NZNO calls for audit of Middlemore Hospital’s voucher and app scheme

8:16 pm on 8 September 2020

The New Zealand Nurses Organisation (NZNO) has criticised Middlemore Hospital's emergency department for its use of vouchers to get non-acute patients to go to private accident and emergency (A&E) clinics.

Accident and Emergency

File image. Photo: 123RF

Sandra Richardson is the chair of the NZNO College of Emergency Nurses. She said the use of vouchers and an app was not addressing the underlying problem.

"Presentations in emergency departments (EDs) are increasing across the country but there has been limited or very minimal investment in nursing staffing positions in New Zealand EDs," Richardson said.

"The Ministry of Health (MOH) has a redirection process, but NZNO and the NZNO College of Emergency Nurses New Zealand believe no member of the community should be denied care in the emergency department (as per the MOH guide) and patients must be given the opportunity for an informed choice without undue influences."

The DHB started work two years ago on a plan to improve the care and flow of patients in and out of the hospital and the use of the Emergency Q app and vouchers were adopted on a trial basis as a result.

The DHB typically issues 200-300 vouchers a month and up to 500 at busier times.

The app allows emergency department staff to advise patients of the wait times at local urgent care centres and whether they need to go to the hospital, or visit an accident and emergency clinic.

Richardson called for a thorough review of the scheme.

"We are unaware of any quality processes and audit criteria surrounding the Emergency Q app - but emergency nurses are being instructed to use this process during the times of overcrowding, which are representative of the wider health system issues," she said.

"However the unmet need is recurring daily. An app is not the solution. Ensuring safe staffing in EDs is. Evaluation of the system is needed including following-up with patients, and any patients who are sent back to the ED for further treatment."

Richardson said providing better primary healthcare services was vital.

"It is unclear whether primary care is resourced to take these redirected presentations via the Emergency Q app. The need for accessible, low-cost primary health care is crucial for ensuring communities' health needs are safely and efficiently met.

"Evaluation of the system is needed including following-up with patients, and any patients who are sent back to the ED for further treatment."

The DHB was not willing to say how much the vouchers cost each month, citing commercial sensitivity.

But a Counties Manukau Health spokesperson said the system ensured the emergency department was available for acute emergencies, while enabling non-acute patients to be treated at other healthcare centres without having to pay for the visit.

Association of Salaried Medical Specialists (ASMS) executive director Sarah Dalton said there were benefits in using the voucher system.

She said a lot of people went to hospital emergency departments for primary healthcare because they could not afford the cost of visiting their GP, or they could not take time off work.

"For emergency departments like Middlemore Hospital, the vouchers are a good option and for the patient it means less time spent waiting in accident and emergency," Dalton said.

But she said the issue did highlight the need for free after hours primary healthcare at public hospitals. That would allow non-urgent patients access to treatment without increasing the workload of emergency department staff.

Counties Manukau Health was asked to comment on this story.

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