• Module 1: Collecting Patient Data
• Module 2: Working with Patient Data

To find out more, go to:  http://learnonline.health.nz/course/category.php?id=23

Health Minister Jonathan Coleman says good progress is being made towards accurately measuring patient flow from GPs to hospital based specialists and the outcome of those referrals.

“The Government is focused on delivering better and faster access to health services, including more elective surgeries,” says Dr Coleman.

“We’ve backed that up in Budget 2015 with a further $98 million for increased access to elective surgery. This comes on top of the $110 million committed in Budget 2014.

“The number of patients receiving surgical first specialist assessments has significantly increased over the last six years, from around 260,000 patients a year, to over 315,000 patients assessed each year.

“However there have always been an uncounted percentage of patients who are returned to the care of their GPs.”

The previous Government in 2006 estimated around 25 percent of all GP referrals to specialists were returned to GP care. This would mean that of the 260,000 patients seen each year under Labour, at least 65,000 patients were being referred back to their GPs for care.

“Generally we know that patients can be referred back to their GP for a variety of reasons in addition to not meeting the threshold,” says Dr Coleman. 

“These may be cases where management in primary care is more appropriate such as if the patient has been referred for tests that primary care can access. Patients may also have been referred with incomplete information or to the wrong DHB.

“We are keen to better understand the exact outcomes of GP referrals.

“It is a significant undertaking to standardise the way this data is recorded by different DHBs and to understand referral outcomes. New Zealand will be one of a few countries to be collecting information of this kind at a national level.

“The Ministry of Health is working with DHBs to collect data in a comparable way.

“Ultimately this data will provide more comprehensive information for primary care on their patients.”

The project is on track to release the first set of reliable information in early to mid-2016.

Notes:

The National Patient Flow project has a three year implementation plan, with preliminary data expected to be available in early to mid-2016

The first phase being the collection of information on referrals received by DHBs for first surgical assessments. This has been underway since July 2014.

The second phase will commence in October 2015 and will include information on referrals for elective surgery, and some other procedures, including colonoscopy.

The third phase of the collection will commence in July 2016, and will include the full scope of the collection.  This will encompass a wider range of services, including diagnostics, and will allow linking of related referrals, and capture of a clinical classification of referral reason. This will allow more defined understanding of outcomes for patients

The approach combined systematic review with logic modelling synthesis techniques to develop an evidence-based framework of factors influencing the pathway between interventions and system-wide changes. A narrative synthesis and logic model summary of the data was completed.

This report is available to read in free full text at:  http://dx.doi.org/10.3310/hsdr03240

Blank L, Baxter S, Woods HB, Goyder E, Lee A, Payne N, et al. (2015). What is the evidence on interventions to manage referral from primary to specialist non-emergency care? A systematic review and logic model synthesis. Health Services and Delivery Research, 3(24).

Primary health workers throughout the Whanganui District Health Board (WDHB) area have reason to celebrate as the Minister of Health’s national health targets results show primary care achieving the Better help for smokers to quit target for the first time with a 91 percent result. 
 
The results released today report the performance of DHBs against the six national health targets over the 2014/15 Quarter Three period of January to March 2015. Whanganui GP and national primary care tobacco target champion John McMenamin says he’s delighted to see the primary care Better help for smokers to quittarget reached in Whanganui.
 
“Whanganui health workers have every reason to celebrate. This result reflects the determination of primary health workers to encourage people to quit smoking,” Dr McMenamin says. “It’s a result that is very deserving as well as timely, with World Smokefree Day coming up on 31 May.”
 
While the WDHB narrowly missed out by one percent on achieving the 95 percent smoking target set for hospitals, the consistent results achieved for this target each quarter are a credit to the hospital staff offering advice and support for patients to quit smoking, says WDHB chief executive Julie Patterson.

Emergency Department clinical director Athol Steward is delighted that the WDHB’s hospital-wide efforts to admit, discharge or transfer 95 percent of patients from ED within the six-hour target, have been sustained. Dr Steward says it’s interesting to see the WDHB once again achieving 96 percent. “It shows consistency by the Whanganui Hospital’s entire clinical team and management.”
 
The 2014/15 Quarter Three national health target results show Whanganui district residents continue to enjoy a high access rate to elective surgical procedures with the DHB achieving 103 percent for the 100 percentImproved access to elective surgery.
 
But disappointingly, Whanganui’s result for the 95 percent Increased immunisation target has dropped to 86 percent. Whanganui Regional Health Network chief executive Judith McDonald says in addition to the 181 children who were immunised in this quarter, there were a further 19 children who did not receive their immunisation on time. “And given that the target performance includes families who have made an informed decision to decline immunisations, and, families who despite being offered support have not met the target timeline, the result is not surprising,” Mrs McDonald says.

Meanwhile, Mrs McDonald is delighted that for a third quarter in a row, Whanganui exceeded the 90 percent national target for More heart and diabetes checks by one percent. She says this is down to the dedicated efforts of general practice teams and the Whanganui Regional Health Network’s success in targeting patients who have not had a completed cardiovascular disease risk assessment.
 
Mrs Patterson is pleased with the steady progress being made on the new 85 percent Faster cancer treatmenttarget. This quarter’s 67 percent result is a five percent improvement on the 62 percent result achieved in the October to December quarter. The target asks that 85 percent of patients will receive their first cancer treatment (or other management) within 62 days of being referred as having a high suspicion of cancer. The target will increase to 90 percent by June 2017.

Click here for the full National Health Targets results table for 2014/15 Quarter 3.

Integration efforts across the Canterbury Health System remain pivotal to Canterbury District Health Board's performance in meeting health targets.

The National Health Targets performance summary quarter three results for 2014/2015 show Canterbury has exceeded the Shorter Stays in ED target achieving 96 percent despite increasing demand and capacity restraints within the hospital.

David Meates, Canterbury DHB chief executive, says the "remarkable" result represents the ongoing integration of services across the health system, particularly for older people to help them stay well in their own homes for longer.

"Although attendance has grown continuously since the February 2011 earthquakes, we are seeing little growth among the older population, which is a reflection of the strategies to care for older people in their own homes and communities being well embedded," Mr Meates says.

He says the biggest growth in attendances remain the younger adult population where there's been a 46 percent increase in non-enrolled patients aged 25-29 presenting to ED.

"We have increased focus on capturing home addresses appropriately and ensuring this group are provided with the right information on where to access primary care rather than defaulting to ED."

Primary care efforts particularly from the 24 Hour Surgery on Bealey Ave, Moorhouse Medical and Riccarton Clinic play a key role in the Canterbury Health System successfully managing acute demand. 

Other impressive results this quarter have been in our Improved Access to Elective Surgery delivering 100 percent of our target delivery (12,851 elective surgeries out of our 17,484 annual target).

"This is really outstanding given the theatre capacity constraints. It is a sign our priorities to improve patient flow, as well as ensuring we are tracking, monitoring and responding to any changes quickly, are working.

Performance exceeded the 'Better Help for Hospitalised Smokers to Quit' target where the Canterbury DHB achieved 97 percent of the 95 percent target.

"There's been a big emphasis on staff education, documentation and referrals. Hospital staff are also being supported to take on roles to support smoking cessation previously held by the Smokefree control team."

Quarter three has been a first for Canterbury in achieving the Increased Immunisation target of immunising 95 percent of eligible children.

"Low opt-off decline rates have contributed to this quarter's performance as well as targeted efforts by primary care."

Canterbury DHB continues efforts towards the meeting the Primary Care Health Targets of Better Help for Smokers (83 percent) and More Heart and Diabetes Checks (78 percent).

"We are committed to working closely with our Primary Health Organisations to actively support the delivery of primary care Health Targets. Initiatives include ongoing education, enhanced clinical engagement, and supporting high risk populations."

*Canterbury received an achieved based on improvement against the quarter two results.  

More information about how Canterbury performed in the health targets can be found on our website.

The West Coast health system has improved its performance in most of the Government’s health target categories thanks to efforts of teams across the Coast health system.

West Coast District Health Board Chief Executive David Meates says the performance improvements across the various targets have resulted from the health system working together on the areas that needed more focus.  A greater awareness of programmes designed to help people take responsibility for their own health has also played a part.

In the emergency department target which requires 95% of patients to be admitted, discharged or transferred from an emergency department within six hours, the West Coast DHB has scored an impressive 99.4%.

The West Coast’s elective surgery target is to deliver 1592 surgeries during the year ending June 30.  The DHB is tracking at 111.3% with 1288 elective surgeries delivered to date.

“With our smoking cessation advice and services, we have met both hospital and primary care targets this quarter.  West Coast DHB staff provided 97.8% of hospitalised smokers with smoking cessation advice and support – exceeding the 95% target with our best result yet,” Mr Meates says.

West Coast Primary Health Organisation Executive Officer Helen Reriti says general practices have reported giving 4,575 smokers advice about stopping, in the 12 months ending March 2015, representing 94% of smokers expected to attend general practice during the period.

“It’s particularly pleasing to have exceeded the 90% target for the first time.  Our clinicians have made huge efforts to tackle this issue, alongside the introduction of new technology to support their initiatives,” Ms Reriti says.

“Likewise, with 90.3% we have met for the first time the 90% target of ensuring the eligible enrolled West Coast population have had a cardiovascular risk assessment in the last five years.  That represents a 7.6% increase on our figures for the last quarter,” she says.

The range of approaches used to increase performance included identifying cardiovascular risk assessment champions within general practices; nurse-led clinics in practices; evening clinics and protected appointment time allocations for checks; Poutini Waiora nurses collaborating with general practices; conducting checks at local events; and using technology to remind patients.

High opt-off and declines continue to be challenging in meeting the immunisation target (95% nationally).  On the West Coast 89% are being immunised, however, we are reaching 100% of “high deprivation children” and 93% of all Maori children. 

This is the second time DHBs have been assessed against the new cancer treatment target and 62.5% of West Coast DHB patients received their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer.

Mr Meates says the Coast’s small population poses a challenge in this area. 

“We are missing this target by just one patient. But work is ongoing to improve the capture and quality of the Faster Cancer Treatment data which will improve our performance over the next few quarters.” 

Full information on the West Coast DHB’s Health Target performance can be found here, and information on the Ministry of Health’s Health Targets site here.

The results for Quarter Three of 2014/15 have been released by the Ministry of Health.

Results indicate that in this quarter, the Taranaki DHB has performed well in improving access to elective surgeries. With results ahead of the national average, the DHB is also paving the way towards the new faster cancer treatment goal, currently ranking fourth in the country for this target. Taranaki DHB has also achieved its target of 95 percent for shorter stays in Emergency Departments.

Taranaki DHB Planning, Funding, and Population Health General Manager, Becky Jenkins said, “A focus on the six key areas is important to continue to improve health, reduce inequalities and improve the quality of health services for local people. This quarter’s results have seen Taranaki DHBs maintain performance in a number of areas.”

Taranaki DHB Chief Operating Officer Gillian Campbell said, “In terms of our hospital services, the results show people in Taranaki have improved access to elective surgery and that we are working hard to ensure patients referred with a high suspicion of cancer are treated in a timely manner.”

The health target results for Taranaki DHB are:

Shorter stays in Emergency Departments: Target 95%, Achieved 95%
95 percent of patients seen in Taranaki Emergency Departments were admitted, discharged, or transferred from the department within six hours.

This result can be attributed to Taranaki DHB and Midland Health Network, the network of 99 percent of General Practitioners (GPs) in Taranaki, working closely together to ensure patients receive the right care, at the right place. That is, the Emergency Department for all emergencies, and their GP for other non-urgent medical needs.

