Health comes in colours everywhere
FAREWELL Code Black, we barely knew you. Or, at least so far as health authorities were concerned, we never knew you.
Last week the government unveiled a new national system, ‘‘ED At A Glance’’, which aims to standardise management of emergency department wait times on a nationally consistent basis. Whereas previously when EDs had reached more than 145% of maximum occupancy a ‘‘Code Black’’ alert was issued, in future ‘‘Code Red’’ will be the highest alert level . . . and the previous mark of 120% of capacity which formerly triggered ‘‘Code Red’’ was to be boosted to more than 135% of capacity.
For hospitals in the South the code system came into place in 2020 when the Southern District Health Board adopted an ‘‘escalation plan’’ to manage ED overcrowding.
Then chief medical officer Nigel Millar had drawn upon overseas practice to create a colourcoded system intended to alert hospital planners when crisis points in hospital capacity were looming. The intention was that at lower levels managers would rearrange rosters, discharge patients who could go home, or call on more resources, depending on the circumstances.
‘‘Black’’, the most critical situation, was to result in an emergency response team being called out and the organisation’s chief executive and board chairman being notified.
In early March 2021 Dunedin Hospital did indeed reach Code Black, and staff reacted swiftly to manage patient flow back down to a reasonable level. The SDHB fully reviewed what had led up to the alert level being reached and instituted changes to try to avoid a repeat of the situation.
However, it did so at the cost of a PR nightmare, its worthy attempt at transparency being overshadowed by the illomened phrase ‘‘Code Black’’ and the connotations of doom and disaster it brought with it.
Ever since, southern health officials, and managers at other hospitals which also introduced what was and is a sensible tool to alert them to imminent problems, have struggled their hardest to argue that their facilities have not indeed hit ‘‘Code Black’’, even if it seems manifestly obvious to patients and staff that they had.
Unfortunately, hitting ‘‘Code Black’’ came to be seen as a consequence of management failure rather than a reflection of its causes: high patient flow, often of complex cases which take longer to treat, and severe staff shortages which mean that not enough fully staffed beds are available. Politicians were especially sensitive to any suggestion of a ‘‘Code Black’’ situation, especially politicians who had campaigned on reducing ED wait times back towards the longstanding target of being seen within six hours — a target which in itself is far too long, but that is another discussion.
Hence, like some miracle cure, ‘‘Code Black’’ has been wished away by the bureaucrats and we have awoken in a ‘‘Code Red’’ world, one which has all the hallmarks of the old one but none of the troublesome nomenclature. This is pure sophistry. None of the existing problems have been addressed by this nonsensical shifting of the goalposts and frontline staff will still have to manage the conflicting demands of not turning anyone in critical need away from ED with actually having somewhere and someone to treat them.
Noone wants ambulances to be backed up outside hospital doors with ill patients on board, or for those patients who are lucky enough to gain admission to be left languishing in corridors for hours until a suitable bed can be found, all the hallmarks of Code Black . . .
sorry, Code Red.
But pretending that this is not the daily reality for many New Zealand emergency departments is ignoring the elephant in the ED. The energy and resources which went into repapering the Parthenon would have been better spent addressing the resourcing issues which contribute so much to an alert level of any colour being reached.