• All hospital emergency departments (EDs) are failing to assess patients with “imminently” or “potentially” life-threatening conditions on time.
• More than 300,000 patients with time-critical conditions were not seen within recommended time frames during the first six months of last year, according to official information obtained exclusively by the Herald.
• Staff shortages, overcrowding, and hospital bed block contribute to delays, causing poor outcomes for patients and staff burnout.
• Analysis by the Herald reveals which EDs are performing the best and worst, and which are busiest.

All of the country’s hospital emergency departments (EDs) are failing to assess patients with “imminently” or “potentially” life-threatening conditions on time – a trend senior doctors say is a “massive problem” which increases the chance of death.

An analysis of official information obtained exclusively by the Herald has revealed the worst and best EDs when it comes seeing patients on time according to the Australasian Triage Scale – a best-practice standard followed by New Zealand’s EDs.

Wairarapa, Palmerston North, Auckland City, North Shore and Middlemore EDs are the worst in terms of not assessing and treating patients within clinically recommended timeframes.

TeKūiti, Gisborne, Taumaranui, Greymouth and Queenstown’s EDs - while still failing standards - perform the best.

Nationally, the data show 640,129 patients visited an ED in the first six months of last year and were assigned what’s known as a triage score – a rating which assesses how urgently a patient needs to be seen and treated based on their condition.

Two-thirds – or 424,677 patients – were not seen within the recommended clinical timeframes.

Anyone visiting an ED is rated on a scale from one to five depending on the seriousness of their condition. For example, a patient in cardiac arrest will be considered category one and should be assessed and treated immediately because of their risk of dying.

Even though data shows more than 1800 category one patients were not seen immediately in the first six months of last year, Health New Zealand Te Whatu Ora (HNZ) says it’s “rare” for critical patients not to be seen straight away noting staff don’t always record treatment times given how busy they get helping patients.

Even if it’s assumed all category one patients are seen immediately [despite official data not showing this], more than 300,000 patients arriving at EDs with “imminently” or “potentially” life-threatening conditions – classified as category two or three – were not seen and treated on time during the period in question.

Category two patients should be seen in 10 minutes, and category three patients within 30 minutes. An example of a category two patient could be someone with chest pain or a patient in respiratory distress, while a category three patient could be persistently vomiting, have dehydration or sepsis.

Category four patients should be assessed and treated within 60 minutes. Category five patients – who are less urgent – should be seen within 120 minutes. The following graphic ranks the worst to best-performing EDs based on how frequently patients classified in categories two to five are not being seen on time.

Long waits the ‘new normal’

Association of Salaried Medical Specialists executive director Sarah Dalton. Photo: RNZ / Nick Monro

Sarah Dalton, the executive director of the Association of Salaried Medical Specialists (ASMS), told the Herald patients not being assessed in a timely fashion “absolutely” increased the chance of death or the patients suffering further complications.

“If you are not seen within the recommended time frame, the likelihood of your hospital stay being longer is increased, and the likelihood of there being a negative outcome, which is either lifelong harm or even death is increased,” she said.

Asked how the country’s EDs are performing based on the data, Dalton said they were failing.

“If it was NCEA, it would be not achieved.”

She said long waits at EDs had become the “new normal” and it was because of failures across the health system which included not having enough GPs, what’s known as “access block” where there are no free beds on wards to admit new patients, and delays discharging elderly or vulnerable patients who have nowhere safe to go.

Dalton claims concerns raised by her union about understaffing are “routinely ignored” by managers at HNZ.

She said she felt blocked by excessive Government bureaucracy.

“Increasingly under Health New Zealand, decision-making has moved further and further up the hierarchy, so it’s almost impossible to get anything done,” she said.

HNZ chief clinical officer Dr Richard Sullivan said he was aware of the failures, and acknowledged staffing, workload and patient surges in EDs contributed to the problem.

