"The Rural Hospital Doctors Workforce in New Zealand"
An Article of interest Published on the Rural and Remote Health website 19th April 2011.
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2008 New Zealand Emergency Department Conference
On the 26th - 27th of September 2008, I attended the inaugural New Zealand Emergency Departments conference held in Taupo.
The Conference was organised primarily by the Midlands Emergency Care Co-ordination Team (ECCT) and Midland District Health Boards, with Ascribe the Gold Sponsor. It was a nonclinical conference designed to focus on issues common to all New Zealand Emergency Departments, such as overcrowding, long waiting times, ED and hospital access block and workforce issues.
Those attending included Emergency Doctors, both FACEMs and non FACEMs, ED Clinical Nurse Managers, politicians and representatives from the Ministry of Health and the Accident Compensation Corporation (ACC). The Conference provided an opportunity for the Ministry of Health to follow up from the national workshop they sponsored on May 13, 2008.
The opening address was by the Hon Ms Steve Chadwick, Associate Minister of Health. Ms Chadwick acknowledged that New Zealand Emergency Departments are under stress, but noted that Triage 1 and 2 performance indicators had much improved over the past four years. The Labour Government has invested $2.2billion into Primary Care which she felt should take pressure off our Emergency Departments. Mr Craig Climo, CEO for Waikato Hospital noted the following day that much of this $2.2billion had gone into incomes rather then skill development. Ms Chadwick mentioned an initiative arising out of the recent Ambulance Review, that is paramedics who will be able to treat some patients at home, rather than transporting to hospital.
The recommendations of an ED Working Party, formed after the meeting on May 13, will be submitted to the Minister of Health in December, with the Ministry anticipating that these recommendations, if accepted, will begin to be implemented bu July 2009. A draft of the recommendations was provided bu the Ministry of Health
at the Conference, and included retaining Triage for benchmarking but measuring ED performance using the health target of Length of Stay (LOS) of 6 hours.
The remainder of the Conference was divided into six sessions: Patient flow, Models of Care, Workforce Planning, Leadership, Ruralities and Quality and Audit. We learnt about three EDs who are currently involved in pilots of Optimising the Patient Journey; Lean Thinking; the development of a community based Acute Demand Strategy in Christchurch; and assessment units run by in-patient teams for GP referrals at both Auckland City and Christchurch Hospitals.
Other topics included the development of a Waikato Hospital Service Level Contract called Standing Operating Procedures, which specifies the response time expected from the Specialities to Pager contact and time to physically arrive in Emergency to assess patients. The Rural Hospital Medicine vocational pathway was introduced, as well as the evolution of ED Nurse Practitioners and Clinical Nurse Specialsits in New Zealand.
On the second day there was a very entertaining debate on the topic "Primary Care cases are major stressors on NZ Emergency Departments". Such convincing arguments were provided by both sides that the outcome was a draw.
The Conference was a resounding success. It was well attended with over 80 delegates - the presentations were excellent with plenty of time for discussion and networking during the breaks. The hotel facility on the shores of Lake Taupo was outstanding. At the end of the Conference the delegates were unanimous in their desire for a similar Conference to be held again next year, probably in the South Island, co-hosted by the Canterbury/West Coast and Otago/Southland ECCTs.
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