Doctors were against adding extra beds at Waikato Hospital to relieve pressure in ED

Doctors at Waikato Hospital did not support patients placed in extra beds in treatment and family rooms, according to emails discussing the new policy. Photo / File

Extra beds will now be put in treatment and family rooms at Waikato Hospital but it has been revealed some clinical leaders did not initially support the move.

Patients about to be sent home from 24 of Waikato Hospital's 28 wards may be moved to make space for patients from the Emergency Department, where a health target states that 95 per cent of patients must be admitted, discharged or transferred within six hours.

The policy, which came into effect on Monday, would free up space on the wards, and ease some of the backlog in the ED.

Initially, patients about to be discharged were to have been put in ward corridors and patients would use "cow bells" to call nurses, but that changed when doctors and nurses raised potential safety risks and the possibility for negative media reaction, according to emails released to the Herald under the Official Information Act.

Intensive care specialist Dr Grant Howard, the hospital's former group manager, told critical care nurse manager Colleen Hartley in an email in September he had not been told to implement the procedure and asked her not to progress it.

"Given my reservations about the idea, we will require written instruction from an appropriate named line manager to comply with the procedure in HDU [high dependency unit]."

As a result, the HDU and intensive care unit (ICU) will not house the overflow beds.

Planning for the policy began in July and a pilot was rolled out in early October.

Clinical leaders Cameron Buchanan, Chris Nunn and Chris Holdaway told managers the initiative was flawed, lacked evidence and logic, and would not bear scrutiny.

There were also fears the practice would become routine instead of only being used during week days when the ED was full and a patient had been waiting for a bed for more than five hours.

Nurses also expressed reservations including surgery nurse manager Melody-Rose Mitchell who said charge nurse managers were "trying to accommodate the processes that have been agreed at a higher level but will not sacrifice good basic medical nursing standards".

"I will not have a patient in a bed in the corridor, or in the middle of a four-bed room."

And initial moves to pay more than $32,000 to create bed spaces were blocked.

A week after the pilot was rolled out, operations and performance executive director Marc ter Beek said he had grown "increasingly nervous" about the procedure.

He wrote it "creates new and unknown risks elsewhere in the organisation for which I have no confidence that we have ability to monitor and respond to adequately".

Waikato Hospital Service executive director Brett Paradine told chief executive Dr Nigel Murray some of the senior doctors were unconvinced but that he was "entirely comfortable" with the procedure being implemented.

"I just mention as this confirms my suspicion that Marc and I will need to push this through, rather than waiting on sign off from the CULs [clinical unit leaders]."

Ter Beek told the Herald last week that the final policy was changed from the draft after managers took on feedback from the trial in October, and it was accepted by all clinical leaders in November.

"We have been experiencing very high demand in our Emergency Department recently, particularly between 6-7am when people who are due to be discharged haven't left the ward yet, but we have many patients in ED waiting for a bed.

"It's much safer for people to be on a ward with specialist nursing care than lying in ED. Under the new protocol, at times of acute pressure, patients who are ready for discharge home would go into the overflow bed, which all have electronic call bells and privacy curtains, and new patients would be given an ordinary bed.

"The decision to use the overflow beds is taken by on call nurse management in the morning of each weekday, based on clear criteria assessed by our bed capacity manager before making a decision to trigger the protocol."

Auckland City Hospital can add beds within dedicated patient rooms on wards and at Wellington Hospital, extra beds can be added to clinical areas.