The target was achieved nationally for the first time against a continuing increase in the number of emergency department presentations with 4,481 more people attending this quarter when compared to quarter two.

Improved Access to Elective Surgery: Target 100%, Achieved 120%
Taranaki DHB has again achieved over the target of 100% (for the population) for the improved access to elective surgery target, with a 4 percent increase from quarter two 2014/2015 results. Taranaki DHB has delivered this across a wide range of surgical specialities and is ranked second for its performance.

Assisting in this result has been an ongoing focus on ensuring patients are well prepared for surgery, and a continued reduction in day-of surgery-cancellations. Taranaki DHB is also undertaking a project to increase the surgical day procedure rate. This project is supported by the Ministry of Health.

Significant benefits also continue to be realised from the implementation of the Enhanced Recovery After Surgery (ERAS) programmes.

The national elective surgery health target has been achieved with 123,585 elective surgical discharges provided, against a year-to-date target of 115,588. This is 7997 (6.9 percent) more than planned.

Faster Cancer Treatment: Target 85%, Achieved 72%
This is the second quarter of public reporting of the new faster cancer treatment health target results. Nationally, results increased by 1.6 percent compared with the previous quarter to 67.4 percent overall. Data includes patients who received their first cancer treatment between October 2014 and March 2015. No DHBs have met the 85 percent target.

Taranaki DHB plans to continue this strong performance, and its collaborative relationship with the MidCentral DHB, to continue to work towards the target.

The target is 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks by July 2016, increasing to 90 percent by June 2017. Results cover those patients who received their first cancer treatment between July and December 2014.

Increased Immunisation: Target 95%, Achieved 91%
This quarter, 91 percent of Taranaki eight-month-olds were fully immunised. This is a decrease of 2% from the last quarter. These results are in line with historical expectations for quarter three because of the difficulty in vaccinating children during the summer holidays.

Nationally, the increased immunisation health target, national coverage at eight months was 92.9 percent, an overall decrease of 0.6 percent compared with the previous quarter but 1.5 percent higher than the same quarter in 2013/14.

Taranaki DHB has worked closely with primary care organisations, hospital services, outreach immunisation services, the National Immunisation Register and Well Child Providers on strategies to help improve our immunisation uptake, including early enrolment of new-borns with a GP.

A high level of immunisation coverage (around 95%) is required to prevent community spread of two common infectious diseases - measles and whooping cough. Taranaki DHB and the wider sector are working together to increase activity through to June 2015, with the aim of reaching the 95% target.

Better Help for Smokers to Quit (Hospital Target): Target 95%, Achieved 94%
Taranaki DHB continues to work hard to ensure patients and visitors to its hospitals are given advice about quitting smoking. By supporting smokers to quit, the aim is to improve the health of those around them by reducing exposure to second hand smoke.

A national total of 31,522 hospitalised smokers were offered brief advice and/or cessation support during quarter three, out of a possible 32,980.

Better Help for Smokers to Quit (Primary Care Target): Target 90%, Achieved 86%
Taranaki DHB is committed to working collaboratively with our Primary Care Organisation to continue to strengthen and implement a range of good practices to ensure all patients who smoke are offered or given effective stop smoking support.

More Heart and Diabetes Checks: Target 90%, Achieved 91%
This quarter, 91 percent of the eligible population had heart and diabetes checks. This is a one percent increase on Taranaki’s quarter one results.

Diabetes and cardiovascular disease remains one of the main causes of ill health in Taranaki and Taranaki DHB continues to work hard to provide the best outcomes for these people.

The implementation of a multidisciplinary team to support the care provided by GP practices, and the ongoing education of GP’s and practice nurses in the care and management of diabetic patients in the community, are just two examples.

Results show there were approximately 150,600 more checks provided in the five years to the end of March 2015 compared with the five years to the end of March 2014.

Nearly 500 more people were admitted, discharged or transferred within six hours of presenting to Wellington Hospital’s emergency department between January and March this year, an increase of three percent from the previous three months.

Latest health target results released today show that despite another record increase in the number of presentations to the emergency department in the first quarter of 2015, Capital & Coast District Health Board (CCDHB) has improved its performance against the shorter stays in emergency departments target, and three of the five other targets.

“These results reflect the improvements we’ve made to change how we care for people in hospital and the community, and the tremendous efforts made by our staff to provide high-quality healthcare for our patients,” says chief operating officer Chris Lowry.

“Elective surgery performance has improved and we are on track to meet the target this year as we have done in previous years,” she says.

The DHB is also providing more people with help to quit smoking, rising from 80% in the last quarter to 92% of patients provided with brief advice and support to quit this quarter.

“Quitting smoking is the single best thing a person can do for their health. While we have some more work to do in this area to achieve the target, it is promising to see we are supporting more of our patients to do this, especially at the primary care level,” she says.

CCDHB continues to lead the country in the new Faster Cancer Treatment target, and achieved the national immunisation target as second-highest performer.

“Our goal is to achieve all six targets. These latest results are very promising and reflect the amount of time and effort put in by our staff put in to date,” Ms Lowry says.

The results of the six national health targets across all 20 District Health Boards (DHBs) have been released today for the January to March 2015 quarter.  We sustained our improvements to achieve the goals again this quarter for Shorter Stays in the Emergency Department, and Better Help for Smokers to Quit for patients admitted to hospital.  A summary of our results for all the national health targets this quarter is provided below.

Just under 96% (9520) of 9961 people were admitted, discharged or transferred from the Emergency Department (ED) within six hours of presenting – A small improvement on last quarter and again achieving the national target.  Compared to the same quarter last year when we had a similar number of people presenting to the Emergency Department, 559 more people had shorter stays in ED this quarter – a sizeable improvement that reflects the concerted effort of a large number of staff to ensure better patient flow processes, and, together with our general practice teams, better manage the demand for acute health care services.

We continue to be ahead of target for the number of people discharged following their elective surgery.  Over this quarter, another 1701 patients were discharged following their elective surgery bringing the total number to 5377 patients who have had their elective surgical procedure over the last nine months – delivering 110% of our planned target year to date.  About 11% of our patients have their planned surgery at other hospitals that provide specialist surgery to residents of the wider region, like Wellington for heart surgery, and Hutt Valley for plastic and burns surgery.

The new national target for faster cancer treatment was published for the first time last quarter.  The target is that by July 2016, 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks.  Our result this quarter, at 67%, is consistent with last quarter and the same as the national average for this period (results cover those patients who received their first treatment between October 2014 and March 2015).  This target focuses on a sub-set of patients who are referred through a managed, outpatient pathway.  Our aim is to make steady improvements toward this target by examining referral guidelines and pathways to earlier diagnosis and treatment that will ultimately benefit all cancer patients.

The hospital component of the national health target for offering advice and support to quit smoking was achieved for the second consecutive quarter, with a result of 97.0%.  This was a small improvement on the result last quarter and just above the national average (96%).  Of the adult patients admitted to hospital who smoke (about 15% of all admissions), 1111 patients have been offered brief advice and support to quit smoking over the last nine months.

The result for providing better help for smokers to quit in the primary healthcare setting could not be reported in time for publishing this quarter.  This was disappointing, especially as the targeted ‘quit smoking’ campaign that was undertaken over the last few months by our primary health organisation (CentralPHO) and general practice teams is likely to have contributed to a big improvement on our previous results.  We are currently verifying the data and expect that updated data will be published on the health targets website within the next week or so.

Our result for eight-month-old infants being fully immunised on time fell slightly this quarter to 94.4% - just short of the 95% target, which we attained last quarter.  A drop in the rate this quarter is similar to the pattern last year, with the summer holiday period making it a bit more difficult to reach families with infants due for their immunisation.  Our immunisation team, including general practices and outreach services, continue to work together with families to ensure the vast majority of our children are immunised against vaccine preventable diseases.

The proportion of our eligible enrolled population that have had their risk for cardiovascular disease assessed in the last five years was much the same as last quarter.  Although there were another 367 heart and diabetes checks undertaken between January and March, the proportion of the total expected number to have had a risk assessment over the last 12 months fell short of the 90% target, at 85% of the 47,260 eligible enrolled adults.  CentralPHO is continuing to support general practice teams and our Maori and Pacific health providers to enable more people to have a heart and diabetes check to minimise the risk of them having a heart attack or stroke in the next five years.

Chief executive officer Kathryn Cook has thanked staff for their continued efforts to improve on our performance against these targets.

For more details and FAQs about the Health Targets go to: www.health.govt.nz/healthtargets and the 'MyDHB' website.

Health Minister Jonathan Coleman says the latest quarterly health target results show the shorter stays in emergency departments target has been met for the first time.

“DHBs are continuing to improve their performance on the Government’s health targets,” says Dr Coleman.

“Across the country over 250,000 New Zealanders were admitted, discharged or transferred from an emergency department within six hours. Achieving the 95 per cent target for the first time is a significant achievement.

“The number of patients presenting to emergency departments continues to increase. In quarter three, 4,481 more people attended an emergency department compared to the last quarter.

“Reaching the target is a tribute to all the staff working within emergency departments and DHBs. We know that emergency departments only work well when the rest of the hospital is working well too.”

The improved access to elective surgery and the hospital component of the better help for smokers to quit targets were also met:

• 96 per cent of smokers in hospitals were offered advice on how to quit.
• DHBs delivered 7,997 more elective surgical discharges than planned.

“DHBs remain focused on reducing waiting times for elective first specialist assessments and treatment,” says Dr Coleman.

“The extra $98 million for elective surgery in Budget 2015 will provide more New Zealanders with timely surgery. The Government is committed to continuing to deliver increases in elective surgery.”

The results also show good progress on other targets, including:

• The more heart and diabetes checks target increased to 88 per cent.
• The primary care component of the better help for smokers to quit target increased to 89 per cent.
• The new faster cancer treatment health target increased to 67 per cent – this is the second time this target has been reported.

The quarter three (January-March 2015) results can be found at www.health.govt.nz.

The results of district health board performance against six health targets for the third quarter 2014/15 has been released.

The results are available at:  http://www.health.govt.nz/new-zealand-health-system/health-targets/how-my-dhb-performing/how-my-dhb-performing-2014-15

This is an economic evaluation from the perspective of the payer: the Ministry of Health and Long-Term Care of Ontario. All eConsults submitted during April 1, 2011 to March 31, 2014 were included. The authors attributed cost savings only to those cases where an eConsult led to the avoidance of a face-to-face specialist visit.

A total of 2606 eConsults directed to 27 different speciality groups were included. In 40.3% (n=1051) of cases processed, a face-to-face specialist visit was originally planned but avoided as a result of eConsult, while 29% led to a referral. The estimated cost per eConsult for Years 1, 2, and 3 were $131.05, $10.34, and $6.45 respectively. Results from a sensitivity analysis project that the eConsult service will break even once it reaches 7818 eConsults.

The authors note that this is one of the first studies to examine costs across a multispecialty eConsult service. They saw a marked decrease in the cost per eConsult over each annual period. They go on to say that future research is needed to identify and examine similar outcomes that may lead to cost savings.

This is an open access document and can be downloaded in free full text at:  http://dx.doi.org/10.3233/978-1-61499-505-0-67

Liddy, C., et al. (2015). What are the costs of improving access to specialists through eConsultation? The Champlain BASE Experience. In: Vol. 209: Global Telehealth 2015: Integrating Technology and Information for Better Healthcare.

