disparate” data reporting systems used by former district health boards to make them nationally consistent.
The status of a hospital and ED was dynamic and its status could “change back and forth in minutes over the course of a 24-hour period”, she said.
“Hospitals are experienced at managing these changes and have processes in place to support this.
“Providing care to the local community remains our priority and to be clear, we never turn people away from EDs in any hospital across New Zealand when they need our care.”
Health NZ director of health targets Duncan Bliss said all districts were now using the national framework.
“The triggers for escalation are determined nationally and trigger levels set locally, ensuring hospitals can apply their own expertise and decision making.
“The aim is to ensure the best possible care for our patients, and best use of our dedicated kaimahi.”
New ED At A Glance system
Green: under 88 percent capacity
Yellow (moderate reduced care capacity): over 89 percent
Amber (significantly reduced care capacity): over 108 percent
Red (critically reduced care capacity): over 135 percent (or over 114 percent between 11pm and 7am)
Progressive actions include:
- Reviewing ED patients and moving patients who are stable and waiting for diagnostic results or to be discharged to waiting room or transit lounges
- Offering telehealth or other referrals to less urgent patients
- Sending unstable patients to critical care beds
- Delaying non-emergency procedures
- Calling in staff
- Delaying ambulance handovers
- Hospital-wide escalation response – free up ward beds.