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Waikato Hospital made an urgent call to intensivists in New Zealand and Australia to plug staffing gaps that have fuelled cardiac surgery delays and threatened the important tertiary status of its intensive care unit.
The extraordinary situation is outlined in a December 6 memo seen by the Heraldand sent to senior medical staff and hospital leaders.
“Waikato Hospital Intensive Care Unit (ICU) has been under significant pressure for the past 12 months due to staff vacancies,” states the memo, written by three senior managers.
“In June 2023, a decision was made to reduce cardiac surgery planned care to eight cases per week to assist with relieving some pressure within the unit and to reduce the complexity of patient load over the weekend.
“The Waikato Hospital Intensive Care Unit is in need of urgent support from intensivists across the country and Australia to work as locums in order to maintain a tertiary ICU within Te Manawa Taki.”
Waikato Hospital serves Te Manawa Taki, previously known as the Midlands region, taking in Waikato, Rotorua, Gisborne, Taranaki and Bay of Plenty districts with a population of more than 985,000.
Being certified as a tertiary ICU is vital. The status allows for more complex surgeries to be supported.
The December 6 memo outlined the development of an “Interim Regional Patient Flow Protocol” for the region’s critical care patients, in case patients had to be sent to other hospitals.
“The aim is to ensure that the Waikato Intensive Care Unit operates at lower volumes over the next six months while recruitment into the SMO [senior medical officer] vacancies takes place, by limiting Waikato ICU bed numbers to match resource capacity,” the memo stated.
“As much as practicable, all tertiary level patients requiring transfer out of the Te Manawa Taki region will be sent to the nearest tertiary level intensive care unit … if intensive care capacity within the North Island is fully utilised then the transfer of patients to the South Island would need to occur.”
Michelle Sutherland, Te Whatu Ora/Health NZ’s interim group director of operations for Waikato, told the Herald the memo described a plan to be used only “if acute demand increased to a level which exceeded capacity”.
That hadn’t happened to date, she said, and enough locums had been secured to bolster permanent staff, meaning ICU rosters were filled through to the end of January.
“But we are asking staff to implement the relevant processes now so we are prepared if the protocol is required.
“Bed numbers change daily to reflect demand and resourcing. To date we have had capacity for all patients for whom ICU level care has been considered to be clinically appropriate and no patients have been diverted.”
Five hospitals perform cardiac surgery, and the delays are worst at Waikato. As of November 19, 62 per cent of cardiac surgery patients were overdue.
Cardiac surgery patients often need to recover for days in intensive care. In June, the number of planned cardiac surgeries was reduced to eight per week, down from about 12.
Some patients have been sent to other hospitals for their surgery. Those unable to be transferred included Tracy Collins, 68, who had a triple bypass in August, after waiting five weeks.
“At any given time there were four to five people in the ward, all sitting playing the waiting game … from Taupō, Thames, New Plymouth, Ōpōtiki,” his wife Theresa Collins told the Herald.
“The cost to the health system, the cost to people’s well-being, is huge.”
Theresa and Tracy Collins, from Ōhope. Tracy waited for over a month for a vital heart operation at Waikato Hospital, which was done in August.
There are less than half the number of permanent senior medical officers (senior doctors) required currently working in Waikato’s ICU, with 6.7 fulltime equivalent (FTE) vacancies out of a budgeted 11.5 FTE.
Two new SMOs will start in February, and will share head of department duties.
For registered nurses, there are 13 FTE vacancies, out of a budgeted 94 FTE. Registrar and house officer positions are fully staffed.
The vacancies relate to the current 16 resourced ICU beds. Construction recently expanded that to 22 beds, and other recruitment is underway to staff the increase.
“We have had a very good response from locums within New Zealand … there is a national and international shortage for intensivists, and because it is a specialist area, it can be difficult to recruit SMOs internationally who hold qualifications which are also recognised here,” Sutherland said.
“Our preference is to have permanent staff at budgeted levels and recruitment is ongoing for ICU. While the locum support is greatly appreciated, achieving our budgeted FTE would improve flexibility to cover staff illness or a spike in acute cases requiring ICU care.”
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If you can help us shed light on this issue, contact investigative reporter Nicholas Jones by email: nicholas.jones@nzme.co.nz
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Nicholas Jones is an investigative reporter at the New Zealand Herald. He won the best individual investigation and best social issues reporter categories at the 2023 Voyager Media Awards.
Natalie Akoorie is the Open Justice deputy editor, based in Waikato and covering crime and justice nationally. Natalie first joined the Herald in 2011 and has been a journalist in New Zealand and overseas for 28 years, recently covering health, social issues, local government, and the regions.