This Account focuses on the quality of services Hutt Valley DHB provided during 2013/2014.

Contents include: Health targets; Quality & safety markers; Serious adverse events; Patient experience Receiving care closer to home; Getting in shape before joint surgery; Getting better at home; Helping cancer patients find their way; Encouraging attendance; Community Safety Initiatives HealthPathways; More heart and diabetes checks; Help quit smoking; Disability services; Empowering staff; Giving babies the best possible start; Patient safety initiatives; Open campaign; Care capacity demand management; Electronic whiteboard; Newborn hearing screening; Malnutrition screening & training; Supervisor training; Looking forward; Future Focus.

This Quality Accounts is available to read in full text at:  http://www.huttvalleydhb.org.nz/content/10ff5f6d-fe7e-4a44-8667-5b72672d3214.html

"Laparoscopic surgery was associated with reduced complications... and length of stay .... Increasing ERAS compliance was correlated with fewer complications ... and shorter primary hospital admission .... Shorter hospital stay was associated with preoperative carbohydrate and fluid loading .., and totally intravenous anesthesia ...; longer stay was associated with intraoperative epidural analgesia .... Reduced postoperative complications were associated with restrictive perioperative intravenous fluids".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1097/SLA.0000000000001029 or contact your DHB library, or organisational or local library for assistance.

The ERAS Compliance Group (2015). The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: Results from an international registry. Annals of Surgery, 261(6), 1153-1159.

An extra $98 million will be invested in Budget 2015 to provide more New Zealanders with timely elective surgery, and to improve the prevention and treatment of orthopaedic conditions, Health Minister Jonathan Coleman says.

“Access to elective surgery is a top priority for the Government. Elective surgery makes a real difference to patients and their families – it reduces pain, increases independence, and improves quality of life,” Dr Coleman says.

“The number of patients receiving elective surgery has increased from 118,000 in 2007/08 to 162,000 in 2013/14. That’s 44,000 more operations - a 37 per cent increase.

“This funding boost will mean that even more New Zealanders can benefit from elective surgery. We want to maintain the momentum and continue to deliver year-on-year increases in elective surgery.”

The extra $98 million includes $48 million over four years as part of the continued effort to increase elective surgeries by an average of 4,000 a year.

An additional $50 million is being invested over three years to support extra orthopaedic and general surgeries, and to create early intervention orthopaedic teams, as announced last year. This includes:

• $30 million to lift surgery for people with a range of orthopaedic conditions (such as hip, knee, shoulder and spinal conditions);
• $14 million for extra general surgeries (including hernia, vein and gall stone operations);
• $6 million to create community based multi-disciplinary early intervention teams for diagnosis and management of orthopaedic conditions, helping to improve patients’ quality of life and avoid unnecessary hospital visits.

“We want to keep people active and well for longer at home in their community,” Dr Coleman says. “There are a lot of people with osteoarthritis where early intervention in a community setting is appropriate.

“Early intervention can deliver improvements in diagnosis, self-management, education and exercise, and pain management. These new early intervention teams will make a real difference to patients and their families.”

Health funding has increased every year under this Government. Health is expected to receive the largest share of new funding in Budget 2015.

This involved a multidisciplinary approach to an ER clinical education programme. The programme aimed to develop knowledge of the physiology of post-operative recovery and the evidence underpinning the interventions required. This was considered crucial to secure longer term staff engagement while avoiding unthinking protocol driven compliance. Success of the education programme was measured by improved outcomes in patient LOS and readmission statistics.

During the four months of the clinical education programme there were no significant changes in monthly LOS. At six months post implementation of the programme there was a reduction in LOS of 0.6 days compared to the previous six months. At 12 months there was a reduction in 1.1 days compared with previous 12 months. There was a mean reduction of 28 day readmissions for all elective gynaecology surgery of 1.1 patients per month in the 12 months post programme implementation compared to the 12 months before. Delivering a multidisciplinary participatory education programme improved overall understanding of ER, and achieved sustained improvement in ER for patient benefit.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1136/bmjquality.u208370.w3387

McDonald, R. (2015). Enhanced recovery clinical education programme improves quality of post-operative care. BMJ Quality Improvement Reports, 4(1).

Health Minister Jonathan Coleman says Waikato DHB patients are receiving their first surgical assessments faster compared to 10 years ago.

“Speeding up patient’s access to their first surgical assessments has been a priority for this Government,” says Dr Coleman.

“At the same time, we have also increased the number of patients receiving their first surgical assessment compared to 10 years ago.

“Last year a record 30,076 Waikato patients received their first surgical specialist assessment, compared to 25,002 in 2009.

That’s an increase of 20 per cent.

Waikato and Thames hospitals group manager Mark Spittal said there was only one patient at Waikato Hospital who had not received a first specialist appointment within the four month period at the end of March which excludes those who, for personal reasons, had rescheduled their appointments who did not turn up for their appointment.

“In 2005 there were 33,000 patients nationwide waiting over six months for either a specialist assessment or surgery. Today there are just 35,” said Dr Coleman.

“We have set clear health targets which have helped to reduce the wait for the first surgical assessment as well as increase the volume being seen.

“These results are a credit to Waikato’s health professionals and helped by the Government’s investment of around $460 million in new money into the health budget each year.”

Mr Spittal paid tribute to the teams of people – from booking clerks, to nurses, doctors, Allied Health staff and managers – for the huge effort involved in Waikato’s results.

In this study, the authors evaluate the effectiveness of aviation-style teamwork training in improving operating theatre team performance and clinical outcomes in 3 operating theatres in a UK district general hospital (1 control group and 2 intervention groups).

Women waiting to see a breast care specialist at Waikato Hospital are now seen sooner than in the past because of an improvement in ‘did not attend’ rates by the Breast Care Centre.

Waikato DHB Breast Care manager Clare Coles said the service had increased the number of booked appointments and reduced ‘did not attend’ rates in the past two years.

“We have been tracking at less than 3 per cent of our appointments being missed since we introduced phoning women the day prior to their appointment,” she said.

Women are referred to the centre by their GP typically with a new breast symptom that needs investigating and some women may also be asked to return for a follow-up appointment after the initial investigation has occurred, said Coles.

With the demand for each appointment available always being higher than the actual capacity, it is vital that wastage of these appointments is kept to an absolute minimum to keep waiting times as short as possible.

The centre year to date has over delivered on contracted numbers seeing more than 25 new women and 60 returns per week.

It has four breast surgeons and three breast clinicians each working in one to three clinics per week.

In the three months since November last year, only eight women out of 1112 did not attend their appointments.

“The Breast Care Centre team leader started this [phoning women] as part of a several activities aimed to increase efficiency as a result of attending the Lean Thinking training.”

Coles said the team tested how efficient it was to call women by moving from calls to texts.

“Last month our did not attend rate shot up to 7.2 per cent. This is when we stopped phoning and texted women instead,” she said.

As a result the Breast Care Clinic team will be doing some more investigative data analysis to try and reduce the rate further while still best utilising resources.

Coles said while phoning women had not saved the service financially, it has impacted on being able to book appointments for other women sooner if an appointment was no longer needed.

“Women like to be able to re-book there and then if they are unable to attend a planned appointment when we ring and it gives us a chance to offer their appointment to someone who is waiting.”

412 patients were enrolled to the pre-ERAS (existing-practice) phase and compared with 297 patients in the ERAS phase. For ERAS patients, compared with existing-practice patients, hospital stay was reduced and there was a significant improvement in the proportion of patients ready for discharge on day 3 after surgery. The authors also found improved indicators of processes and outcomes of care, including improved patient education, reduced fasting times, less blood loss, better analgesia, earlier ambulation and improved overall quality of recovery.

This article is available to read in free full text at:  http://dx.doi.org/10.5694/mja14.00601

Christelis, N., et al. (2015). An enhanced recovery after surgery program for hip and knee arthroplasty. Medical Journal of Australia, 202(7): 363-368.

A quality improvement project was undertaken to assess this problem and to propose a new patient pathway whereby patients are contacted by ENT nursing staff by telephone three months following surgery. During these telephone conversations only 9.5% of patients requested outpatient follow-up and all of these patients were discharged upon their follow-up. The project demonstrates that nurse-led follow up is an efficient, effective and safe way of managing patient care post-nasal surgery.

This article is available to read in free full text at:  http://dx.doi.org/10.1136/bmjquality.u208386.w3311

Sooby, P. & Kirkland, P. (2015). Use of nurse-led telephone follow-up as a sole method of assessing patients after nasal surgery. BMJ Quality Improvement Reports, 4.

Eighteen studies were included (3 randomised controlled trials, 5 case-controlled studies and 10 case series) - 7 on gastric and 11 on oesophageal resection. 

Based on their analysis, the authors conclude that "the evidence for enhanced recovery schemes following gastric and oesophageal resection is weak, with only three (low volume) published randomised controlled trials. However, the enhanced recovery approach appears safe and may be associated with a reduction in length of stay".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1308/003588414X14055925061630 or contact your DHB library, or organisational or local library for assistance.

Gemmill, E.H., et al. (2015). Systematic review of enhanced recovery after gastro-oesophageal cancer surgery. Annals of The Royal College of Surgeons of England, 97(3), 173-179.

Janice was presenting the poster which describes the patient journey through the South Island Bariatric Service, the first South Island Service where there is just one treatment waiting list and pooled funding for the service".

To read the full story and download the poster, go to:   http://www.sialliance.health.nz/CDF_ModuleNews/Display/Details/139?NewsSetId=32&PageId=22806

The first in New Zealand, the CT scanner is a vital tool in the diagnosis of disease, trauma, or abnormality and for planning, guiding, and monitoring therapy.

Reducing unnecessary wait times for patients is critical to providing a high level of patient care says Andrew Potts, general manager surgical services.

“CT scanning is now a standard triage tool for medical staff attending patients in the Emergency Department. For clinicians it is now as vital in terms of patient management as laboratory tests and chest x-rays”.

To read the full media release from Northland DHB, go to:  http://www.scoop.co.nz/stories/GE1503/S00098/scanner-brings-world-leading-ct-capabilities-to-northland.htm

Two hundred and twenty-five patients were analysed, of which 155 (69%) were in the group (Monday to Wednesday) and 70 (31%) in the group (Thursday to Friday). No significant differences were observed amongst the groups for age, sex, tumour location, operation performed, type of surgery (laparoscopy or open), complications. However, a significant shorter length of stay was present in the first group six days (interquartile range: 4–10) versus eight days (interquartile range: 5–11) (p = 0.045).

Based on their analysis of the results, the authors conclude that "operating on colorectal patients early in the week is associated with a significant decreased hospital stay. This should be put into consideration by units practising enhanced recovery programme if the maximal benefit of this is to be attained".

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.1177/2054270414562983

Ihedioha, U., et al. (2015). Enhanced recovery programmes in colorectal surgery are less enhanced later in the week: An observational study. JRSM Open February, 6(2).

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/ans.13043 or contact your DHB library, or organisational or local library for assistance.

Mir, M. C., Zargar, H., Bolton, D. M., Murphy, D. G. and Lawrentschuk, N. (2015), Enhanced Recovery After Surgery protocols for radical cystectomy surgery: review of current evidence and local protocols. ANZ Journal of Surgery, 17 March [Epub before print]

More people are getting access to elective surgery and more people are getting faster treatment for cancer as Tairāwhiti District Health (TDH) comes close to achieving national Health Targets.

The latest quarterly results show TDH is well on the way to meeting all Health Targets set by the Ministry of Health.

