1. Aotearoa: New Zealand
Michael Tetwiler

2. Auckland, New Zealand

3. Middlemore Hospital

4. Middlemore Hospital
The largest hospital operated by Counties Manukau Health.  Offering secondary-level (hospital and specialist) care and a selected range of community and domiciliary services.
The hospital was originally built for service patients from Allied military forces in the Pacific during WWII.
With a reputation for having the busiest Emergency Department in Austalasia…

5. Middlemore Emergency Department

6. Tari Rongoa Ohorere (Maori name for the Middlemore ED)
Health inequities of the indigenous Maori population clearly apparent in the ED.
Maori have mortality rates 2-3 times higher in middle age groups.
Rheumatic Fever rates are 25 times higher in Maori, making this effectively a disease limited to Maori and Pacific people.

7. Emergency Department Assessment of Chest Pain Score
EDACS is a clinical decision support tool developed in New Zealand to identify chest pain patients with low risk of major adverse cardiac events.
99-100% sensitive for correctly identifying patients as low-risk and identified 45% of its cohort as low-risk.
This is much higher than other ED-based risk scores like HEART, Vancouver Chest Pain Score, ADAPT, Marberg, and GRACE.

8. Shorter Stays in the Emergency Room
New Zealanders make 1 million visits to Emergency Rooms Annually
Demand for services has gone up due to increasing populations size and a higher proportion of patients living to advanced age.
This has resulted in patients experiences delays before being admitted to hospital, transferred or sent home.
July 2009 the Government introduced a new health target:
95% of patients will be admitted, discharged, or transferred from an ED within 6 hours.

9. Middlemore Emergency Department’s effort to meet the goal

10. Recognizing causes of long wait times

11. Lessons Learned to Improve Patient Flow

12. Recommendations to improve performance

13. Realizing these initiatives can be successful. Invaluable.

15. References
Ardagh M. How to achieve New Zealand’s shorter stays in emergency departments health target. New Zealand Medical Journal (1316).
Richardson DB, Mountain D. Myths versus facts in emergency department overcrowding and hospital access block. Med J Aust. 2009; 190:
Ardagh M, Tonkins G, Possenniskie C. Improving acute patient flow and resolving emergency department overcrowding in New Zealand hospitals-the major challenges and promising initiatives. New Zealand Medical Journal (1344)
Ardagh M, Richardson S. Emergency department overcrowding- can we fix it? NZ Med J. 2004;117 (1189). URL:
National Emergency Departments Advisory Group A Quality Framework and Suite of Quality Measures for the Emergency Department Phase of Acute Patient Care in New Zealand. Wellington: Ministry of Health.