STAFF at John Hunter Hospital have said the decision to put overnight patients in a "makeshift" ward at the back of the recovery unit in busy periods to cut down on costs was coming at the expense of patient safety and comfort.
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Staff members, who spoke to the Newcastle Herald on condition of anonymity, said patients typically stayed in the Post Anaesthetic Care Unit (PACU) for just a few hours following surgery before they were discharged or moved to another ward.
But overnight patients were being accommodated in the unit - without toilet facilities "or a chair to sit on" - for about 12-to-14 hours, and in one case, 36 hours. They said the PACU was not an appropriate area to accommodate patients for extended periods. It was noisy, and the lights could not be dimmed as surgeries continued throughout the night. Patients who needed to use the toilet either had to be "panned" or wheeled to a bathroom in the Intensive Care Unit (ICU). The unit had been used as a way to save beds during the recent flu epidemic.
"We were told it was never to happen again. But it has," a staff member said. "If they have a nurse look after patients in the back of recovery, they only pay for one nurse, but if they open up the over-flow unit - which is the day stay unit, so there are toilet facilities and it is better designed for patients - they have to pay two nurses."
Staff members also accused management of having patients admitted "into the back of recovery" before surgeries to get them out of the ED to meet targets.
"They are just shoving them into makeshift areas to get rid of them, and it is not an ideal place for people."
The Herald understands there have been as many as eight official complaints made to the hospital by patients who stayed in the PACU overnight.
Debbie Bradley, general manager of John Hunter Hospital, said the PACU was used "temporarily" to accommodate overnight stays due to an increase in admitted patients during January and part of February.
"The occasions where this area is used for this purpose are rare," she said. "The PACU is not a 'makeshift ward', it’s an appropriately equipped ward where we provide beds to patients who need them. The PACU was identified as the most appropriate space as it allowed a safe level of supervision for these patients. Most patients only stayed overnight and were discharged or moved to another ward the next morning."
Ms Bradley said some patients stayed longer if they needed specialised care and it was safest to remain in PACU, but extra staff were rostered to these beds to ensure patients received appropriate care and attention.
"All wards are staffed according to the State Award and shifts may vary depending on patient mix and need."
She said toilet facilities were available for PACU patients in the "close-by" ICU.
"If it’s not safe for patients to walk, bed pans and bottles are available, just like in any other ward."
Judith Kiejda, of the NSW Nurses and Midwives’ Association, said members had raised concerns with management to highlight the drain on resources. She said Hunter New England Health was doing a "disservice" to patients recovering in the PACU, as well as the additional patients "crammed into the unit" overnight.
"It is completely unacceptable for a major tertiary referral hospital like John Hunter to be treating patients like pawns; shuffling patients around in an attempt to save a few dollars by not staffing a short-stay or general ward appropriately," she said.
Ms Kiejda said Hunter New England Health appeared to be manipulating the "midnight census" which under-counts patient numbers, lowering the overall number of nursing staff to be rostered.
"This is yet another example of why NSW must introduce mandated, shift-by-shift nurse to patient ratios into our public hospitals," she said.
“Issues in the PACU appear to be more about a reluctance to provide additional staffing to the short-stay unit, rather than a bricks and mortar problem that the Liberal-Nationals have promised to fix in a few years’ time.
"We fear Hunter New England LHD will continue attempts to cut corners on staffing to save costs. We know staffing is always the biggest resource expenditure, that’s why senior management has had such a bad track record of manipulating nurse staffing across John Hunter. We really do need minimum nurse-to-patient ratios to be guaranteed in law, ensuring a future redeveloped John Hunter is staffed safely.”
Newcastle MP Tim Crakanthorp said he had been contacted by staff at the John Hunter Hospital who were concerned about patients being accommodated in the PACU during busy times.
He said appropriate nurse-to-patients ratios were vital to prevent skilled hospital staff becoming stressed out and over-worked.
"We are going to put 5,500 more nurses into this system over the next four years, which will benefit people throughout the state, another 1500 paramedics, another 2,240 cleaning and support personnel, and 250 more hospital security staff," he said.
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