Wellington Hospital's emergency department. Photo: RNZ / REECE BAKER
- A Health NZ review shows a sharp spike in patients who discharged themselves dying within 30 days of presenting at an Emergency Department
- Health NZ says there's been an increase in "self-discharge" cases, but the rise in deaths is not attributable to this alone
- The report also shows patient access to prompt and appropriate primary and hospital healthcare has deteriorated "markedly" in recent years
A Health NZ review shows a sharp spike in patients who discharged themselves dying within 30 days of presenting at an Emergency Department.
The spike was revealed in the review released on Thursday.
Analysis by Health NZ showed the average number of Triage 2 and 3 patients (whose condition is deemed to be imminently or potentially life-threatening respectively if they are not seen within a certain time) who self-discharged from EDs increased by 120 percent from 2016-2019.
Meanwhile the mortality rates for Triage 2 and 3 patients who discharged themselves, were twice as high in 2022-2023 (0.31 per 100 Triage 2 and 3 self-discharges) compared to a baseline period of 2016-2019 (0.15 per 100).
In 2016, less than 25 Triage 3 patients died within a month of leaving ED early, compared to 2022 when around 90 self-discharged Triage 3 patients died.
Health NZ says there has been an increase in people discharging themselves, but the rise in deaths is not attributable to this alone.
Annual deaths by triage category for self-discharged ED patients (national). And 30-day mortality ratio by triage category for self-discharged patients (national), Aotearoa New Zealand, 2015-2023. Photo: Te Tāhū Hauora
Chief clinical officer Richard Sullivan said the data would be analysed more closely, but it appeared 40 percent of the cases knew they were terminally ill.
"So our assumption is that it may have been around issues of accessing primary care or services in the community, which is obviously a concern because that would be better managed there."
Some of those people were also admitted, he added. "But the data system did not pick it up and they passed away in hospital."
He said it was "reassuring" that some of those people did not die unexpectedly, but the issue of "care in the right place" needed to be fixed.
Sullivan said the 30-day mortality rate for patients discharging themselves was trending down.
"The peak we saw in 2022 is not ongoing," he said, adding that it was "not quite" at 2016 baseline levels "but close to it".
The Clinical Quality and Safety Review: Longitudinal Data report also shows patient access to "timely" primary and hospital healthcare has "markedly deteriorated" in recent years.
Along with self-discharge ED mortality rates, things that got worse in the past decade included people waiting for more than four months for a first specialist appointment, and rising rates of healthcare-associated Staphylococcus aureus bactaeremia (HA-SAB) cases. The rise in staph infections, which can be serious or fatal for vulnerable hospital patients, occurred despite improved hand hygiene among medical staff.
The rate of preventable pressure injuries to hospital patients also rose significantly, with hospital admission coded data showing a 42.5 percent increase in the rate of hospital-acquired pressure injuries between 2017 and 2023/24.
Areas of improvement included a reduction in patient harm in relation to falls, and decreases in surgical site infections and in-patient cardiac arrests.
The health system review examined quality and safety, patient experience, and harms data over the last decade. It was requested by outgoing health commissioner Lester Levy last year and completed in November.
In Health NZ's response to the report, Sullivan said the agency would take "a belts and braces approach" to areas where concerns had been identified.
"Identification has been made easier by our better ability to collect data across the system, and work to address issues will be enhanced with a more prominent clinical voice."
Health NZ says the findings of the review will be incorporated into "ongoing clinical quality and safety monitoring and improvement", while a national Health NZ clinical governance framework, that aligns with Te Tāhū Hauora Health Quality & Safety Commission governance framework, will be in place by mid-2025.
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