It is very pleasing to see an improvement in the number of eight month olds who have had their immunisation at six weeks, nine months, five months and are now fully immunised, says Chief Executive Jim Green. “Reaching this target is a partnership between TDH staff and those working in primary care including GP practices.”

“We have also made a great start to achieving the new cancer target. Already 74% of people in Tairāwhiti who are referred with a high suspicion of cancer are getting treatment within 62 days from the time they are first referred. Our team is refining their processes to make sure our patients get the treatment that they require in what is often stressful circumstances for them. The team is committed to working together to ensure we meet the target of 85 percent of our people getting that fast treatment by July 2016”

This is the first time of reporting the faster cancer treatment target results. The new target is broader than the previous shorter waits for cancer treatment target. It measures how long patients wait from the time their GP’s referral is accepted by the hospital and clinicians strongly suspect they have cancer, to the start of treatment – which could be surgery, chemotherapy, radiation therapy or even palliative care.

The percentage refers to the number of patients who receive their first cancer treatment (other than management) within 62 days of being referred with a high suspicion of cancer.

The intent is to measure right across the cancer diagnosis and treatment pathway.

TDH’s results (compared to the national target) for the quarter are:

• Shorter stays in emergency departments 96% (95%)

• Improved access to elective surgery 99% (100%)

• Faster cancer treatment 74% (85% by June 2016)

• Increased immunisation 93% (95%)

• Better help for smokers to quit – hospitals 94% (95%); primary care 87% (90%)

• More heart and diabetes checks 88% (90%)

Eight studies were included: three randomised controlled trials and five interrupted time series (ITS) studies involving a total of 135 general practices/primary care clinics, seven hospitals and one outpatient clinic. The studies were heterogeneous, making meta-analysis unfeasible.

The authors conclude that, "as only a handful of low-quality studies are presently available, we cannot draw any firm conclusions about the effectiveness of the evaluated interventions in reducing waiting times. However, interventions involving the provision of more accessible services (open access or direct booking/referral) show some promise".

Available to read in free full text at:  http://dx.doi.org/10.1002/14651858.CD005610.pub2

Ballini L, Negro A, Maltoni S, Vignatelli L, Flodgren G, Simera I, Holmes J, Grilli R. (2015). Interventions to reduce waiting times for elective procedures. Cochrane Database of Systematic Reviews, 2. Art. No.: CD005610. 

The Canterbury District Health Board continues improving on the National Health Targets particularly in prevention and early detection of disease despite ongoing post-quake challenges.

The National Health Targets report for quarter 2 was released today and results show more Cantabrians are receiving advice and support for smoking cessation and heart and diabetes checks.

In this quarter, 86.7 percent of smokers attending primary care received advice to quit – which is a 6 percent increase on the previous quarter and is almost double the previous year's quarter 2 result of 49 percent.

Canterbury also has had the largest increase of all health boards in the More Heart and Diabetes Checks target – with 76.7 percent of eligible patients receiving a check – a 5.6 percent increase on quarter 1 and up more than 30 percent on the year before.

David Meates, Canterbury DHB Chief Executive, says efforts to ensure our community is kept well and in their own homes through prevention and early detection of disease are nothing short of dedicated.

"It's remarkable how our results have gone from strength to strength in the past year and this reflects the commitment, collaboration and integration across the Canterbury Health System.

"I continue to be impressed by, and thankful for, the efforts and achievements of staff in the context of a still challenging environment of hospital redevelopment and post-quake recovery."

Mr Meates says the Canterbury is faced with significant challenges four years on from the earthquakes.

"Many of the associated health impacts post a major disaster are panning out in the community – particularly in mental health. While it's amazing to see things coming together with the rebuild – there's also a whole set of new challenges emerging for the Canterbury Health System."

Mr Meates says one major challenge is the continued growth in presentations to Christchurch Hospital's Emergency Department.

"Since the quakes and the influx of about 30,000 workers to Christchurch, use of our Emergency Department has spiked 50 percent for the 25-29 age group and almost 30 percent for the 20-24 year old age group."

"Remarkably staff met the target in quarter 2 for Shorter Stays in ED with 95 percent of patients admitted, discharged or transferred from ED within six hours – but if numbers continue to climb it only increases waiting times, contributing to crowding and placing ED staff under greater pressure."

Meanwhile Mr Meates says overall the DHB's performance in all targets was strong.

"It's about having the initiatives and integration in place to enable us to do that.

"For example, in the last year Canterbury provided care to 30,000 people in the community who in any other parts of the country would otherwise have been admitted to hospital."

"Keeping everything we do patient centric keeps us focused on our six key priorities to ensure our system is running as efficiently as it can be."

The five priorities and key spotlight area :

• Frail Older Person's Pathway – better support for frail older people both in an out of hospital
• Theatre Utilisation – capacity remains a major constraint until the new hospital is built.  Clinicians are focused on improving the performance and productivity of operating theatres, reducing cancellations, improving patient flow and achieving shorter waiting times for patients before their treatment and ensure no time is wasted in the system
• Enhanced Recovery after Surgery (ERAS) – supports early recovery and discharge from hospital and reduced waiting times
• Faster Cancer Treatment – timely access and better links across the health system to improve care;
• Outpatient and Surgical Flow (100 days) – aiming to provide a patient's first appointment with a specialist or surgical treatment within 100 days (to a maximum of four months)
• Mental Health – services are coming under increased pressure and the DHB has prioritised ensuring we can meet the needs of the community.

Targets at a glance:

• Increased immunisation – this target rose from 90 percent at June 30 2014, to 95 percent by December 31. Canterbury achieved immunisation rates of 93.49 percent of eligible children, while five percent of parents or caregivers of the eligible population declined or opted out of the free immunisation programme
• Faster cancer treatment - a new target was introduced this quarter. The target is 85 percent of patients receiving their first cancer treatment within 62 days of being referred with a high suspicion of cancer. Canterbury achieved 68 percent against a national average of 65.8 percent. Canterbury continues to meet the previous target of 100 percent of cancer patients who are ready for treatment, getting it within a month
• Improved access to Elective Surgery -  Canterbury delivered 97.4 percent of its elective surgery target this quarter, and expected to increase numbers over the next few quarters
• Better help for smokers to quit – hospitalised - Canterbury met the target of 95 per cent of eligible hospitalised smokers getting cessation advice and support.

Chief executive Kevin Snee said two priority projects within Hawke’s Bay Hospital, which had been running for some months, were now making an impact. The Acute Inpatient Management (AIM24/7) project was improving the quality and timeliness of care for patients seen in or admitted through the Emergency Department (ED), and the Theatre Productivity project was working to improve the ability to provide more elective surgery for the people of Hawke’s Bay.

To read the full story, go to:  http://www.voxy.co.nz/health/improvements-four-health-targets-hb-dhb/5/214657

The latest quarterly results show Waikato DHB tracking well on all national health targets.

“It is very pleasing to see an improvement in the 6 hour acute goal and to make a start toward achieving the new cancer target,” said interim chief operating officer Brett Paradine.

“Improvement in both of these areas will be a priority for the coming year,” he said.

Waikato DHB’s results (compared to the national averages for all district health boards) for the quarter are:

• Shorter stays in emergency departments 94% (94%)
• Improved access to elective surgery 115% (107%)
• Faster cancer treatment 68% (66%) – this is a new target, see below.
• Increased immunisation 91% (94%)
• Better help for smokers to quit – hospitals 96% (95%); primary care 87% (89%)
• More heart and diabetes checks 88% (87%)

Four out of the six target rates show improvement by Waikato DHB compared to the previous quarter, and the other two have held steady.

This is the first time of reporting the Faster cancer treatment target results. The new target is broader than the previous Shorter waits for cancer treatment target. It measures how long patients wait from the time of their GP’s referral is accepted by the hospital and clinicians strongly suspect they have cancer, to the start of treatment – which could be surgery, chemotherapy, radiation therapy or even palliative care. The percentage refers to the number of patients who receive their first cancer treatment (other than management) within 62 days of being referred with a high suspicion of cancer.

The intent is to measure right across the cancer diagnosis and treatment pathway. The target is to reach 85 percent by July 2016, but the current result of 66 percent averaged across all DHBs was expected – this is very similar to the UK results when a similar target was introduced. The target will be reported on a rolling 6-month basis rather than quarterly.

“At Waikato DHB we are now adopting a whole team approach to make sure our patients get the treatment that they require in what is often stressful circumstances for them,” said Amanda Wright, assistant group manager Internal Medicine and Oncology at Waikato Hospital.

“A lot of effort has gone into ensuring we have a robust process for tracking these patients. Our cancer care coordinators and clinical nurse specialists have done a wonderful job. We are pleased with the result and are working on a plan that will focus on improving our percentage to the expected 85 percent by June 2016,” she said.

Read the Waikato DHB results here

Read all national results here

Health Minister Jonathan Coleman says the latest quarterly health target results show DHBs are making good overall progress.

“DHBs are continuing to improve their performance on the Government’s health targets,” says Dr Coleman.

“The latest results for quarter two show that almost all DHBs are now exceeding the number of elective surgeries they had planned.

“DHBs carried out 5,441 more elective surgeries than planned in the last three months of 2014. DHBs have also been focused on reducing waiting times for elective first specialist assessments and treatment, such as hip replacements.

“Despite more people presenting to emergency departments, DHBs have continued to perform well on the target with a national result of 94 per cent.”

Results have been reported for the first time on the new faster cancer treatment health target. DHBs consistently achieved the previous target and the new broader target covers time from referral to treatment.

“Two thirds of patients with a high suspicion of cancer received their first treatment within 62 days of referral,” says Dr Coleman.

“This is comparable with other countries when they have first introduced a similar new target. I know we will continue to see steady improvement towards the target of 90 per cent by June 2017.”

Results for quarter two 2014/15 show improvements in all the targets:

• 94 per cent immunisation coverage for eight-month-olds is the highest ever level of coverage for any immunisation health target.
• 87 per cent of eligible people had their heart and diabetes check.
• The number of smokers in primary care offered advice or support on quitting slightly increased to 89 per cent.
• The hospital component of the target has been consistently achieved in the last two years, with a national result of 95 per cent.

The latest health target results can be found at www.health.govt.nz.

MidCentral District Health Board has improved sufficiently to attain two of the six national health targets –results of which were announced today.

MidCentral’s has  previously struggled to achieve the Shorter Stays in the Emergency Department and Better Help for Smokers to Quit –both of which it attained for the first time since targets were introduced.

Our results across all the national health targets for this quarter are outlined below.

Just over 95% of 9,812 people who attended the Emergency Department were discharged, transferred or admitted within six hours presenting – achieving this target for the first time.

While we have been steadily improving our performance toward achieving this target, it has been the concerted effort of many staff and departments that have been making changes to improve the flow of patients throughout the hospital that has made the big difference in recent months.  Operations Director, Hospital Services Lyn Horgan has praised staff throughout the organisation on reaching this goal.  “While this result is to be commended and celebrated by all staff involved we need to continue the momentum to ensure we sustain these results in the future to benefit our patients.  We know that the last quarter of the year is generally a quieter period in all hospital work, so with the coming build-up toward the higher demand for beds over autumn and winter it will be a challenge to maintain these improvements.  We are mindful that maintaining the drive and applying what we learned through the second half of last year will be required if we are to continue to achieve the high rate for shorter stays in the Emergency department in future quarters,” she said.

