Hospital chiefs answer patient and staff concerns following opening
NORTHERN Beaches Hospital bosses have defended themselves over complaints they were unprepared for the massive influx of sick people coming through the doors since opening on October 30. READ the full Q&A here.
NORTHERN Beaches Hospital bosses have defended themselves over complaints they were unprepared for the massive influx of sick people coming through the doors since opening on October 30.
The Manly Daily has received complaints from a string of unhappy staff and patients this week.
Hospital CEO Deborah Latta and Medical Director Louise Messara said the hospital had seen a greater number of extremely sick patients than anyone had anticipated and acknowledged it had put pressure on staff, as well as stocks of drugs and products such as bandages and syringes.
Staff had complained of a shortage of drugs and other basic essentials.
Reports that there were no tetanus injections available over the weekend was also confirmed.
A Healthscope spokesperson said: “Northern Beaches Hospital had a demand and supply issue for a short period of time over the weekend. This was rectified on Monday.”
READ SUMMARY OF Q&A BELOW:
Dr Messara said that on busy days they were seeing 50 per cent more ambulances arriving than Manly and Mona Vale hospitals used to receive combined — and 30 per cent more patients coming into the Emergency Department.
“It’s exceeded our expectations, ” Dr Messara said.
She said another challenge was many of the patients they were treating were also far sicker than they expected and were coming from out-of-area, including the lower north shore and Hornsby.
Dr Latta said on a couple of occasions paramedics had overruled the matrix which told them where to take a patient — they were allowed to do this — and brought patients to Frenchs Forest who would normally have gone elsewhere.
In response to concerns there was a bottleneck in ED due to a lack of staff to open more beds, Ms Latta said the plan had always been to open up more wards in stages.
In response to demand, they had doubled the capacity of medical and surgical beds since opening, with nearly 250 beds now available.
While recruitment was ongoing, another 50 to 60 per cent — on top of those who migrated from Manly and Mona Vale hospitals — would start soon.
Despite the bumpy start, Dr Messara said they had met all their targets for the most seriously ill but those who were not so critical had suffered long waiting times.
One example was a patient with a hand laceration, who needed a simple half- hour operation, being bumped off the surgery list five days in a row.
“We acknowledge that some members of the public have been really inconvenienced,” Dr Messara said.
“We appreciate the patience of the community. The staff have worked tirelessly to really understand the processes to make this the best hospital for the people of the northern beaches.
“We think over the last week we have seen improvement every single day in every single area.”
A summary of the Q&A with Hospital CEO Deborah Latta and Medical Director Louise Messara:
These are incidents and concerns that have been reported to the Manly Daily by patients and staff since the hospital opened:
A patient needing a half-hour operation for a laceration on their hand was bumped off the surgery list for five days in a row due to the number of cases coming through the doors? Is this true, do you know about it?
Deborah Latta: Yes absolutely. There were some less complex, less urgent cases that did take a while to get through the operating theatres, but it was because we had very complex, very seriously ill patients, and like any hospital they had to be seen more urgently. There were quite a number of those.
Were there more people coming through the operating theatres than you expected?
Deborah Latta: Yes and through the whole hospital than we expected. We expected that bump you always get lots more patients when you open a new hospital, a bright, shiny new hospital and people come but it has been greater than expected and more complex, seriously ill patients.
Are they coming from the local area or further afield?
Deborah Latta: Further afield.
How far?
Louise Messara: Definitely out-of-area in ambulances as well as self arrivals.
Debeorah Latta: The Lower North Shore we anticipated would probably come, probably not as early as they have.
Louise Messara: Patients that might have been closer to Hornsby Hospital.
Do you expect that to continue:
Deborah Latta: Probably. We have no control over that.
Will you be able to cope of they continue to come?
Deborah Latta: yes, we are building every day and we then just need to manage the demand.
A child had to wait eight hours in paediatrics for antihistamine? Is this true? Basic drugs were not in stock.
Deborah Latta: Again the demand was significantly greater than we anticipated. But we’re having deliveries twice a day every day for supplies. We have diverted resources to not just getting them into the hospital but also to get them into the departments they need to be in. We have done a lot of work to get that resolved.
Staff were saying they were not in stock to start with on day one. Why?
Deborah Latta: They were it was just the matter of making sure they were in the right places.
A patient who needed an iron infusion had to wait two days because there was none in stock?
Louise Messara: I have not heard about this but again I suppose at the beginning of any big enterprise like this everybody, it was their first day at work some of these processes are being ironed out about how to do these things effeicently and we are certainly getting better and better at that every day.
Other items staff said were not in stock were body bags, bandages, syringes and IV sets? Is this true?
Louise Messara: Yes in every unit there have been times where we have had to replace stock or divert stock and we’ve acted rapidly to reverse that situation but certainly when you look at some of the numbers on some of the days, 50 per cent more ambulance arriving at the hospital than had ever seen before at Manly and Mona Vale hospitals combined, 30 per cent more patients coming into ED overall. Although we planned for the increase in patient numbers it has exceeded our expectations and has been sustained.
