A close to 30% drop in bed nights at Oamaru Hospital following the controversial restructure in February is not “entirely due” to staffing shortages, clinical director Dr Pragati Gautama says.
Waitaki District Health Services figures, released to the Oamaru Mail under the Official Information Act, reveal between the start of February and the end of June, the average number of bed nights at Oamaru Hospital per month was 420.
The hospital is contracted by the Southern District Health Board to provide 6900 bed nights each year, an average of 575 per month.
In 2017-18, 8177 patients stayed the night at Oamaru Hospital. Over the past 12 months, that dropped to 6320.
The lowest occupancy was in June this year, when just 320 patients stayed overnight.
Waitaki District Health Services (WDHS) chief executive Ruth Kibble said the restructure was a “contributing factor” to the loss of bed nights over the past five months, but the hospital was “coming out the other side of that”.
“We have had high staff sick leave. Was that due to stress or was that due to the flu that was going round? Probably a bit of both,” Mrs Kibble said.
“Was it that people were bypassing us because they didn’t want to come in here? Maybe.
“Was it because we were discharging people sooner?
“We are not that naive. Going through the change process we went through, it would have impacted.”
But bed nights were just one measure of how the hospital was functioning, she said.
“Our contracts have not changed in their volumes.
“[In 2017-18] we provided 1277 bed nights more than we were funded for.”
It was a question of where patients were rehabilitated, she said.
“Do we have them sitting on a bed for a week, or do we get them home and put supports in their home?”
Emergency department numbers had remained constant, Dr Gautama said.
“Maybe we didn’t keep as many, but what you have to say is we are still seeing them coming through the front door,” she said.
“We haven’t dropped our quality of service.”
In 2018-19, 7755 people presented to the Oamaru Hospital emergency department, 166 more than the previous 12 months.
Oamaru Hospital only receives funding to see 4000 people through the emergency department each year, based on the population of the catchment.
“A lot of the people we see normally would be seen by their GP in primary care,” Mrs Kibble said.
“We could turn those 3755 people away from our door, [but] what we do know is if we did that the majority of them wouldn’t go to their GP, therefore we would have un-met health need.”
The hospital had applied for contracts to get funding for the extra work it was doing in the emergency department, Mrs Kibble said.
“We will need to evolve – not necessarily to change what we do, but hopefully receive better recognition for what we do.”
Oamaru Hospital was struggling to attract full-time doctors because of a nationwide skill shortage, Mrs Kibble said.
In recent months, the Oamaru Mail has been approached by members of the community who expressed concern about the number of patients being transferred to Dunedin Hospital for medical care.
According to figures obtained under the Official Information Act, an average of 62 patients were transferred to Dunedin Hospital each month over the past six months.
Mrs Kibble said there had been times when patients were transferred because there was not the correct staffing mix in Oamaru, but it was based on clinical need.
“I cannot quantify how often this has happened over the last six months, but it is not frequent.”
At present, the staffing mix at Oamaru Hospital was good, she said.
“We still have some staff who have only been with the organisation for under three months, but they are settling in well and we continue to support them.”
Between June and August, 24 patients were transferred from Oamaru Hospital by helicopter, compared with 11 between March and May.
WDHS does not foot the bill for air transfers and the decision to retrieve patients is made by the ICU in Dunedin.
Some clinical pathways also now require air retrieval within a specified timeframe to ensure treatment is within national standards for some strokes and heart attacks.
“This increase in helicopter usage does coincide with improved sharing of clinical information with Dunedin, therefore it is possible that our assessment of the unwell patient is now of better quality and therefore these people are accessing appropriate medical interventions in a timely manner as compared to previously,” Mrs Kibble said.
Mrs Kibble and Dr Gautama both expressed concerns that negative perceptions about the hospital were having an impact on the community’s wellbeing.
During a recent audit, a patient told auditors they had deliberately delayed coming to Oamaru Hospital because of their perception of the quality of care and services.
“That patient said, actually, their experience was the direct opposite – they were well cared for by good staff,” Mrs Kibble said.
“It was quite a humbling moment hearing that this person had become very, very unwell.”