The national health target for offering advice and support to adult inpatients who are smokers to quit smoking was achieved for the first time this quarter, with a result of 96.3%.  While we have been making steady improvements across the hospital, we have never managed to reach the 95% target for any previous three-month period until now.  Director Patient Safety and Clinical Effectiveness Muriel Hancock said this is a great result and was largely the effect of better electronic data capture and increased staff knowledge.  “It is a fantastic result for everyone involved and a great effort by all of our staff. The longer term objective is to reduce smoking-related health issues in our community, so it is important that we keep this high rate going in the hospital setting as well as support our healthcare partners to improve performance in the primary care setting”.  The result for providing brief advice and help to quit smoking in primary health care settings was disappointing – reducing to the lowest result for quite some time at only 73% of the estimated 17,237 adults seen in general practice over the year to December.  The DHB and Central PHO are committed to working with general practice teams and others to improve this result over the coming months.

We continued to achieve the target rate (95%) of eight month old infants being fully immunised on time.

The national target increased from 90% to 95% by the end of December 2014. We have been consistentlymeeting the higher target rate this year through the efforts of a strong team approach across the district to ensure we improve and sustain excellent immunisation coverage rates.  

We were well ahead of target again for the number of people discharged following their elective surgery.

Over this quarter, 203 more patients than originally planned had had their elective surgical procedure bringing the total to 3676 discharges by the end of December – 108% of target.

The proportion of eligible people who have had their cardiovascular disease risk assessed in the last five years reduced slightly to 85% of 46,959 eligible enrolled adults this quarter   – below the 90% target and lower than the national average for all DHBs (87%).

While there are some general practice teams throughout the district that are achieving, or close to achieving, this target, there are others that need to lift their performance levels to ensure more eligible patients receive their assessment for risk of heart disease.  Central PHO is helping these practices with a number of strategies, including “text to remind”, better information management, health promotion material and having health checks at health expos like the Whanau Ora days.

The new national target for faster cancer treatment was introduced in July and is reported for the first time this quarter.

This health target replaces the previous one for shorter waits for chemotherapy and radiotherapy which has been consistently achieved over the last couple of years.  The new target is that by July 2016, 85 percent of patients referred with a high suspicion of cancer and a need to be seen within two weeks receive their first cancer treatment (or other management) within 62 days. It covers the time patients wait for all tests and investigations needed to confirm a cancer diagnosis and subsequent treatment, such as radiotherapy, chemotherapy, surgery, non-intervention management such as active surveillance, and palliative care.  The new cancer target applies to a specific group of patients who are referred through a managed, outpatient pathway with a high suspicion of cancer and a need to be seen within two weeks. Focusing on this group presents the greatest opportunity to improve the cancer pathway, from referral to first treatment, and make improvements that benefit all cancer patients.

Our result, at 66%, is the same as the national average.  At this stage, the volume of eligible patients referred through the outpatient pathway is quite small and so a rolling six-month period is reported.

For more details and FAQs about the Health Targets go to: www.health.govt.nz/new-zealand-health-system/health-targets.  

The results of district health board performance against six health targets for the second quarter 2014/15 has been released.

Health Minister Jonathan Coleman says patients recovering from hip or knee replacement surgery are spending less time in hospital as a result of a new national quality improvement programme.

Dr Coleman was today launching new Orthopaedic Enhanced Recovery After Surgery (ERAS) patient education videos at Waitemata DHB Electives Surgical Centre.

“The national Orthopaedic ERAS programme is a patient centred approach designed to prepare patients for surgery,” says Dr Coleman.

“A key part of ERAS is involving patients in the preparation for surgery. If people know what to expect, they are better prepared, recover faster, have fewer complications, and can get out of hospital quicker.

“ERAS also makes better use of staff time, contributes to fewer cancelled operations, and increases the capacity for more operations to be done.

“Coordinated by the Ministry of Health, ERAS has involved orthopaedic teams from 18 DHBs. It is a good example of collaboration across DHBs.

“The Ministry of Health is looking at other specialties where ERAS can be applied. Efforts are also underway to increase primary care involvement.”

The number of patients receiving hip, knee and other elective surgery each year has increased from 118,000 in 2007/08 to 162,000 in 2013/14. The Government committed in Budget 2014 a further $110 million into elective surgery over four years to continue to meet increased demand.

The videos ‘Your Guide to Hip Replacement Surgery’ and ‘Your Guide to Knee Replacement Surgery’ can be found at www.health.govt.nz.

The College develops strategic consumer alliances with the aim of creating 100% access and zero disparities in NZ health care, while providing a leading voice for the nursing profession and professional commentary on issues which affect nurses, and also the health of the whole community.

Pre- and post-operative surveys were completed by patients who underwent major hepatic, colorectal, or oesophagogastric surgery and surveys were also sent to surgeons, anesthetists, and nurses experienced in delivering enhanced recovery protocols. 

"Overall, both patients and care providers rated the majority of items as important and supported ERAS principles. Freedom from nausea ... and pain at rest ... were the care components rated the highest by both patients and care providers. Early return of bowel function ... and avoiding preanesthetic sedation... were scored the lowest by care providers". The authors conclude that ERAS principles are supported by both patients and care providers, althoough controversies still remain regarding the relative importance of individual ERAS components.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1016/j.jss.2014.06.032 or contact your DHB library, or organisational or local library for assistance.

Hughes, M., et al. (2015). Attitudes of patients and care providers to enhanced recovery after surgery programs after major abdominal surgery. Journal of Surgical Research, 193(1), 102–110.

"Lack of manpower, poor communication and collaboration, resistance to change, and patient factors were cited by most as barriers. Discipline-specific issues were identified although most related to resistance to change. Overall, interviewees were supportive of implementation of a standardized ERAS program and agreed that a standardized guideline based on best evidence; standardized order sets; and education of the staff, patients, and families are essential". The authors discuss the implications of these findings.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1097/SLA.0000000000000604 or contact your DHB library, or organisational or local library for assistance.

Pearsall, E.A., et al. (2015). A qualitative study to understand the barriers and enablers in implementing an enhanced recovery after surgery program. Annals of Surgery, 261(1), 92–96.

Knowledge sharing will take place at this website, where there will be:

• Examples of patient information
• A list of publications with articles concerning ERAS-nursing care
• Inspiration for organizational changes
• A list of names and contact details of the members of the ERAS Nursing group

Includes information on health targets; quality and safety markers; patient experience; nursing practice partnership; consumer experience; communication skills development; community safety initiatives; community based care without the wait; pathways to good health; the shared care record; disability services; advance care planning; immunisation; patient safety initiatives. 

To read the quality accounts, go to:  http://www.ccdhb.org.nz/aboutus/statutory-publications.htm

Ten articles were included (with a level of evidence graded as low to moderate). None reported an adverse effect on perioperative morbidity or mortality. Length of stay was decreased, and readmission rates were unchanged in six of seven studies that compared these outcomes.

The authors conclude that "... ERAS protocols may be implemented in pancreatic surgery without compromising patient safety or increasing [length of stay]" They go on to say that programmes should be based upon the best available evidence, and trials involving multiple centres should be undertaken.

Now available to read in free full text at: http://dx.doi.org/10.1111/hpb.12265 

Kagedan, D. J., Ahmed, M., Devitt, K. S. and Wei, A. C. (2015), Enhanced recovery after pancreatic surgery: a systematic review of the evidence. HPB, 17(1), 11–16.

The document is available to read in full text at:  http://www.wdhb.org.nz/content/page/key-documents/m/886/

The quality accounts are available to read at:  http://www.northlanddhb.org.nz/Portals/0/Communications/Publications/E38_NDHB_Quality_Accounts_14_FINAL_LRes.pdf

Nursing staff at Auckland DHB are celebrating this month after completing the 10th year of a successful Operating Room (OR) education program.    

More than 200 nurses have completed the New to OR course since it was introduced in January 2004, with more than 120 nurses remaining in post. And, of those who left, around 50 have remained in the perioperative environment, both nationally and internationally.   

Nurse Consultant, Tracey Lee, is the facilitator for the course which runs two to three times a year. “The 12-week course has naturally progressed over the years to ensure standardised training and education across all Auckland DHB ORs, and incorporates knowledge and skills across approximately 22 specialties that use the operating rooms. 

“Candidates have theory study days on specific aspects and roles within the OR before moving into the clinical area to work alongside their preceptor. The emphasis is to provide a safe learning environment that uses all aspects of training such as the simulated OR in the Clinical Skills Centre,” she adds.  

Candidates are supernumerary during the course and are either new graduates or those with nursing experience but not in operating rooms.  

New to OR nurse, Jeeyoung Yi, who took part in the course last year says: “Understanding the complexities of pre-operative preparation, and post-operative care gave me a greater understanding of the patients’ journey through the perioperative area and how this care impacts on patient outcomes.” 

Each new nurse has a chance to focus on a particular area of practice at a time and develop skills in a nursing role while gaining confidence, before moving on to a different nursing role.    

Auckland DHB’s Chief Nursing Officer, Margaret Dotchin, applauded the achievement. “The dedication of the nurse educators, charge nurses and preceptors who support the New to OR nurses to gain the knowledge and then apply it to nursing practice in the clinical area, is testament to the program’s success.”  

“And for more than 80 per cent of nurses to remain in posts in our ORs or in perioperative care elsewhere is impressive. I congratulate all those involved.” 

To find out more about the course, contact Sonu Anand at the Careers Centre on (09) 638 0429, e-mail: or look out for the forthcoming advert in April.   For further information about a career with Auckland DHB visit http://www.careers.adhb.govt.nz

 The Quality Accounts showcase progress to date in improving service delivery and health outcomes for our population; highlighting our successes, what the DHB has learned and our future improvement goals.

The Quality Accounts are available to read in full text at: http://www.westcoastdhb.org.nz/publications/quality/WCDHB-QualityAccounts-Jul2013-Jun2014.pdf

Its essence is the distillation, examination and application of clinical evidence to improve surgical outcome.

Main areas of interest include but are not limited to:

•  Surgical outcome
•  Evidence-based care
•  Preoperative evaluation and testing
•  Surgical risk scoring
•  Development of Perioperative guidelines
•  Perioperative haemodynamic monitoring
•  Surgical optimisation
•  Enhanced surgical recovery programs
•  Cardiopulmonary exercise testing
•  Perioperative Fluids

This evidence-based framework provides comprehensive advice on optimal perioperative care for the patient undergoing gastrectomy and facilitates multi-institutional prospective cohort registries and adequately powered randomized trials for further research.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1002/bjs.9582 or contact your DHB library, or organisational or local library for assistance.

Mortensen, K., et al. (2014). Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. British Journal of Surgery, 101(10), 1209–1229.

Includes information on health targets; quality and safety markers; patient experience and consumer feedback; serious adverse events; elective services; maternal and infant; child and youth health; health of older people; primary care; medical and acute care; and mental health.

The Quality Accounts are available to read in full text at:   http://www.scdhb.health.nz/news/key-documents/quality-accounts.html

The report includes discussion of health targets; serious and sentinel events; improving patient care and safety; quality and safety markers; patient experience; matching staffing to demand for patient care; Improving Māori health; Project Maunga – Base Hospital Redevelopment; Improving quality and the patient experience.

The report is available to read in full text at:  http://www.tdhb.org.nz/misc/documents/Quality-Accounts-2013-2014.pdf

Tairāwhiti District Health (TDH) completed a number of projects in the last year to improve healthcare for the people of Tairāwhiti and these are covered in the 2013/14 Quality Account that was released just prior to Christmas.

