· by carlhorsley.bsky.social ·18h ago · view on bsky.app ↗

Auckland hospital hits 'terrifying' record as patients treated in corridors (nzherald.co.nz)

Healthcare workers say the 'broken' system is 'on the brink of collapse'.

Middlemore has always been a bellwether for the wider system. Previous ED targets had some impact due to frontline driven improvements, relatively high staff morale and supported with additional resources. These are not the conditions currently. #nzpol www.nzherald.co.nz/nz/auckland/...

#nzpol

4 comments — live from bluesky

Stu Innes · 2 · 18h ago

But why give any carrots when they cost money, meanwhile you can just keep beating people with the stick?

Sophie these days · 1 · 6h ago

Thanks for posting. This is the crisis everyone saw coming.

Carl Horsley · 9 · 18h ago

Staff have expressed concerns for many years, including the report from staff in 2024: www.nzherald.co.nz/nz/more-than...

Carl Horsley · 4 · 18h ago

The increase in numbers has also been accompanied by an increase in the ED triage severity. There are more people coming and they are sicker when they present. Delays in seeking care due to costs and the availability of alternative services are long-standing and well recognised.

Carl Horsley · 10 · 18h ago

But the problem is difficult to solve. Previous optimisation of ED to ward flow has reached its limits. Hospital, primary care and community care (including ARC) have limited capacity in the face of increasing demands. ED performance reflects a "whole of system" problem, not just the hospital

Alan Garner · 4 · 18h ago

Collapse of the ED workforce is coming fast. You can’t keep turning up for that if you care even a shred.

Carl Horsley · 2 · 18h ago

And they do. I'm in awe of the dedication of the ED team. Doing great work under difficult conditions.

Alan Garner · 4 · 17h ago

It is not sustainable. I have left ED practice - I’m old so maybe it matters less. But I know emergency physicians in their 30s who are much smarter than me who are actively planning their exits.

Alan Garner · 2 · 4h ago

I should add that caring is the problem. The cognitive dissonance required to continue in an environment that guarantees poor care and error when you personally strive to deliver excellent care to everyone is the core of the looming crisis.

Carl Horsley · 1 · 3h ago

Moral injury = the gap between the care we want to provide vs the care we are able to provide. Efficiency - thoroughness tradeoff at the heart of this. What care can I provide to the individual vs the level of care needed to keep the wider system functioning? Both have associated harms

Carl Horsley · 2 · 16h ago

I completed my FACEM before switching to ICU. There are good people there but personally glad to be in ICU currently.

Alan Garner · 0 · 16h ago

Exactly

Carl Horsley · 5 · 18h ago

Again, the concept of "Going Solid" is highly relevant in understanding this. Increasing load drives a focus on efficiency. The system is highly optimised but increasingly brittle. It has less ability to adapt to additional loads and may degrade unexpectedly. pmc.ncbi.nlm.nih.gov/articles/ins...

Kev Lucky - Left of centre moderate. · 0 · 15h ago

I'm never going to subscribe to the Herald,[ too much of it is pure slop] but I'd be keen to know what the report was that they referenced and if it is available in full online for an unedited viewing.

Caroline · 0 · 18h ago

My daughter may never walk again due to delay in care at Middlemore. She nearly lost both feet

Carl Horsley · 0 · 18h ago

I'm so sorry to hear that. That is incredibly hard and an outcome no one would have wanted. The staff there have been doing the best they can and aim to provide the best care possible. I know and respect the work they do, especially given the conditions. I wish your daughter well in her recovery.