In and out of ED in 6 hours? Maybe, if you're dying

Saturday, 19 July 2025

An ED nurse has described Wellington hospital’s emergency department as, at times, unsafe, while another has told of patients, distressed and in pain, waiting in corridors for up to 30 hours before being seen by a doctor.

Their experiences are not unusual; similar scenes play out every day in hospitals in our biggest cities. A perfect storm of lengthy wait times to see a GP, an upswing in young people presenting with mental health issues and increasing numbers of patients with complex needs is pushing emergency and after hours services to the brink.

Once typically linked to higher illness rates over winter months, crowded EDs and after hours clinics are now the norm, with Wellington Hospital ‒ where less than half of all ED are patients seen within the recommended six hours ‒ the most stretched in the country.

Nurses union delegate Storm Baker, an ED nurse with 38 years under her belt, paints a grim picture of treating trauma cases in a nearly always at-capacity hospital: patients in beds and trolleys in corridors, sometimes for hours; emergency transfers to CT or ICU blocked; staff wheeling intubated patients past families and others stuck in hallways.

“Can you imagine being stuck in a corridor waiting for 15, 30 hours? Imagine someone in crisis being seen by dozens of strangers in a corridor. Where’s the privacy? Where’s the dignity. It’s distressing ‒ ethically and emotionally.”

While a chronic staff shortage was at the heart of the crisis with big numbers of nurses heading to Australia for better pay and working conditions, overflow from general practices, overwhelmed aged care facilities and mental health services meant EDs were now a last resort for many, exacerbating the problem, she said.

“We're trying to deliver high-quality care in a system that’s chronically under-resourced. And it shows. Health and education are the basic needs for a productive society surely.”

Another ED nurse, who The Post agreed not to name, was also worried about patient safety with the department overcrowded and “clogged up more often than not”.

“Things can change really rapidly. One moment it’s fine and you can cope, but then you have an influx of ambulances arriving, like within the space of 20 minutes … and they all need to be seen immediately.

“We’re always sort of putting out fires. It's scary for us, and we feel that stress, but it's also scary for the patients. We have families constantly come up to us saying, ‘you know, my mum or my brother, they haven't been seen by anyone for ages and now their pain is really bad’, or ‘now they're like, vomiting more’.

'Last week I came on to a night shift, and there were code twos ‒ high-acuity patients ‒ who had been waiting six hours to be seen by a doctor. That’s just not the standard we want to give.

“It can be really frustrating because you feel like you’re not a good enough nurse for your patients. And [you] just feel kind of shit about that. We don't like having to say ‘we don’t know’ to patients, when they ask, ‘how long is it going to be till I'm seen’ or ‘how long until I'm able to go home’.”

People turning up in acute mental distress was common “and that’s absolutely reasonable” but, again lack of staff was an issue, he said, with the region’s crisis resolution services (CRS) team numbering just three.

“Every second day, I'm getting at least one presentation of someone coming in with suicidal ideation or suicide attempt. You've got these people who really need a lot of attention and emotional care and reassurance, and to be seen kind of quickly.

“They’re asking ‘when can the CRS team going to see them?’ It could be one or it could be 12 hours. The mental health services are just completely overrun.”

‘Medieval-level care’

Meanwhile one parent has labelled Wellington’s after hours health care as medieval following a nightmare few weeks of not being able to get doctors’ appointments for her two daughters.

In the first instance the woman, who asked not to be named to protect her daughters’ privacy, was forced to take one of them to the after hours medical centre in Newtown after being told ambulance wait times “for less serious cases” were unknown.

“We called the ambulance because my daughter was having an extremely painful reaction to a new drug. They said, look, yes, she needs to be seen by someone, but we don't have a time where we could come and get her, so you’re better off to drive her yourself.”

It was early Friday evening. They spent 4½ at the clinic. During that time, she says, people were being told there would be more doctors on later, “there were people coming in with little kids who were leaving and coming back to start waiting all over again, because they just couldn’t stay … it was really bad”.

A week later her other daughter tried to get an appointment with her doctor for an infected toe, having tried unsuccessfully to treat it at home.

After failing to get an urgent appointment during a Saturday clinic ‒ “she rang the moment they opened in the morning but the queue was so long she couldn’t get seen that day” ‒ she was told the next available appointment was in three weeks.

“By which point she might have had sepsis. This is on top of incredibly long waits by friends and colleagues in ER last year; often involving their very much younger small children.

“The staff are amazing, but this is medieval-level care we’re talking about … it’s scary. People shouldn’t have to cry and scream before their kids get seen.”

Another mum told The Post she recently spent 12 hours in ED waiting for a consultation for her son who has mental health issues.

Samantha Murton, a Wellington doctor and the president of the Royal New Zealand College of General Practitioners, said the six-hour target ‒ where 95% of patients should have their ED stay completed (admitted, discharged, or transferred to a ward) within six hours of arrival ‒ was standard in many countries.

Triaging would always prioritise the sickest and most seriously injured, but patients categorised as lower priority “shouldn’t be there for more than six hours” either, she said.

A recent UK study published in Emergency Medicine Journal found that a five-hour wait to be admitted to a hospital bed results in one additional death for every 82 such patients. This death rate increased if patients were left waiting even longer.

More than bad architecture

Health Minister Simeon Brown puts Wellington ED’s poor performance down to outdated infrastructure “that is no longer fit for purpose”, saying its layout was contributing to long wait times and people leaving without receiving care.

