Woman, 62, hits health worker after 21-hour wait in ED

As the medical system faces overload again during a busy winter, documents reveal healthcare workers in the busy Auckland City Hospital emergency department regularly face abusive behavior and threats from mentally ill patients. Sophie writes.
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A health worker was punched in the face by a 62-year-old woman who had spent 21 hours in the emergency department of Auckland City Hospital because there were no beds available in the mental health unit.

Another “extremely verbally abusive” patient told a hospital staff member, “I will remember your face and cut your throat, cut out your eyeballs and shoot you in the face.”

Documents released under the Official Information Act have exposed safety concerns at New Zealand’s busiest emergency department last winter, many voiced by frontline staff.

Hospital staff and managers are already concerned that with the arrival of winter illnesses and Covid-19, hospital emergency departments may not be able to cope.

Emergency medicine specialist Dr. Scott Orman wrote in an email last June that extended emergency department stays due to “lack of resources and flawed models of care” were not uncommon for ill health patients. mental. Patients could wait more than 12 hours to be seen by the emergency response service, an external community mental health team that responded to patients “in crisis.”

“We think these delays are contributing to the behavior escalating and everyone’s safety being affected,” he said.

In May of last year, a hospital health care assistant was punched in the face by a psychotic patient. The 62-year-old woman had been in the emergency department for 21 hours because there were no beds available at Te Whetu Tawera, the hospital’s adult acute mental health unit.

The patient waited a total of 27 hours before being admitted after being evaluated by an emergency physician as psychotic. She was referred for a mental health check at 2:30 pm that day and was seen by the emergency response service at 6:00 pm, which determined that she needed to be seen by a doctor.

An overnight psychiatry registrar finally saw her at 4 a.m. the next day, more than 13 hours after she was initially evaluated and referred to a mental health doctor for review. The woman was placed under the Mental Health Act, but she remained in the emergency department due to a shortage of beds in the mental health unit. As there were also no mental health surveillance personnel available, she was supervised by a health care assistant in that department.

The woman was not admitted to the mental health unit until 4 p.m., despite her behavior “escalating” and culminating in a punch to the face by the health worker. She then called security personnel to take over the guard. The health care assistant was forced to return to care for the same patient later that day to cover another staff member’s break.

In another incident, in July last year, a patient who had undergone psychiatric evaluation had to be restrained after threatening to commit suicide and attempting to leave the hospital. She was restrained by multiple security personnel who were kicked, spat on and racially abused by the woman in the emergency department.

While the patient was immobilized, there was discussion around her about the options for her care, whether to take her to the police or sedate her because the patient “was occupying an emergency bed for hours.”

The immobilized patient had a history of trauma.

The author of the email covering the incident also expressed concern that the restraint, while necessary for safety, had activated the patient, who had a history of trauma.

“I feel the pts [patient] was restrained for an unnecessary amount of time while arguments were made for her care,” the email reads.

“I feel it was inappropriate to be forced to argue a pt’s right to remain in the apartment while the pt was obviously distressed and causing other pts distress and required intervention.”

Internal emails from the Auckland District Board of Health referred to a third incident in August in which a patient was “extremely verbally abusive”.

The email, from the workplace violence and assault prevention advisor, said a patient had threatened to slit a staff member’s throat, while maintaining eye contact with them.

The incident occurred on the first day of Level 4 in Auckland’s August Covid-19 outbreak, with the assessor referring to increased levels of stress and anxiety already being experienced by staff due to the stress of the lockdown.

In response to questions about the delay in admitting mental health patients, Auckland District Health Board (DHB) director of provider services Mike Shepherd said there was no specific time frame for admitting mental health patients. ED in the service.

“Factors that affect the wait time to be admitted include the capacity and demand for the service, which fluctuates from day to day, and whether a Mental Health Law assessment is required.”

When a patient required an evaluation under the Mental Health Act, it could take six hours or more, Shepherd said. A mental health nurse educator was hired to work in the emergency department in response to the incident involving the woman waiting 27 hours to be admitted, she said.

The board of health also improved the handover information that is passed between specialists in the mental health service and the clinical emergency team. Shepherd said the DHB continued to provide “extensive training to reduce aggressive behavior” for adult emergency medical care and clinical safety teams.

“Some of the specialty or emergency services we provide involve caring for vulnerable patients with sometimes challenging behaviors,” he said.

It was important that staff remain safe and supported while providing the best possible care for patients.

“When violence or assault against our staff occurs, we come together to support them, their whānau and their colleagues.”

Staff were encouraged to report any incidents so that measures could be put in place to minimize the risk of a similar problem occurring again.

Emergency under pressure in winter

Emergency departments across the country have been under pressure over the past year, with an outbreak of respiratory illness (RSV) overwhelming some hospitals even before the community outbreak of the Delta variant coronavirus last August.

Security was called to the Auckland City Hospital emergency department 260 times during the winter months of last year, including 88 times in June, 95 in July and 77 in August. On June 30, security personnel were called nine times in 24 hours.

An audit of Christchurch emergency departments, published this month, found that violence and aggression towards staff was not improving.

Published in the New Zealand Medical Journal, the report found that verbal abuse and threats towards staff accounted for 69 per cent of all reports.

Incidents involving physical threats or assaults accounted for 20 percent.

Patients were often the aggressors, and the report found that intoxication and mental illness were common contributing factors.

OIA (Official Information Act) data reveals that security personnel were called to the Christchurch Hospital emergency department a total of 85 times during the winter of 2021.

Wellington Hospital’s emergency department operated at full capacity last winter, forcing Capital and Coast DHB to restrict visits in June after the RSV outbreak.

Security at the Wellington emergency department increased in July after an interim improvement notice was issued to management, which formally outlined nurses’ health and safety concerns, including overcrowding and feelings of insecurity. A security breach in July last year involved an incident in which a patient stole a magnetic card to get out of the emergency room.

That month, a group of junior doctors from Wellington wrote to the Herald saying that overcrowding and understaffing in the emergency department was dangerous and posed significant risks to patient safety.

The medical director of the Royal New Zealand College of General Practitioners and Porirua’s GP, Dr Bryan Betty, said last month that he was worried about the approaching winter.

“Every winter, the system stretches in New Zealand and [now] we are going to have Covid on us,” said Betty.

“Covid is going to be around, it’s just going to have ups and downs… so that’s a really mixed picture with a lot of potential demand on the system in the coming months.

“And I think it’s going to be a real challenge for ambulances, emergency services and hospital beds as well.”