The account shows that TDH met or exceeded five of the six Ministry of Health targets. The only target not met was providing stop smoking advice in primary care. The target is 90 percent and in Tairāwhiti, 86 percent of smokers received advice. That is an increase of nearly 30 percent on the previous year.

The account also covers what TDH is doing to prevent falls – the most common risk to patient’s safety, reduce hospital acquired infections, make surgery even safer, prevent Sudden Unexpected Death in Infancy, reduce the number of mental health patients that are secluded as well as detail of the learnings from the two serious adverse events that occurred last year.

District Health Boards produce Quality Accounts to report on the quality of the services they provide. “They are a snapshot of the areas where services are continually improving, areas where we would like to be doing better, and areas where we are intending to focus in the year ahead, says Chief Executive Jim Green. “Quality Accounts are designed to be published alongside financial accounts to demonstrate that quality and patient safety is of equal value to organisations like TDH.”

“We are an organisation that only exists because people need to be supported to gain optimal health. As a funder and provider of services we are geared to meet this need. That is not enough however. We need to know that the care provided in our district, is to a standard that meets the expectations of our communities. Our Quality Account should make it clear to the community just what they can expect from TDH, and what we will not tolerate and take action to correct.”

The TDH Board regards quality as the number one priority, says Board Chair David Scott. “Close scrutiny and discussion of the quality indicators is a frequent feature at monthly Board meetings. The Quality Account indicates the time and energy invested by our dedicated staff with pleasing improvements shown.”

Responsibility for managing patient quality and risk lies with the Director of Nursing and Midwifery, Sonia Gamblen “About 12 years ago I started asking myself and the people with whom I worked ‘Why do patients have such differing experiences of health care? Why does patient “A” have a good experience and patient “B” have a completely different experience?’ I have seen marvelous patient outcomes, but also patients suffering various forms of harm as a result of their hospital experiences. While I firmly believe none of the harm was intentional, it was often not seen as preventable. The change in thinking – to consider and put in place measures that prevent adverse patient outcomes and promote safe expert care – makes it an exciting time to be working in health care.”

TDH’s key areas of focus in the year ahead are meeting or exceeding national health targets, improving patient safety, improving connections between primary and secondary care, improving access to clinicians for those living in remote communities, improving TDH’s facilities to treat cancer and addressing Tairāwhiti’s high level of obesity and diabetes.

“We are making excellent progress,” says Mr Green, “but there is still much work to be done and I am grateful for the efforts of the staff dedicated to doing it.”

If you have any feedback about this Quality Account and whether they provide relevant and useful information on the quality of health services being delivered in Tairāwhiti please use the feedback form.

Read Tairāwhiti District Health’s 2013/14 Quality Account

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1308/003588414X13946184903649 or contact your DHB library, or organisational or local library for assistance.

Chen, S., et al. (2015). A meta-analysis of fast track surgery for patients with gastric cancer undergoing gastrectomy. Annals of The Royal College of Surgeons of England, 97(1), 3-10.

The Quality Account includes: 

• Lakes DHB’s first Patient Experience Week which actively sought feedback from patients who had recently been in hospital and received some candid and thoughtful views on their experience during their stay 
• The Woman Child and Family Service’s child health consumer reference group which provides suggestions as to how to improve services in this area 
• Improvement across the six Quality and Safety Markers including hand hygiene 
• Safe and Standardised Clinical Handover which has become embedded in the way things are done at Lakes DHB 
• Awhi midwives, a new model of maternal and child health integrated service provision which is proving to be well accepted and popular in the Turangi community with some very good clinical results 
• Community pharmacists working on a new model of care that puts the service user at the centre. 

The report for 2013/14 Quality Account aims to show Lakes DHB’s position nationally by reporting on the health targets and quality and safety markers and compares results across the country. It reports on serious adverse events and actions taken to minimise the events reoccurring. 

To download the document, go to:  http://www.lakesdhb.govt.nz/Resource.aspx?ID=30014

State Services Minister Paula Bennett has welcomed the latest Kiwis Count survey results, showing the levels of trust and satisfaction New Zealanders have in the frontline public services they use continues to increase.

The State Services Commission’s annual Kiwis Count survey looks at trust based on experience and perception, and satisfaction in public services, and shows improvements in both measures this year compared to last year.     

“This Government’s unwavering commitment to delivering better public services, as New Zealanders expect and deserve, is reflected in the steady improvement in feedback over the past seven years,” says Mrs Bennett.   

New Zealanders’ trust in public services based on a recent experience has increased to 77 per cent, up ten points from 2007.

Satisfaction levels have also increased, up one point from 2013 to 73 per cent out of 100 this year.

“We are incredibly lucky in New Zealand to have a high calibre, responsive and transparent public sector that genuinely works to put New Zealanders first,” says Mrs Bennett.

“Agencies are increasingly changing the way they work so that the needs of people using their services come first and foremost. This means integrating and streamlining services to make things easier, and recognising what it is people need, and tailoring services towards that,” says Mrs Bennett. 

“The rising levels of satisfaction people are reporting with our public services is a reflection of this improved approach, and it’s pleasing today’s results highlight the increase in positive experiences that people are having.” 

The latest Kiwis Count survey was carried out between July 2013 and June 2014, and surveyed 6099 people. The report is available here: www.ssc.govt.nz/kiwis-count.

The report includes information on progress with health targets, patient safety, quitting smoking, allied health, the pre-admissions hub, community  rheumatology, enhanced recovery after surgery, a diabetic eye clinic, advanced directives, the Coordinated Access Referral Electronic Service, and the Service User Board.

To read the report in full text, go to:  http://www.nmdhb.govt.nz/filesGallery/New%20Website/09Board%20Documents/Quality%20Report%202014.pdf

The West Coast District Health Board once again leads the country's DHBs in the health targets for shorter stays in emergency departments, achieving 100%.

The target of 95% measures what proportion of patients are admitted, discharged or transferred from an emergency department within six hours.

The DHB's performance against six targets is measured quarterly and the figures for Quarter 1 in the 2014/15 financial year have just been released.

All DHBs have met the 100% target for shorter waits for cancer treatment - this target ensures people are ready for radiotherapy or chemotherapy and start treatment within four weeks.

In terms of smoking cessation advice, the West Coast has got close to the 95% target for giving advice to hospitalised patients, at 93%. It has increased on the previous quarter's target for advice to primary care patients, which now sits at 71% against the 90% target.

The DHB falls a little short of the 100% target for improved access to elective surgery over the past year - meeting 95%.

David Meates, West Coast and Canterbury DHB chief executive, says the results reflect continued efforts to provide outstanding healthcare for the people of the West Coast.

"It's pleasing to see we're leading the country in some areas. We still have some work to do in others."

Immunisation numbers dropped on last quarter's results, from vaccinating 81% of our eligible children for the Increased Immunisation Health Target, to 77% in this quarter. High opt-off and declines continue to be challenging in meeting this target.

Eligible enrolled adult West Coasters are having more heart and diabetes checks with general practice teams than the previous quarter, with 79% compared to 76.6%. The target for the DHB is 90%.

Full information on the West Coast DHB's Health Target performance can be found here http://coastweb/wcdhb_new/publications/perfAgainstHealthTargets.asp>, and
information on the Ministry of Health's Health Targets site.

Canterbury DHB's first quarter results in the 2014/2015 National Health Targets show targets on track to being achieved.

Improvements on the primary care targets for Better Help for Smokers to Quit and the More Heart and Diabetes Checks – have more than doubled in the last year to 81 and 71 percent respectively – bringing them much closer to achieving the 90 percent.

David Meates, Canterbury DHB chief executive, says Canterbury continues to work with the Primary Health Organisations to support quit smoking incentives and the delivery of heart and diabetes checks in General Practice.

"Initiatives for quit smoking include text to remind and appointment systems that assist to identify people who are yet to receive a targeted service," Mr Meates says.

"For heart and diabetes checks, there's ongoing education and engagement with practices and ongoing support for practices to contact and recall eligible and hard to reach patients."

Mr Meates says the commitment from across the health system to achieve these targets after coming from a very low base line, is remarkable.

"I'm really impressed with the efforts from everyone to bring these targets within reach."

Canterbury achieved the Shorter Waits for Cancer treatment target and the Better Help for (Hospitalised) Smokers to Quit target at 100 percent and 95 percent but fell short by two percent of the Shorter Stay in ED and the Increased Immunisation targets of 95 percent.

ED attendances have continued to increase in quarter 1 with the winter months.

"Strategies to care for older people in their own homes and the community are well embedded and have flattened previous growth over the past three years in this age group but we're still seeing increasing growth in younger male adult presentations," Mr Meates says.

"Canterbury DHB is monitoring the Christchurch rebuild population to assess what impact this has made on ED attendances – we hope to have some strategies in place early next year."

Only three DHBs achieved the Increased Immunisation Target in Quarter 1, which changed from 90 percent by 30 June 2014 to 95 percent by 31 December.

Overall Canterbury partially achieved the target vaccinating 93 percent of eligible children.

Despite narrowly missing out overall, Canterbury achieved the target for most ethnicities with strong results for Asian (97 percent), Pacific (96 percent), NZ European (95 percent). Maori coverage improved to (91 percent).

"This is a really great result – it shows that the majority of children are being immunised on time and having that protection will go a long way towards keeping them healthy now and into the future."

Find more about Canterbury DHB health targets 

The national Enhanced Recovery After Surgery (ERAS) programme introduced at Wanganui Hospital early this year to improve patients’ recovery following hip and knee replacement surgery, is proving successful.

Local project lead Shona Kirkby says besides delivering safe, effective patient/family-centred care for patients undergoing planned hip and knee replacements, the internationally recognised ERAS model of care is focused on improving patient outcomes through the engagement, commitment and involvement of a multi-disciplinary team who work with patients undergoing the two operations.

Mrs Kirkby says patients have a thorough pre-operative assessment of their circumstances and needs, followed by carefully targeted care right through their hospital stay and their recovery at home.

“The evidence-based, ERAS approach has transformed patients’ outcomes in Europe and the UK so it’s great to see patients across New Zealand beginning to benefit from the same approach,” Mrs Kirkby says.

“Patients are mobilising earlier and we are seeing reduced lengths of time patients stay in hospital. To help them achieve this, we encourage them to sit up in chairs while having their meals and to dress in their own clothes from the first day after surgery.

“Importantly, ERAS is an approach that asks patients to engage with every member of the team we have in place to support them through the lead up to their operation, their stay in hospital and their recovery back at home.

“We give patients a lot of practical information and ask them to think ahead about things such as making sure they have prepared meals in their freezer. We like to know if they have family and friends to support them through the recovery process and what aids or other assistance they may need at home to assist with their mobility and recovery. We explain why it is vital that they follow instructions before surgery and why they must attend their medical appointments.”

Mrs Kirkby says the Whanganui District Health Board (WDHB) has welcomed the opportunity to improve clinical outcomes for patients and families. It also recognises the benefits of being able to reduce waiting times for surgery and enable more effective use of WDHB resources. Orthopaedics is one of the largest elective services provided by DHBs.

Health Minister Jonathan Coleman says the latest National Health Target results show that over the busy winter months people were treated more quickly in emergency departments across the country than in previous years.

“Today’s quarter one result for 2014 is the best result in emergency department wait times over winter since targets began in 2009, which is significant as this is when services are traditionally at their most stretched,” says Dr Coleman.

Almost 93 out of every 100 people presenting to an emergency department during winter were admitted, discharged or transferred within six hours.

