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Shameem SafihShameem Safih looks in control as all around him is chaotic. It’s just another typical day in Waikato Hospital’s emergency department. From next month Dr Safih, the hospital’s clinical director will swap the job he’s held for nearly 10 years in Hamilton for one as southern rural hospitals emergency departments clinical director. Surely he’ll miss the pace - the adrenalin rush that comes with being head of one of the country’s busiest emergency departments? However, the shifts he’ll do in Tokoroa Hospital’s emergency department, where staff see 9000 patients a year compared to 54,000 at Waikato, will be just as rewarding, he says. “I tell you sometimes the adrenalin there can pump faster (than at Waikato) because you don’t have the same support services around you. You get trauma with two or three patients, or even one patient in trouble and you are it. “You have yourself, maybe a security officer, maybe an attendant and maybe a couple of nurses. The pressure is on.” Dr Safih says he’s been working shifts at Tokoroa since December last year - two or three shifts here and there. “I really enjoyed it and find it rewarding probably because of the patients you see. It’s different from Waikato. You’re not double or triple handling because you’re it. You’re not waiting for some other doctor in a particular specialty to come and you’re not waiting for a bed.” However, sometimes the wait for the ill to transfer to Waikato can be traumatic for everyone. “Having to care for sick patients for two, three or sometimes four hours while waiting for the patient retrieval team to come can be very stressful.” Dr Safih recalls just recently he was with a one-day old baby who got sicker over three hours. “Just waiting those two to three hours for the helicopter to arrive seems like days, not hours. “Those are some of the challenges I want to go in and address, see if I can improve that area not just in Tokoroa but in Te Kuiti and Taumarunui.” The plan is to do three shifts a week at Waikato as an emergency department consultant and then two at Tokoroa with some consulting and administrative work at Taumarunui and Te Kuiti. “Even though they’re rural hospitals and you might argue the workload is not as much as Waikato, you still need people on the ground 24 hours a day, seven days a week. That’s the challenge. What we provide has to be clinically sustainable,” he says. The Fijian doctor came to New Zealand in 1987. He studied at the University of South Pacific and the Fiji School of Medicine in Suva and did his basic training at Lautoka Hospital where he stayed five years. Work there prepared him for his next stints at Auckland and Middlemore hospitals although he doesn’t get to see as many car vs train accidents as was the norm in Lautoka where the sugar cane trains claimed many victims. Clinical sustainability seem like buzz words but they drive district health boards these days, particularly ones like Waikato serving a population of more than 360,000 - 60 per cent of it considered rural - and the tertiary Midland population of 860,000. Dr Safih says Waikato Hospital’s emergency department has steadily become busier - the year he started there was 43,000 - last year it was 54,250. “The population has aged. We now see many elderly or complex patients who have many different illnesses. Nothing is simple anymore. They take longer to sort out because they are more complex cases and take more time to sort out.” Admission rates stayed the same - the admission rate from the emergency department into hospital is about 40 per cent. However, it’s the time that takes for admission, which has Dr Safih and his staff looking for support outside the department. There are challenges aplenty. Waikato’s is the smallest emergency department for the numbers they process. It is a busy place. “It creates a chaotic high-risk environment with lots of noise, lots of distractions, there are communication failures which results in issues for us.” So the prospect of a new emergency department next year has definite appeal. But it’s not just the department - the new medical assessment unit built above it will alleviate the pressure, he said. “It will get everyone else in the organisation playing their role in the management of acute care patients.” Another recent innovation is the Ministry of Health’s six-hour target rule for emergency departments. The goal is to see and process 95 per cent of all patients within six hours. “Until that came in we were left to carry on as best we can with everyone else’s patients in our department. We carried on looking after the patient until someone else came along. There is a drive now to get these other specialities working as well to clear the patient load. “I support the six hour target because it will mean improved quality of care to the patient and a shorter stay in the department. Our emergency department is not the best environment for people to stay in short term. It’s not like the quietness of the ward where wellness is apparent,” says Dr Safih. In his time at Waikato, many incidents stand out. The response to the Tamahere fire where the team performed very well under pressure. “People came in off duty. Whenever there is a crisis like that, people have the ability to drop everything and turn on. It’s the day to day overload where we struggle.” The real highlight though is the development of the consultant team. The department started with Dr Safih and now there are 10 specialist consultants. “It really means better care for the patient. It’s not possible for one person or two persons on a shift to see 30-40 people at a time. We’ve got that support now. We keep an eye on everyone in the department.” Low points are the increasing numbers of teenagers presenting drunk. “When the drinking age lowered we saw a definite increase in the number of teenage drunks - about 13, 14 and 15 years old. They become really, really drunk. “My feeling is Hamilton is becoming more violent. There’s a lot more assaults. Knifes weapons, kicks and punches all resulting in multiple serious injuries. My last shift I saw someone with a clot in the brain just from an assault. It’s a real worry.” ends Date: 17 February 2010 Job vacancy for clinical director here Picture copyright Waikato District Health Board Large version here |
