This year, for the health target Improved Access to Elective Surgery, the district health board achieved number one status in the country. We performed elective surgery on 7,235 Northland patients.
During the year the district health board was asked by Government to assist in delivering 400 additional cases out of a national requirement for 4,000. This need arose out of the significant challenges facing Canterbury and its district health board as they recover from the earthquake.
All 400 cases were completed within three months from April through to June 2011.
Northland DHB was only able to deliver these discharges by working closely with district health board clinicians and private facilities in Whangarei. Seventy percent of the 400 cases was delivered by private contractors with the rest being completed by district health board staff and undertaken mostly during weekends and after hours. These contracts and extra hours were necessary as the DHB was still required to meet its own targets. This was an exceptional effort by all; it required significant co-ordination and hard work to fulfil this undertaking while still meeting the health target.
Smoking Cessation - ABC
In July 2009, a national health target was set to help smokers to quit. The target requires district health boards to ensure that 90% of hospitalised smokers will be provided with advice and help to quit by July 2011, and 95% by July 2012.
In Quarter 4 (July 2011) Northland DHB successfully achieved 93%. This data includes patients presenting to Emergency Departments, Day Stay Surgical admissions, Maternity Ward, Mental Health Unit and other hospital-based interventions.
Specially trained Smokefree Champion staff train and support other health professionals to provide ‘ABC’ quit smoking intervention (Ask about smoking status; give Brief advice to stop smoking to all smokers, and provide evidence-based Cessation support for those who wish to stop smoking).
Northland DHB continues to introduce new systems and initiatives to encourage patients and staff to be smokefree. These initiatives include security staff distributing smokefree cards informing visitors of the district health board’s smokefree policy and advice on how individuals can access support to become smokefree. Northland DHB staff are also actively encouraged to access nicotine replacement therapy and cessation support services.
The district health board is committed to ensuring its health professional workforce deliver a consistent message about the health benefits of smoking cessation and of living in a smokefree environment.
Research shows that one person in forty will, in the long-term, quit following brief advice from a health professional. This equates to about 125 patients who quit in the last year, and 62 lives saved as a result of this intervention.
Emergency Department Length of Stay
Northland DHB is continuing steady progress towards meeting the national health target 95% of patients will be admitted, discharged, or transferred from an Emergency Department (ED) within six hours.
In Quarter 4, Northland DHB achieved 90%; the average of all district health boards was 92% for the same period.
Focus continues on identifying and removing barriers to achieving shorter length of stays in the emergency department. The acute care reform programme has been successful in improving our admission and discharge processes to ensure optimal flow through the hospital. Improvements have been made in the bed management process including a more coordinated system for transfers of patients to district hospitals. Increased medical registrar cover and social work resource has been put in place within Whangarei
Hospital’s emergency department and in April 2011, a Lamson tube system was installed to streamline laboratory specimen transfers to and from the department.
In April 2011, an electronic whiteboard was introduced to the emergency department which allows staff in the department and across Whangarei Hospital the ability to track and manage patient care. Within the emergency department, the whiteboard allows for prioritisation of patient care and for tracking of patients’ progress through their journey of care. Within the hospital it allows a clear understanding of anticipated admissions and this facilitates timely availability of beds. The whiteboard has improved care and minimised the work of tracking patient flows.
Challenges impacting on target performance include the high number of patients presenting to the emergency department. This has been much higher than previous years. Northland DHB had 30,930 presentations to the emergency department last year, this equated to a 3.4 percent increase over the previous year. Work is continuing with primary care providers to address this.
Acute Care Reform Programme
The vision of the project is to provide the acutely ill patient access to the highest quality of acute care by the right person, in the right setting – first time. It also aims to assist the achievement of the national 6-hour emergency department length of stay target.
Key workstreams of the project are in relation to the management of the acutely ill patient in secondary care is as follows:
- Primary care- impact on secondary services
- Efficiencies in emergency department
- Models of care
- Discharge planning
- Communication and handover
- Use of and access to diagnostics.
Northland DHB recognises that the care of the acutely ill patient needs to be improved right across all services. The purpose of the acute reform programme is to support the development of consistently high quality care throughout all its services. The key is to reduce variation and develop standardise practices. In essence, Northland DHB wishes to ensure that the first assessment of the acutely ill patients is by a competent clinical decision maker, supported when necessary by ready access to senior clinical decision makers. Competent decision making also requires diagnostic support and the availability of these services will need to be better aligned to when and where they are needed. The combination of competent first assessment and appropriate levels of diagnostic support guarantees that the right assessment and treatment are delivered first time.
Acute Performance and Length of Stay
This year, the Ministry of Health identified productivity as a key priority, aiming for district health boards to achieve rapid, rather than incremental, improvement. The Ministry initiated the benchmarking of several attributes across all district health boards at the beginning of the year. Among these, and specifically for acute inpatient services, were the average length of the patient’s stay (ALOS) and also the quantity of hospital readmissions.
Average length of stay is a widely accepted measure of hospital throughput and productivity; Northland DHB’s standardised (for age, sex, ethnicity etc. factors) ALOS at the year-end was 3.81 days. This result was better than the national target of 3.92 days and placed Northland DHB as the seventh top performing district health board in New Zealand. The district health board will seek further performance improvement in this area.
It is important to ensure that gains in productivity are not made at a cost to clinical quality of care. Hospital unplanned acute readmission rates are a well-established measure of quality of care, efficiency, and appropriateness of discharge for hospital patients, particularly as a counter-measure to average length of stay. International experience is that shorter lengths of stay are correlated with higher rates of acute readmission.
Northland DHB’s standardised readmission rate has improved significantly from 11.89% to 10.42% in the final quarter of the year, against a Ministry of Health suggested goal of 10.4%, also improving our national ranking from 15th to 14th. Further performance initiatives in this area will be undertaken.