Hospital's bone surgery delays worsen

By MARTIN JOHNSTON health reporter

Auckland Hospital is not treating many broken-bones patients quickly enough, increasing the risk of complications and taking up hospital beds.

Inadequate treatment of such injuries can affect patients' rehabilitation.

In one group of patients at Auckland Hospital with broken thigh bones, only 43 per cent were treated within the recommended time.

Guidelines accepted by the hospital say these patients should be treated on the day of admission.

Yet 46 per cent waited two to four days for their surgery.

Eleven per cent waited longer, says a study made at the hospital, New Zealand's largest centre for treating accident victims.

The study compares bone fractures figures from July to December last year with delays during the preceding six months.

The hospital's director of orthopaedic trauma, Bruce Twaddle, who did the study, said the trend was that the more acute the fracture, the less likely the patient was to receive surgery within the guidelines.

"Disappointingly, although we made improvement in some areas after the initial report, we are still failing to reach recommended guidelines in all but the least acute cases."

He said yesterday that the legs of patients with broken ankles who had to wait too long for an operation could swell, meaning they had to stay in hospital waiting for the swelling to go down before they could have surgery.

They were in danger of developing a blood clot, which could need drug treatment.

Mr Twaddle is worried that the new Auckland City Hospital will perpetuate the shortage of beds.

Last August, after Mr Twaddle presented the findings of his initial study to the hospital, it responded with a plan to delay non-urgent surgery for other patients during "spikes" of high numbers of acute orthopaedic cases.

Mr Twaddle said the only way to deal with the delays was to pay for the staff needed to allow theatres to operate beyond the current 10pm limit applied to all but life-or-limb-threatening cases.

But he acknowledged this was unlikely to happen because of the Auckland District Health Board's $55 million deficit.

His study shows that 24 per cent of patients with compound fractures, 43 per cent of those with fractured necks of the thigh bone, 7 per cent with fractured shinbones and 35 per cent with fractured ankles had to wait beyond the recommended time for surgery in the second six months.

Other studies have found that delaying surgery beyond the second day in hospital in such cases is associated with an increased death rate.

The hospital's general manager, Meng Cheong, said: "We have done everything we can within our current resourcing to make sure there are no clinically unacceptable delays."

He forecasts improvements when the hospital shifts next door to the new Auckland City Hospital in October - which will increase the health board's number of operating theatres by four - and when North Shore Hospital begins treating acute, as well as non-urgent, orthopaedic patients.

North Shore Hospital wants this to happen in November next year, but the Auckland board wants to advance the change-over date to this October.

Waiting for surgery

* Treatment for broken bones at Auckland Hospital is still falling short of guidelines.

* Among one group of patients, 46 per cent waited up to four days for surgery.

* They should have been treated when admitted.