Acute care is usually time-sensitive and can result in death or long-term disability if the person does not receive the care they need in a timely manner.
People generally manage their own health through self-diagnosis and care, supported by people around them.
However, when acute care is required the goal is that people are able to access the most appropriate care, when and where they need it.
This could be at a general practice or other primary health care provider, diagnostics or mobile services or home support services. It can also be in hospitals and will often be in emergency departments in the first instance.
As in other developed countries, the demands on New Zealand’s acute care services are growing, due in part to our growing and ageing population and the proliferation of long-term conditions like cardiovascular disease and diabetes.
In addition, our workforce will continue to be stretched as many GPs and nurses will retire over the next 10 years.
As the demands on our acute care system are projected to increase even further over the next 10 years it is important that acute care services identify different ways of working so that they can manage these demands effectively.
Key acute care performance indicators
The models of care used by DHBs around the country will vary depending on a range of factors.
Although each model of care will have its own measures of success, there are two key measures that are monitored to gain an overall sense of how well the acute care system is performing.
These two measures are the:
- Health System Indicator of acute hospital bed days
- 6 hour target of shorter stays in emergency departments (SSED).
Changes in these two measures help identify whether any changes within the system have been effective.
A range of other health indicators can build on these measures to give a wider view of acute care performance.
These include performance in planned care, timely triaging of patients, patient experience, access to services (including cancer services) and other quality and safety metrics.
Health System Indicator: Acute hospital bed days
The Health System Indicator of acute hospital bed days establishes the use of acute services per person in secondary care that could be improved by:
- effective management in primary care
- transition between the community and hospital settings
- discharge planning
- community support services
- good communication between health care providers.
The indicator is used to manage the demand for acute inpatient services on the health system.
Its purpose is to reflect the level of integration between community, primary and secondary care services and to enable making the best use of health resources for planned care rather than acute care.
Information about performance against the acute hospital bed days Health System Indicator is available on the Health Quality & Safety Commission website.
Shorter stays in emergency departments (6 hour target)
To meet the target of shorter stays in emergency departments, an emergency department must admit, discharge or transfer 95 percent of patients within six hours.
Long stays in emergency departments are linked to overcrowding, which is associated with delays to care, longer hospital stays, decreased satisfaction, adverse outcomes and, most significantly, increased mortality.
The underlying causes of emergency department overcrowding span the whole health system.
One cause is access block – that is, an inability to admit emergency department patients to inpatient wards.
Information on performance against the 6 hour target is available at How is my DHB performing?
Top tips for managing acute demand
It is important that acute care services identify new ways of working to manage greater demands effectively.
A Top Tips document has been designed to identify gaps in local acute service delivery.
It provides tips to implement strategies for teams, departments and organisations wanting to see improved practice and improved health outcomes for their patients.
The Top Tips resource was produced in 2018. We are currently seeking feedback from the sector on what needs updating and where there are examples of implementation of good practice that others may be able to learn from.
Emergency departments (or EDs) are one of the key entry points into the acute care system.
Information about New Zealand ED departments is available at Emergency departments.
Acute Care Sector Advisory Group
The Acute Care Sector Advisory Group (ACSAG) provides expert advice to Te Whatu Ora about proven ways to improve acute care.