A new study has found that Middlemore Hospital has the highest number of patients across Australasia, with over 400 patients presenting daily.

The study, published in the NZ Medical Journal today, looked at the number of patients that presented to the hospital over one winter week in 2016.

It was carried out by Emergency Department (ED) doctor Matt Wright and then-medical student Dr Alistair Lock.

It found that between August 1-7, 2016, a total of 2011 patients attended Middlemore Hospital, with 53 patients excluded from the study.

Advertisement

Of these 1958 patients, there were 78 different complaints and 444 individual final diagnoses.

Between August 1-7, 2016, a total of 2011 patients attended Middlemore Hospital. Photo / Michael Craig
Between August 1-7, 2016, a total of 2011 patients attended Middlemore Hospital. Photo / Michael Craig

The five most common complaints were cough, chest pain, shortness of breath, finger pain and collapse.

Other common symptoms were head injury, abdominal pain, leg pain, seizure, and hand pain.

Viral illness, pneumonia, and laceration or incised wound were the three most common diagnoses.

Only two of the 25 most common diagnoses could be classified as severe conditions - pneumonia and ST-Elevation Myocardial Infarction (heart attack).

Of those who presented with a cough, just under 50 per cent were aged under 1, and 60 per cent were aged under 6.

People aged 65 and older were the highest percentage to present with chest pain, shortness of breath and collapsing.

While the highest percentage of people with finger pain were aged 18-34 and most likely to be diagnosed with a laceration or incised wound, fracture or sprain.

Advertisement
Of these 1958 patients, there were 78 different complaints and 444 individual final diagnoses. Photo / Michael Craig
Of these 1958 patients, there were 78 different complaints and 444 individual final diagnoses. Photo / Michael Craig

Dr Alistair Lock said Middlemore's high patient turnover could be attributed to the large District Health Board area, as well as the area's lower-socioeconomic position.

"The hospital is also not close to another emergency clinic, for example like the North Shore Hospital which is close to Shorecare Urgent Care Clinic"

Lock said the study's findings were really targeted for junior doctors and emergency staff, so they could read up in advance on the types of conditions commonly presented and treatment plans.

The report said, while there was a large proportion of patients diagnosed with mild conditions; there is a significant requirement for a broad diagnostic approach by all clinicians so that severe conditions are not missed.

"The audit allows for tailoring of service delivery at CMDHB, perhaps by optimising appropriate use of general practitioners and alternative urgent care clinics," it said.

"However, this information needs to be analysed with caution as doctors at such services have limited investigations at their disposal and severe conditions were only ruled out in this study with the benefit of hindsight.

"Specific analysis of common diagnoses show that not all signs and symptoms are
required for diagnosis. This information can be used to educate medical students and resident medical officers, prepare them for placements and remind them of the importance of a broad diagnostic approach.

"It will also contribute to understanding the case-mix within the Middlemore emergency department to allow for tailoring of service delivery, effective patient flows and enhancement of positive patient outcomes."

Lock said because the audit was done in winter, when patient admission is higher, it would also be good to compare this to summer.

A Counties Manukau DHB spokeswoman said the findings were in line with what the DHB expect each year.

The audit had been presented to the emergency department and would be "used in a practical way to educate staff and give them an understanding of what to expect in the ED and enable them to ensure they have the right skills to deal with presentations as they arise," she said.