No beds, so patients waited in tent

Patients arriving at Nelson Hospital’s emergency department on Anzac Day had to be triaged in a tent outside after the hospital ‘‘simply ran out of beds’’.

On the public holiday, Nelson Marlborough Health took the ‘‘rare’’ step of initiating its Ambulance Ramping Plan ‘‘to support the pressure on beds’’, chief executive Lexie O’shea wrote in a report to the district health board on Tuesday.

Ambulance ramping is the practice of having patients wait outside in ambulances until a bed becomes available, rather than being admitted to the hospital.

In this incident, the hospital and St John opted to erect a tent where patients could wait, to keep ambulances free for other jobs.

About five patients were monitored in the tent over 24 hours.

Nationally, ambulance ramping occurs about four times a year in New Zealand, but a top emergency doctor warned this month that it could become more prevalent through winter as the Covid pandemic continues and winter bugs hit.

Nelson Hospital resorted to ramping for 24 hours, Nelson Marlborough Health general manager clinical services Pat Davidsen said.

‘‘We simply ran out of beds due to the acute demand over the holiday weekend, which led to ED being completely full.’’

Ambulance ramping was ‘‘very rarely used’’ – he could not recall another time it had been done in Nelson – and he did not expect it to become a regular occurrence.

Patients were triaged and monitored by St John and hospital staff in the tent ‘‘as a buffer to entering ED’’, he said.

They were very grateful to staff and partner agencies for responding when ‘‘exceptional demand made the situation severely challenging’’.

‘‘We had huge support from St

‘‘St John will instead opt to establish a location or area on site at the hospital, either in a medical tent or another part of the hospital, where patients can be triaged and cared for by St John and hospital staff until they can be admitted to ED. This was the case for us at Nelson Hospital on Anzac Day.’’

Resorting to ambulance ramping came as Nelson Hospital continues to grapple with a bed and staff shortage through the pandemic response.

O’shea’s report noted that occupancy in April averaged 76% in Wairau Hospital, and 87% in Nelson – but there were reduced beds in Nelson due to Covid-19 management.

‘‘Nelson continues with bed availability challenges.’’

Davidsen said the criteria for ambulance ramping required the ED to be ‘‘so full that patients cannot move through ED, all discharges have been completed and potential to transfer to other hospitals completed’’.

The main pressure on beds was Covid-19 cases, along with other respiratory illnesses, such as RSV and influenza and acute admissions.

‘‘Having a Covid ward reduces the number of beds available for general use as we cannot mix Covid and non-covid patients. The ability to staff beds also has an impact, especially as significant numbers of staff are off on sick leave often due to Covid isolation requirements.’’

Prior to Anzac Day the 20-bed Assessment Treatment and Rehabilitation ward was only accepting Covid patients, he said.

Since then, a review had freed up eight beds for other patients.