Murton argues it’s a lot more than badly designed architecture. It was also about training more doctors, “300 to 400 a year”, and about having the resources to do that.

The General Practice Owners Association (GenPro) last year estimated 290,000 Kiwis are not enrolled with a general practice, and that “about half” of general practices had closed their books to new patients as doctors struggle to keep up with demand.

Murton said evidence out of Norway, which has the same population as New Zealand, showed that for people who had been with the same GP for several years, mortality dropped by 24%, hospitalisations went down by 28%, and after hours care fell by 30%.

Australia had an average of 110 full-time equivalent (FTE) general practitioners (GPs) per 100,000 people. Here it was 74 “at most and in some parts of the country it’s 57 per 100,000”.

“We’re way short. We are seeing 80,000 [patients] a day across the whole of general practice.

“Where the volume needs to be is in primary care, because we're dealing with people [with] complex multi-morbidity, lots of different conditions. It’s the people with heart attacks, rampant infections, pneumonia that are getting admitted acutely.

“They are all things that if you dealt with them early enough in the community then they wouldn’t end up there.”

It was also about the continued pressure and stress of the job for those working at the coalface.

“It’s a really, really busy job and it’s a really interesting job, but it needs to be long-term doable. And I think that’s where people struggle, being put under this level of pressure all the time, not be able to have holidays because there’s no one else to fill in for you … all those things. More doctors in the community would make an enormous difference.“

Murton, like a number of GPs, is also on the roster to provide after hours care at the Wellington Accident and Urgent Medical Centre (WAMC) in Newtown, working two shifts a month, either at weekends or after wrapping up at her own practice.

While the Government funds GP clinics based on the number of enrolled patients they have regardless of the services they receive, through a capitation system, after hours centres do not receive the same funding.

WAMC is Wellington’s only ACC-accredited urgent care centre, and forms part of a wider urgent care network, collaborating with Wellington Hospital’s emergency department, Wellington Free Ambulance, and Kenepuru and Hutt after hours.

Having been among those who have queued up outside the Adelaide Rd clinic before it opened in an attempt to see a doctor more quickly, its general manager Michelle Chadwick understands the frustration.

“It’s always busy, but that’s health, we’re always short of one resource or another. It’s either doctors or nurses or money or a combination so it’s business as usual, really, for us.”

Similarly The Post reported last year the Lower Hutt After Hours clinic had taken to unlocking its doors half an hour before it officially opened to accommodate queues.

The Wellington centre sees about 42,000 presentations annually ‒ on average between 115 to 145-plus each day ‒ with peaks at 8am and 5pm.

Wait times could vary, and arriving first thing didn’t necessarily mean it would be less busy, Chadwick said.

“We can’t predict when we're going to be busier, it depends what people are presenting with. If someone's coming in with a sore toe and we have lots of people like that, then the turnover is quite quick. But if people come in and they're more unwell, then even with fewer patients, you can have an increased wait time.”

Other factors included the number of doctors on at any given time, and in winter, the impacts of staff sickness.

Chadwick said the clinic was seeing growing numbers of young people with mental health issues, some of whom could be referred on to counsellors at the new Crisis Recovery Café at Whakamaru, and patients who either weren’t enrolled with a GP or couldn’t get an appointment with one.

As with other emergency departments it used a triage system to prioritise patients before they saw a doctor. Currently two thirds were triaged within 15 minutes, 45% were seen by a doctor within an hour and 60% were seen within two hours.

“Ideally we would be funded so that we could have urgent care doctors running here all the time. The GPs are completely overwhelmed in their own practices, so to come here and do an extra shift … they do it because they're looking after the patients. It’s hard work on top of what they're already doing.”

Chadwick said Health NZ was actively engaged with the centre to help deliver improvements, reduce ED wait times and ultimately achieve better outcomes for patients.

In the quarter ending December 31, 2024, there were 12,000 more patients presenting to emergency departments compared with the same quarter in the prior year. However, wait times in emergency departments are falling, with the most recent data showing 74.2% of patients being admitted or discharged within six hours, an improvement from 70.1% in the same quarter last year.

The Australasian Triage Scale (ATS) is used in emergency departments to assess and prioritise patients based on the severity of their illness or injury. The Government has a target of 95% of patients to be admitted, discharged, or transferred from an emergency department within six hours.

At just 49.1%, Wellington hospital has the worst wait times, something Brown said the Government was looking to fix. While a plan to cut beds from its gynaecology and maternity wards in a trial aimed at making more room for ED patients was short-lived, he said redevelopment of the department would provide 126 additional beds and treatment spaces.

In comparison, the Hutt Valley saw 70.6% of patients within the target time, Auckland saw 67.9%, Counties Manukau 69.1% and MidCentral 60%.

Official information provided by Health NZ shows the median time from arrival to discharge for category 1 patients presenting at Wellington hospital ED over the two years to December 2024 ranged between 210 minutes (May 2024) and 302 minutes (June 2023), while for category 2 patients times varied between 341 minutes (May 2024) and 369 minutes, just over six hours, in July 2024.

Categories are as follows:

• Category 1 and 2 patients need lifesaving treatment within seconds or minutes of arriving

• Category 3 and 4 patients are considered urgent but non-emergency or semi-urgent

• Category 5 indicates a non-urgent patient who may wait several hours to see a doctor during busy periods