NHB Newsdesk - August 2012
A Ministry of Health funded mass casualty preparedness tool has been put to the test in a recent influenza pandemic exercise based at Nelson Marlborough District Health Board (NMDHB).
The Emergo Train System (ETS) tool was designed to test the resilience of the health sector during emergency events.
St John is licenced to carry out the exercises with DHBs and over the last three years has used the tool to test the sector on a range of scenarios, including pandemics, train crashes, stadium collapses and natural disasters. It was also used to prepare services for the 2011 Rugby World Cup.
The tool requires emergency services to work collaboratively in a simulated environment and takes into account such things as ambulance utilisation, staff availability and placement, hospital constraints and clinical resources available, as well as a range of other factors.
NMDHB Emergency Manager Pete Kara said the tool enabled the staff to take part in a valuable practise opportunity.
“It also gave us an understanding of the importance of working efficiently and effectively with other regional health agencies,” he said.
It was great to see how the people who would be involved in a real pandemic response worked together.
"For us, the simulation underlined the importance of testing and reviewing emergency systems ahead of significant events.”
Following the exercise, the DHB was able to evaluate their response and identify areas for improvement and any training requirements that might be needed.
For more information about the ETS, visit the Emergo Train website.
The National Health IT Board (NHITB) has nearly completed a series of seminars about electronic sharing of health information.
By the end of 2014 the Government’s aim is for all New Zealanders and the health professionals caring for them to have electronic access to their health information.
We knew from the Future of Health workshops we ran in 2010 that people supported the concept of sharing information, so the 2012 seminar series was an opportunity to provide an update on the work underway and gather additional feedback.
We have done this through public seminars, forums aimed at particular community groups, and a series of district health board briefings.
We have really appreciated people’s willingness to talk to us and give us the opportunity to hear what they think.
A number of themes and questions have arisen, especially around issues of privacy, access to information, ownership of data, and security. The NHITB will be addressing these issues by focusing on the importance of the relationship between consumers and their health professionals.
There are significant benefits for clinicians and consumers from improvements to the way we share our personal health information, and we will be taking the feedback into account as we move ahead to achieve the eHealth vision.
You can find out more about electronic sharing of health information at www.health.govt.nz/sharedhealthinfo.
The electives team has developed an online course to help people use the National Booking Reporting System (NBRS) and improve reporting of patient information.
We use the NBRS to tell us how many patients are waiting for elective surgery, what type of surgery they are waiting for, and how long they have been waiting.
It also allows us to monitor whether district health boards (DHBs) are meeting their commitments to patients about maximum waiting times. If patients are told they will be seen by a specialist or receive elective surgery, DHBs are then required to do this within six months.
This is part of our work to reduce elective waiting times, which are an area of focus for us and the health sector. Maximum waiting times are expected to be reduced to four months by the end of 2014.
We hope the new NBRS training will improve DHBs’ understanding of the importance of collecting accurate patient information. The training modules cover the points at which information is collected along the patient’s elective pathway, the need for accuracy, and the link with the Ministry of Health’s monitoring of DHB performance.
The use of good quality NBRS patient information to assist decision-making will mean better care for patients.
To access the online training modules visit www.learnonline.health.nz
For further information please contact Sylvia Watson, Senior Analyst, Electives: Sylvia_watson@moh.govt.nz
The Ministry of Health has established the NZ Medical Assistance Team (NZMAT) to help local and Pacific Island health services get through a major emergency.
We have created NZMAT to include experts from a wide range of health disciplines such as emergency ambulance services, emergency medicine, surgery, paediatrics, obstetrics, primary care, public health, mental health, emergency management and allied health. Logistics and communications support is also included.
To prepare the medical teams for some of the harsh conditions they may face, we have already trained 22 medical staff through the Australian Medical Assistance Team (AusMAT) course at the National Critical Care and Trauma Response Centre in Darwin.
