Wednesday, 26 November 2008

Tony Ryall and the Chamber of A&E

A few days ago Tony Ryall announced that he was going to institute the maximum time should be six hours and that no patient should be left waiting in an emergency department corridor.

Holy crap. You'd think that someone in the hospital sector would have thought of putting targets in place before. Well it seems some DHBs already did. But it seems the biggest productivity drives haven't come from management telling medical staff to treat them or turf them but from medical staff themselves.

But the system will only stretch so far and this weekend I was reminded why. It was pretty shitty weekend. First I had to pay for they clutch in my car to be replaced which was an expensive proposition and then was struck down by some god awful virus. The reason I went to the doctor immediately was not because I worried about myself but I had been looking after the Child on Sunday and if I did have something serious which I might have passed on to her I wanted to the Mother to have a heads up.

Now here's the rub, my PHO (otherwise known as a GP practice) is open from 8 to 5.15 weekdays and 2 hours on Saturday. After that I have a choice between an after hours clinic where they payments are high ($75 in my case) or I can head along to the emergency department where you can be seen for free even though the wait might be long. Obviously for me it was a no-brainer, you swallow the cost of the clinic visit even though your savings have just been depleted by a 4-figure car repair bill. But I'm lucky, I have no dependents and money in the bank. Some people don't have that luxury. I hazard a guess that along with a lack of resources, too many people are ending up at the ED department because of the restrictive hours most PHOs operate and the high costs of going to those after hours clinics.

I hadn't been this sick since my infamous bout of food poisoning in Cambodia where I spent the last 36 hours of my trip lying on the toilet floor in between bouts of puking my guts out. In this case suppose I could have waited until the mid-morning to get an appointment at my PHO, but that's the thing with sickness, it doesn't alway fit nicely into a 9-5 work day. And when there's kids involved, you do tend to want health problems addressed urgently when things are looking nasty.

So wave your wand oh health wizard. But perhaps to make spell more effective, you need to talk to the medicial staff in the ED to find out how and why the system has blockages. It's what us muggles call consultation.

Update: Since the last post I just spent 2 hours at the GPs office being pumped with fluids and antibiotics since the first doc missed that I had a kidney infection.


Anna said...

The assumption that problems with A&E lie entirely with poor organisation by DHBs really irks me. It's possible that this is a contributor, but good old-fashioned resourcing problems haven't just disappeared.

The problem you point to with PHO opening hours is absolutely huge for people with kids. In my experience, you're more likely to need to take your kid to the doctor out of hours. If you're working, you may not know your child is sick until you get to spend time with them after work. Respitory problems - eg croup - often surface at night.

I took my daughter to the urgent doctor on Saturday, and all up it cost $60. Judging by looks, I was the 'wealthiest' person in the waiting room - and all the people there were there on behalf of their kids. The silly thing about it was I was 90% sure I'd be told exactly what I was told: fluids, paracetemol and rest. But when meningitis is a possibility, you must always err on the side of caution. It's when we stop doing that that our children end up disfigured or dead - and the nasties potentially spread to other kids. A $60 bill isn't much of an incentive to do the socially responsible thing.

Anonymous said...

If you are in a rural area these problems are magnified further. Many can't afford the petrol to get to the nearest A&E and local Drs seldom provide weekend coverage.

I am with Anna though - you can't blame poor organisation soley its also largely about resources and staffing. I am lucky and in a 2am dash to A&E (in an ambulance) we were quickly and efficiently dealt with. However at 6am on a winter morning we were discharged with no way of getting home (over an hour away by car) So me and my sick child took a 2 hour ride on public transport. I don't think that is good enough.

Hugh said...

Well, who'd have thunk, in seventy years of state provided healthcare, nobody's ever thought to just tell doctors to treat people quicker. Tony Ryall, my hat's off to you.

I look forward to Bill English telling the economy to start growing faster, and Paula Bennett telling unemployed people to get jobs.

The sad thing is, much as I'd love to write this off as new-government-syndrome, Ryall's been a Minister before.