Christchurch Emergency Department's Observation Unit opens four years after being built

Christchurch Emergency Department's Observation Unit is finally open, four years after it was built.

The Observation Unit is part of Christchurch Hospital's Hagley Block, a $500 million project, which opened in 2020.

Dr Mark Gilbert, an emergency physician and the Emergency Department's clinical director, said the unit had not been able to open because there was no funding for the required staff.

The unit, which opened last week, required 16 additional nurses, six junior doctors, three full-time-equivalent senior doctors, and administration staff.

A Health New Zealand spokesperson said there was $4.2m in additional funding to operationalise and staff the unit, "but this will be at least partially offset by reducing inpatient admissions" by use of the unit.

Dr Gilbert said it had been frustrating to have the unit there but not be able to use it for the past four years.

"Emergency Department Observation Units are proven to be really efficient models of care. They are good for the ED, good for the hospital, good for the patients and for the staff. So having this built area and not staffed was frustrating. We are really pleased to be given approval to open it."

The Observation Unit bridged the gap between those who needed emergency care, and those who needed to be admitted to hospital, Dr Gilbert said.

The unit allowed them to observe those in-between patients for a bit longer, such as waiting to see if a treatment was taking affect, or complete observations after a head injury, he said.

"It might be someone with kidney stones who we are waiting to see if painkillers and things are taking effect. Also other medical type issues like allergic reactions, drug overdoses. Also elderly folk who are on that borderline of needing admission, who can come here for dedicated Allied Health input to get them home."

Without the unit, many of those patients would be admitted to hospital or made to wait in the corridors of the Emergency Department, Dr Gilbert said.

There were many benefits from not admitting people who did not need it, he said.

"If you are admitted, you are generally here overnight, minimum 24 hours to 36 hours, it is just the way the cadence of the hospital works with ward rounds and things like that," Dr Gilbert said.

"Whereas here, we have on-site senior decision-making capability 16 to 18 hours a day, and we are able to make those decisions late into the evening and even in the early hours of the morning."

That had benefits for the hospital with less admissions and less overcrowding, helped to decrease overcrowding in the ED, and was good for patients, he said.

"If you don't need to be admitted to hospital, then hospital is not a good place to be. Particularly for elderly patients. We know that elderly patients are prone to get confused in hospital, prone to falls, can lose the strength in their legs. If we can possibly get them home with some Allied Health support and follow-up support at home, that is a much better place for them to be."

The unit is currently not operating at night. But Dr Gilbert said once they had tested and adjusted all the processes and brought on full staffing, they would open 24/7.

They were fully staffed for doctors, and had 90 percent of the required nurses, but were still "on-boarding" new staff, he said.

He expected the unit to move to 24/7 operation in the next few weeks.

Minister says unit 'will make a real difference'

Health Minister Shane Reti said the unit should have been able to open alongside the new ED back in 2020, but its staffing was not prioritised by successive Labour ministers or in the then-District Health Board or Health New Zealand's subsequent internal budgeting.

"This is exactly what I expect Health NZ to focus on in future: delivering on frontline services to improve outcomes for both patients and staff.

"Its opening will make a real difference to the people of Christchurch - having an Observation Unit eases strain on ED by bridging the gap between emergency care and full hospital admission."

Reti said their target was to deliver 95 percent of patients being admitted, discharged or transferred from an emergency department within six hours, adding that initiatives like this would help deliver on that goal.

"I agree with clinicians that observation rooms should form an ongoing part of Health NZ's work plan to deliver faster ED times at other sites."

Labour health spokesperson, and former health minister, Ayesha Verrall said Labour was so focused on workforce that the current government had come in and put a pause on filling vacancies and nursing placements.

"Just like the new hospital in North Shore in Auckland, there was a plan to fund more staff and pay them what they deserve, so that when the unit opened, those facilities would be available.

"Shane Reti is again trying to divert attention from the fact he knew the health system needed more money but was unable to get it out of his own government."