The result was achieved at a time when more patients were presenting to emergency departments – there were 272,972 patients seen this quarter – 7185 more people than at the same time last year.

The quarterly result of 93 per cent is slightly down on the previous quarter and reflects the impact of the usual winter rush caused by seasonal illness such as influenza.

“Overall, this is a very good result as we work steadily towards the 95 per cent goal. It is thanks to the hard work of the many health professionals working in emergency departments, across our hospitals and in primary care,” says Dr Coleman.

“It is also tribute to the leadership shown by Professor of Emergency Medicine Mike Ardagh who steps down as the Target Champion next month after five and a half years.”

Other target results show that three health targets have been met:

• Improved access to elective surgery - 2,120 (5 per cent) more elective surgical discharges were provided than planned.
• Every patient ready for cancer treatment received it within the world gold standard of four weeks.
• 95 per cent of smokers in hospital were given advice on how to quit.

Improvements continue to be made in the other targets:

• The national coverage result for infant immunisation at 8 months of age is 92 per cent, an increase of 0.8 per cent on quarter four against the revised target of 95 per cent.
• The primary care component of the better help for smokers to quit target increased by 2.6 per cent to 88 per cent.
• More heart and diabetes checks target increased by 1.3 per cent to 86 per cent this quarter.

The shorter waits for cancer treatment health target is being replaced by the Faster Cancer Treatment Target. This is the last result published for this target. The first results for the new target will be published in February 2015.

A summary of district health board performance against six health targets for the first quarter 2014/15 has been released.

Contents include:

Priority One: Continue to keep our patients safe during their care

• Reducing falls resulting in harm
• Health Care associated infections
• Hand Hygiene
• Reducing perioperative harm
• Reducing Medication Errors
• Reducing Hospital acquired pressure injuries
• Seclusion Minimisation in Mental Health

Priority Two: Continue to improve the quality of end of life care

Patient Outcomes

Priority Three: Continue to work to improve our escalation process when a patient’s condition deteriorates

Patient Experience

Priority Four: Improve our customer care and responsiveness to patient needs

Our focus for 2014/2015

Priorities for improvement and why we chose them

Capability Development

The report is available to read online at: http://waikatodhb-ebooks.co.nz/qualityreport/index.html

This year's Quality Accounts focuses on the following 10 areas:

Implementation of ERAS  will lead to the delivery of safe, effective, and patient and family centred care for elective patients undergoing primary total hip or knee joint arthroplasty (TJA) and acute patients with fractured neck of femur (#NOF).

This Collaborative Change Package is designed for use by all health professionals in District Health Boards (DHBs) that are responsible for the planning and delivery of care for patients undergoing TJA or with #NOF. For DHB teams, the adoption of ERAS will lead to a more integrated, team based approach to patient care.  By adopting and implementing ERAS principles patients and their families will:

• Be more educated and engaged in their care and recovery
• Experience improved functional outcomes and reduced length of stay, complications and readmissions
• Be more satisfied with their care experience

The Change Package is available to download below.

The accounts are available to read at: http://www.hawkesbay.health.nz/file/fileid/49713

The Quality Accounts are aligned with many other CM Health accountability documents, including their
Annual Report covering the 2013/14 financial and service performance, and their Annual Plan.

The Quality Accounts are available to read at: http://www.countiesmanukau.health.nz/About_CMDHB/Planning/planning-documents.htm#Quality_Accounts

The Award recognises Fellows of the College who have given long and dedicated service to their local community – more often than not unheralded – but without which the standard of surgical care in that community would have been less than society demands.

Mr Gowland established the first mobile lithotripter service in 1995, which provided an effective nationwide non-invasive treatment of kidney stones.

This significantly reduced the need for patients to travel to major centres for treatment and has provided lithotripsy services to more than 17,000 New Zealand patients.

To read the full story, go to:  http://www.scoop.co.nz/stories/GE1411/S00044/surgeon-recognised-for-contribution-to-rural-health.htm

The authors undertook three inter-related reviews of quantitative and qualitative evidence relating to theoretical explanations for appointment behaviour (review 1), the effectiveness of different approaches to reminding patients to attend health service appointments (review 2) and factors likely to influence non-attendance (review 3).

Findings from 31 randomised controlled trials and 11 separate systematic reviews (review 2 only) revealed that reminder systems are consistently effective at reducing non-attendance at appointments, regardless of health-care setting or patient subgroups. Simple reminders that provide details of timing and location of appointments are effective for increasing attendance at appointments.

Reminders that provide additional information over and above the date, time and location of the appointment (‘reminder plus’) may be more effective than simple reminders at reducing non-attendance and may be particularly useful for first appointments and screening appointments; simple reminders may be appropriate thereafter for most patients the majority of the time. There was strong evidence that the timing of reminders, between 1 and 7 days prior to the appointment, has no effect on attendance; substantial numbers of patients do not receive their reminder; reminders promote cancellation of appointments; inadequate structural factors prevent patients from cancelling appointments; and few studies investigated factors that influence the effectiveness of reminder systems for population subgroups.

The authors conclude that simple reminders or ‘reminder plus’ should be sent to all patients in the absence of any clear contraindication. Other reminder alternatives may be relevant for key groups of patients: those from a deprived background, ethnic minorities, substance abusers and those with comorbidities and/or illnesses. 

This article is available to download and read in free full text at: http://www.journalslibrary.nihr.ac.uk/hsdr/volume-2/issue-34#abstract

Mclean S, Gee M, Booth A, Salway S, Nancarrow S, Cobb M, et al. (2014). Targeting the Use of Reminders and Notifications for Uptake by Populations (TURNUP):  A systematic review and evidence synthesis. Health Services Delivery Research, 2(34).

"Participants reported high levels of satisfaction with patient care and support received from doctors, ward nurses and the hospital as a service and care organisation, within the context of a fast-track surgical programme. Early hospital discharge after gynaecological surgery results in both enhanced recovery after surgery (ERAS) and high levels of patient satisfaction".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/ecc.12254 or contact your DHB library, or organisational or local library for assistance.

Philp, S., Carter, J., Pather, S., Barnett, C., D'Abrew, N. and White, K. (2014), Patients' satisfaction with fast-track surgery in gynaecological oncology. European Journal of Cancer Care. doi: 10.1111/ecc.12254

The Annual Report contains the Ministry's achievements as a leader of the health sector and its contribution to the government’s priorities. The report includes detail on the Ministry's financial and non-financial performance over the past year.

The publication also includes the Director-General of Health's Annual Report on the State of Public Health (the Health and Independence Report) which provides an overview of the current state of public health in three main sections: health status, factors that influence New Zealanders' health and health system performance.

The report is available to read in full text at: http://www.health.govt.nz/publication/annual-report-year-ended-30-june-2014

Health Minister Jonathan Coleman says the annual report on Implementing the New Zealand Health Strategy 2014 shows that public health and disability services continue to offer better access to safe and effective care.

“Waiting times are reducing, and services are increasingly being planned, managed, funded, and delivered in a sustainable way,” says Dr Coleman.

The report from the Health Minister shows the public health service continues to perform well against the Government’s Health Targets, and further deliver improvements in priority areas.

“The Prime Minister’s Youth Mental Health Project has seen further positive progress. School-based health services are now offered in 44 out of 48 decile three secondary schools and the online e-therapy programme SPARX is available to provide support to young people,” says Dr Coleman.

“The report highlights progress in other significant areas. For instance Whānau Ora is trialling a new information system that enables better patient care through the collection and sharing of data.

“The Better Public Services programme continues to drive efforts across departments. This includes efforts to reduce the rate of rheumatic fever, in which the Government invested an additional $20 million in Budget 2014, taking the Government’s overall investment to over $67 million.

“The report also highlights the challenges of responding to demographic changes.

“Health and disability services are moving towards a more integrated system of care and this report shows we are on the right track,” says Dr Coleman.

Implementing the New Zealand Health Strategy 2014 is released alongside the Director-General of Health’s Health and Independence Report and the Ministry of Health’s Annual Report available at www.health.govt.nz.

With a record 64 nominations to choose from, a winner for the MidCentral DHB Health Awards judges’ choice award has never been harder to pick.

This year the award went to MidCentral Health’s Gastroenterology Service for their work in reducing waiting times, refocusing the direction of their service, and developing better care for their patients.
Rewind a few years, and it was not uncommon for the service to have waiting times of up to six months for elective endoscopies. Coupled with a loss of strategic focus, it was apparent that something needed to change. It is this change that the judges have recognised, with new initiatives resulting in a significant drop in waiting times, to the point where the majority of patients are waiting less than two months.

There are several factors that have contributed to this. The implementation of a Global Rating Scale that provided a patient-centred, quality framework has been key to the change that has been made. The creation of a role for a Clinical Nurse Specialist Lead in Gastroenterology has also been a big boost for the department. The CNS role has provided more clinical leadership and helped to change the culture of the organisation. She has also been appointed in a part-time role as the Nursing Workforce Development Lead for the National Endoscopy Quality Improvement Programme.

The judges saw the changes and the work that continues to be done as worthy of recognition.

They said: “Faced with a huge workload and difficulties with waiting times the department focused on team work, collective responsibility and strategic focus; reorganising itself to make a commitment to improving the patient experience which will have long term benefits to its service users.”

Health Minister Jonathan Coleman is getting out of the Beehive to meet the health sector, starting with Southern District Health Board tomorrow.

“I will be visiting all 20 District Health Boards over the next few months to engage with doctors, nurses and management. As a doctor I know the value of clinicians in helping to drive progress in the health system,” says Dr Coleman.

“I want to engage with the sector to hear their views, and look at how we can make the best use of resources, people, facilities and funding. It is vital that patients are at the centre of our health system, and receive the healthcare they need.

“Visiting Southern District Health Board is my first priority. I want to hear about the issues first-hand from clinicians and management.

“The Government is focused on investing in primary care, screening, early intervention and disease prevention. We want to make progress on more elective surgery, faster cancer treatment, and shorter stays in emergency departments. We are also committed to investing $50 million over three years to reduce pain in bones, muscles and joints, and we plan to increase hospice funding by $20 million a year.

“As Minister for Sport and Recreation I am also looking to strengthen the link between exercise and keeping New Zealanders healthy. Obesity is a major risk factor for diabetes.”

Dr Coleman’s visit to Southern District Health Board will include meetings with senior doctors and board members. He will also meet with primary care leaders and Otago University.

Based on the results, they conclude that "auditing an already successful ERP and implementing a number of marginal gains has led to a significant decrease in the median LOS for radical cystectomy. The LOS for open radical cystectomy at University Hospital Southampton has halved. In the second phase of our ERP, our median LOS is 7 days".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/bju.12644 or contact your DHB library, or organisational or local library for assistance.

Smith, J., Meng, Z. W., Lockyer, R., Dudderidge, T., McGrath, J., Hayes, M. and Birch, B. (2014), Evolution of the Southampton Enhanced Recovery Programme for radical cystectomy and the aggregation of marginal gains. BJU International, 114: 375–383.

Of all 17,625 patients scheduled for elective surgery 6,911 (39%) received one or more cancellations. The most common reason for cancelling a planned surgery was different patient-related factors 3,293 (33%). Cancellations due to treatment guarantee legislation reached 2,885 (29%) and 1,181 (12%) of the cancellations were related to incomplete pre-operative preparation of the patients. Organisational reasons were the cause of approximately 869 (9%) of the cancellations.