Training in Darwin's challenging and physically demanding environment, meant staff were able to gain vital skills to help them treat victims in a disaster zone, with limited resources.
Eventually we aim to have enough capability within NZMAT to send rotations of up to 40 staff at any time, either locally or to the South-West Pacific as part of a fully trained multi-disciplined team. The teams will then work under a leading health agency such as a local district health board, or equivalent Pacific Island nation's health organisation.
The first NZMAT course will be run jointly with AusMAT and is scheduled for April 2013. Until then we will continue to train medical staff in conjunction with AusMAT. NZMAT is managed by the Ministry, with Counties Manukau District Health Board holding the contract to set up and administer the later courses.
More information, including a registration of interest form is available from https://volunteerhealth.org.nz
Director, Emergency Management
June figures show nearly all district health boards (DHBs) have achieved the significant goal of no patient waiting longer than six months for elective services.
This is a big improvement from the end of January 2011, when there were over 9000 patients waiting longer than six months for elective services around the country.
In 2011 the Ministry and DHBs agreed a target of having no patient waiting longer than six months by the end of June 2012.
DHB clinicians, managers, front line teams and support staff all made reducing patients waiting times a priority.
They focused on addressing the needs of each long-waiting patient and improving processes such as scheduling and pre-surgery assessment, to support the patient's access to treatment.
As a result of this activity, I am pleased to say that 17 out of 20 DHBs had no patient waiting longer than six months for elective services at the end of June 2012.
And, with the exception of Canterbury DHB which is managing under special circumstances, only 33 patients nationally were waiting over six months for an elective first specialist assessment, and only 119 patients for an elective treatment.
These patients are expected to be seen within the next quarter. We are now focusing on no patient waiting longer than five months for elective services, to be achieved by the end of July 2013.
Increase in patients treated
This sizeable reduction in waiting times has been achieved in parallel with the work DHBs are doing to increase the number of elective surgery patients treated each year. Over the last four years the number of elective surgery patients treated nationally has risen from around 118,000 to over 153,000 in 2011/12.
This 30 per cent increase in patients treated since 2007/08, combined with a reduction in waiting times, is a very positive improvement in access to services for patients.
We are seeing people receive their treatment in a more timely way, with less time spent with injury, pain, or impairment. As a result more people are having a better quality of life, through regaining their physical health or independence from receiving surgery.
This continuing reduction in waiting times and the increase in numbers of patients treated is a substantial achievement.
I would like to acknowledge the hard work and effort of DHB staff, the Ministry of Health and our own Elective Services team.
The volume of elective surgery will be increased by at least 4000 discharges per year.
This target is associated with the goal of reducing waiting times for elective surgery from six to five months, and to four months by the end of 2014.
Disability Issues Minister, Hon Tariana Turia, has officially launched the Maori Disability Action Plan - Whaia Te Ao Marama. The launch took place at Wellington's, Wainuiomata Marae on 02 August.
For Disability Support Services, this launch marks a significant milestone in the finalisation of the plan. Through the plan we are helping Maori disabled define what a good life is for them.
Senior Advisor Roger Jolley says Maori disabled had a big input into the development of the plan.
"The consultation process involved over 200 Maori disabled individuals who participated in hui, focus groups, and interviews. Some of their stories are re-told in the plan.
"During the development of the plan we were guided by the involvement and oversight of the Maori Disability Leadership Group. We also worked in collaboration with organisations such as Te Piringa, Needs Assessment Service Co-ordination Association, NZ Federation of Disability Information Centres, disability support service providers, and Maori communities."
In the plan Maori disabled have been clear about what makes a positive difference to their lives, including:
the opportunity to have leadership, choice and control over their lives (te rangatira)
- being supported as both Maori and as disabled to thrive, flourish, and live the life they want
- being able to participate in te ao Maori
- having their whanau valued as the primary support system for Maori disabled
- being connected to natural support networks, including Maori and disability communities
- having a holistic approach to their disability that also values the beneficial effects of Maori cultural views and practices on spiritual, mental, physical, emotional and whanau wellbeing.
