Security has increased at Wellington's overcrowded emergency department after health and safety concerns were formally lodged last month.
The emergency department at Wellington Regional Hospital has been operating at capacity for months on end, with reports of patients treated in corridors and one visitor last month describing the waiting room as "busier than an airport terminal".
Earlier this week the Herald reported a woman with terminal cancer waited more than 30 hours for a hospital bed, according to an ED doctor.
On July 8 the emergency department's health and safety representatives issued a Provisional Improvement Notice (PIN) to Capital and Coast DHB, outlining safety concerns that included security breaches that put nurses at risk.
New Zealand Nurses Organisation Wellington Representative Jo Coffey said the PIN - which was lifted last week on July 28 - outlined a number of safety concerns that had been taken to CCDHB.
"They had far too many patients in the waiting room, and they weren't feeling like they could adequately triage them, and they didn't feel like there was enough security support to keep them safe," she said.
"Since then they've put a security camera in the waiting room and they've got security orderlies to do more rounds."
"They used to do them hourly, now they're doing them half-hourly. We're now reviewing whether they actually need to be there permanently."
She said Wellington's emergency department had been under "an extreme amount of pressure" for more than 12 months, but demand had been exacerbated by an outbreak of respiratory illness over winter.
On the day the PIN was issued, multiple factors had come to a head.
"That week was the RSV virus so a whole lot of things collided together at once," Coffey said.
"The hospital was short-staffed, there was difficulty with bed flow, we had all the RSV patients coming in so that was causing impacts on the pediatric area as well as the ICU, [and] it was difficult to get the patients out of ED."
There was also high sickness among hospital staff and difficulty covering nurses who were absent, contributing to the long wait times.
"The target's six hours and they average about nine hours ... but there have been patients that have been there overnight and had to wait fifteen hours."
Capital and Coast DHB Provider Services Joy Farley said a PIN is a written notice issued to a person or organisation asking them to address a health and safety concern in the workplace.
She said the Te Pae Tiaki Wellington ED had been regularly exceeding 100 per cent capacity with the recent increase in patients with respiratory illness exacerbating patient volumes.
"This increasing demand is placing pressure on our staff, and we received a PIN in July in regards to safe staffing in Te Pae Tiaki Wellington ED," she said.
"Our ongoing work to manage demand and keep our staff safe continues and to address the matters raised in the PIN, we are in the process of implementing a number of measures."
This included improving monitoring of clinical staff during periods of high demand and ensuring staff had access to security support. They had also reviewed the visitor policy introduced last month to manage overcrowding in ED.
The DHB said there had always been CCTV throughout the hospital, but they were enhancing the capabilities of the camera in the ED so it could be monitored by the charge nurse manager on shift.
Farley said high demand in ED was not a Wellington-specific issue.
"Like all DHBs, we continually look at how we can best manage demand and ensure that patients and staff remain safe.
"Our work to address and overcome these challenges is ongoing and includes improving patient flow across our hospitals, bed configuration, and better use of spaces across the 2DHB hospital network."
Coffey believed it was the first time a PIN had ever been issued in relation to Wellington's ED, but was a problem reflected across the country.
"I have noticed that more of the EDs have been doing them nationally … that's just a sign that all of our EDs are in crisis, and they're not coping with the volumes of patients coming through."
"There needs to be a review nationally around that I believe."
She said the changes to be implemented by CCDHB would also include hiring a waiting room nurse, to free up triage nurses to help within the department.
"They need double the amount of staff plus probably, but you need the space to be able to work in," Coffey said.
Farley said in June the two DHBs were looking to increase capacity at Wellington Regional, Kenepuru Community, and Hutt Hospital due to the continued high levels of occupancy, requiring investment in the coming year.
Coffey said the project underway to redesign Wellington's ED would hopefully provide the space for more staff to be hired.
"The project is going to be huge but what we don't want is for the Government and the DHB to be like 'We've done that now' and then not review it in three or four years time if it continues to change."
"Most EDs need a review at least every 10 years and they need to redesign and look at their capacity."
Although it was positive the DHB had addressed the safety concerns, Coffey said it was disappointing it had taken so long.
"It's not like we haven't been having ED meetings every fortnight, trying to look at all the issues. None of it was new but everything had compounded at that time because of the RSV virus."