We are being told by staff that ED is a bottleneck because there’s not enough nurses to open all the wards and therefore ED patients can only be admitted when another patient is discharged from a ward? Why?
Deborah Latta: We have doubled the capacity of medical and surgical beds since opening, with nearly 250 beds now available.
How many were open on day one:
Louise Messara: The way we tried to set things up was to establish wards that would develop and grow based on demand. As people have moved into the hospital we have constantly opened beds as we have brought in additional staff. We had only 105 transferring over from Manly and Mona Vale and we have doubled capacity in just a week.
Deborah Latta: We have always had that recruitment plan to continue to recruit and it is ongoing. We have another two thirds on top of those that migrated across that have been recruited before and since then.
Staff I have heard from said there was a lack of staff stopping more beds being opened, which was why ED was a bottleneck?
Louise Messara: It was always planned not to open all the beds on day one.
Responsible planning means we had to stagger and stage how we opened beds in the hospital.
How many beds are open now?
Deborah Latta: There’s around 220 beds open and we’re opening more every day. Actually it’s nearly 250.
Louise Messara: What we don’t want to do is over extend the bed numbers beyond where we need to be, it’s a fine balance and it’s what every hospital in NSW tries to do everyday.
Deborah Latta: The ED is improving every day in that respect as well.
Staff say they struggle to work machinery and patients have confirmed this. Why did not they not receive adequate training?
Deborah Latta: They received as much training as we could possibly give them while trying to keep Manly and Mona Vale operational at the same time. But we actually put machinery in like IV pumps and monitors of the same brand and sort they already had been using. We are continuing with training it’s ongoing. We have vendors and educators continuing to help them.
When agency nurses come in they don’t know how to use them either? Do you train them?
Deborah Latta: You can’t do that with agency staff, that’s the same in every hospital. There’s no way any hospital trains agency nurses before they come.
How many agency nurses are you using at the moment?
I haven’t got those numbers, we are supplementing the staff with agency to keep the beds open. Eventually we will have less than three per cent of staff from agencies. We’ve got as little bit of a way to go for that, but that that’s what we are aiming for.
Some people have missed out on meals and relatives have had to buy them meals.
Deborah Latta: Partly that’s a training issue for staff because people have been pretty busy and they have to put diet codes in order for that to happen properly. We have been educating people around that and we are understanding that people have missed a meal we get them one. I am surprised they’ve had to buy them.
Louise Messara: There are teething problems when you open but what we are doing is we are all on the floor all the time hearing directly from patients and staff acting immediately to rectify these situations. A lot of issues that you are raising will certainly no longer be issues. New computers, new processes, new phone numbers. It does take some time to understand what the next step is. If you patient doesn’t have a meal what is the right number to call? We have rectified this now and there’s a back up plan. Some of these issues are only detected once you start.
Staff are complaining that they are already stressed, they don’t have time for meal breaks and are working extra hours. What’s your response?
Louise Messara: We have to congratulate the staff the effort they have put in the weeks and months leading up to the hospital has been extraordinary. We understand change is really challenge at the best of times and change in healthcare can be very stressful and I think when you talk to people that things are getting calmer and more settled every day.
Deborah Latta: The staff say that every day is better than the last.
Louise Messara: But there’s no question it’s a stressful process. It’s an incredibly challenging process.
Deborah Latta: It’s actually a grieving process for them. People have been working at Manly and Mona Vale have been working there a long time. They are coming to something brand new and while it is exciting it’s also scary. They have risen to this.
From what I understand it is more than just grieving they are coming in and they feel it is chaotic and they are worried for the patients and stressed about the patients and the workload they are under.
Louise Messara: You will hear from clinicians about what they can provide and the quality of care that it being delivered (After this interview I spoke to five clinicians about some of the good work that had been done since the hospital has opened, which will form further articles in the coming weeks) People are stressed when they don’t know process. For some people it’s extremely exciting, others want to know the things they did yesterday will be exactly the same today. To some extent we have a job to do to reassure people that we have made process as close to what they had yesterday today.
Deborah Latta: We have had conversations to say how you care for people will not be different at all here to what you do before.
I’m just going back to what I am being told is that they are stressed because they haven’t got all the equipment or the drugs and that sort of thing?
Deborah Latta: Well they have all the equipment, they have better quipment than they ever have had ever before and lots of it. Yes, we have talked about the problems with supply of drugs and consumables abut we have moved to try and resolve it all for them.
Some say they have thought of quitting? Have you heard that?
Louise Messara: There’s been no resignations. All I get is excited feedback from doctors reporting that the images you see on the equipment is the crispiest they ever seen, the teamwork is amazing the morale is amazing. That is not to minimalise the stress that people are feeling, the tension people are feeling, the challenge of change. But there is another side to a lot of the stories we are hearing.
If you were to give yourself a mark on how well you had performed since opening what would it be?
Louise Messara: I think a mark would be minimising the complexity of this situation. We acknowledge that some members of the public have been really inconvenienced. We appreciate the patience of the community. The staff have worked tirelessly to really understand the processes to make this the best hospital for the people of the northern beaches. We think over the last week we have seen improvement every single day in every single area.
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