It has taken 18 months of work to reach this point with the plan. Now it has been launched, it is not the conclusion of our journey, but the start of a new phase for Maori disabled.
Toni Atkinson, Group Manager
Disability Support Services
DHB Regional News
By Waitemata District Health Board - 06 August 2012
The chairs of Health Workforce New Zealand and the National Health Board have jointly praised Waitemata District Health Board's joint arthroplasty pilot programme.
In a June editorial for the New Zealand Internal Medicine Journal, the pair describe the pilot's 'formula for success' as one that should be adopted 'as much and as widely as possible'.
The clinician-led pilot, based at Waitakere Hospital, started in 2010 to trial a new 'productive' model of care for hip and knee replacement operations.
The model's key components include having specific surgeon/anaesthetist teams driving theatre throughput, cohorting patients together on theatre lists and in recovery wards, having a dedicated theatre and surgical beds, and not using junior doctor staffing.
The editorial comments from Professor Gorman and Dr Horn followed the release of a Waitemata DHB paper, published in the same journal, that revealed the pilot's evaluation findings.
Between 1 July 2010 and 31 March 2011 the pilot model enabled more hip and knee replacement surgeries to be performed for less money. Or, as the editorial states: '...the WDHB, and the community that it serves, got more and better for less.'
Compared to those performed under the traditional model at North Shore Hospital, the operating times for pilot hip and knee replacements were 39% and 36% shorter respectively, and the lengths of stay for patients 38% and 39% shorter.
Clinical sponsor for the Elective Surgery Centre project and paper co-author, Dr John Cullen, says extensive international research informed the design of the DHB's pilot.
"And ultimately that has paid off. The pilot has shown it is possible to introduce an innovative new model in a public health setting and achieve results that benefit both patients and the public purse."
Where possible, some of the pilot's successful elements will be deployed in the Elective Surgery Centre when it opens mid-next year.
In the meantime, the pilot programme will continue to operate at Waitakere Hospital.
Want to know more?
Read Professor Des Gorman and Dr Murray Horn's joint editorial, and the arthroplasty pilot paper in full:
Internal Medicine Journal, Volume 42, Issue 6:
- Productivity gain a triumph for clinical leadership.
- Increasing productivity, reducing cost and improving quality in elective surgery in New Zealand: the Waitemata District Health Board joint arthoplasty pilot.
By Waikato District Health Board - 27 July 2012
The Midland region is entering a new era in preparation and recovery from bowel surgery, with the introduction of the Enhanced Recovery After Surgery (ERAS) programme.
Wendy Carey, Project Manager of Surgical Services at Bay of Plenty DHB and lead for the project, says that the Denmark-developed programme has resulted in many benefits to both patients and staff.
Anaesthetic and surgical protocols have been developed to reduce the stress of surgery, to improve pain relief and to enhance patient recovery. Under this programme, the average length of stay in hospital after a bowel resection can be greatly reduced.
"Patients are able to eat and drink and are out of bed the day of their surgery, and start walking about the ward the following day," says Carey.
"Patients feel better quicker and require less time in hospital following their operation."
The ERAS process is dedicated to helping patients recover sooner. This requires the patient to play an active role in their own recovery, starting before surgery. The majority of patients are seen at pre-admission clinics, where they meet with a nurse, an anaesthetist, and other specialised staff as necessary. This is to ensure that the patient is fit to have the operation, that they understand all that will happen in hospital and that there is a plan in place for discharge.
Introduction of the principles of ERAS is expected to result in fewer complications and patients returning sooner to their usual activities.
The ERAS project for patients who have had colon surgery is taking place at BOP and Waikato DHBs, and will then be rolled out to Taranaki, Lakes and Tairawhiti DHBs.
The project started at Waikato and Thames hospitals this month, said Waikato Hospital unit manager Lynley Gardner.