The Australasian College for Emergency Medicine said staff were facing significant violence and aggression in EDs and the problem was growing (file picture). Photo: RNZ / Marika Khabazi
Emergency department doctors are calling for political parties to commit to 24 hour security staff in every department across the country.
The Australasian College for Emergency Medicine has issued a list of fixes in staffing, data, security, mental health and aged care management that it said were crucial to restore struggling emergency departments.
A senior emergency clinician quoted in the college's report said a lack of staffing and beds was overflowing into emergency departments with dangerous consequences.
"There are so many staff, patients, carers and whānau exhibiting stress behaviours. This can cause breakdowns in communication and processes and can lead to aggression and violence. Staff start to yell at each other for basic requests. Patients and relatives often get angry and frustrated if they perceive they are not receiving timely care," the clinician said.
College chairperson Dr Kate Allan said staff were facing significant violence and aggression in EDs and the problem was increasing.
"All people must be safe to receive, deliver and support care in emergency departments, and violence or aggression cannot be accepted. 24/7 security staff posted at every ED, integrated and appropriately trained to best support staff, patients, whānau and visitors, can free up medical staff to focus on delivering crucial care," Allan said.
There were over 1.2 million presentations at ED's during last year and the number of people waiting longer than six hours to receive care was five times what would be expected from a well resourced health system.
That number had grown dramatically over the previous five years from less than 10 percent to nearly a quarter of patients presenting.
Allan said inadequacies across the health system were compounding wait-times and putting staff and patients in danger.
"Emergency doctors from across the motu tell me that there are simply too many sick and injured people needing care, and not enough skilled staff, hospital beds, mental health care, aged care and other resources to go around," Allan said.
In 2022 their were more than 650 instances when hospitals were operating at or beyond their full capacity.
Against a surging demand for specialist mental health care the number of beds in dedicated facilities was declining leading to a growing number of people becoming stuck in emergency departments for long waits.
Beds in mental health and addiction facilities had dropped by 10 percent in the last five years while the number of ED presentations for mental health related reasons had leapt from less than 20,000 to nearly 30,000 during last year.
A similar effect was occurring for elderly people awaiting beds in aged care homes.
The college's report said at any time there were approximately 150 elderly people stuck in hospitals waiting for a high level aged care bed to become available.
The doctors were calling for security staff to be posted 24 hours a day at every ED in the country.
They said parties contesting the 2023 election should also commit to the urgent delivery of 150 high-level aged care residential beds, the fulfilling of the 2019 mental health budget's pledges to increase staffing in all mental health facilities and putting measures in place to boost and retain emergency care workforce staff numbers.
The situation at North Shore Hospital
North Shore Hospital emergency medicine clinical leader Dr Andrew Ewens told Checkpoint generally the hospital had very good security if it required it.
"The problem we have with EDs is the busier they get the crowded they get, the harder they are to work in. The overall environment becomes more stressful."
When someone with higher needs comes in, like from a mental health facility, it increases the demands overall, he said.
"When they are full, EDs become stressful anyway and what we do see is the behaviour tends to escalate under those situations in particular so we rely very heavily on our security services under those circumstances."
"The problem we have with EDs is the busier they get the crowded they get, the harder they are to work in" - North Shore Hospital emergency medicine clinical leader Dr Andrew Ewens
Ewens said he would see the full spectrum of behaviour you might expect from someone who was under stress or under the influence of alcohol or drugs.
"Generally verbal but occasional physical and it can also be some outright violent behaviour... including damage done to the facility and assault on staff and occasionally other patients as well."
Verbal abuse was reasonably common and de-escalation tactics were used, he said.
Ewens said EDs did not work in isolation and require the system around them to be functional.
When EDs were blocked and staff could not get patients through the department to an in-patient facility, it caused troubles, he said.
"That's when EDs become really dysfunctional."
Hipkins uncertain 24/7 ED security 'required in every instance'
During a media briefing where Labour Party leader Chris Hipkins pledged more frontline police, he said staff safety was something that hospital management needed to take very seriously.
Hipkins said he was not convinced that 24/7 security staff were needed at all New Zealand emergency departments in every instance.
"But what we will do is work with the staff who are expressing legitimate concerns about their safety as to how we can best address that.
"If extra security is required of course we will work with the people who are running Te Whatu Ora, who are running the hospital, to make sure extra security is put in place where it's needed."
In the area of mental health, Hipkins said that the government had made good progress, but more work was needed to train the workforce in the mental health area.