High Dependency Unit at Wellington Hospital helps ease bottleneck

Staff at Wellington Hospital say they could do with a hundred more beds, but the year-old High Dependency Unit has gone some way to easing the bottleneck.

The unit has 12 beds for people too sick for the ward, but too well for intensive care.

On this particular Tuesday, nurse manager Stephen James takes us past the family room, staff office, sleuce room, and a desk behind which a number of screens show patients' vitals in real-time, making it easy for staff to monitor every patient from a central location.

The rooms are light and airy, with windows - unlike intensive care - and it is mostly quiet, aside from the steady beep of machines and the sound of nurses discussing medication at the foot of a patient's bed.

Many of the processes mirror those used in the ICU, including paper charting.

"This is where we're not electronic," James said. "The transition of the technology is still so expensive we're just not ready to make that yet."

The staff monitoring patients are looking for trends - someone getting worse will head back to ICU, or if they are getting better, to a ward.

That meant patients were able to recover somewhere a bit quieter, while still being monitored closely, and beds on wards and ICU were freed up, improving patient flow through the hospital.

"Sometimes we would be forced to push patients to the ward sooner than we were happy to," he said. "And we have statistics and data that we analyse where we see patients bounce back from the ward. So if we transferred somebody in the middle of the night, it's not great to come in the morning and see that they're needing to come back."

James explained planned surgeries would be cancelled if acute patients demanded the bed space, so making more beds available for the sickest patients meant planned surgeries went ahead more often.

But when it came to beds, they could always use more.

"I think you would say we need another 100 beds in every hospital, and that we would fill them. And it's because there's so much we can do for people."

While work was underway at a national level to understand how care in the home could add capacity to the system, the sickest people still needed to be in hospital.

"We're very much in the middle of it all in the acute setting, so we can be a bottleneck," he said.

The unit was built following the Covid pandemic, at a cost of $17.3 million, financed through annual hospital depreciation funding.

It was part of a government push in 2024 to bolster the country's preparedness in the event of another pandemic.

"We were very underdone internationally in our critical-beds-per-100,000-population, and we've made great strides in the last several years to improve that, which these 12 beds are part of," James said.

Winter illness, too, increased demand every year.

Health minister Simeon Brown announced a winter funding boost of $25m earlier this year to increase capacity and staffing nationwide.

Dr Paul Young, intensive care specialist and co-clinical leader in the ICU, said it would not increase the HDU's numbers, as the unit was at or near capacity year-round.

He said the ICU had 24 beds, and along with the 12 in the HDU, the units required a combined staff of between 250 and 300 nurses, 14 intensive care specialists, and 28 registrars.

Another four were being added to the ICU currently.

"The entire hospital doesn't have enough beds, and beds need to have people in them," Young said.

But winter would likely increase the acuity of the patients.

"We'll probably basically stay as busy as we are now, just looking after slightly different people."

Variability was a hallmark of the job. On this particular day, Dr Young would work his shift and then remain on-call overnight, treating anyone from trauma patients, to those recovering from major surgery or with acute medical conditions.

"Intensive care medicine is the triangle you get if you chop the top off all the other triangles and make a new triangle," Young said. "The kind of things that we see from day-to-day are really varied."

The one thing they had in common was that they were among the sickest people in the hospital - and for them, having one of those 12 beds could make all the difference.

Sign up for Ngā Pitopito Kōrero, a daily newsletter curated by our editors and delivered straight to your inbox every weekday.