Cardiac Surgery Services in New ZealandCardiac Surgery Service Development Working Group Report
Date of publication: October 2008
Introduction
This Report into Cardiac Surgery Services in New Zealand was initiated in May 2008 by the Ministry of Health (the Ministry) with the Cardiac Society, in direct response to ongoing concerns relating to an overall declining level of service, a high level of variation amongst the different regions, an apparent lower provision of cardiac services in most regions in New Zealand compared to other countries, and many DHBs not achieving the planned level of increase with the Electives Initiative funding from 2006/07 onwards.
Aims of the report
This report aims to review:
- the current level of cardiac surgery provision in New Zealand compared to other countries
- variation in provision of cardiac surgery by region within New Zealand
- where in New Zealand the cardiac surgery is provided
- the level of cardiac surgery provision that should be provided in New Zealand
- the quality of service to patients, especially in relation to safety, adequacy, fairness, clarity and timeliness.
- critical success factors and barriers to access and provision of services
- options for overcoming barriers and improving service delivery
- further information that needs to be collected to more effectively monitor and manage the provision of cardiac surgery services.
Key recommendations
Service to Patients
- That the patient journey for cardiac surgery is mapped with a focus on redesign to improve quality of service to patients.
Level of Provision
- That the intervention rate for Coronary Artery Bypass Graft (CABG)1, Valve and CABG plus Valve surgery is increased over the next five years, while maintaining the current level of provision of other cardiac procedures.\
- That the national intervention rate for these three types of operation is increased from 54: 100,000 in 2007/08 to 73: 100,000 by 2012/13.
- A review of the level of service is also recommended to take place in three years.
Prioritisation
- That a consistent prioritisation system is used in all five cardiac centres in New Zealand, and for acute and elective cases.
- That current prioritisation systems are reviewed and aligned.
- That all patients (acute and elective) are assigned a clinical priority prior to surgery and are treated according to the priority where reasonably possible
- That data on time to treatment versus assigned priority is monitored
- That factors which affect treatment according to priority are identified and addressed.
Monitoring
- That key patient-focused and throughput performance indicators are reported consistently and monitored closely.
- Use of the National Booking Reporting System is made more consistent.
- Artificial distortions of performance measures created by including only “elective” patients should be eliminated as far as possible
Capacity of Units
- That a specific project is established to investigate capacity issues and link these with the needs of service delivery to patients
- That each cardiac centre develops specific plans to make better use of current resources and to increase capacity in order to deliver to the above recommended intervention rate.
- That specific capacity constraints in each of the units are identified and resolved.
- That there is engagement and discussion with Intensive Care Unit staff and others, to identify and resolve the specific resource constraints and prioritisation issues relating to access to appropriate immediate post operative care for cardiac surgery patients.
Workforce Capacity
- That each cardiac centre will review workforce requirements as part of the review of the patient journey and development of capacity plans.
- That the Medical Council is asked to consider the role and utilisation of overseas trainees to assist as cardiac surgical registrars
- That consideration is given to utilising alternative roles across the patient journey eg Operating Department Practitioners (ODPs), as used in the United Kingdom
- That in order to develop a sustainable cardiothoracic nursing workforce:
- a National Cardiothoracic Nursing Workforce oversight group is established to support national and local workforce strategies
- consideration is given to the establishment of designated (separately funded by the Ministry) senior nursing roles in each of the five cardiac centres that are dedicated to developing and maintaining a sustainable cardiothoracic nursing workforce.
Implementation
- That an implementation taskforce is established by the Ministry of Health to refine and lead implementation of the recommendations of this report. This will include a process of wider consultation.
- That the taskforce will ensure that key patient focused and throughput performance indicators are monitored closely.
- That each cardiac surgery centre develops strategies and plans to improve local performance and collaborate in a national production plan for each year to be developed with the Taskforce and reviewed with all of the DHBs, the Ministry and the Minister of Health.
- That the taskforce assists in identifying and resolving shared issues critical to the provision of enhanced cardiac surgery services.
- That the task force ensure better information is obtained to clarify the place of cardiac surgery in managing heart disease, the degree to which this is being achieved in different parts of New Zealand, and to refine the targets for service delivery.
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Publishing information
Date of publication: October 2008
Citation: Ministry of Health. 2008. Cardiac Surgery Services in New Zealand - Cardiac Surgery Service Development Working Group Report. Wellington: Ministry of Health. |
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