He said all hospitals had plans to change the way they deal with acute patients – anyone who suddenly or unexpectedly needs to go to hospital.

“All districts have acute flow improvement plans in place. As we see the length of stay in our EDs improve, we expect assessment times to also improve,” he told the Herald.

‘Really concerning’

The New Zealand chair for the Australasian College of Emergency Medicine Dr Kate Allan has been an emergency physician for almost 20 years and works at North Shore Hospital and Waitākere Hospital. Photo / Corey Fleming

The New Zealand chair for the Australasian College of Emergency Medicine, Dr Kate Allan, told the Herald the data showing the number of seriously sick patients not being seen on time was “really concerning” and indicative of a system under “intense pressure”.

Allan has been an emergency physician for 20 years and works as an emergency medicine physician at North Shore Hospital and Waitākere Hospital.

“At the moment we are not delivering the care we need to our patients and what we need from our ministers and our Government is to listen to the clinicians on the front line,” she told the Herald.

Allan says by its very nature, emergency medicine can be stressful and overwhelming.

However, she worries about all staff in EDs when the cycle of being overloaded is perpetual.

“When it’s day after day and you’re unable to deliver care or you see harm happen that is when it gets really challenging. When you’re buffering a system that feels broken, that can be really challenging.”

She said the Herald’s data shows a “system that’s failing”.

Like Dalton, Allan said not seeing patients in a timely manner could lead to poor outcomes.

She said staff shortages at some EDs was a contributing factor.

“We do have significant workforce pressures. We need to retain the staff we have and keep bringing people into emergency medicine.”

The country’s busiest EDs

Doctors and nurses at work in a Auckland Hospital's emergency department.

Analysis by the Herald reveals which emergency departments were the busiest, according to all patients who were given a triage ranking between January to June last year.

On average, New Zealand’s EDs saw 147 patients every hour, or a patient every 24 seconds, during the period in question.

Christchurch’s ED tops the list with a total of 65,926 patients coming through the doors in the six-month period.

Middlemore Hospital’s ED comes next with 56,187 patients in the same time period.

Both emergency departments saw a patient, on average, about every four minutes.

Waikato Hospital, Auckland City Hospital and Wellington Hospital round out the top five as being the busiest in the country.

‘A constipated system’

Official information obtained by the Herald shows none of the country's EDs are seeing patients with life-threatening conditions on time. Photo / Ben Dickens

Another emergency medicine physician, who asked to remain anonymous, likened the failures to see people on time as a symptom of a “constipated system” where hospitals are unable to cope with demand.

“Seen by times are an essential part of providing quality care, and due to significant systemic understaffing and overcrowding our EDs fail to meet them,” she told the Herald.

The emergency doctor emphasised what evidence shows about ED delays, saying there’s a 10% greater chance of dying when more than 10% of patients are waiting for admission to a hospital bed.

She was critical of inaction by HNZ and backed up concerns about an unwillingness to listen to clinicians.

“Concerningly, rather than take action on the lack of hospital capacity and ED staffing when hospitals are close to capacity, the response from Health NZ has been threshold creep, with an increasing occupancy criteria required to be in ‘code red’, and a lambasting of clinicians who added an additional code black when occupancy is greater than 150% capacity.”

The Herald sought a response from Health New Zealand about whether occupancy thresholds have been quietly increased and is awaiting a response.

The doctor said staff were frequently faced with “dreadful decisions”, like who was safe to wait in their car for 10 hours if there were no seats in the ED, or which patient was more likely to have fatal abnormal heart rhythms and should get the remaining bed with monitoring equipment.

“This perpetuates a vicious cycle of staff burnout and further resignations and understaffing, which threatens to fully collapse our health system.”

Michael Morrah is a senior investigative reporter/team leader at the Herald. He won the best coverage of a major news event at the 2024 Voyager NZ Media Awards and has twice been named Reporter of the Year. He has been a broadcast journalist for 20 years and joined the Herald’s video team in July 2024.