The authors conclude that it should be possible to eliminate many of these cancellations, while others are unavoidable or caused by factors outside the responsibility of the individual clinic or even hospital. One possible way of influencing the high rate of cancellations might be to change the view of the patients and involve them in the overall planning of the care process.

This is an open access article and is available to read in full text at: http://www.pssjournal.com/content/8/1/24

Caesar, U., et al. (2014). Incidence and root causes of cancellations for elective orthopaedic procedures: A single center experience of 17,625 consecutive cases. Patient Safety in Surgery, 8:24.

Auckland DHB’s Hidden Hospital project has been selected as a 2014 New Zealand Innovators Award finalist – Innovation in Health & Science.

The Hidden Hospital innovation has involved a system-wide transformation of how acute care is managed at Auckland City Hospital, benefitting tens of thousands of patients by improving their quality of care, safety and experience in our healthcare system.

This innovation involved engagement of the whole hospital system to reduce the time patients spent waiting for care in emergency departments, further treatment and discharge from hospital wards. The social impacts are significant with people receiving more timely care and being able to return to their home and families sooner with better outcomes.

Challenge
Each year more and more patients present to Auckland City Hospital. The Emergency Department (ED) was busy and all beds were occupied.

Process
In 2009, Auckland DHB formed a Performance Improvement Team consisting of experts in continuous improvement from other industries. This team worked alongside clinicians to apply principles developed outside of healthcare to innovate and implement sustainable ways to improve care for our patients and reduce the time patients spent waiting.

Outcome
Our patients now spend less time waiting in ED and hospital, have fewer elective procedures cancelled, and receive more bedside care from their nurses than ever before. We have achieved the following results for our patients since 2009…

• Average stay in ED has reduced by 38% (160,000 hours/year saved).
• Average wait time to be admitted to the hospital from ED has reduced by over 80%
• to under 1 ½ hours.
• 90% reduction in cancelled surgeries due to no available beds.
• An increase in direct care time on wards of up to 2 hours per 8 hour shift.

The innovations implemented have saved millions of dollars for the organisation and empowered staff to make sustained improvements to the way the healthcare service is delivered. Without these initiatives, we would have over 100 additional patients occupying beds every night.

New Zealand Innovators Award
The Awards are an initiative of the New Zealand Innovation Council with the aim of recognising great kiwi talent and services. The winners of the New Zealand Innovators Awards 2014 will be announced at the awards evening on Wednesday October 15. For more information go to www.innovators.org.nz.

The Stanford Translational Research Integrated Database Environment (STRIDE) was utilized to identify all ASA PS 2 or 3 patients who underwent primary THA at Stanford Medical Center from February 1, 2008 through January 1, 2013. Patients were divided into five groups based on the BMI weight classification. Regression analysis was used to quantify relationships between BMI and the different components of total OR time.

1,332 patients were included in the study. There were no statistically significant differences in age, gender, height, and ASA PS classification between the BMI groups. Normal-weight patients had a total OR time of 138.9 min compared 167.9 min (P < 0.001) for morbidly obese patients. At a BMI > 35 kg/m2 each incremental BMI unit increase was associated with greater incremental total OR time increases.

The authors conclude that morbidly obese patients required significantly more total OR time than normal-weight patients undergoing a THA procedure. This increase in time is relevant when scheduling obese patients for surgery and has an important impact on health resource utilisation.

This is an open access article and is available to read in full text at: http://dx.doi.org/10.7717/peerj.530

Kadry, B., Press, C.D., Alosh, H., Opper, I.M., Orsini, J., Popov, I.A., Brodsky, J.B., Macario, A. (2014). Obesity increases operating room times in patients undergoing primary hip arthroplasty: A retrospective cohort analysis. PeerJ, 2:e530 

"Sixteen studies were included. Two randomised controlled trials demonstrated shorter hospital stay in elderly patients with ERAS compared to elderly patients with non-ERAS ... Fewer complications occurred with ERAS in both RCTs ... The majority of observational studies did not show differences in outcome between elderly and younger patients in terms of hospital stay, morbidity or mortality". The authors conclude that "ERAS can be safely applied to elderly patients to reduce complications and shorten length of hospital stay", although they suggest further studies are needed to determine if elderly patients can adhere to, and benefit from, ERAS protocols to the same extent as younger patients.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/codi.12718 or contact your DHB library, or organisational or local library for assistance.

Bagnall, N.M., et al. (2014). A systematic review of enhanced recovery care after colorectal surgery in elderly patients. Colorectal Disease, 16(12), 947–956.

Auckland District Health Board (DHB) is celebrating after achieving all six national Health Targets, proving its dedication and commitment to provide high quality services for patients and their families.

As one of only two DHBs in the country to achieve all six targets, alongside Counties Manukau DHB, the results demonstrate a high performing organisation focused on meeting the needs of patients.

"This is an outstanding achievement and I personally thank everyone at Auckland DHB for their continued efforts to provide high quality health services for patients and their families," said Chief Executive, Ailsa Claire.

With the support of local Primary Health Organisations (PHOs), Auckland DHB  achieved two key community targets this quarter that support people to maximise their health and wellbeing - in heart and diabetes checks (92 per cent), the highest in the country, and in better help to support smokers to quit.

"When you bring together the better help for smokers to quit target in primary care with the work offering brief advice to smokers in hospital, this shows a real demonstration of our determination to do the right thing for patients," added Ms Claire. "This achievement wouldn't have been possible without the support of our local PHOs and I'd like to acknowledge their commitment and efforts to improve the health and wellbeing of the Auckland population."

All six targets achieved include:

Shorter stays in Emergency Departments
Target: 95 per cent of patients to be admitted, discharged or transferred within six
hours
Our result: 95 per cent

Improved Access to Elective Surgery
Target: At least 4000 extra discharges per year nationally
Our result: 101 per cent

Shorter Waits for Cancer Treatment
Target: All patients ready for treatment to wait less than four weeks for
radiotherapy or chemotherapy
Our result: 100 per cent

Increased Immunisation
Target: 90 per cent of all eight-month-olds to be fully immunised.
Our result: 93 per cent

Better Help for Smokers to Quit
Target: 95 per cent of hospitalised smokers to be offered brief advice and support
to quit; 90 per cent in primary care
Our result: 97 per cent in-hospital; 100 per cent in primary care

More Heart and Diabetes Checks
90 per cent of the eligible population to have had their cardiovascular risk assessed.
Our result: 92 per cent (top performing DHB in New Zealand)

Ms Claire said: "Everyone involved has worked incredibly hard to achieve such great results, which are seen not just in our DHB but by all three DHBs across the Auckland area. This achievement sets us in a really good position to continue our focus on providing the best possible care for our patients and their families across Auckland."

Further information about the national Health Targets can be found on the Auckland DHB website and the Ministry of Health's website.

The Canterbury DHB has achieved five of the seven targets – and made significant improvements on two of its primary care targets in quarter four of the National Health Targets.

David Meates, Canterbury DHB chief executive, says efforts across the health system to achieve targets have been remarkable.

“Improvements on the primary care targets for Better Help for Smokers to Quit and the More Heart and Diabetes Checks have been outstanding over the past year going from 36 and 37 percent respectively in quarter one to 75 and 66 percent in quarter four,” Mr Meates says.

“That’s an increase of around 40 percent and translates to around 105 people a day who are receiving support and advice to quit smoking and another 133 people a day who are getting a cardiovascular risk assessment – this is nothing short of impressive.”

To read the full media release, go to: http://www.scoop.co.nz/stories/GE1408/S00122/performance-in-primary-health-targets-almost-doubles.htm

The West Coast District Health Board's fourth quarter performance against the National Health Targets has improved or equalled in all results, bar immunisations.

For the first time this year the DHB has met the 95% target to provide hospitalised smokers with cessation advice and support.

The West Coast's figures for Shorter stays in Emergency Departments once again tops the chart for all DHBs with 100%, up from 99.6% last quarter. The target of 95% measures what proportion of patients are admitted, discharged or transferred from an emergency department within six hours.

The DHB is also exceeding its target of 1592 patients accessing elective surgery over the past year - numbers for the quarter brought the total to 1695 discharges.

And the West Coast DHB has for the fourth quarter in a row achieved the Shorter Waits for Cancer Treatment Health Target for the 2013/14 financial year, with 100% of people ready for radiotherapy or chemotherapy beginning treatment within four weeks.

David Meates, West Coast and Canterbury DHB chief executive, says the results reflect continued efforts to provide outstanding health care for the people of the West Coast.

"It's fairly good news this quarter. While we have targets we are not yet meeting, good progress is being made in most areas."

Immunisation numbers dropped on the third quarter results. Although only vaccinating 81% of our eligible children for the Increased Immunisation Health Target, we vaccinated 99% of consenting children. High opt-off and declines (18.4%), continue to be challenging in meeting this target.

Performance against the Better Help for Smokers attending primary care to quit improved by 6.5% from the previous quarter (and is now at 61.9%) but still has some way to go to meet the 90% target.

Eligible enrolled adult West Coasters are having more heart and diabetes checks than the previous quarter, with 76.6% compared to 69.6%. The target for the DHB is 90%.

Full information on the West Coast DHB's Health Target performance can be found here <http://coastweb/wcdhb_new/publications/perfAgainstHealthTargets.asp>, and
information on the Ministry of Health's Health Targets site
here <http://www.health.govt.nz/healthtargets>.

The latest national health target results released today are a tribute to the professionalism and expertise of health care staff working across the region says Whanganui District Health Board (WDHB) acting chief executive Brian Walden.
 
The WDHB not only reached all six health targets but it surpassed five of them with 96 percent for the 95 percent Shorter stays in Emergency Departments target; 106 percent for the 100 percent Improved access to elective surgery target; 95 percent for the 90 percent Increased immunisation target; 97 percent for the 95 percent Better help for smokers to Quit target; and 91 percent for the 90 percent More heart and diabetes checks target. For the remaining 100 percent Shorter waits for Cancer Treatment target, the WDHB scored 100 percent.
 
Whanganui GP John McMenamin says he’s delighted with the results for More heart and diabetes checksand Increased immunisation which are led by the primary care sector. Dr McMenanim says Whanganui’s health care workers have worked tirelessly to lift the region’s immunisation rates and that effort has now paid off. The same principle applies to More heart and diabetes checks which achieved a five percent lift since the previous quarter.
 
On a different note, Dr McMenamin who is also the national tobacco targets champion says he was  disappointed that the primary care sector’s Better help for smokers to quit  result dropped from 84 percent to 76 percent.  “The decrease is unfortunate so we have put actions in place which we believe will see this result lift over time.”
 
While it was no surprise to see all 20 DHBs once again achieve 100 percent for the 100 percent Shorter waits for cancer treatment target, Mr Walden says it’s a result that should never be taken lightly because it requires dedication and effort from many staff working across Whanganui and MidCentral DHBs. “It’s a collaborative effort between our the two teams to ensure that Whanganui’s cancer patients wait less than four weeks for radiotherapy or chemotherapy.”       
 
In the meantime, the WDHB is delighted with the Shorter stays in Emergency Departments result and the fact they had improved by one percent. WDHB Emergency Department head Athol Steward says it’s an important quality target for emergency departments to reach because it’s a hospital-wide target which requires every department to function efficiently to cut out unnecessary delays in the process of delivering care.
 
Mr Walden says he’s sure the Whanganui community will be pleased and reassured to know the WDHB is performing so well. “We’re a small DHB but I believe we are serving our population very well in all six target areas. I want to thank every member of staff who has contributed to these results.”
 
Click here to view the full WDHB National Health Target results table